Taiwanese women’s experiences of becoming a mother to a very-low-birth-weight preterm infant: A grounded theory study
Introduction
Every year about 7% of all babies in Taiwan are born preterm and/or have a low-birth-weight (Teng, 2001) many of which have positive outcomes (Hsieh et al., 2007) due to advances in neonatal care resulting in an increased survival rate. These positive outcomes result in many more premature newborns remaining in hospital for longer periods than previously (Holditch-Davis, 2007). As the number of neonatal intensive care unit (NICU) admissions increase, the parents exposed to prolonged hospitalisation associated with this experience also increases.
Prolonged hospital care intrudes on maternal interactions and mother–infant bonding, especially so in NICUs where mothers and their infants are often separated for long periods of time. Mothers’ experiences are completely different from that anticipated when they discovered they were pregnant and began planning for the eventual arrival (Holditch-Davis and Miles, 2000, Jackson et al., 2003, Lupton and Fenwick, 2001). Although larger numbers of mothers are going through this experience, it remains potentially traumatic because of the sudden onset.
Rubin, 1967, Rubin, 1975, Rubin, 1977 described the maternal role as a complex cognitive and social process which is learned, reciprocal, and interactive. Building on the work of Rubin, Mercer studied mothers of all age groups and experiences and created the practice-oriented theory of maternal role attainment (Mercer, 1981, Mercer, 1985, Mercer, 1986). It proposes that the mother–infant attachment process evolves through the mother’s increasing awareness of creating a new life during pregnancy to post birth when she begins to recognise the infant’s unique characteristics and capabilities. Contact with and caring for the infant facilitates mother–infant attachment, as does the infant’s increasing responsiveness to caregiving. However, when infants are born preterm and are hospitalised, the customary mothering role is difficult to realise because the care provided to the newborns is temporarily the responsibility of professional caregivers.
Giving birth is recognised not only as a difficult emotional and physical experience, but also as a developmental or life transition (Mercer, 2004). The transition to motherhood, as a normal developmental crisis, poses significant adjustment problems for most women and is of particular concern to healthcare providers (Bruschweiler Stern, 1998, Cowan and Cowan, 1995, Lee, 1997). Not only is the health and well being of individual mothers at risk during this period, but the well being of their infants and the stability of their families are also threatened (Nelson, 2003). When a preterm birth occurs, the added stress complicates mastery of this developmental crisis, which is further complicated when the infant is admitted to NICU.
Women in Taiwan, moreover, are traditionally required to rest for 1 month after childbirth (called Zuo Yue Zi). The rationale behind the practice of Zuo Yue Zi is the dual cosmic principal of Yin and Yang in Chinese medicine. Findings demonstrate that most Chinese women follow the custom of Zuo Yue Zi and believe that it can improve their health, not only immediately following the birth but also in later life (Cheung, 1997, Holroyd et al., 1997, Wong, 1993). Currently, Taiwanese women follow the indigenous beliefs and practices inherent in ‘Zuo Yue Zi’ for 1 month following the birth of their infant (Wong, 1993, Wong, 1994). During this postnatal period a protective ritual is conducted, which signifies the vulnerability of new mothers and ensures social seclusion and mandated rest, with relatives carrying out necessary tasks (Hung and Chung, 2001). Mothers are not supposed to go out, even to visit their premature infants in hospital. This means that mothers might not be able to visit their preterm infants in hospital or they might visit seldom. Consequently, during this period, it is more difficult for mothers to carry out their new role when their infants are in the hospital.
There is little literature about neonatal nursing care of preterm infants in Taiwan and no theory exists in Taiwan to help nurses understand mothers’ subjective parenting experiences while their infants are in NICUs. There is no previous evidence about mothers’ lived experiences that they could use to help design and guide nursing interventions. In Taiwan many nursing interventions to promote parenting are based on research carried out in the Western world based on medical perspectives, which ignore Chinese cultural factors. The importance of research evidence from different countries is underlined by the nature of nursing as a cultural activity: lived experiences differ from country to country. Taiwanese mothers’ parenting experiences involving the Chinese custom of Zuo Yue Zi have not yet been addressed adequately. Two important questions need to be asked. First, how do Taiwanese mothers experience the birth of premature infants when practicing Zuo Yue Zi during the postnatal period? Second, how do neonatal nurses attempt to meet their needs? If healthcare professionals are to address these issues that impact on the life of women, the construction of knowledge from their standpoint is important. The purpose of this study was to examine Taiwanese mothers’ perceptions of their parenting experiences during the time of their very-low-birth-weight (VLBW) preterm infant’s hospitalisation.
Section snippets
Methodology
The work of Strauss and Corbin (1990) provided the methodological underpinning that gave structure to this research. Although grounded theory was introduced by Glaser and Strauss in 1967 and Strauss and Corbin (1990) suggested a new way of coding data using a coding paradigm involving phenomena, causal conditions, context, intervening conditions, action/interaction strategies and consequences. It was selected for three main reasons. Firstly, the aim of this study was to explore mothers’
Findings
A theoretical model delineating Taiwanese women’s journey of becoming a mother to a VLBW preterm infant during the time of their infants’ hospitalisation surfaced from the data. In this paper, the paradigm model comprising: (1) causal conditions, (2) context, (3) intervening conditions, (4) action/interaction strategies and (5) consequences (Strauss and Corbin, 1990) is used as a theoretical map to guide presentation of the findings.
Discussion
Our findings illustrated a comprehensive conceptual model demonstrating how a group of Taiwanese mothers journeyed toward becoming mothers to their VLBW premature infants in a hospital setting. The findings from the current study support other research indicated that the preterm birth, together with the admission of their infants to a NICU, presented mothers with a novel situation as well as an unexpected crisis (Calam et al., 1999, Padden and Glenn, 1997). The birth of VLBW preterm infants
Limitations of the study
The data collected was drawn from only one hospital in this present study. In addition, the sample was restricted to those who did not have additional social, cultural or medical circumstances to consider. These groups need additional research building on the work presented here. The reality and truth of the conceptual model was established, as the process of theoretical sampling and constant comparative analysis continued until data saturation occurred.
Conclusions
The theoretical model developed in this study is the first of its kind to contribute to the field of neonatal nursing in Taiwan. This present study extends our understanding of Taiwanese mothers’ experiences of parenting their VLBW preterm infants in the hospital setting. The findings from this study provide insight into and raise awareness of Taiwanese mothers’ perceptions of their experiences during the maternal transition. The conceptual model could significantly enhance the quality of care
Conflict of interest statement
This work is from a self-founded doctoral study. No existed or potential conflict of interest has been identified.
Funding
This work is from a self-founded doctoral study. No Funding source for the study.
Ethical approval
The ethical considerations of this study were approved by China Medical University Hospital.
Acknowledgments
The authors would like to thank those mothers who generously volunteered to participate in this study. It was their unselfish willingness to tell their stories that made this work possible.
References (50)
Chinese Zuo Yue Zi (sitting in for the first month of the postnatal period) in Scotland
Midwifery
(1997)Kangaroo care: expanding our practice to critically ill neonates
Newborn and Infant Nursing Review
(2001)- et al.
Trustful bonds: a key to “becoming a mother” and to reciprocal breastfeeding. Stories of mothers of very preterm infants at a neonatal unit
Social Science & Medicine
(2006) - et al.
“I wanted to do a good job”: experiences of ‘becoming a mother’ and breastfeeding in mothers of very preterm infants after discharge from a neonatal unit
Social Science & Medicine
(2007) Outcomes of prematurity and neonatal intensive care unit care
Journal of Obstetric, Gynecologic, Neonatal Nursing
(2007)- et al.
‘They’ve forgotten that I’m the mum’: constructing and practising motherhood in special care nurseries
Social Science & Medicine
(2001) Transition to motherhood
Journal of Obstetric, Gynecologic and Neonatal Nursing
(2003)Concepts related to Chinese patients’ perceptions of health, illness and person: issues of conceptual clarity
Accident and Emergency Nursing
(1996)Health care across cultures
Nursing Outlook
(1990)- et al.
Early skin to skin contact for mothers and their health newborn infants
The Cochrane Library, Issue 1
(2004)
The nature of attachment in the neonatal intensive care unit
Journal of Perinatal and Neonatal Nursing
Facilitating kangaroo care
Journal of Neonatal Nursing
Early emotional care for mothers and infants
Pediatrics
Partnerships between mothers and professionals in the NICU: caregiving, information exchange, and relationships
Neonatal Network
Maternal appraisal of information given at the time of preterm delivery
Journal of Reproductive and Infant Psychology
Reproductive Health Beliefs and Practices of Chinese and Australian Women
Interventions to ease the transition to parenthood
Family Relations
Very low birthweight newborns and parents as early social partners
Interactions in neonatal nurseries: women’s perceptions of nurses and nursing
Journal of Neonatal Nursing
‘Chatting’: an important clinical tool in facilitating mothering in neonatal nurseries
Journal of Advanced Nursing
Kangaroo car
Neonatal Network
Theoretical Sensitivity
The Discovery of Grounded Theory
Mothers’ stories about their experiences in the neonatal intensive care unit
Neonatal Networks
Doing the month: an exploration of postpartum practice in Chinese women
Health Care for Women International
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