Parents’ Experiences of the First Year at Home with an Infant Born Extremely Preterm with and without Post-Discharge Intervention: Ambivalence, Loneliness, and Relationship Impact
Abstract
:1. Introduction
1.1. Parental Mental Health Following Premature Birth
1.2. The Inner Parental Experience of Preterm Birth
1.3. Preterm Birth Affecting Interaction and Attachment
1.4. Theoretical Approach and Previous Evidence of Home-Visiting Programs
1.5. Theoretical Approach of Health and Development
1.6. Aim
- (I).
- How do parents of children born EPT describe the first year at home post-discharge?
- (II).
- How is participating in an interaction- and strength-based home-visiting program perceived by parents of children born EPT?
2. Materials and Methods
2.1. Study Design
2.2. Participants
2.3. Treatment as Usual (TAU)
2.4. The Intervention
2.5. Two Semi-Structured Interview Guides
2.6. Procedure
2.7. Ethical Considerations
2.8. Thematic Analysis
3. Results
3.1. The First Year at Home, Regardless of Group (Answering Research Question I)
3.1.1. Main Theme 1: Child-Related Concerns
Subtheme: Continued Medical Concerns
Subtheme: Child Regulation and Body Functions
Subtheme: Incomplete Recovery When Coming Home
He had a cold at discharge, he received it in the neonatal unit, it’s written in the medical record that they suctioned his nose [of mucus], you know, some day before we went home. Everybody knew that he had a cold. But the cold got worse, that is the first thing I say to her [the neonatal visiting nurse] when she comes, “how are you?” and I answer “he has a bit of a cold”. And then I take him in my arms, and it is like holding your [pause] dead child. He is… completely lifeless. And totally grey, I still almost cannot talk about it. [Interviewer: even if it is one year ago?] Yes. So… eh… we try to get him back to life and then I leave him to her [the neonatal visiting nurse] and she makes him inhale…he is breathing a bit, and she says “no, you have to call 911”.(N, mother from TAU+)
We were home for maybe one and a half days, and we noticed that [infant name] lost her muscular tone, which was a little longer, so we called and they transferred us to [name of hospital], where we came from [name of another hospital], so we called and they said we should go there, and we had to stay another week. They were a bit upset with [name of hospital] that they had sent us home so early, that it was completely, well, one doctor was very angry, thought it was too early. It is enormously stressful to come home and see that she did not cope with it. And, then, she received oxygen for one more week and they discussed oxygen at discharge.(L, mother from TAU+)
3.1.2. Main Theme 2: Parental Inner State
Subtheme: Loneliness
So, just to meet other people, during wintertime when we came home, there were many infections around, so just telling people “you may not lift, not caress, you may not… keep away, you may look—but not touch. I think it is very hard for many people to understand, just that tiny part, you may look but do not touch. Because everybody says “oh, a baby”, [approaching body language] it is something imprinted in this…(H, mother from IG)
Well my husband, he helps a lot, but when it comes to hospitals, he cannot handle…he thinks, he cannot handle the hospital environment for example. So, it has been tough for me, because I lived there for two and a half months. Many parents took turns, and that was ’what I missed the most. You have to take turns, because it’s just not possible.(G, mother from IG)
I found it [the SPIBI-intervention] very rewarding and it has given me security, so I found it very good. We did not have any home care, for us it was quite abrupt because he was fully breastfed and had no oxygen supply when we came home around term age, so for us we went from meticulous monitoring, to practically not speaking. So, we were lucky to be a part of the study and have [interventionist name] coming to our home.(I, mother from IG)
Subtheme: Ambivalence
It’s the first time he leaves the hospital, tastes air, sits in a chair or a baby car seat. Those were some tough hours. Yes. When he came home, we called the nurse and asked why his saturation was so low. Turns out, he had been sitting like this [shows crouched position] in the baby car seat and had not been getting enough air, so he was tired. So, when we arrived home, it took more time than we expected, maybe an hour./…/He was so tired, he could not even poop. And for us it was like “not today—not when we just arrived home”.(D, mother from TAU+)
But, when that day came [the one-year corrected age birthday], then one felt a bit guilty. Because when we speak with this group, they wrote, they said that they lost one of the twins, so it has been tough for her, he died in the womb. And the other, I think she had some anxiety before, so, they have felt really bad.(G, mother from IG)
Subtheme: Preterm Parental Identity
So, it’s a bit scary, like it feels like we have now distanced ourselves from that [the extreme preterm birth] then maybe you should not stick in this [Facebook group] flow of the process. So, the thought has struck me if I should sort of leave that group, because we are trying to let it go now. Because you always hear… there are a lot of problems in these kinds of groups as well, how people air their concerns./…/Or it’s something that makes me hang in there [in the Facebook group], a little. Still. For some reason.(F, mother from TAU+)
I cannot relate her to her early birth any longer. But when I see the photos in my phone, that I took [in the hospital] at that time, then I feel “has that happened to me?” One forgets so fast and that is good, in one way, I think, because it has been OK, she is here and growing. Why should I go back and dwell upon what has been when there is no point?(K, mother from TAU+)
3.1.3. Main Theme 3: Changed Family Dynamics
Subtheme: The Parental Dyad
Yes, but then he went back to work in March, yeah, so he stayed home a bit longer. Uhm, but then I felt… I felt quite bad mentally during spring, I felt extremely stressed, like I was approaching fatigue depression, everything stressed me out, just visiting the well-baby clinic [BVC] was stressful. I don’t know if it was, that so many things that caught up from the past time, or the shock of becoming parent of two children, which was much tougher than I ever imagined. Or if it was interconnected.(F, mother of TAU+)
And then when we change TPN [total parenteral nutrition], from the beginning we said that I changed one time, then my husband changed the next. But his, you know, men are not so careful as women are, or not so [pause] skilled as women. So, I just told him “you have to do it like this” and he got very angry, because he thought I was saying I was more capable than he was. It’s not like I don’t believe in him, even if that is what he thinks. But, the first period, it was about how we fed him, how we gave him medicine, replaced the tube. It was a bit tense at times, during that period.(J, mother from TAU+)
It is incredibly stressful to come home and like try to handle that you are coming home with a newborn, but also somebody that fragile, and then I was eh… more or less all alone in this situation from discharge/…/At the hospital, that was at [name of hospital], we were, there were so many staff members that came to us and were fascinated by how nicely we handled it together and that was my experience too. But then, as I said before, when we came home… then… well it was a personality change, absolutely.(L, mother from TAU+)
Well, we, it felt like we are persons who “We will be fine, we’ll be fine, we do not need anybody”. But this time I felt more like “no, we will not be fine—we need help” and there is nothing wrong in asking for help.(M, mother from IG)
Subtheme: Thoughts Relating to Siblings
Subtheme: Intergenerational Support
So, in that way we have had the support that somebody, if I regained lost sleep, the first week my mother lived with us and then I could sleep while he was awake with my mother. So, because she is not updated in his [medical state], but just to cook, clean, and everything. And then the second week, his [the father’s] mother came and lived with us and did the same thing.(D mother from TAU+)
3.2. Specific Themes Connected to the Intervention, Answering Research Question II
It was in three parts, so in the beginning I felt that [name of interventionist] was like a psychologist almost, just so you feel that…You have had psychological support/…/And then it is a bit like a physiotherapist, she has coached me a lot, like “he will soon start with this, so do this”/…/and then the food, when one has been forever worried, that we could discuss that a bit.(I, mother from IG)
3.2.1. Intervention Group (IG)-Theme 1: Security
More home-visits maybe. Sitting talking, like we do now. How it works at home, if it is something we need… But when we came home, it was all over, it was just me going there all the time because of the [child’s] constipation. Nobody came. I asked somebody there when I was worried that it will be a tough situation at home. They said ”no, you don’t need home care because he does not have a tube or anything”/…/but still, he was not very…very strong/…/but you know, the worry is stuck here [points to her heart].(A mother from TAU+)
3.2.2. IG-Theme 2: Knowledgeable Interventionist
I think it gave me quite a lot, regarding that, eh, I learned to think in another way, it opened my eyes, I had an “Aha-moment”, for example things that you take for granted, you think he does not understand, but all of a sudden, “oops, he understands”.(M, mother from IG)
It has not always been us posing questions, more that she mentions or says this is common amongst preterm born, or extremely preterm born … and maybe you have not thought of that at the time, but then when you compare to other children, or what shall I say, at some point, then you are not like “but why does my child don’t do that”, because she has prevented that worry.(H, mother from IG)
It was very fun to be able to participate, really, when [name of interventionist] came and gave tips and suggested what to do, things I did not think of with my previous children, “aha, that is why they do that, it is for this reason.(G, mother from IG)
It was good, because as [name of child] is our first child, we did not know much about parenting, so when [name of interventionist] came and said “she’s going to do this thing in a few days, a few weeks” it was helpful for us.(E, father from IG)
3.2.3. IG-Theme 3: Important, but Not Necessary
4. Discussion
5. Conclusions
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
References
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Main Theme | Subthemes | Dealing with Issues of |
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1. Child-related concerns | Continued medical concerns | Diagnoses and technical supplies. |
Child regulation | Questions of eating, sleeping, and digestion. | |
Incomplete recovery when coming home | The timing of discharge, medical assessment of the child’s state versus the parental perception of the child’s state. | |
2. Parental inner state | Loneliness | From a practical and existential perspective. |
Ambivalence | Towards different aspects of the process (i.e., the feeling of relief mixed with worry, or happiness for one’s own child’s development mixed with guilt towards other less fortunate parents). | |
Premature parental identity | Opposing drives of keeping or letting go of the premature parent label and social media support from peers. | |
3. Changed family dynamics | The parental dyad | Differences in reactions ranging from complementing parental skills to more severe disagreements within the parental dyad was reported in 10 of the 14 families. |
Thoughts relating to siblings | (Both in an enriching sense in terms of parenting experience and in a worrisome sense in terms of prioritizing parental attention). In the case of the first child, the absence of siblings was sometimes discussed. | |
Intergenerational support | When asked about non-hospital related support during the first year at home, grandmothers and grandfathers of the child were mentioned as a main source of help. |
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Baraldi, E.; Allodi, M.W.; Smedler, A.-C.; Westrup, B.; Löwing, K.; Ådén, U. Parents’ Experiences of the First Year at Home with an Infant Born Extremely Preterm with and without Post-Discharge Intervention: Ambivalence, Loneliness, and Relationship Impact. Int. J. Environ. Res. Public Health 2020, 17, 9326. https://doi.org/10.3390/ijerph17249326
Baraldi E, Allodi MW, Smedler A-C, Westrup B, Löwing K, Ådén U. Parents’ Experiences of the First Year at Home with an Infant Born Extremely Preterm with and without Post-Discharge Intervention: Ambivalence, Loneliness, and Relationship Impact. International Journal of Environmental Research and Public Health. 2020; 17(24):9326. https://doi.org/10.3390/ijerph17249326
Chicago/Turabian StyleBaraldi, Erika, Mara Westling Allodi, Ann-Charlotte Smedler, Björn Westrup, Kristina Löwing, and Ulrika Ådén. 2020. "Parents’ Experiences of the First Year at Home with an Infant Born Extremely Preterm with and without Post-Discharge Intervention: Ambivalence, Loneliness, and Relationship Impact" International Journal of Environmental Research and Public Health 17, no. 24: 9326. https://doi.org/10.3390/ijerph17249326