The National Perinatal Association contributes a monthly column to Neonatology Today
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Find out how National Perinatal Association members are leading the way in interdisciplinary care and collaboration.
National Perinatal Association’s Perinatal Mental Health Workgroup: Collaborative Efforts to Address Perinatal Mental Health by Tiffany Willis, PsyD; Sharon Tan, PsyD; Andrea Werner Insoft, LICSW, ACSW
"The field of perinatal mental health has expanded significantly in recent years. This is in part due to the increasing recognition that Postpartum Mood and Anxiety Disorders (PMADs) are well regarded as the most common complication during the pregnancy and postpartum period. Furthermore, women have been found to develop depression and anxiety more frequently during the first year after childbirth and at any other time."
Child Maltreatment of NICU Graduates: Focus on Health Disparities by JaNeen Cross, DSW, MSW, MBA
"The purpose of this article is to highlight the maltreatment of NICU infants as a public health concern resulting from health disparities. Description: The article provides evidence that NICU infants are represented in the highest maltreatment group and fatal neglect group. Similarly, mothers are the highest reported group for maltreatment. This crisis is viewed through the lens of health disparities. The health disparities for the infant, mother, and health system are discussed and how these disparities increase maltreatment risks and poor outcomes. Assessment: Health disparity gaps need to be addressed in order to improve maltreatment and morbidity outcomes with an emphasis on maternal-infant attachment. Conclusion: NICU providers and child welfare professionals need to understand the health disparities that lead to poor outcomes. Similarly, providers must address the health-related disparities for infants, maternal mental health disparities, and system gaps that leave mothers and infants vulnerable."
Cultural Humility in the NICU by Alison R. Hartman, BA, Pamela A. Geller,Ph.D., Chavis Patterson, PhD
The scope of NICU care was once focused solely on the medical needs of the neonate. Today, compelled by an international movement towards family-centered care, many NICU environments now prioritize attending to the psychosocial needs of the patient’s family. As society has grown increasingly attuned to the unique experiences and needs of diverse populations, so too is healthcare adopting the idea of cultural humility. Cultural humility goes above and beyond cultural sensitivity or competency; rather, practicing cultural humility in healthcare “incorporates a lifelong commitment to self-evaluation and selfcritique, to redressing the power imbalances in the patient-physician dynamic, and to developing mutually beneficial and non-paternalistic clinical and advocacy partnerships”
The National Perinatal Association and 1,000 Days Partner to Support Paid Family Leave Legislation by Cheryl A. Milford, EdS
"The First 1,000 Days was initiated in 2010 by Secretary of State Hillary Clinton in response to ground-breaking scientific evidence that identified a powerful window of opportunity from a woman’s pregnancy to a child’s 2nd birthday when nutrition has a long-term impact on the future health and development of both children and societies."
Coping with Infant Illness in the NICU During the Holiday Season by Navy C. Spiecker, BA; Pamela A. Geller, PhD; Chavis A. Patterson, PhD
"An extended stay in the NICU can be a challenging experience for families, especially during the holidays. Fortunately, there are many ways that NICU providers can help to ease parents’ distress, and maintain a sense of holiday cheer in their NICU."
Insights and Suggestions to Support Lesbian, Gay, Bisexual, Transgender, and Queer/Questioning (LGBTQ) Parents in the NICU by Vincent C. Smith, MD, MPH and Jonathan S. Litt, MD MPH ScD
Further Insights and Suggestions to Support the Lesbian, Gay, Bisexual, Transgender, and Queer/ Questioning (LGBTQ)-Headed Family in the NICU by Vincent C. Smith, MD, MPH and Jonathan S. Litt, MD MPH ScD
"Most NICU providers have limited training about and experience with the unique needs and issues for LGBTQ-headed in a NICU setting. There are some national and local resources available to support LGBTQ-headed families and staff who care for them."
The Fourth Trimester: Where Has the Village Gone? by Jerasimos (Jerry) Ballas, MD, MPH
"After 40 weeks of gestation, the fragile and helpless state of a human newborn is striking when compared to the abilities of other mammals and primates born at term."
"Members of the NPA firmly believe that breastfeeding and breast milk are the standards for newborn and infant feeding. Supporting and normalizing breastfeeding of newborns and infants is a cornerstone of NPA’s advocacy work... We also believe that the way that people choose to use their bodies is a deeply personal decision. We have responsibilities to support parents’ decisions, including when those are decisions that are different from the ones we want them to make."
NICU Discharge Preparation and Transition Planning by Vincent C. Smith, MD, MPH
"NICU discharge readiness is the attainment of technical skills and knowledge, emotional comfort, and confidence with infant care by the primary caregivers at the time of discharge."
Routine Screening for Perinatal Mood and Anxiety Disorders by Cheryl Milford, EdS
"Pregnancy and the birth of a child is an exciting and celebratory time for many families. However, for approximately 20-25% of these women and their families, PMADs can have profound adverse effects on the women, children, and their family’s mental, physical and emotional health."
Shedding Light on the Dark Reality of Disparities in Perinatal Care by Viveka Prakash Zawisza, MD, FACOG
"The repeated dismissal of her symptoms by her providers and the ultimate delayed diagnosis of a postpartum pulmonary embolism is a story to which many black mothers can relate."
"The National Perinatal Association is committed to integrating diverse voices, educating providers and patients and advocating for policy changes that will advance the national discussion on perinatal health care access and disparities."
The Neonatal Intensive Care Unit (NICU): Self Efficacy of Caregiving and the Lived Experience of Parents Post-NICU Discharge by Jenene Woods Craig, Ph.D., MBA, OTR/L, CNT
“ At the end of what is sometimes a long stay in the NICU, parents mustassume responsibility for caregiving tasks thatwere, up until that time, handled by NICU staff.”
BLACK + PREGNANT = DEATH? Racial disparities in perinatal morbidity and mortality in the United States by C Cody Miller, MS-4 and Ealing Tuan, MS-3
“ Even when accounting for known differences in educational attainment, black women still fare worse; a black woman with a college degree or higher is still more than twice as likely to suffer severe maternal morbidity than a white woman who never graduated high school.”
NICU Transition Planning with Military Families by Vincent C. Smith, MD, MPH and Julia Yeary, ACSW, LCSW, IMH-E
“There are special support programs designed to help with the unique needs of military families. Clinicians should be aware of how to direct military families to access this information.”
Maternal Mortality in the US is Due to Inefficiency in the Healthcare System by Viveka Zawisza, MD FACOG
“...Mike Hynan, PhD, Sue Hall, MD and Raylene Phillips, MD, presented the opening plenary session by describing a Neonatal Intensive Parenting Unit (NIPU), which was based on a concept they published in the Journal of Perinatology in 2017. Developing ways to transform NICUs into NIPUs is an ongoing project of NPA, which includes a focus (in theory and practice) on the parent as the primary caregiver in the NICU and on the role of NICU staff in supporting parents in parenting their NICU baby.”
Can People Heal as They Grieve? by Andrea Werner Insoft, LICSW, ACSWD
"When a baby dies, how can we help families – and each other – heal as we grieve?... To provide grieving parents with a tool to guide their recovery, I use an acronym: LEVER, which stands for Language, Express, Validate, Educate, Rituals. A lever is a device that allows one to lift something that one could not lift on their own... Making meaning out of an event that was so unexpected or arbitrary is at the heart of healing. Love and grief go hand in hand. The goal is not to let go, but to integrate this experience into who we are, to create a new identity that allows joy to co-exist with sadness."
“For several decades we have been aware of the critical role families play in supporting the physiological and emotional wellbeing of their babies in the NICU. The Family-Centered Care model has been accepted by hospitals and healthcare organizations as a proven way to improve care for patients of all ages and has been adapted to the NICU as the Family-Centered Developmental Care model and, more recently, the Family Integrated Care model.”
National Perinatal Association 2018 Respiratory Syncytial Virus (RSV) Prevention Clinical Practice Guideline: An Evidence-Based Interdisciplinary Collaboration by Mitchell Goldstein, MD; Raylene Phillips, MD; John P. DeVincenzo, MD; Leonard R. Krilov, MD; T. Allen Merritt, MD; Ram Yogev, MD; Suzanne Staebler, DNP, APRN, NNP-BC, FAANP, FAAN; Munaf Kadri, MD; Jaimie E. Fergie, MD; Michael S. Schechter, MD, MPH; Millicent Gorham, PhD, MBA, FAAN; James D. Cherry, MD, MSc
“Over the course of the last several years, the proportion of infants eligible for RSV prophylaxis who have actually received palivizumab has decreased as providers and insurers have increasingly followed guidelines that are not in compliance with the Food and Drug Administration indication resulting in needless morbidity and increased hospitalization.”
Psychosocial Support for Perinatal Substance Use: Mothers and Their Newborns by Cheryl A. Milford, EdS
“The use of prescription pain relievers has increased significantly in the last 15 years, with 4.3 million people in the United States using opioid medications in 2014. While there will always be a place for the appropriate use of prescription pain relievers, the use of opioid medications as a substance of abuse has become a major public health concern.”
Respiratory Syncytial Virus is a Really Serious Virus for Many At-Risk Babies by Mitchell R. Goldstein, MD; Vincent C. Smith, MD; Raylene Phillips, MD
"October is Respiratory Syncytial Virus (RSV) Awareness Month, which gives us an opportunity to examine concerns that arise each year during RSV season."
Supporting Families on Their Journey Home: A Comprehensive Approach to NICU Discharge/Transition Planning by Vincent C. Smith, MD; Trudi N. Murch, PhD, CCC-SLP2
"The days, weeks, and months immediately following a baby’s discharge from the NICU constitute a critical period in the life of the family. While trying to balance multifaceted emotions, the family must also deal with their job-related demands, financial responsibilities, the needs of other family members, and numerous other stressors including mental health issues. Families need help and support."
Who Takes Care of Us?: Understanding and Managing Secondary Traumatic Stress in the NICU by Stephen Lassen, PhD
"Working in a NICU brings all those involved into regular contact with trauma...It is important health professionals normalize this aspect of their work in NICUs and act together to create a supportive environment where staff well-being is valued and seen as a critical aspect of the care they provide to infants and their families.”
The Development of New Pharmacological Therapies for Infants - The National Perinatal Association’s Position of Support for Senate Bill S.2041 - Promoting Life-Saving New Therapies for Neonates Act of 2016 by Sue Hall, MD; Raylene Phillips, MD; Vincent C. Smith, MD; Cris Glick, MD; Mitchell Goldstein, MD; T. Allen Merritt, MD
“Despite a recognition by Congress that children’s interests are not being met with pediatric pharmaceutical development, very little progress has been made to meet this need. As a result, efforts to offer even more incentives to pharmaceutical companies such as those described in Bill S.2041 are being made.”
Supporting NICU Staff Mental Health by Cheryl A. Milford, EdS
“Supporting the mental health of the NICU staff is as important as scaffolding the mental health needs of parents. Utilizing the family-centered care principles and the tenets of trauma-informed care in maintaining professional attitudes, choices and behaviors is vital to the practices and culture of the NICU.”
Perinatal Loss and Bereavement: A Transcultural View (part 2) by Marylouise Martin, MSN, RNC-NIC
“Children are not supposed to die. The pregnancy, newborn and childhood periods are expected only to be happy times. Children are expected to fulfill both the personal and social needs of their parents. The death of a child is a powerful loss.”
Comprehensive Family Support in NICUs by Sue Hall, MD
"Comprehensive family support goes beyond just 'allowing' parents to 'visit' their baby and keeping them informed of the baby’s medical status... it requires that neonatologists collaborate with an interdisciplinary team towards a common goal of providing this support..."
Advocating for More Effective Healthcare for Drug-Using Women and Their Babies by Bernadette Hoppe, MA, JD, MPH
“All of the aspects of appropriate developmental care, which are needed for all babies, are even more necessary with fragile babies, including those exposed to opiates during pregnancy. As neonatologists, you have an important role to advocate for the highest level of evidence-based treatment for fragile babies.”
"The goal of discharge readiness is to equip primary caregivers to be competent and confident in caring for their baby at home in order to ensure a safe transition from the NICU to home for the baby and family."
The National Perinatal Association Facilitates Collaboration to Improve Perinatal Care by Raylene M. Phillips, MD
“A more recent project facilitated by the NPA integrates the expertise and experience of physicians, nurses, psychologists, social workers, case managers, therapists and parents in the Neonatal Intensive Care Unit to develop interdisciplinary recommendations for program standards to provide psychosocial support for NICU parents, a support system that is entirely missing in most NICUs and highly variable in others.”