Suspended liminality: breastfeeding and becoming a mother in two NICUs

  • Authors

    • Khulood Kayed Shattnawi Jordan University of Science and Technology
    2015-08-29
    https://doi.org/10.14419/ijans.v4i2.4877
  • Breastfeeding, Preterm Infants, Mothers' Experiences, Neonatal Intensive Care Unit, Liminal, Jordan.

  • Objectives: This paper presents the results of an ethnographic study of breastfeeding and mothers’ experiences within two neonatal intensive care units (NICU).

    Methods: The data collection involved 135 hours of participant observation over a 6-month period and semi-structured interviews of 17 mothers.

    Results: 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.

    Conclusions: 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.

  • References

    1. [1] Ali, A.Y., 1989. The holy Qur'an: text translation and commentary. Amana Corp.

      [2] Barclay, L., Everitt, L., Rogan, F., Schmied, V. and Wyllie, A., 1997. Becoming a mother--an analysis of women's experience of early motherhood. Journal of advanced nursing, 25(4), pp. 719-728. http://dx.doi.org/10.1046/j.1365-2648.1997.t01-1-1997025719.x.

      [3] Baumiller, R., 2002. Spiritual development during a first pregnancy. International Journal of Childbirth Education, 17(3), p. 7.

      [4] Bialoskurski, M.M., Cox, C.L. and Wiggins, R.D., 2002. The relationship between maternal needs and priorities in a neonatal intensive care environment. Journal of advanced nursing, 37(1), pp. 62-69. http://dx.doi.org/10.1046/j.1365-2648.2002.02057.x.

      [5] Bourhis, R.Y., Roth, S. and Macqueen, G., 1989. Communication in the hospital setting: a survey of medical and everyday language use amongst patients, nurses and doctors. Social Science & Medicine, 28(4), pp. 339-346. http://dx.doi.org/10.1016/0277-9536(89)90035-X.

      [6] Browne, J.V., 2003. New perspectives on premature infants and their parents. Zero to three, 24(2), pp. 4-12.

      [7] Callister, L.C. and Khalaf, I., 2010. Spirituality in childbearing women. The Journal of perinatal education, 19(2), pp. 16. http://dx.doi.org/10.1624/105812410X495514.

      [8] Condon, L., Rhodes, C., Warren, S., Withall, J., and Tapp, A., 2013. ‘But is it a normal thing? ’Teenage mothers’ experiences of breastfeeding promotion and support. Health Education Journal, 72(2), 156-162. http://dx.doi.org/10.1177/0017896912437295.

      [9] Davis-Floyd, R., 1992. Birth as an American rite of passage. Berkeley London: Berkeley London University of California Press.

      [10] Davis-Floyd, R. E., & Sargent, C. F. (Eds.), 1997. Childbirth and authoritative knowledge: Cross-cultural perspectives. University of California Pr.

      [11] Fenwick, J., Barclay, L. and Schmied, V., 2001a. Struggling to mother: a consequence of inhibitive nursing interactions in the neonatal nursery. Journal of Perinatal & Neonatal Nursing, 15(2), pp. 49-64. http://dx.doi.org/10.1097/00005237-200109000-00005.

      [12] Flacking, R., Ewald, U., Nyqvist, K.H. and Starrin, B., 2006. Trustful bonds: A key to “becoming a mother†and to reciprocal breastfeeding. Stories of mothers of very preterm infants at a neonatal unit. Social science & medicine, 62(1), pp. 70-80. http://dx.doi.org/10.1016/j.socscimed.2005.05.026.

      [13] Flacking, R., Lehtonen, L., Thomson, G., Axelin, A., Ahlqvist, S., Moran, V.H., Ewald, U. and Dykes, F., 2012. Closeness and separation in neonatal intensive care. Acta Paediatrica (Oslo, Norway: 1992), 101(10), pp. 1032-7.

      [14] Gold, R.L., 1958. Roles in sociological field observations. Social Forces, 36(3), pp. 217-223. http://dx.doi.org/10.2307/2573808.

      [15] Griffin, T., Wishba, C. and Kavanaugh, K., 1998. Nursing interventions to reduce stress in parents of hospitalized preterm infants. Journal of pediatric nursing, 13(5), pp. 290-295. http://dx.doi.org/10.1016/S0882-5963(98)80014-6.

      [16] Hartmann, P.E. and Ramsay, D.T., 2005. Mammary anatomy and physiology. In: E. JONES and C. KING, Eds, Feeding and Nutrition in the Preterm Infant. London: Elsevier, pp. 53-68.

      [17] Herbst, A. and Maree, C., 2006. Empowerment of parents in the neonatal intensive care unit by neonatal nurses. Health SA Gesondheid, 11(3), pp. 3-13. http://dx.doi.org/10.4102/hsag.v11i3.232.

      [18] Holditch-Davis, D. and Miles, M.S., 2000. Mothers' stories about their experiences in the neonatal intensive care unit. Neonatal Network, 19(3), pp. 13-21. http://dx.doi.org/10.1891/0730-0832.19.3.13.

      [19] Hutchinson, S.W., Spillet, M.A. and Cronin, M., 2012. Parents’ Experiences during their Infant’s Transition from Neonatal Intensive Care Unit to Home: A Qualitative Study. The Qualitative Report, 17(23), pp. 1-20.

      [20] Kavanaugh, K., Meier, P., Zimmermann, B. and Mead, L., 1997. The rewards outweigh the efforts: breastfeeding outcomes for mothers of preterm infants. Journal of Human Lactation, 13(1), pp. 15-21. http://dx.doi.org/10.1177/089033449701300111.

      [21] Kearvell, H. and Grant, J., 2010. Getting connected: how nurses can support mother/infant attachment in the neonatal intensive care unit. Australian Journal of Advanced Nursing, 27(3), pp. 75-82.

      [22] Kenner, C. and McGrath, J., 2004. Developmental care of newborns & infants. Edited by Kenner C, McGrath JM.Mosby ed.St Louis MO, 63123.

      [23] Khalaf, I. and Callister, L.C., 1997. Cultural meanings of childbirth: Muslim women living in Jordan. Journal of Holistic Nursing, 15(4), pp. 373-388. http://dx.doi.org/10.1177/089801019701500405.

      [24] Kirkham, M. (Ed.), 2007. Exploring the dirty side of women's health. Routledge.

      [25] Kitzinger, S., 1987. The experience of breastfeeding. Penguin.

      [26] Landro, L., 2010. Taking Medical jargon Out of Doctors' Visits. [Online]. Available at: <http://online.wsj.com/article/SB10001424052748703620604575349110536435630.html#articleTabs%3Darticle>. [Accessed September 2012].

      [27] Lindberg, B. and Öhrling, K., 2008. Experiences of having a prematurely born infant: from the perspective of mothers in northern Sweden. International journal of circumpolar health, 67(5), pp. 461-71. http://dx.doi.org/10.3402/ijch.v67i5.18353.

      [28] Linhares, C.H., 2012. The Lived Experiences of Midwives with Spirituality in Childbirth: Mana from Heaven. JOURNAL OF MIDWIFERY & WOMENS HEALTH; J.Midwifery Women Health, 57(2), pp. 165-171. http://dx.doi.org/10.1111/j.1542-2011.2011.00133.x.

      [29] Lupton, D. and Fenwick, J., 2001. ‘They’ve forgotten that I’m the mum’: constructing and practising motherhood in special care nurseries. Social Science & Medicine, 53(8), pp. 1011-1021. http://dx.doi.org/10.1016/S0277-9536(00)00396-8.

      [30] Mahon-Daly, P. and Andrews, G.J., 2002. Liminality and breastfeeding: women negotiating space and two bodies. Health Place, 8(2), pp. 61-76. http://dx.doi.org/10.1016/S1353-8292(01)00026-0.

      [31] McInnis, R. and Chambers, J., 2008. Supporting breastfeeding mothers: qualitative synthesis. Journal of Advanced Nursing, 62(4), pp. 407-427. http://dx.doi.org/10.1111/j.1365-2648.2008.04618.x.

      [32] Mercer, R.T., 2004. Becoming a mother versus maternal role attainment. Journal of Nursing Scholarship, 36(3), pp. 226-232. http://dx.doi.org/10.1111/j.1547-5069.2004.04042.x.

      [33] Morse, J.M., 1991. Strategies for Sampling. In: J.M. MORSE, ed, Qualitative Nursing Research: A Contemporary Dialogue. London: Sage Publications, pp. 127-145. http://dx.doi.org/10.4135/9781483349015.n16.

      [34] Morse, J.M. and Field, P.A., 1996. Nursing research: the application of qualitative approaches. 2 edn. Thousand Oaks, Calif. London: Chapman and Hall. http://dx.doi.org/10.1007/978-1-4899-4471-9.

      [35] Mubaideen, M. and Al-Saraireh, M. R., 2006. Breast-feeding pattern in selected antenatal care clinics in jordan. JRMS, 13(2), pp. 74-78.

      [36] Nelson, A.M., 2003. Transition to motherhood. Journal of Obstetric, Gynecologic, & Neonatal Nursing, 32(4), pp. 465-477. http://dx.doi.org/10.1177/0884217503255199.

      [37] Oakley, A., 1974. The sociology of housework. Martin Robertson.

      [38] Obeidat, H. and Callister, L., 2011. The lived experience of Jordanian mothers with a preterm infant in the neonatal intensive care unit. Journal of Neonatal-Perinatal Medicine, 4(2), pp. 137-145.

      [39] Obeisat, S., Gharaibeh, M.K., Oweis, A. and Gharaibeh, H., 2012. Adversities of being infertile: the experience of Jordanian women. Fertility and sterility, 98(2), pp. 444-9. http://dx.doi.org/10.1016/j.fertnstert.2012.04.036.

      [40] Polkinghorne, D.E., 2005. Language and meaning: data collection in qualitative research. Journal of Counseling Psychology, 52(2), pp. 137. http://dx.doi.org/10.1037/0022-0167.52.2.137.

      [41] Redwood, T., 2007. Becoming a mother: a phenomenological exploration of transition to motherhood, its implications for the professional lives of nurses, midwives and health visitors, School of Nursing and Midwifery, University of East Anglia.

      [42] Roper, J.M. and Shapira, J., 2000. Ethnography in nursing research. Thousand Oaks, Calif. Sage Publications. http://dx.doi.org/10.4135/9781483328294.

      [43] Sachs, A. M. (2005). "Following the line": an ethnographic study of the influence of routine baby weighing on breastfeeding women in a town in the Northwest of England (Doctoral dissertation, University of Central Lancashire).

      [44] Schmied, V., & Lupton, D., 2001. Blurring the boundaries: breastfeeding and maternal subjectivity. Sociology of Health & Illness, 23(2), 234-250. http://dx.doi.org/10.1111/1467-9566.00249.

      [45] Shakespeare, J., Blake, F. and Garcia, J., 2004. Breast-feeding difficulties experienced by women taking part in a qualitative interview study of postnatal depression. Midwifery, 20(3), pp. 251-260. http://dx.doi.org/10.1016/j.midw.2003.12.011.

      [46] Skeggs, B., 1994. Situating the production of feminist ethnography. In: M. MAYNARD and J. PURVIS, Eds, Researching women's lives from a feminist perspective. Great Britain: Taylor & Francis Ltd, pp. 72-92.

      [47] Shin, H. and Whiteâ€Traut, R., 2007. The conceptual structure of transition to motherhood in the neonatal intensive care unit. Journal of advanced nursing, 58(1), pp. 90-98. http://dx.doi.org/10.1111/j.1365-2648.2006.04194.x.

      [48] Singer, L.T., Salvator, A., Guo, S., Collin, M., Lilien, L. and Baley, J., 1999. Maternal psychological distress and parenting stress after the birth of a very low-birth-weight infant. JAMA: Journal of the American Medical Association, 281(9), pp. 799-805. http://dx.doi.org/10.1001/jama.281.9.799.

      [49] Spencer, R. L., 2008. Research methodologies to investigate the experience of breastfeeding: a discussion paper. International Journal of Nursing Studies, 45 (12), 1823 - 1830. http://dx.doi.org/10.1016/j.ijnurstu.2008.04.008.

      [50] Stern, D.N. and Bruschweiler-STERN, N., 1999. The birth of a mother: how the motherhood experience changes you forever. New York: New York Basic Books.

      [51] Teather, E.K., ed, 1999. Embodied Geographies: Spaces, Bodies and Rites of Passage. London: Routledge.

      [52] Turner, V., 1967. Betwixt and Between: The Liminal Period in Rites de Passage. The forest of symbols: Aspects of Ndembu ritual. Cornell University Press, pp. 93-111.

      [53] Turner, V., 1969-last update, Liminality and Communitas: Form and Attributes of Rites of Passage [Homepage of London: Aldine,], [Online]. Available at: <http://faculty.dwc.edu/wellman/Turner.htm> [Accessed August 2012].

      [54] Turner, V., 1987. Betwixt and between: The liminal period in rites of passage. In: Mahdi, Foster and Little, ed, Betwixt and between: Patterns of masculine and feminine initiation,pp. 5-19.

      [55] Van Gennep, A., 1960. The rites of passage. London: Routledge & Kegan Paul.

      [56] Watson, G., 2011. Parental liminality: a way of understanding the early experiences of parents who have a very preterm infant. Journal of Clinical Nursing, 20(9), pp. 1462-1471. http://dx.doi.org/10.1111/j.1365-2702.2010.03311.x.

      [57] Wendling, G., 2008. Understanding Change through the Rites Of Passages Framework.

      [58] Yuen, E., 2011. Spirituality and the Clinical Encounter. International Journal for Human Caring, 15(2), pp. 42-46.

      [59] Zabielski MT, 1994. Recognition of maternal identity in preterm and fullterm mothers. Maternal-child nursing journal, 22(1), pp. 2-36.

  • Downloads

  • How to Cite

    Shattnawi, K. K. (2015). Suspended liminality: breastfeeding and becoming a mother in two NICUs. International Journal of Advanced Nursing Studies, 4(2), 75-84. https://doi.org/10.14419/ijans.v4i2.4877