Our Lady of Fatima University

College of Nursing

Valenzuela City

PhilippinesDATE COMPLETED

SIGNATURE OF THE PROPONENTS

RESEARCH PROPOSAL CAPSULE

ProponentsFernandoFloidasLopez

BacchusRanelie GayePanem

BonzonJenikaAlcalin

DavidMelissaDe Guzman

Dela CruzLintonPillado

RepasoArleneRarang

Last NameFirst NameMiddle Name

Field of SpecializationNursing

Research AttributesResearch ApproachQualitative

Research DesignPhenomenological

Research TechniqueIn-depth Interview with guide questions

Research DomainMaternal Care

Delineated FactorsMother; Voice; Challenges; Coping; Caring, Low Birth; Baby

Project Title

(as proposed by the candidates)A Mothers Voice: Challenges and Coping of Mother Caring for a Low Birth Baby

ISI Journals Reviewed

(Follow the APA Style)Aagaard, H. and Hall, E.O.C. (2007). Mothers experiences of having a preterm 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.2012.129Gennaro, 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.Jackson, K. Ternestedt, B.M. and Schollin, J. (2003). From alienation to familiarity: Experiences of mothers and fathers of preterm infants. Journal of Advanced Nursing, 43(2):120-129. doi:10.1046/j.1365-2648.2003.02686.x.

Johnson, T.P. (2005). Snowball Sampling. Encyclopedia of Biostatistics, 7. DOI:10.1002/047001 1815.b2a16070

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.

Mazedl, S. (2013). Mom with small-for-gestational-age baby at increased risk for recurrence in second pregnancy. In What to Expect. Retrieved from http://www.whattoexpect.com/wom/ pregnancy/0225/mom-with-small-for-gestational-age-baby-at-increased-risk-for-recurrence-iMitchell, E.A.,Thompson, J.M.,Robinson, E.,Wild, C.J.,Becroft, D.M.,Clark, P.M.,Glavish, N.,Patisson, N.S.,Pryor, 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-2011-11-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 births: a systematic review. American Journal of Obstetrics and Gynecology, 202(2):103-123. DOI:http://dx.doi.org/10.1016/j.ajog.2009.08.026Singer, 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= P02411Tyson, 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 Eneh, A. (2010). The proportion of low birth weight babies due to 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: 92-806-3832-7Van den, B. G.,Van Eijsden, M., Galindo-Garre, F., Vrijkotte, TG. and Gemke, R.J. (2013). Smoking early. Human Development, 89(7):497-501. doi: 10.1016/j.earlhumdev.2013.03.007.

Proposal Abstract 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 barangay captains of selected barangays in Metro Manila that have mothers who 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.

Introduction

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 tobabies who are born prematurely. If the baby was premature, her situation is different from babies who are small but are born between37 weeksand42 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. 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 impact on neonatal and infant mortality at a population level. Almost 70 per cent of all low birthweight births occur in Asia (United Nations Childrens Fund and World Health Organization, 2004). The number of low birthweight babies is concentrated in two regions of the developing world: Asia and Africa. Seventy-two per cent of low birthweight infants in developing countries are born in Asia. The Philippines is one of the countries in Asia and it is also one of the developing countries nowadays. In the data of WHO and UNICEF, it should be noted that in developing countries, more than 50 per cent of low birthweight infants are born in 13 of the countries that have birthweight estimates available and that have among the highest incidences (20 per cent or higher), whereas only 14 per cent are born in 53 countries with an incidence of less than 10 per cent. Just because an infant is born small for gestational age does not mean additional care is needed at home. Infants will be kept in the hospital, if there are anycomplications, until they are deemed healthy enough for discharge. After such time, any extra care will be provided by the pediatrician or other specialist as needed, but as for parent-based care the parent may find their tiny baby is just as resilient and tough as larger infants.If the small for gestational age infant was bornpreterm, there may be additional care needed such as daily oxygen or special feeding practices. A special formula may also be suggested if the infant is not breastfeeding. The formula is high in calories and healthy fats to help baby gain weight.Breastfeedingis typically suggested for infants born small for gestational age, especially if they are premature. Breast milk contains antibodies that help protect your infant from infection and disease.

As the incidence of low birth weight babies is prevalent to developing countries like Philippines, it is important to understand and know not only the situation of the babies but also the situation of person who is mostly caring for them such as their mothers. Since babies like this are not that easy to care for because of their conditions, many challenges that the mother may faced such as maternal stress (Jackson, Ternestedt, and Schollin, 2003; Singer, 2009), 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 Argumentative)

2.1 Theoretical Framework

The study is guided on the theory of Ramona Mercer which is the Maternal Role Attainment Theory. It was developed to serve as a framework to nurses to provide appropriate health care interventions for non traditional mothers in order for them to develop a strong maternal identity. This mid range theory can be use throughout pregnancy and post natal care, but it is beneficial for adoptive or foster mothers, or others who find themselves in maternal role unexpectedly. The process used in this nursing model helps the mother develop an attachment to the infant, which in turn help the infant from a bond with the mother. This helps develop the mother-child relationship as the infant grows.

The primary concept of this theory is the developmental and interactional process, which occurs over a period of time. In the process the mother bonds with the infant acquires competence in general caretaking tasks and then comes to express joy and pleasure in her role as mother. For the mothers caring for small for low birth babies, this theory will guide them on how to care for their infant and bond with them. It is hard to take care of low birth babies but because there is no doubt that one of the most crucial relationships in human dynamics is the relationship between a mother and her child, there is big chance that low birth babies will have a normal growth and development. 2.2 Review of Related Literature2.2.1 Low Birth Weight Small for gestational age is a term used to describe a baby who is smaller than the usual amount for the number of weeks of pregnancy. SGA babies usually have birth weights below the 10th percentile for babies of the same gestational age. This means that they are smaller than many other babies of the same gestational age. Although some babies are small because of genetics (their 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.2.2.2 Challenges Experienced by Mothers with Low Birth Weight Baby

According to Mazedl (2013), while most babies born with a low birth weight do well, asmall-for-gestational-age babycan have some health problems early on -- such as maintaining a normal body temperature, blood sugar levels that are too low, or difficulty fighting infections. Fortunately, more than 90 percent of SGA babies catch up to their counterparts in the first few years of life. Researchers at the Academic Medical Center in Amsterdam used the Netherlands Perinatal Registry (a population-based database that includes information on the pregnancies and deliveries of 96 percent of pregnancies in the Netherlands) to focus on women whose first babies were born with a birth weight below the tenth percentile (defined as weighing less than 5 pounds, 8 ounces after 37 weeks of gestation). Twenty-three percent of those women gave birth to small-for-gestational-age babies the second time around as well, while those women who had an average size baby in their first pregnancies only had a three percent chance of having an SGA in their second pregnancy.

On the study of Bukowski et al. (2012), they mentioned that delivery of a 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