'I don't want him to always be so far behind': Parental perceptions of child independence in the context of extreme prematurity; a qualitative study

This study addresses the paucity of research on parents of extremely preterm adolescents (born <27 weeks of gestation) and their experiences within the framework of parental determinism. We conducted semi-structured interviews with twenty-two mothers and one father. Data were analysed thematically, revealing three overarching themes and eight subthemes shaping parental accounts. These themes centred on parental ambitions for their children, their perceptions of their child's abilities, and the parenting behaviours employed to support parental aspirations. Parents' actions were influenced by their ambitions and the belief that they could impact their child's future independence. While some parents adopted 'trusting', non-intensive parenting behaviours, those anticipating challenges for their child's future independence resorted to intensive parenting practices. These findings align with the concept of parental determinism, emphasising the perceived causal link between present parental actions and future child outcomes. In the context of extreme prematurity, a nuanced understanding of parental perceptions regarding their child's future independence aligned with a delicate balance between hope and realistic aspiration is crucial for enhancing parental support and well-being.

Family Resilience as an Emerging Concept in Neonatology: Evidence From a Metasummary Review

BACKGROUND

Family resilience can be observed through specific resilience-promoting processes, namely, shared belief systems, communication, and organizational processes, but the concept remains mostly unstudied in neonatology. This metasummary aims to evaluate the frequency of family resilience processes in qualitative scientific literature to illustrate how family resilience is exhibited in the neonatal intensive care unit (NICU) setting.

METHODS

A search among 4 databases yielded 7029 results, which were reviewed for inclusion. Following Sandelowski and Barroso's qualitative metasummary method, findings from each study were independently coded and frequency effect size was calculated.

RESULTS

Forty-six primary qualitative studies published between 2016 and 2022 conducted with parents of preterm infants who discussed their NICU hospitalization experience were included in this metasummary. All 9 of Walsh's family resilience processes were identified in the literature, and their frequency effect size ranged from 4% to 91%. Four additional themes emerged pertaining to specific family resilience behaviors exhibited by NICU families.

CONCLUSION

This analysis sheds new light on the most recent qualitative evidence of parents' experiences in the NICU by analyzing it through the lens of family resilience and posits family resilience as a promising concept in relation to the predominance of the family-centered care philosophy in neonatal units.

What makes a good mother? Two decades of research reflecting social norms of motherhood

Over the past two decades, scholars have investigated a multitude of different aspects of motherhood. This article provides a scoping review of research published from 2001 to 2021, covering 115 Social Science Citation Index-referenced papers from WEIRD countries, with the aim of reconstructing social norms around motherhood and mothers' responses to them. The analysis is theoretically based on normological and praxeological concepts. The findings reveal five contemporary norms of motherhood that reflect both stability and increasing differentiation, and are related to five types of mothers: the norms of being attentive to the child (present mother), of securing the child's successful development (future-oriented mother), of integrating employment into mothering (working mother), of being in control (public mother), and of being contented (happy mother). Relying on an intersectional lens, we analyze mothers' heterogeneous responses to these norms of motherhood, and examine how neoliberal demands build on and perpetuate inequalities.

Parents' Experiences of the First Year at Home with an Infant Born Extremely Preterm with and without Post-Discharge Intervention: Ambivalence, Loneliness, and Relationship Impact

With increasing survival rates of children born extremely preterm (EPT), before gestational week 28, the post-discharge life of these families has gained significant research interest. Quantitative studies of parental experiences post-discharge have previously reported elevated levels depressive symptoms, posttraumatic stress-disorder and anxiety among the parents. The current investigation aims to qualitatively explore the situation for parents of children born EPT in Sweden during the first year at home. Semi-structured interviews were performed with 17 parents of 14 children born EPT; eight parents were from an early intervention group and nine parents from a group that received treatment as usual, with extended follow-up procedures. Three main themes were identified using a thematic analytic approach: child-related concerns, the inner state of the parent, and changed family dynamics. Parents in the intervention group also expressed themes related to the intervention, as a sense of security and knowledgeable interventionists. The results are discussed in relation to different concepts of health, parent-child interaction and attachment, and models of the recovery processes. In conclusion, parents describe the first year at home as a time of prolonged parental worries for the child as well as concerns regarding the parent's own emotional state.

Perspectives of time: a qualitative study of the experiences of parents of critically ill newborns in the neonatal nursery in North Queensland interviewed several years after the admission

DESIGN

A qualitative study informed by grounded theory principles to explore the experiences of parents who had extremely preterm or babies with antenatally diagnosed life-threatening diagnoses who were cared for in a regional tertiary neonatal unit. The study was conducted when the child was old enough to be diagnosed with long-term neurodevelopmental or medical sequelae.

SETTING

North Queensland is a large area in Eastern Australia of 500 000 km², which is served by one tertiary neonatal unit.

PARTICIPANTS

Seventeen families representing 21 extremely preterm babies and one baby with congenital malformations who was not expected to survive prior to delivery (but did) were interviewed using grounded theory principles. Interviews were coded and themes derived.

RESULTS

Parents who recollect their neonatal experiences from 3 to 7 years after the baby was cared for in the neonatal intensive care described negative themes of grief and loss, guilt and disempowerment. Positive enhancers of care included parental strengths, religion and culture, family supports and neonatal unit practices. Novel findings included that prior pregnancy loss and infertility formed part of the narrative for parents, and hope was engendered by religion for parents who did not usually have a religious faith.

CONCLUSIONS

An understanding of both the negative aspects of neonatal care and the positive enhancers is necessary to improve the neonatal experience for parents. Parents are able to contextualise their previous neonatal experiences within both the long-term outcome for the child and their own life history.

“Living for others”: Narrating agency in the context of failed marriages and singleness in urban Sri Lanka

Marriage is a cultural imperative in Sri Lanka and is constructed as the principal source of personal fulfilment for women. This paper critically examines through two case studies – a never-married woman and a woman in a “failed” marriage – how women from older generations narrate their life histories using culturally coherent repertoires. By deconstructing the subject positions of the “long-suffering wife”, the “devoted mother”, and the “selfless woman”, I reveal the spaces for manoeuvre these women create to experience well-being and exercise agency outside of the culture’s “hegemonic narrative” of successful marriage and maternity. Using the life history narratives I challenge the tendency to imagine older women’s lives as more constrained and illustrate the ways in which equivocal narratives about independence and self-sacrifice, about freedom and suffering simultaneously conceal agency while allowing non-normative ways of being.