Email this article 
Impact of Maternity Support Program on the Stress of Mothers in the First Encounter with the Preterm Infants
Abstract
Background: Mothers of premature infants experience a high level of stress. The current study was conducted aiming at investigating the impact of maternity support program on the stress of mothers in the first encounter with infants.
Methods: This experimental study began in neonatal intensive care units (NICUs) of two hospitals of Tehran; that is, Mahdieh (intervention) and Shahid Akbar‑Abadi (control), from Feb 14, 2016, to May 14, 2016. Both are educational and referral centers including three levels of NICU that were randomly allocated to intervention and control sites. In the span of study period all 75 infants and mothers with inclusion/exclusion criteria in the Mahdieh hospital were included in the intervention group and vis‑à‑vis all 68 infants and mothers in Shahid‑Akbar‑Abadi were enrolled in the control group. The designed intervention was conducted based on the support system pattern of mothers with premature infants in the interventional group. In the first stage of intervention, in the intervention group, mothers were provided informational, emotional, and spiritual support before and during the first exposure and were empowered for comfortable interactions. The control group received routine care. After the first exposure, the mothers’ stress was measured by the Parental Stressor Scale: Neonatal Intensive Care Unit (PSS: NICU). The data were analyzed by STATA software as well as t‑test, Chi‑square, and average treatment effects (ATEs) were estimated using inverse probability treatment weights (IPTW).
Results: After adjusting pre‑treatment variables by IPTW, the adjusted average difference in the stress score over the NICU environment, infant’s behavior and appearance, the special treatments on him/her, and the change in the parental role and total stress were 1.47 (1.19–1.75), 1.06 (0.73–1.14), 1.21 (0.93–1.49), and 1.18 (0.93–1.44), which were lower than the control group (P < 0.001).
Conclusions: The intervention reduced significantly the stress of mothers. The policy‑makers are suggested to conduct this method.
Keywords
Full Text:
PDFReferences
Chertok IRA, McCrone S, Parker D, Leslie N. Review of
interventions to reduce stress among mothers of infants in the
NICU. Adv Neonatal Care 2014;14:30‑7.
Brett J, Staniszewska S, Newburn M, Jones N, Taylor L.
A systematic mapping review of effective interventions for
communicating with, supporting and providing information to
parents of preterm infants. BMJ Open 2011;1:e000023.
Guillaume S, Michelin N, Amrani E, Benier B, Durrmeyer X,
Lescure S, et al. Parents’ expectations of staff in the early
bonding process with their premature babies in the intensive care
setting: A qualitative multicenter study with 60 parents. BMC
Pediatr 2013;13:18. PubMed PMID: 23375027. eng.
Horsch A, Tolsa JF, Gilbert L, du Chene LJ, Muller‑Nix C,
Bickle Graz M. Improving maternal mental health following
preterm birth using an expressive writing intervention:
A randomized controlled trial. Child Psychiatry Hum Dev
;47:780‑91. PubMed PMID: 26659113. Epub 2015/12/15. eng.
De Bernardo G, Svelto M, Giordano M, Sordino D,
Riccitelli M. Supporting parents in taking care of their infants
admitted to a neonatal intensive care unit: A prospective
cohort pilot study. Ital J Pediatr 2017;43:36. PubMed PMID:
Pubmed Central PMCID: PMC5392981. Epub
/04/18. eng.
Alkozei A, McMahon E, Lahav A. Stress levels and depressive
symptoms in NICU mothers in the early postpartum period.
J Matern Fetal Neonatal Med 2014;27:1738‑43.
Cano Giménez E, Sánchez‐Luna M. Providing parents with
individualised support in a neonatal intensive care unit reduced stress, anxiety and depression. Acta Paediatr 2015;104:e300-5.
Janvier A, Barrington K, Farlow B. Communication with
parents concerning withholding or withdrawing of life‑sustaining
interventions in neonatology. Semin Perinatol 2014;38:38‑46.
PubMed PMID: 24468568. Epub 2014/01/29. eng.
Arnold L, Sawyer A, Rabe H, Abbott J, Gyte G, Duley L, et al.
Parents’ first moments with their very preterm babies: A qualitative
study. BMJ Open 2013;3. PubMed PMID: 23550091. Pubmed
Central PMCID: 3641451. Epub 2013/04/04. eng.
Cleveland LM. Parenting in the neonatal intensive care unit.
J Obstet Gynecol Neonatal Nurs 2008;37:666‑91. PubMed
PMID: 19012717. Epub 2008/11/18. eng.
Melnyk BM, Feinstein NF, Alpert‑Gillis L, Fairbanks E,
Crean HF, Sinkin RA, et al. Reducing premature infants’ length
of stay and improving parents’ mental health outcomes with the
creating opportunities for parent empowerment (COPE) neonatal
intensive care unit program: A randomized, controlled trial.
Pediatrics 2006;118:e1414‑e27.
Ravn IH, Smith L, Smeby NA, Kynoe NM, Sandvik L,
Bunch EH, et al. Effects of early mother–infant intervention on
outcomes in mothers and moderately and late preterm infants
at age 1 year: A randomized controlled trial. Infant Behav Dev
;35:36‑47.
Als H, Gilkerson L, Duffy FH, Mcanulty GB, Buehler DM,
Vandenberg K, et al. A three‑center, randomized, controlled trial
of individualized developmental care for very low birth weight
preterm infants: Medical, neurodevelopmental, parenting, and
caregiving effects. J Dev Behav Pediatr 2003;24:399‑408.
Holditch‑Davis D, White‑Traut RC, Levy JA, O’Shea TM,
Geraldo V, David RJ. Maternally administered interventions for
preterm infants in the NICU: Effects on maternal psychological
distress and mother–infant relationship. Infant Behav Dev
;37:695‑710.
Morey JA, Gregory K. Nurse‑led education mitigates maternal
stress and enhances knowledge in the NICU. MCNAm J Matern
Child Nurs 2012;37:182‑91.
Whelan ML. Training Parents in Multimodal Neurological
Enhancement: A Survey of NICU Music Therapists. Tallahassee,
Florida: Florida State University; 2019.
Preyde M, Ardal F. Effectiveness of a parent “buddy” program
for mothers of very preterm infants in a neonatal intensive care
unit. CMAJ 2003;168:969‑73.
Matricardi S, Agostino R, Fedeli C, Montirosso R. Mothers are
not fathers: Differences between parents in the reduction of stress
levels after a parental intervention in a NICU. Acta Paediatr
;102:8‑14.
Landsem IP, Handegård BH, Tunby J, Ulvund SE, Rønning
JA. Early intervention program reduces stress in parents of
preterms during childhood, a randomized controlled trial. Trials
;15:387.
Horwitz SM, Leibovitz A, Lilo E, Jo B, Debattista A, St. John N,
et al. Does an intervention to reduce maternal anxiety, depression
and trauma also improve mothers’ perceptions of their preterm
infants’vulnerability? Infant Mental Health J 2015;36:42‑52.
Komoto K, Hirose T, Omori T, Takeo N, Okamitsu M, Okubo N,
et al. Effect of early intervention to promote mother‑infant
interaction and maternal sensitivity in Japan: A parenting
support program based on infant mental health. J Med Dent Sci
;62:77‑89.
O’Brien K, Bracht M, Robson K, Xiang YY, Mirea L, Cruz M,
et al. Evaluation of the family integrated care model of neonatal
intensive care: A cluster randomized controlled trial in Canada
and Australia. BMC Pediatr 2015;15:210.
Sgandurra G, Beani E, Inguaggiato E, Lorentzen J, Nielsen JB,
Cioni G. Effects on parental stress of early home‑based care
toy intervention in low‑risk preterm infants. Neural Plasticity
;2019:7517351.
Castel S, Creveuil C, Beunard A, Blaizot X, Proia N, Guillois B.
Effects of an intervention program on maternal and paternal
parenting stress after preterm birth: A randomized trial. Early
Hum Dev 2016;103:17‑25.
Afand N, Keshavarz M, Fatemi NS, Montazeri A. Effects of
infant massage on state anxiety in mothers of preterm infants
prior to hospital discharge. J Clin Nurs 2017;26:1887‑92.
Cho E‑S, Kim S‑J, Kwon MS, Cho H, Kim EH, Jun EM,
et al. The effects of kangaroo care in the neonatal intensive
care unit on the physiological functions of preterm infants,
maternal–infant attachment, and maternal stress. J Pediatr Nurs
;31:430‑8.
Johnston AM, Bullock CE, Graham JE, Reilly MC,
Rocha C, Hoopes RD, et al. Implementation and case‑study
results of potentially better practices for family‑centered
care: The family‑centered care map. Pediatrics
;118(Suppl. 2):S108‑14.
Mousavi SS, Chaman R, Mohagheghi P, Mousavi SA,
Khosravi A, Keramat A. Development of a support system for
parents of premature infants. Iran J Pediatr 2017;27:e9578.
Ghorbani M, Dolatian M, Shams J, Alavi‑Majd H. Anxiety,
post‑traumatic stress disorder and social supports among parents
of premature and full‑term infants. Iranian Red Crescent Med J
;16:e13461.
Busse M, Stromgren K, Thorngate L, Thomas KA. Parents’
responses to stress in the neonatal intensive care unit. Critical
Care Nurse 2013;33:52‑9.
Miles MS, Funk SG, Carlson J. Parental stressor scale: Neonatal
intensive care unit. Nurs Res 1993;42:148‑52. PubMed PMID:
Epub 1993/05/01. eng.
Borimnejad L, Mehrnoush N, Seyyed Fatemi N, Haghani H.
Maternal stressor agents with premature infants in neonatal
intensive care units. IJCCN 2011;4:39‑44.
Mansournia MA, Altman DG. Inverse probability weighting.
BMJ (Clinical research ed) 2016;352:i189.
Beheshtipour N, Baharlu SM, Montaseri S, Ardakani SMR. The
effect of the educational program on Iranian premature infants’
parental stress in a neonatal intensive care unit: A double‑blind
randomized controlled trial. Int J Community Based Nurs
Midwifery 2014;2:240.
Kaaresen PI, Rønning JA, Ulvund SE, Dahl LB. A randomized,
controlled trial of the effectiveness of an early‑intervention
program in reducing parenting stress after preterm birth.
Pediatrics 2006;118:e9‑e19.
Mianaei SJ, Karahroudy FA, Rassouli M, Tafreshi MZ. The
effect of creating opportunities for parent empowerment program
on maternal stress, anxiety, and participation in NICU wards in
Iran. Iran J Nurs Midwifery Res 2014;19:94‑100.
Tran C, Medhurst A, O’Connell B. Support needs of parents of
sick and/or preterm infants admitted to a neonatal unit. Neonatal
Paediatr Child Health Nurs 2009;12:12‑7.
Fakhri B, Hasanpoor–Azghady SB, Farahani LA, Haghani H.
The relationship between social support and perceived stress in
the mothers of infants with colic. Iran J Pediatr 2019;29:8. En.
Hamid N, Wasy S. Effectiveness of logotherapy together with
Quran recitation and prayers on treatment of depression and T
helper Cell (CD4+). Interdiscipl Quranic Stud 2013;3:27‑38.
Hunt H, Whear R, Boddy K, Wakely L, Bethel A, Morris C,
et al. Parent‑to‑parent support interventions for parents of babies cared for in a neonatal unit‑protocol of a systematic review of
qualitative and quantitative evidence. Syst Rev 2018;7:179.
PubMed PMID: 30382886. Pubmed Central PMCID:
PMC6211448. Epub 2018/11/02. eng.
Huckabay LM. Impact of a research study a decade later: The
use of pictures in a neonatal intensive care unit as a mode of
nursing intervention to enhance maternal‑infant bonding. Sch Inq
Nurs Pract 1999;13:367‑73. PubMed PMID: 10731851. Epub
/03/25. eng.
Griffin T, Kavanaugh K, Soto CF, White M. Parental evaluation
of a tour of the neonatal intensive care unit during a high‑risk
pregnancy. J Obstet Gynecol Neonatal Nurs 1997;26:59‑65.
PubMed PMID: 9017548. Epub 1997/01/01. eng.
Turan T, Başbakkal Z, Özbek Ş. Effect of nursing interventions
on stressors of parents of premature infants in neonatal intensive
care unit. J Clin Nursing 2008;17:2856‑66.
Chourasia N, Surianarayanan P, Bethou A, Bhat V. Stressors of
NICU mothers and the effect of counseling—experience from
a tertiary care teaching hospital, India. J Matern Fetal Neonatal
Med 2013;26:616‑8.
Petteys AR, Adoumie D. Mindfulness‑based neurodevelopmental
care: Impact on NICU parent stress and infant length of stay;
a randomized controlled pilot study. Adv Neonatal Care
;18:E12‑22.
Glazebrook C, Marlow N, Israel C, Croudace T, Johnson S,
White IR, et al. Randomised trial of a parenting intervention
during neonatal intensive care. Arch Dis Child Fetal Neonatal
Ed 2007;92:F438‑F43. PubMed PMID: 17301114. Epub
/14. eng.
Voos KC, Ross G, Ward MJ, Yohay A‑L, Osorio SN, Perlman JM.
Effects of implementing family‑centered rounds (FCRs) in a
neonatal intensive care unit (NICU). J Matern Fetal Neonatal
Med 2011;24:1403‑6.
Franck LS, Oulton K, Nderitu S, Lim M, Fang S, Kaiser A.
Parent involvement in pain management for NICU infants:
A randomized controlled trial. Pediatrics 2011;128:510‑8.
Abdeyazdan Z, Shahkolahi Z, Mehrabi T, Hajiheidari M.
A family support intervention to reduce stress among parents
of preterm infants in neonatal intensive care unit. Iran J Nurs
Midwifery Res 2014;19:349‑53.