The studies reported on in this thesis addressed the development of suckingpatterns in preterm newborns. Preterm infants often have problems learningto suckle at the breast or to drink from a bottle. It is unclear whether this isdue to their preterm birth or whether it is the consequence of neurologicaldamage. From the literature, as well as from daily practice, we know thatthere is much variation in the time and in the way children start suckingnormally. Factors such as birth weight and gestational age may indeed berisk factors but they do not explain the differences in development. A smallspot-check proved that most hospitals in the Netherlands start infants onoral feeding by 34 weeks’ post-menstrual age (pma). By and large the policyis aimed at getting the infant to rely on oral feeding entirely as soon aspossible. The underlying rationale is to reduce the stay in hospital, and theidea that prolonged tube-feeding delays or even hampers the development ofsucking.
Investing in parents is important because their well-being ispositively related to the development and well-being of theirchildren. This study investigated which factors predict twotypes of parents’ well-being: individual well-being and parenting-related well-being. Participants were 416 parents (90fathers, 326 mothers) of a baby (younger than age 1 yearold), both first-time parents and not-first-time parents.Relationship quality, life skills, parenting skills, and social supportwere taken into account. Results show that both types ofwell-being have different main predictors. Self-esteem, selfmanagement,and interpersonal relationship skills contributeto both types of well-being, suggesting that interventionsaimed at improving these skills could be very beneficial forparents in their transition to parenthood. Fathers and mothersdiffer significantly on several predictors—for example, selfesteem,self-management, parenting behavior, and empathy—suggesting they might have different needs for support inthe transition to parenthood. Finally, results show that, thoughparents get better at providing basic care for their children,regarding well-being and relationship quality, not-first-timeparents are not better off then first-time parents. Therefore,interventions aimed at easing the transition to parenthoodshould not only be aimed at first time parents, they might bemore effective for parents who already have children.
In most countries, maternal and newborn care is fragmented and focused on identification and treatment of pathology that affects only the minority of women and babies. Recently, a framework for quality maternal and newborn care was developed, which encourages a system-level shift to provide skilled care for all.This care includes preventive and supportive care that works to strengthen women’s capabilities and focuses on promotion of normal reproductive processes while ensuring access to emergency treatment when needed. Midwifery care is pivotal in this framework, which contains several elements that resonate with the main dimensions of primary care. Primary health care is the first level of contact with the health system where most of the population’s curative and preventive health needs can be fulfilled as close as possible to where people live and work. In this paper, we argue that midwifery as described in the framework requires the application of a primary care philosophy for all childbearing women and infants. Evaluation of the implementation of the framework should therefore include tools to monitor the performance of primary midwifery care.
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