Suspended liminality: breastfeeding and becoming a mother in two NICUs

Abstract

<p><strong>Objectives:</strong> This paper presents the results of an ethnographic study of breastfeeding and mothers’ experiences within two neonatal intensive care units (NICU).</p><p><strong>Methods:</strong> The data collection involved 135 hours of participant observation over a 6-month period and semi-structured interviews of 17 mothers.</p><p><strong>Results:</strong> Data analysis showed that the mothers faced many obstacles that prohibited them from practicing breastfeeding within the NICUs, which impacted on their experiences as mothers. Their experiences were revealed as a developing process as their feeling changed from fearful and terrifying toward becoming and feeling like a ‘real’ mother. Four distinct themes emerged; the first highlighted the crisis, which involved the mother's feelings of emotional instability, their strategies for coping such as not visiting the baby, and recognition of the NICU as a stressful environment. The second theme described issues relating to control and power. This involved the perception of having a lack of control and needing to seek permission, the use of language as a mechanism for control, and mothers being placed in a subordinate role. The third theme related to the separation, which included difficulties of acceptance, feeling like stranger and not being important, and the need for physical closeness. The final theme, becoming a mother, included issues such as the special moments, breastfeeding as a turning point, and practical and informational needs.</p><p><strong>Conclusions:</strong> A finding suggests that mothers, who deliver prematurely, may have their rite of passage into motherhood interrupted, resulting in them being placed in a position of suspended liminality.</p>

“You Can Only Give Warmth to Your Baby When It’s Too Late”: Parents’ Bonding With Their Extremely Preterm and Dying Child

“…When physical contact is barely possible, child-parent interaction is relatively nonreciprocal. Shattnawi (2015) revealed that this physical distance is extremely stressful for mothers. Flacking et al (2006) illustrated how mothers felt "they had become mothers physically but not socially or emotionally" (p. 73).…”

“…First, studies show that parents who experience the birth of an extremely preterm baby do not feel mentally prepared for this situation (Hall, Kronborg, Aagaard, & Brinchmann, 2013). They enter a world foreign to them, encountering the NICU, with its sounds, incubators, wires, and tubes, as a highly technologized environment (Cleveland, 2008; Hutchinson, Spillett, & Cronin, 2012; Lundqvist, Nilstun, & Dykes, 2002; Shattnawi, 2015; Shin & White-Traut, 2007). This open space immediately “signal[s] life and death” (Flacking et al, 2006, p. 73).…”

Breastfeeding woman or lactating object? A critical philosophical discussion on the influence of Cartesian dualism on breastfeeding in the neonatal intensive care unit

“…While this physical separation may be considered a necessary standard of care by the institution and its providers, it represents a likely unconscious disregard for, and further separation of, the emotional needs of mothers and their infants in favour of their perceived overriding physiological needs (Dykes & Flacking, ). This separation also has direct repercussions on breastfeeding as it can delay and deplete milk creation (Shattnawi, ).…”

“…For parents of preterm (born ≤37 weeks’ gestation) or critically ill infants, an added layer of complexity is affixed to decisions around infant feeding. The subsequent admission to the neonatal intensive care unit (NICU) is typically unexpected and involves forms of medical intervention far beyond what is anticipated in the “typical” birth of a baby (Shattnawi, ). Breastfeeding and/or provision of expressed breast milk can take on a whole new meaning within the NICU environment.…”

Applying Feminist Poststructuralism as a Framework for Exploring Infant Feeding Interactions in the Neonatal Intensive Care Unit

“…The acuity and highly technical realm of the neonatal intensive care unit creates a complex environment for both care providers and families. Admission of a preterm and/or critically ill infant to the NICU is typically an unexpected event for parents (Shattnawi, 2015), posing unique stressors and altering the birthing experience from what is often anticipated in the days and months leading up to a 'typical' birth. Existing neonatal literature has established that the experiences of parents of preterm and/or critically ill infants differs from those of healthy, term infants and that NICU admission elicits feelings of heightened anxiety, emotional and psychological distress (Boykova, 2016;Bicking & Moore, 2012).…”