NPA Position Statements

A Consensus Statement on Family-Presence in NICUs published with the National Association of Neonatal Nurses (NANN) and the Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN)

Today, neonatal intensive care unit (NICU) staff are challenged with ever-changing and extraordinary conditions while they navigate a global pandemic. Evidence-based practice guidelines for the provision of care during a pandemic simply do not exist. Instead, NICU staff and leaders must balance the risks and benefits of specific policies, such as visitation guidelines, with respect to the holistic needs of the family. The National Association of Neonatal Nurses (NANN), the National Perinatal Association (NPA), and the Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN) continue to support and emphasize adoption of a shared decision-making model for family presence.

A joint position statement published with the National Association of Neonatal Nurses (NANN).

The National Association of Neonatal Nurses (NANN) and the National Perinatal Association (NPA) fully support the incorporation of a shared-decision model between the mother and the clinical team to determine the best care for the mother/newborn dyad. NANN and NPA encourage the ideal scenario, which is to keep mother and newborn together while respecting the unique challenges individual institutions may encounter. While we recognize the myriad uncertainties in understanding the best evidence-based practice for the mother/newborn dyad during the postpartum period, we encourage families and clinicians to remain diligent in learning up-to-date evidence and ultimately working in partnership for the safest and best practice for all parties involved. NANN and NPA acknowledge the potential trauma and exacerbation of postpartum mental health issues that may negatively impact the fourth trimester. We encourage healthcare providers to assist the mother to recognize the ideal versus realistic scenarios, acknowledge the uncertainty and grief over changing expectations, and consider higher-touch care in the weeks following delivery.

See these resources that accompany our position statement.

The National Perinatal Association is committed to integrating diverse voices, educating providers and patients, and advocating for policy changes that will advance the national discussion on perinatal health care access and disparities. Public health priorities can only be addressed and resolved when all stakeholders are brought together. The goal should be to not only include providers, families, and family advocates but to also bring national policy makers to the table.

NPA supports de-stigmatization of perinatal mental health complications by providing education and awareness on the issue. A healthy society includes a focus on addressing the mental health needs of parents, their children, and their communities.

Members of the National Perinatal Association and other organizations have collaborated to identify principles to guide the care of women, their families, and the staff, in the event of the loss of a pregnancy at any gestational age in the Emergency Department (ED). Recommendations for ED health care providers are included. Administrative support for policies in the ED is essential to ensure the delivery of family-centered, culturally sensitive practices when a pregnancy ends.

NPA supports the use of a qualified midwife for prenatal, intrapartum, and postnatal care of the healthy childbearing woman. A qualified midwife is someone who has completed a nationally accredited midwifery education program with a curriculum of evidence-based theory integrated with practice.

While the perinatal period presents unique risks for those who are substance dependent and their babies, it is also a time when there are unique opportunities for positive intervention. As clinicians, mental health, and community health care providers, it is imperative that we understand the nature of perinatal substance use disorders and provide interventions and care that preserve the parent-infant dyad, promote parenting potential, and support the baby’s health and development.

Research indicates that intimate partner violence is a significant source of ill-health and injury for women. Women who are abused by an intimate partner or family member are more likely to experience unintended pregnancy, delay entry into prenatal care, and experience poor pregnancy outcomes. They are more likely to manifest perinatal mood and anxiety disorders (PMADs) and post-traumatic stress, have higher rates of STDs including HIV, and are at greater risk for problematic substance use. Additionally, the co-occurrence of intimate partner violence and child abuse is estimated to range from 30-60%, adding further danger to the postnatal period.Of great concern is that intimate partner violence during pregnancy is quite common. In fact, research suggests that intimate partner violence impacts pregnancy more often than any other physiological complication of pregnancy.

The National Perinatal Association advocates the position that greater public awareness and professional transparency should assist prospective parents in making informed decisions regarding their potential choices in seeking ART as well as their options involving adoption of the many infants already born who are in need of loving parents.

Studies are urgently needed regarding every aspect of ART, including neurodevelopment outcomes, school performance, and differences in the incidence and onset of adult diseases when conceived using ART versus naturally. As with other technologies that may impact the human genome through epigenetic modification, continued research into the influences of emerging technologies on the health and well being of the infants born should be a national priority.

Postpartum depression is more common in both new fathers and mothers than in the general public, but is often unidentified in fathers. NPA recommends increased awareness of this issue, scheduled screening and appropriate follow up of fathers, as well as mothers, in the first year postpartum year.

As an organization built to align multidisciplinary decision-making, collaborative problem-solving and innovative teaching, NPA recognizes the need for interdisciplinary discussion, reflective planning, and disclosure of transparent and viable options when pursing ongoing healthcare reform. NPA promotes the rights of vulnerable pregnant women, children and families to receive quality healthcare services regardless of socioeconomic status.

The NPA wishes to confirm the value of palliative care and hospice for affected parents and their children, from prenatal diagnosis through childhood. Bereavement support for the family is an essential component of any loss. The NPA wishes to ensure that all children and their families receive culturally competent care at the end of life.

NPA supports comprehensive drug treatment programs for pregnant women that are family- centered and work to keep mothers and children together whenever possible. The most successful treatment models will include access to quality prenatal and primary medical care, child development services, crisis intervention, drug counseling, family planning, family support services, life skills training, mental health services, parent training, pharmacological services, relapse strategies, self-help groups, stress management, and vocational training. 

The National Perinatal Association (NPA) opposes legislation defining fetal personhood at conception. The time when a fetus becomes a person should be left for medical experts and patients. The NPA encourages its members to oppose any legislation defining fetal personhood at conception and encourages its members to support legislators in favor of leaving this discussion to the medical sphere.

© 2020 National Perinatal Association
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