Pediatrisk omvårdnad och föräldrarskap : Studier av ett vårdprogram med tidig hemgång av underburna barn, mödrars upplevelse av vården vid BVC samt föräldrarstress

Sammanfattning: This thesis aimed at: 1) evaluating the effect of early discharge of preterm infants, followed by domiciliary nursing care, on infant health, utilisation of health services, parental anxiety and breastfeeding; 2) identifying risk factors for not being satisfied with the overall care provided at the child health clinic (CHC) during the infant's first year in a national sample of Swedishspeaking mothers; and 3) studying risk factors for parenting stress one year after childbirth in the same sample. In total, 88 infants who were physiologically stable but in need of additional care, such as gavage feeding , were allocated either to an early discharge group (EDG = 45 infants) where they were offered home visits by a nurse and back-up by neonatologists, or to a control group where they were offered standard neonatal care (CC = 43 infants). Length of hospital stay after birth was on average 9.3 days shorter in the EDG than in the CC. No statistical differences were found in health outcomes, except a lower rate of respiratory infections in the EDG (6 infants vs. 16 in CC; p=0.02). Hospital admissions and visits to the out-patient clinic did not differ between the two groups during the infant's first 12 months, and breastfeeding rates were similar during the first 6 months. No statistical differences were observed regarding parental anxiety. The study of maternal satisfaction with CHC care included 2,415 women recruited from 593 (97 %) antenatal clinics in Sweden, who answered three questionnaires: in early pregnancy, 2 months after the birth and 1 year after the birth. Seventy-nine per cent were satisfied with the overall care given, while 21 % had mixed or negative feelings. Maternal depressive symptoms, worry about caring for the newborn baby, and saying that the infant had serious feeding problems were risk factors for not being satisfied. Thirty-five per cent of all mothers were not satisfied with the attention paid to their own needs, and 35 per cent said information about vaccinations was insufficient. Mothers with depressive symptoms at 2 months as well as 1 year after the birth were least satisfied. The study of risk factors for parenting stress included 2,424 women. Risk factors identified during pregnancy were unemployment, non-Swedish speaking background, inconvenient timing of pregnancy and expecting a second child. Factors identified postpartum were maternal worry, depressive symptoms, lack of support from the woman's partner and dissatisfaction with support by the CHC nurse. The mother's own experience of her infant's health and behaviour was associated with parenting stress, but not preterm birth, functional impairment or chronic illness. Social support seemed to protect against parenting stress. In conclusion, this thesis demonstrated the feasibility of a programme with early discharge of preterm infants. With the support of a neonatal nurse and back-up by neonatologists, new parents were able to care for their infant at home, even when gavage feeding and oxygen therapy was necessary. The findings regarding infant health and parents' experiences were promising, but larger studies are necessary in order to allow valid conclusions about these outcomes. A majority of Swedish-speaking women were satisfied with the care provided at the CHC during the infant's first year. Women with depressive symptoms and those who experienced that their infant had feeding problems were at the highest risk of not being satisfied. Many women were dissatisfied with the attention paid to their own needs. The mother's psy cho-social background and experience of her baby's health and behaviour were more important predictors of parenting stress than the more objective measures of infant health.