A prospective study to identify critical factors which indicate mothers' readiness to care for their very low birthweight baby at home

Over the past 25 years enormous advances have been made in the management of very low birthweight babies. Understanding of the psychological impact on parents has not kept pace with the rapid progress in technology. A prospective descr ipti ve study was conducted to investigate the perceptions of 21 mothers of singleton babies weighing 1500g or less who were free from congenital abnormali ties. In-depth interviews were held on six occasions from one week after delivery to three months after the baby's discharge from hospital with particular focus on the time of discharge. Diaries, Neonatal Perception Inventories and demographic data records were additional tools employed in this research. Six phases were identified and each was characterised by certain cr i tical factors. These phases have been descr ipti vely named as anticipatory grief, anxious waiting, positive anticipation, anxious adjustment, exhausted accommodation and confident car ing. Critical factors were found to be changes in the mother's emotional state, in her perceptions of the baby and in the responses of family members. The mothers' concerns and the support they received varied in the different phases. Significant statistical differences were found between those mothers who were not ready to take the infant home at the time of his discharge and the rest of the sample. Those who were not ready demonstrated a marked difficulty in establishing and maintaining relationships and held inappropr iate perceptions of the infant. This finding has important implications for the discharge of VLBW babies after a prolonged stay in an Neonatal Intensive Care Unit. Recommendations have been made for closer attention to individual perceptions, progress and support networks in each fami ly. Avenues for the education of both hospital and communi ty health workers in the needs of families who have a very low birthweight baby are also outlined