Japanese Nurse Incorporates HUG into her PhD Research

Development of a Web-Based Comprehensive Educational Programme for Nurses to Facilitate Mother-Infant Bonding
Yasue Otal,  Mari Takahashi 
 Juntendo University graduate school of health care and nursing Doctoral course 
 Juntendo University Faculty of health care and nursing
Juntendo University graduate school of health care and nursing

Background: 
Yasue Ota on right
The acknowledgement of the importance of the role nurses can play in facilitating mother-infant bonding during the very early postnatal period has created many interventions. But most of them don’t seem to function as well as expected due to low availability, and requirement of rigorous training and certification. This motivated us to develop a user-friendly, easy-to-access, web-based comprehensive training programme for nurses to effectively enhance their responsiveness to postnatal mother-infant bonding.

Methods: 
First, observations of nurses and mother-baby dyads were conducted. Then, semi-structured interviews with those nurses were implemented to generate a structural nursing care model for facilitating mother-infant bonding during the early postpartum period. Finally, this model and a literature review were synthesized. And then the theory of the ICE model (F. Young) and the Reflective approach model (G. Gibbs) were applied to design our educational programme. It was pilot-tested with ten midwives at a birth centre.
Results: Our educational programme comprises a web-based programme and a case study through reflection on clinical practice. The web-based programme has three following steps: Step 1, application of HUG Your Baby programme (J. Tedder) to enhance knowledge and skills about infants’ behaviours; Step2, construction of effective communication skills and sustainable childrearing support to engage as an “Attacher”, who helps enhance mother-infant bonding and; Step 3, case studies for incorporation of acquired knowledge and skills into clinical practice. The process evaluation generated positive feedback regarding its course length, interestingness and levels of difficulty.

Conclusion: 
This comprehensive educational programme for nurses has the potential to contribute to facilitating nurses’ responsiveness to infants and mother-infant bonding in the early postnatal period.
Keywords: early postnatal nursing care, mother-infant bonding, educational programme


References: 
Yasue Ota, Mari Takahashi (2016). Nurses’ support to facilitate mother-infant attachment during the early postpartum period. Japanese Journal of Maternal Health, 56(4), 618-625.

"Opening Our Hearts" - HUG Your Baby's Outreach to Muslim Americans

HUG Your Baby honors the goodness in every person and strives to meet each new baby--and all those who serve expectant and young families--with an open and welcoming heart. At this time of national strain and division HUG Your Baby wishes to reach out to colleagues who might find themselves, or the families they serve, targets of anger and disrespect.

Belinda M.., a childbirth educator, was inspired by HUG Your Baby. She contacted me to say that she was grateful that "people who look like me" are included in the current edition of the HUG Your Baby video. Our conversation moved me to create a special opportunity for American Muslims who work as birth, lactation, and parenting professionals. 

HUG Your Baby is delighted to offer an 75% discount to qualified professionals taking HUG Your Baby online courses. Qualified professionals are: 1) Muslim Americans, who are 2) practicing doulas, nurses, early childhood educators, lactation specialists, or infant massage and childbirth educators, with 3) a desire to begin or complete HUG Your Baby training.

30 scholarships are available. To request this scholarship, please email Jan at jan@hugyourbaby.org  She will send you a brief application so that she can learn about your hopes for incorporating HUG Your Baby into your work with young families.




CAPPA Gets The HUG at their National Conference!


It was my pleasure to speak at the 2016 national CAPPA conference and to share HUG Your Baby with birth and parenting professionals committed to innovative, evidence-based care. What a joy to reconnect with colleagues I have known for years and to meet new professionals eager to learn a family-friendly approach to helping parents understand and bond with their newborn! After my presentation my exhibit table was a buzz with enthusiastic professionals wanting to further their HUG training and to access effective resources for their clients.

Here are the stats and feedback comments CAPPA sent me about the 2016 HUG presentation:


“Fabulous! Bring Jan to every conference!”

“Great information! I can’t wait to bring this all home and share with my co-workers and families.”

“Understandable, in-depth, lovely teaching manner.”


“My favorite speaker! Love her personality, her teaching techniques, and her expertise and knowledge on the subject!

Evaluation of HUG Your Baby's (Part I) Online Course

Feedback is now available from 296 professionals who recently completed the HUG Your Baby online course: Helping Parents Understand their Newborn. Here's what they have to say.










Can My Baby Really See?

The young father has come to all the childbirth classes and is determined to help his baby grow and develop as best he can. "But, he won't look at his rattle," the dad reports, as he quickly moves the toy back and forth in front of the baby's eyes. "On that film you showed us I saw a baby look at his rattle. So what's wrong with Eric?" Dad asks.

The nurse is delighted by the new father's interest and attention to his little one. She reminds Dad that though a baby can see up close almost as well as an adult, infant eyes move more slowly. So she steadies Dad's hand as he holds the rattle 10 inches from the baby's face. Together they move the rattle slowly as Eric attends to the toy. When the baby's eyes hesitate and drop off the rattle, she and Dad stop the movement. Then Eric's eyes seem to catch on again. Now Dad and the nurse inch the ball over a second time as Eric looks on.

The nurse also shows Dad how to vary the sound of the rattle to keep Eric's attention. Since babies have the ability to ignore repeating, overwhelming stimulation (habituation or the "Shutting Down" SOS), varying the cadence of the rattle keeps a baby interested. Eric likes what Dad is doing now.

In another few seconds Dad notices Eric start to get a bit red in the face; he also sees his son's breathing pick up. "That's one of those SOSs!," Dad exclaims. "I think he's done showing off right now." Dad cuddles Eric closely and speaks quietly into his ear. The baby's color returns to normal and his breathing slows down as he melts into his father's arms.

Babies do have remarkable abilities to see and can see their parent's face at birth! Research shows that at only four hours old, a baby can even pick her mother out of a lineup of women's photos! However, it is normal for babies to hesitate as they engage with and follow an object. Human faces are especially attractive to babies. They seem programmed to respond to the contrasting colors, curves, and movement of a parent's face.

Babies who are born early, or who are more fragile, may have normal vision but not yet be able to orient as fully to a toy or to Dad's face as Eric can. The nurse may notice that such a baby only gets still and quiet when a rattle is shaken. But she know that this, too, is normal. Watching for those SOSs, and giving extra support with swaddling, will help some babies orient easier. Surprisingly, some babies who are not yet able to look at a toy may simply lift their chin toward the object as proof that "I get it! I can't do it right now, but soon I will!"

The nurse loves to finish an encounter with a family by helping the parent experience a baby's attention to his parent's voice. The nurse holds the baby as Dad calls Eric's name. Dad is surprised and delighted to see the baby turn toward him and look him in the face. 

This young father is reassured to see how attending to the rate and rhythm of the "rattle game" and responding to his son's SOSs helps Eric pay attention to the wonderful world around him--and Dad feels even more connected to the newest member of his family.

© HUG Your Baby 2017

I LOVE, but do not LIKE, my Baby.

I was rather shocked by the perspective of the young mother referred by my colleague, Gale. "Gale thought you could help me out," the young woman explains.

Lizzie was Samantha and Sarah's second baby. She was healthy and full-term. Labor and delivery had gone well, breastfeeding was successful, and Samantha had two months of maternity leave. "What could be that wrong?" I wonder.

"She fusses all the time!" Samantha explains as she lays the baby on the exam table. "See, like now! Hear her making all those grumpy sounds! I love, but sometimes, do not like my baby."

Lizzie is a robust, wide-eyed six-week-old. She is very busy in her movements as she wiggles and squirms on the exam table. Her level of activity is a wonder to behold. She seems to wind up a second, then one arm shoots out to the side, both legs kick upward, and she arches her back. She is also very busy with her vocalizing—a grunt here, a groan there, or was that a coo? The activity and sounds coming from her cute little body are normal and even entertaining to me. But her activity level and vocalizing seem to be off-putting to her mothers, who thinks Lizzie is fussing all the time.

"See Jessie there," Sarah says as she points to her four-year-old daughter coloring peacefully on the floor at our feet. "She is so calm and easy to be around. When Samantha and I decided to have a family we promised each other that we would have a peaceful household! But Lizzie just keeps on fussing," Sarah remarks as she hands me her baby.

Samantha and Sarah are describing a temperament difference in their children. The work by Thomas and Chess in the mid and late 1950's was important in confirming what all grandmas know: babies are born different one from another! Some are quiet and laid back, while another is busy and rather demanding. One is predictable while another is a surprise every minute. And a parent's own temperament makes it easier to "hang" with one kind of child than another. Certainly issues in a parent's own upbringing also impact their ease (or not) with a certain style or temperament. If a parent misunderstands a child's temperament or intention, problems in the developing parent-child relationship can begin and escalate.

What an opportunity and a challenge this moment is! Can I help this mother see her second daughter through a different lens? As usual, when I feel challenged by a patient encounter, I focus on and begin to describe the behavior of the baby.  I demonstrate Lizzie's normal reflexes and get excited when she brings her hand to her mouth and begins to calm down. I pick up the end of my red stethoscope and engage the baby in a little game of following its movement with her eyes. Of course, I finish with the grand finale of having Samantha call out the baby's name. Lizzie hesitates only a moment before she turns toward her mother and—I believe she actually gives her a wink!

Samantha giggles and scoops up the baby from my arms as I discuss this high, but normal, level of activity and vocalizing. We talk about how each baby has a special temperament and style, right from birth. "Her body activity and enjoyment of vocalizing are part of Lizzie's inborn personality," I explain. Both Samantha and Sarah smile as Samantha gives Lizzie a hug. “I guess she’s just a real go-getter,” Sarah responds.

Lizzie is three years old now. Every time she and her family come to the clinic to see Gale, they stop by and say hello to me. "Lizzie's not really fussy anymore," Samantha explains. "But she's still a busy and noisy little gal!" Lizzie runs down the hall ahead of her mom, who laughs out loud as sister Jessie squeals in pursuit.

© HUG Your Baby 2017

Why Does My Baby Cry So Much?

“Ayesha doesn't like my breast milk!" the young mother declares. "I guess it's time for formula."

Ayesha was born two weeks early, after a long labor and an epidural. The baby's initial suck was a bit unorganized. In addition, her bilirubin was elevated, and she had jaundice for a couple of days. Though she ended up with a few bottles of formula in the hospital, the baby was breastfeeding at discharge.

But today the mother's words are a surprise to the nurse at the community clinic. Exclusively breast-fed, four-week-old Ayesha had regained her birth weight in just ten days and is now growing at an amazing, one ounce-per-day. The nurse sees the baby's cheeks filling out, and she is "filling" her diapers with gusto. Why is this mother thinking that her breastfeeding is going poorly?

"She just doesn't seem satisfied," Ayesha's mother explains. After a deep sigh, this young mother adds, “She seems to be crying much more now than she did last week.”

The young mother lifts Ayesha out of her car seat. Ayesha has a startle and moves quickly from the peaceful, Ready Zone, to crying intently. This mother pats her baby's head, jiggles her on her shoulder, stands up and walks around the room, and talks to her baby in an energetic (if somewhat anxious) voice. 

Research on breastfeeding demonstrate that this mother's feelings are common: Mothers often notice non-feeding behaviors and worry that these are signs of inadequate milk. In addition, mothers who cannot manage their infants' crying are less likely to continue breastfeeding and more likely to develop postpartum depression.  

The nurse remembers that babies born early increase their crying at just this age. She also considers that this baby has risk factors for Zone regulation issues, which could make her a baby who fusses more than many. Perhaps a stepwise approach to calming this baby will help Mother both settle the baby and appreciate her daughter's capabilities. 

"Let's see how your baby responds to your voice," the nurse remarks. "Many babies like that sing-song voice you were just using." 

With some encouragement the mother leans over the baby and repeats several times, "Hey little one! I see you are trying to calm down." The nurse then encourages the mother to bring the baby's arms to her chest while continuing that sing-song voice. Next the nurse shows mother how to sway the baby. Almost like magic, Ayesha takes a big breath and stops crying. 

The nurse describes the behavior she now witnesses. “Though Ayesha needs your help right now, she looks so content in your arms. When you talk to your baby her forehead relaxes, her eyes widen, and her eyebrows go up.” A moment later she goes on, “When you speak, Ayesha lifts her face toward yours and slows down her breathing.” 

At the end of her visit with this family, the nurse encourages the young mother to call her baby's name. When she hears her mother’s voice, the baby initially gets still; then her eyes shift up toward her mother. The mother is delighted to see her daughter's eyes “lock” in an endearing gaze. With a big grin Ayesha's mom lifts her from the nurse's hands and snuggles her face into the baby's soft head. One of the mother's hands go to her breast to suppress the unexpected let-down of milk. 



Three months later, Ayesha's mom is a breastfeeding star and a support for other new moms. One afternoon she comes to the nurse's breastfeeding class to discuss the challenges and joys of breastfeeding. Cuddling with her baby, she remarks, "Don't just count those pees and poops. Learn about the amazing abilities of your newborn, and you'll know for sure that your breastmilk is perfect!" 

© HUG Your Baby 2017

HUG Your Baby included in Nurse's PhD Project in Japan

Yasue Ota has just been awarded her PhD in Nursing from Juntendo University in Chiba. We are delighted that she incorporated HUG Your Baby into her PhD implementation project to enhance nurses’ ability to promote mother-infant bonding.

Background: Nurses can play an important role in facilitating mother-infant bonding during the early postnatal period. But often nurses do not meet this goal.  This researcher worked to develop a user-friendly, accessible, web-based training to enhance nurses’ ability to facilitate mother-infant bonding.

Methods: First, nurses and mother-baby dyads were observed. Next, semi-structured interviews with those nurses was conducted, a literature review was performed and the web-based  program was developed. The web-based program included: 1) Completion of HUG Your Baby’s Japanese online program (J. Tedder) to enhance nurses’ knowledge about infants’ behaviors; 2) training in effective communication skills and childrearing support to enhance mother-infant bonding and; 3) review of case studies to apply knowledge and skills to clinical practice. The ICE Model Theory (F. Young) and the Reflective Approach Model (G. Gibbs) were applied to the design of this educational program. The program was pilot-tested with ten midwives at a birth center.

Results: There was positive feedback from nurses about the course’s length, its interest and its level of difficulty.

Conclusion: This comprehensive educational programme for nurses has the potential to contribute to facilitating nurses’ responsiveness to infants and mother-infant bonding during the early postnatal period.


Publication: Yasue Ota, Mari Takahashi (2016). Nurses’ support to facilitate mother-infant attachment during the early postpartum period. Japanese Journal of Maternal Health, 56(4), 618-625.