Year: 2013
Type: dissertation
Abstract: OBJECTIVES: To explore why so few mothers breastfeed when their babies are \nadmitted to neonatal intensive care unit (NICU), and to gain an understanding of \nthe impact of this for the mothers and staff involved. \nDESIGN: This study adopted an ethnographic approach. The data collection \ninvolved 135 hours of participant observation over a 6-month period and 32 \nsemi-structured interviews of 17 mothers, 10 nurses, and 5 physicians. \nFINDINGS: Data from the participants’ interviews and the participant \nobservation were analysed focusing on the two different perspectives; one \nrelating to the mothers and the other to the staff members and their working \nconditions. The mothers’ experiences were revealed as a developing process as \ntheir feeling changed from fearful and terrifying toward becoming and feeling like \na ‘real’ mother. Their experience of mothering and breastfeeding differed from \ntheir expectations in that breastfeeding became a complex process for some and \nimpossible for others. Five distinct themes emerged; the first highlighted the \ncrisis, which involved the mother's feelings of emotional instability, their \nstrategies for coping such as not visiting the baby, and recognition of the NICU \nas a stressful environment. The second theme described issues relating to \ncontrol and power. This involved the perception of having a lack of control and \nneeding to seek permission, the use of language as a mechanism for control, \nand mothers being placed in a subordinate role. The third theme related to the \nseparation, which included difficulties of acceptance, feeling like stranger and \nnot being important, and the need for physical closeness. Acceptance and \nadaptation comprised the fourth theme in which gradual acceptance occurred \nand a spiritual aspect emerged. The final theme, becoming a mother, included \nissues such as the special moments, breastfeeding as a turning point, and \npractical and informational needs. Almost all the mothers in this study spoke \nabout going through all these stages during their infants’ stay in the NICU. \nAnalysis of these findings suggests that mothers who deliver prematurely, may \nhave their rite of passage into motherhood interrupted, resulting in them being \nplaced in a position of suspended liminality. v \n \nThe data also suggest that while staff members agree with the benefits of \nbreastfeeding for preterm infants, the actual implementation of a breastfeeding \npolicy within the neonatal units is more problematic. Three key themes emerged \nfrom the analysis relating to the staff perspectives. The first described the \ncontradiction that exists between the staff beliefs and behaviours in relation to \nbreastfeeding and supporting mothers. Elements that comprised this theme were \n“breast milk is best”, perceiving breastfeeding promotion as a nicety not a \nnecessity; lacking support for mothers, and abdication of responsibility. The \nsecond theme related to their working conditions: this included a lack of \ninstitutional support for the health care team, and barriers to support \nbreastfeeding. The final theme of controlling relationships captured the essence \nof the practitioner: mother association. Together, these elements revealed a \nsituation whereby staff appeared more preoccupied in addressing the task \naspect of care for the babies than supporting mothers in feeding and \nsubsequently mothering their preterm child. \nCONCLUSIONS: An understanding of the experiences of mothers of preterm \ninfants who wish to breastfeed, and the connection that breastfeeding has to the \nprocess of becoming a mother, allows for the finding of more positive strategies \nto support mothers and breastfeeding within the NICU. This study reveals a new \nunderstanding of how breastfeeding is connected to the process of becoming a \nmother, within the context of two Jordanian NICUs. It also highlights the difficult \nworking conditions for nurses within these units. It is anticipated that recognition \nof these findings may assist with service developments and lead to \nimprovements in the NICU environment in Jordan, thus enhancing health care \ndelivery in accordance with the individual needs of infants and their mothers.
Author: Khulood Kayed Shattnawi
Language: English
Subfield: Epidemiology
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W377923893