The Influence of Space and Place on Parent-Baby Relationship and Feeding

in NICUs in Sweden and England

The Influence of Space and Place on Parent-Baby Relationship and Feeding

in NICUs in Sweden and England

Renée Flacking, RN, PhDSchool of Health, University of Central Lancashire;

School of Health and Social Studies, Dalarna University; Dep of Women’s and Childrens’ Health, Uppsala University

The preterm babyThe preterm baby

One year survival:One year survival:22 gw = 10%22 gw = 10%23 gw = 52%23 gw = 52%24 gw = 67%24 gw = 67%25 gw = 82%25 gw = 82%26 gw = 85%26 gw = 85%

45% - no sign of significant 45% - no sign of significant morbiditymorbidity

The EXPRESS Group. One-year survival of extremely preterm infants after active perinatal care in Sweden. JAMA. 2009; 301: 2225-33

Becoming a mother – in a NICU?

• Thrown into a situation not prepared for

• Experiences of loss

• Life on hold

• Thrown into a situation not prepared for

• Experiences of loss

• Life on hold

Percentage of infants born very preterm – Percentage of infants born very preterm – breastfeeding at dischargebreastfeeding at discharge

AimAim

To explore in-depth the breastfeeding/ feeding process in mothers of preterm infants at NICUs in Sweden and England, with a special focus on relationality.

Today: influences of space and place on relationships and feeding

To explore in-depth the breastfeeding/ feeding process in mothers of preterm infants at NICUs in Sweden and England, with a special focus on relationality.

Today: influences of space and place on relationships and feeding

Grounded in data?Grounded in data?

•2 Neonatal Intensive Care Units in each country

•11 months of fieldwork

•600 hours of observations – 300 hours of direct observations/interviews

•52 mothers, 19 fathers and 102 staff

•2 Neonatal Intensive Care Units in each country

•11 months of fieldwork

•600 hours of observations – 300 hours of direct observations/interviews

•52 mothers, 19 fathers and 102 staff

The WombThe Womb

• Complete ownership• No separation, no interruption• At-homeness• Ability to regulate socialising

Identity as a parent Enables a focus within Shared awareness → attunement

The WombThe Womb

“The big difference is that these parents care for their babies immediately after birth and then they move into a room and we have never interrupted the presence. They have a total togetherness. They never leave their infant, they take turns. It’s amazing.”

The Hotel RoomThe Hotel Room

• Negotiated ownership• Varying at-homeness• Door as a shield

against ”watchers” protects the infant facilitates a focus within enables reflection

The Hotel roomThe Hotel room

“I’ve had this room for 2 weeks now. It’s building my confidence up. Having them and getting to know the cues. So that I won’t be standing there when I come home and won’t have the nurses telling me that it’s time for a feed. I have them with me in the room all the time. It’s been invaluable. When I didn’t have the room, I felt distanced from them. I couldn’t be a proper career.”

A safe cornerA safe corner

• ”Ownership” of space/place• Type signals level of importance and expected presence

A safe cornerA safe corner

• ”Ownership” of space/place• Type signals level of importance and expected presence

A safe cornerA safe corner

• ”Ownership” of space/place• Type signals level of importance and expected presence

A safe cornerA safe corner

• ”Ownership” of space/place• Type signals level of importance and expected presence

A safe cornerA safe corner

• ”Ownership” of space/place• Type signals level of importance• Actual shield or not• Others ’entering’• Varying privacy• Intermittent ’focus within’• Socialization +/–

A safe cornerA safe corner

MB6 How’s it going?MB2 It’s going fine. She’s breastfeeding on demand now

and she’s gained weight. How’s it going for him?MB6 He has just started to suck… he’s not breastfeeding on demand.. MB2 And they were born practically at the same time, weren’t they?MB6 Yeah, but boys are a bit slow aren’t they.”

A musical chairA musical chair

• No ownership → subordinated visitor• No door

Everyone can ”see” you No focus within Less socialization

A musical chairA musical chair

“It’s difficult with breastfeeding ’cause the mums aren’t here that much and they need to be here…with their breasts…to make it happen. But they’re not. A lot of mums have a lot of social problems. And they have older children at home…. And they haven’t established a relational bond. They’ve had their ‘mothering’ interrupted and they don’t feel it’s their baby. They might think they’re in the way and there isn’t really a place for them. They don’t even have comfy chairs. So it’s not easy.”

ImpactsImpacts

• Support for relational aspects of feeding• Feeding part of mothering• Feeding not only nutrative but relational• Supportive care routines

“In breastfeeding – there is everything. Worries, fear, love, joy, sadness, the present... the physical closeness that has so many expressions. But also hopes, future, but most of all love and non-demanding. The love that doesn’t demand anything back. If a mother at this unit has the chance to see her baby and feel trust in herself, then we’ve enabled the start of the bonding. Breastfeeding starts when the father carries the baby to the unit or when they can take care of their baby the first day and we stand behind, but not too close. It’s such things that sticks with you and facilitate the bonding. It’s a process.

When you talk about breastfeeding you talk about emotions…

Emotions affect everything, the rest happens as a result!”

“In breastfeeding – there is everything. Worries, fear, love, joy, sadness, the present... the physical closeness that has so many expressions. But also hopes, future, but most of all love and non-demanding. The love that doesn’t demand anything back. If a mother at this unit has the chance to see her baby and feel trust in herself, then we’ve enabled the start of the bonding. Breastfeeding starts when the father carries the baby to the unit or when they can take care of their baby the first day and we stand behind, but not too close. It’s such things that sticks with you and facilitate the bonding. It’s a process.

When you talk about breastfeeding you talk about emotions…

Emotions affect everything, the rest happens as a result!”