Professional Documents
Culture Documents
University
College of Nursing
Valenzuela City
Philippines
DATE COMPLETED
SIGNATURE OF THE
PROPONENTS
Floidas
Ranelie Gaye
Jenika
Melissa
Linton
Arlene
First Name
Lopez
Panem
Alcalin
De Guzman
Pillado
Rarang
Middle Name
Qualitative
Phenomenological
In-depth Interview with guide questions
Maternal Care
Mother; Voice; Challenges; Coping; Caring, Low Birth;
Baby
Project Title
(as proposed
A Mothers Voice: Challenges and Coping of Mother Caring for a Low Birth Baby
by the
candidates)
ISI Journals
Reviewed
Aagaard, H. and Hall, E.O.C. (2007). Mothers experiences of having a preterm
(Follow the
APA Style)
infant in the neonatal care unit: A meta-synthesis. Journal of Pediatric
Nursing, 23(3):e-26-36. doi:10.1016/j.pedn.2007.02.003.
Anderzen-Carisson, A., Lamy, Z.C. and Eriksson, M. (2014). Parental experiences
of providing skin-to-skin care to their newborn infantPar1: A qualitative
systematic review. International Journal of Qualitative Studies on Health and
Well-being, 9(0). Doi: 10.3402/qhw.v9.24906.
Bukowski , R., Davis, K.E., and Wilson, P.W.F. (2012). Delivery of a small for
gestational age infant and greater maternal risk of ischemic heart disease.
PLoS ONE 7(3): e33047. doi:10.1371/journal.pone.0033047
Eikenes, L., Martinussen, M.P., Lund, K., Lhaugen, G.C., Indredavik, M.S.
(2012). Being born small for gestational age reduces white matter integrity in
adulthood: a prospective cohort study. Pediatric Research, 72: 649654.
doi:10.1038/pr.2012.129
Gennaro, S., York, R. and Brooten, D. (1990). Anxiety and depression in mothers
of low birthweight and very low brithweight infants: Birth throughy 5 months.
Comprehensive
Pedaitric
Nursing,
13(2):97-107.
doi:10.3109/01460869009009029.
Kost, K., David, L.J. and Darroch, J.E. (1998). The effects of pregnancy
planning status on birth outcomes and infant care. Family Planni9ng
erspectives, 30(5):223. doi:P10.2307/2991608.
http://www.whattoexpect.com/wom/
pregnancy/0225/mom-with-small-for-
gestational-age-baby-at-increased-risk-for-recurrence-i
Mitchell,
E.A., Thompson,
D.M., Clark,
P.M., Glavish,
J.M., Robinson,
N., Patisson,
E., Wild,
N.S., Pryor,
C.J., Becroft,
J.E.
(2002).
Smoking, nicotine and tar and risk of small for gestational age babies. Acta
Paediatr. 91(3):323-8.
Mutale, T., Creed, F., Maresh, M. and Hunt, L. (1991). Life events and low
birthweight analysis by infants preterm and small for gestational age. BJOG:
An International Journal of Obstetrics and Gynaecology, 98(2):166-72.
doi:10.111/j.1471-0528.1991.tb13363.x.
OECD. (2011). Infant health: Low birth weight. In Health at a Glance: OECD
Indicators, OECD Publishing. http://dx.doi.org/10.1787/health_glance-201111-e
Oluwafemi, R.O., Njokanma, O.F., Disu, E.A., Ogunlesi, T.A. (2013). Maternal
factors in the etiology of small-for-gestational age among term Nigerian
babies. Niger J Paed, 40 (2): 119 124.
Redshaw, M.E. (1997). Mothers of babies requiring special care: attitudes and
experiences. Journal of Reproductive and Infant Psychology, 15(2):109-20.
doi:10.1080/02646839708404538.
Sha, P.S. (2009). Paternal factors and low birthweight, preterm, and small for
gestational age
Obstetrics
Gynecology,
202(2):103-123.
DOI: http://dx.doi.org/10.1016/j.ajog.2009.08.026
Singer,
L.T. (2009). Parenting very low birth weight children from birth to
adolescence. The Schubert Center for Child Studies Policy Brief, 15.
Subedi, K., Aryal, D.R. and Gurubacharya, S.M. (2009). Kangaroo mother care for
low birth weight babies: A prospective observational study. Journal of Nepal
Paediatric Society, 29(1). Doi:10.3126/jnps.v29i1.1593.
Tr
Tr Trevino, H.M. (2015). What is small for Gestational Age (SGA)? Retrieved from
http://www.urmc.rochester.edu/encyclopedia/content.aspx?
ContentTypeID=90& ContentID=
P02411
Tyson, J.E., Parikh, N.A., Langer, J., Green, C. And Higgins, R.D. (2008). Intensive
care for extreme prematurity moving beyond gestational age. New England
Journal of Medicine, 358(16):1672-81. doi:10.1056/NEJMoa073059.
Ugwu, R. and
small for gestational age (SGA) and prematurity in Port Harcourt, South-South
Nigeria - changing trends. The Internet Journal of Pediatrics and Neonatology,
13(1).
United Nations Childrens Fund and World Health Organization. (2004). Low
Birthweight: Country, regional and global estimates. UNICEF, New York, 2004.
ISBN: 92-806-3832-7
Van den, B. G., Van Eijsden, M., Galindo-Garre, F., Vrijkotte, TG. and Gemke, R.J.
(2013).
Smoking
early.
Human
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89(7):497-501.
doi:
10.1016/j.earlhumdev.2013.03.007.
The study aims to determine the challenges and coping mothers caring for
a low birth baby. The study will specifically dwell on the challenges experienced
by the mothers with low birth weight baby as well knowing the coping strategy to
overcome these challenges. The researchers will ask permission from the
Proposal
barangay captains of selected barangays in Metro Manila that have mothers who
Abstract
gave birth with a low birth weight baby. In-depth interview will be utilized for
data collection using aid memoir as guide questionnaire. The questionnaire is in
the form of open ended. The key informants must be those mothers who gave
birth with low birth weight baby for the last one year. Cool and warm analysis will
be utilized to analyze the data that will be gathered from the interview.
There are many reasons why a baby may have a low birth weight. The
baby may be small simply because it runs in the family. Parents who are shorter
and weigh less than the European average, or who were themselves small at
birth, may have smaller children. If this applies to you, mention the possibility to
your midwife or doctor.
If the baby weighs much less than 2.5kg, midwives, doctors and nurses
may describe her as having a very, or extremely, low birth weight. This can
happen to babies who are born prematurely. If the baby was premature, her
situation is different from babies who are small but are born between 37
weeks and 42 weeks (full-term).
Some mothers give birth to low birth babies although they knew that
during pregnancy they had enough pre-natal check ups and ate nutritious foods.
However, there are still causes why some mothers give birth to an under weight
baby.
Introduction
Interventions to improve care during pregnancy, childbirth and the
postnatal period as well as feeding are likely to improve the immediate and
longer-term health and well-being of the individual infant and have a significant
education, social support, and financial strain (Singer, 2009). Also, health risk of
babies born with LBW (Mazedl, 2013) and the health of mothers (Bukowski,
Davis, and Wilson, 2012) are also challenges for mother. Knowing their coping
strategies over these challenges may help other mothers and future mothers
who are and who will care for babies with LBW.
The purpose of this qualitative study is to determine the challenges and
coping of mothers caring for low birth weight baby.
Review of
Literature
(Synoptic and
Argumentativ
e)
parents are small), most SGA babies are small because of fetal growth problems
that occur during pregnancy. Many babies with SGA have a condition called
intrauterine growth restriction (IUGR). IUGR occurs when the fetus does not
receive the necessary nutrients and oxygen needed for proper growth and
development of organs and tissues. IUGR can begin at any time in pregnancy.
Early-onset IUGR is often due to chromosomal abnormalities in the fetus,
maternal disease, or severe problems with the placenta. Late-onset growth
restriction (after 32 weeks) is usually related to other problems (Trevino, 2015).
World Health Organization (WHO) and United Nations Child Fund (UNICEF)
(2004) (cited by OECD, 2011), defined low birth weight as newborns weighing
less than 2 500 grams is an important indicator of infant health because of the
close relationship between birth weight and infant morbidity and mortality. There
are two categories of low birth weight babies: those occurring as a result of
restricted fetal growth and those resulting from pre-term birth. Low birth weight
infants have a greater risk of poor health or death, require a longer period of
hospitalization after birth, and are more likely to develop significant disabilities.
small for gestational age (SGA) infant has been associated with increased
maternal risk of ischemic heart disease (IHD). It is uncertain whether giving birth
to SGA infant is a specific determinant of later IHD, independent of other risk
factors, or a marker of general poor health. Delivery of a SGA infant is strongly
and independently associated with later IHD in women, and potentially a risk
factor that precedes the onset of IHD by decades. These results suggest that a
pregnancy that produces a SGA infant induces long term cardiovascular changes
that augment risk for clinical IHD. SGA is associated with the risk of IHD
independently of traditional risk factors, but not necessarily independently of
potential mediating factors and other pregnancy complications. However, birth
weight is relatively easily and reliably obtainable for potential prediction of IHD in
comparison to other complications of pregnancy.
On the other study, Eikenes, Martinussen, Lund, Lhaugen, Indredavik
(2012), specified that being born small for gestational age (SGA) (birth weight
<10th percentile) is connected to decreased white matter (WM) integrity in
newborns and increased prevalence of psychiatric symptoms in adulthood. The
results of their study demonstrated that being born SGA leads to reduced WM
integrity in adulthood, and suggest that different factors modulate the
development of WM in SGA and control groups. The authors explained that in the
SGAs, no relationship was found between FA and intrauterine head growth in the
third trimester, although total intelligence quotient was negatively correlated to
FA. In controls, a positive correlation was found between FA and brain growth in
the third trimester and maternal smoking. No relationship was found between FA
and psychiatric measures in SGAs or controls.
Furthermore, there are other challenges that a mothers gave birth with
LBW baby. In the study of Singer (2009), she explained that education, financial
strain, social support and maternal stress as some of the challenges that a
mother of LBW baby experienced. The research demonstrated that mothers who
had term infants increased their educational attainment at a faster rate than
mothers who had very low birth weight (VLBW) children such that, by the time
the children had reached 14 years of age, mothers of term infants had achieved
more years (14.28 vs. 13.65, p< .035) of education than had VLBW mothers.
On the same study, Singer (2009) explained that mothers of high risk
VLBW children reported experiencing higher levels of financial strain than
mothers in the other groups. These mothers reported both higher negative
financial impact and a greater negative effect on the family in general than did
mothers with low risk VLBW children. With
With regards to social support, Singer (2009) insists that social support was
shown to buffer these effects. Mothers with high risk VLBW children who reported
high levels of social support did not differ in terms of negative impact from
mothers in the low risk or term groups. Mothers of high risk VLBW children who
had low levels of social support reported more negative strain than other
mothers.
Lastly, on the same study of Singer (2009), when asked about the stress of
parenting a child, mothers of high risk VLBW children reported higher levels of
stress, especially until age three. As children got older, these differences
decreased until they were no different from mothers of term children.
Maternal stress also discuss as one of the challenges may face by a mother
with LBW baby. According to Jackson, et. al. (2003), the birth of a preterm infant
has a along-term impact on both parents. Mothers report more stress and poor
adjustment compared with fathers. Influencing factor, such as family situation
and health status of the child, can support or weaken the coping ability of the
parents.
and care giving needs, were simply unable to avoid the reality of their childrens
situation through such coping strategies as denial. Additionally, positive mastery
was found to be higher among mothers of VLBW children at 14 years of age
compared to mothers of children who were born at term. Of note, this difference
seems to be related to higher feelings of stress among term mothers, and an
associated decrease in feelings of positive mastery as children get older which
was not observed in mothers of high or low risk VLBW children.
To cope with the challenges faced by mothers with LBW baby, healthcare
providers are good help for them. Aagaard and Hall (2007) stated that neonatal
nurses today challenged not only to provide the best possible developmental
care for a preterm infant but also to help the mother through an uncertain
motherhood toward a feeling of being a real mother for her preterm baby. An
increasing interest in mothers experiences of having a preterm baby is seen.
2.2.4 Causes of Low Birth Weight
On the study of Ugwu and Eneh (2010), they mentioned that low birth
weight (LBW), defined as a birth weight <2500g is basically due to prematurity or
small for gestational age (SGA). These infants remain a significant public health
problem in both developing and developed countries due to their significantly
higher rates of morbidity and mortality. This study was undertaken to find out the
proportion of LBW due to prematurity and SGA in Port Harcourt, South-South
Nigeria. A retrospective chart analysis of babies admitted into the Special Care
Baby Unit (SCBU) between January 2002 and December 2009. The differences in
the mean age and height of mothers who delivered an SGA and preterm infant
were not statistically significant (p = 0.3 and 0.5 respectively). When compared
to mothers of normal weight babies, mothers of LBW babies were significantly
younger (p = 0.01) and shorter (p = 0.0001). Identified predisposing factors in
preterms
were
hypertensive
disorders,
multiple
births,
antepartum
association between small for gestational age (SGA) and socioeconomic status
(SES), it is not known to what extent explanatory factors contribute to this
association. Among a large array of potential factors, the elevated risk of SGA
birth among low-educated women appeared largely attributable to maternal
smoking and to a lesser extent to maternal height. To reduce educational
inequalities more effort is required to include low-educated women especially in
prenatal intervention programs such as smoking cessation programs instead of
effort into reducing other SGA-risk factors, though these factors might still be
relevant at the individual level.
On the study of
Clark, Glavish, Patisson, Pryor (2002), it suggests that maternal smoking and
environmental tobacco smoke (ETS) were on risk of small for gestational age
infants (SGA). Maternal smoking in pregnancy was associated with an increased
risk of SGA. An increased risk of SGA was find with exposure to ETS in the
workplace or while socializing. Infants of mothers who ceased smoking during
pregnancy were not at increased risk of SGA, but those who decreased but did
not stop remained at risk of SGA. There was no evidence that the concentration
of nicotine and tar in the cigarettes influenced the risk of SGA. Maternal smoking
in pregnancy is a major risk factor for SGA.
According to Oluwafemi, Njokanma, Disu, Ogunlesi (2013), babies are
classified according to the relationship between birth weight and gestational age,
the latter being the strongest determinant of birth weight. Small-for-gestational
age (SGA) babies have birth weights less than the 10th percentile for age and
sex or more than two standard deviations below the mean for age and sex. In the
cross-sectional survey, the anthropometric parameters of term singleton infants
were related to maternal age, parity, socio-economic class, anthropometry and
medical disorders in pregnancy. Clearly, the identified predisposing factors to
SGA delivery constitute a valid prerequisite for evolving the relevant intervention
strategies. It is therefore recommended that steps be taken to improve the
nutritional status of mothers before and during pregnancy, as well as improve
utilization of antenatal services in order to ameliorate the identified risk factors.
On the study of Sha (2009), it stated that paternal LBW was associated with
lower birthweight of the offspring. Paternal characteristics including age, height,
and birthweight are associated with LBW. Paternal occupational exposure and low
lived
experiences
as
among
the
key
informants
of
the
study.
sampled
respondents
to
other
persons
believed
to
have
the
characteristics or criteria set for selecting informants. The researchers set the
following criteria as the bases for selecting key informants of the study: 1)
gravity parity; 2) term delivered (between 38-42 wks); 3) gave birth for less than
6 months; 4) first time to take a low birth weigh baby; 5) social economic status.
3.4Ethical Considerations
The study entails ethical considerations to protect the researchers, the
subjects and the institution under study. One of the potential ethical issues that
the informant might deal is the principle of informed consent. The informant has
a right to fully know the purpose of the study and the research procedure and
they must give their consent willingly before gathering any data. Another ethical
concern is the respect for persons. This means that the key informants shall
voluntarily participate in the research and she should be aware of the
consequences of her participation. The informants identity and all information
about them will be kept confidential. Additional ethical consideration if the
approval from IERC Institutional Ethics Review Committee (IERC).
3.5Research Instrument
The researchers will use an aide memoire as the data gathering tool which
was constructed and subjected for content validation. This is to ensure the
correctness and completeness of the questions created. The experiences of the
key informants will be explored. The aide memoir is the guide questionnaire to be
used in the interview. This is in the form of open-ended questions which means
the answers are in the essay or narrative form. Fourteen (14) items were
included in the guide questionnaire, which are all about the challenges and
coping the informant in caring for low birth weight infant. The data generated will
be digitally recorded and then transcribed verbatim into field text. The main
purpose of the interview process is to get a deeper understanding of the key
informants challenges and coping of caring for a low birth weight baby. The
interview will be conducted in a room where the key informants will be
comfortable and they will be able to answer the interview questions without
disturbance. Interviews will be conducted three times to cross-check previous
responses.
3.6Data Collection
The researchers will ask permission from the Health Centers in Metro
Manila to furnish us records of mothers who recently gave birth to low birth baby.
After permission will be granted, the researchers will visit the possible key
CURRICULUM VITAE
communication
skills.
Outstanding
in
maintaining
and
confidentiality,
REVIEWED BY
Program Coordinator
APPROVED BY
Lurceli L. Santos, RN,
RM, MAN
Dean of the College of Nursing