Taiwanese women’s experiences of becoming a mother to a very-low-birth-weight preterm infant: A grounded theory study

Abstract

Background

Significant improvements have occurred in the survival rates of small preterm infants. As more infants survive their preterm birth, the number of parents associated with this experience has also increased. Clearly, the birth of very-low-birth-weight (VLBW) preterm infants poses considerable challenges for all mothers. These challenges are further compounded in Taiwan, where women are traditionally required to practise the cultural ritual (Zuo Yue Zi) which includes confinement to the house with a special balanced diet for the first month postnatally. Moreover, there is a deficit of information on mothers’ experiences when their preterm infants are in neonatal intensive care units (NICUs).

Aims

The aim of this study was to explore Taiwanese mothers’ (n = 26) parenting experiences when their preterm infants were in NICUs.

Design

A qualitative research approach, grounded theory, was used to explore the mothers’ lived reality of these experiences.

Methods

In-depth interviews and participant observations were conducted to gain insight into the experience of parenting.

Findings

A theoretical model was formulated from the findings delineating Taiwanese mothers’ parenting experiences during their preterm infants stay in hospital. The findings indicated that the preterm birth, together with the admission of their infants to a NICU, presented mothers with an unexpected crisis. The particular cultural postnatal ritual posed this group of Taiwanese mothers with an additional difficulty in establishing physical interactions. However, the Taiwanese mothers created alternative channels of contact with their hospitalised infants using emotional connections, while the physical interactions were certainly limited. Despite all the difficulties this group of Taiwanese mothers faced and resolved, they all gradually captured and embraced the parenting role. The finding of this study further indicated that the support the mothers received from the healthcare professionals and the social networks the mothers made helped to create the connections that developed between the mothers and infants, making their journey towards parenthood possible.

Conclusion

The theoretical model developed in this study is the first of its kind to contribute to the field of neonatal nursing in Taiwan. This would help Taiwanese women come to terms with becoming mothers of VLBW infants and subsequently enhance their parenting role.

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.