Although NUMB (Neonatal Unity for Mothers and Babies) was formed only a year ago the battle for parents and babies and children to be able to stay together is a much longer one. In the early 1950’s babies were routinely whisked away to the nursery straight after birth and their mothers might not get the chance to hold them for another 12 hours and children admitted to hospital could only be visited for one hour a week. Once the fledgling Parents Centre movement started educating parents and encouraging natural birth, women began to rebel. The fight for rooming-in, both after birth and with sick children, was backed by reference to the words of Dr John Bowlby: “The infant and young child should experience a warm, intimate and continuous relationship with his mother or mother-substitute in which both find satisfaction and enjoyment.”
Today when rooming-in is the norm and parents are able to spend as much time as they wish with their hospitalised children there is still one group of children who are not thought to need the continuous presence of their mothers – premature babies. It was to address the needs of these babies and their families that NUMB was formed.
The origins of NUMB date back to a weekend breastfeeding workshop that some of NUMB’s founders attended. The issue of premature babies was raised and the group agreed that mothers and premature babies should have the same rights as children and their parents on the paediatric wards. They decided that if one of them ever had a premature baby then they would support her to stay with her baby and that they would take it in turns to stay beside the baby if the mother was unwell. They had no idea how difficult this would be to achieve in reality and the experience of trying to stay with a premature baby in special care was the catalyst that led to the first NUMB meeting in May 2002. Present at the inaugural meeting were interested representatives from Waikato Home Birth Assoc; Hamilton Parents Centre, Parents Centres New Zealand, an official La Leche League New Zealand representative, as well as several La Leche League Leaders; midwives, lactation consultants, and other interested individuals. The group was known initially as the premature baby lobby group but later changed its name to NUMB, which stands for ‘neonatal unity for mothers and babies’. This acronym accurately represents the group’s purpose, which is to lobby for mothers and babies to stay together in newborn units. The word ‘numb’ has also been used by many mothers to describe their feelings around the time of their baby’s birth and their time spent in a newborn unit.
Achievements to Date
Parents Centres’ Advocacy and Lobbying manager, was keen to work alongside NUMB and wrote to the Minister of Health who replied that “Rooming in facilities for mothers of premature babies may be part of future policy. This would be part of a trend that values contact between parents and their babies.”
Four Parliamentary questions were asked:
- Is there a national standard for care of premature babies? . . . no
- Do parents have a right to see their child’s medical records? . . . no
- Is there a mechanism for identifying premature baby breastfeeding data? . . . no
- Does the implementation of BFHI includes neo-natal units? . . . yes
A letter on the issues involved was sent to all DHB’s and there was a variety of responses ranging from no response to “Kangaroo care is actively practiced and mothers who are feeding frequently are offered rooming in facilities in the NICU.”
Two articles were published in Kiwi Parent and there were a number of press releases on the issue. Currently Parents Centre is encouraging local centres to follow up with their DHB’s and has recently raised the issues of kangaroo care and provision of facilities at the Maternity Services Consumer Forum.
We have also found research to back our position and have established an e-mail contact address, and a web site.
NUMB has spent many hours collecting and reading research on the benefits of not separating premature babies from their mothers. Dr Nils Bergman discovered that in his hospital, which has limited access to technology and few resources; the survival of infants 1000-1500g improved from 10 to 50% when kangaroo care was introduced. Dr Bergman has identified three main components of Kangaroo Mother Care:
- Skin to skin contact
- Exclusive breastfeeding, or provision of mothers own milk.
- Support, including family and health care providers as well as advanced technology as necessary.
Dr Bergman believes that skin-to-skin contact is a basic and evolutionary need for mother and baby. He says: “The primary violation, the worst case scenario to any newborn is separation from its habitat” and he adds that the need for a natural habitat is even greater for premature babies, than for those at full-term “We need to design our health care and adjust our routines to ensure that primarily support is afforded to the mother to provide the habitat, and assistance is given to the premature to provide for its own needs, recognising that the neurobehavioural capability may not be matched with physical development.”
Other research has shown that while the ability to suck on a bottle only starts at 36 weeks post-conceptional age, suckling, (a myographically distinct behaviour from sucking), from the breast is possible at 28 weeks
A recent article about prematurity for Kiwi Parent, gave a quote from Dr Pat Tuohy, from the Ministry of Health. “Over the past few decades there has been a significant shift in the models of care for parents and their babies. There is increased contact between parents and their babies to enable bonding and parents now expect to be able to spend as much time with their baby as possible. This model of care extended into the future may ultimately lead to the provision of facilities such as beds for mothers beside their baby’s incubator or cot in neonatal units.”
Whilst the above statement does not reveal an action plan, at least it recognises the direction that needs to be taken.
Hospitals Putting it into Practice.
Two examples of keeping mothers and premature babies together are High Wycombe in England and Tallinn Children’s Hospital in Estonia. Dr Adik Levin, the director of Tallinn Children’s hospital describes three guiding principles that form the basis of care at his hospital:
- 24 hour care of the neonate by the mother
- minimal use of technology
- minimal contact between the baby and medical and nursing staff
Dr Levin says that these guiding principles ensure the preservation of the psychological and biological umbilicus that binds mother and baby together.
- The psychological umbilicus is the social and bonding behaviour that occurs between a mother and her new born child.
- The biological umbilicus is the closeness of proximity of mother to child, as determined by nature.
In a recent BFHI publication, an article on the Tallinn Children’s hospital quotes Dr Levin as saying: “As technology continues to develop hospitals should not lose sight of the compassionate aspects of treatment. It is the humane and individual right of the baby not only to be surrounded by very good apparatus and a highly qualified staff…but also to be with his or her mother and, ideally, with the father as well.”
In England, the High Wycombe Hospital Special Care Baby Unit has ‘family-centred’ care as a guiding principle. They have created an environment where mothers and babies can stay together, and they have an active ‘rooming in’ policy-which is not just the 24 to 48 hours before discharge. Women can go straight to the unit after a normal birth, or when they are well enough after a caesarean or complicated birth. The unit has six ‘mothers’ rooms, five opening onto a central nursery, and one separate room, where a mother and father can both stay together. Some mothers choose to stay with their babies the whole time they are in the unit, whilst others choose to come and go during the day, and stay when they can.
How can you support NUMB?
- You can encourage mothers with stories to contact us
- Discuss this issue with your colleagues, and think how you might feel if this was your experience.
- Identify how you personally can support mothers with premature babies, to spend as much time with their babies as they can.
- If you wish to lend us your expertise, services and support, please also contact us.