Clinical Studies
Improving Interactions Between Substance-Abusing Mothers and Their Substance-Exposed Newborns

https://doi.org/10.1111/j.1552-6909.1998.tb02648.xGet rights and content

Objective:

To determine whether teaching comforting and interacting techniques within 24 hours of delivery to substance-abusing mothers will improve mother-infant interactions 48-72 hours after discharge.

Design:

An experimental three-group, random assignment, pretest-posttest design.

Setting:

Mothers attending a clinic serving a mostly indigent population.

Participants:

Eighty-three women whose urine was positive for drug use were invited to participate. Sixty mother-newborn couplets completed the study.

Interventions:

Two observers, blind to the mothers’ drug history, completed the Nursing Child Assessment Feeding Scale (NCAFS) of all participants within 24 hours of delivery. Mothers in the experimental group were given the intervention. The observers completed the NCAFS in the mothers’ homes 48-72 hours after discharge.

Results:

At the home visit, couplets in the treatment group showed significant improvement in their total NCAFS score (F = 5.18; p = .008). When analyzed separately, only maternal scores showed a significant difference between the treatment and control groups at the home visit (F = 6.48; p = .0029).

Conclusions:

Nurses, by demonstrating caregiving behavior, can help mothers recognize and respond to newborns’ behavioral cues, thus enhancing mother-newborn interactions.

Section snippets

Purpose

The purpose of the current study was to determine whether teaching comforting and interacting techniques within 24 hours of delivery to substance-abusing mothers would improve mother-newborn interactions 48-72 hours after hospital discharge, as measured by the Nursing Child Assessment Feeding Scale (NCAFS).

Literature Review

Griffith (1988) found that many mothers who use cocaine experience guilt concerning the damage that their habit may have done to their infants. Some such mothers doubt their ability to cope with and meet the demands of their infants. When these insecure mothers are paired with irritable, easily overloaded, and unresponsive infants, the mothers often interpret the infants’ attempt to shut out external stimulation as personal rejection and blame the infants for rejecting them. This situation

Design

This study used intervention, control, and comparison groups in a pretest/posttest design.

Setting

The study was conducted in a 550-bed inner-city private hospital that serves a mostly indigent clinic population in northwest Ohio with approximately 1,800 deliveries each year. The target population was mothers attending the hospital’s prenatal clinic.

Participants

Three groups (intervention, control, and comparison), each containing 20 participants, 10 first-time mothers, and 10 mothers with more than one child, were

Maternal Characteristics

Almost one third of the women reported using THC only. More than two thirds of the women reported using a combination of drugs (i.e., alcohol with THC, cocaine, or both). Eight of the 40 participants (20%) in the intervention and control groups who initially reported they had not used drugs tested positive for cocaine and/or THC.

Newborn Characteristics

A one-way analysis of variance (ANOVA) indicated a difference in gestational age among the groups (F = 11.57, p = .0001). Post hoc comparisons using the Tukey-HSD

Discussion

Marijuana (THC) was the drug most frequently used by mothers in the current study. These results are consistent with the 1990 National Institute on Drug Abuse Household Survey on drug abuse that found THC to be the most preferred drug, with cocaine being second. Other researchers have reported that women who use cocaine are likely to use other substances, such as alcohol and THC (Bergin et al., 1996, Bresnahan et al., 1991; Keith et al., 1989). Four mothers who tested positive for THC at

Summary

Teaching and demonstrating caregiving behavior was effective in helping substance-abusing mothers comfort their newborns, recognize their newborns’ cues, and develop ways to respond appropriately to their newborns’ needs during the early postpartum period. However, when mother and newborn behavior were considered separately, only maternal scores showed an improvement. Newborn scores showed the same direction of effect, but did not differ significantly. A comparison group was used to establish

REFERENCES (24)

  • I.J. Chasnoff

    Drug use in pregnancy: Parameters of risk

    Pediatric Clinics of North America

    (1988)
  • L.M. Barabach et al.

    Maternal perception and parent-infant interaction of vulnerable cocaine-exposed couplets

    Journal of Perinatal and Neonatal Nursing

    (1992)
  • K.E. Barnard

    Nursing child assessment feeding scale

  • T. Brazelton

    Behavioral assessment on the premature infant: Uses in intervention

  • T. Brazelton et al.

    The earliest relationship

    (1990)
  • K. Bresnahan et al.

    Prenatal cocaine use: Impact on infants and mothers

    Pediatric Nursing

    (1991)
  • C. Bergin et al.

    Behavior of drug-exposed infants and maternal perceptions of stress. Paper presented at the conference of the World Association of Infant Mental Health

    (1996, July)
  • I.J. Chasnoff

    Adoption of drug exposed infants and children

    Perinatal Addiction Research and Education Update

    (1992)
  • I.J. Chasnoff

    August). Cocaine, pregnancy, and the growing child

    Current Problems in Pediatrics

    (1992)
  • G.M. Chisum

    Nursing interventions with the antepartum substance abuser

    Journal of Perinatal and Neonatal Nursing

    (1990)
  • M. Chouteau et al.

    The effect of cocaine abuse on birth weight and gestational age

    Obstetrics and Gynecology

    (1988)
  • L. Cordero et al.

    Effects of maternal cocaine abuse on perinatal and infant outcome

    Ohio Medicine

    (1990, May)
  • Cited by (20)

    • Developments in Nursing Practice to Address Substance Use in the Perinatal Period

      2022, JOGNN - Journal of Obstetric, Gynecologic, and Neonatal Nursing
      Citation Excerpt :

      Additionally, many people with SUD are distrustful of health care providers and often experience unstable housing or homelessness, which makes it challenging to retain these participants in research studies (Western et al., 2016). The earliest research conducted by nurses focused on studying the effect of interventions developed to promote attachment between mothers with SUD and infants (Donaldson, 1991; French et al., 1998). Several research teams reported judgmental attitudes among nurses toward mothers who used substances and a lack of knowledge by nurses (Gerace et al., 1995; Selleck & Redding, 1998) and nurse-midwives (Corse et al., 1995).

    View all citing articles on Scopus
    View full text