Mother-Newborn Couplet Care: Zero Separation

A mother and her baby are inseparable. When there is a newborn, there is associated maternal care. A newborn always exists in a relationship with the mother. As awareness about the significance of nurturing care increased, it has become apparent how important it is to keep the mother and the infant in close physical and psychological closeness with each other. The significance of involving the parents as primary caregivers right from the beginning has also become clear. 

Yet, separation is common in case of infants born ill or preterm. There is a need for medical facilities to plan the care of the mother and the infant in a way that there is minimal separation, and the goal should be “zero separation”.

Nurturing care and Infant- and Family-Centred Developmental Care (IFCDC) are key concepts which are designed to promote infant and parent well-being, decrease stress and pain, promote healthy sleep, support parent-infant co-regulation, support bonding and attachment, limit the strain on parents, eventually improving the baby’s brain development. All this tends to have a positive impact on long-term child development.

This can be achieved by ‘Mother-Newborn Couplet Care’, a concept where the ill or premature newborn is cared for, besides caring for the new mother in the same ward, without any interruption, right from the birth until discharge. 

In order to put ‘Mother-Newborn Couplet Care’ into practice, there is a need for close collaboration and proper communication between the members of the team that assists with the delivery and the team that cares for the newborn. Babies that require specialized neonatal care have to be stabilized and continued care has to be planned in close collaboration and communication with the obstetrical team. Transfer to the neonatal unit can be planned in an uninterrupted skin-to-skin-position with the mother/parent and the postpartum care of the mother can continue in the neonatal unit. The key is that the neonatal and maternity units work towards adjusting the design and structure of the unit and follow the guidelines for both infant and mother. Some conditions that may render Mother-Newborn Couplet Care difficult include eclampsia, severe pre-eclampsia, excessive bleeding or hemodynamic instability, a contagious disease or severe psychiatric illness. Infants cared for at the maternity unit usually have mild medical conditions that need extra care, such as being born late preterm, feeding problems, mild hypoglycemia, need for phototherapy for jaundice, observation for mild transient tachypnea, or risk of neonatal infection.

Adequate staff education and training is the pre-requisite to accomplish Mother-Newborn Couplet Care. Besides the systems change in the organization of care practices and training, unit designs also need to be adjusted. The units are required to enable the parents to stay with the baby while delivering safe care for both the patients.

Caregiving in medical facilities has to conform to infant behavior and needs and must focus on mother/parent-infant bonding and attachment. In order to provide the best possible care and environment for the development of ill or prematurely born infants and the parents, an organized systems change allowing zero separation right from birth, focused on Mother-Newborn Couplet Care, is the need of the hour.

Source: Klemming S, Lilliesköld S, Westrup B. Mother-Newborn Couplet Care from theory to practice to ensure zero separation for all newborns. Acta Paediatr. 2021 Nov;110(11):2951-2957.