Fragile Infant Forums for Implementation of IFCDC Standards: Pain and Stress, Families

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Joy V. Browne, Ph.D., PCNS, IMH-E

Having a baby is stressful enough for any family, but it can be much worse with the unexpected complication of having their baby admitted to intensive care. Although every family is different, almost all families admitted to intensive care experience increased stress, sometimes extreme.

When referring to families, we infer that parents, siblings, grandparents, foster parents, and other relations suffer the consequences of intensive care pain and stress. However, most literature focuses on the parents, primarily mothers. Experiencing pregnancy, labor, delivery, and postpartum events, mothers, in particular, have documented pain and stress. (1, 2, 3) The result of vaginal birth and/or Cesarean section often leaves the mother with pregnancy-related physiologic changes, including pain, stress, and recovery from stressful medical procedures. (2)

A baby’s admission to intensive care can lead to maternal and paternal mental health issues not previously experienced. Perinatal posttraumatic stress disorder, anxiety disorders, and postpartum depression have been documented in rates over and above those related to more typical births. (4, 5, 6, 7, 8, 9) Mothers who have a prior history of a mental illness like depression, anxiety, or another diagnosed mental health condition, may bring mental health complexities that are compounded by the stress of intensive care. (10, 11)

Addressing and managing stress related to intensive care experiences is essential to maximize outcomes for babies, parents, and future family functioning post-discharge. (12) Family mental health issues that develop due to an intensive care experience can impact the baby’s development and outcomes. (1, 13) Additionally, the immediate and extended family also suffer the ramifications of the intensive care experience, as there is a disruption in familiar routines, support network availability, travel, and care for siblings. Cultural practices and family customs are also likely to be disrupted. As all families come to the intensive care experience with different expectations, backgrounds, and parenting practices, individualizing approaches and interventions to address stress and promote wellbeing are essential. Consideration for the entire family constellation is appropriate as all members are likely to be experiencing stress as a result of the hospitalization. (14)

The Infant and Family-Centered Developmental Care Standards, Competencies, and Best Practices (IFCDC) have articulated evidence-based practices to assess and ameliorate family pain and stress (https://nicudesign.nd.edu/nicu-care-standards/ifcdc–recommendations-for-best-practice-reducing-managing-pain-stress-in-newborns-families/). The standards, listed in the chart below, are consistent with the Psychosocial Program Standards for NICU Parents. (15) The IFCDC standards aim to recognize the prevalence of family mental health issues resulting from a baby’s hospitalization and provide caregiving environments that ameliorate stress and promote wellbeing.

[READ FULL ARTICLE ON COMPETENCY STANDARDS AFTER REFERENCES]

References:

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  2. Sharp M, Huber N, Ward LG, Dolbier C. NICU-Specific Stress Following Traumatic Childbirth and Its Relationship With Post-traumatic Stress. J Perinat Neonatal Nurs. 2021;35(1):57-67.
  3. Harris R, Gibbs D, Mangin-Heimos K, Pineda R. Maternal mental health during the neonatal period: Relationships to the occupation of parenting. Early human development. 2018;120:31-9.
  4. Garfield L, Holditch-Davis D, Carter CS, McFarlin BL, Schwertz D, Seng JS, et al. Risk factors for postpartum depressive symptoms in low-income women with very low-birth-weight infants. Advances in neonatal care: official journal of the National Association of Neonatal Nurses. 2015;15(1):E3-8.
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Disclosures: There are no conflicts of interest or sources of funding to declare.

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