INTRODUCTION:

Empowerment is widely acknowledged as a process by which those who have been disempowered are able to increase their self-efficacy, make life-enhancing decisions, and obtain control over resources [1, 2, 3]. In addition, empowerment is multi-dimensional – a woman may be empowered in one dimension or sphere (such as financial) but not in another (such as in sexual and reproductive decision-making). Most countries now recognize the importance for girls and women to become more empowered, both as a goal in it self, as well as to achieve a more gender equitable society [4].

More recently, researchers have been assessing the contexts and mechanisms by which empowerment directly or indirectly affects various aspects of women’s health [5, 6, 7]. A better understanding of the situations where greater empowerment is associated with improved health outcomes can assist policymakers in planning and prioritizing their investments.

Definition of maternal empowerment:

The WHO defined empowerment as a process through which people gain greater control over decisions and actions affecting their health [8]. Maternal empowerment is a valuable outcome, but also an important predictor of maternal and child health and increased health care utilization.

Purpose:

Maternal empowerment programme help the mothers of preterm infants as follows:

· It helps to reduce the negative feelings about the preterm infant and improve positive outcomes.

· It helps to reduce the level of stress among mothers of preterm infants.

· It promotes the wellbeing of mothers of preterm infants as well as the preterm infants.

· It improves the parenting confidence of mothers of preterm infants.

REASONS WHY THE BABY MIGHT BE SENT TO THE NICU:

[9, 10] Babies born early (less than 37 completed weeks) is the most common reason for a NICU admission. Premature babies aren’t quite physically and developmentally developed and are unable to transition to the outside environment as well as full-term babies. They can’t control their body temperature and often have excessive weight loss and unstable vital signs, which all affect long-term neurological outcome. These babies need to remain in a controlled, enclosed environment known as an isolate or incubator, which provides heat to keep a constant body temperature and mimics the uterine environment.

HYGIENIC CARE:

When the baby arrives, it’s important to be aware of hygiene and safety at home. All babies are at risk of infection due to their sensitive immune system but this especially true for premature babies. Because their immune systems might not be fully equipped to fight harmful germs, premature babies need and special care.

Here are 4 simple safety and hygiene practices for when the baby arrives.

1. Take care of own hygiene

2. Clean your baby’s toys regularly

3. Avoid too many visitors and public spaces

4. Keep the baby clean

1. Take care of own hygiene:

Anyone who has close contact with the baby should be vigilant about hygiene and should always wash their hands thoroughly before handling the baby. A premature baby hasn’t yet developed a mature immune system and dirty hands are an easy way for harmful germs to spread.

2. Clean the baby’s toys regularly:

When the baby is going through the phase of putting things in their mouth, it’s important to know how to thoroughly clean the baby’s toys to prevent germs from spreading, especially for a premature baby. Most toys can be kept clean by soaking in warm water and a little bit of soap.

3. Avoid too many visitors and public spaces:

Friends and family may be eager to meet the little one, but premature babies are extremely susceptible to germs and so might not quite be ready to be passed around. When it’s time for visitors, let them know what to expect by being clear on things like no smoking, colds and even not bringing their own toddlers during the early stages.

4. Keep the baby clean:

Last but definitely not least, it’s important to keep the baby clean. Use a warm, wet cloth to clean the baby’s face, neck, ears and nose. Remember, there’s no need to bathe the baby every day, especially with premature babies as their skin can be very sensitive. 2-3times a week is just fine.

In lots of ways, caring for a premature baby may not be so different than a term baby. Care giver has plenty of time to bond with new baby but it’s important to take special care where hygiene is concerned and to create safe and healthy environment for the baby to live and grow in.

HOLDING TECHNIQUES:

If the baby is very small or sick, care giver might not be able to hold him yet, but who can still touch him. Just like any baby, the premature baby needs the comfort of human touch. But touch can also over stimulate and stress a very tiny, fragile premature baby.

As the premature baby grows and gets stronger, care giver able to sing or talk while touch or hold him. Kangaroo care is simply holding premature baby in upright position, skin to skin on chest.

CUDDLING/KANGAROO CARE:

This refers to placing an infant in a vertical position on the naked chest. Mothers and fathers can both participate in skin to skin cuddling if desired. Infants may skin to skin cuddle for extended periods of the 24 hour day or periodically depending on parental visiting patterns. This gives the infant the opportunity to enjoy the stimuli of the breast and often facilitates increased milk supply. Maximum benefits of skin to skin cuddling occur after the baby and parents have been cuddling for more than 30 minutes.

· Assist mother/father with skin to skin cuddling

· Give gavage feed while parent is doing skin to skin cuddling

· Infant may start to move towards mother’s breast and nuzzle or lick the breast

· Infant criteria for skin to skin cuddling needs to be defined in each nursery

· Continue to encourage skin to skin cuddling in the home. Family members may assist.

FEEDING TECHNIQUES:

Breast feeding:

Breastfeeding is universally accepted as the best method of feeding term infants, and the nutritional and immunological superiority of breast milk is well documented in the literature. Short-term and long-term health benefits associated with feeding breast milk to preterm infants include:

· Reduced incidence of infections

· Reduced incidence of necrotizing enterocolitis

· Improved feeding tolerance

· Enhanced neurodevelopment

· Decreased number of hospital readmissions

· Enhanced family bonding, maternal involvement and interaction

· Enhanced maternal self-esteem and maternal role attainment

SUPPLEMENTARY FEEDING OPTIONS:

Indications for supplementation include:

· Separation of mother and infant.

· Infant requires medically prescribed supplement of expressed breast milk or requires formula.

· Ineffective milk transfer.

· As a temporary measure during transition to breastfeeding. Many infants may continue to require some supplemental feeding post discharge.

PREMATURE BABY CARE AT HOME [11]:

1. Discharge and arrival home:

Regardless of the reason, prematurity is a risk factor associated with certain health problems and, for that reason, premature neonates are hospitalized until they are able to suitably regulate their body temperature, feed correctly by sucking, and do not have episodes of apnea. Normally, discharge from hospital takes place between week 34 and40 of postmenstrual age, and with a weight of between 1800-2000g, also depending on the level of seriousness the patient has displayed. Once home, these children have a series of healthcare requirements and need close medical monitoring, particularly during their first 1-2 years of life.

2. Hygiene:

It is very important to always wash your hands with soap and water before picking up or handling newborns and you must pay special attention to the cleanliness of their clothes and room. It is not necessary to systematically use antiseptics. Contact with people should be avoided as this can transmit infections.

3. Environment:

Because preterm babies have less body fat, they should normally be wrapped up to regulate their temperature correctly. The temperature of the room should be between 21ºC and 24º. Their body temperature should be between 36.5ºC and 37ºC. If it is below the recommended minimum temperature, they consume calories to increase their temperature and gain less weight; if they have a constantly high temperature, they are at greater risk of sudden infant death syndrome.

4. Feeding:

The best way to feed newborn babies is with breast milk, as among many other advantages it helps fortify the immune system. Preterm babies need to eat very frequently (eight to ten times a day).

5. Vaccines:

These newborns must follow the official immunization schedule and receive vaccines according to their chronological age. The anti-flu vaccine is recommended for everyone in the family environment.

6. Sleep:

Newborns normally sleep between 16 and 18 hours a day and premature babies may sleep even more. They should be laid down on their backs (in the supine position) and there should be no toys or other objects in the crib.

7. Visits:

It is recommendable to limit visits, particularly at the beginning, and avoid contact with anyone with an infectious disease or cold.

8. Medical follow up:

Preterm newborns need specific medical monitoring, especially those with a birth weight of less than 1500 g. Their neurodevelopment should be periodically monitored. Extremely preterm babies, patients with neurological damage, or where warning signs are observed during follow up, should go to specific centers for early stimulation and multidisciplinary treatment from a physiotherapist, psychologist, speech therapist, and so on. Also, depending on their clinical evolution, they may require care from a pulmonologist, paediatric endocrinologist, cardiologist, gastroenterologist, and nutritionist or neuropaediatrician, among other specialists.

CONCLUSION:

Maternal empowerment gives an valuable outcome, but also an important predictor of maternal and child health which increased health care utilization. Maternal empowerment programme help to reduce the level of stress among mothers of preterm infants and promote the wellbeing of mothers of preterm infants as well as the preterm infants.

REFERENCE:

1. Kabeer N. Reflections on the measurement of women’s empowerment. In: Discussing Women’s Empowerment-Theory and Practice. Stockholm: Novum Grafiska AB; 2001.

2. Malhotra A, Schuler SR, Boender C. Measuring Women's Empowerment as a Variable in International Development. Washington: World Bank; 2002.

3. Sen G. Womens empowerment and human rights: the challenge to policy. In: Population -- the complex reality. A Report of the Population Summit of the World's Scientific Academies, edited by Francis Graham-Smith. London: Royal Society; 1994. p. 363–72.

4. Klugman J, Hanmer L, Twigg S, Hasan T, McCleary-Sills J, Santamaria J. Voice and agency: Empowering women and girls for shared prosperity. Washington: World Bank Publications; 2014.

5. Pratley P. Associations between quantitative measures of women's empowerment and access to care and health status for mothers and their children: A systematic review of evidence from the developing world. Soc Sci Med. 2016;169: 119–31.

6. James-Hawkins L, Peters C, VanderEnde K, Bardin L, Yount KM. Women's agency and its relationship to current contraceptive use in lower- and middle-income countries: A systematic review of the literature. Glob Public Health. 2016:1–16. doi:10.1080/ 17441692.2016.1239270. Epub ahead of print.

7. Ahmed S, Creanga AA, Gillespie DG, Tsui AO. Economic status, education and empowerment: implications for maternal health service utilization in developing countries. PLoS One. 2010;5(6): e11190.

8. Carlson GJ, Kordas K, Murray-Kolb LE. Associations between women's autonomy and child nutritional status: a review of the literature. Matern Child Nutr. 2015;11(4):452–482. doi: 10.1111/ mcn.12113.

9. Hou X, Ma N. The effect of women's decision-making power on maternal health services uptake: evidence from Pakistan. Health Policy Plan. 2013;28(2):176–184. doi: 10.1093/heapol/czs042.

10. Bloom SS, Wypij D, Das Gupta M. Dimensions of women's autonomy and the influence on maternal health care utilization in a north Indian city. Demography. 2001;38(1):67–78. doi: 10.1353/ dem.2001.0001.

11. Pratley P. Associations between quantitative measures of women's empowerment and access to care and health status for mothers and their children: a systematic review of evidence from the developing world. SocSci Med. 2016;169: 119–131. doi: 10.1016/ j.socscimed.2016.08.001.

Received on 08.10.2020 Modified on 14.11.2020

Int. J. of Advances in Nur. Management. 2021; 9(1):106-109.

DOI: 10.5958/2454-2652.2021.00028.7