Abstract
One of the most difficult tasks facing staff caring for sick infants, or sick mothers of young infants, is to keep both mothers and babies in mind. The care of ‘the other’ has often not been well managed in the past. Parents are seen to be well and coping, just as infants of sick mothers are often treated as ‘necessary baggage’. This book is thus very welcome as it clearly demonstrates that the parents of sick infants are under a great deal of stress and in need of help. It emphasises the importance of keeping all family members in mind.
This book explores the emotional world of the mothers and fathers in the first 12 weeks of the life of their premature baby. It is the result of an unusual and innovative piece of research, which questions the effects of prematurity on the vulnerable psychic processes of normal pregnancy.
The research design involved a series of interviews with 12 sets of parents, six of whom had had an uneventful, full-term pregnancy and six of whom had delivered babies of between 600 and 1200 g and/or under 32 weeks gestation. The interviews commenced within the first week of the baby's birth, were initially weekly with the ninth and final interview being at 12 weeks.
The interviews conducted by Norma Tracey, a psychoanalytic psychotherapist, were aimed to give a space to think and talk about how the parents were feeling about themselves, their partners and their baby. There were to be no questions or interpretations, just occasionally a clarification. These interviews were audiotaped and transcribed and shared with a chosen group of senior and experienced clinicians, coming from different, although sympathetic, theoretical backgrounds and various disciplines. Most chapters are by individual authors, although some have been written by a couple or a team.
The book is divided into sections, the first on the mothers, beginning with the response to the interviews with mothers of full-term babies. It is clear from these interviews that no pregnancy is without some difficulties and each detail is very significant to the mother. The next chapters give a dynamic overview of the psychological work and processes that are part of a normal pregnancy, and how prematurity may distort and disrupt the processes.
The chapters on the mothers' interviews use a great deal of the mothers' own words, so that there is rich and powerful material in each narrative. It demonstrates clearly the distress each mother experiences, the need for the repetition in the telling and how long it takes for the mother to overcome her sense of unreality. It takes time and a lot of work for her to feel she is a real mother to this baby.
The chapters on the fathers are especially moving; fathers are rarely given the time and space to tell their stories, or to reveal the work that they undertake in order to feel good and validated as a father. They need to remember and rethink about their own experiences as a child and how they were fathered. This process is made doubly difficult by their intense anxiety about their partners as well as their premature infant.
There is a chapter on the baby, which is a good overview on present thinking with an excellent and comprehensive list of references.
An important aspect of the work of a neonatal intensive-care unit (NICU) is the effect of pressure on the staff. The work is demanding, painful and exhausting. A difficult part of the work is the management of powerful emotions engendered. There is always the pain of working closely with the interface of life and death, especially ‘with such vulnerable infants’. The lives of the infants now depend on modern technology and skilled staff, rather than on the maternal nurture and protection of the mother's body. Out of this exchange comes the ever-recurring question ‘Whose baby is it?’ This results in tension between the staff and parents. These problems are well covered by the chapters of Paul and Sim and Barnett.
Beulah Warren, in her chapter, poses another interesting question: ‘Is it possible for the NICU to be both life saving and emotionally nurturing of all involved – infant, family and staff?’ This book makes a valuable contribution towards an answer.
This book will be valuable for the staff of neonatal care intensive care units and all those involved in perinatal care.