Addressing Health Service Needs of Mothers With Infants in the NICU

Along with the excitement and joy of a new baby come stresses, increased health concerns for mom and the newborn, and other health service issues. Women with infants in the neonatal intensive care unit (NICU) often experience more distress than their counterparts with healthy infants, yet they may lack the resources to address these needs. Dr Kathryn Menard, director of the Center for Maternal and Infant Health and division director and distinguished professor of obstetrics and gynecology at the University of North Carolina at Chapel Hill Medical School, and colleagues sought to ascertain the specific needs of this patient population to help determine if these needs can be met in the NICU setting. The researchers shared their findings at 59th Annual Clinical Meeting of the American Congress of Obstetricians and Gynecologists.

As part of the study, the researchers instituted a change of care policy, making available the services of a nurse midwife to all mothers with children in the NICU. (Prior to the study, women with health issues or queries were referred to their physician or the emergency department of the hospital.) Between 2008 and 2009, the NICU distributed postcards about the availability of this program to the new mothers upon their infants’ admission to the NICU. Women were not billed for any services provided. Participation in the program increased when the postcards explained how the mother’s immediate health status impacted their infant’s health status. The nurse midwife recorded basic data about the interactions for analysis.

In total, Menard and colleagues noted 424 health service encounters, with an average of 21 visits per month. Issues raised during the encounters included questions about breastfeeding and family planning, depression and anxiety complaints, postpartum care, health insurance queries, and tobacco use (Figure). Almost one-half (43%) of the encounters lasted longer than 30 minutes. Some of these women presented with very complex problems; more complicated issues required up to 4 hours of assistance to help the women reach resolution. About one-third (37%) of the encounters were shorter than 10 minutes, and the remainder (21%) lasted between 10 and 30 minutes. To make it easier for the mother to accept care/counseling, about one-third (29%) of the encounters were completed at the infant’s bedside in the NICU.
 

Figure.

Issues raised by mothers during encounters.

The encounters often led to further services. For example, 40% of all the encounters resulted in at least one prescription. Similarly, 14% of the encounters led to referrals for further lactation support or mental health services.

“Mothers of infants in the NICU have a multitude of unmet postpartum health needs,” Menard and colleagues concluded. “Providers of obstetric care in regional centers are well positioned to care for these high-risk mothers who have urgent health care needs yet may be unable to access their usual providers. Health care system modifications that bring services to these women are feasible and well-received.”

More Information

UNC Center for Maternal & Infant Health
 

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Reference

Menard MK, Verbiest S, Hamden K, et al. Postpartum health needs of women with infants in neonatal intensive care. ACOG Annual Meeting. Poster 96. May 1, 2011.