How Can Clinicians Best Serve New Mothers With Medically Fragile Infants?

Despite great advances in maternity care, the number of women who give birth to infants requiring special care is still high. The Centers for Disease Control and Prevention’s National Preconception Health Plan has called for care to ameliorate health problems, support pregnancy spacing, and improve future birth outcomes in those women with a previous adverse pregnancy outcome. Unfortunately, little is known about how to best address these needs, including how to recruit and retain women in health programs and when these women might be most open to assistance.

To better understand this patient population and their needs, Dr Sarah Verbiest, adjunct assistant professor at the Department of Maternal and Child Health and executive director for the Center for Maternal and Infant Health at the UNC Gillings School of Global Public Health, and colleagues conducted a longitudinal prospective cohort study of 45 women who had an infant receiving care in the NICU. Their findings were presented at the 59th Annual Clinical Meeting of the American Congress of Obstetricians and Gynecologists.

In the study, nurse midwives approached mothers whose infants were in the NICU for at least 3 days to obtain consent for participation. Average age of the participants was 29 years, with ages ranging from 20 years to 40 years. About half the women were non-Hispanic Caucasian (57%); the study also included women who were African American (26%), Hispanic (15%), and Arabic (2.2%). Approximately half (52%) the women were Medicaid recipients; the remainder either had commercial insurance (24%), Tricare (15%), or were uninsured (9%). For about half the women (51%), the infant in the NICU was their first live child.

Infants’ average length of stay in the NICU was 64 days (range = 3 to 294 days). Prematurity was the primary diagnosis for NICU admission for 30% of the infants. Almost three-quarters (70%) of the infants had one or more anomaly; 53% were also born preterm.

The researchers found that more than half the women (65%) had quarterly contact with the nurse midwife. And, while only 2% had weekly contact, one-third of the women went through a period during the study where they had weekly contact with the coordinator; results showed that the spike in contact was usually due to a crisis in the infant’s health. In addition, although Verbiest and colleagues expected that the mothers only would be reachable by phone, the majority of the mothers received in-person support in addition to telephone support. In fact, they found that mothers were often open to talking with the nurse midwife during pediatric visits for their infants. As such, the number of contacts per woman ranged from 6 to 49, with the lowest statistic still above the researchers’ expectations. Overall, the women in the study had a combined 712 contacts instead of the anticipated 225 total contacts. Interestingly, the researchers found that the majority of the contacts began with a mother-led conversation about their infant’s health.

There were several main needs found during the study. Specifically, all the women were in need of family planning. Anxiety/depression (44%) and disease management (31%) were the other top clinical issues presented by the women. The program also helped the mothers set and work on such health goals as stress management, exercise, healthy eating, and chronic disease management.

The nurse midwife also assisted the women with nonhealth issues. For instance, 19 women needed help navigating the health care system. The women also required assistance with the infant’s father, poverty, employment, and loss/grieving.

“Mothers of medically fragile infants are receptive to wellness messages when provided along with clinical care for themselves and their baby. The NICU provides a key opportunity for initial outreach to high-risk mothers,” the authors concluded. “Innovative partnerships between OB/GYN and NICU Follow-Up Clinics should be considered to best serve both high-risk mothers and infants.”

More Information

Recommendations to Improve Preconception Health and Health Care

Proceedings of the Preconception Health and Health Care Clinical, Public Health, and Consumer Workgroup Meetings

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Reference

Verbiest S, McClain E, Hamden K, Menard MK. Receptivity to interconception care among mothers with medically fragile infants. ACOG Annual Meeting. Poster 113. April 30, 2011.