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      The forgotten mothers of extremely preterm babies: A qualitative study

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          Abstract

          Aims and objectives

          To explore the experiences of mothers of extremely premature babies during their Neonatal Intensive Care Unit stay and transition home.

          Background

          Mothers of extremely preterm infants (28 weeks’ gestation or less) experience a continuum of regular and repeated stressful and traumatic events, during the perinatal period, during the Neonatal Intensive Care Unit stay, and during transition home.

          Method

          An interpretive description method guided this study. Ten mothers of extremely premature infants who had been at home for less than six months were recruited via a Facebook invitation to participate in semi‐structured telephone interviews exploring their experiences in the Neonatal Intensive Care Unit and the transition home. The data were examined using a six‐phase thematic analysis approach. The COREQ checklist has been used.

          Results

          Two main themes emerged: (a) things got a bit dire; and (b) feeling a failure as a mother. Participants had a heightened risk of developing a mental disorder from exposure to multiple risk factors prior to and during birth, as well as during the postnatal period in the Neonatal Intensive Care Unit and their infant's transition to home. Mothers highlighted the minimal support for their mental health from healthcare professionals, despite their regular and repeated experience of traumatic events.

          Conclusion

          The mothers were at high risk of developing post‐traumatic stress symptoms and/or other mental health issues. Of note, study participants relived the trauma of witnessing their infant in the Neonatal Intensive Care Unit, demonstrated hypervigilance behaviour and identified lack of relevant support needed when their infant was at home.

          Relevance to Clinical Practice

          This study highlights the need for nurses to include a focus on the mothers’ psychosocial needs. Supporting maternal mental health both improves maternal well‐being and enables mothers to be emotionally available and responsive to their extremely preterm infant.

          Related collections

          Most cited references29

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          First-time mothers: social support, maternal parental self-efficacy and postnatal depression.

          To examine the relationships between social support, maternal parental self-efficacy and postnatal depression in first-time mothers at 6 weeks post delivery. Social support conceptualised and measured in different ways has been found to positively influence the mothering experience as has maternal parental self-efficacy. No research exists which has measured the relationships between social support, underpinned by social exchange theory and maternal parental self-efficacy using a domain-specific instrument, underpinned by self-efficacy theory and postnatal depression, with first-time mothers at 6 weeks post delivery. A quantitative correlational descriptive design was used. Data were collected using a five-part questionnaire package containing a researcher developed social support questionnaire, the Perceived Maternal Parental Self-Efficacy Scale and the Edinburgh Postnatal Depression Scale. Four hundred and ten mothers completed questionnaires at 6 weeks post delivery. Significant relationships were found between functional social support and postnatal depression; informal social support and postnatal depression; maternal parental self-efficacy and postnatal depression and informal social support and maternal parental self-efficacy at 6 weeks post delivery. Nurses and midwives need to be aware of and acknowledge the significant contribution of social support, particularly from family and friends in positively influencing first-time mothers' mental health and well-being in the postpartum period. The development of health care policy and clinical guidelines needs to define and operationalise social support to enhance maternal parental self-efficacy. These findings suggest that nurses and midwives need to be cognisant of the importance of social support for first-time mothers in both enhancing maternal parental self-efficacy and reducing postnatal depressive symptomatology in the early postpartum period. © 2011 Blackwell Publishing Ltd.
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            Helping parents cope with the trauma of premature birth: an evaluation of a trauma-preventive psychological intervention.

            To ascertain whether a trauma-preventive psychological intervention program for parents of premature infants during hospitalization in a level III NICU may reduce the severity of symptomatic response to the traumatic impact of premature birth. Mothers of premature infants were enrolled consecutively in a sequential control group design. Intervention group mothers received a structured psychological intervention in the first days after birth. Each mother could make use of additional psychological support if required and was actively approached at critical times during her infant's NICU stay. Control group mothers did not receive psychological intervention but could ask for counseling by the hospital minister. At discharge, mothers of both groups answered a questionnaire covering key outcome variables (symptoms of traumatization, emotions at discharge, and sample and control variables). At discharge, intervention group mothers (N = 25) showed significantly lower levels of symptomatic response to the traumatic stressor "premature birth" than those in the control group (N = 25; mean overall symptom level 25.2 [SD: 13.9] vs 37.5 [SD: 19.2]). This intervention program for parents after premature birth, combining early crisis intervention, psychological aid throughout the infant's hospitalization, and intense support at critical times, reduced the symptoms of traumatization relating to premature birth.
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              Evolution of Depression and Anxiety Symptoms in Parents of Very Preterm Infants During the Newborn Period.

              Mothers experience heightened depression and anxiety following very preterm (VPT) birth, but how these symptoms evolve during the first months after birth is unknown. Research on the psychological adjustment of fathers following VPT birth is limited.
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                Author and article information

                Contributors
                Cathrine.fowler@uts.edu.au
                Journal
                J Clin Nurs
                J Clin Nurs
                10.1111/(ISSN)1365-2702
                JOCN
                Journal of Clinical Nursing
                John Wiley and Sons Inc. (Hoboken )
                0962-1067
                1365-2702
                08 March 2019
                June 2019
                : 28
                : 11-12 ( doiID: 10.1111/jocn.2019.28.issue-11pt12 )
                : 2124-2134
                Affiliations
                [ 1 ] University of Technology Sydney Sydney New South Wales Australia
                [ 2 ] University of Hertfordshire Hatfield UK
                Author notes
                [*] [* ] Correspondence

                Cathrine Fowler, Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia.

                Email: Cathrine.fowler@ 123456uts.edu.au

                Author information
                https://orcid.org/0000-0002-7838-8434
                https://orcid.org/0000-0002-6081-5442
                https://orcid.org/0000-0002-3639-2881
                http://orcid.org/0000-0003-4184-1933
                Article
                JOCN14820
                10.1111/jocn.14820
                7328789
                30786101
                cadcb000-8212-47c0-83c7-5bc6660da7eb
                © 2019 The Authors. Journal of Clinical Nursing Published by John Wiley & Sons Ltd

                This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.

                History
                : 13 September 2018
                : 17 January 2019
                : 12 February 2019
                Page count
                Figures: 0, Tables: 2, Pages: 11, Words: 9172
                Funding
                Funded by: University of Technology and University of Hertfordshire , open-funder-registry 10.13039/501100001315;
                Categories
                Original Article
                Original Articles
                Custom metadata
                2.0
                June 2019
                Converter:WILEY_ML3GV2_TO_JATSPMC version:5.7.1 mode:remove_FC converted:12.11.2019

                Nursing
                mental health,neonatal care,preterm,psychosocial adjustment,qualitative study,women’s health
                Nursing
                mental health, neonatal care, preterm, psychosocial adjustment, qualitative study, women’s health

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