Categories
Nursing

Rooming-in’ with the baby throughout the stay in the hospital

Aims/Objectives

The proposed study will explore the different dimensions of newborn care and attention by mothers through in-rooming after the births of their newborns. This type of experience is unique in that it provides a greater understanding of the bond between mother and child and what is necessary to create that bond in a successful manner. The in-rooming experience will be explored in greater detail through interviews with new mothers and will evaluate their concerns and other challenges that they might encounter with this practice. It is important for researchers to identify the extent to which this relationship plays a role in shaping the maternal-child bond in a favourable manner. This will encourage the practice of in-rooming in developing evidence-based practice methods for new mothers and their infants. In particular, this study will examine the opportunities available for the in-rooming experience for new mothers in Singapore residing in the restructured hospital environment. The use of interviews will provide further evidence that there are significant alternatives available in the hospital environment to encourage in-rooming as a plausible opportunity to encourage maternal-child bonding. In addition, these interviews will determine if there is a greater tendency towards breast feeding with the in-rooming experience.

A number of existing studies have explored the relationship of in-rooming in improving maternal-child bonding. For example, a study conducted in Korea demonstrates that new mothers who practice in-rooming in the hospital environment are more likely to maintain breastfeeding their infant children for longer periods of time than when the in-rooming experience does not occur (Kim and Wang, 2009).  Another study conducted in Korea addressed the relevance of the newborn response to in-rooming care, and the results indicated that rooming-in provides a number of positive and important benefits for newborns which contribute to their early development and growth (Lee et.al, 2010). This study further supports the belief that “Direct skin-to-skin contact on mother’s chest gives protection from infection, emotional stability, maximized mother to baby interaction with joy. It provides more opportunity for successful breast feeding and opportunity for good acquisition of understanding baby’s natural physiology for their mother” (Lee et.al, 2010). Under these conditions, it is important for new mothers to be provided with this option as a means of encouraging the bonding experience through breastfeeding and skin contact (Lee et.al, 2010). Maternal-child bonding is a critical component of a child’s emotional development and physical growth and provides the newborn with an intimate bonding experience with the mother in a positive manner (Lee et.al, 2010). Furthermore, the experience of skin-to-skin contact is highly beneficial in determining a mother’s sensitivity rate in relation to the newborn (Bigelow et.al, 2010). Another study indicates that skin-to-skin contact is an underlying factor in reducing stress and depression for women postpartum (Bigelow et.al, 2012). Although this practice is not universal across all hospitals, it is nonetheless a positive contributor to improving newborn outcomes, as well as those of their mothers (Haxton et.al, 2012). It is also expected that skin-to-skin contact is an effective contributor to the breastfeeding experience after being discharged from the hospital, in addition to regulating body temperature (Marin Gabriel et.al, 2010). Finally, Dalybe et.al (2011) demonstrate that newborns have a generally positive and happy response to skin-to-skin contact and experience a higher level of comfort in the arms of their mothers.

In general, there are a number of expectations that many new mothers have after birth, including the desire to breastfeed their children, at least for several months following birth (Martucci, 2012). However, the circumstances in which births occur are not always feasible for this type of maternal-child bond, which may discourage some mothers from choosing this route (Martucci, 2012). It is important to recognize that the surrounding environment plays a role in these practices and strongly influences these bonding events (Martucci, 2012). Therefore, it is likely that the creation of a supportive and meaningful environment for maternal-child bonding is strongly dependent upon the in-rooming experience, given the history of and the overall advantages of this practice. Therefore, mothers are likely to seek means to bond with their newborns using these techniques in a positive and meaningful manner. This practice will also encourage breastfeeding and a more natural developmental approach.

The in-rooming experience is complex and multifaceted for a number of reasons, as it provides the opportunity for new mothers to bond with their newborns without hesitation in a close and intimate manner. New mothers typically respond positively to this experience, particularly when they possess the knowledge and strength that are necessary to forge a successful bond. Nonetheless, the responsibilities of motherhood are so complex that some mothers might not recognize the most feasible alternatives in providing care to their children (Kurth et.al, 2010). These experiences provide further evidence that the practice of in-rooming is generally positive and provides significant advantages for new mothers and their children (Kurth et.al, 2010). Perhaps the most important finding of the study is as follows: “The views expressed by the women in this study reflect the ongoing discourses on the most beneficial child rearing practices over the last decades. Not putting infants’ demands centre-stage was a common approach in prior generations, whereas infant-centered care spread with the popularization of the bonding theory which emphasizes neonates’ need to develop a basic sense of trust” (Kurth et.al, 2010). This perspective is critical because it provides further evidence of the ability of a close knit bond to encourage proper newborn growth and development (Kurth et.al, 2010).

A study by Altaweli and Roberts (2010) addresses the maternal-child bonding phenomenon and how this practice is grounded in a theoretical approach which encourages the influence of healthcare providers. The concept of in-rooming has a definitive impact on the early bonding experience because it supports such activities as breastfeeding and skin-to-skin contact on a consistent basis (Altaweli and Roberts, 2010). Similarly, a study conducted in Hong Kong supports the belief that “baby-friendly practices” are likely to encourage the development of a greater bonding experience between mother and child (Tarrant et.al, 2011). Hospitals and healthcare providers must determine how to promote in-rooming practices so that their newborn patients will properly develop through regular bonding (Tarrant et.al, 2011). In evaluating the practices of different geographic areas, there are visible advantages and disadvantages; therefore, the proposed study evaluating Singapore mothers will benefit from existing lessons learned in this capacity, including the in-rooming experience.

For newborns that experience a skin-to-skin separation from their mothers, it is likely that they lose some of the important bonding that is necessary to complete their very early emotional development (Moore et.al, 2012). These experiences demonstrate that direct skin contact between mother and child is a critical practice, one which is dependent upon the ability of these newborns to achieve total emotional bonding and growth potential in this capacity (Moore et.al, 2012). A number of trials were conducted regarding the separation factor in order to determine if this creates any psychological or emotional developmental detachment problems, and it was established that direct contact is likely to benefit improved breastfeeding behaviours in this group (Moore et.al, 2012). These efforts are particularly critical because they convey the potential benefits of in-rooming post birth as an effective and meaningful practice on both the physical and emotional/psychological levels (Moore et.al, 2012).

Hodgson and Abrahams (2012) evaluated the in-rooming experience from the perspective of an opiate-dependent newborn and conveyed the importance of this practice in improving the chances of opiate withdrawal in newborns. Similarly, it is important to recognize that the factors associated with this practice apply not only to accommodate the bonding experience, but also the challenges of opiate and other forms of drug addiction in newborns (Hodgson and Abrahams, 2012). In this context, “mothers are encouraged and taught how to hold their babies, with the aim of settling the baby and minimizing withdrawal symptoms” (Hodgson and Abrahams, 2012, p. 476). These findings suggest that it is very important for new mothers and healthcare providers to take any and all steps that are necessary to improve withdrawal and to promote wellbeing in their newborns (Hodgson and Abrahams, 2012).

From the earliest possible time post birth, new mothers should be given the opportunity to bond and have direct skin-to-skin contact with their newborns to encourage breastfeeding behaviours and emotional attachment (Bramson et.al, 2009). These conditions are important because breastfeeding is the ideal choice for feeding newborns due to the nutritional benefits for these children, in addition to the natural bonding experience that occurs (Bramson et.al, 2009). As a result, it is necessary to establish a greater understanding of this relationship and how it impacts the overall mother-newborn bonding experience (Bramson et.al, 2009). However, many healthcare organizations practice different measures post birth which often detach the mother from her newborn, in spite of its benefits (Bramson et.al, 2009). Nonetheless, when these behaviours are practiced, there is a much greater chance that the newborn will develop an effective and appropriate attachment to the mother to reduce the trauma of life outside the womb (Bramson et.al, 2009).

Finally, from the perspective of the healthcare facility, it is important to recognize the challenges associated with the development of a practice method or approach which supports in-rooming as a viable and effective environment for mothers and their newborns (Smith et.al, 2012). These factors play a role in shaping how organizations create a more comprehensive and meaningful mother-child bonding experience to ensure positive outcomes (Smith et.al, 2012). It is necessary for healthcare organizations to establish an effective approach to providing the best possible mother-child experience in this capacity (Smith et.al, 2012). In addition, the experiences across different cultures are unique and diverse, which requires healthcare organizations to accommodate patient needs and cultural expectations as needed to improve overall healthcare delivery for mothers and newborns in this manner, including the feasibility of the in-rooming experience (Rassin et.al, 2009).

Research Design

In evaluating the study population and the specific objectives sought, it is important to recognize the value associated with conducting interviews to improve study outcomes. It is necessary for new mothers to have the opportunity to share their experiences to improve research and perhaps adjust current practice methods as needed. One aspect of this process to consider is the entire hospital experience from start to finish, including length of stay and treatment while hospitalized, as these factors contribute to the overall perceptions of the hospital and their practices (Ellberg, 2008). The research design must incorporate the basic concepts of in-rooming, accompanied by such factors as hospital status and performance (McKeever and St. Fleur, 2012). Patient satisfaction must be taken into consideration and should provide some degree of opportunity for the selected participants to express their level of satisfaction with the hospital experience (Salonen et.al, 2010). Perceptions regarding the in-rooming experience should be included in the study to improve results and expand knowledge of these practices.

Population, Sampling, and Recruitment

The criteria for the proposed study should consider such factors as vaginal birth versus caesarean delivery, for which the latter involves anaesthesia and other risk factors that could harm the newborn (Kuguoglu et.al). These factors must be taken into consideration during the interview process and may be effective as inclusion/exclusion criteria for study participation. The study population will include a small sample of mothers from Singapore who have experienced in-rooming practices in a restructured hospital environment. This environment is transitional to some degree because there is an opportunity to evaluate the facility as newer to this practice, which may lead to a different perspective or approach than a more traditional facility with significant experience in this area. The sample will be derived from a listing of Singaporean mothers with in-rooming experience in this specific environment, whereby they are able to provide important insight into this program and its overall effectiveness. This listing will be tabulated from a registry of patients who have directly experienced the in-rooming event and potentially possess the insight and wherewithal to provide reasonable judgement and information regarding this practice and its overall effectiveness. The recruitment process will take place over a period of several months so that the appropriate participants will be selected for study inclusion. This recruitment process will attempt to select the most viable participants for study inclusion who have direct experience and knowledge of the in-rooming process. The inclusion of these participants will be dependent upon a number of factors, including type of birth, age, and number of children.

Data Collection

Data collection will be conducted using a standardized and open-ended interview method so that the same questions are asked of all participants, but their responses are likely to be very diverse. This will enable the researcher to establish a series of criteria during the interviews but obtain a broad sense of discovery regarding the population and their specific experiences. The interview method will ask a series of questions with open-ended answers that are designed to gauge some diversity in the responses that are provided. This will encourage the development of an approach that will draw a variety of conclusions regarding the study and its applicability to future studies. The study questions will be carefully selected to ensure that the responses are consistent with the desired objectives, while also providing an element of surprise and a range of diversity in the responses. The data collection phase must be organized and appropriate for the research protocol and should provide a comprehensive perspective in interpreting the results during the data analysis process. It is expected that data collection will also protect study participants through full disclosure and informed consent to ensure that this data is not corrupted in any way.

Data Analysis

Data analysis within a qualitative research study continues to be defined and supported by theoretical approaches and perspectives which influence study outcomes. In this context, it is important for interviewers to assume an approach that will decipher the data that is derived from interviews in a comprehensive and unbiased manner. This will encourage the development of possible new criteria and/or approaches to the subject matter in future studies. The data analysis process will decipher the quality of the data that is derived to determine if it should be included in the final analysis and recommendations. This practice will also enable the research team to decipher any irrelevant data and information that does not provide any real contribution to the study findings. By establishing different categories based upon the interviews, it is possible to determine if there are any apparent themes in the direction of the interviews, as well as the similarities and differences between responses. This will encourage a more well-defined approach to the study and in establishing comprehensive reporting and recommendations. It is expected that the study will lead to a number of important outcomes that could be used to shape the in-rooming framework in healthcare facilities throughout Singapore so that mothers and their newborns will have the optimal bonding experience throughout the entire pre and post-birth process.

Ethical Considerations

Throughout all areas of the study, it is critical to establish and maintain an ethically responsible approach to data collection and analysis. This includes the development of approaches which require informed consent for all study participants accepted into the study, as well as Institutional Review Board approval of the research protocol that will be performed. This protocol must incorporate the study objectives and clearly identify any possible risks to participants throughout the course of the study. These efforts will enable the researchers to conduct the study in an ethically appropriate and responsible fashion at all levels. These elements will also provide an opportunity to establish safeguards for all participants throughout the process, from acceptance into the study, to informed consent, to conducting the actual interviews, and in protecting the data that is derived. The ethical nature of the study will serve as an effective benchmark in establishing the efficacy of the proposed results and outcomes for future research.

Trustworthiness

The proposed study will evaluate subject matter that might be considered sensitive in nature for some if not all participants; therefore, it is important to establish a level of trust between the interviewers and interviewees as early as possible to facilitate honest and truthful responses to the questions that are asked. This practice is often difficult to achieve in some studies because of the sensitive nature of the study and its objectives. However, in this example, the interviewer will establish a collaborative relationship with the interviewees to facilitate a more comfortable and rewarding research experience. This practice will also provide additional evidence that the research strategy and approach is appropriate for the study objectives under consideration. In addition, the study will be conducted in such a way that the objectives and reliability of the data will be reliable and appropriate. These objectives are critical to the overall success and reliability of the study and its desired outcomes, and will establish the tone of the study to achieve success and set a precedent for future studies, as well as the healthcare organizations that provide pre and post-childbirth services.

References

Altaweli, R., and Roberts, J. (2010). Maternal-Infant bonding: a concept analysis. British Journal of Midwifery, 18(9), 552-559.

Bigelow, A.E., Littlejohn, M., Bergman, N., and McDonald, C. (2010). The relation between early mother-infant skin-to-skin contact and later maternal sensitivity in South African mothers of low birth weight infants. Infant Mental Health Journal, 31(3), 358-377.

Bigelow, A.E., Power, M., MacLellan-Peters, J., Alex, M., and McDonald, C. (2012). Effect of mother/infant skin-to-skin contact on postpartum depressive symptoms and maternal psychological stress. Journal of Obstetric, Gynecologic, & Neonatal Nursing, 41(3), 369-382.

Bramson, L., Lee, J.W., Moore, E., Montgomery, S., Neish, C., Bahjri, K., and Lopez Melcher, C. (2010). Effect of early skin-to-skin mother-infant contact during the first 3 hours following birth on exclusive breastfeeding during the maternity hospital stay. Journal of Human Lactation, online, retrieved from https://www.urmc.rochester.edu/flrpp/breast-feeding-hospital- policy/documents/EffectofEarlySkintoSkinContactonExclusiveBreastfeeding.pdf

Dalbye, R., Calais, E., and Berg, M. (2011). Mothers’ experiences of skin-to-skin care of healthy full-term newborns – a phenomenology study. Sexual & Reproductive Healthcare, 2(3), 107-111.

Ellberg, L. (2008). Postnatal care – outcomes of various care options in Sweden. Umea University Medical Dissertations.

Marin Gabriel, M.A., Martin, I.L., Lopez Escobar, A., Fernandez Villalba, E., Romero Blanco, I., and Touza Pol, P. (2010). Randomized controlled trial of early skin-to-skin contact: effects on the mother and the newborn. Acta Paediatrica, 99(11), 1630-1634.

Haxton, D., Doering, J., Gingras, L., and Kelly, L. (2012). Implementing skin-to-skin contact at birth using the Iowa model: applying evidence to practice. Nursing for Women’s Health, 16(3), 220-229.

Hodgson, Z.G., and Abrahams, R.R. (2012). A rooming-in program to mitigate the need to treat for opiate withdrawal in the newborn. Journal of Obstetrics and Gynecology Canada, 35(5), 475-481.

Jaafar, S.H., Lee, K.S., and Ho, J.J. (2012). Separate care for new mother and infant versus ooming-in for increasing the duration of breastfeeding (review). The Cochrane Library, online, retrieved from http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD006641.pub2/pdf

Kuguoglu, S., Yildiz, H., Kurtuncu Tanir, M., and Canan Demirbag, C. Breastfeeding after a caesarean delivery. Retrieved from http://cdn.intechopen.com/pdfs/37218/InTech-Breastfeeding_after_a_cesarean_delivery.pdf

Kurth, E., Spichiger, E., Zemp Stutz, E., Biedermann, J., Hosli, I., and Kennedy, H.P. (2010). Crying babies, tired mothers – challenges of the postnatal hospital stay: an interpretive phenomenological study. BMC Pregnancy and Childbirth, 10(21), retrieved from http://www.biomedcentral.com/1471-2393/10/21

Lee, Y.M., Song, K.H., Kim, Y.M., Kang, J.S., Chang, J.Y., Seol, H.J., Choi, Y.S., and Bae, C.W. (2010). Complete rooming-in care of newborn infants. Korean Journal of  Pediatrics, 53(5), 634-638.

Martucci, J. (2012). Maternal expectations: new mothers, nurses, and breastfeeding. Nursing History Review, 20(1), 72-102.

McKeever, J., and St. Fleur, R. (2012). Overcoming barriers to baby-friendly status. Journal of Human Lactation, 28(3), 312-314.

Moore, E.R., Anderson, G.C., Bergman, N., and Dowswell, T. (2012). Early skin-to-skin contact for mothers and their healthy newborn infants (review). The Cochrane Collaboration,5, 1-84.

Rassin, M., Klug, E., Nathanzon, H., Kan, A., and Silner, D. (2009). Cultural differences in child delivery: comparisons between Jewish and Arab women in Israel. International Nursing Review, 56(1), 123-130.

Salonen, A.H., Kaunonen, M.., Astedt-Kurki, P., Jarvenpaa, A.L., Isoaho, H., and Tarkka, M.T. (2010). Parenting satisfaction during the immediate postpartum period: factors contributing to mothers’ and fathers’ perceptions. Journal of Clinical Nursing, 19(11-12), 1726-1728.

Smith, P.B., Moore, K., and Peters, L. (2012). Implementing baby-friendly practices: strategies for success. The American Journal of Maternal/Child Nursing, 37(4), 228-233.

Tarrant, M., Wu, K.M., Fong, DYT, Lee, ILY, Wong EMY, Sham, A., Lam, C., and Dodgson, J.E. (2011). Impact of baby-friendly hospital practices on breastfeeding in Hong Kong. Birth: Issues in Prenatal Care, 38(3), 238-245.

Wang, H.J., and Kim, I.O. (2009). Effect of rooming-in of new mothers on breast feeding rate. Korean Journal of Women Health Nursing, 15(1), 5-12.