transition to motherhood for first time mothers 35 years and above

442 Pages·2007·13.71 MB·English

by  Mary Concepta Carolan

''Doing it Properly''
Transition to motherhood for first-time mothers
35 years and above
Mary Concepta Carolan
RN RM BN MPI I (Won1en's I Iealth)
Submitted in total fulfilment of the requirements of the degree of Doctor of Philosophy
August 2004
School of Nursing,
Faculty of Medicine, Dentistry and llealth Sciences
The University of Melbourne
Victoria 30 I 0
Australia
ABSTRACT
This qualitative study investigated the experiences of first mothering for a new social
category of mothers, primiparae' aged greater than 35 years. Participants were recruited
from a tertiary hospital in Melbourne, Australia, a city of more than 3 million people. A
total of22 new mothers were interviewed about their experiences of transition to
motherhood. In a smaller sidearm of this study, three focus groups of midwives and
maternal and child health nurses were conducted in a bid to identify clinical needs for this
particular group of mothers.
In general, participants reported high levels of anxiety in the early days of tnothering and
over 3 in-depth interviews, these women revealed a need for additional social and
professional support. However, despite a shaky start, participants ultimately described
themselves as both resourceful and proactive, in terms or recruiting information to meet
their needs. Despite negative appraisal of their maternal capabilities by a variety of health
professionals including midwives and maternal and child health nurses, and common
associations of maladjustment, this study 1()und to the contrary. By 6 months post
partum, most participants had, by their own admission, become confident mothers and
were overwhelmingly positive about their mothering experiences. Although these women
used services and phoned for advice more than perhaps younger mothers, they did not
demonstrate the high levels of post-natal maladjustment or depression anecdotally
associated with older first-time mothering. Focus group data also clearly indicated that
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first time mothers
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this growing group of mothers had concerns and needs that differed from younger
mothers, particularly in regard to confidence building in the first three months post
partum. Findings explored ways to provide more meaningful support and improved
professional care.
The importance of this study is located in the intellectual contribution it makes to the
debate surrounding the social context of mothering. An opportunity also presents for
health professionals to gain an understanding of the experiences of maternity f()f
contemporary older prin1iparae. This new understanding may in turn enable health
professionals to challenge existing preconceptions of maladjustment among this group of
mothers. Finally, an identification of the specific needs of this cohort may give rise to
more meaningful maternal support and patient sensitive care.
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Statement of original authorship
The University of Melbourne
Doctor of Philosophy
This is to certify that:
1. The intellectual content of the thesis is the product of my work.
2. Due acknowledgement has been made in the text to all other materials used.
3. This thesis is Jess than I 00,000 words in length, exclusive of bibliographies and
appendices.
Name: Mary Carolan
Signed ........................................... .
Date:
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Acknowledgements
It is with great appreciation that I would like to thank my family, Hugo, Emer, Aoife and
Andrew, each of whom has contributed positively to my candidature. Thank you all for
your patience and forbearance when I have often been so unavailable to you. I would
particularly like to thank Professor Sioban Nelson who has been a great source of
inspiration and intellectual stimulation and I am forever indebted to her challenging and
motivational supervision. The members of my doctoral panel Professor Judith Parker and
Dr Marilys Guillemin have also been unstintingly generous of time and intellect and have
uniquely contributed to my growth both intellectually and personally.
Thanks also to my nursing colleagues at Jessie MacPherson I lospital who have
unanimously assisted and encouraged my efforts. Special thanks to Di Sexton, Ell ice
McLaren, Maggie Brougham and Chris Crossbie for proofreading and advice. Finally,
and most importantly, I would like to acknowledge the mothers of this study, without
whom this research could not have taken place.
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CHAPTER 1 ................................................................................................ 6
IN"TRODUCTION ........................................................................ ···· ........... · 6
Introduction ........................................................................... ·. ......... ·· · · · 9
Demographic shifts in birthing trends ..................................................... 10
Historical overview .............................................................................. 10
The 'greying' of the maternal population ............................................ 1 1
The emergence of the elderly primipara I a new social phenomenon ....... I 2
Risk I clinical issues ............................................................................. 1 4
Older mothering I timing of pregnancy I mixed messages .................... 15
Transition issues ..................................................................................... 17
Problem statement I research question ..................................................... 18
Structure of the thesis .............................................................................. 2 0
Summary ............................................................................................. 21
CHAPTER2 .............................................................................................. 23
THE SOCIAL CONTEXT OF MOTHERING ........................................... 23
The social context of mothering .............................................................. 2 5
Mothering as a social and dynamic category ........................................ 2 5
The social context of contemporary women's lives .............................. 2 8
Competing discourses of womanhood .................................................. 3 3
Intensive mothering: the provision of 'quality time' ............................ 40
Transition to motherhood literature ......................................................... 4 3
Medical research .................................................................................. 43
Studies ,of Mothering ........................................................................... 4 5
Mothering over 35 years ...................................................................... 4 7
Theoretical framework ............................................................................ 48
Discourses in post-structuralist inquiry ................................................ 4 9
The nature of self that is particular to post-structuralism ...................... 50
Fittingness of approach ........................................................................ 52
The self as a performance I subjectivity ............................................... 53
Feminist Theory ................................................................................... 54
Feminism and post-structural theory, points of convergence ................ 55
Summary ............................................................................................. 51
CHAPTER 3 .............................................................................................. 59
METHODOLOGY ..................................................................................... 59
Storytelling and self construction ............................................................ 60
Stories as a snapshot in time ................................................................ 62
Evolving method, study rationale ......................................................... 64
Sample .................................................................................................... 66
Recruitment and rationale .................................................................... 66
Data collection ........................................................................................ 70
Interview format, rationale and methodological strengths .................... 71
Positioning of the researcher in the research ............................................ 74
Reciprocity .......................................................................................... 75
Ethical considerations ............................................................................. 79
Concerns .............................................................................................. 80
Researcher transparency ...................................................................... 81
Data Analysis .......................................................................................... 84
Transcription and data reduction .......................................................... 84
Content analysis ................................................................................... 85
Value and credibility ............................................................................... 88
Value and credibility of the current study ............................................ 90
Participants ............................................................................................. 93
Summary ............................................................................................. 96
CI-IAP,..fER 4 .............................................................................................. 98
Tl-IE PROJ EC,..f .......................................................................................... 98
The project I 'doing it properly' ............................................................ 100
Infonnation seeking ........................................................................... 100
Planning and preparing ...................................................................... 10 8
Setting up a plan ................................................................................ 121
Work and pregnancy ............................................................................. 127
Plans to accommodate family and work ............................................. 128
Work-related tensions ........................................................................ 130
Working n1others within the literature ............................................... 135
C~ot1cerns ............................................................................................... 13 7
Perceived vulnerability ...................................................................... 137
Sttmtnary ........................................................................................... 139
ClfAil'fE~R 5 ............................................................................................ 141
'I'liE NIGI-I'fMARE BEGINS .................................................................. 141
The transition to tnotherhood I early mothering l-4 weeks .................... 143
The project is completed .................................................................... 144
Feeling helpless ................................................................................. 146
Infonnation overload I tnismatch ....................................................... 147
Terri tying anxieties ...................................................................... , ..... 154
Infant vulnerability ............................................................................ 157
Vigilance ........................................................................................... 159
Major concerns .................................................................................. 162
Breastfeeding difficulties ................................................................... 171
Lack of support I feeling isolated at home .......................................... 174
The struggle 1-4 months ........................................................................ 177
Realising that the task was a long standing one .................................. 17 7
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Ambivalence I my whole life is changing .......................................... 181
Issues of self I wanting to keep something of myself ......................... 185
Feeling very unsure ............................................................................ 188
Working through using work strategies. ............................................. 18 9
The unsettled infant ........................................................................... 195
Sum.mary ........................................................................................... 200
CHAPTER 6 ............................................................................................ 202
GIVING IN I LETTING GO .................................................................... 202
Giving in (4 -6 months) .......................................................................... 205
Letting go because it makes life easier: ................................................. 206
The surrender ..................................................................................... 207
A different way of thinking ................................................................ 208
Realising ............................................................................................... 212
Realising that the infant was not so fragile ......................................... 213
Realising it was OK to have negative feelings ................................... 214
Realising you just can't 'do it all' ...................................................... 215
Realising I could do it. ....................................................................... 216
Realising that there was no one right way .......................................... 21 7
Finding my own way ............................................................................. 218
Making sense of the information ........................................................ 219
Skills I can draw on ........................................................................... 227
The little person emerges ...................................................................... 229
Getting something back ..................................................................... 23 I
Feeling special ................................................................................... 232
'His things are taken for granted and mine can be arranged' .............. 233
Concerns ............................................................................................... 234
Infant sleeping patterns ...................................................................... 234
Sleep schools and controlled crying ................................................... 236
SIDS .................................................................................................. 240
Issues of self I wanting to keep something of myself ......................... 242
Social concerns I how we will develop as a family ............................ 244
Stlmtnary ........................................................................................... 248
CI--fAPTER 7 ............................................................................................ 250
FEELING LIKE A MOTHER .................................................................. 250
Age and the maternal self. ..................................................................... 252
'Been there, done that' ....................................................................... 253
Maternal maturity advantages both mother and baby ......................... 256
Age-related concerns ......................................................................... 260
Issues of self ...................................................................................... 265
Personal reflection I re-negotiation of self and life goals .................... 268
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Feeling like a mother I achieving the transition ..................................... 274
Enjoying it more I my wonderful baby ............................................... 277
Importance of family support ............................................................. 283
Maternal employment ........................................................................... 288
Returning to work .............................................................................. 288
Career women and work .................................................................... 2 8 9
Changing priorities ................................................................................ 2 92
Comparison with young achievers ..................................................... 299
Discourse and the literature around mothers and work ....................... 302
Maternal work, stress and guilt .......................................................... 304
Finding a balance between work and family ...................................... 307
Social implications of later timing of pregnancy ................................... 3 12
Following the social order ................................................................. 313
Soial approval .................................................................................... 3 14
Mixed messages about mothering ...................................................... 3 16
Summary ........................................................................................... 3 19
CHAPTER 8 ............................................................................................ 321
DISCUSSION AND RECOMMENDATIONS ........................................ 321
Importance of this study I contribution to existing literature .............. 322
Overview of the findings I what is new to this study? ........................... 324
Vulnerability and anxiety ................................................................... 325
The project 'doing it properly' I finding my own way ........................ 327
Later than usual achievement of transition to n1otherhood ................. 328
Re-definition of' self' as an 'older tnother' ........................................ 328
Work and balance I confusing social messages .................................. 329
Resourceful and proactive .................................................................. 331
The social context of first tnothering over 35 ........................................ 332
Contribution to the intellectual debate ............................................... 3 35
Feedback from patiicipants ................................................................... 336
'fhe 'little things' ................................................................................ 3 37
Timing of information I impossible to be fully prepared .................... 338
More positive infonnation about tnature mothers .............................. 338
Implications for nursing I midwifery practice ........................................ 339
Campaigning to include first-titne tnothers over 35 on tnidwifery
curricttla ............................................................................................. 340
Strategies to formalise existing casual care arrange1nents .................. 341
Dispelling the myths .......................................................................... 342
Raising awareness in terms of 'risk status' ......................................... 344
Diminution of the levels of anxiety .................................................... 345
Limitations I strengths of the study I recommendations for research ..... 347
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Summary ........................................................................................... 349
References ................................................................................................ 35 1
APPENDICES .......................................................................................... 410
Appendix A ........................................................................................... 411
Information leaflet I themes for interview .......................................... 411
Appendix B ........................................................................................... 413
Overview of study themes I feedback from participants ..................... 413
Appendix C ........................................................................................... 419
Focus group data and findings ........................................................... 41 9
Care requirements/ Particular concerns .............................................. 424
Older primiparae as a challenging group ............................................ 426
Dealing with the dilemmas of older primiparae ................................. 428
Possible solutions .............................................................................. 429
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