Listening Matters for Mothers

For most women, childbirth is an intense experience, culminating in the joy of delivering a newborn, swaddled and sweet, resting in the mother's arms within hours. Yet for those who deliver their babies prematurely, the experience is bereft of such bonding, laden with anxiety, confusion and doubt.

“Having a prematurely born baby is like a nightmare for the mother,” explained Lisa Segre, assistant professor in the University of Iowa College of Nursing. “You're expecting to have a healthy baby, and suddenly you're left wondering whether he or she is going to live.”

These new moms have a tremendous need for help while they're in the hospital's neonatal intensive care unit, or NICU. So, Segre and a longtime NICU nurse, Rebecca Siewert, decided to find out whether women who delivered babies prematurely would benefit from having a nurse sit with them and listen to what they had to say. In a new study, published in the Journal of Perinatology, Segre's research team writes that pre-term baby mothers who participated in a series of personal sessions with a NICU nurse reported lower anxiety and depression symptoms, while their self-esteem improved.

Segre says it's the first proof-of-concept study conducted that enlisted NICU nurses in “listening visits” with mothers of pre-term infants. The research shows that “listening matters,” said Segre, who is a psychologist. “These mothers are stressed out, and they need someone to listen to them,” she added.

The trial at University of Iowa Children's Hospital involved 23 mothers with pre-term infants and ran from 2010 through the first half of last year. The women received an average of five one-on-one sessions lasting about 45 minutes each with Rebecca Siewert, an advanced registered nurse practitioner who has worked in NICUs for three decades and is a coauthor on the paper. The mothers chose the setting – their room, an outdoor patio or the cafeteria. The first sessions generally focused on the birth, in which the women described the emotional roller coaster of giving birth to a baby they hardly saw afterward and whose health was compromised.

“The mothers wanted to tell their birth stories,” Siewert recalled. “They wanted someone to understand what it felt like for their babies to be whisked away from them. They were very emotional.”

Subsequent sessions allowed the mothers to focus on themselves and their needs, which many tend to consider subsidiary or perhaps even trivial when compared to their newborns' plight, Siewert maintained.

“A lot of times they suffer in silence because they don't want to sound as if they're weak and not doing well, and because all the focus is on the baby, they become secondary,” said Siewert, an associate clinical professor in the College of Nursing. “But the mother needs to be healthy to be able to take that baby home and for that baby to do well.”

The mothers' depression level dropped from a mean of 14.26 – considered elevated as measured by the Edinburgh Postnatal Depression Scale – before the listening visits, to a mean of 9.00, below the standard for professional help, after the sessions ended. Anxiety levels also fell, from a mean of 16.57, as measured by the Beck Anxiety Inventory, to a mean of 9.13, according to the study. Both drops are considered statistically significant, the authors write.

The participants also felt better about themselves and their situation, according to the Quality of Life, Enjoyment and Satisfaction Questionnaire they filled out before and after the listening sessions. A follow-up assessment one month after the last listening visit showed further declines in depression and anxiety on average, and higher quality-of-life feelings.

“Listening is what nurses have done their whole career,” Siewert said. “We've always been the ones to listen and try to problem solve. So, I just think it was a wonderful offshoot of what nursing can do. We just need the time to do it.”

Some 15 million babies are born prematurely worldwide, of which one million die, according to the World Health Organization, or WHO. In the U.S., more than half a million babies are pre-term each year, WHO reports.

Last year, a different research team found that when leaving the hospital, 1-in-5 mothers still had elevated depression levels and more than 4-in-10 reported at least moderate anxiety.

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