Substance abuse during early motherhood has become a significant problem and has led to accelerated efforts to develop specific treatment facilities for these mothers and children. Despite the often intensive treatment efforts in residential settings, there is surprisingly little evidence of their efficacy for enhancing the quality of caregiving. The situation of these mother-child pairs is exceptionally complex and multilevel, and has to be taken into account in the content and structuring of treatment. Intensive work in the “here and now” focusing on the mother-child relationship from pregnancy onwards in an effort to enhance maternal reflective capacity and mindedness is considered a key element for better treatment prognosis, in terms of both abstinence and quality of parenting. Pioneering work with such a focus is described in this article.

Enhancing the effectiveness of residential treatment for substance abusing pregnant and parenting women: focus on maternal reflective functioning and mother-child relationship.

Background: Although much is known about risk factors for postpartum depression (PPD), many potentially important clinical variables have still not been investigated. In this systematic literature review, we examine the published evidence for the prevalence of PPD among three populations of women commonly seen by providers of perinatal care: women who use substances, women with current or past experiences of abuse, and women with chronic illness. Methods: We searched Medline, CINAHL, EMBASE, PsycINFO, and the Cochrane Library from their start dates through to August 1, 2008, using keywords relevant to depression and each of the three target clinical populations. All published, peer-reviewed papers in English or French were included in the review if a standardized assessment of depression between 3 and 52 weeks postpartum was used and if either the prevalence of PPD in the target population or a comparison of depression scores between the target population and a control group were reported. Result...

http://g.psychcentral.com/blog/2009/07/ross_ppd_2009.pdf

The prevalence of postpartum depression among women with substance use, an abuse history, or chronic illness: a systematic review.

Objective To compare patient comfort in preterm infants treated with heated humidified high flow nasal cannulae (HHHFNC) versus nasal continuous positive airway pressure (NCPAP). Design Randomised cross-over trial (2×24 h). Setting Single tertiary neonatal unit. Patients 20 infants less than 34 weeks postmenstrual age treated with NCPAP due to mild respiratory illness. Interventions After parental consent, infants were randomised to 24 h of treatment with NCPAP or HHHFNC followed by 24 h of the alternate therapy. Main outcome measures Primary outcome was patient comfort assessed by the EDIN (neonatal pain and discomfort) scale. Secondary outcomes were respiratory parameters (respiratory rate, FiO 2 , SpO 2 , TcPCO 2 ), ambient noise, salivary cortisol and parental assessments of their child. Results We found no differences between HHHFNC and NCPAP in mean cumulative EDIN score (10.7 vs 11.1, p=0.25) or ambient noise (70 vs 74 dBa, p=0.18). Parents assessed HHHFNC treatment as significantly better in the three domains, 1) child satisfied, 2) parental contact and interaction and 3) possibility to take part in care. Mean respiratory rate over 24 h was lower during HHHFNC than CPAP (41 vs 46, p=0.001). Other respiratory parameters were similar. Conclusions Using EDIN scale, we found no difference in patient comfort with HHHFNC versus NCPAP. However, parents preferred HHHFNC, and during HHHFNC respiratory rate was lower than during NCPAP. ClinicalTrials.gov, number NCT01526226.

https://fn.bmj.com/content/fetalneonatal/early/2013/11/13/archdischild-2013-304525.full.pdf

Patient comfort during treatment with heated humidified high flow nasal cannulae versus nasal continuous positive airway pressure: a randomised cross-over trial

Bonding in neonatal intensive care units: Experiences of extremely preterm infants' mothers.

National survey data suggest that new mothers have high prevalences of alcohol and illicit drug use. Depression correlates with substance use, and new mothers with postpartum depression may be at high risk for substance use. Understanding postpartum substance use and its relationship to postpartum depression can inform future research and intervention. A literature search was conducted resulting in 12 studies published from 1999-2012 examining postpartum alcohol use, drug use, or combined postpartum depression and substance use. Postpartum alcohol (prevalence range 30.1%-49%) and drug use (4.5%-8.5%) were lower than use among not pregnant, not postpartum women (41.5%-57.5%, 7.6%-10.6%, respectively) but higher than use among pregnant women (5.4%-11.6%, 3.7%-4.3%, respectively). Correlates of postpartum problem drinking were being unemployed, unmarried, and a cigarette smoker. Prevalence of drug use was highest among white new mothers, followed by blacks and Hispanics, but black new mothers appeared at greater risk of drug use. No identified studies examined correlates of postpartum drug use beyond race/ethnicity. Postpartum depressive symptoms were prevalent among postpartum substance users and those with a substance use history (19.7%-46%). The postpartum period is a critical time. Prevalent substance use and the scarcity of studies warrant research to identify means to reduce maternal substance use.

/pdf/postpartum-substance-use-and-depressive-symptoms-a-review-3e0vmoqtcw.pdf

Postpartum substance use and depressive symptoms: a review.

In this paper, we highlight the need for acknowledging the importance and impact of both physical and emotional closeness between the preterm infant and parent in the neonatal intensive care unit. Physical closeness refers to being spatially close and emotional closeness to parental feelings of being emotionally connected to the infant (experiencing feelings of love, warmth and affection). Through consideration of the literature in this area, we outline some of the reasons why physical closeness and emotional closeness are crucial to the physical, emotional and social well-being of both the infant and the parent. These include positive effects on infant brain development, parent psychological well-being and on the parent–infant relationship. The influence of the neonatal unit environment and culture on physical and emotional closeness is also discussed. Conclusions: Culturally sensitive care practices, procedures and the physical environment need to be considered to facilitate parent–infant closeness, such as through early and prolonged skin-to-skin contact, family-centred care, increased visiting hours, family rooms and optimization of the space on the units. Further research is required to explore factors that facilitate both physical and emotional closeness to ensure that parent–infant closeness is a priority within neonatal care.

/pdf/closeness-and-separation-in-neonatal-intensive-care-44hd357ai9.pdf

Closeness and separation in neonatal intensive care.

An early report on the mother-baby interactive capacity of substance-abusing mothers.

In this pilot study, the interactive skills of infants with their high-risk, substance-dependent mothers were explored in residential treatment from pregnancy until the infant was 6 months of age. Fourteen mother–infant pairs were videotaped in feeding and free play situations at 6 months after birth. A comparison, low-risk group consisted of 12 ordinary Finnish mother–infant pairs with minimal clinical risks. The findings show significantly higher levels of dyadic interactive deficiencies among the high-risk mother–infant pairs compared to the low-risk pairs, displayed especially in the feeding situation as lack of mutuality and flat, empty, constricted affective tone of interaction. Also, more interactive deficiencies were found among the high-risk infants compared to the low-risk infants, but the differences were not significant. In this study, this finding might reflect the reduced amount of somatic complications and the benefits of treatment, the impacts of which were not explored. The differences be...

Interactive skills of infants with their high-risk mothers.

Objective: Examination of maternal interactive behavior and psychosocial situation of substance-abusing mothers in treatment. Method: Twelve mothers with an alcohol or drug abuse problem and 12 control mothers were assessed in random order with the Parent ‐ Child Early Relational Assessment, for the analysis of videotaped mother ‐ infant interactions at 3 and 6 months’ postpartum. Depressive symptoms were assessed with Edinburgh Postnatal Depression Scale and aspects of social support with two Social Support Questionnaires. Results: Substance-abusing mothers tended to have more problematic areas in their interactive behavior, a tendency which increased during the study period. As was expected, they were more often depressive, and experienced more social environment difficulties and less social support. Conclusions: Mothers with alcohol and drug abuse problems need intensive professional support in early motherhood, and are seen to be particularly motivated to strive for abstinence and accept help at this stage of life. D 2001 Elsevier Science Inc. All rights reserved.

Sari Ahlqvist

Papers

Closeness and separation in neonatal intensive care.

An early report on the mother-baby interactive capacity of substance-abusing mothers.

Interactive skills of infants with their high-risk mothers.

Regular article An early report on the mother-baby interactive capacity of substance-abusing mothers