Abstract
Māori (Indigenous peoples of Aotearoa New Zealand) bear an unequal burden of poor perinatal health outcomes, including preterm birth. An infant arriving preterm disrupts the birth imaginary of whānau (family collectives) and situates them in a foreign health environment that may not be culturally safe and nurturing. A cross-sectional interpretative phenomenological analysis of first interviews with 19 whānau participating in a Kaupapa Māori (by, with, for Māori) qualitative longitudinal study of preterm birth identified themes from their experiences and the meanings they attributed to them. Preterm birth was an emotional roller coaster, with the birth imaginary and anticipated roles disrupted as health practitioners took over the care of their infants. Whānau expressed the desire to be close to their infants, holding them, loving them, nurturing them, and emplacing them within whakapapa (genealogy, continual layering of foundations) networks. When health practitioners or hospital policies inhibited this intimacy by isolating, excluding, or discriminating, whānau were frustrated. Being familiar with hospital routines, staff, peers, infant cares, and being wrapped in wider whānau support were key for whānau coping. Whakawhanaungatanga (processes of establishing relationships) create safe spaces for whānau to be themselves. This quietens the ‘storm’ and returns whānau to a sense of calm, through the reclamation of their environment.
Highlights
Much attention is paid to the influence that the first five years of life, starting from conception, have on lifelong health and well-being [1]
In the first superordinate theme, Preterm birth is ‘an emotional roller coaster’, we discuss the disruption of preterm birth to the imagined birth journeys of whānau and the emotional toll that this has on whānau as they question themselves and fear for their infant/s, living in uncertainty
The second superordinate theme, In the neonatal intensive care unit (NICU), ‘I just wanna hold my baby’, explores the strength that whānau draw from their love for their infant/s as taonga tuku iho, and the detrimental impact that separation and denigration of their identities as Māori can have
Summary
Much attention is paid to the influence that the first five years of life, starting from conception, have on lifelong health and well-being [1]. In Aotearoa (New Zealand), pregnant Māori (Indigenous) women and their infants experience marked inequities in health outcomes [2]. These are part of a wider picture that includes racism, education, financial, and housing inequities for Māori whānau (family collectives) (see Box 1 for a guide of Māori language terms) [3]. Māori whānau experience persistent perinatal inequities, including higher rates of maternal mortality, infant mortality, and preterm birth [4,5]. Preterm (or premature) birth refers to infants born before 37 weeks gestation, and the younger the gestation, the higher the risk of adverse outcomes. Preterm birth is the most common cause of death for infants in Aotearoa and there has been little
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