The lived experience of mothers regarding care of their hospitalized preterm baby

191 Pages·2012·1.72 MB·English

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University of Cape Town
THE LIVED EXPERIENCES OF MOTHERS REGARDING CARE OF
THEIR HOSPITALISED PRETERM BABIES

Rosinah Kereemang Ncube
Student no: NCBROS001

SUBMITTED TO THE UNIVERSITY OF CAPE TOWN
In fulfilment of the requirements for the degree of
Master of Science in Nursing

DIVISION OF NURSING AND MIDWIFERY
DEPARTMENT OF HEALTH AND REHABILITATION SCIENCES
UNIVERSITY OF CAPE TOWN

Submitted September 2011
Supervisors: Ms Hilary Barlow, Child Nurse Practice Development Initiative, School of Child
and Adolescent Health, University of Cape Town
Dr Pat Mayers, Division of Nursing and Midwifery, University of Cape Town
University of Cape Town
DECLARATION

I Rosinah K. Ncube, hereby declare that the work on which this dissertation is based is my original
work (except where acknowledgements indicate otherwise) and that neither the whole work nor
any part of it has been, is being, or is to be submitted for another degree in this or any other
university.
I empower the university to reproduce for the purpose of research either the whole or any
portion of the contents in any manner whatsoever.

_________
Signature

___________
Date

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DEFINITION OF TERMS

Care
Carrying out routine practices such as changing the baby’s nappy, sponging the baby’s
body, feeding the baby (Lupton & Fenwick, 2001) as well as interacting with the baby.

Preterm baby
Babies born before 37 completed weeks of pregnancy or with fewer than 259 days, also
referred to as premature babies (Valero de Bernabe, Soriano, Albeladejo, Juarranz, Calle,
Martinez & Dominguez-Rojas, 2004).

Phenomenology
“Is an umbrella term encompassing both philosophical movement and a range of research
approaches. In general, phenomenology is the study of phenomena, their nature and
meanings. The focus is on the way things appear to us through experience or in our
consciousness. The phenomenological researcher aims to provide a rich textured
description of ‘lived experience’” (Finlay & Ballinger, 2006:263) .

Experience
“Encounter, know, endure, and suffer. Undergo refer to encountering situations,
conditions etc. in life or to having certain sensations or feelings. Experience implies being
affected by what one meets with”.
(http://www.dictionary.reference.com/browse/experience)

Kangaroo mother care
“Kangaroo is derived from the practices similar to those of the marsupial care, in which
the baby is kept warm in the maternal pouch close to the breasts for unlimited feeding.
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University of Cape Town
Kangaroo care is defined as skin-to-skin contact between a mother and her low birth
weight (LBW) infant in a hospital setting. The term Kangaroo mother care (KMC) was
adopted during the first International workshop on Kangaroo Care in Trieste” (Kirsten,
Bergman & Hann, 2001:443).

Baby-Friendly Hospital Initiative
“Is a strategy adopted by the United Nations Children’s Fund (UNICEF) and the World
Health Organisation (WHO) in accordance with the Innocenti Declaration on the
Protection, Promotion and Support of breastfeeding (1990) as well as the World Summit
for Children (1990)” (Department of Health of South Africa, 2010:1).

Stillbirth rate
Late foetal deaths after 24 weeks of gestation, as expressed per 1000 live and stillbirths
(Cartlige & Steward, 1995).

Perinatal mortality rate
“The number of stillbirths and deaths in the first week of life per 1000 live births.” (WHO,
2006b:13).

Early neonatal mortality rate
Deaths occurring within the first week of life as expressed per 1000 live births (WHO,
2005).

Late neonatal mortality rate
Deaths occurring after the first week but before 28 completed days of life (WHO, 2005).

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ABBREVIATIONS

BFHI Baby-Friendly Hospital Initiative
KMC Kangaroo mother care
SCBU Special care baby unit
UNICEF United Nations Children’s Fund
WHO World Health Organisation
NICU Neonatal intensive care unit
LBW Low birth weight
HIV Human immunodeficiency virus
AIDS Acquired immune deficiency syndrome

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ABSTRACT

INTRODUCTION AND BACKGROUND
Trends in neonatal care aim to minimise separation of the baby from the mother, as shown by
initiatives such as Kangaroo mother care, the Baby-Friendly Hospital Initiative and the Humane
Neonatal Care Initiative. These were developed in an effort to promote the well-being of both the
mother and the baby, with proven positive effects on reduction of neonatal mortality and
maternal health benefits. The maternal benefits include parental sense of fulfilment and
confidence in caring for the baby (Ruiz-Pelaez, Charpak & Cuervo, 2004) and reduction in breast
and ovarian cancer (UNICEF, 2010).
Most preterm babies are born with low birthweight (LBW), and are often admitted to the
neonatal unit for provision of warmth and technological support (Tilokskulchai,
Phattanasiriwethin, Vitchitsokun & Serisathien, 2002). This leads to separation of babies from
their mothers, which may delay the attachment process and be painful for the parents since it
increases their anxiety and fear (Hall, 2005).
AIM OF THE STUDY
The aim of this study was to explore and describe the lived experiences of mothers regarding care
of their hospitalised preterm babies.
METHODOLOGY
Research design
A qualitative, explorative design which is contextual in nature was utilised to conduct the study in
a phenomenological approach. In-depth interviews were conducted twice with eight mothers of
hospitalised preterm babies.
Setting
The study was conducted in the Special Care Baby Unit of Princess Marina Hospital, a
Government referral hospital in the capital city of Gaborone, Botswana.
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DATA ANALYSIS
The interviews were transcribed verbatim and the data were analysed according to the steps for
analysing phenomenological transcriptions as described by Colaizzi (1978:59-61) and Hycner
(1985:280-294). Trustworthiness was ensured according to the criteria described by Guba and
Lincoln (1989).
FINDINGS
Mothers were shocked by the delivery of a preterm baby, since theyd id not expect to deliver ‘too
soon’. The neonatal environment increased the mothers’ fear and anxiety and delayed
development of a relationship between mothers and their babies. Support from staff, other
mothers in the neonatal unit and family members enabled the mothers to overcome their fear
and eventually to develop an emotional connection with their babies since they could cope with
their difficulties and challenges.
IMPLICATIONS OF THE STUDY
The findings of this study demonstrate that there is a need for adequate staff support of mothers
while providing care to their preterm babies. The quality of care provided to mothers and their
preterm babies could be improved by ongoing communication with the mothers while in the
neonatal unit, since this promotes their confidence and competence. This in turn enables positive
interactions between mothers and their babies and promotes mother-infant attachment.

KEY WORDS:
Lived experience, mothers, care, preterm infant, neonatal unit

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ACKNOWLEDGEMENTS

This study would have not been achieved without the Power of God Almighty who strengthened
me even when things seemed bleak. Indeed nothing is impossible with Him.
Thanks to my family, who have been supportive throughout my study period. I would like to
extend my sincere gratitude to my husband Moses, who supported me by encouraging me, taking
care of our son and ensuring that our house was well taken care of in my absence; our son
Obakeng, who was courageous although deprived of the love of a mother for the period that I
was away from home; and my sister, Mrs Magowe, who was patient enough to assist us with the
care of our son.
My special thanks to Pat Mayers and Hilary Barlow, my supervisors, who have been supportive
both academically and at a personal level. Thank you for your constant encouragement, your
guidance, and for spending endless hours in reading, correcting my work and advising me. It was
a wonderful experience working with you.
I would like to thank my supervisors from my workplace who have always encouraged me and
assisted me in different ways before and during the course of my study. Thank you for showing
your confidence in me.
Thanks to Leverne Gething who diligently edited this study and made sure that the work is
presented well. Keep up the good work.
Thanks to the managers and staff of the special care baby unit and postnatal ward in the hospital
where the data were collected. Your assistance is much appreciated.
Thanks to the mothers of preterm babies who were willing to share their experience regarding
care of their hospitalised preterm babies, without which this study would have not been possible.

Source of funding:
Ministry of Health - Training Office 2010-2011, through the Botswana Consulate Office in
Braamfontein, Johannesburg.

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TABLE OF CONTENTS

DECLARATION .............................................................................................................................................. I
DEFINITION OF TERMS ................................................................................................................................ II
ABBREVIATIONS ....................................................................................................................................... IV
ABSTRACT .................................................................................................................................................. V
KEY WORDS: ............................................................................................................................................. VI
ACKNOWLEDGEMENTS ............................................................................................................................ VII
CHAPTER 1: INTRODUCTION ...................................................................................................................... 1
1.1 INTRODUCTION AND BACKGROUND ....................................................................................................... 1
1.2 GLOBAL INITIATIVES ................................................................................................................................ 4
1.2.1 Kangaroo mother care ...................................................................................................... 4
1.2.2 The Baby-Friendly Hospital Initiative ................................................................................ 5
1.2.3 Humane Neonatal Care Initiative ...................................................................................... 6
1.3 BACKGROUND TO THE STUDY ................................................................................................................. 6
1.4 PROBLEM STATEMENT ............................................................................................................................ 7
1.5 RESEARCH AIM ........................................................................................................................................ 8
1.6 RESEARCH OBJECTIVES ............................................................................................................................ 9
1.7 RESEARCH QUESTION .............................................................................................................................. 9
1.8 CONCLUSION ........................................................................................................................................... 9
CHAPTER 2: REVIEW OF THE LITERATURE ................................................................................................. 11
2.1 INTRODUCTION ..................................................................................................................................... 11
2.2 HISTORICAL OVERVIEW OF NEONATAL CARE ........................................................................................ 11
2.3 TRENDS IN NEONATAL CARE .................................................................................................................. 13
2.3.1 KMC ................................................................................................................................. 14
2.3.1.1 Cost savings .............................................................................................................. 16
2.3.1.2 Other benefits of KMC .......................................................................................... 16
2.3.2 The Baby-Friendly Hospital Initiative .............................................................................. 17
2.3.3 The Humane Neonatal Care Initiative ............................................................................. 24
2.4 THEMES ARISING FROM THE REVIEW ............................................................................................................ 26
2.4.1 Struggling to mother ....................................................................................................... 26
2.4.2 Neonatal environment .................................................................................................... 27
2.4.3 Mother’s role-claiming strategies ................................................................................... 27
2.4.4 The role of breastfeeding ................................................................................................ 28
2.4.5 Establishing connections and forming relationships with their baby ............................. 28
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