IV. Global Summit for Preemies

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1 The importance of mental support for parents during NICU and beyond Dora Monostori (Hungary) 1, University of Szeged, Faculty of Health and Social Care 2, University of Pécs, Faculty of Health Sciences, Doctoral School of Health Sciences 3, I Arrived Earlier Foundation for the Southern Great Plain Perinatal Intensive Care Unit

2 Consultant specialist in the NICU My role in the Hungarian health system Health Visitor Mental Hygiene Specialist Mourning Consultant Social Worker in Health Care = Child life specialist, Key worker, Family support worker

3 NICU Case report Mater: aged 38, married, graduated, good social background, lives on the countryside Mater was accommodated on the mothers residence Successful pregnancy after 5 in vitro fertilisation attempts Twins were born on the 28th gestational week 10 weeks of hospitalisation Feeding difficulties, infection, respiratory support

4 NICU Case report In one child: severe intraventricular bleeding occurred, shunt implantation was performed Maternal grandmother was diagnosed with degenerative neurological disorder, rapid degradation Mater showed signs of depression and mourning, was temporarily incapacitated and hesitating Father visited them twice a week, paternal grandmother visited as well

5 Major steps of intervention A psychologist was involved to support the mother Involvement of a psychiatrist was recommended but was refused by the mother Mourning support was initated Family consultation was organized: mother, father, paternal grandmother supporting resources were seeked, coping strategies were developed Peer-to-peer support was organized Case discussion among NICU professionals

6 The role of the psychologist An external psychologist was available (affiliated with another health care facility) Therapy lasted for 5 weeks 1 meeting per week Problems were well communicated by the mother Phone consultation between me and the psychologist, in agreement with the mother

7 Mourning support The guidance in the mourning was my task Focus in the first weeks was the loss of the maternal grandmother Later: a progressing hydrocephalus developed in the premature baby Topics: - Support in the course of the dual mourning - Communication of the mother s feeling for the twins (neglection of the healthier child could be observed)

8 Health Visitor guidance Continuous daily support Daily guidance in the care of the twins, improvement of practical skills: technique of holding and handling, changing nappies and clothes, kangaroo mother care, bathing Support of the constant extension of parental skills Nutritional guidance, maintenance of feeding with mother s milk Resuscitation training Daily course of medication

9 Family consultation The mother was open for my requests. Goal: - Establishment of communicational channels within the family - Organization of supporting resources within the family Results: - The family members visit them more often - The father and the paternal grandmother become involved into the care of the twins in the NICU (permission required)

10 Involvement of peer-to-peer support Another mother was involved in the care, who had had similar experience with twins, now 6 years old The peer-to-peer support person was selected, trained and supervised 3 visits by the mother Results: - The mother gained strength from the discussions - Patterns could be followed with the help of the peer - Improvement in the attitude of the mother

11 Support prior to discharge Consultation with the local Health Visitor Consultation with a movement therapy professional (planned) Guidance for developing the daily routine Continuation of the supporting consultations in their home, organization of a psychologist Training of the parents for the discharge of the baby

12 Results of the NICU-story Motivated health care team to give psychological support Education of nurses and physicians through case discussions Improvement of the coping strategies of the health care team in case of unusual situations

13 Summary The supportive network organized for the mother allowed the avoidance of the psychiatric care Sufficiently trained coordinator assures the management of the case The continuous presence of the mother by the premature twins is ensured The mother s adaptation to the situation is constantly improved The coping story of a peer becomes an essential resource

14 Thank you for your attention!