Background: Preterm delivery is a stressful and life threatening situation to both mothers and pre-term babies(Celik, Demirel, Canpolat & Dilmen, 2013). In South Africa, women who have complications of pregnancy, such as pre-term labour resulting from HIV/AIDS infections, drugs abuse, poor nutritional intake, strenuous activities, deliver at secondary or tertiary hospital. These pre-term neonates have to be admitted sometimes up to three months to the neonatal care unit for their survival. Literature review has shown that mothers of pre-term babies experiences stressful situation, as a result of daunting hospital environment, different equipment used to care for their babies and the neonatal care unit routine(WHO, 2012). This stress renders mothers unable to carry out their expectations such as caring for their preterm babies. It is well understood that the wellbeing of mother is essential for future development of the pre-term baby (Lloyd and De Witt,2013). However, in South Africa, it is unknown the experiences of mothers with pre-term babies and challenges they are facing during their hospital stay, what types of support available to enable them to deal with the challenges.
Purpose: This paper presents research that was aimed at understanding the experiences of mothers with preterm babies admitted to a neonatal care unit in a public hospital in Cape Town, South Africa.
Objective: Understanding the emotional stresses of mothers with preterm babies admitted in a public hospital; to explore challenges experienced by mothers of preterm babies during their hospital stay; to assess the types of psychosocial support available to help them to overcome their challenges.
Methods: A qualitative research approach with an exploratory and descriptive design was applied to elicit information from participants. Study population was mothers with pre-term babies admitted in the public hospital at the time of data collection. Participants were aged 19 years and older, had delivered preterm babies, and their babies had been admitted to the neonatal care unit for at least three days during the time of data collection. A purposive sampling techniques was used to select a sample of twelve (n=12) participants from mothers with pre-term babies. The sample size of the participants was determined by data saturation. The selection of the participants was assisted by nursing manager in the ward. Semi-structured interview guide was used for data collection. The interview guide was composed of an open-ended question which was followed by probes for clarity and in-depth understanding of the phenomenon under investigation. The interviews were conducted in English and Xhosa languages. English-speaking participants were interviewed by the researcher while non-English-speaking participant was interviewed by a trained data collector. The collected data were transcribed verbatim, and back translation was done for interview not conducted in English to ensure accuracy. Data were analysed manually using an inductive thematic analysis approach. Results
were deductively interpreted and discussed in comparison with relevant literature and theoretical framework. Guba’s criteria of trustworthiness were applied to ensure rigour of the study. Prolonged engagement, audit trail and member check are some of the strategies applied to ensure trustworthiness. The ethics approval for the study was obtained from research ethics committee of the institution and department of health. This research adhered to all the ethics principles such as beneficence, autonomy, respect for human dignity and justice. Participants were treated with dignity and respect throughout this research process.
Results: Maternal ages of the participants ranged between 19 and 43years. Only two mothers completed high school education. Majority of these mothers were single and unemployed. Eleven of the mothers that participated in this study were Christians and one was Muslim. The average gestational age was 28 completed weeks and most of the mothers participated in the study delivered at 26 completed weeks of gestation. Three themes emerged from the analysis which include, feeling sadness & guilt, lack of skills and professional support, and support received from one’s social circle as well as from professional. Participants expressed that they were feeling sad for giving birth to a small size pre-term baby and seeing the baby’s conditions made them feel that the baby might not survive, self-blaming or feeling guilt for what had happened, withdrawn from the baby and unable to go home with the new born baby, unable to sleep, lack of support and uncomfortable hospital environment to stay long for mothers newly gave birth. Participants highlighted the challenges facing them to deal with their emotional stress was insufficient or lack of skills on how to care and handle such small babies. There was lack of skills and knowledge to teach the skills to the mothers of pre-term babies on how to care for the baby, as well as there were negative attitudes of some healthcare providers. Some participants felt that their baby was treated differently than the others babies, and nurses were rude and unsupportive to them. This made the hospital environment unpleasant and boredom. Furthermore, participants expressed that there were no counselling services in the hospital for mothers undergoing through such stressful emotional trauma, and there was no freedom of movement for mothers such as going home and come back were not allowed.
Conclusion: Findings have shown that mothers of preterm babies undergoing through different emotional stresses and challenges, such as sadness, anxiety, guilt, withdrawn, lack of skills and support. The study has also revealed that although the support that have been received from their social circle and professional support was important to cope with the emotional stress, the available professional support, such as counselling, support group session and professional support were inadequate. Hence, it is recommended that mothers of pre-term babies need counselling services, group sessions with other mothers to share their experiences, support needs related to freedom of movement, such as to be allowed to visit home and comeback based on their other family responsibilities. Healthcare providers tasked with the responsibility of caring for mothers and their preterm babies in the neonatal care unit should be skilled and knowledgeable about these different support needs for mothers of preterm babies. This will make health care delivery to mothers of preterm babies more approachable, with understanding between mothers and health care providers thus making the event of preterm delivery less stressful. In this wise, mothers would be well supported to cope with emotional stresses, more infant care oriented and be more attached to their babies in a mother infant-bond. This will enhance good care of the baby by the mother which might prevent mother infant separation effects, illness and subsequent death of the baby. This research has the potential to add to the body of knowledge in the nursing and health field in general. Another research study of this nature at a larger scale could be conducted using a quantitative research approach to gain generalizability and to influence clinical practices.
