What does ZERO SEPARATION mean? And what does it mean specifically to you?
Zero Separation means that parents and especially the mother is not separated from her child/children, even not when the baby is born preterm or sick and needs intensive care. Most hospitals are not build to ensure a zero separation policy. The NICUs are too small and there is no space that parents can stay longer, especially not over night. During the last centuries NICUs were build without space for an extra bed for the mother, no bathrooms or providing food and drinks for them when they want to see their baby. That makes it difficult for parents to stay over night or even stay there for a longer time perios. Zero separation is therefore in most hospitals not possible because parents can simply not stay 24/7 with their sick or preterm baby. Generally means zero separation that parents have always access to their baby and are welcomed whenever they come and want to be with their baby. The unit should have a welcoming policy which implicates that parents are not visitors, parents are the main caregiver of their child – even when the child needs to stay in a NICU for a long time. 27 years ago, when my twins were born preterm, we had only visiting hours and permission was needed to see or touch our children. We never felt like parents until Lukas came home and nobody told us anymore what was allowed or not. Therefore, it is for me extremly important to share not only my experience but showing evidence that separation is toxic and influences the outcome of children and their parents.
Why do you believe a premature newborn should be kept as close to their mother as possible?
To keep preterm, sick or term born babies to their mothers is natural but mainly it is in the meanwhile evidence proven that immidiate skin-to-skin care supports bonding, reduces the risk of mortality and morbidity, reduces sepsis and improves breastfeeding which reduces necrotising enterocolitis. We, the parents believed this already long-time ago but it was needed to show the medical evidence that zero separation and imidiate and long-time skin-to-skin care has a huge influence of the outcome of preterm infants. World Health Organisation has published research data and also recommendation where they recommend minimum 8 hours per day skin-to-skin care as well as imidiate skin-to-skin care and involvment of parents as main caregiver. Now it is important to implement this recommendations worldwide.
How do individual European countries fare in terms of implementing ZERO SEPARATION policies?
As mentioned before, most NICUs are not build to be able to provide a real zero separation policy, but in many hospitals parents are welcomed during the opening hours of the hospital. Parents are still seen as visitors and therefore treated as visitors and can only come when hospitals are open. Many hospitals, especially in East and South Europe have visiting timelsots per day where visitors can enter. As long as parents are seen as visitors, the understanding of the role of parents will not change. However, we see also the trend that since our European Standards of Care for Newborn Health were published, hospital architects double check what a NICU really needs, like how many square meters per patient to ensure a bed or a big comfortable chair is possible per patient or, is there a room to eat or have bathrooms for parents. Even in some hospitals they provide space for siblings or a room for all parents to exchange. It is a long time where parents stay with their baby in a NICU and therefore it is important to think on all the needs they have as well.
Is there a frontrunner where premature newborns are truly not separated from their mothers?
There are some best practise examples across Europe. In the nordic countries the social system is also better that parents have longer maternaty and parental leave to be able to stay with their child and the hospitals have started to welcome parents of sick and preterm babies already end of the last century. The hospitals provide space, even when the building is old and not prepared for such a wlcoming policy. The staff are all trained and involve actively the parents in the care of their baby. But it took also time to change the bahavior in those counties. We have really good but individual examples in many European countries. That means that there are light houses who have started and others critisised them a lot. It is not easy to start in countries where others still have visition hours to open your own NICU 24/7 for parents. There is often not enough space, like in a brand new family friendly NICU but it is often not the space which makes the difference, it is the warm welcoming and inegrating the parents in the care of their baby. It is the mind change, which is often the most difficult part of the change.
And do we know who the hypothetical losers are? In which European countries, according to your information, is it the worst, and premature babies are heavily separated from parents?
Well, it is difficult to name whole countries because most of the countries have light house hospitals who really practise a welcoming policy but are lacking of space that parents can really stay over night with their baby. Often it happens that hospital administration regulations alow only 8 hours visiting hours and hospital administration is not willing to open the doors for parents – the responsiblity for restrictions are often not in the hands of NICU staff. We have hospitals in Western Europe as well as in Eastern or Southern Europe who welcome parents 24/7 and try their best to actively involve parents in the care of their child, even when they cannot stay over night because of lacking space.
In your opinion, what is the ideal future for neonatology regarding the staying of tiny babies with their mothers?
The ideal future would be that all neonatal staff has a standard education and training across Europe which trains doctors and nurses as well as midwifes on the need of zero separation and parents involvment from the beginning. The European School of Neonotology from the European Society of Pediatric Research comes out soon with such a master program. EFCNI was actively involved in the curicula and all participants have to attend a training on infant and family centered developmental care. We hope that this will give the next generation a chance to understand from the beginning of their education that parents need to be actively involved in the care of their infant and separation is toxic. It is important that architects who build NICUs but also medical directors of hospitals understand that new pland for a hospials or re-building of a NICU needs space for both, the baby and the parents and that this concept is improving the outcome of the child and therefore reduce long-term burden for the child, the family and finally the whole society, which should be the interest of decision makers and payers.
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