Mothering Work and Perinatal Transfer: An Institutional Ethnographic Investigation

Managerial thinking in neonatal care: a qualitative study of place of care decision-making for preterm babies born at 27-31 weeks gestation in England

OBJECTIVES

Preterm babies born between 27 and 31 weeks of gestation in England are usually born and cared for in either a neonatal intensive care unit or a local neonatal unit-with such units forming part of Operational Delivery Networks. As part of a national project seeking to optimise service delivery for this group of babies (OPTI-PREM), we undertook qualitative research to better understand how decisions about place of birth and care are made and operationalised.

DESIGN

Qualitative analysis of ethnographic observation data in neonatal units and semi-structured interviews with neonatal staff.

SETTING

Six neonatal units across two neonatal networks in England. Two were neonatal intensive care units and four were local neonatal units.

PARTICIPANTS

Clinical staff (n=15) working in neonatal units, and people present in neonatal units during periods of observation.

RESULTS

In the context of real-world neonatal practice, with multiple (and rapidly-evolving) uncertainties relating to mothers, babies and unit/network capacity, 'best place of care' protocols were only one element of much more complex decision-making processes. Staff often made judgements from a less-than-ideal starting point, and were forced to respond to evolving clinical and organisational factors. In particular, we report that managerial considerations relating to demand and capacity organised decision-making; demand and capacity management was time-consuming and generated various pressures on families, and tensions between staff.

CONCLUSIONS

Researchers and policymakers should take account of the organisational context within which place of care decisions are made. The dominance of demand and capacity management considerations is likely to limit the impact of other improvement interventions, such as initiatives to integrate families into the neonatal care provision. Demand and capacity management is an important element of neonatal care that may be overlooked, but significantly organises how care is delivered.

Mothering sweetness mixed with the bitterness of death: the lived mothering experience of near-miss mothers

PURPOSE

Maternal near miss (MNM) refers to women who survive death as a result of life-threatening obstetric complications or organ system dysfunction during pregnancy, childbirth or postpartum. The aim of the present study was to gain an understanding of mothering experiences in survivors 'mothers due maternal near miss event.

MATERIALS AND METHODS

Heideggerian hermeneutic phenomenology guided this qualitative study. The study was conducted 1 June and 30 December 2019. The sampling was purposeful with maximum variation of 11 near miss mother that used unstructured face-to-face interview for data collection. Data analyzed using Diekelmann, Allen, and Tanner seven stage thematic analysis approach.

FINDINGS

Emergent theme was "mothering sweetness mixed with the bitterness of death." The two themes constituting the essence was: "An Angel with Broken Wings" and "Mothering in the Shadow of Death." The subthemes comprised five sub-sub themes which emerged from over 850 meaning units. Data were analyzed using MAXQDA10 software.

CONCLUSION

Maternal health providers need to know that it is not enough only to focus on saving the mother's physical life. While strengthening the role of mothering is essential element to support near-miss mothers who have experienced difficult physical and psychological conditions. The "beyond numbers" concept, implies that it is not enough only to focus on saving the mother's physical life. Removing barriers in order to achieve to early mothering, can have a significant impact on reducing the psychological burden of MNM events.