After delivery continue to establish a therapeutic relationship with parents/caregivers and engage and empower parents to be involved with the care of their newborn.
Why we are recommending this best practice
Involving parents in newborn care early will increase their confidence in and preparation for managing neonatal abstinence syndrome (NAS) symptoms, establish healthy attachment to their newborn, and allow both mother and baby to better succeed in the transition to home.
Strategies for implementation
- Ideally, parents receive prenatal counseling and meet members of the newborn care team.
- Train staff to maintain a non-judgmental and supportive attitude and treat the mother as a parent first, not someone with a substance use problem.
- Provide consistency in care team members as much as possible.
- Ensure confidentiality by not discussing NAS or other clinical matters in front of other family members or friends unless the parents have explicitly consented.
- Promote positive maternal/paternal attachment to the newborn:
- Engage the parents in the care of their newborn.
- Encourage the parents to visit and help them maintain a quiet environment for the newborn.
- Emphasize and reinforce positive attributes of the newborn and maternal/paternal behavior.
- Consider providing a parent/caregiver diary so that the parents may record eating and sleeping information about their newborn.
- Consider posting a HIPAA-compliant sign at the bedside to remind parents and staff about general tips for calming their newborns, skin care, feeding, and other non-pharmacologic interventions.
- Consider providing a brochure or written guide about NAS for parents and standardizing the hospital’s method of pre-natal and postnatal counseling.
Since Kayla was identified as having been exposed to opioids during pregnancy, the pediatric team was notified prior to delivery. The pediatrician assigned to care for Baby M met with Kayla and started to build a relationship with her, describing Kayla’s important role as a mother and the importance of skin-to-skin care and breastfeeding. In addition, due to her exposure, the pediatrician explained the plan for assessing Baby M for symptoms of NAS after delivery.
Training staff to maintain a non-judgmental and supportive attitude and treat the mother as a parent first is an important aspect of establishing a constructive therapeutic relationship with the family. This attitude should be present whether or not the baby develops NAS. Staff should not discuss confidential information in front of family and friends unless the mother has given explicit consent for that communication to occur.
- Grossman MR, Berkwitt AK, Osborn RR, et al. An initiative to improve the quality of care of infants with neonatal abstinence syndrome. Pediatrics. 2017;139(6).
- Wachman EM, Grossman M, Schiff DM, et al. Quality improvement initiative to improve inpatient outcomes for neonatal abstinence syndrome. J Perinatol. 2018;38(8):1114-1122.