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Indicator 11: Togetherness - 24h/7d family access to inpatient newborn care unit

This indicator is the proportion of facilities with 24h/7d family access to the unit where infants are inpatient for the duration of their stay. This indicator is only calculated in facilities with separate inpatient newborn care units (e.g., in Comprehensive and Intensive EmONC facilities).

Numerator:No. facilities where mothers, fathers and designated support persons have 24h/7d access to the unit where infants are inpatient for the duration of their stay

Denominator:Total no. facilities assessed with separate inpatient newborn care units

× 100

Purpose

Increased attention to respectful maternity care has led to an increased focus on the maternal-newborn dyad and ensuring togetherness of women, their families and their newborns. This is especially important for small and sick newborns who require inpatient care. There are many known benefits to keeping newborns, including those who are small and sick, together with their mothers and families: physiologically, this includes facilitating breastfeeding, skin-to-skin care, and thermal regulation, as well as encouraging bonding (with parent(s) and other caregivers), emotional support, and early developmental care.12345678910 In most cases, keeping the newborn with the mother, parents, or family or allowing the option, is respecting the preferences of women. Health facilities should therefore promote and facilitate families’ continuous access to their babies who are inpatients in special newborn care and newborn intensive care units.

Data collection and calculation

The numerator for this indicator is the number of facilities with separate inpatient newborn care units where families (i.e., mother, father and/or designated support person) have 24h/7d access to their babies who are staying in the special newborn care unit or newborn intensive care unit.

To assess whether facilities allow families 24h/7d access to inpatient newborns, facility/unit in-charges and/or health personnel assigned to inpatient care units can be asked who has access to the inpatient newborn care unit when a newborn is admitted (mother/father/designated support person) and whether that access is 24h/7d.

The denominator for this indicator is the total number of facilities with separate inpatient newborn care units that are being assessed.

This indicator is typically expressed as a percentage.

To monitor whether facilities make it possible for families to have 24h/7d access to their inpatient newborns, it is recommended that facilities are assessed and the indicator calculated on an annual basis.

The benchmark for this indicator is 100% of facilities with separate inpatient newborn care units have 24h/7d family access to inpatient newborns.

Analysis and interpretation

When this indicator is less than 100%, interventions are needed to ensure that families have 24h/7d access to their inpatient newborns.

Disaggregation of this indicator by geographical area, and/or facility managing authority may help target specific groups of facilities for implementation.

Supplemental studies

The indicator “Proportion of facilities with 24h/7d family access to inpatient newborn care unit” measures whether facilities have formal / informal policies related to family access to inpatient newborn care units. A step further would be to look at the actual practice in these units. A special study could be conducted that would look at what percent of infants that were admitted as inpatient for >12 hours had a parent or designated support person with them at all times (or for a specific threshold of time, to be defined) during their inpatient stay, excluding any required separations during rounding and during invasive medical procedures.

Another way to measure whether women and their families had access to their inpatient babies would be to incorporate a question into exit interviews or population-based studies that asks: were you allowed to stay with your baby as much as you wished? These responses could then be disaggregated by women with babies who were admitted to SNCUs / NICUs versus women with babies who did not require inpatient care. It could also be analyzed for women with and without obstetric complications.

If facilities routinely separate women and families from their babies who are admitted, studies could be designed to identify root causes: Does the inpatient unit’s physical environment / layout / configuration limit the number of parents and caregivers who can be in the room at one time? Are there places for parents and caregivers to sit or sleep in the unit? In cases where separation is required for medical procedures, do health providers explain to women and families why?

Useful links

  1. Karimi FZ, Sadeghi R, Maleki-Saghooni N, Khadivzadeh T. The effect of mother-infant skin to skin contact on success and duration of first breastfeeding: A systematic review and meta-analysis. Taiwan J Obstet Gynecol. 2019;58(1):1-9. doi:10.1016/j.tjog.2018.11.002 ↩︎

  2. Marín Gabriel MA, Llana Martín I, López Escobar A, Fernández Villalba E, Romero Blanco I, Touza Pol P. Randomized controlled trial of early skin-to-skin contact: effects on the mother and the newborn. Acta Paediatr. 2010 Nov;99(11):1630-4. doi: 10.1111/j.1651-2227.2009.01597.x. PMID: 19912138. ↩︎

  3. Bystrova K, Ivanova V, Edhborg M, Matthiesen AS, Ransjö-Arvidson AB, Mukhamedrakhimov R, Uvnäs-Moberg K, Widström AM. Early contact versus separation: effects on mother-infant interaction one year later. Birth. 2009 Jun;36(2):97-109. doi: 10.1111/j.1523-536X.2009.00307.x. PMID: 19489802. ↩︎

  4. Chavan A, Paul N, Manerkar S, DSN AK, Gupta A, Sahu TK, Kalathingal T, Krishna VV, Mondkar J. Impact of kangaroo father care in stable very low birth weight infants on father-infant bonding. J Neonatal Nurs. 2023; DOI: 10.1016/j.jnn.2023.10.012. ↩︎

  5. Pathak BG, Sinha B, Sharma N, Mazumder S, Bhandari N. Effects of kangaroo mother care on maternal and paternal health: systematic review and meta-analysis. Bull World Health Organ. 2023 Jun 1;101(6):391-402G. doi: 10.2471/BLT.22.288977. Epub 2023 Mar 31. PMID: 37265678; PMCID: PMC10225947. ↩︎

  6. Feldman R, Eidelman AI. Skin-to-skin contact (Kangaroo Care) accelerates autonomic and neurobehavioural maturation in preterm infants. Dev Med Child Neurol. 2003 Apr;45(4):274-81. doi: 10.1017/s0012162203000525. PMID: 12647930. ↩︎

  7. Feldman R, Eidelman AI, Sirota L, Weller A. Comparison of skin-to-skin (kangaroo) and traditional care: parenting outcomes and preterm infant development. Pediatrics. 2002 Jul;110(1 Pt 1):16-26. doi: 10.1542/peds.110.1.16. PMID: 12093942. ↩︎

  8. Moore ER, Anderson GC, Bergman N, Dowswell T. Early skin-to-skin contact for mothers and their healthy newborn infants. Cochrane Database Syst Rev. 2012;5(5):CD003519. Published 2012 May 16. doi:10.1002/14651858.CD003519.pub3 ↩︎

  9. Sheedy GM, Stulz VM, Stevens J. Exploring outcomes for women and neonates having skin-to-skin contact during caesarean birth: A quasi-experimental design and qualitative study. Women Birth. 2022 Nov;35(6):e530-e538. doi: 10.1016/j.wombi.2022.01.008. Epub 2022 Jan 26. PMID: 35090856. ↩︎

  10. Widström AM, Brimdyr K, Svensson K, Cadwell K, Nissen E. Skin-to-skin contact the first hour after birth, underlying implications and clinical practice. Acta Paediatr. 2019 Jul;108(7):1192-1204. doi: 10.1111/apa.14754. Epub 2019 Mar 13. PMID: 30762247; PMCID: PMC6949952. ↩︎