Just half of the hospitals in Spain currently allow parents free access to neonatal units, thus depriving many premature babies of extensive physical contact with their parents. Forty-five percent of hospitals allow 24-hour access, while 23 percent of centers limit contact to five hours a day or fewer. The El Parto es Nuestro association (or, The Delivery is Ours), a non-profit group that works to improve pre- and post-natal treatment in Spain, is working to draw attention to these conditions, which fall short of Health Ministry and World Health Organisation guidelines.
"Progress has been made," explains Carmen Pallás, the head of the neonatal unit at Madrid's 12 de Octubre hospital, which is one of Spain's more progressive centers, and allows 24-hour access for new parents. "Six or seven years ago only 10 percent of neonatal units were fully open to parents."
When a hospital permits such skin-to-skin access, as well as allowing for breastfeeding and so-called kangaroo care, it receives the European Nidcap accreditation, something that just nine centers across Europe have. Madrid's 12 de Octubre hospital and Barcelona's Vall d'Hebron hospitals have secured this stamp.
There is work to be done in Spain, however, in particular with regard to private centers, where just 23 percent of clinics meet these requirements. Public centers are doing slightly better, with 33 percent meeting Nidcap's regulations. According to a study by El Parto es Nuestro, Aragon, Madrid, Catalonia and Andalusia are home to the most advanced centers in this regard.
We saved 6,000 euros on every premature child given this care"
Fortunately, the crisis in hospital funding has no impact on the implementation of systems like this. "It's quite the opposite," says Adolfo Gómez Papí, neonatologist at the Joan XXIII hospital in Tarragona. "Parents actually ask for premature babies to be discharged early, because they have got used to dealing with them - they've lost their fear, and have more confidence. We did an economic study on the issue and found that we saved 6,000 euros on every premature child that was given this kind of care," he says.
What's more, there is plenty of scientific evidence of the benefits of this kind of care. "This is no longer up for debate," says Gómez Papí. "Not only is it a question of profitability, but it is also good practice - it is the right thing to do. A friend of mine went to America in the 1980s and what caught his attention was the 'open-door policy' for the family to take care of their baby."
Dr Pallás agrees that this is simply a question of a change in mentality. She is aware that many of her colleagues are conflicted on the issue, given their belief that a physician's responsibility goes no further than simply healing a sick baby. "That is our goal, of course, but we also use kangaroo care so that the child's development continues, as if it were in the uterus, with the appropriate conditions with regard to light and noise," she explains. "The parental bond is a complex issue - it is not love, but rather what determines the survival of the species," she says.
Pallás says that there is no lack of institutional support in this case. The administration fully backs the adoption of these standards, and has even taught courses, presented lectures, and incorporated workshops for professionals wanting to know more about this type of childcare. Pallás understands, however, that these changes must come from those responsible for neonatal services. "Staff should get used to working closely with parents - not just treating them like visitors, but delegating a lot of the care to them. Skin-to-skin contact improves the quality of milk from the breastfeeding mother - which is vital for premature babies - and brings down stress and anxiety levels, so that the baby can maintain a consistent temperature and gain weight easily. Not to mention the analgesic effects: it has been proven that any procedure, such as inserting an IV line, hurts less when a mother is in direct contact with the child," explains Pallás.
Hospital staff should get used to delegating a lot of the care to parents"
Child psychiatrist Ibone Otza works at the Puerta del Hierro Hospital in Madrid, a center with the Initiative for the Humanization of Birth accreditation (BFHI). She explains that at this center, there are areas for parents "to take a nap or warm up food, as well as having access to a comfortable chair next to their babies." Sometimes parents rely on volunteers to care for their other children while they attend to newborns. "Many anxiety disorders in children who were born prematurely manifest themselves when they are aged between eight and 10 years of age, and are due to them being separated from their parents in the first few days of their lives," Olza explains.
This same state of restlessness can affect the parents of these premature children. "Eighteen months after these premature babies are born, about half of the parents experience PTSD, insomnia, and panic attacks," says the psychiatrist.
The European Charter for Children in Hospital, which was approved by the European Parliament in 1986, explicitly includes a child's right to be accompanied by their parents or the person who replaces them for as long as possible during their hospital stay - not as passive spectators but as active elements of hospital life. Little is gained from a mother or father's affectionate gaze from behind glass. A baby should be able to benefit from direct contact during its first days of life - it's an experience whose benefits go further than just skin deep.