A qualitative study: Mothers of late preterm infants relate their experiences of community-based care

Abstract

PurposeIn Alberta, the high occurrence of late preterm infants and early hospital discharge of mother-infant dyads has implications for postpartum care in the community. Shortened hospital stay and complexities surrounding the care of biologically and developmentally immature late preterm infants heighten anxiety and fears. Our descriptive phenomenological study explores mothers’ experience of caring for their late preterm infants in the community.MethodsEleven mothers were interviewed using a semi-structured interview guide. Interview transcripts were analysed using an interpretive thematic approach.FindingsThe mothers’ hospital experience informed their perspective that being a late preterm infant was not a “big deal,” and they tended to treat their infant as normal. “Feeding was really problem,” especially the variability in feeding effectiveness, which was not anticipated. Failing to recognize late preterm infants’ feeding distress exemplified lack of knowledge of feeding cues and tendencies to either rationalize or minimize feeding concerns. Public health nurses represent a source of informational support for managing neonatal morbidities associated with being late preterm; however, maternal experiences with public health nurses varied. Some nurses used a directive style that overwhelmed certain mothers. Seeing multiple public health nurses and care providers was not always effective, given inconsistent and contradictory guidance to care. These new and changing situations increased maternal anxiety and stress and influenced maternal confidence in care. Fathers, family, and friends were important sources of emotional support.ConclusionAfter discharge, mothers report their lack of preparation to meet the special needs of their late preterm infants. Current approaches to community-based care can threaten maternal confidence in care. New models and pathways of care for late preterm infants and their families need to be responsive to the spectrum of feeding issues encountered, limit duplication of services, and ensure consistent and effective care that parents will accept.

Breastfeeding the late preterm infant: experiences of mothers and perceptions of public health nurses

“…This article will focus on breastfeeding practices. Other results of our study can be found elsewhere [23]. Mothers completed a questionnaire about maternal characteristics at delivery, infant characteristics, and demographic information.…”

Supporting Public Health Nurses with Breastfeeding Interventions for Late Preterm Infants

“…Due to the nature of the Delphi technique, that comments are used to build consensus, study participants were informed that if they chose to withdraw from the study, data cannot be removed. We employed a "real-time" Delphi, in which multiple rounds were compressed to occur over several meetings [24]. We used three rounds of questioning.…”

“…Each round provided an opportunity for the experts to respond to and revise their answer in light of other group members' previous responses. Over multiple rounds, the process gradually led to consensus or near-consensus [24]. After the Delphi rounds AD ensured all current literature was included until saturation was reached and critically synthesized the information according to systems and important concepts.…”

“…GC and a research assistant gathered and collated information available in the literature. We used a modified Delphi approach to define the issues and important concepts related to LPIs and feeding, order issues by importance, determine priorities, and identify best practices [24]. This method is commonly used to "obtain the most reliable consensus of opinion of a group of experts" [25].…”

Contexto da atenção pré-natal na prematuridade tardia [Context of antenatal care in late prematurity] [Contexto de la atención prenatal en la prematuridad tardía]

“…Um atendimento pré-natal qualificado faz-se necessário para que as gestantes de risco sejam identificadas, minimizando possíveis complicações 10 . A relevante concentração de nascimentos prematuros na faixa de idade gestacional entre 34 semanas e 36 semanas e 6 dias, os denominados prematuros tardios 8,19 , configura-se como uma problemática tanto em relação a maior morbidade, como também ao fato de que frequentemente esses bebês recebem cuidados de saúde usuais 20 . Embora equivocadamente sejam percebidos como um grupo com baixo risco para intercorrências, os prematuros tardios representam índices significativos de morbimortalidade quando comparados ao dos nascimentos à termo 21,22 .…”