A Phenomenological Study of the Lived Experiences of Mothers and Healthcare Professionals Caring for Preterm Babies in Abuja, Nigeria

A Phenomenological Study of the Lived Experiences of Mothers and Healthcare Professionals Caring for Preterm Babies in Abuja, Nigeria | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article A Phenomenological Study of the Lived Experiences of Mothers and Healthcare Professionals Caring for Preterm Babies in Abuja, Nigeria Igoche David Peter, Ayomide Oshagbami, Jemimah Kuyet Danjuma-Karau, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4359884/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background and Objectives : The survival of preterm infants and the mental health of their mothers have attracted global health concerns. The present study explored the lived experiences, challenges, and coping strategies of mothers with preterm infants and those of healthcare professionals attending to the preterm infant-mother dyad in Abuja, Nigeria. Methods : A qualitative research design using an interpretative phenomenological approach with semistructured interviews was used. Purposively sampled participants (10 mothers, 5 pediatricians, and 5 nurses) were recruited from Limi Children’s Hospital, Abuja, Nigeria, until data saturation was reached. The data were audio recorded and transcribed using TurboScribe.ai â software. Codes were manually generated, and themes were formed and analyzed using inductive content analysis. This study followed the consolidated criteria for reporting qualitative research. Results : Overall, this was an emotionally and physically stressful experience for mothers of preterm infants and healthcare professionals caring for premature babies. Five major themes determining the lived experiences of participants emerged: 1) experience as a spectrum; 2) how we coped; 3) how we supported the mothers; 4) meaning drawn; and 5) suggestions for improvement. Conclusions : Mothers of preterm infants and attending healthcare professionals face diverse challenging lived experiences that are both physically and psychologically demanding. Apart from extended family and healthcare professionals’ support, religion was found to play a significant role in the coping strategies adopted by these mothers. Healthcare professionals should pay attention to the mental health of mothers of preterm infants and prioritize empathy with effective communication during care for the preterm infant–mother dyad. Preterm infant Mothers lived experiences coping strategies phenomenological study. Figures Figure 1 Introduction Preterm birth is a potentially stressful and unexpected life event for mothers, and this is further compounded by several associated immediate and delayed morbidities [ 1 ]. In addition to preterm birth being a significant stressor, having their babies hospitalized for weeks in a neonatal unit with limited access, coupled with the need to adapt to changing responsibilities, is an unanticipated event for which mothers are usually ill prepared. It has been reported that parents who have preterm infants admitted to the newborn intensive care unit view this as a traumatic event for the family, and they experience stress, anxiety, and depressive symptoms, especially during prolonged NICU stays with highly limited parent–infant contact, in addition to their frequent expression of dissatisfaction with the peculiarities of care rendered [ 2 , 3 ]. Despite the multifaceted challenges experienced by mothers and healthcare providers caring for premature babies, it is still possible to attain avoidable mortality for them and enhance the quality of life of their mothers if we understand the experiences and challenges they face in Nigeria, where newborn death rates are unacceptably high. Although the pediatric healthcare team is primarily responsible for the care of premature babies, to the best of the authors’ knowledge, what they know about these psychologically fragile mothers and how holistic the care can be delivered by medical and nursing teams via a patient-centered approach are largely unexplored areas. This study explored maternal and health professionals’ experiences, challenges, and coping strategies in caring for premature babies from birth to the first few months of life in the Nigerian context. To date, there is a paucity of exploration of maternal challenges with preterm newborn care in Nigeria, and none at all from the perspective of healthcare professionals. Materials and methods Study Design- This study used a qualitative interpretative approach to explore the lived experiences and challenges of mothers with preterm infants and healthcare professionals (Pediatricians and Nurses) caring for these babies managed in a neonatal intensive care unit in Abuja, Nigeria. Semi structured in-depth face-to-face interviews were conducted to explore the study objectives. The consolidated criteria for reporting qualitative research (COREQ) checklist was used for this study [4]. Study Population and Study Site- This research was undertaken at The Limi Children’s Hospital, a center with a newborn care facility for preterm babies in Abuja, FCT, Nigeria. The participants included mothers, pediatricians, and pediatric nurses who were caring for living preterm infant(s) managed in the neonatal intensive care unit of the study institution. Inclusion criteria Primary caregiving mothers aged 18 years and above whose babies were delivered at <37 weeks of pregnancy and hospitalized in the NICU. A medical practitioner with postgraduate specialization in Pediatrics and registered nurses who currently treats preterm babies. The exclusion criterion was mothers whose preterm babies died. Mothers with an established prepregnancy history of mental illness Foster/adopting mothers. Sample Size and Sampling Techniques- Participants (10 eligible mothers, 5 Pediatricians and 5 Nurses working in the newborn section who have cared for preterm babies at the same institution for at least 6 months) were recruited through purposive sampling until the data reached theoretical saturation (i.e., no new themes were identified via successive interviews). Purposive sampling, a nonprobability sampling strategy used for this study that is common to qualitative research, is based on the premise that the researcher is knowledgeable about the study concept and is hence able to identify and recruit suitable participants. Data Collection for the Study- Baseline data of preterm babies were obtained from hospital records. Researchers conducted in-depth interviews with mothers, pediatricians and nurses. Ethical Considerations- This study adhered to both local and international Good Clinical Practice (GCP) requirements. Ethical approval was obtained from the Institutional Review Board (IRBs) with ethics clearance number LIMI/REC/2024/001. Data Analysis Procedures- All interviews were audio recorded and then transcribed using TurboScribe.ai â software. Hermeneutic (interpretative) phenomenological analysis was performed manually using six steps as outlined by previous scholars [5,6]. Results In March 2024, 20 subjects were approached, and they agreed to participate in this research (10 mothers, 5 pediatricians and 5 nurses). The interviews were conducted in a quiet consulting room in the hospital. The sociodemographic and physical characteristics of the mothers and their preterm infants and the demographic characteristics of the healthcare professionals are given in Tables 1 and 2, respectively. The mean maternal age was 30 years (SD=7); most mothers delivered by Cesarean section, and all were currently married. A majority (53.8%) of the preterm infants were born between 28 and <32 weeks of gestation. The pediatricians and nurses interviewed had 15 years (SD=3) and 8 years (SD=4) of experience, respectively, and 40% of these nurses had basic pediatric nursing qualifications. Table 1: Sociodemographic and physical characteristics of the mothers and their preterm infants Mothers n(%) Age; mean (SD) 30yrs (7) Marital status Currently married; n (%) Single parent; n (%) 10 (100) 0 (0) Mode of delivery Cesarean section; n (%) Vaginal; n (%) 8 (80) 2 (20) Maternal medical condition Pregnancy induced hypertension; n (%) Malaria; n (%) Others; n (%) Nil known; n (%) 5 (50) 1 (10) 0 (0) 4 (40) Type of pregnancy Singleton; n (%) Multiple; n (%) 7 (70) 3 (70) Birth experience First time mother; n (%) Previous preterm birth; n (%) Previous term birth; n (%) 7 (70) 1 (10) 2 (20) Religion Christianity; n (%) Islam; n (%) 10 (100) 0 (0) Preterm baby n = 13 Gender Male; n (%) Female; n (%) 5 (38.5) 8 (61.5) Gestational age classification of prematurity Extremely preterm (<28 weeks); n (%) Very preterm (28 to <32 weeks); n (%) Moderate to late preterm (32 to 37 weeks); n (%) 4 (30.8) 7 (53.8) 2 (15.4) Duration of NICU stay; mean (SD) 30 (15) Table 2: Demographic characteristics of the health care professionals Pediatricians n= 5 Years of experience; mean (SD) 15 (3) Gender Male; n (%) Female; n (%) 2 (40) 3 (60) Nurses n= 5 Years of experience; mean (SD) 8 (4) Gender Male; n (%) Female; n (%) 0 (0) 5 (100) Post basic nursing qualification. Pediatric nurse; n (%) Registered nurse; n (%) 2 (40) 3 (60) Five major themes (with associated subthemes) were identified from the exploration of mothers’ and healthcare professionals’ experiences and challenges in caring for preterm infants: 1) experience spectrum, 2) coping, 3) supporting mothers, 4) meaning drawn, and 5) suggestions for improvement. Figure 1 is displaying the thematic analysis map, and the themes are described below. Theme 1: Experience as a spectrum This theme centered around the spectrum of experience and challenges of the study participants, as it relates to the care of preterm newborns spanning from a stay in the NICU to transitioning to a private ward where mothers nurse their preterm infants under nurses’ supervision to discharge home and encounters in the immediate post discharge weeks of life. This theme has 6 subthemes, each with various minor themes. Subtheme i: Emotional roller coaster Eighteen participants, including all mothers with 4 nurses and Pediatricians each, described their feelings of unease with preterm infants nursed in the NICU, with restrictions on caregiver access. Just after the joy of safe delivery, I was told that I was going to leave my preterm twins in the NICU. I did not understand it because it was new to me… what was in my head was how I would leave my babies in the hands of strangers. I know it is a hospital, fine, but in hospitals, I know that you stay with your child to nurse the child so that is how I felt. It was not an easy decision. [M. El] Therefore, it has been a roller coaster. The down times where we lose a preemie after bonding with them, that is very heart-breaking. Sometimes I cry. Even when I get home, I will be thinking about the baby, feeling down, you know. However, it is also a very nice experience. I feel happy when I see a NICU baby going home, a premature baby going home after all this rollercoaster, up and down and everything. Therefore, it has been a wonderful experience. [N. Je] A total of ten mothers and two pediatricians reported the regular occurrence of mothers crying when they had their usual first and only opportunity to sight their preterm infants who were nursed in the incubator at the NICU. Certain mothers were moved to tears inside the NICU because they felt that the baby was too “tiny”. Imagine, apart from the day of birth, I did not see her until four days after I left the hospital since I delivered through the emergency CS. The next time I saw my baby in the NICU, I cried because considering her weight at birth and seeing her now, she had already lost more weight. [M. Ta] Two Pediatricians felt that the mothers cried because they were going through a lot, which is sometimes associated with emotional outbursts. You see them crying. They can easily burst into tears, and they can easily pick offenses in nurses, nurses, nurses, doctors, or whatever. [D. Ke] Six mothers felt guilty, imagining that preterm birth may have been their fault: some wondered what they would have done differently to avoid this prematurity, while others felt bad bringing forth a helpless baby just to face “punishment in life”. He was so tiny; I could see his ribs from his skin, and I felt like why did I have to punish this baby like this? I just felt so guilty, like I brought him to be stressed, and he looked so helpless. [M. Tr] This was a traumatizing experience for all mothers with preterm newborns for several reasons. Because caregivers have restricted access to their babies in the NICU, phone calls were made by nurses to the mothers to give updates and make requests for things such as expressed breastmilk, diapers, etc. Such calls were traumatic and greeted with fear of the unknown (M. Cy.). Subtheme ii: Period of uncertainties Thirteen participants described the mothers’ feelings of uncertainty expressed through numerous unanswered questions mostly bothering on chances of survival of their preterm infant. The day the baby came forth, I was like, God, why did this happen to me? Like, is my world different? Is my world different? I was like, will the baby survive? Because I have not heard before that you can give birth to a 27-week baby, and it will survive. [M. Ju] Other first-time mothers expressed their uncertainties and had questions about the fate of subsequent deliveries. As a preemie mother, you get to think, if this is your starting point. You begin to worry for the next one. Therefore, I think that is the disadvantage I have. I will not say disadvantage, everything's an advantage that he came first. Now I'm thinking, is there something that might reoccur with the other ones, you know? [M. Tr] Uncertainties related to the ability to take care of preterm babies were reported by 11 participants, including mothers and nurses. The fact that these babies are tiny and fragile evokes worry about the ability of mothers and nurses, who are the immediate caregivers, to handle them without causing harm. They fear that the baby may fall from their hand, or they may even break the baby’s bones. At first, I was like, how will I carry her? She's too small. Ah, my baby is small. I was scared if she would fall from my hand. Or sometimes I would ask my nurses, how are you holding her? I cannot even carry her. [M. Ta] Subtheme iii: Reality is different. Because the reality of having a premature baby differs from what these mothers imagined prior to delivery, these mothers saw these differences as a new normal. Five mothers revealed the difference between their intentions of exclusive breastfeeding and the reality of not keeping up with the demands of expressing breastmilk for the needed 2-hourly interval infant feeding. I had the intention that I would do exclusive breastfeeding and brag about it. However, it is easier said than done. Because with my preterm baby, at the point, I was not lactating properly because of the stress and everything. So I had to switch to formula. However, that did not stop me from breastfeeding. I was still breastfeeding too, but not as much as before, and this was not what I imagined. [M. Ta] The wealthier mothers had to come to terms with having their babies in Nigeria against their concluded plans for delivery abroad. What I was thinking of spending a lot of money on was to travel and have him abroad. However, when the baby came very suddenly, traveling was not even an option. Now that we're putting him at risk, if we had to travel, so looking at how much we have spent, you know, it is nothing compared to him. [M. Tr] Subtheme iv: Stressful moments Three pediatricians reported different levels of stress, some related to their interaction with their mothers and others related to the medical care given to premature babies. Therefore, in my experience, taking care of these babies, some of these babies have a smooth ride through their stay. Some also have very turbulent times. In addition, so of course, when it is turbulent like that, even for you, the healthcare worker, though you're not the mother. [D. Ch] Some, for the late preterm ones, it could be a very happy one, a very pleasant experience. However, for extreme preterm infants, it could be very stressful for both healthcare workers and mothers while in the NICU and even thereafter. You can agree with me that the experiences differ from baby to baby, from mother to baby. [D. Nw] Ten participants revealed that stressed mothers pass through to produce enough breast milk to feed their preterm babies. Additionally, coping with the two hourly feeding schedules with a cup and spoon was stressful for all the mothers. One of my major challenges was the fact that I was not having, I was not truly letting milk like I did in my first pregnancy. I do not know if it is because of CS or because the baby is not being able to, I cannot put the baby to breast. [M. An] While feeding my baby through using a cup and spoon, sometimes she has not even finished, and then there is another two hours turn for feeding. You will be feeding her two hours! [Exclaims] The nurses will say, it is time to feed baby. Another two hours, like, the world was like, sometimes I will cry myself. I will be like, hey, this job is not easy. I will ask myself questions. Why is all this happening to me? I will be crying. [M. Ju] All the mothers complained that their sleep was adversely affected while caring for their preterm infant. I had a challenge with waking up every two hours to feed my baby because I'm not that kind of person. I love my sleep. Therefore, she needs to eat to gain weight while trying to wake up every two hours. Honestly, waking up every two hours is stressful. [M. Cy] Subtheme v: Personal health issues Five mothers and a pediatrician reported that poor maternal health compounded the already challenging experience of caring for their fragile babies. Because most of them were delivered by Cesarean section, the occurrence of poor wound healing made the already stressful environment more stressful. I had CS, so I was healing. I did not heal well, so I still got readmitted. [M. Tr] Other ailments, such as the preexisting medical conditions that led to preterm delivery, were heath conditions that some of the mothers were battling with. Apart from the emotional and physical stress associated with caring for their preterm birth, some mothers had preexisting medical conditions that led to preterm delivery. Since some were still hospitalized, having to come often to see their babies took a toll on their own health. [D. Ch] Subtheme vi: Leaving the NICU As part of the hospital protocol, when preterm babies stabilize to a certain weight, they leave the NICU to stay with mothers who are personally involved in the care process and are supervised ahead of their final home. Whereas the news of leaving the NICU is considered good news by all mothers, others were initially agitated about this but gained proficiency over time. When we tell them we are bringing your baby out from the NICU to the ward, you hear the excitement in their voice. [N. Je] Even at the time I left the NICU to the house yeah if I had the resources, I would have opted to pay for a home service nurse to follow me to the house to help me watch me for like a week or two to just see what I am doing. [M. Os] Theme 2: How we copped Different coping strategies were used by different mothers, some alone and others in combination. This theme has three subthemes: sources of strength, extended family support, and support from doctors and nurses. Subtheme i: Sources of strength Interestingly, all the mothers drew strength to cope through this stressful experience of caring for a preterm infant, albeit from different sources. Believing and claiming bible promises was a source of inspiration for most of them since all mothers in this study were of the Christian faith. Therefore, I was comforting myself with the word of God [M. Ta]. I literally hear in my head in my spirit that she will be fine. That was great comfort for me. Therefore, I can say that God, one, I did a lot of praying and thank God for God's mercy. I prayed and got some relief, you know, before I could say that, okay, I felt better. [M. An] Subtheme ii: Extended family support Extended family support was reported by eight mothers. The support of spouses, grandparents and in-laws was a recurrent source of support through the challenging experience of preterm care. I had a very strong support system. My husband was there. My mother-in-law was there. We made a good team. [M. Ta] Subtheme iii: Support from doctors and nurses A report from six of the mothers revealed that doctors and nurses caring for their premature infants were also very supportive of them. …the helping hands, I got through nurses when I was in the ward. The teaching they gave me, it helped me a lot. In addition, I followed what they said. [M. Ju] Theme 3: How we supported the mothers. Nine healthcare professionals expressed how they supported these mothers through the stressful experience of nurturing a premature baby. So personally, when I see the mothers are a bit scared, I tend to carry the babies and place them on the mother's chest. I do not mind sitting down with the mother and watch her feed for approximately 30 minutes. Just to enable her to know that these things are what she needs to do. [N. Cy] Normally , we introduce Kangaroo Mother Care. Nature has its own, because the bonding, flesh to flesh, baby is lying on the mother's chest, there is this attachment. That, I believe, has contributed most to the bonding of the child. [N. Ke] Theme 4: Meaning drawn. Mothers’ lives influence their interpretation of the entire experience of having and caring for a premature baby. They saw and understood the realities of life in a new dimension and learned some virtues. Subtheme i: Realities of life Ten mothers drew lessons from the new realties and experiences in caring for their babies. Again, because all mothers studied are Christians, the reference to God’s preference for one’s proposal was a recurring theme. What you propose for yourself may not be what God wants. He has given you what He wants, and it will be better. Therefore, you must be strong. [M. Ju] Sometimes, how you think life should go is not with how it seems. You can plan your way, but God's plan for you is always different. Therefore, life happens, and you face it head on. Like they say, when life gives you lemons, make lemonade out of it. Therefore, you think it has happened, it has happened. Therefore, you do not have to face life squarely. [M. Ta] Subtheme ii: Virtues learnt. Nine mothers discussed virtues they had taken from the experience of caring for their preterm newborns. Seven of the mothers explained that the virtues of patience and optimism were nonnegotiable in caring for special gifts such as preterm babies. Being with a preterm baby is all about patience. You need patience with them… you need more patience and diligence to be able to handle them because they are special. They are very special from God, and you need patience to handle them. [M. Ta] Now I know I can go through anything with a positive mind and scale through it. In my wildest dream, I never imagined I will give birth and spend weeks in the hospital and go through all the processes of the NICU, having to go home and come back. My first child was… she was 4.2 kg, she was big, we went home, and the next day, we started feeding, unlike this patient. [M. El] Theme 5: Suggestions for improvement Since all participants had their own share of challenges with caring for preterm infants, they had suggestions that would improve their care experience for the mother-infant dyad. Subtheme i: Improved communication and focused enlightenment Eighteen participants stressed the need for improvement in the existing practice of communication between the healthcare team and the mothers of preterm infants, as this may be appropriate. …what I'm still saying is that communication, letting them know what they are expected to do. …if you are communicating with them and allowing them also to express their mind, their feelings, their unsaid fears, and concerns, and being able to put them through based on the information. [N. Ke] Subtheme ii: Need for mental health support. The need for mental health support was echoed by 12 study participants due to the prolonged use of an emotional roller coaster, the reality of depression among them and the fact that the experience itself is traumatic. Therefore, I think mental support is very, very needed because sometimes mothers are depressed. Yes. You're depressed and you're thinking about yourself. Your CS scar is not healing, and you are thinking about your baby's pain at that point in time. Therefore, I think mental support from healthcare professionals is very, very important for mothers. Yes. [M. Ta] Then, I was away from people for a long time. I for me, it was more like, I'm just trying to be sane. Like I went through something traumatic. In addition, it is not everyone you can tell that this is what happened. Therefore, the wisdom to even manage that is stressful. [M. Tr] Subtheme iii: Enabling ecosystem. Two of these mothers wish that employers of labor understand that the duration of maternity leave for preterm births should be longer than what is available for term deliveries. I think that Nigeria needs to have like a rule that protects mothers who have premature babies, maybe an extended period from work because our cases are different. Therefore, the few months that you would normally give mothers of term babies will never be enough for a mom who has a premature baby because our time is different; the way we count it, the actual dates are completely different. [M. Tr] Interestingly, there is a need for a community of mothers who have successfully cared for a preterm baby, as this will encourage the sharing of experiences and serve to encourage new preemie mothers. Another thing that I think can be helpful is to have a vocal preemie mom community in Nigeria. Therefore, many people end up feeling alone through the process because everybody is hiding what they went through. It would have been nice if there was a community of mothers who had gone through it. Therefore, nothing would seem, you would be more relaxed because you would see evidence that you can go through it and come out fine. [M. Tr] Subtheme iv: Empathy from the healthcare team Six mothers cited the need for a supportive and encouraging attitude of nurses to help them sail through the challenging experience of caring for a preterm newborn. Because the nurses, like I'd stop them when you need something and sometimes I wish they would view it from this angle of “I'm new to this”, “I do not know anything”, I'm not just trying to make you repeat yourself, I just would rather be safe and have my baby alive even if it means I have to ask you a million and one questions”. [M. Tr] I feel it boils down to the attitude of the health care worker in terms of friendliness and empathy. [N. Ke] Discussion The themes developed in the present study are in tandem with the observations made by several scholars, albeit with some unique contrasts. For instance, previous studies have consistently identified the emotional stress associated with caring for preterm infants, and this experience has been linked with a myriad of expressions. In contrast to the pleasant care experience of mothers’ preterm infants observed by Russell et al. [ 7 ] in Southeast England, where no limit is imposed on maternal access to the NICU, all mothers in the present study lamented the uneasy feelings they had, as they could not see or be with their newborn baby, as they wished, as was reported in several other studies [ 2 , 3 , 8 ]. This widely practiced restricted access of mothers to preterm newborns has been shown to have a negative impact not only on immediate maternal mental health but also on the mother–infant dyad in the long run; in their study on the association of a zero-separation neonatal care model with stress in mothers of preterm infants, van Veenendaal et al. [ 9 ] showed that mothers of preterm infants experienced less stress at discharge when there was no separation between the mother and her preterm newborn compared with the standard neonatal care model with limited or restricted maternal access to her baby. Their study revealed that when the preterm infant and her mother were nursed together, the mothers were more present and participated more in neonatal care, and this was found to be associated with improved mental health outcomes, including less depression, better bonding of the mother-preterm infant dyad, and greater self-efficacy. For most of the mothers in the present study, as similarly reported by Pinar and Erbaba [ 1 ], motherhood commenced on a difficult note, with the restriction of access to their babies triggering considerable emotional stress, as these mothers felt detached from their babies, thus confirming the finding of van Veenendaal et al. [ 9 ]. This experience was worse among mothers who had never had previous preterm birth experience. Similar observations were reported by Abuidhail et al . and Yu et al. [ 2 , 3 ], among others, and this may not be unrelated to their naivety. In the present study, 60% of the mothers reported experiencing anxiety with guilt, supposing that they contributed to the “suffering” tiny baby whom they were unable to help. Schmücker et al. [ 10 ] suggested that maternal anxiety, among other factors, may be an outcome of conventional practices, with hospitals dictating the care of preterm infants and disrupting normal maternal-infant care routines, resulting in a maternal care gap that arouses uncertainty about infants’ survival. Interestingly, similar feelings were reported among mothers of preterm babies by other researchers [ 3 , 11 , 12 ]. Additionally, the mothers in the present study uniformly confirmed that the experience of caring for their preterm infant was altogether traumatizing and hence their crying at the first opportunity to sight their babies inside the incubator. Similar to the observations of Pinar and Erbaba [ 1 ] among Turkish mothers, some of these mothers cried because they felt that their babies had emaciated compared with what they saw at birth, coupled with their feelings of guilt and fear that they may be incapable of caring for their “fragile” newborns. At the same time, mothers had numerous unanswered questions about the baby’s chances of survival, which is somewhat related to observations made by Adu-Bonsaffoh et al. [ 13 ] among Ghanian mothers. These questions may not be unrelated to their knowledge of the odds of preterm survival, multiple complications, and the possibility of long-term sequalae after counseling sessions by pediatricians at admission of their babies to the NICU. These mothers were also informed about how quickly their predelivery plans were aborted following unanticipated preterm delivery. Two mothers had plans to deliver their babies abroad, but unfortunately, this prospect of their baby having dual citizenship became unfulfilled due to the abrupt delivery before full maturity of their babies. For these, motherhood came rather too sudden, and like the Turkish mothers studied by Pinar and Erbaba [ 1 ], they had no chance to complete their intended routine arrangements prior to preterm delivery. Nevertheless, with respect to the alteration of plans, some mothers intended to breastfeed their babies exclusively and brag about it but could not achieve this dream. This stress-induced lactation failure leads to preterm infant formula, a challenge noted by Russel et al. [ 7 ] and Pinar and Erbaba [ 1 ]. Additionally, none of the mothers without prior preterm birth experience imagined that feeding their newborn will take a toll on their sleep pattern. The practice of two-hourly feeding of these babies, now to be done by the mothers at the point of transitioning outside the incubator, was reported uniformly as the most unanticipated and most stressful encounter. Through the challenging experiences of caring for their preterm infant, it is interesting to note that in a similar observation by Sih et al. [ 14 ] among South African mothers, all the mothers in the present study who were of the Christian religious faith drew strength from the scriptures and the prayers they made to God for divine help. This observation is nearly the same as what was obtained in the studies by Abuidhail et al. [ 2 ] in Jordan and Arzani et al. [ 11 ] in Iran, where their subjects sorted help from God through prayers and drew inspiration from the Quran. It is therefore obvious that the role of religion as a coping strategy used by these mothers should not be underestimated and would probably be beneficial when designing interventions to help mothers cope with caring for their preterm babies. The mothers drew meaning from the realities of life as seen from the prism of the new motherhood experience and the virtues learned therein, most of which were related to their religious inclination, as they believed in the supremacy of God in life encounters. Mothers also developed the ability to toughen up via mental conditioning to cope and face whatever life presents, such as the coping strategy adopted by the mothers studied in Iran [ 11 ]. Unlike the previous report of inadequate spousal emotional support, coupled with spousal rejection by Abeasi and Emelife [ 8 ] in Abuja, the present study consistently reported good support from their husbands and extended family. The reasons for these diametrically opposed observations are, however, not immediately perceptible. In addition to family support, these mothers also appreciated the sensitive, emotional, and physical support from HCPs, as they attested to the encouragement received by the pediatricians and the practical helping hands given by nurses in a way similar to that reported by mothers in the study by Russel et al. [ 7 ]. Even though the mothers were glad to have received both clinical and emotional support from the HCPs, the nurses also experienced emotional turmoil associated with caring for these babies, as 40% of them described their experience as a “roller coaster.” They often feel emotionally down and even cried when babies with whom they have bonded die and feel very fulfilled when preterm babies are being discharged after their usual prolonged hospitalization. Similarly, the Pediatricians frequently battled to suppress their emotions while caring for these babies and described this as a “uphill task.” These experiences of the healthcare professionals were previously unreported to the best of the author’s knowledge. Additionally, these HCPs occasionally felt overwhelmed by the physical demands of care for preterm babies, as was cited among Tanzanian nurses who cared for preterm babies [ 15 ]. Like these Tanzanian nurses, 60% of the nurses reported that they were unable to use the equipment, especially the mechanical ventilator, for preterm babies’ care. This is immediately traceable to the fact that although they were all registered nurses, not all of them had subspecialty training in pediatric nursing. Regardless of the challenges faced by these HCPs, beyond their clinical and nursing responsibilities, they reported that it was still part of their routine duties to remain sensitive and supportive of these mothers as they passed through the demanding experience of caring for their delicate newborns. Apart from the frequent reassurance given, the nurses are physically present to guide these mothers through the period of transitioning of care when mothers become fully involved ahead of discharge from inpatient care. This gesture by the nurses was the emotional support provided beyond their functional duties to care for the preterm infant-mother dyad, as cited by Russel et al . [ 7 ]. Similarly, the pediatricians assisted the sometimes emotionally detached mothers in bonding with their babies by granting brief access so that they could see, touch, and pray with their babies while still remaining inside the incubator despite the largely restricted access to the NICU. This finding is similar to that of a report by Fleury et al. [ 16 ], who ascribed the same experience to HCPs in the southeastern region of Brazil in helping mothers bond with their premature babies through providing support and encouragement. The mothers in the present study desired more in terms of empathy, communication, and preemptive enlightenment on care of their preemie from the HCPs. This is because, in addition to other things, mothers perceived unwelcoming body language from some of the nurses, making them unapproachable, as previously reported by mothers [ 1 ]. However, other authors, such as Russel et al. [ 7 ] and Mitchell et al. [ 17 ], reported that mothers in their study uniformly experienced empathy, emotional support, and reassurance, which made the harrowing experience of caring for a delicate preterm feel like a “person” rather than just another “number.” Conclusions Mothers of premature babies faced diverse challenging lived experiences ranging from moments of stress, a roller coaster of emotions, to periods of uncertainty, battles with personal health issues, realization that reality differs from their anticipations, and difficulties adapting to maternal roles upon discharge from the NICU. Like mothers, healthcare workers also had fluctuating emotions that they had to suppress to focus on physically demanding care for preterm infants. Apart from support received from extended family and healthcare professionals, religion played a prominent role in helping these mothers cope with care demands for their preterm newborns. In addition, mothers learn patience as a virtue while caring for their preterm infants, and the quality of their family relationships reflects the extent of support they receive from them. All participants emphasized that communication between HCPs and mothers is invaluable in caring for the preterm infant-mother dyad. Recommendations Neonatal units should relax some of the strict access restrictions while still upholding infection control practices. Maternal mental health support should be available to mothers of preterm infants as a primary prevention strategy against emotional breakdown. Public health interventions related to mothers’ religious inclinations should be designed to help mothers of preterm newborns cope. Healthcare professionals should be trained to provide emotional support for mothers of preterm infants. Advocacy groups such as preemie mothers’ communities, if established, will be beneficial for sharing experiences, coping strategies, and influencing policy makers to factor in the peculiarities of prematurity care during the duration of maternity leave. Declarations Author Contribution I.D.P and J.A (of Redeemer University, Ede, Osun State) conceptualised and wrote the main manuscript text. A.O and J.K.D did data analysis, tables and figures.All authors reviewed the manuscript. Declaration of competing interests The authors hereby declare that there are no competing interests. Research funding declaration. Not applicable as this research in this manuscript did not receive any grants/funders. Data availability Not applicable as this manuscript does not report data generated or analysis. References Pinar G, Erbaba H. Experiences of new mothers with premature babies in neonatal care units: A qualitative study. J Nurs Pract. 2020;3(1):179-85. Abuidhail J, Al-Motlaq M, Mrayan L, Salameh T. The lived experience of Jordanian parents in a neonatal intensive care unit: A phenomenological study. Journal of Nursing Research. 2017 Apr 1;25(2):156-62. Yu X, Zhang J, Yuan L. Chinese parents' lived experiences of having preterm infants in NICU: A qualitative study. Journal of pediatric nursing. 2020 Jan 1;50:e48-54. Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. International journal for quality in health care. 2007 Dec 1;19(6):349-57. Tindall L. JA Smith, P. Flower and M. Larkin (2009), Interpretative Phenomenological Analysis: Theory, Method and Research. London: Sage. Larkin M, Flowers P, Smith JA. Interpretative phenomenological analysis: Theory, method and research. Russell G, Sawyer A, Rabe H, Abbott J, Gyte G, Duley L, Ayers S. Parents’ views on care of their very premature babies in neonatal intensive care units: a qualitative study. BMC pediatrics. 2014 Dec;14:1-0. Abeasi D, Emelife B. What mothers go through when the unexpected happens: A look at challenges of mothers with preterm babies during hospitalization in a tertiary institution in Nigeria. Journal of Nursing and Midwifery Sciences. 2020;7(1):22-9. van Veenendaal NR, van Kempen AA, Broekman BF, de Groof F, van Laerhoven H, van den Heuvel ME, Rijnhart JJ, van Goudoever JB, van der Schoor SR. Association of a zero-separation neonatal care model with stress in mothers of preterm infants. JAMA network open. 2022 Mar 1;5(3):e224514. Schmücker G, Brisch KH, Köhntop B, Betzler S, Österle M, Pohlandt F, Pokorny D, Laucht M, Kächele H, Buchheim A. The influence of prematurity, maternal anxiety, and infants' neurobiological risk on mother–infant interactions. Infant Mental Health Journal: Official Publication of The World Association for Infant Mental Health. 2005 Sep;26(5):423-41. Arzani A, Valizadeh L, Zamanzadeh V, Mohammadi E. Mothers' strategies in handling the prematurely born infant: a qualitative study. Journal of caring sciences. 2015 Mar;4(1):13. Lundqvist P, Weis J, Sivberg B. Parents’ journey caring for a preterm infant until discharge from hospital‐based neonatal home care—A challenging process to cope with. Journal of clinical nursing. 2019 Aug;28(15-16):2966-78. Adu-Bonsaffoh K, Tamma E, Nwameme AU, Mocking M, Osman KA, Browne JL. Women’s lived experiences of preterm birth and neonatal care for premature infants at a tertiary hospital in Ghana: a qualitative study. PLOS Global Public Health. 2022 Dec 1;2(12):e0001303. Sih DA, Bimerew M, Modeste RR. Coping strategies of mothers with preterm babies admitted in a public hospital in Cape Town. Curationis. 2019 Jan 1;42(1):1-8. Mwikali M, Salim N, Sylvester I, Munubhi E. Nurses’ knowledge, perceived challenges, and recommended solutions regarding premature infant care: A mixed method study in the referral and tertiary hospitals in Dar es salaam, Tanzania. Plos one. 2023 Mar 29;18(3):e0281200. Fleury C, Parpinelli MA, Makuch MY. Perceptions and actions of healthcare professionals regarding the mother-child relationship with premature babies in an intermediate neonatal intensive care unit: a qualitative study. BMC pregnancy and childbirth. 2014 Dec;14:1-0. Mitchell EJ, Pallotti P, Qureshi ZP, Daniels JP, Oliver M, Were F, Osoti A, Gwako G, Kimani V, Opira J, Ojha S. Parents, healthcare professionals and other stakeholders’ experiences of caring for babies born too soon in a low-resource setting: A qualitative study of essential newborn care for preterm infants in Kenya. BMJ open. 2021 Jun 1;11(6):e043802. Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4359884","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":300605808,"identity":"048b2f1f-9762-46b2-b676-1a2bf4f36264","order_by":0,"name":"Igoche David Peter","email":"","orcid":"","institution":"Limi Children’s Hospital","correspondingAuthor":false,"prefix":"","firstName":"Igoche","middleName":"David","lastName":"Peter","suffix":""},{"id":300605812,"identity":"ccb4a0a4-308f-47ed-bea6-a26bf31a9c67","order_by":1,"name":"Ayomide Oshagbami","email":"","orcid":"","institution":"Limi Children’s Hospital","correspondingAuthor":false,"prefix":"","firstName":"Ayomide","middleName":"","lastName":"Oshagbami","suffix":""},{"id":300605817,"identity":"5c238c0e-947f-4842-a89a-02ffca421b13","order_by":2,"name":"Jemimah Kuyet Danjuma-Karau","email":"","orcid":"","institution":"Limi Children’s Hospital","correspondingAuthor":false,"prefix":"","firstName":"Jemimah","middleName":"Kuyet","lastName":"Danjuma-Karau","suffix":""},{"id":300605821,"identity":"cc01c169-d889-48cd-a373-28f84645a9e9","order_by":3,"name":"Joseph Ashaolu","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA60lEQVRIiWNgGAWjYFACHsYDjA0SjA0g9gcgZmMnrIUBroVxBkgLM3FaGMBamHlAAoS0mLP3HjjwcYeFbL/Y4YOPbX5tk+djZmD88DEHtxbLnnMJB2eekTCeOTst2Ti377ZhGzMDs+TMbbi1GNzIMTjM2yaRuOF2jpl0bs9tRqAWNmZeQlr+ArXsv53//bdlz2174rQwgmyRzgGG1Y/biYS1nAH6pRfolxm304wlextuJ7cxMzbj98vx3oMPfu6ok+2fnfzww48/t23ntzcf/PARjxZUwNgGJhuIVQ8Cf0hRPApGwSgYBSMFAAAadViWZ6eg/gAAAABJRU5ErkJggg==","orcid":"","institution":"","correspondingAuthor":true,"prefix":"","firstName":"Joseph","middleName":"","lastName":"Ashaolu","suffix":""}],"badges":[],"createdAt":"2024-05-02 15:02:28","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4359884/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4359884/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":56548357,"identity":"16886b5b-5f93-49df-8812-6627ba7bf13b","added_by":"auto","created_at":"2024-05-15 15:41:17","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":41248,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eThematic analysis map with 5 major themes\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-4359884/v1/1f6d77be150f52ae15973509.png"},{"id":75697463,"identity":"2a65fbaa-f240-4254-80e2-972122bf6008","added_by":"auto","created_at":"2025-02-07 08:39:16","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1053759,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4359884/v1/980939be-1710-4d43-befa-3ad66219a8ee.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eA Phenomenological Study of the Lived Experiences of Mothers and Healthcare Professionals Caring for Preterm Babies in Abuja, Nigeria\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003ePreterm birth is a potentially stressful and unexpected life event for mothers, and this is further compounded by several associated immediate and delayed morbidities [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. In addition to preterm birth being a significant stressor, having their babies hospitalized for weeks in a neonatal unit with limited access, coupled with the need to adapt to changing responsibilities, is an unanticipated event for which mothers are usually ill prepared. It has been reported that parents who have preterm infants admitted to the newborn intensive care unit view this as a traumatic event for the family, and they experience stress, anxiety, and depressive symptoms, especially during prolonged NICU stays with highly limited parent\u0026ndash;infant contact, in addition to their frequent expression of dissatisfaction with the peculiarities of care rendered [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eDespite the multifaceted challenges experienced by mothers and healthcare providers caring for premature babies, it is still possible to attain avoidable mortality for them and enhance the quality of life of their mothers if we understand the experiences and challenges they face in Nigeria, where newborn death rates are unacceptably high.\u003c/p\u003e \u003cp\u003eAlthough the pediatric healthcare team is primarily responsible for the care of premature babies, to the best of the authors\u0026rsquo; knowledge, what they know about these psychologically fragile mothers and how holistic the care can be delivered by medical and nursing teams via a patient-centered approach are largely unexplored areas. This study explored maternal and health professionals\u0026rsquo; experiences, challenges, and coping strategies in caring for premature babies from birth to the first few months of life in the Nigerian context. To date, there is a paucity of exploration of maternal challenges with preterm newborn care in Nigeria, and none at all from the perspective of healthcare professionals.\u003c/p\u003e"},{"header":"Materials and methods","content":"\u003cp\u003e\u003cstrong\u003eStudy Design-\u0026nbsp;\u003c/strong\u003eThis study used a qualitative interpretative approach to explore the lived experiences and challenges of mothers with preterm infants and healthcare professionals (Pediatricians and Nurses) caring for these babies managed in a\u0026nbsp;neonatal intensive care unit\u0026nbsp;in Abuja, Nigeria. Semi structured in-depth face-to-face interviews were conducted to explore the study objectives. The consolidated criteria for reporting qualitative research (COREQ) checklist\u0026nbsp;was\u0026nbsp;used for this study [4].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudy Population and Study Site-\u003c/strong\u003eThis research was undertaken at The Limi Children’s Hospital, a center with\u0026nbsp;a\u0026nbsp;newborn care facility for preterm babies in Abuja, FCT, Nigeria.\u0026nbsp;The participants included mothers, pediatricians, and pediatric nurses who were\u0026nbsp;caring for living preterm infant(s) managed in the neonatal intensive care unit of the study institution.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInclusion criteria\u003c/strong\u003e\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003ePrimary caregiving mothers aged 18 years and above whose babies were delivered\u0026nbsp;at\u0026nbsp;\u0026lt;37 weeks of pregnancy and hospitalized in\u0026nbsp;the\u0026nbsp;NICU.\u003c/li\u003e\n \u003cli\u003eA medical practitioner with postgraduate specialization in Pediatrics and registered nurses who currently treats preterm babies.\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eThe exclusion criterion was mothers\u0026nbsp;whose preterm babies died.\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eMothers with an established\u0026nbsp;prepregnancy\u0026nbsp;history of mental illness\u003c/li\u003e\n \u003cli\u003eFoster/adopting mothers.\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003eSample Size and Sampling Techniques-\u0026nbsp;\u003c/strong\u003eParticipants (10 eligible mothers, 5 Pediatricians and 5 Nurses working in the newborn section who have cared for preterm babies\u0026nbsp;at the\u0026nbsp;same institution for at least 6 months) were recruited through purposive sampling until\u0026nbsp;the\u0026nbsp;data reached theoretical saturation (i.e., no new themes\u0026nbsp;were\u0026nbsp;identified\u0026nbsp;via\u0026nbsp;successive interviews). Purposive sampling,\u0026nbsp;a nonprobability sampling strategy\u0026nbsp;used for this study\u0026nbsp;that\u0026nbsp;is common to qualitative research,\u0026nbsp;is based on the premise that the researcher is\u0026nbsp;knowledgeable about\u0026nbsp;the study concept\u0026nbsp;and is\u0026nbsp;hence able to identify and recruit suitable participants.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Collection for the Study-\u0026nbsp;\u003c/strong\u003eBaseline data of preterm babies were obtained from hospital records.\u0026nbsp;Researchers\u0026nbsp;conducted in-depth interviews\u0026nbsp;with\u0026nbsp;mothers,\u0026nbsp;pediatricians and nurses.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical Considerations-\u0026nbsp;\u003c/strong\u003eThis study adhered to both local and international Good Clinical Practice (GCP) requirements. Ethical approval was obtained from\u0026nbsp;the\u0026nbsp;Institutional Review Board (IRBs) with ethics clearance number LIMI/REC/2024/001.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Analysis Procedures-\u0026nbsp;\u003c/strong\u003eAll interviews were audio recorded\u0026nbsp;and\u0026nbsp;then transcribed using TurboScribe.ai\u003csup\u003eâ\u003c/sup\u003e software. Hermeneutic (interpretative) phenomenological analysis was performed manually using six steps as outlined by previous scholars [5,6].\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eIn March 2024, 20 subjects were approached, and they\u0026nbsp;agreed\u0026nbsp;to participate in this research (10 mothers, 5\u0026nbsp;pediatricians\u0026nbsp;and 5\u0026nbsp;nurses). The interviews\u0026nbsp;were conducted in a quiet consulting room in the hospital.\u0026nbsp;The sociodemographic\u0026nbsp;and physical characteristics of the mothers and their preterm infants and\u0026nbsp;the\u0026nbsp;demographic characteristics of the healthcare professionals are given in Tables 1 and 2,\u0026nbsp;respectively.\u0026nbsp;The mean\u0026nbsp;maternal age\u0026nbsp;was\u0026nbsp;30\u0026nbsp;years\u0026nbsp;(SD=7);\u0026nbsp;most\u0026nbsp;mothers\u0026nbsp;delivered by Cesarean section, and all\u0026nbsp;were\u0026nbsp;currently married. A majority (53.8%) of the\u0026nbsp;preterm infants\u0026nbsp;were born between 28\u0026nbsp;and\u0026nbsp;\u0026lt;32 weeks of gestation. The\u0026nbsp;pediatricians and nurses\u0026nbsp;interviewed had 15 years (SD=3) and 8 years (SD=4) of experience,\u0026nbsp;respectively, and 40% of these nurses\u0026nbsp;had\u0026nbsp;basic pediatric nursing\u0026nbsp;qualifications.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1:\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eSociodemographic\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;and physical characteristics of the mothers and their preterm infants\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"69.05158069883528%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eMothers\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.948419301164726%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; n(%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"69.05158069883528%\" valign=\"top\"\u003e\n \u003cp\u003eAge; mean (SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.948419301164726%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 30yrs (7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"69.05158069883528%\" valign=\"top\"\u003e\n \u003cp\u003eMarital status\u003c/p\u003e\n \u003cp\u003eCurrently married; n (%)\u003c/p\u003e\n \u003cp\u003eSingle parent; n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.948419301164726%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 10 (100)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"69.05158069883528%\" valign=\"top\"\u003e\n \u003cp\u003eMode of delivery\u003c/p\u003e\n \u003cp\u003eCesarean section; n (%)\u003c/p\u003e\n \u003cp\u003eVaginal; n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.948419301164726%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;8 (80)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;2 (20)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"69.05158069883528%\" valign=\"top\"\u003e\n \u003cp\u003eMaternal medical condition\u003c/p\u003e\n \u003cp\u003ePregnancy induced hypertension; n (%)\u003c/p\u003e\n \u003cp\u003eMalaria; n (%)\u003c/p\u003e\n \u003cp\u003eOthers; n (%)\u003c/p\u003e\n \u003cp\u003eNil known; n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.948419301164726%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 5 (50)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 1 (10)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 0 (0)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 4 (40)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"69.05158069883528%\" valign=\"top\"\u003e\n \u003cp\u003eType of pregnancy\u003c/p\u003e\n \u003cp\u003eSingleton; n (%)\u003c/p\u003e\n \u003cp\u003eMultiple; n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.948419301164726%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 7 (70)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;3 (70)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"69.05158069883528%\" valign=\"top\"\u003e\n \u003cp\u003eBirth experience\u003c/p\u003e\n \u003cp\u003eFirst time mother; n (%)\u003c/p\u003e\n \u003cp\u003ePrevious preterm birth; n (%)\u003c/p\u003e\n \u003cp\u003ePrevious term birth; n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.948419301164726%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 7 (70)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;1 (10)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 2 (20)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"69.05158069883528%\" valign=\"top\"\u003e\n \u003cp\u003eReligion\u003c/p\u003e\n \u003cp\u003eChristianity; n (%)\u003c/p\u003e\n \u003cp\u003eIslam; n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.948419301164726%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 10 (100)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"69.05158069883528%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePreterm baby\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.948419301164726%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;n = 13\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"69.05158069883528%\" valign=\"top\"\u003e\n \u003cp\u003eGender\u003c/p\u003e\n \u003cp\u003eMale; n (%)\u003c/p\u003e\n \u003cp\u003eFemale; n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.948419301164726%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;5 (38.5)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;8 (61.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"69.05158069883528%\" valign=\"top\"\u003e\n \u003cp\u003eGestational age classification of prematurity\u003c/p\u003e\n \u003cp\u003eExtremely preterm (\u0026lt;28 weeks); n (%)\u003c/p\u003e\n \u003cp\u003eVery preterm (28 to \u0026lt;32 weeks); n (%)\u003c/p\u003e\n \u003cp\u003eModerate to late preterm (32 to 37 weeks); n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.948419301164726%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 4 (30.8)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;7 (53.8)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;2 (15.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"69.05158069883528%\" valign=\"top\"\u003e\n \u003cp\u003eDuration of NICU stay; mean (SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.948419301164726%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 30 (15)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eTable 2: Demographic characteristics of the health care professionals\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"69.05158069883528%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePediatricians\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.948419301164726%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003en= 5\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"69.05158069883528%\" valign=\"top\"\u003e\n \u003cp\u003eYears of experience; mean (SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.948419301164726%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;15 (3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"69.05158069883528%\" valign=\"top\"\u003e\n \u003cp\u003eGender\u003c/p\u003e\n \u003cp\u003eMale; n (%)\u003c/p\u003e\n \u003cp\u003eFemale; n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.948419301164726%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e2 (40)\u003c/p\u003e\n \u003cp\u003e3 (60)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"69.05158069883528%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eNurses\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.948419301164726%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003en= 5\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"69.05158069883528%\" valign=\"top\"\u003e\n \u003cp\u003eYears of experience; mean (SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.948419301164726%\" valign=\"top\"\u003e\n \u003cp\u003e8 (4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"69.05158069883528%\" valign=\"top\"\u003e\n \u003cp\u003eGender\u003c/p\u003e\n \u003cp\u003eMale; n (%)\u003c/p\u003e\n \u003cp\u003eFemale; n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.948419301164726%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003cp\u003e5 (100)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"69.05158069883528%\" valign=\"top\"\u003e\n \u003cp\u003ePost basic nursing qualification.\u003c/p\u003e\n \u003cp\u003ePediatric nurse; n (%)\u003c/p\u003e\n \u003cp\u003eRegistered nurse; n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.948419301164726%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e2 (40)\u003c/p\u003e\n \u003cp\u003e3 (60)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eFive major themes (with associated subthemes) were identified from the exploration of mothers\u0026rsquo; and healthcare professionals\u0026rsquo; experiences and challenges in caring for preterm infants: 1) experience spectrum, 2) coping, 3) supporting mothers, 4) meaning drawn, and 5) suggestions for improvement. Figure 1 is displaying the thematic analysis map, and the themes are described below.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTheme 1: Experience as a spectrum\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis theme centered around the spectrum of experience and challenges of the study participants, as it relates to the care of preterm newborns spanning from a stay in the NICU to transitioning to a private ward where mothers nurse their preterm infants under nurses\u0026rsquo; supervision to discharge home and encounters in the immediate post discharge weeks of life. This theme has 6 subthemes, each with various minor themes.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eSubtheme i: Emotional roller coaster\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEighteen participants, including all mothers with 4 nurses and Pediatricians each, described their feelings of unease with preterm infants nursed in the NICU, with restrictions on caregiver access.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eJust after the joy of safe delivery, I was told that I was going to leave my preterm twins in the NICU. I did not understand it because it was new to me\u0026hellip; what was in my head was how I would leave my babies in the hands of strangers. I know it is a hospital, fine, but in hospitals, I know that you stay with your child to nurse the child so that is how I felt. It was not an easy decision. [M. El]\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eTherefore, it has been a roller coaster.\u003c/em\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003cem\u003eThe down times where we lose a preemie after bonding with them, that is very heart-breaking. Sometimes I cry. Even when I get home, I will be thinking about the baby, feeling down, you know.\u003c/em\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003cem\u003eHowever, it is also a very nice experience. I feel happy when I see a NICU baby going home, a premature baby going home after all this rollercoaster, up and down and everything. Therefore, it has been a wonderful experience. [N. Je]\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eA total of ten mothers and two pediatricians reported the regular occurrence of mothers crying when they had their usual first and only opportunity to sight their preterm infants who were nursed in the incubator at the NICU. Certain mothers were moved to tears inside the NICU because they felt that the baby was too \u0026ldquo;tiny\u0026rdquo;.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eImagine, apart from the day of birth, I did not see her until four days after I left the hospital since I delivered through the emergency CS.\u003c/em\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003cem\u003eThe next time I saw my baby in the NICU, I cried because considering her weight at birth and seeing her now, she had already lost more weight. [M. Ta]\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eTwo Pediatricians felt that the mothers cried because they were going through a lot, which is sometimes associated with emotional outbursts.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eYou see them crying. They can easily burst into tears, and they can easily pick offenses in nurses, nurses, nurses, doctors, or whatever. [D. Ke]\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eSix mothers felt guilty, imagining that preterm birth may have been their fault: some wondered what they would have done differently to avoid this prematurity, while others felt bad bringing forth a helpless baby just to face \u0026ldquo;punishment in life\u0026rdquo;.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eHe was so tiny; I could see his ribs from his skin, and I felt like why did I have to punish this baby like this? I just felt so guilty, like I brought him to be stressed, and he looked so helpless. [M. Tr]\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThis was a traumatizing experience for all mothers with preterm newborns for several reasons. Because caregivers have restricted access to their babies in the NICU, phone calls were made by nurses to the mothers to give updates and make requests for things such as expressed breastmilk, diapers, etc. Such calls were traumatic and greeted with fear of the unknown (M. Cy.).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eSubtheme ii: Period of uncertainties\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThirteen participants described the mothers\u0026rsquo; feelings of uncertainty expressed through numerous unanswered questions mostly bothering on chances of survival of their preterm infant.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eThe day the baby came forth, I was like, God, why did this happen to me? Like, is my world different? Is my world different? I was like, will the baby survive? Because I have not heard before that you can give birth to a 27-week baby, and it will survive. [M. Ju]\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eOther first-time mothers expressed their uncertainties and had questions about the fate of subsequent deliveries.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eAs a preemie mother, you get to think, if this is your starting point. You begin to worry for the next one. Therefore, I think that is the disadvantage I have. I will not say disadvantage, everything\u0026apos;s an advantage that he came first. Now I\u0026apos;m thinking, is there something that might reoccur with the other ones, you know? [M. Tr]\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eUncertainties related to the ability to take care of preterm babies were reported by 11 participants, including mothers and nurses. The fact that these babies are tiny and fragile evokes worry about the ability of mothers and nurses, who are the immediate caregivers, to handle them without causing harm. They fear that the baby may fall from their hand, or they may even break the baby\u0026rsquo;s bones.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eAt first, I was like, how will I carry her? She\u0026apos;s too small. Ah, my baby is small.\u0026nbsp;\u003c/em\u003e\u003cem\u003eI was scared if she would fall from my hand. Or sometimes I would ask my nurses, how are you holding her? I cannot even carry her. [M. Ta]\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eSubtheme iii: Reality is different.\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eBecause the reality of having a premature baby differs from what these mothers imagined prior to delivery, these mothers saw these differences as a new normal.\u003c/p\u003e\n\u003cp\u003eFive mothers revealed the difference between their intentions of exclusive breastfeeding and the reality of not keeping up with the demands of expressing breastmilk for the needed 2-hourly interval infant feeding.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eI had the intention that I would do exclusive breastfeeding and brag about it.\u003c/em\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003cem\u003eHowever, it is easier said than done. Because with my preterm baby, at the point, I was not lactating properly because of the stress and everything. So I had to switch to formula. However, that did not stop me from breastfeeding. I was still breastfeeding too, but not as much as before, and this was not what I imagined. [M. Ta]\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe wealthier mothers had to come to terms with having their babies in Nigeria against their concluded plans for delivery abroad.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eWhat I was thinking of spending a lot of money on was to travel and have him abroad.\u0026nbsp;\u003c/em\u003e\u003cem\u003eHowever, when the baby came very suddenly, traveling was not even an option. Now that we\u0026apos;re putting him at risk, if we had to travel, so looking at how much we have spent, you know, it is nothing compared to him. [M. Tr]\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eSubtheme iv: Stressful moments\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThree pediatricians reported different levels of stress, some related to their interaction with their mothers and others related to the medical care given to premature babies.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eTherefore, in my experience, taking care of these babies, some of these babies have a smooth ride through their stay.\u003c/em\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003cem\u003eSome also have very turbulent times. In addition, so of course, when it is turbulent like that, even for you, the healthcare worker, though you\u0026apos;re not the mother. [D. Ch]\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eSome, for the late preterm ones, it could be a very happy one, a very pleasant experience. However, for extreme preterm infants, it could be very stressful for both healthcare workers and mothers while in the NICU and even thereafter. You can agree with me that the experiences differ from baby to baby, from mother to baby. [D. Nw]\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eTen participants revealed that stressed mothers pass through to produce enough breast milk to feed their preterm babies. Additionally, coping with the two hourly feeding schedules with a cup and spoon was stressful for all the mothers.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eOne of my major challenges was the fact that I was not having, I was not truly letting milk like I did in my first pregnancy. I do not know if it is because of CS or because the baby is not being able to, I cannot put the baby to breast. [M. An]\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eWhile feeding my baby through using a cup and spoon, sometimes she has not even finished, and then there is another two hours turn for feeding. You will be feeding her two hours! [Exclaims] The nurses will say, it is time to feed baby. Another two hours, like, the world was like, sometimes I will cry myself. I will be like, hey, this job is not easy.\u003c/em\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003cem\u003eI will ask myself questions. Why is all this happening to me? I will be crying. [M. Ju]\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eAll the mothers complained that their sleep was adversely affected while caring for their preterm infant.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eI had a challenge with waking up every two hours to feed my baby because I\u0026apos;m not that kind of person. I love my sleep. Therefore, she needs to eat to gain weight while trying to wake up every two hours. Honestly, waking up every two hours is stressful. [M. Cy]\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eSubtheme v: Personal health issues\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFive mothers and a pediatrician reported that poor maternal health compounded the already challenging experience of caring for their fragile babies. Because most of them were delivered by Cesarean section, the occurrence of poor wound healing made the already stressful environment more stressful.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eI had CS, so I was healing. I did not heal well, so I still got readmitted. [M. Tr]\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eOther ailments, such as the preexisting medical conditions that led to preterm delivery, were heath conditions that some of the mothers were battling with.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eApart from the emotional and physical stress associated with caring for their preterm birth, some mothers had preexisting medical conditions that led to preterm delivery. Since some were still hospitalized, having to come often to see their babies took a toll on their own health. [D. Ch]\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eSubtheme vi: Leaving the NICU\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAs part of the hospital protocol, when preterm babies stabilize to a certain weight, they leave the NICU to stay with mothers who are personally involved in the care process and are supervised ahead of their final home. Whereas the news of leaving the NICU is considered good news by all mothers, others were initially agitated about this but gained proficiency over time.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eWhen we tell them we are bringing your baby out from\u0026nbsp;\u003c/em\u003e\u003cem\u003ethe\u0026nbsp;\u003c/em\u003e\u003cem\u003eNICU to the ward, you hear the excitement in their voice. [N. Je]\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eEven at the time I left the NICU to the house yeah if I had the resources, I would have opted to pay for a home service nurse to follow me to the house to help me watch me for like a week or two to just see what I am doing. [M. Os]\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTheme 2: How we copped\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDifferent coping strategies were used by different mothers, some alone and others in combination. This theme has three subthemes: sources of strength, extended family support, and support from doctors and nurses.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eSubtheme i: Sources of strength\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eInterestingly, all the mothers drew strength to cope through this stressful experience of caring for a preterm infant, albeit from different sources. Believing and claiming bible promises was a source of inspiration for most of them since all mothers in this study were of the Christian faith.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eTherefore, I was comforting myself with the word of God [M. Ta].\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eI literally hear in my head in my spirit that she will be fine. That was great comfort for me. Therefore, I can say that God, one, I did a lot of praying and thank God for God\u0026apos;s mercy.\u003c/em\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003cem\u003eI prayed and got some relief, you know, before I could say that, okay, I felt better. [M. An]\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eSubtheme ii: Extended family support\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eExtended family support was reported by eight mothers. The support of spouses, grandparents and in-laws was a recurrent source of support through the challenging experience of preterm care.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eI had a very strong support system. My husband was there. My mother-in-law was there. We made a good team. [M. Ta]\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eSubtheme iii: Support from doctors and nurses\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA report from six of the mothers revealed that doctors and nurses caring for their premature infants were also very supportive of them.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026hellip;the helping hands, I got through nurses when I was in the ward. The teaching they gave me, it helped me a lot. In addition, I followed what they said. [M. Ju]\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTheme 3: How we supported the mothers.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNine healthcare professionals expressed how they supported these mothers through the stressful experience of nurturing a premature baby.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eSo personally, when I see the mothers are a bit scared, I tend to carry the babies and place them on the mother\u0026apos;s chest.\u003c/em\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003cem\u003eI do not mind sitting down with the mother and watch her feed for approximately 30 minutes. Just to enable her to know that these things are what she needs to do. [N. Cy]\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eNormally\u003c/em\u003e\u003cem\u003e,\u003c/em\u003e\u003cem\u003e\u0026nbsp;we introduce Kangaroo Mother Care. Nature has its own, because the bonding, flesh to flesh, baby is lying on the mother\u0026apos;s chest, there is this attachment. That, I believe, has contributed most to the bonding of the child. [N. Ke]\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTheme 4: Meaning drawn.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMothers\u0026rsquo; lives influence their interpretation of the entire experience of having and caring for a premature baby. They saw and understood the realities of life in a new dimension and learned some virtues.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eSubtheme i: Realities of life\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTen mothers drew lessons from the new realties and experiences in caring for their babies. Again, because all mothers studied are Christians, the reference to God\u0026rsquo;s preference for one\u0026rsquo;s proposal was a recurring theme.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eWhat you propose for yourself may not be what God wants. He has given you what He wants, and it will be better. Therefore, you must be strong. [M. Ju]\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eSometimes, how you think life should go is not with how it seems. You can plan your way, but God\u0026apos;s plan for you is always different. Therefore, life happens, and you face it head on. Like they say, when life gives you lemons, make lemonade out of it.\u003c/em\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003cem\u003eTherefore, you think it has happened, it has happened. Therefore, you do not have to face life squarely. [M. Ta]\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eSubtheme ii: Virtues learnt.\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNine mothers discussed virtues they had taken from the experience of caring for their preterm newborns. Seven of the mothers explained that the virtues of patience and optimism were nonnegotiable in caring for special gifts such as preterm babies.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eBeing with a preterm baby is all about patience. You need patience with them\u0026hellip; you need more patience and diligence to be able to handle them because they are special.\u003c/em\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003cem\u003eThey are very special from God, and you need patience to handle them. [M. Ta]\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eNow I know I can go through anything with a positive mind and scale through it. In my wildest dream, I never imagined I will give birth and spend weeks in the hospital and go through all the processes of the NICU, having to go home and come back. My first child was\u0026hellip; she was 4.2 kg, she was big, we went home, and the next day, we started feeding, unlike this patient. [M. El]\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTheme 5: Suggestions for improvement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSince all participants had their own share of challenges with caring for preterm infants, they had suggestions that would improve their care experience for the mother-infant dyad.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eSubtheme i: Improved communication and focused enlightenment\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEighteen participants stressed the need for improvement in the existing practice of communication between the healthcare team and the mothers of preterm infants, as this may be appropriate.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026hellip;what I\u0026apos;m still saying is that communication, letting them know what they are expected to do. \u0026hellip;if you are communicating with them and allowing them also to express their mind, their feelings, their unsaid fears, and concerns, and being able to put them through based on the information. [N. Ke]\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eSubtheme ii: Need for mental health support.\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe need for mental health support was echoed by 12 study participants due to the prolonged use of an emotional roller coaster, the reality of depression among them and the fact that the experience itself is traumatic.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eTherefore, I think mental support is very, very needed because sometimes mothers are depressed. Yes. You\u0026apos;re depressed and you\u0026apos;re thinking about yourself. Your CS scar is not healing, and you are thinking about your baby\u0026apos;s pain at that point in time. Therefore, I think mental support from healthcare professionals is very, very important for mothers.\u003c/em\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003cem\u003eYes. [M. Ta]\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eThen, I was away from people for a long time. I for me, it was more like, I\u0026apos;m just trying to be sane.\u003c/em\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003cem\u003eLike I went through something traumatic. In addition, it is not everyone you can tell that this is what happened. Therefore, the wisdom to even manage that is stressful.\u003c/em\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003cem\u003e[M. Tr]\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eSubtheme iii: Enabling ecosystem.\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTwo of these mothers wish that employers of labor understand that the duration of maternity leave for preterm births should be longer than what is available for term deliveries.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eI think that Nigeria needs to have like a rule that protects mothers who have premature babies, maybe an extended period from work because our cases are different. Therefore, the few months that you would normally give mothers of term babies will never be enough for a mom who has a premature baby because our time is different; the way we count it, the actual dates are completely different. [M. Tr]\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eInterestingly, there is a need for a community of mothers who have successfully cared for a preterm baby, as this will encourage the sharing of experiences and serve to encourage new preemie mothers.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eAnother thing that I think can be helpful is to have a vocal preemie mom community in Nigeria. Therefore, many people end up feeling alone through the process because everybody is hiding what they went through. It would have been nice if there was a community of mothers who had gone through it. Therefore, nothing would seem, you would be more relaxed because you would see evidence that you can go through it and come out fine. [M. Tr]\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eSubtheme iv: Empathy from the healthcare team\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSix mothers cited the need for a supportive and encouraging attitude of nurses to help them sail through the challenging experience of caring for a preterm newborn.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eBecause the nurses, like I\u0026apos;d stop them when you need something and sometimes I wish they would view it from this angle of \u0026ldquo;I\u0026apos;m new to this\u0026rdquo;, \u0026ldquo;I do not know anything\u0026rdquo;, I\u0026apos;m not just trying to make you repeat yourself, I just would rather be safe and have my baby alive even if it means I have to ask you a million and one questions\u0026rdquo;.\u003c/em\u003e\u003cem\u003e\u0026nbsp;[M. Tr]\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eI feel it boils down to the attitude of the health care worker in terms of friendliness and empathy. [N. Ke]\u003c/em\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe themes developed in the present study are in tandem with the observations made by several scholars, albeit with some unique contrasts. For instance, previous studies have consistently identified the emotional stress associated with caring for preterm infants, and this experience has been linked with a myriad of expressions. In contrast to the pleasant care experience of mothers\u0026rsquo; preterm infants observed by Russell \u003cem\u003eet al.\u003c/em\u003e [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e] in Southeast England, where no limit is imposed on maternal access to the NICU, all mothers in the present study lamented the uneasy feelings they had, as they could not see or be with their newborn baby, as they wished, as was reported in several other studies [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. This widely practiced restricted access of mothers to preterm newborns has been shown to have a negative impact not only on immediate maternal mental health but also on the mother\u0026ndash;infant dyad in the long run; in their study on the association of a zero-separation neonatal care model with stress in mothers of preterm infants, van Veenendaal \u003cem\u003eet al.\u003c/em\u003e [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e] showed that mothers of preterm infants experienced less stress at discharge when there was no separation between the mother and her preterm newborn compared with the standard neonatal care model with limited or restricted maternal access to her baby. Their study revealed that when the preterm infant and her mother were nursed together, the mothers were more present and participated more in neonatal care, and this was found to be associated with improved mental health outcomes, including less depression, better bonding of the mother-preterm infant dyad, and greater self-efficacy. For most of the mothers in the present study, as similarly reported by Pinar and Erbaba [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e], motherhood commenced on a difficult note, with the restriction of access to their babies triggering considerable emotional stress, as these mothers felt detached from their babies, thus confirming the finding of van Veenendaal \u003cem\u003eet al.\u003c/em\u003e [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. This experience was worse among mothers who had never had previous preterm birth experience. Similar observations were reported by Abuidhail \u003cem\u003eet al\u003c/em\u003e. and Yu \u003cem\u003eet al.\u003c/em\u003e [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e], among others, and this may not be unrelated to their naivety.\u003c/p\u003e \u003cp\u003eIn the present study, 60% of the mothers reported experiencing anxiety with guilt, supposing that they contributed to the \u0026ldquo;suffering\u0026rdquo; tiny baby whom they were unable to help. Schm\u0026uuml;cker \u003cem\u003eet al.\u003c/em\u003e [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e] suggested that maternal anxiety, among other factors, may be an outcome of conventional practices, with hospitals dictating the care of preterm infants and disrupting normal maternal-infant care routines, resulting in a maternal care gap that arouses uncertainty about infants\u0026rsquo; survival. Interestingly, similar feelings were reported among mothers of preterm babies by other researchers [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Additionally, the mothers in the present study uniformly confirmed that the experience of caring for their preterm infant was altogether traumatizing and hence their crying at the first opportunity to sight their babies inside the incubator. Similar to the observations of Pinar and Erbaba [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e] among Turkish mothers, some of these mothers cried because they felt that their babies had emaciated compared with what they saw at birth, coupled with their feelings of guilt and fear that they may be incapable of caring for their \u0026ldquo;fragile\u0026rdquo; newborns. At the same time, mothers had numerous unanswered questions about the baby\u0026rsquo;s chances of survival, which is somewhat related to observations made by Adu-Bonsaffoh \u003cem\u003eet al.\u003c/em\u003e [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e] among Ghanian mothers. These questions may not be unrelated to their knowledge of the odds of preterm survival, multiple complications, and the possibility of long-term sequalae after counseling sessions by pediatricians at admission of their babies to the NICU.\u003c/p\u003e \u003cp\u003eThese mothers were also informed about how quickly their predelivery plans were aborted following unanticipated preterm delivery. Two mothers had plans to deliver their babies abroad, but unfortunately, this prospect of their baby having dual citizenship became unfulfilled due to the abrupt delivery before full maturity of their babies. For these, motherhood came rather too sudden, and like the Turkish mothers studied by Pinar and Erbaba [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e], they had no chance to complete their intended routine arrangements prior to preterm delivery. Nevertheless, with respect to the alteration of plans, some mothers intended to breastfeed their babies exclusively and brag about it but could not achieve this dream. This stress-induced lactation failure leads to preterm infant formula, a challenge noted by Russel \u003cem\u003eet al.\u003c/em\u003e [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e] and Pinar and Erbaba [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Additionally, none of the mothers without prior preterm birth experience imagined that feeding their newborn will take a toll on their sleep pattern. The practice of two-hourly feeding of these babies, now to be done by the mothers at the point of transitioning outside the incubator, was reported uniformly as the most unanticipated and most stressful encounter.\u003c/p\u003e \u003cp\u003eThrough the challenging experiences of caring for their preterm infant, it is interesting to note that in a similar observation by Sih \u003cem\u003eet al.\u003c/em\u003e [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e] among South African mothers, all the mothers in the present study who were of the Christian religious faith drew strength from the scriptures and the prayers they made to God for divine help. This observation is nearly the same as what was obtained in the studies by Abuidhail \u003cem\u003eet al.\u003c/em\u003e [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e] in Jordan and Arzani \u003cem\u003eet al.\u003c/em\u003e [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e] in Iran, where their subjects sorted help from God through prayers and drew inspiration from the Quran. It is therefore obvious that the role of religion as a coping strategy used by these mothers should not be underestimated and would probably be beneficial when designing interventions to help mothers cope with caring for their preterm babies. The mothers drew meaning from the realities of life as seen from the prism of the new motherhood experience and the virtues learned therein, most of which were related to their religious inclination, as they believed in the supremacy of God in life encounters. Mothers also developed the ability to toughen up via mental conditioning to cope and face whatever life presents, such as the coping strategy adopted by the mothers studied in Iran [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eUnlike the previous report of inadequate spousal emotional support, coupled with spousal rejection by Abeasi and Emelife [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e] in Abuja, the present study consistently reported good support from their husbands and extended family. The reasons for these diametrically opposed observations are, however, not immediately perceptible. In addition to family support, these mothers also appreciated the sensitive, emotional, and physical support from HCPs, as they attested to the encouragement received by the pediatricians and the practical helping hands given by nurses in a way similar to that reported by mothers in the study by Russel \u003cem\u003eet al.\u003c/em\u003e [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eEven though the mothers were glad to have received both clinical and emotional support from the HCPs, the nurses also experienced emotional turmoil associated with caring for these babies, as 40% of them described their experience as a \u0026ldquo;roller coaster.\u0026rdquo; They often feel emotionally down and even cried when babies with whom they have bonded die and feel very fulfilled when preterm babies are being discharged after their usual prolonged hospitalization. Similarly, the Pediatricians frequently battled to suppress their emotions while caring for these babies and described this as a \u0026ldquo;uphill task.\u0026rdquo; These experiences of the healthcare professionals were previously unreported to the best of the author\u0026rsquo;s knowledge. Additionally, these HCPs occasionally felt overwhelmed by the physical demands of care for preterm babies, as was cited among Tanzanian nurses who cared for preterm babies [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Like these Tanzanian nurses, 60% of the nurses reported that they were unable to use the equipment, especially the mechanical ventilator, for preterm babies\u0026rsquo; care. This is immediately traceable to the fact that although they were all registered nurses, not all of them had subspecialty training in pediatric nursing. Regardless of the challenges faced by these HCPs, beyond their clinical and nursing responsibilities, they reported that it was still part of their routine duties to remain sensitive and supportive of these mothers as they passed through the demanding experience of caring for their delicate newborns. Apart from the frequent reassurance given, the nurses are physically present to guide these mothers through the period of transitioning of care when mothers become fully involved ahead of discharge from inpatient care. This gesture by the nurses was the emotional support provided beyond their functional duties to care for the preterm infant-mother dyad, as cited by Russel \u003cem\u003eet al\u003c/em\u003e. [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Similarly, the pediatricians assisted the sometimes emotionally detached mothers in bonding with their babies by granting brief access so that they could see, touch, and pray with their babies while still remaining inside the incubator despite the largely restricted access to the NICU. This finding is similar to that of a report by Fleury \u003cem\u003eet al.\u003c/em\u003e [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e], who ascribed the same experience to HCPs in the southeastern region of Brazil in helping mothers bond with their premature babies through providing support and encouragement.\u003c/p\u003e \u003cp\u003eThe mothers in the present study desired more in terms of empathy, communication, and preemptive enlightenment on care of their preemie from the HCPs. This is because, in addition to other things, mothers perceived unwelcoming body language from some of the nurses, making them unapproachable, as previously reported by mothers [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. However, other authors, such as Russel \u003cem\u003eet al.\u003c/em\u003e [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e] and Mitchell \u003cem\u003eet al.\u003c/em\u003e [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e], reported that mothers in their study uniformly experienced empathy, emotional support, and reassurance, which made the harrowing experience of caring for a delicate preterm feel like a \u0026ldquo;person\u0026rdquo; rather than just another \u0026ldquo;number.\u0026rdquo;\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eMothers of premature babies faced diverse challenging lived experiences ranging from moments of stress, a roller coaster of emotions, to periods of uncertainty, battles with personal health issues, realization that reality differs from their anticipations, and difficulties adapting\u0026nbsp;to\u0026nbsp;maternal roles upon discharge from\u0026nbsp;the\u0026nbsp;NICU.\u0026nbsp;Like\u0026nbsp;mothers, healthcare workers also had fluctuating emotions\u0026nbsp;that\u0026nbsp;they had to suppress to focus on physically demanding care for preterm infants.\u003c/p\u003e\n\u003cp\u003eApart from support received from extended family and healthcare professionals, religion played a prominent role in helping these mothers cope with care demands for their preterm newborns. In addition, mothers\u0026nbsp;learn\u0026nbsp;patience as a virtue while caring for their preterm infants, and the quality of their family relationships\u0026nbsp;reflects\u0026nbsp;the extent of support they\u0026nbsp;receive\u0026nbsp;from them.\u003c/p\u003e\n\u003cp\u003eAll participants\u0026nbsp;emphasized\u0026nbsp;that communication between HCPs and mothers is invaluable in\u0026nbsp;caring\u0026nbsp;for the preterm infant-mother dyad.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRecommendations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNeonatal units should relax some of the strict access restrictions while still upholding infection control practices. Maternal mental health support should be available to mothers of preterm infants as a primary prevention strategy against emotional breakdown. Public health interventions related to mothers’ religious inclinations should be designed to help mothers of preterm newborns cope. Healthcare professionals should be trained to provide emotional support for mothers of preterm infants. Advocacy groups such as preemie mothers’ communities, if established, will be beneficial for sharing experiences, coping strategies, and influencing policy makers to factor in the peculiarities of prematurity care during the duration of maternity leave.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAuthor Contribution\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eI.D.P and J.A (of Redeemer University, Ede, Osun State) conceptualised and wrote the main manuscript text. A.O and J.K.D did data analysis, tables and figures.All authors reviewed the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDeclaration of competing interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors hereby declare that there are no competing interests.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResearch funding declaration.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable as this research in this manuscript did not receive any grants/funders.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable as this manuscript does not report data generated or analysis.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003ePinar G, Erbaba H. Experiences of new mothers with premature babies in neonatal care units: A qualitative study. J Nurs Pract. 2020;3(1):179-85.\u003c/li\u003e\n \u003cli\u003eAbuidhail J, Al-Motlaq M, Mrayan L, Salameh T. The lived experience of Jordanian parents in a neonatal intensive care unit: A phenomenological study. Journal of Nursing Research. 2017 Apr 1;25(2):156-62.\u003c/li\u003e\n \u003cli\u003eYu X, Zhang J, Yuan L. Chinese parents\u0026apos; lived experiences of having preterm infants in NICU: A qualitative study. Journal of pediatric nursing. 2020 Jan 1;50:e48-54.\u003c/li\u003e\n \u003cli\u003eTong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. International journal for quality in health care. 2007 Dec 1;19(6):349-57.\u003c/li\u003e\n \u003cli\u003eTindall L. JA Smith, P. Flower and M. Larkin (2009), Interpretative Phenomenological Analysis: Theory, Method and Research. London: Sage.\u003c/li\u003e\n \u003cli\u003eLarkin M, Flowers P, Smith JA. Interpretative phenomenological analysis: Theory, method and research.\u003c/li\u003e\n \u003cli\u003eRussell G, Sawyer A, Rabe H, Abbott J, Gyte G, Duley L, Ayers S. Parents\u0026rsquo; views on care of their very premature babies in neonatal intensive care units: a qualitative study. BMC pediatrics. 2014 Dec;14:1-0.\u003c/li\u003e\n \u003cli\u003eAbeasi D, Emelife B. What mothers go through when the unexpected happens: A look at challenges of mothers with preterm babies during hospitalization in a tertiary institution in Nigeria. Journal of Nursing and Midwifery Sciences. 2020;7(1):22-9.\u003c/li\u003e\n \u003cli\u003evan Veenendaal NR, van Kempen AA, Broekman BF, de Groof F, van Laerhoven H, van den Heuvel ME, Rijnhart JJ, van Goudoever JB, van der Schoor SR. Association of a zero-separation neonatal care model with stress in mothers of preterm infants. JAMA network open. 2022 Mar 1;5(3):e224514.\u003c/li\u003e\n \u003cli\u003eSchm\u0026uuml;cker G, Brisch KH, K\u0026ouml;hntop B, Betzler S, \u0026Ouml;sterle M, Pohlandt F, Pokorny D, Laucht M, K\u0026auml;chele H, Buchheim A. The influence of prematurity, maternal anxiety, and infants\u0026apos; neurobiological risk on mother\u0026ndash;infant interactions. Infant Mental Health Journal: Official Publication of The World Association for Infant Mental Health. 2005 Sep;26(5):423-41.\u003c/li\u003e\n \u003cli\u003eArzani A, Valizadeh L, Zamanzadeh V, Mohammadi E. Mothers\u0026apos; strategies in handling the prematurely born infant: a qualitative study. Journal of caring sciences. 2015 Mar;4(1):13.\u003c/li\u003e\n \u003cli\u003eLundqvist P, Weis J, Sivberg B. Parents\u0026rsquo; journey caring for a preterm infant until discharge from hospital‐based neonatal home care\u0026mdash;A challenging process to cope with. Journal of clinical nursing. 2019 Aug;28(15-16):2966-78.\u003c/li\u003e\n \u003cli\u003eAdu-Bonsaffoh K, Tamma E, Nwameme AU, Mocking M, Osman KA, Browne JL. Women\u0026rsquo;s lived experiences of preterm birth and neonatal care for premature infants at a tertiary hospital in Ghana: a qualitative study. PLOS Global Public Health. 2022 Dec 1;2(12):e0001303.\u003c/li\u003e\n \u003cli\u003eSih DA, Bimerew M, Modeste RR. Coping strategies of mothers with preterm babies admitted in a public hospital in Cape Town. Curationis. 2019 Jan 1;42(1):1-8.\u003c/li\u003e\n \u003cli\u003eMwikali M, Salim N, Sylvester I, Munubhi E. Nurses\u0026rsquo; knowledge, perceived challenges, and recommended solutions regarding premature infant care: A mixed method study in the referral and tertiary hospitals in Dar es salaam, Tanzania. Plos one. 2023 Mar 29;18(3):e0281200.\u003c/li\u003e\n \u003cli\u003eFleury C, Parpinelli MA, Makuch MY. Perceptions and actions of healthcare professionals regarding the mother-child relationship with premature babies in an intermediate neonatal intensive care unit: a qualitative study. BMC pregnancy and childbirth. 2014 Dec;14:1-0.\u003c/li\u003e\n \u003cli\u003eMitchell EJ, Pallotti P, Qureshi ZP, Daniels JP, Oliver M, Were F, Osoti A, Gwako G, Kimani V, Opira J, Ojha S. Parents, healthcare professionals and other stakeholders\u0026rsquo; experiences of caring for babies born too soon in a low-resource setting: A qualitative study of essential newborn care for preterm infants in Kenya. BMJ open. 2021 Jun 1;11(6):e043802.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Preterm infant, Mothers, lived experiences, coping strategies, phenomenological study.","lastPublishedDoi":"10.21203/rs.3.rs-4359884/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4359884/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground and Objectives\u003c/strong\u003e: The survival of preterm infants and the mental health of their mothers have attracted global health concerns. The present study explored the lived experiences, challenges, and coping strategies of mothers with preterm infants and those of healthcare professionals attending to the preterm infant-mother dyad in Abuja, Nigeria.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e: A qualitative research design using an interpretative phenomenological approach with semistructured interviews was used. Purposively sampled participants (10 mothers, 5 pediatricians, and 5 nurses) were recruited from Limi Children’s Hospital, Abuja, Nigeria, until data saturation was reached. The data were audio recorded and transcribed using TurboScribe.ai\u003csup\u003eâ\u003c/sup\u003e software. Codes were manually generated, and themes were formed and analyzed using inductive content analysis. This study followed the consolidated criteria for reporting qualitative research.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e: Overall, this was an emotionally and physically stressful experience for mothers of preterm infants and healthcare professionals caring for premature babies. Five major themes determining the lived experiences of participants emerged: 1) experience as a spectrum; 2) how we coped; 3) how we supported the mothers; 4) meaning drawn; and 5) suggestions for improvement.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions\u003c/strong\u003e: Mothers of preterm infants and attending healthcare professionals face diverse challenging lived experiences that are both physically and psychologically demanding. Apart from extended family and healthcare professionals’ support, religion was found to play a significant role in the coping strategies adopted by these mothers. Healthcare professionals should pay attention to the mental health of mothers of preterm infants and prioritize empathy with effective communication during care for the preterm infant–mother dyad.\u003c/p\u003e","manuscriptTitle":"A Phenomenological Study of the Lived Experiences of Mothers and Healthcare Professionals Caring for Preterm Babies in Abuja, Nigeria","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-05-15 15:40:54","doi":"10.21203/rs.3.rs-4359884/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"6b4f5c27-5285-412b-b9ee-61321efd0932","owner":[],"postedDate":"May 15th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-02-07T08:38:48+00:00","versionOfRecord":[],"versionCreatedAt":"2024-05-15 15:40:54","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4359884","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4359884","identity":"rs-4359884","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}