The journey towards motherhood after a very preterm birth: Mothers' experiences in hospital and after home-coming

The experience of mothering a preterm: a prolonged crisis with the potential for personal growth

OBJECTIVE AND BACKGROUND

The nine months of pregnancy allow mothers to plan for the birth of their child practically and emotionally. A very preterm birth, which is generally unexpected and requires the infant's stay in the Neonatal Intensive Care Unit (NICU), is perceived as a crisis by most mothers. This study sought to investigate the significance for the mother of the combined experience of a very preterm birth and the infant's stay in the NICU two-three years after the birth.

METHODS

Using qualitative methodology, semi-structured in-depth interviews were conducted with 13 mothers (age 26-44) whose infants were born at 24-32 weeks. The analysis adopted the approach of multi-level listening to the diverse voices of the interviewees.

RESULTS

Four core themes emerged: negative feelings about the preterm birth; the NICU experience as a crisis; long-term effects of the very preterm birth and NICU experience; personal growth following the preterm birth and NICU.

DISCUSSION

In view of the findings, we discuss the meaning of the circumstances surrounding preterm birth on motherhood, and offer recommendations for practitioners.

Living with a birthmark: Phenomenology of prematurity for mothers in Turkey

BACKGROUND

Mothers of premature infants are in the risk group for having psychological symptoms and attachment-interaction difficulties. Preventing these maternal risks is essential for providing optimal care and health opportunities for infants, consequently improving developmental outcomes.

METHODS

In this study, we aimed to understand how mothers experienced prematurity within four processes retrospectively: (a) the mother's hospitalization after birth, (b) the infant's hospitalization in the Neonatal Intensive Care Unit (NICU), (c) after discharge, and (d) in early childhood. We adopted Max van Manen's phenomenology of practice and interviewed nine mothers whose children were born premature and reached early childhood.

FINDINGS

The themes were as follows: (a) incomplete mother; (b) facing prematurity, uncertainty, natural touch barrier, facing reductive social response, and NICU friendship; (c) being on the alert, a period of complete closure, and fighting with the reductive social response; (d) association to prematurity and (cannot) overcome the difficulties. We expressed the mothers' overall experiences through the metaphor "living with a birthmark." This metaphor represents the longitudinal effects of prematurity. As much as it is apparent and painful at first, it fades over time, and the pain lessens, but the effects of the birthmark remain in early childhood. The birthmark becomes a part of the mother-baby relationship.

CONCLUSIONS AND PRACTICE IMPLICATIONS

Our study contributes to premature infant care and health literature by highlighting the longitudinal experiences of mothers on prematurity.

Developing eHealth in neonatal care to enhance parents' self-management

BACKGROUND

Discharge from a neonatal care unit is often experienced as a vulnerable time for parents. By communicating through digital technology, it may be possible to improve the support for parents and thereby make the transition from hospital to home less stressful.

AIM

To develop an eHealth device supporting the transition from hospital to home for parents with a preterm-born child in Sweden using participatory design.

METHOD

Employing a framework of complex interventions in health care using participatory design. Parents of preterm-born infants and professionals at a neonatal department identified specific technical requirements for an eHealth device to be developed in the context of neonatal care and neonatal home care. The prospective end-users - parents and professionals - were continuously involved in the process of designing solution prototypes through meetings, verbal and written feedback, and interviews. The interviews were analysed using thematic analysis.

RESULTS

Technical development was carried out with the perspectives of professionals and parents in mind, resulting in an eHealth application for computer tablets. The findings from the interviews with the parents and professionals revealed three categories: The tablets felt secure, easy to use and sometimes replaced visits to hospital and at home.

CONCLUSION

The use of participatory design to develop an eHealth device to support a safe transition from hospital to home can benefit parents, the child, the family, and professionals in neonatal care.

Nurse Perceptions of Babywearing for Neonates With Neonatal Abstinence Syndrome in the Neonatal Intensive Care Unit

BACKGROUND

Infants diagnosed with neonatal abstinence syndrome (NAS) often spend several weeks in a neonatal intensive care unit (NICU) and have difficulty being consoled. Infant carriers may be used to help with irritability, while allowing the adult user to be more mobile, through the practice of babywearing (the facilitated holding of an infant using a soft cloth infant carrier worn on the body).

PURPOSE

To examine the experience of babywearing infants diagnosed with NAS while admitted in the NICU from the perspective of the nurses who care for them.

METHODS

Nurses (N = 18; mean age = 35.44 years, SD = 9.45) were recruited and interviewed using a semistructured interview method from a 38-bed NICU in the Southwestern United States.

RESULTS

A thematic content analyses using an open coding scheme yielded 6 themes that fell into 2 categories: (1) benefits of babywearing infants with NAS in the NICU (Infant Consoling, Adult Multitasking, Caregiver-Infant Trust); and (2) suggestions to maximize babywearing in the NICU (Infection Control, Reoccurring Infant Carrier Education, and Reduced Patient Load).

IMPLICATIONS FOR PRACTICE

Many NICUs incorporate kangaroo care (or skin-to-skin contact) as a treatment option; however, NICU staff cannot participate in kangaroo care. Babywearing is a practical alternative for nurses and support staff. Nurses supported the practice of babywearing as a means to improve the well-being of infants with NAS while also allowing for increased efficiency in nursing tasks.

IMPLICATIONS FOR RESEARCH

More prospective studies are needed that evaluate the carryover effects and long-term impact of babywearing for infants diagnosed with NAS.

"Babywearing" in the NICU: An Intervention for Infants With Neonatal Abstinence Syndrome

BACKGROUND

The US opioid epidemic has resulted in an increase of infants at risk for developing neonatal abstinence syndrome (NAS). Traditionally, treatment has consisted of pharmacological interventions to reduce symptoms of withdrawal. However, nonpharmacological interventions (eg, skin-to-skin contact, holding) can also be effective in managing the distress associated with NAS.

PURPOSE

The purpose of this study was to examine whether infant carrying or "babywearing" (ie, holding an infant on one's body using cloth) can reduce distress associated with NAS among infants and caregivers.

METHODS

Heart rate was measured in infants and adults (parents vs other adults) in a neonatal intensive care unit (NICU) pre- (no touching), mid- (20 minutes into being worn in a carrier), and post-babywearing (5 minutes later).

RESULTS

Using a 3-level hierarchical linear model at 3 time points (pre, mid, and post), we found that babywearing decreased infant and caregiver heart rates. Across a 30-minute period, heart rates of infants worn by parents decreased by 15 beats per minute (bpm) compared with 5.5 bpm for infants worn by an unfamiliar adult, and those of adults decreased by 7 bpm (parents) and nearly 3 bpm (unfamiliar adult).

IMPLICATIONS FOR PRACTICE

Results from this study suggest that babywearing is a noninvasive and accessible intervention that can provide comfort for infants diagnosed with NAS. Babywearing can be inexpensive, support parenting, and be done by nonparent caregivers (eg, nurses, volunteers).

IMPLICATIONS FOR RESEARCH

Close physical contact, by way of babywearing, may improve outcomes in infants with NAS in NICUs and possibly reduce the need for pharmacological treatment.See the video abstract for a digital summary of the study. VIDEO ABSTRACT AVAILABLE AT:.

A framework synthesis reviewing the impact of neonatal care unit admission on early caregiver-infant relationships

AIMS

To critically review and synthesize qualitative research pertaining to the establishment of early caregiver-infant relationships in the neonatal care unit (NCU).

BACKGROUND

It is well-established that bonding and attachment, established across the prenatal and early childhood periods, affect child cognitive and behavioural development. Proximity, reciprocity, and commitment are key to the formation of these early relationships. It is intuitively likely that an admission to the NCU may affect early reciprocal caregiver-infant relationships.

DESIGN

A qualitative best-fit framework synthesis.

DATA SOURCES

A systematic search of four databases (PsycINFO, MEDLINE, British Nursing Index and CINAHL) was conducted, from January 2000-December 2018.

REVIEW METHODS

The RATS quality appraisal tool was used to evaluate study quality. To ensure reliability, 20% of studies were randomly selected for independent rating. A "best-fit" synthesis approach using an existing framework of early parent-infant attachment and bonding was adopted to synthesize the review findings.

FINDINGS

Twenty studies, from an original 3,526 unique articles, were included in the review. Studies varied in the extent to which they demonstrated transparency of procedures and in the quality of recruitment information provided. The meta-synthesis demonstrated that proximity, reciprocity, and commitment were affected by admission to a NCU and identified that parental reflections on bonding and the role of staff in this process, were important factors to consider.

CONCLUSIONS

Caregiver-infant relationships are affected by admission to the NCU. The review theoretically supports moves to Family Integrated Care. Units should evaluate caregiver emotional state and consider the role of peer support.

IMPACT

The synthesis revealed that areas typically implicated in the formation of attachment and bonds were affected by admission to a NCU. Results have implications on the clinical care delivered as part of neonatal care.

Translation, Adaptation and Psychometric Validation of the Indonesian Version of the Readiness for Hospital Discharge Scale for Parents of Low Birth Weight Infants

PURPOSE

Parental readiness is a requirement for discharge of the high-risk infant from the hospital. Currently, in Indonesia, there are no standard tools to measure parental readiness according to parents' perceptions. This study aimed to undertake cross-cultural adaptation and psychometric validation of the original version (English) of the Readiness for Hospital Discharge Scale (RHDS)-Parent into Bahasa Indonesia.

DESIGN AND METHODS

The cross-cultural adaptation was comprised of seven steps: forward translation, forward translation review, blind-back translation, back translation review, pilot testing of the pre-final version with mothers of low birth weight (LBW) infants, expert panel for conceptual and content equivalence, and initial psychometric testing. In the fifth and sixth steps, content validity index was estimated. In the seventh step, exploratory factor analysis (EFA) and internal consistency reliability were conducted. In total, 146 mothers of LBW infants were included in the psychometric testing using convenience sampling.

RESULTS

The 22 item Bahasa-RHDS-Parent emerged in a four-factor structure evident from EFA. This version has good reliability with Cronbach alpha values for knowledge and coping ability (0.92), physical-emotional readiness (0.89), pain and power (0.83), expected support (0.80) and 0.90 across the total Bahasa-RHDS-Parent.

CONCLUSION

The Bahasa-RHDS-Parent presents good cross-cultural adaptation and initial psychometric properties for assessing parental readiness in parents with LBW infants before hospital discharge.

PRACTICE IMPLICATIONS

This questionnaire can be used by nurses to measure readiness for discharge of parents of low birthweight babies. Further testing is needed with a larger sample and parents of children of other ages and conditions for instrument improvement.

Maternal self-efficacy mediates the association between spousal support and stress among mothers of NICU hospitalized preterm babies

The mediating effect of maternal self-efficacy on the association between spousal support and stress, among mothers of hospitalized babies in the Neonatal Intensive Care Unit (NICU) is examined. Findings confirmed partial mediation effect implying that professionals may contribute to the reduction of stress levels among preterm mothers.

Improving Perinatal Care Through Theory Application

Theories from various perspectives can increase nurses' understanding of maternal behaviors throughout the developmental process of pregnancy and postpartum. The purpose of this article is to present relevant theories that maternity nurses will likely find useful, and to demonstrate their applicability through an unfolding exemplar case. Nurses can provide improved and more sensitive care when guided by psychosocial theories such as Rubin's tasks of pregnancy, prenatal attachment, pregnancy as a liminal phase, and the grief work in postpartum as proposed by Mercer. Use of relevant theories can promote holistic nursing care, increase critical thinking, and improve nursing responsiveness to unique family situations such as pregnancy after loss and premature birth.

Chinese Parents' Lived Experiences of having Preterm Infants in NICU: A Qualitative Study

PURPOSE

To explore Chinese parents' experiences and expectations of having preterm infants in a Chinese neonatal intensive care unit.

DESIGN AND METHODS

A qualitative descriptive design with semi-structured interviews was used to describe the experiences and expectations of parents of preterm infants in a neonatal intensive care unit in the central region of China. Purposive sampling was adopted to recruit parents (n = 15) of preterm infants and data were collected by face-to-face interviews from January to May 2018. Themes were identified by thematic analysis. This study followed the consolidated criteria for reporting qualitative research (COREQ).

RESULTS

Five themes emerged from the analysis: (1) mixed emotional experiences; (2) separation from the infants; (3) perceived incompetence in taking care of preterm infants; (4) obtained support through various sources; (5) desired more from healthcare professionals.

CONCLUSIONS

Parents experienced additional emotional burdens due to separation from their infants as well as a lack of an effective approach to their associated needs. While NICU staff adopted several strategies to help parents cope with their infant hospitalization, these parents still expected to receive more support from healthcare providers to meet their needs.

PRACTICE IMPLICATIONS

Healthcare providers should be more aware of parents' various needs in neonatal intensive care units and of their important role as constant caregivers. Hospital-based neonatal care should be specifically designed to supply positive support and necessary strategies for parents to strengthen their confidence in parenting infants.

Transitioning Into the Role of Mother Following the Birth of a Very Low-Birth-Weight Infant: A Grounded Theory Pilot Study

This qualitative grounded theory pilot study investigated the concerns and coping mechanisms of mothers of very low-birth-weight (VLBW; <1500 g) infants following discharge from the neonatal intensive care unit in Alberta, Canada. In-depth, semistructured, face-to-face, audio-recorded interviews were conducted with women of VLBW infants. Interviews lasting 75 to 90 minutes were transcribed verbatim and coded using grounded theory methodology. Data saturation and theoretical redundancy were achieved in interviews with 6 mothers of VLBW infants. The core variable of "reconstructing normal" emerged from the interview data. Women indicated that mothering a VLBW infant is an unfolding experience that is continuously being revised, creating a new sense of normal. The construct consists of 4 categories; mother-infant relationship, maternal development, maternal caregiving and role-reclaiming strategies, and infant developmental milestones. Findings from this study suggest that women found the transition into motherhood following the birth of a VLBW infant as a multidimensional and dynamic process. Further research is warranted to confirm these results and to further explore mothering issues with VLBW infants.

"Weathering the storm:" Mothers' and fathers' experiences of parenting a preterm infant

Parenting preterm infants is a unique experience distinct from parenting full-term infants, characterized by a delayed transition to parenthood and limited caregiving opportunities. This study explored mothers' and fathers' lived experiences of parenting during infancy in the context of preterm birth. Semistructured qualitative interviews were conducted with 13 parents (6 fathers, 7 mothers) of preterm infants. Data were analyzed using interpretative phenomenological analysis. Four superordinate themes emerged: (a) An unnatural disaster: The traumatic nature of preterm birth, (b) The immediate aftermath: Disconnected and displaced, (c) Breaking the ice: Moving from frozen to melted, and (d) Aftershocks: Transitioning home. Both parents experienced preterm birth as traumatic. Similarities and differences in mothers' and fathers' experiences were identified. Preterm birth posed challenges for nurturant and social caregiving and resulted in anxiety, hypervigilance, and overprotective parenting behavior. The results highlight the need for trauma-informed care and further research developing and testing empirically based interventions.

Experiences of Mothers of Extremely Preterm Infants after Hospital Discharge

PURPOSE

The purpose of this study was to describe and understand the experiences of mothers of extremely preterm infants during the first twelve months at home following discharge from a neonatal intensive care unit.

DESIGN AND METHODS

A qualitative, interpretative approach using Gadamer's philosophical hermeneutics was carried out. One focus group and fifteen in-depth, semi-structured interviews were conducted twelve months after hospital discharge. Responses were recorded, transcribed and analyzed using computer-assisted qualitative data analysis.

RESULTS

The study´s participants were twenty women. The following themes emerged from the data analysis: 1) 'The journey home: the discharge process', which included the sub-themes 'escaping the hospital environment: between desire and fear' and 'preparing parents for hospital discharge: practice and formal support'; and 2) 'The difficulty of living with an extremely preterm infant', including the sub-themes 'the challenge of an unexpected form of childcare', 'overprotection of and bond with a child with special needs' and 'disturbance in the social/familiar setting: when a mother becomes a nurse'.

CONCLUSIONS

The process of hospital discharge and the first months at home are difficult. The birth and care of an extremely preterm infant affect the mothers' quality of life as well as their family and social life. Practice and early discharge programmes can make the discharge process easier.

PRACTICE IMPLICATIONS

The knowledge and understanding of the experience of mothers of extremely preterm infants in the first months at home after hospital discharge could help healthcare professionals to develop educational strategies and counselling interventions in accordance with the mothers' needs.

Mothers' experiences after coming home from the hospital with a moderately to late preterm infant - a qualitative study

BACKGROUND

Mothers of preterm infants are at greater risk of symptoms of stress and anxiety compared to mothers of term infants.

AIMS

This study aimed to explore mothers' experiences after coming home from the hospital with a moderately to late preterm infant.

METHODS

A qualitative and explorative method was used. Ten mothers who had given birth to a preterm baby with a gestational age between 30.0 and 36.0 were interviewed. The interviews were conducted two to three months after the mothers and their babies were discharged from hospital. The data were analysed by means of latent and manifest qualitative content analysis.

FINDINGS

One overall theme emerged from the analysis: 'Seeing the light at the end of the tunnel' and four categories were identified 'Finding a safe haven at home', 'Gaining support and learning to ensure optimal feeding', 'Seeing the child's possibilities' and 'Receiving professional attention and reassurance'. In particular, adequate breastfeeding guidance and help with practical tasks at home were emphasised as important for the mothers, and need to be incorporated into the practice of public health nurses.

CONCLUSIONS

Practical help and support from close people, combined with individual professional follow-up, were important for the mothers' ability to cope with the hospital-to-home transition. There should be a strong focus on breastfeeding guidance as the mothers experienced problems for several months after discharge, and felt they were missing out on breastfeeding guidance given to term babies in hospital.

Posttraumatic Stress in Mothers While Their Preterm Infants Are in the Newborn Intensive Care Unit: A Mixed Research Synthesis

In this mixed research synthesis on posttraumatic stress in mothers related to their preterm infants' stay in the newborn intensive care unit (NICU), we synthesized and integrated a total of 37 studies, 25 of which were quantitative and 12 were qualitative studies. The prevalence rates of NICU mothers with elevated posttraumatic stress symptoms ranged from 18% in the United States to 81% in Turkey. Nine of the 12 studies testing interventions to decrease mothers' stress related to their NICU experiences reported significant results. Content analysis of the qualitative studies' findings revealed 5 themes: stark contrast to images of joyous motherhood, cultural overlay, issues of ownership and control, support, and learning to be a NICU mother.

Parents' experiences of neonatal transfer. A meta-study of qualitative research 2000-2017

Transfers of critically ill neonates are frequent phenomena. Even though parents' participation is regarded as crucial in neonatal care, a transfer often means that parents and neonates are separated. A systematic review of the parents' experiences of neonatal transfer is lacking. This paper describes a meta-study addressing qualitative research about parents' experiences of neonatal transfer. Through deconstruction and reflections of theories, methods, and empirical data, the aim was to achieve a deeper understanding of theoretical, empirical, contextual, historical, and methodological issues of qualitative studies concerning parents' experiences of neonatal transfer over the course of this meta-study (2000-2017). Meta-theory and meta-method analyses showed that caring, transition, and family-centered care were main theoretical frames applied and that interviewing with a small number of participants was the preferred data collection method. The meta-data-analysis showed that transfer was a scary, unfamiliar, and threatening experience for the parents; they were losing familiar context, were separated from their neonate, and could feel their parenthood disrupted. We identified 'wavering and wandering' as a metaphoric representation of the parents' experiences. The findings add knowledge about meta-study as an approach for comprehensive qualitative research and point at the value of meta-theory and meta-method analyses.

"You Can Only Give Warmth to Your Baby When It's Too Late": Parents' Bonding With Their Extremely Preterm and Dying Child

This study on end-of-life decisions in extremely preterm babies shows that the parents under study experience a multitude of stressors due to the immediate separation after birth, the alienating setting of the neonatal intensive care unit (NICU), the physical distance to the child, medical uncertainties, and upcoming decisions. Even though they are considered to be parents (assigned parenthood), they cannot act as primary caregivers. Instead, they depend on professional instructions for access and care. Embodied parenthood can be experienced only at the end-of-life, that is, during the dying trajectory and after the child's death. Professionally supporting parents during this compressed process (from assigned and distant to embodied parenthood) contributes fundamentally to their perception of being a family and supports their mourning. This calls for the further establishment of palliative and bereavement care concepts in neonatology.

Bonding in neonatal intensive care units: Experiences of extremely preterm infants' mothers

BACKGROUND

The birth of an extremely preterm infant can disrupt normal mother-infant physical contact and the care provided by the mother. This situation has an impact on the process of bonding between the mother and the child.

AIM

The objective of this study was to describe and understand the experiences of mothers who have extremely preterm infants admitted in Neonatal Intensive Care Units with regard to their bonding process.

METHODS

An interpretive, qualitative research methodology using Gadamer's philosophical hermeneutics was carried out. A focus group and eleven in-depth, semi-structured interviews were conducted. Data were collected between June and September of 2016.

FINDINGS

Sixteen women with a mean age of 34.4 years participated in the study. Two themes emerged from the data analysis: (1) premature labour and technological environment, a distorted motherhood, with the subthemes 'feeling of emptiness and emotional crisis' and 'the complexity of the environment and care generate an emotional swing'; (2) learning to be the mother of an extremely preterm infant, with the subthemes "the difficulty of relating to a stranger" and 'forming the bond in spite of difficulties'.

CONCLUSIONS

The bonding with extremely preterm infants is interrupted after giving birth. The maternal emotional state and the environment of the neonatal intensive care unit limit its development. Nursing care can facilitate mother-infant bonding by encouraging communication, participation in care, massaging or breastfeeding.

Perceptions of Parents With Preterm Infants Hospitalized in Singaporean Neonatal Intensive Care Unit

Perceptions of parents with preterm infants who were hospitalized in a Singapore-based neonatal intensive care unit were observed. Convenience sampling method was used to recruit 8 parents of preterm infants. Semistructured face-to-face in-depth interviews were used to collect data between November 2013 and February 2014. Data were analyzed using thematic analysis. Four themes were identified: "negative emotions versus positive emotions," "finding ways forward," "nature of support received from various sources," and "need more informational and professional support." Parents of preterm infants experienced a multitude of emotions that varied from shock and sadness to excitement and anticipation through their babies' birth, hospitalization, and impending discharge. These parents adopted several strategies to cope with their birth and subsequent infant hospitalization. While their neonatal intensive care unit (NICU) experience was perceived as positive for most parents, some suggestions were made to improve on the information provided and professional care. This study provides evidence to health care professionals in addressing parents' negative emotions and coping abilities in practice. Emotional and informational support for parents is important for them to be more competent in coping with the hospitalization of their newborn in the NICU.

'I still have difficulties feeling like a mother': The transition to motherhood of preterm infants mothers

OBJECTIVE

The premature birth of their infant can constitute a sudden interruption of the transition to motherhood that requires a reorganisation of the process. The present study aimed to analyse the experience of the transition to motherhood of preterm infants' mothers, framing it within Stern's transition to motherhood theory.

METHOD

A semi-structured interview was administered to 30 mothers during the recovery of the infant in the Neonatal Intensive Care Unit. The interview explored the experience of mothers related to pregnancy, the infant's birth and recovery.

RESULTS

Thematic Analyses evidenced four interrelated themes: disconnection from the child, perception of maternal inadequacy, loss of parental role and temporal suspension. The themes showed that the mothers' experience of preterm birth not only concerns the traumatic delivery, but is also embedded in the entire process of becoming a mother within an institutional context.

CONCLUSIONS

Results were connected to Stern's theory. Findings revealed difficulties for preterm mothers that could affect the development of the maternal constellation and thus their transition to motherhood. These difficulties may influence the construction of maternal identity, mother's representation of their child and the bond with their child.