Misunderstood as mothers: Women’s stories of being hospitalised for illness in

the post-partum period

ABSTRACT

Aims of the paper: This paper aims to explore women’s experiences with health care pro-

viders to ascertain ways in which health care may be improved for women disrupted in their

mothering.

Background: Women can find it difficult to relinquish care even when they are acutely un-

well requiring hospitalisation. Despite mothering being a priority for women many healthcare

professionals do not understand the importance of continuing to mother during maternal ill-

ness.

Design: This research used a qualitative methodology drawing upon principles of feminism

and storytelling.

Methods: Women’s stories were collected through face-to-face interviews, email and via the

telephone. The twenty-seven women who participated were from either Australia or the

United States of America, had between one and six children, and identified themselves as

having been disrupted in their mothering by illness. Once collected, data were analysed them-

atically.

Findings: The majority of participants had been hospitalised at some point in time for acute

illness. A sub-set of participants reported feeling judged by nurses and that their efforts to

continue to mother their new-born children despite their illness were misunderstood and not

facilitated.

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Conclusion: Findings from this study suggest that health professionals failed to understand

the primacy that mothering held for women and facilitate women’s efforts to satisfy the

mothering role despite illness. Nurses and midwives need to explore the values and judge-

ments they hold in regards to mothering, validate women’s attempts to mother to the best of

their ability during illness and find ways to support and empower women in their mothering.

KEYWORDS: Women’s health, Mothering, Nurse patient relationships, nurse, nursing

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SUMMARY STATEMENT

Why is this research needed?

Mothering is often an invisible issue in healthcare. Women do not readily relinquish the mothering role even when they are ill and mothering

responsibilities will influence decisions they make about treatment.

What are the key findings?

Nurses and midwives were perceived as judgemental and unhelpful by women who were trying to simultaneously mother their children and receive treatment for illness.

Stories of poor care dominated the women’s recollections. When they were pro-active nurses made a significant difference to one woman’s ability to

continue to mother despite serious illness.

How should the findings be used to influence practice?

Health professionals should be encouraged to reflect upon their beliefs and attitudes re-garding mothering and foster a non-judgemental, affirmative and solution-oriented ap-proach to caring for mothers who are ill.

Women and their breastfed infants need to be viewed as inseparable except in the direst circumstances.

Nurses and midwives should seek to support and validate women in the mothering role.

INTRODUCTION

The early months of motherhood can be both a precious and challenging time for women.

However, the expected difficulties of caring for a newborn baby can be compounded when a

woman is experiencing acute illness requiring hospitalisation. Although pregnancy is a

natural condition, at least 15-20% of women entering prenatal care have their pregnancies

complicated by existing or emergent health issues (Keely & Barbour 2008; Lyerly et al.

2009). This paper reveals the tensions faced by mothers of dependent children when being

admitted to healthcare facilities.

BACKGROUND

Although having and raising children could be considered an essentially private matter, the

social constructions of mothering and the hegemonic ideologies they culminate in make it a

political concern (Goodwin & Huppatz 2010; #### year). The Western ideologies of

mothering currently construct responsibility for children as almost wholly within the

mother’s domain (Sevón 2012). A mother typically considers herself and is considered by

others to be responsible for the health and wellbeing of her children (Collett 2005; Ruddick

1980; Seagram & Daniluk 2002; Wall 2010). Despite the presence of other adults, a mother is

still predominantly responsible for raising a child who can function well and be accepted by

society (Dillaway 2006; Liamputtong 2006; Ruddick 1980). Not measuring up to the cultural

expectations of mothering results in guilt, shame and feelings of inadequacy for many women

(#### year; Seagram & Daniluk 2002; Sutherland 2010).

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As women are invested in their identities as mothers, it is important for health care

professionals to acknowledge when a patient is also a mother (Davies & Allen 2007; Fisher

& O'Connor 2011). However, health care professionals are portrayed as uninterested in, and

insensitive to the maternal concerns of their patients, instead focusing upon the disease and

its treatment (Backman et al. 2007; Elmberger, Bolund & Lützén 2005; Montgomery et al.

2006; Wilson 2007). Women report that health professionals objectify them and expect that

they will prioritise medical treatment over everything else in their lives (Fisher & O'Connor

2011). The failure of health professionals to acknowledge their pre-existing familial and

social obligations can disempower, alienate and silence women (Kralik 2002).

Mothering considerations can heavily influence women’s treatment decisions (#### year).

Women tend to prioritise their children’s needs before their own (Fisher & O'Connor 2012;

Vincent 2010) and seek to mitigate the effects that maternal illness has upon them (####

year; Townsend, Wyke & Hunt 2006). Women diagnosed with illness during pregnancy can

be torn between a desire to protect their unborn baby and commencing treatment that would

maximise their chances of a positive outcome (Ives, Musiello & Saunders 2011). Pregnant

women are often prepared to delay or sacrifice optimum treatment in order to protect the

unborn child (Ives, Musiello & Saunders 2011). Breastfeeding can be another motive to

forego treatment as women can be reluctant to take medication, fearful it might be

transmitted through breast milk, or disrupt their milk supply (Pearlstein et al. 2009). If it

means being separated from their child, women who have infants may be disinclined to be

hospitalised (#### year) as even short term disruption of mother and child can have long term

detrimental effects to bonding and breastfeeding (Elmir et al. 2012).

Although many researchers have investigated mothering in the context of specific diseases,

few have approached mothering in illness from the perspective of mothering, as opposed to

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disease. Although this focus upon mothering in the context of specific diseases is valuable, it

is less helpful when trying to discern the overall effect of illness on mothering. It was

therefore worthwhile to examine the disruptive nature of illness in the context of mothering

generally.

THE STUDY

Aim

This paper is drawn from a larger study that explored women’s stories of mothering disrupted

by illness (#### 2012). One of the aims of the study was to investigate women’s experiences

with health care providers to ascertain ways in which health care may be improved for

women disrupted in their mothering.

Methodolgy

The incursion of the political into the private prompted the use of feminist principles and

storytelling to underpin this research. Women are less able to separate their public and

personal lives than men due to their continued association with the tasks of childbearing and

rearing (Jackson, Clare & Mannix 2003). While it might be assumed that mothering would

constitute mostly private experiences, in fact, women are subject to scrutiny of their

mothering from conception throughout the life of the child (Goodwin & Huppatz 2010b;

Jackson & Mannix 2004). Much as storytelling is an opportunity to reflect and come to find

meaning in experience (Frank 1995; Williams 2009), the consciousness raising potential of

feminist research exists in women who participate having an opportunity to reflect upon their

experiences and make connections between their lives and the systems that influence them

(Brayton 1997).

Storytelling is a classical and ancient method of conveying accounts of events and

experiences to others (Mafile’o & Kaise Api 2009), constructed as people attempt to make

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meaning of happenings in their lives (Bailey & Tilley 2002; Frank 1995; Koch 1998;

McCance, McKenna & Boore 2001; Riley & Hawe 2005). Given that nursing practice is

frequently focused on the care of the ill (Holloway & Freshwater 2007b), and that qualitative

nursing research is concerned with discovering people’s experiences and the meaning they

ascribe to these experiences (Borbasi, Jackson & Langford 2004){Borbasi, 2004, Navigating

the maze of nursing research: an interactive learning adventure}, storytelling is an appropriate

and useful nursing research methodology.

Sample/Participants

Using a convenience sample, twenty-seven women (see table 1) were recruited via posters in

pharmacies, press releases in publications, and advertisements on internet support-group

sites. The recruitment documents sought women who identified that their mothering had been

disrupted by illness. As mothering is an ongoing process and it was anticipated that women

with adult children could provide valuable, retrospective stories that would reveal the long-

term consequences of disrupted mothering, there was no upper age limit. Inclusion criteria

were that the women had cared for a child in a mothering capacity; had simultaneously

experienced a diagnosable illness severe enough to interfere with their day-to-day

functioning; were fluent in English; and willing to share their stories with the researcher.

Recruitment continued until data saturation was reached. Saturation was established through

the repetition of responses (Morse 1995).

Experiences of hospitalisation were not a particular focus of this study but emerged as a

significant theme. This paper focuses upon a sub-set of participants’ that were admitted to

healthcare facilities for acute illness in the post-partum period. The time from the experience

to the re-telling for the women who discussed being hospitalised while caring for infants

spans a period of 3-16 years.

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Data collection

27 stories were collected by the first author through face-to-face interviews (3) in the wo-

men’s homes, via the telephone (9), and via email exchanges (15), based on the preference of

the participant. Face-to-face and telephone interviews were digitally recorded and transcribed

verbatim. Emailed stories were copied and pasted into Microsoft word documents. The inter-

net stories were typically collected within three to four email exchanges. Each of the tele-

phone interviews took approximately an hour. Face-to-face interviews varied from an hour to

over three hours. Offering women alternative modes of communication was designed to make

the study inclusive given that participants were likely to have mothering responsibilities and

be possibly incapacitated by illness. Regardless of the mode of interview all women were ini-

tially asked to “please tell me your story of mothering in illness”, with prompting questions

used as necessary to encourage elaboration and clarification.

Ethical considerations

This study was approved by the relevant institutional human ethics committee. Following

procedures of informed consent, all participants were provided with contact numbers for free

counselling services in the event that recalling events distressed them. Pseudonyms have been

used to protect participants’ privacy.

Data analysis

Data was managed using NVivo 8 (QSR International Pty Ltd 2008). The women’s stories

were analysed thematically through a feminist lens in order to reveal shared experiences and

understandings. By developing awareness of the issues that concern women, aspects of

gendered oppression can be examined and challenged (Jackson, Clare & Mannix 2003).

This process resulted in 62 categories. These categories were then shifted and sorted into lists

of like concepts or affinity groups. Once sorted, similar categories were collapsed into one

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another and subthemes and themes began to be identified. Once identified, themes were re-

garded cautiously until the end of data collection and writing up of the findings. A thorough

discussion of the method of thematic analysis can be found in #### (2012). Findings from

this study resulted in four themes and 12 subthemes (Table 2). This article presents findings

from the sub-theme ‘Reading different scripts: Nurses misunderstanding mothers’.

Validity and reliability/Rigour

As recommended by Guba (1981) and Guba and Lincoln (1994), the operational techniques

of credibility, dependability, confirmability and transferability were followed when designing

this study. Credibility refers to how accurately participants experiences are represented by re-

searchers (Tobin & Begley 2004). Although member checking is a commonly recommended

method of ensuring credibility we chose not to engage with this process as stories are time

and context bound. The story participants shared was their personal truth at that time, and to

subject it to further scrutiny would dishonour the original telling and threaten the trustworthi-

ness of the study (Sandelowski 1993). Rather we ensured that the participants’ exact words

were correctly transcribed and the essential meaning of their stories retained. The essential

meaning of the stories was discerned after prolonged engagement with the data, which com-

bined with saturation is a further measure of credibility (Houghton et al. 2013).

Dependability refers to the truthfulness and constancy of the data findings (Polit, Beck &

Hungler 2001). Lincoln and Guba (1985) discussed the importance of research being ap-

praised by a competent outsider. As this study was undertaken as part of a doctoral program,

the findings of the first author were subject to constant evaluation, discussion and scrutiny by

an international team of supervisors.

Confirmability is, in effect a process audit (Speziale & Carpenter 2007). The process of this

study is described in detail elsewhere (#### 2012) so that readers can follow the reasoning

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that transformed the women’s stories into findings of this study. The use of NVivo further en-

hanced auditability as it provided a record of decisions during the analysis phase (Houghton

et al. 2013).

Although not easily generalised qualitative research must be transferable to be of use to nurs-

ing practice (Polit, Beck & Hungler 2001). Lincoln & Guba (2004) recommend including

thick descriptive data when writing up in order to provide context for comparison to other

studies. As much information as possible has been included here given the constraints of an

article and further information is available elsewhere (See ##### 2012).

FINDINGS

Twenty-seven women participated in the larger study (see table 1). All of the participants

were White and spoke English as their first language. Fifteen of the women had been

diagnosed with a physical illness or injury, seven with a psychiatric illness, and five had been

diagnosed with both physical and psychiatric illnesses. The women had between one and six

children each, aged from five months to fifty-five years, and were themselves aged twenty-

five to seventy-five years old. The length of time women were hospitalised varied from

frequent day admission to several months.

The women’s stories were marked by the conflict they felt between their ability to mother to

their ideal standards and to answer the demands made upon them by their illness. Whereas

the mothering role invariably represented self-sacrifice and putting the children’s needs first,

the patient role required the woman to prioritise her health. Where possible the women

resisted succumbing to illness, tailoring medication and treatment decisions to better

accommodate their mothering. Both Quin and Olivia resisted hospitalisation on the grounds

of their maternal responsibilities, and in both cases they were convinced to remain in hospital

by doctors appealing to them as responsible mothers in order to convince them to accept

treatment. Lilly also resisted hospitalisation so that she could continue to care for her

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children, explaining: “I would be very, very unwell when I went in because I would try to

hang on and not go there. Being a typical mother I would try to pretend that everything was

fine both before and after admission.”

In the hospital the focus was on the woman as a patient, and the treatment of her illness or

injury. As patients, women described feeling that it was expected that they would put their

maternal responsibilities aside and co-operate with the treatments and medications prescribed

for them. However, the women in this study stated that they could not, simply relinquish their

responsibility to their children. It became evident that within the hospital arena, a woman’s

dual role of mother and patient was perceived to be misunderstood by nursing staff. The

women reported this sometimes resulted in tension between them and the nurses caring for

them.

Women who were breastfeeding when they were hospitalised were faced with an immediate

dilemma. Acute illness left no time for planning, for storing breast milk, or for coming to

terms with the possibility of having to give a baby feeding formula. Pearl insisted upon

having her eight-week-old baby with her as a baby boarder when she was admitted to hospital

with pancreatitis from gallstones. However, she was acutely ill and totally responsible for the

welfare of her baby, despite being hampered by intravenous lines, medical machinery, strong

analgesia, unstable blood sugar levels and not being permitted to eat. Although she was

allowed to keep her baby with her, Pearl felt that the lack of support she received was

punitive and placed the baby at risk of harm:

“I got no help with the baby. I was nil by mouth for a week and I have these horrible

memories of walking up and down the corridor dragging an Imed, and a screaming eight

week old [...] there are legal implications and the staff are told not to touch your baby, which

was fine, she was my responsibility. But at one point I had a hypo and I could barely stay

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conscious. I had this baby screaming next to me and the staff wouldn’t touch her because she

was a boarder, she was not the patient.”

Although Pearl was successful in keeping her child with her during that admission, she felt

she was fighting a constant battle with some of the nursing staff and ward management. From

Pearl’s perspective there was a failure to recognise that, as a mother, it would be difficult to

simply relinquish the care of a fully breastfed child. While Pearl was supported by her

medical specialist to keep the baby with her, and keep breastfeeding, she said that the nursing

unit manager made it very clear to her that they would prefer the baby to go home with her

husband. Pearl also discussed individual nurses’ expressing their opinions regarding her

infant feeding choices:

“I had a supportive specialist who was of the opinion there was more benefit to gain by her

having the milk than there was risk of having the antibiotics. A lot of the nursing staff were

very critical of me for continuing to feed with the massive antibiotics I was on. Some of them

were very open about that.”

Although she was admitted multiple times for day procedures, and did not stay overnight at

the hospital, Yasmin also took her baby to hospital with her. Like Pearl, Yasmin discussed

nursing staff imposing their own parenting values upon her, which she believed contributed

to her developing a form of post-traumatic stress disorder:

I started to get physical symptoms at the thought of having to go to hospital, my heart would

pound, sweaty palms and I just dreaded it wondering how bad would today be? In all I've

had about 120 procedures (Yasmin).

Yasmin described numerous episodes of nurses expressing judgement about her mothering

choices. She recalled nurses making negative comments to her regarding bringing her baby to

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hospital with her, her decision not to use formal childcare, and her choice to continue

breastfeeding. The criticism that concerned her most however, involved questioning either

her choice to become a mother in the first place, or her ability to be a good mother, as she

required frequent epidural injections for a back injury. Yasmin said one staff member implied

that she had considered reporting her to the Department of Children’s Services:

“She said if you have this much pain that you need nerve blocks are you really able to look

after your daughter properly, we have an obligation to report any child that is at risk. It was

a very definite threat. I felt guilty that I had had her that maybe I wasn't good. I did not really

resent her [infant], rather the nastiness from staff about having her. I don't think that type of

conflict is helpful or healthy.”

Not only ward or theatre nurses were criticised by the women for misunderstanding their

need to mother their children despite their illness. Midwives were also felt to have failed to

facilitate mothering. The disappointment in the care received from midwives was especially

poignant given that midwifery, as a profession, generally espouses the importance of mother-

child bonding and initiating and continuing breastfeeding.

Adelaide had a protracted and severe dural headache as a result of her dura mater being

punctured during an epidural injection when she was in labour. To stand for any length of

time was extremely painful and difficult. Her distress was compounded by the fact that her

baby daughter was born with a heart defect and was in the neonatal intensive care ward. She

herself was admitted to the postnatal ward but felt entirely ignored by the midwives: “I

hardly saw the midwives. It was like well, she doesn’t have her baby in there with her so she

doesn’t need us.” Already feeling distressed by the medical incident and subsequent severe

headache, Adelaide spoke of numerous incidents where she perceived she was neglected by

the staff. However, what really disturbed her was the lack of compassion she felt she received

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as a new mother of a critically ill child. Due to the dural headache, Adelaide needed physical

assistance to get to the neonatal unit. She said her requests for help were not met by hospital

staff, and family members were required to locate a wheelchair to assist her in visiting her

infant, her distress was clear as she recalled:

“I really didn’t get to see her [infant daughter] that much. I think I got to hold her maybe

three times. And I was asking a midwife ‘can somebody take me down to see my baby’? And

she said ‘we’re far too busy to be doing that, we can’t leave the ward!’ So I said ‘well could

you call an orderly?’ And she said, ‘we’ve only got one orderly for the whole hospital.’ It

was just all too hard. So I thought ‘well stuff you!’ And I walked the length of the hospital

with a dural headache, because nobody would take me to see my baby.”

At five days post-delivery, Adelaide’s baby was transferred to a larger paediatric hospital in

another city to undergo heart surgery, suffered a cardiac arrest and spent five days on a heart

and lung bypass machine. The next time Adelaide held her daughter she had been

disconnected from life support and had died. Adelaide’s abiding memories are of regret:

“I don’t know, I should have fought harder. I sometimes think if only I’d made more fuss. But

again Mum’s like ‘but you were so sick!’ And you just expect that they’ll [nurses and

midwives] do the right thing. I don’t know... if it was now I would kick and scream. I just

thought that they would do the right thing, and let me see my baby.”

Although many of the stories the women told were predominantly negative depictions of

interactions between women and nursing or midwifery staff, it should be acknowledged that

not all of the nurses discussed in the women’s stories were portrayed in a negative light.

However, when nurses or midwives were deemed to be caring or compassionate it was rarely

elaborated upon. Of the twenty-seven women who told their stories only two portrayed nurses

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or midwives in a positive light. Differentiating from those she discussed earlier, Yasmin

recalled that “the theatre charge nurse was lovely” and when discussing midwives she said:

“They are not controlling and overly opinionated. They seemed to be happy to accept you as

a person rather than a condition or no.3 on the theatre list. They also loved that my baby

was fully breast  fed - scored points with them for that, and they seemed to value my desire to

be with my baby and saw it as a positive.”

Unity had ceased taking anti-psychotic medication during her pregnancy to protect the

development of her unborn child. After the baby was born she was admitted to a specialist

mental health mother-baby unit for the first three months of her life as a mother. There she

was stabilised on her medication and her mothering skills developed and monitored. Unity

had a pact with the staff that if she did everything she had to do for the baby consistently for

three months, she would be able to retain care of her. Unity was eventually deemed

successful in the mothering role and was discharged with her baby. So for Unity health

professionals not only permitted her to be admitted with her child but were an intrinsic force

in allowing her to develop the mothering skills necessary to retain custody of her child. Her

story focused on both her gratitude and the hard work involved:

I had to get up every three hours, every night and every day to feed her, upstairs, before she

came downstairs, and I did it. I kept on doing it, and I kept on doing it until they said, okay,

we think you’re okay, and I would suggest everybody has that chance, with any illness,

especially mental illness [...] It happened and I was bloody lucky. I was so lucky (Unity).

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Findings from this study reveal that although compassionate sensitive care does occur, where

women are supported to continue to mother during illness, it is the times that the mothering

role is misunderstood and discounted that they remember vividly.

DISCUSSION

The vast majority of the stories that the women told were of negative experiences and

reflected times when they felt frustrated, unacknowledged, disempowered and victimised.

This does not imply that all their healthcare experiences were poor; indeed some affirmative

stories were shared. We have aimed to avoid highlighting examples of poor practice over

good or good-enough practice by including the two accounts of positive experiences as we

accept that whilst stories of poor practice may make for ‘scintillating’ reading, they can fail to

present a realistic and balanced account (Carter 2008). We believe that there were probably

many positive moments with health care professionals, but that these are expected and

therefore not remarked upon as readily.

Listening and attending to the stories that people tell of illness can not only reveal how

people experience illness and health care, but also the way they view health professionals

(#### year). Understanding how we are positioned in people’s narratives, and the way we

contribute to shaping their health care experience, can allow us to reflect upon practice, and

become more responsive practitioners in the future (Holloway & Freshwater 2007a; ####

year). From the women’s stories it is apparent that nurses need to be more aware of their

women patient’s roles as mothers and avoid language that is perceived as judgemental or

unsupportive. Many women experience pregnancy, breastfeeding and caring for their children

as a moral undertaking that has consequences for their self-perception and social standing

(Thomas 2003; Thompson et al. 2008). Therefore they may be extremely sensitive to

perceived judgement of their mothering.

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Moral judgement of patients by health professionals is an understudied area in the literature

(Hill 2010). The caring ideology that governs nursing discourages forthright examination of

what nurses really think of their patients (Hill 2010; Nelson & Gordon 2006). Much of the

research regarding moral reasoning in health care examines decision-making in the face of

ethical dilemmas (Dierckx de Casterlé et al. 2008), attitudes to stigmatised conditions, and

difficult clinical relationships (Hill 2010). Many examinations of morality in nursing research

focus upon the clinical moral dilemmas of nurses and these fail to acknowledge that

subjectively nurses may be less than entirely altruistic and patient-focused.

A survey of Dutch nurses found that when considering moral problems in practice, many

nurses considered them objectively and not in relation to their own actions (van der Arend &

Remmers-van den Hurk 1999). Yet nurses are human and susceptible to being influenced by

personal, cultural, and social beliefs when interacting with patients in the already pressured

health care environment (Brennan 1998; Carse 1996; Hill 2010). Furthermore, nurses have

historically experienced subordination and oppression in the hospital hierarchy, and may find

themselves caught between facilitating their patients’ desire to be ‘good’ mothers and

meeting the demands of the institution (Martucci 2012).

Nurses care intimately for patients and thus become familiar with their stories. This

familiarity with patients can result in harsh moral evaluation by nurses (Hill 2010). Negative

moral judgements being made by health professionals also increase in the face of time and

resource restraints (Hill 2010). Patients at increased risk of being negatively labelled are

those “who fail to validate the clinicians’ sense of themselves as effective professionals, who

threaten their control, and/or who create fruitless work” (Hill 2010, p. 2). However, with

more informed patients, the expertise and power of nurses that nurses have as a reflection of

their professional status is increasingly being challenged (Wilson, Kendall & Brooks 2006).

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After giving birth, there is evidence that some women feel pressured by health professionals

to breastfeed (Hall & Hauck 2007; Lamontagne, Hamelin & St-Pierre 2008; Mantha et al.

2008; Marshall, Godfrey & Renfrew 2007). Yet this is at odds with these participants’ stories

of feeling discouraged to retain the care of their infants, when they the mothers were unwell.

Sweet (2008a), too, raised the question of who is actually responsible for promoting

breastfeeding beyond the postpartum period when mothers and babies are integrated into the

general health system. The lack of commitment to sustaining the breastfeeding dyad reported

by participants in this study implies that once women and babies are outside of the maternity

wards, the importance of breastfeeding could be disregarded within some hospital

environments. Yet it is in the interest of public health to support the initiation and

continuation of breastfeeding (Sweet & Power 2009). Therefore health professionals need to

find ways to facilitate contact and breastfeeding for mothers and their infants when the

mothers are ill.

On a positive note, in the Australian state where this study was conducted it is mandatory for

public health services to have a policy to support women to continue breastfeeding when

either they or their infant are accessing services “including accident and emergency and

surgical wards” including “enabling breastfeeding infants to stay with their mother in

hospital” (Department of Health NSW 2006, p. 12).

Without interviewing nurses, motivation for commenting on women’s mothering and

treatment choices can only be speculated upon. The nurses discussed by the participants may

never have intended to portray hostility or reveal their discomfort but this was how the

women perceived their responses.

CONCLUSION

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There are many implications for health care professionals that can be derived from these

women’s experiences. The majority of these implications are not expensive, difficult or

dependent on institutional resources. Rather, they rely on encouraging health professionals to

reflect upon their beliefs and attitudes regarding mothering and for them to foster a non-

judgemental, affirmative and solution-oriented approach to caring for mothers who are ill.

Women’s mothering responsibilities should be part of a routine nursing assessment. Although

the appropriateness of the admission would have to be judged upon an individual basis,

women and their breastfed infants need to be viewed as inseparable except in the direst of

circumstances. Women who have children should be asked how they are coping and if they

have any particular concerns. Acknowledging women’s maternal responsibilities and

encouraging them to discuss challenges they face also offers an opportunity to identify

problems that may be amenable to other interventions or referrals.

Nurses should seek to support and validate women in the mothering role and avoid criticising

women for their mothering choices. The therapeutic relationship between patients and nurses

may be threatened if women feel vulnerable, disempowered and judged as mothers. It is

therefore important to ensure that patients feel respected and that their concerns as mothers

are heard and taken seriously.

LIMITATIONS

Although findings presented in this paper resonate with others in the literature, it draws its

conclusions from the experiences of a small number of women. The inclusion criteria that

specified women were fluent in English potentially limited the sample size. All of the women

who responded were Western, White, heterosexual, and predominantly middle class. These

participant characteristics located this study firmly within the Western ideologies of

mothering, and therefore did not address other cultures, communities and socioeconomic

18

constructions of mothering. The experiences of women from more diverse cultures and

socioeconomic backgrounds could conceivably be quite different.

The participants featured predominantly in this paper were hospitalised while caring for

infants from 3-16 years ago. While it is acknowledged that experiences of being hospitalised

sixteen years ago may not be reflective of contemporary practice, such accounts have been

included here with more recent stories to highlight that women are persistently challenged in

their mothering by hospitalisation.

It is acknowledged that perhaps the stories shared contained predominantly negative accounts

as the recruitment documents called for women who identified as disrupted in their

mothering. Women who identified as disrupted were more likely to have had negative

experiences than women who had more positive experiences. That their stories were negative

however, does not make them any less worthy of dissemination.

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Name Age Nationality Diagnosis Marital Status

Children

1.Alice 34 Australian Long medical history, including pulmonary fibrosis, post-natal depression, and a brain tumour (ependymomas).

Married A 6 year old daughter and 4year old son.

2. Bailey 34 Australian Dilated cardiomyopathy. Married A 12 year old daughter, and 2 sons aged 7 and 4.

3. Cate 45 Australian Crohns disease. Married 3 daughters aged 22, 19, and 17, and a son 10 years old.

4.Dee 47 Australian Crohns disease, which led to right hemicolectomy, illeostomy, proctolectomy, also iritis and rheumatoid arthritis.

Separated 3 daughters aged 28, 25 and 22.

5. Eliza 35 Australian Post natal-depression, pneumonia, deep vein thrombosis.

Married A 5 year old daughter and 2 year old son.

6. Farrah 65 Australian Borderline personality disorder and agoraphobia.

Divorced 6 adult children.

7. Ginger 31 American Lyme disease, fibromyalgia, chronic fatigue, hypothyroidism.

Married 2 children aged 5 and 9. One child is a son the sex of the other child was not revealed.

8. Heather 25 American Bipolar disorder. Engaged 1 son, 4 years old.

9. Isabella 32 American Ulcerative colitis resulting in removal of colon and ileostomy, plus seizures following a head injury.

Married 1 son, 6 years old.

10. Jane 31 American Ulcerative colitis. Married 1 son, 5 months old.

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11. Karina 59 Australian Depression. Divorced 1 son 35 years old and 2 daughters 29 and 34 years old.

12. Lilly 57 Australian Bipolar disorder Divorced 2 daughters 17 and 19 years old.

13. Maggie 51 Australian Lupus and haemorrhagic stroke, resulting in left sided hemiplegia.

Married 1 son 19 years old and 1 daughter 14 years old.

14. Nora 44 Australian Breast cancer resulting in a mastectomy, chemotherapy, and radiation

Married 1 daughter 10 years old.

15. Olivia 75 Australian Two bouts of tuberculosis one as a child aged 13, a second as an adult and mother.

Widowed. 1son 55 years old.

16.Pearl 40 Australian Cholecystitis, pancreatitis and Cholecystectomy.

Married 1 son 9 years old and 2 daughters, 7 and 4 years old.

17.Quin 75 Australian Viral myocarditis Married 3 daughters, 47, 49 and 50 years old and a 44 year old son.

18.Rachael 26 Australian Ulcerative colitis, resulting in two separate stomas and bowel reconnection, plus depression.

Married 1 son two years old.

19.Samantha 35 Australian Schizophrenia. Defacto 2 sons 8 and 10 years old.

20.Tanya Australian Post natal depression that evolved into pre-menstrual psychosis.

Married 1 daughter 10 years old and 1 son 7 years old.

21. Unity 49 Australian Schizophrenia, epilepsy and thyroid disease. Single 1 daughter 16 years old.

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22. Veronica 40 Australian Crohns disease resulting in two bowel resections and depression.

Married 2 boys aged 10 and 3 years old.

23. Winter 49 Australian Breast Cancer resulting in mastectomy, chemotherapy and radiation.

Married 2 daughters 19 and 7 years old and 1 son, 16 years old.

24. Xanthia 45 Australian Hyperparathyroidism. Married 2 daughters, 10 and 12 years old.

25. Yasmin 44 Australian Severely prolapsed discs. Married 1daughter, 12 years old.

26. Zeta 43 Australian Cholecystitis and Cholecystectomy. Married 2 daughters, 2 and 4 years old.

27. Adelaide 37 Australian Dural headache and torn ligament post caesarean.

Married 1 daughter 3 years old, pregnant at the time of the interview.

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Table 2: Themes and sub-themes

Themes Sub-Themes

Playing the Part Reconciling roles: The patient mother

The show must go on: The relentless responsibility of mothering

Adlibbing: Doing the best she can

The Healthcare Subplot Reading different scripts: Nurses misunderstanding mothers

The heartbreak scene: Mothering from hospital

Receiving good direction: Supportive health professionals

Supporting Cast The imperfect understudy: Partners in the spotlight

Women in the wings: Friends and female relatives

Behind the scenes: Helpful others

Reviewing the performance Plot resolution: The consequences for mother/child relationships

A performance with poor reviews: Critics, guilt and blame

Rewriting the script: The mostly happy ending

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