The journey towards motherhood after a very preterm birth: Mothers' experiences in hospital and after home-coming

Motherhood starts suddenly when delivering a very preterm baby. The infants spend months in hospital and mothers visit or stay close to their tiny newborns. The aim of this qualitative secondary analysis was to investigate mothers' of very preterm infants' experiences of being a mother, the meaning of staying in the hospital on a 24-hour basis and the experience of home-coming. Five mothers were interviewed repeatedly and data analyzed following Van Manen's phenomenology. The essence of the findings ‘Being on a journey’ is presented in three themes: ‘A sudden and uncertain entering to motherhood’, ‘Being on their way as preterm mothers in a hospital world’ and ‘At home at last – entering a new motherhood journey’. Each theme has a number of subthemes that substantiate the theme. The knowledge from this study hopefully will allow neonatal nurses to tactfully continue guiding mothers of very preterm infants on their motherhood journey.     

Biographies of pregnancy and motherhood in adolescence within rural settlements in Rio Grande do Sul

The objective of this study was to learn about and understand pregnancy and motherhood experiences in adolescence within rural settlements. The study started from a qualitative approach supported by the biographic method. Witnesses comprised women who experienced pregnancy and motherhood in adolescence. Data collection was performed in January and February 2009, by thematic biographic interview. The biographies show family trajectories of instability and constant moves as well as of precarious housing and employment. Pregnancy acceptance by the families of the adolescents is directly conditioned to the partner taking over the parenthood of the child and the adolescent mother as partner or spouse. The most frequently reported changes in the personal life deriving from pregnancy and motherhood were loss of freedom and increase of responsibility. At institutional level, it is observed the lack of public policies and, consequently, of services addressed to and adequate to health specificities within rural settlements.     

Adolescent motherhood: a meta-synthesis of qualitative studies

PURPOSE: To synthesize qualitative studies on the phenomenon of adolescent motherhood. METHODS: Databases were searched for qualitative studies regarding the experience of adolescent motherhood (years 1990-2001). Noblit and Hare's (1988) meta-ethnographic comparative method was used for synthesizing the research. A total of 251 citations were found, with a subgroup of 50 studies on "adolescent motherhood" and "qualitative studies." Twenty-five studies conducted in the United States, Canada, China, England, and Australia met the sample inclusion criteria. The combined sample of participants across studies was 257 adolescent mothers. RESULTS: Certain characteristics are common to the studies of adolescent motherhood. Five overarching metaphors were found: (1) the reality of motherhood brings hardship; (2) living in the two worlds of adolescence and motherhood; (3) motherhood as positively transforming; (4) baby as stabilizing influence; and (5) supportive context as turning point for the future. CLINICAL IMPLICATIONS: Nurses working in hospital, home care, community, and school settings can use the results of this metasynthesis to obtain a clearer picture of how adolescents feel during pregnancy, and the types of nursing interventions that can be developed to help them.     

Experiences of motherhood when suffering from mental illness: A hermeneutic study

Being a mother is inseparable from women's existential life. Mothers with mental illness struggle with conflicting and distressing feelings related to motherhood. They seldom obtain the necessary support to increase their control over the determinants of their role as a mother, thus their opportunity of improving their own and their children's mental health is weakened. The aim of this study was to explore the experiences of being a mother with mental illness. The research question was: How can mothers' experiences of motherhood when suffering from mental illness be understood? The understanding emerged through a hermeneutical interpretation of the empirical material on four different levels of abstraction. The inductive–deductive approach, inspired by the philosophy of Gadamer, was used. The mothers' experiences were understood in their way of struggling to become good enough mothers, managing to become the mother they longed to be, being present in the caring relationship with their child, as well as being recognized as a mother and living openly and honestly in relationships with others. Addressing the existential needs of motherhood is important for their improvement and recovery, as well as for promoting their children's mental health and well‐being.     

Women's experiences of becoming a mother after prolonged labour

Title.  Women's experiences of becoming a mother after prolonged labour.
Aim.  This paper is a report of a study to explore women's experiences of becoming a mother after prolonged labour.
Background.  The negativity associated with a complicated labour such as prolonged labour can lead to a struggle to become a healthy mother and could restrict the process of becoming a mother.
Methods.  Interviews were conducted in 2004 with 10 mothers who had been through a prolonged labour with assisted vaginal or caesarean delivery 1–3 months previously. Thematic content analysis was used.
Findings.  Three themes were formulated, describing women's experiences as fumbling in the dark , struggling for motherhood and achieving confidence in being a mother. The difficulties and suffering involved in becoming a mother after a prolonged labour were interpreted to be like 'fumbling in the dark'. Women experienced bodily fatigue, accompanied by feelings of illness and detachment from the child. Having the child when in this condition entailed a struggle to become a mother. In spite of these experiences and the desire to achieve confidence in being a mother, the reassurance of these women regarding their capacity for motherhood was crucial: it was central to their happiness as mothers, encouraged interaction and relationship with the child, and contributed to their adaptation to motherhood.
Conclusion.  Women experiencing prolonged labour may be comparable with the experience of and recovery from illness, which could contribute to difficulties transitioning to motherhood and limit a woman's ability to be emotionally available for the child.     

Negotiating motherhood: the struggles of teenage mothers

AIMS: This article presents the results of an ethnographic study exploring how teenagers negotiated motherhood. The main aims of the study were to explore how the young women negotiated motherhood and how they constructed their own identities and relationships through teenage parenting. BACKGROUND: Approximately 10% of all births occur to teenage mothers worldwide. This phenomenon is of concern because teenage mothers are reported to be disadvantaged financially, educationally, and cognitively in both the short and long term. Many teenage mothers find strength and fulfillment in their motherhood role but this does not come without cost to themselves or their children, as many teenagers are considered unsuitable to be parents and do not have adequate support. DESIGN: This interpretive study incorporated ethnographic practices and was guided by feminist principles. After ethical approval from the university, data was collected over a 12-month period from five homeless Australian sole-supporting teenage mothers. Methods used included observation, interviews, field notes, journalling, and discussions with key informants. FINDINGS: The five participants described stories of disrupted lives, unhappiness in childhood, turmoil during adolescence and a need to find love and connection in their lives. Analysis of the data revealed four major themes; transforming lives and opportunities for change, accommodating the challenges, tolerating the abandonment of supports and living publicly examined lives. CONCLUSIONS: It was concluded that becoming a sole-supporting mother during the teenage years was a difficult struggle for the young women, because of their youth, their lack of preparation for motherhood and their reliance on welfare supports. In addition, they experienced negative public attitudes directed towards them wherever they went, and this included their visits to community child health centres. Recommendations are made for nurses to take a different approach when working with teenage mothers to help ameliorate the negative impact of poor parenting.     

Being in charge – new mothers' perceptions of reflective leadership and motherhood

Akerjordet k . & Severinsson e . (2010) Journal of Nursing Management 18, 409–417
Being in charge – new mothers' perceptions of reflective leadership and motherhood Aim To explore new mothers’ perceptions of reflective leadership in relation to motherhood. Background Mindfulness, discovery of a deep personal self, sense of life purpose and authenticity appear to be the essence of self-reflective leadership. In this regard, women may be unprepared for the level of distress associated with the transition to motherhood. Method This study comprised interviews with ten new mothers on day 2–3 after giving birth conducted between March and May 2005. The interviews were audio-taped, transcribed verbatim and interpreted by a method grounded in hermeneutics. Results The content of the text was interpreted as one overall theme; the nature of responsibility in motherhood, encompassing the following four sub-themes: ‘Being a good mother by reflecting and developing self-identity’, ‘managing fear, demands and commitments as a mother’, ‘having the necessary resources to act and lead as a mother’ and ‘believing and trusting in others and self as a leader’. Conclusion In the new mother’s transformation and growth of self, true strength has to overcome the vulnerability of life by means of caring and courage mediated by reflective leadership anchored in love.     

Patients’ experiences of isolation in psychiatric inpatient care: Insights from a meta‐ethnographic study

Historically, people with mental ill‐health have been isolated from society. Although mental health care has moved from closed to more open forms of care, in many societies care is still provided in locked wards, and people with mental ill‐health are sometimes secluded from their fellow patients, families, friends, and visitors. The aim of this study was to illuminate patients’ experiences of isolation in psychiatric inpatient care. A systematic review of qualitative research was conducted, and the key findings were subjected to meta‐ethnographic synthesis. The findings were twofold: ‘being admitted to prison’ and ‘having access to shelter’. The experience of isolated care as prison‐like symbolizes patients’ longing for freedom and feeling restricted and limited by rules, stripped of rights, abandoned, controlled, powerless, and unsupported. In contrast, the experience of isolation as shelter symbolizes safety and the opportunity to regain control over one's own situation. A stigmatizing public view holds that people with mental ill‐health are dangerous and unpredictable and, therefore, unsafe to themselves and others. Being placed in isolation because these fears contribute to self‐stigma among patients. Promoting a sheltered experience in which isolation is used with respect for patients and the reasons are made explicit may encourage recovery. A shift in emphasis in ward culture from observation to engagement is needed to reduce blame, shift patient experiences from prison to shelter, and to support autonomy as a therapeutic intervention.     

Accessing Self-development through Narrative Approaches in Child and Adolescent Psychotherapy

TOPIC: Narrative psychotherapy with children and adolescents. PURPOSE: To demonstrate the integration of developmental theory with narrative approaches to psychotherapy as a means of accessing self-development during childhood and adolescence. SOURCES: Published literature and the author's experience in using narrative therapy with an 8-year-old and his foster mother. CONCLUSIONS: When informed by developmental theory, narrative approaches can be used effectively with children and adolescents to assist them in constructing positive life stories that can influence their identity formation.     

The experience of sexuality by visually impaired adolescents

The combination between transformations in adolescence, the indefiniteness they are accompanied by and the visual impairment justifies a study about the sexual experience of female, visually impaired adolescents included in society and in the school community. Five adolescents were interviewed at a Pedagogical Support Center. Questions attempted to find out their knowledge and understanding about the cause of their visual impairment, family composition and orientations, affective-sexual experience, level of knowledge about sexuality-related issues, including contraceptive methods and sexually transmitted diseases. Results revealed that these adolescents display the same sexuality development characteristics of their age group, though they have particular characteristics. It was observed there is a lack of knowledge regarding contraceptive methods and sexually transmitted diseases, of which the adolescents have superficial information. Making knowledge on the referred issues accessible to this population is indispensible.     

Morality as a predictor of loneliness: a cross-cultural study

Loneliness is currently regarded as one of the most common and prevalent problems experienced by adolescents, and it is also observed as a painful, unpleasant and negative experience. South African adolescents also have to face and cope with this predicament daily. The main objective of this study was to establish the perception of adolescents of different cultures regarding loneliness and morality and to investigate the relationship between them. It was also determined which of the independent variables, namely morality, gender, age, mother tongue and ethnicity, contributed significantly to the prediction of loneliness. A total of 714 adolescents from three different secondary schools in the greater Bloemfontein area between the ages of 13 and 17 were selected. Adolescents were used because they are increasingly being confronted with moral issues and because loneliness occurs more commonly during adolescence. The focus was on three ethnic groups, namely Coloured, black and white. Three different questionnaires, namely the Le Roux Loneliness Scale, the Morally Debatable Behaviours Scale and a biographical questionnaire were completed to obtain the necessary data. A significant inverse correlation between loneliness and morality was determined, while morality was identified as the best predictor of loneliness.     

Treatment of childhood hypercholesterolemia with HMG-CoA reductase inhibitors

OBJECTIVE: To describe the development of coronary artery disease in childhood and review the available literature regarding the safety and efficacy of hydroxymethylglutaryl coenzyme A (HMG-CoA) reductase inhibitors (statins) when used during childhood and adolescence. DATA SOURCES: A MEDLINE search was performed for the period of January 1966 through January 1999 using the key terms hypercholesterolemia, hyperlipidemia, and hydroxymethylglutaryl CoA reductase inhibitors. The search was further limited to English language, human study group, and all-child (0-18 y) age group. STUDY SELECTION AND DATA EXTRACTION: All clinical studies involving the use of HMG-CoA reductase inhibitors exclusively during childhood or adolescence were evaluated. DATA SYNTHESIS: A mean low-density lipoprotein cholesterol (LDL-C) concentration reduction of 25% can be obtained in children and adolescents treated with lovastatin, pravastatin, or simvastatin along with a lipid-lowering diet. The statins are generally well-tolerated in children and adolescents. Transient, asymptomatic elevations in creatine phosphokinase and hepatic transaminase concentrations have been reported in a small number of the children evaluated. Current data do not suggest any adverse effects on normal growth and sexual development in male adolescents, but formal evaluations have not been performed in female adolescents. CONCLUSIONS: The addition of the HMG-CoA reductase inhibitors lovastatin, pravastatin, or simvastatin to diet therapy in children > or =10 years of age may be effective when diet therapy alone has failed to obtain the recommended maximum LDL-C concentration of 130 mg/dL. The use of statins during childhood and adolescence is generally safe, but large, long-term studies should be performed before statins are routinely prescribed to children with elevated cholesterol or lipoprotein concentrations.     

Confianza,vigilancia y responsabilización: cambios en el desarrollo de la autonomía en las familias que viven con un adolescente que padece de fibrosis quística

ObjectiveA growing number of families with an adolescent who has cystic fibrosis can now envisage their child making the transition from adolescence to adulthood. Limited research has been conducted to date regarding the nature of the interactions between adolescents and their parents during the development of the adolescent's independence.MethodThe aim of this qualitative case study was to explore the experience of families with an adolescent who has cystic fibrosis, at the pre-transfer stage from a paediatric clinic to adult care. A systemic framework was used to get a better understanding of this phenomenon. Semi-directed interviews with seven families were conducted and a content analysis was performed.ResultsFeatures of the development of autonomy are characterised by three dimensions of the parental experience: (a) confidence that must be established between the adolescent and the parent, (b) adolescent's gradual increase of responsibility and (c) parent's supervision of the adolescent.ConclusionsThis study gives new information on parental experience as regards the development of autonomy in adolescents who have cystic fibrosis. The results underline the importance of taking parental experience into consideration in order to support families in the development of the adolescent's autonomy.     

Growth versus stability: older primiparous women as a paradigmatic case for persistence

The early pregnancy experience of women over 30 offers paradigmatic evidence which supports the significance of persistence for the study of nursing phenomenon Pregnancy and first-time motherhood have come to be associated with change, growth and development This research, which was undertaken to describe the changes experienced by older primiparous women during early pregnancy, illustrates how research grounded in a particular paradigm, in this case the growth or developmental paradigm, can limit the interpretation of data When viewed from a developmental perspective, women in this sample were seen as resistant to change and could be said to be having trouble 'adapting' to their impending motherhood However, when these women were viewed from the perspective of stability they were seen to engage in activities that allowed them to persist in their current self-view In the biological sciences, persistence refers to a compensatory process which allows a system to maintain goal-directedness in spite of both internal and external disturbances Women in this sample used balancing and buffering to continue their self-patterns Balancing represented the verbal and behavioural processes women engaged in to integrate their experience of themselves as pregnant into their sense of themselves as not pregnant Buffering included those activities that women used to maintain a sense of themselves in the face of the threat posed by their impending motherhood Balancing and buffering represent mechanisms used in the service of persistence and reflect pattern maintenance activities     

Becoming a mother — an analysis of women's experience of early motherhood

This paper presents the results of a qualitative study conducted by midwife researchers into women's experience of new motherhood. Data were collected using focus groups involving 55 first-time mothers and analysed using grounded theory method. The analysis produced six categories: 'realizing', 'unready', 'drained', 'aloneness', 'loss' and 'working it out'. The core category, 'becoming a mother', integrates all other categories and encapsulates the process of change experienced by women. Also explained are factors mediating the often distressing experience of becoming a mother. The analysis provides a conceptualization of early motherhood enabling the development of strategies for midwives, nurses and others helping women negotiate this challenge.     

Maternal adaptation during childbearing in Norway,Sweden and the United States

The purpose of the study of 147 healthy primiparous women is to investigate the relationship between maternal adaptation during pregnancy and postpartum. This report is part of a larger study of relationships between family dynamics and maternal adaptation during childbearing in Norway, Sweden and the US. Variables included maternal adaptation, age, social status, mother's employment, type of birth, length of hospitalization and mother infant time together in the hospital. Mothers reporting greater adaptation during pregnancy reported greater adaptation postpartum. Mothers who believed themselves adapted indicated that they were better prepared for labour, had more control over their birth experience, a better relationship with their partner, and perceived greater participation in child care from their partner. Few differences were found in maternal adaptation among all mothers, and few relationships were found among selected sociodemographic variables and maternal adaptation. Formation of maternal identity and mother's confidence in her ability to cope with the tasks of motherhood was affected by mothers' prenatal identification with the motherhood role, supporting the notion that knowing what to expect provides a sense of control. Mothers' prenatal identification with the motherhood role directly or indirectly affected her satisfaction with motherhood. Nurses may want to develop practice strategies to support these findings.     

The coping responses of the adolescent siblings of children with severe disabilities

Purpose : There is a paucity of literature conducted on adolescents' perceptions of their siblings with severe disabilities. The period of adolescence is characterized by personal and emotional conflicts resulting from teenagers' search towards self-identity and autonomy and exploration of the boundaries of parental support. The study attempts to describe the coping responses of these adolescent siblings in their adjustment to the family stressor of having a sibling with a disability; and the adolescents' available coping resources.

Method : This study is qualitative in nature and open-ended, structured interviews were conducted with 19 adolescents between the ages of 12 and 15 years who had a sibling with severe disabilities. The interviews were then analysed according to categories using an editing analysis style.

Results : The results indicated that the subjects reported limited family interaction and were often reticent in expressing their feelings about their sibling with a disability. In addition, they expressed guilt feelings regarding their siblings with disabilities. Furthermore, siblings of children with severe disabilities received limited information and guidance regarding their sibling's disability.

Conclusion : The need for professional support to facilitate adolescents' coping with the disability and its consequences as well as the establishment of strong support networks for these adolescents became evident.     

Predictors of risk for adolescent childbearing.

The purpose of this research was to develop a predictive model that identifies young women at risk for adolescent motherhood. A stratified sample of 357 adolescents was drawn from public health units and public schools in six randomly selected counties in North Central Florida. Data were collected regarding the environmental context (social and family), individual perceptions of self and trajectory, and adolescent motherhood status. A stepwise logistic regression was used to investigate the combined effects of these variables for identification of risk for adolescent motherhood. Using the combination of these variables, practitioners can identify adolescents at highest risk for early motherhood (97.66%) and those with the least risk of adolescent motherhood (approximately 1%).