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Steps to ease maternal distress when newborns are in NICU
View(s):- Groundbreaking study by EPiNICU Group SL shows need to bring about effective and sustainable solutions to improve well-being of mothers
By Kumudini Hettiarachchi
Within the very heart of the bustling De Soysa Maternity Hospital (DMH) down Kynsey Road, Colombo 8, where numerous babies are born and families leave with big smiles, intense and earnest discussions were the order of the day one rainy morning.
A dedicated group ensconced in the auditorium of the DMH’s Nurses’ Quarters was turning the spotlight towards some mothers and their families who were compelled to deal with the trauma of having their newborns rushed soon after delivery to the Neonatal Intensive Care Unit (NICU).
This discussion, dubbed the first stakeholder meeting to identify practical, effective yet sustainable solutions to improve maternal well-being saw the participation of hospital administrators and clinicians of the DMH and the Colombo South Teaching Hospital (CSTH), Kalubowila, as well as junior doctors and nurses working in NICUs, mothers having babies in NICUs, mothers who have had babies in NICUs and women activists.
The heart-wrenching feelings of mothers vocalized eloquently included not being able to hold the baby close or be with the baby whole day long.
The first groundbreaking meeting leading to the goal of ‘Empowering parents of newborns in NICU’ (EPiNICU) yielded crucial decisions not just on how to empower parents to bring about less heartache but also on staff education, infrastructure improvements to NICUs and policymaking.
Brainstorming after the focused group discussions. Pix by M.A. Pushpa Kumara
The EPiNICU study group Sri Lanka which organised the meeting is not groping in the dark but is armed with solid facts and figures. The group consists of Dr. Marzia Lazzerini, Head of the World Health Organization’s (WHO’s) Collaborating Center for Maternal and Child Health; Prof. Hemantha Senanayake, Emeritus Professor of Obstetrics & Gynaecology of the Faculty of Medicine, University of Colombo; Dr. Mohamed Rishard, Consultant Obstetrician & Gynaecologist at DMH and Senior Lecturer at the Colombo Medical Faculty; Dr. Nimesha Gamhewage, Consultant Neonatologist at CSTH and Senior Lecturer at the Faculty of Medical Sciences, University of Sri Jayewardenepura; Dr. Nalin Gamaathige, Consultant Neonatologist at DMH; and research assistant Loshika Janet.
Explaining that whenever a newborn needs NICU care it induces significant psychological distress for mothers, Dr. Gamhewage said it was due to a variety of causes.
The stark image of one’s baby in an incubator attached to monitors and machines with tubes all around as well as the NICU environment is disturbing. There is also a perception that there has been an alteration in the usual role played by the parents, she said.
Despite many studies being conducted worldwide to assess maternal distress, little had been known about its impact on Sri Lankan mothers. This is why the group had conducted Sri Lanka’s first-ever multi-centre study in the NICUs of the DMH and the CSTH from November 2023 to September 2024 to evaluate the maternal psychological burden as a component of a quality improvement project.
With prior permission from the relevant authorities, 300 mothers, whose newborns required admission to an NICU, had been interviewed using validated questionnaires, after obtaining their consent. The questionnaires were to assess the three psychological conditions of depression, stress and anxiety levels of these mothers. The study had been funded and supervised by WHO Europe.
The findings of the study were an eye-opener:
94% of the mothers had experienced at least 1 of the 3 conditions of depression, stress and anxiety.
59% had all 3 of these conditions.
74% of the mothers showed features of stress, with the perception of the alteration in the parental role being the highest source of stress among them.
Depression was experienced by 87% of mothers. This incidence was extremely high when compared to mothers of healthy newborns in the community, which was around 15%.
Dr. Gamhewage said that they had observed that in Sri Lanka’s NICUs, the participation of mothers in the care of their babies is less, when compared to developed countries.
“We assessed maternal involvement in four domains – activities related to daily living such as feeding; providing comfort to the baby; advocating for newborn health; and taking part in technical tasks,” she says, pointing out that it was “interesting” that anxiety and stress levels were higher in mothers who had lower involvement in taking care of their newborns in the NICU.
Looking at studies that indicate that these mothers may experience long-lasting psychological effects which could adversely affect the parent-infant relationship and the developmental outcome of babies, Dr. Gamhewage reiterated that it is “crucial” to take steps to help them overcome this psychological burden.
And so, the first steps have been taken by the EPiNICU study group Sri Lanka to identify practical, effective yet sustainable solutions to improve the well-being of mothers whose babies are in the NICU.
Important group discussions led by Prof. Hemantha Senanayake, Dr. Nimesha Gamhewage,
Dr. Nalin Gamaathige and Dr. Mohamed Rishard
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