Risk of Negligence in the Maternal Care of the Hospitalized Preterm Newborn

Monday, 9 November 2015

Beatriz Villamizar-Carvajal, PhD, MSN, RN
Carolina Vargas-Porras, MSN, RN
School of Nursing, University Industrial of Santander, Bucaramanga, Colombia

INTRODUCTION: There has been an increase in the incidence of preterm births worldwide, with Colombia not being an exception, not only due to the increase in the population, but as a result of a greater proportion of maternal and gestational problems resulting in deliveries before the end of pregnancy; the figure is significant, 18%, generating emotional and social impacts, and becoming a traumatic experience for mothers, who must deal with feelings of failure, guilt, and the loss of the illusion of having a perfect baby; all this, added to the physical-emotional separation of mother and baby after birth, which interferes with the emotional bonding process. Moreover, the stress associated with the separation from the newborn, long hospitalizations, and the concern for the wellbeing of the baby, often persists well beyond the first year of the child’s life. Thus, mothers should develop a series of abilities, skills and capabilities in order to adopt their new role. When the adoption of the maternal role is deficient, the risk of negligence in child care emerges, characterized by the absence of basic care due to neglect or omission, which affects the neurodevelopment of the newborn baby. Negligence has a negative impact on children’s development, and, unless remedial actions are taken, deficits accumulate and keep influencing negatively the subsequent development of the child. Therefore, healthcare personnel should be aware of and listen to the experiences of mothers and their parenting expectations to provide them with support throughout this process. 

MATERIALS AND METHODS: This was a cross-sectional study conducted between March and September 2014. The study population was composed of mothers of preterm infants delivered at a University Hospital who were at the in-hospital setting, and mothers of preterm infants at the out-of-hospital setting in the city of Bucaramanga (Colombia). Inclusion criteria: -Mothers of hospitalized preterm infants, -mothers of preterm infants out of the hospital. Exclusion criteria: -teenage mothers, mothers with communication problems, -mothers with psychiatric problems. The Parenting Inventory for Adults and Adolescents (IPAA), a valid and reliable instrument, was used. This instrument assesses attitudes toward parenting that are considered as high risk of negligence in child care. The IPAA has 32 items, distributed in 4 dimensions: Expectations, with 0.61 reliability, empathy, 0.88 reliability; punishment, 0.76 reliability, and role reversion, 0.80 investment. The reliability of repeated measures for adults ranges between 0.54 and 0.80. Analysis guidelines were followed as per the IPAA instructions, by adding items and turning them into specific scores as established for adults, with the following interpretation: Extremely low score (1-2) and low score (3-4), equivalent to poor parenting behavior; average score (5-6) equivalent to standard parenting behavior, and high score (7-8) and extremely high score (9-10) equivalent to positive attitudes toward parenting. Finally, the mothers were categorized according to the scores in every dimension, thus determining the risk of negligence. 

RESULTS: The sample included 115 mothers of preterm infants, 56 of whom were assessed at the in-hospital setting, and 59 at the out-of-hospital setting, after all of them had given their informed consent. The mean age of mothers was 26 years, most of them were housewives, with incomplete high-school and low income. The scores of mothers at the in-hospital setting were characterized by low figures as follows: - inadequate expectations toward children (48.2%), -lack of empathy for the needs of the child (51.7%), -belief in the value of physical punishment (48.2%) and –reversion of the mother-child role (55.3%). These scores evidence an inadequate parenting behavior, with a high risk of negligence in child care. On the other hand, the scores of the mothers at the out-of-hospital setting were distributed as follows: -appropriate expectations toward children (49%), -empathy toward the needs of children (32%), - negative value ascribed to physical punishment (66.1%), - appropriate mother-child role (31%). These scores show appropriate parenting expectations among mothers of preterm infants at the out-of-hospital setting.

CONCLUSION: There are significant differences between in-hospital and out-of-hospital settings as to parenting expectations and the risk of negligence in child care. Long hospital stays should become a fertile ground for interdisciplinary interventions aimed at strengthening the maternal role among mothers of preterm babies.