AUSTRALIAN COLLEGE OF MIDWIVES INCORPORATED

THE

INTENSIVE -

MOTHERCRAFT A REPORT

PROGRAM

Carol Hanna, R.N., R.M., Grad.Dip. Health Counselling Lynn Ebdell, Mothercraft Nurse A report on the Intensive Mothercraft Program (IMP) developed at The Queen Elizabeth Hospital (TEQH) Adelaide. Thisprogram was developed in 1987 mainly in response to needs demonstrated by parents, who were physically and~or intellectually disabled.

Introduction Over the past decade there has been a change in c o m m u n i t y attitudes toward sexuality and childbirth. It is n o w considered to be a basic h u m a n right for all people to make their o w n decisions about having children. A m o n g those making these decisions are the physically and/or intellectually disabled.

within the first two or three postnatal days. Once identified, the assistance of other health care personnel, e.g. social workers was sought. This aided in making a more accurate assessment of the client's needs, leading to the development of an individualised program. The clients were kept informed and participated where practical in their program development. The program was set out in a contract format, which enabled goals to be set and a time frame for their achievement to be established. Most programs were designed for 14 days, but some were extended to 21 or 28 days.

The IMP was developed in response to midwives at TEQH discovering that when planning the discharge after childbirth o f clients from these groups, that the above change in attitudes had not been accompanied by an increase in appropriate c o m m u n i t y support systems. While there were mothering units available, most of these clients were unable to utilise these facilities because they did not fulfil the stated entry criteria. A multidisciplinary approach is used to assess the needs and capabilities of the w o m e n and their partners. From the assessment an individuatised program is developed, goals and time frames for the acquisition of suitable mothercraft skills are drawn up. These are in the form of a contract w h i c h is negotiated with the clients.

Aim The aim of the program is to assist the w o m e n and their partners acquire skills, which will enable them to gain from the parenting experience and safety care for their baby.

The Program Clients were encouraged to enter the program w h e n it was perceived that they w o u l d have, or were having difficulty in acquiring skills necessary to safely care for their baby or babies. Sometimes this perceived difficulty was recognised at the time of delivery or before, while at others, it was elected MARCH 1992

Mother cerebral palsy, unsupported twin pregnancy. (Twins now nearly three years old). A summary of the subject matter included in the program is given in Table 1. In addition to this, it was sometimes necessary to teach the clients h o w to

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count or tell the time, so that they could successfully learn and perform the skills being taught. Instruction involved using a variety of methods such as videos, demonstrations, checklists, supervised practice and if needed, an individualised daily activity book. The latter involved the use of photographs taken of the clients, with their baby as appropriate, doing the various activities associated with a particular skill. The photographs were pasted in a book, with any additional instruction needed, often in diagrammatic form, to which the clients referred. The use of photographs was found to be more beneficial than using magazine pictures, as the photographs tended to be more realistic to the clients and referred to more often. For clients with a physical disability alternate techniques of management were often required, e.g. use of foam inserts in a bath, or a "Tubbie Bath'; so that the baby was supported during his or her bath. Velcro was used on babies' clothes instead of buttons and as an alternative to safety pins to secure napkins. When clients first entered the program, single r o o m a c c o m m o d a t i o n was arranged, so that the distractions of the usual ward routine could be reduced. They were assigned one midwife or mothercraft nurse each shift, as far as possible the same nucleus of staff cared for them throughout the client's stay. This enabled (1) a rapport to develop between the client and staff members, (2) expectation of the clients and the information provided to them to be more consistent, and (3) assessment and documentation of progress to be more reliable. The role of the midwife/mothercraft nurse was to teach the clients skills identified in the contract, supervise them, practice and assist with care as needed. This continued until it was assessed that the client could safely perform the skills consistently. For some it was necessary to introduce only one activity at a time, e.g. feeding the baby, de-winding being done by the staff m e m b e r and taught later. This reduced confusion which sometimes occurred when a multitude of new skills n e w mothers have to learn were introduced. Team conferences, which involved the clients, were to give feedback o n progress and if needed, the contract was modified. PAGE 26

As the clients gained confidence and were able to perform the skills they were encouraged to b e c o m e more independent and make decisions for themselves; for many, this was w h e n the activity of the living book proved useful. The midwife's role at this stage was to provide positive reinforcement and assist the clients to problem solve for themselves. Ideally for three days prior to discharge, there was no staff input. Before discharge a network of community supports, suitable for the individual clients were established, examples of these are in Table 2. Where possible, clients met a representative of a particular group, e.g. CAFHS, or the individual with w h o m they would be dealing, e.g. family support worker. These arrangements ensured that the clients were provided with (1) guidance to assist their children reach their milestones and (2) physical and emotional support out in the community. Positive outcomes of the program were defined as clients: (1) safely caring for their child(ren) at six weeks and one year of age; (2) identifying problems and seeking help. Between its inception in 1987 and the end of January 1991, 35 clients have entered the program. Of these, 28 were primipara and seven were multipara, whose other children were in foster care. All clients were assessed as having p o o r skills either from their history and/or at ward level, and could be placed into one or more of the following categories: (1) physically disabled, quadraplegic, paraplegic or cerebral palsy . . . . . . . . . . . . . . . . . . . . . . . . . . 3 (2) intellectually disabled . . . . . . . . . . . . . . . . 13 (3) single with minimal c o m m u n i t y support and/or multiple births . . . . . . . . . . . . . . . . . . . . . . . . 14 (4) psychiatric or anti-social behaviour . . . . . . . 5

Evaluation At the end of 12 months, 28 clients had custody of and were safely caring for their children, although some still required extensive c o m m u n i t y support. The remaining seven had had their children fostered. Two had made this decision while still in hospital, with one other couple w h o had five previous children in foster care, presenting one week after discharge requesting that this child be fostered also.

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Seven clients had returned to have another child and required no specialised care, while one other required a refresher program.

Su m m a r y While the hospital was not the ideal environment for simulating normal living conditions, the IMP has proved to be successful with skills learned being transferred to the h o m e environment. The social workers played a major role in the establishment and co-ordination of c o m m u n i t y support for use by the clients after discharge. In m a n y instances this proved difficult, because existing networks were often not suitable or limited in their capacity to help due to funding difficulties, and sometimes the support required was non-existent and had to be developed. The Friends of TQEH assisted with provisions of financial and s o m e practical help. The experience at TQEH has s h o w n that the community's change in attitude toward people making their o w n decisions about having children has not b e e n a c c o m p a n i e d by an increase in appropriate support mechanisms. Until this is addressed, there will continue to be a need for programs similar to the IMP, even though they are labour and time intensive and therefore expensive. Do not the children of these parents have the right to be offered the best possible future?

MARCH 1992

Table 1 Subjects i n c l u d e d in IMP Infant feeding 9 identification of hungry b a b y 9 positioning of b a b y for feeds 9 de-winding b a b y 9 positioning baby after feeds 9 breastfeeding, or 9 formula feeding Techniques of settling baby Baby hygiene and bathing Dressing baby Laundering of baby's clothes Play and stimulation.

Table 2 Examples of community supports e s t a b l i s h e d for c l i e n t s Child, Adolescent and C o m m u n i t y Health Services (CAFHS) Intellectually Disabled Services Council (IDSC) Family Support Workers Play Groups Day Care New Mum's G r o u p Nannies Financial Advisors Some of these were organised through local councils or g o v e r n m e n t departments.

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The intensive mothercraft program--a report.

A report on the Intensive Mothercraft Program (IMP) developed at The Queen Elizabeth Hospital (TEQH) Adelaide. This program was developed in 1987 main...
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