Resilience in Mothers of Very-Low-Birth-Weight Infants Hospitalized in the NICU.

OBJECTIVE: To develop the theme of Resilience of mothers of very-low-birth-weight infants in the NICU from a qualitative study on maternal role attainment. DESIGN: Secondary analysis using retrospective interpretation, that is, the further development and refinement of content related to resilience that was identified in the original data. SETTING: A tertiary NICU in Chicago. PARTICIPANTS: Twenty-three English-speaking, predominantly single (74%), minority (Black [57%], Hispanic [17%]), low-income (78%), primiparous (78%) mothers of very-low-birth-weight infants. METHODS: Narrative analysis and core story creation were used to analyze the data related to resilience. A narrative of each participant's birth and NICU story was constructed and recurring meanings were analyzed. Identified patterns were compared across narratives to create one coherent core story that synthesized themes common to all stories. RESULTS: Participants found meaning in redefining their priorities to become advocates for their infants and to "pick themselves up for their babies" by using resources that actively promoted their mental health. NICU-based breastfeeding peer counselors and bedside nurses helped guide participants through their NICU experiences, provided support so participants could gain confidence and competence, and allowed participants to cope with their long-term psychological distress. CONCLUSION: Participants demonstrated resilience as they learned to live with what was beyond their control. NICU nurses are ideally positioned to capitalize and expand on mothers' health-promoting strengths, resources, and coping strategies to help them further decrease their NICU-related stress and better integrate mothering behaviors into their lives long after NICU discharge.

Depression, anxiety, and perinatal-specific posttraumatic distress in mothers of very low birth weight infants in the neonatal intensive care unit.

OBJECTIVE: To compare the trajectories and determine the predictors of maternal distress defined as a continuous spectrum of symptomatology and elevated symptomatology, of depression, anxiety, and perinatal-specific posttraumatic stress (PPTS), in mothers of very low birth weight (VLBW) infants throughout the neonatal intensive care unit (NICU) hospitalization. METHOD: Sixty-nine mothers completed psychological questionnaires within the first month of their infant's NICU hospitalization and again 2 weeks before NICU discharge. Multiple regression models determined maternal psychological, reproductive, sociodemographic, and infant medical predictors of maternal distress. RESULTS: Perinatal-specific posttraumatic stress remained stable throughout the NICU hospitalization, whereas other aspects of distress declined. Previous psychological history and infant medical variables predicted higher PPTS but no other aspects of distress. Reproductive variables predicted anxiety and PPTS; history of fetal loss initially predicted lower PPTS but throughout hospitalization primipara status emerged as a predictor of higher anxiety and PPTS. Sociodemographic variables predicated initial, but not later, depressive distress. CONCLUSIONS: Psychological screening is important in the NICU. The PPTS profile suggests it may require distinct treatment. Primiparas should be targeted for intervention.

"I have faith in my milk": the meaning of milk for mothers of very low birth weight infants hospitalized in the neonatal intensive care unit.

BACKGROUND: Mothers who deliver a premature infant often choose to provide milk because it is the "one thing that only the mother can do" to optimize her infant's outcome, helps mothers feel a connection with their infants, and helps relieve the guilt associated with the preterm birth. OBJECTIVE: The purpose of this study was to describe the meaning of milk for mothers who are providing milk for their very low birth weight (VLBW; < 1500 g) infants hospitalized in the neonatal intensive care unit (NICU). METHODS: Using a qualitative descriptive design, in-depth semistructured interviews were conducted with 23 mothers of VLBW infants hospitalized in a level III NICU. Mothers were asked to share their perceptions about what providing milk meant to them. RESULTS: Mothers had faith in the healing properties of their milk and equated providing milk with "giving life" to their infants, mitigating the effects of complications, keeping their infants healthy and stable, and helping themselves address the feelings of failure and guilt associated with the premature birth. Mothers' faith in their milk to achieve these outcomes was a maternal motivator to continue pumping, even for mothers who had not intended to provide milk or who experienced the paradox of disliking pumping but wanting to provide their milk. CONCLUSION: The experiences of these mothers reflect the importance of acknowledging mothers' faith in the healing properties of their milk as a motivating factor for sustaining lactation while coping with the stress and anxiety inherent during the infant's NICU hospitalization.