Exploration of factors affecting parent-infant closeness and separation in hospitals in Nepal - a qualitative study

Closeness is crucial for the physical, emotional and social well-being of both parents and children. Although the benefits of closeness are proven for stable and unstable newborns, separation often remains standard, especially for small and/or sick newborns. We aimed to explore factors affecting the closeness and separation of parents and newborns in hospitals in Nepal.

A qualitative design was used. Data were collected by individual interviews with 10 health care workers from labor rooms, postnatal wards or sick newborn care units/neonatal intensive care units in five referral hospitals in Nepal. Data were analysed using an inductive thematic approach.

Three main themes were generated: (1) hospital resources, (2) in-hospital practices and attitudes, and (3) parental-newborn relationships and social factors. Keeping the newborns spatially close to their mothers, offering a comfortable environment, and privacy were thought to enhance closeness, while heavy workload and lack of workforce hampered efforts to enhance closeness. Routines and rules separated parents and newborns, while actions and attitudes among health care workers strengthened closeness. Parental involvement and the influence of various social aspects, such as education, cultural beliefs and gender discrimination, were discussed.

Although closeness was considered important, separation was common due to limited resources and existing rules and routines in the hospitals. Introducing small, low-cost changes in the wards, such as offering a comfortable place to sit, can help keep the parents close and lessen the workload for health care workers. To avoid separation, hospital rules and practices should be changed, and parents should be supported to take on the role of primary caregivers, with medical support from health care workers. There are traditions and cultural beliefs in society that hamper parental-infant closeness, and gender discrimination remains a problem.