A qualitative study: Mothers of late preterm infants relate their experiences of community-based care.

Shahirose S Premji,Aliyah Dosani,Sandra Reilly,Abhay K Lodha,Lynnette May Oliver,Genevieve Currie,Marilyn Young,Umberto Simeoni

doi:10.1371/journal.pone.0174419

Abstract

PurposeIn Alberta, the high occurrence of late preterm infants and early hospital discharge of mother-infant dyads has implications for postpartum care in the community. Shortened hospital stay and complexities surrounding the care of biologically and developmentally immature late preterm infants heighten anxiety and fears. Our descriptive phenomenological study explores mothers’ experience of caring for their late preterm infants in the community.MethodsEleven mothers were interviewed using a semi-structured interview guide. Interview transcripts were analysed using an interpretive thematic approach.FindingsThe mothers’ hospital experience informed their perspective that being a late preterm infant was not a “big deal,” and they tended to treat their infant as normal. “Feeding was really problem,” especially the variability in feeding effectiveness, which was not anticipated. Failing to recognize late preterm infants’ feeding distress exemplified lack of knowledge of feeding cues and tendencies to either rationalize or minimize feeding concerns. Public health nurses represent a source of informational support for managing neonatal morbidities associated with being late preterm; however, maternal experiences with public health nurses varied. Some nurses used a directive style that overwhelmed certain mothers. Seeing multiple public health nurses and care providers was not always effective, given inconsistent and contradictory guidance to care. These new and changing situations increased maternal anxiety and stress and influenced maternal confidence in care. Fathers, family, and friends were important sources of emotional support.ConclusionAfter discharge, mothers report their lack of preparation to meet the special needs of their late preterm infants. Current approaches to community-based care can threaten maternal confidence in care. New models and pathways of care for late preterm infants and their families need to be responsive to the spectrum of feeding issues encountered, limit duplication of services, and ensure consistent and effective care that parents will accept.

Highlights

In Canada, Alberta has the second highest provincial rate (8.7%) of preterm birth reported by hospitals [1]
We addressed the following question: What does it mean to be a mother of a late preterm infant? In the absence of other studies of this kind, we provide information that could enhance care in the community, could alleviate maternal stress, anxiety, and promote optimal mental health of the mother
The conceptual model provides a framework for describing the Late preterm infants (LPIs)’ characteristics, situational factors, and any imbalance between the needs associated with caring for LPIs and the available perceived resources to meet these needs as contributing factors to maternal stress/ anxiety [10, 18]

Summary

Introduction

In Canada, Alberta has the second highest provincial rate (8.7%) of preterm birth reported by hospitals [1]. Late preterm infants (LPIs), born between 34 0/7 and 36 6/7 weeks’ gestational age, make up an increasing proportion (75%) of these preterm infants [2]. Despite their increased short-term morbidities, no significant difference has been reported in length of stay in birth hospital (in days) for LPIs versus term infants, even when considering mode of delivery [3]. Mothers of preterm infants differ in their adaptation to parenting preterm infants in that they can experience social isolation and lack of support from their partners [14]. Social support can help to alleviate any isolation and lack of home support and help mothers develop confidence in attending to their infants’ needs [15]

Methods

Discussion

Conclusion