Experiences relating to motherhood: aspects to consider for the promotion of child health

INTRODUCTION

Paediatric primary care (PPC) has traditionally been mainly associated with responding to the health-related needs that emerge in children. However, this purpose has been evolving and becoming more complex¹. On one hand, the residency training of physicians (MIR programme) has expanded the skills of professionals in this field, preparing them to manage at the primary care level health problems that used to be treated exclusively at the hospital level. On the other hand, as a consequence of public health interventions implemented over the years, such as vaccination, some of the diseases that used to be among the main reasons for using these services have been eradicated. Also, maternal education and school-based health programmes have led to a significant decline in child mortality due to accidental injury.

Under the present circumstances, we need to recognise that there has been a qualitative shift in child health priorities¹,and therefore in the perception of paediatricians of their own role, which is now within the framework of health promotion^2,3. Thus, paediatricians are currently considered the main professional source of support for families on the development and upbringing of their children.^4,5

To support families in childrearing, paediatricians need to try to understand the feelings that arise in mothers in response to the new challenges posed by maternity⁶. Yet one of the main demands expressed by women in relation to PPC is the need to feel understood or supported as they assume their new role^7,9.

In facing this challenge, it is important to be aware of what motherhood involves, the vital transformation it entails, as it produces significant biopsychosocial transformations in women^10,11. The mother is born psychologically as the baby is born physically, giving rise to a new identity that will be continuously evolving¹². This is reflected in the changes that women report experiencing in their priorities, values and attitudes in relation to motherhood^12,14.

Furthermore, there is evidence suggesting that the doctor-patient relationship can be perceived as a source of support in the transition to motherhood¹⁵as long as it is based on communication that encourages the expression of questions and concerns¹⁶. The development of this new interactive framework can promote the attachment between mother and child^17,18and facilitate the understanding of and adherence to professional advice¹⁶.

In recognition of the challenges posed by women who use paediatric primary care services, our study aimed at exploring the experiences described by a group of women in regard to motherhood with the purpose of identifying the factors that need to be considered in child health promotion. Although there are other studies focused on how motherhood is experienced^13,15,these were based on group interventions that addressed women in at-risk groups, as opposed to discussion groups of women not at risk. Thus, it was necessary to explore the experiences of mothers outside risk groups¹³, which can help define potential strategic plans in PPC.

MATERIALS AND METHODS

Design

The phenomenological design of the study allowed us to delve into the individual subjective experiences of the participants¹⁹, that is, into the perceptions of motherhood and the meaning these experiences have²⁰ for the women that attended the discussion group.

Sample and participants

In collaboration with the Department of Youth and Education of the Town Council of Escoriaza (Guipuzcoa), the School of Humanities and Education Science of the Universidad de Mondragón invited families with children aged 0 to 3 years residing in this town to meet and share their experiences in motherhood.

We included all the individuals that agreed to participate, a total of 7 mothers whose characteristics are presented in Table 1, as they all met the necessary characteristics to carry out the study. Thus, it could be said that we selected participants by purposive sampling²¹, as the selection was based mainly on the topic under study and the availability of the individuals we had approached.

Table 1. Sociodemographic characteristics of the mothers that participated in the discussion group
	Age	Number of children	Had a partner	Currently employed
M1	30-40	2	Yes	Yes
M2	30-40	1	Yes	No
M3	30-40	1	No	Yes
M4	30-40	1	Yes	Yes
M5	30-40	1	Yes	Yes
M6	30-40	1	Yes	Yes
M7	30-40	1	Yes	Yes

Data collection and analysis

We fitted a space in the Museum of Escoriaza where we held five monthly meetings in the format of a discussion group^22,23. Each of the meetings lasted two hours.

The discussions were facilitated by the authors of the present article using a “funnel” approach²⁴. This technique is based on the establishment of a positive atmosphere–as Morgan described²⁵, reciprocal and interactive–and keeping the discussion focused on the subject at hand, in this case motherhood, facilitating the progression from general aspects to more specific aspects.

After obtaining the necessary authorizations and the informed consent of the mothers, we recorded the meetings on tape and transcribed their contents for subsequent data analysis²⁶. The unit of analysis was the sentence. After reading and analysing the individual transcripts, we developed a system of categories and codes collaboratively following the open coding approach, which dispenses with the use of a theory from which to apply definitions, laws or dimensions to the discourse under study²⁷, allowing the emergence of the categories and codes by induction until theoretical saturation is achieved²⁸.

RESULTS

Three categories emerged in relation to how participants described their experiences in motherhood. These categories are detailed in Table 2, along with some of the most relevant verbatim quotes.

Table 2. Categories based on which participating women described their experiences of motherhood
Categories	Codes	Most relevant quotes from participating mothers
Experiences of mothers in regard to their relationship with their children	Enjoyment of relationship	“I am very happy when I spend time with my son” (M3), “I am very happy when I am with my son” (M2), “Giving my child a sense of security feels great to me” (M7), “I sleep with my child and this is a beautiful experience for me” (M3)
	Factors influencing the relationship	“I am doing very well with the leave, enjoying my child” (M7), “If the mother does not have to go to work, the mother feels at ease, and so does the child” (M1), “When I don’t have any chores to do, I have a good time with my son” (M7, M4), “Not having time has an impact on our children” (M1)
Experiences of mothers in regard to themselves	Stress associated with motherhood	“Constant alarm” (M2 and M6), “I am worried about making a mistake or not noticing something” (M1), “I worry when my child seems unwell” (M3), “It worries me that I cannot tell who caused this dependency, he or I” (M3), “The world has changed a lot… I am afraid of the Internet, for example, there’s too much information and bullying in it” (M1)”, “I need time for myself” (M2, M3, M4, M5, M6), “The most important thing is the child, then the chores, then our partners, then the child again, and last of all us mothers” (M1)
Experiences of mothers in regard to their social network	Perceived support	“I am thankful because so far we get along well” (M2), “I have no complaints about my partner, he is very involved” (M7), “My husband is really involved” (M1)
	Perceived absence of support	“When the grandparents tell me that my child does not misbehave with them, they make me feel as if I were doing something wrong” (M6), “My mother is always telling me that we do very stupid things nowadays …” (M1), “Paediatricians put pressure on us, as do grandmothers” (M3))

Maternal experiences regarding the relationship with their children

As described in previous studies^13,29, mothers in our sample experienced their relationship with their children from a place of “happiness”, “joy” and “enjoyment”. Despite this very positive perception of motherhood, mothers that participated in our study highlighted that for this to be the case, they need to be released from various duties, either related to work outside the home or with “house chores”, as these tasks take “time” away from enjoying the relationship.

The identification of “work” outside the home as a barrier to the relationship is not new¹³. It is believed that employed mothers, that is, those employed outside the home, attempt to compensate for their absence by striving to ensure that the time they do spend with their children is quality time³⁰.

When it comes to housework, some researchers assert that the joys of parenting are often compromised by the increase in housework associated with having children³¹, with additional tasks generally falling to mothers.

Maternal experiences regarding themselves

Participants reported living in a state of “constant alarm” in relation to childrearing. In this regard, they assert that motherhood involves, on one hand, “worry” in perceiving at times that their babies are not doing well, or not knowing whether they are doing the right thing—statements that were consistent with the study by Wilkins¹⁴– and on the other “fear” caused by uncertainty, or not knowing the challenges or dangers that their children may face in the future.

In addition, mothers in our study declared that they “need time for themselves”. This statement is consistent with previous studies where mothers have reported feeling stressed, tired and overwhelmed^13,29, signs that they perceive that they have lost control of their own lives to some extent³². If they had the choice, mothers in our study would spend the “time” that they demand being by themselves to try to reconnect with who they used to be by doing things as simple as reclaiming some of the hobbies they had before having children.

The feeling of losing control over their lives was intimately linked to the hierarchy of priorities that they reported, in which “the child is first, then house chores, then the partner, then the child again and last of all themselves”. In the words of Gilligan³³, it could be said that women develop an “ethic of care” that revolves around their responsibility toward others.

Maternal experiences regarding perceived social support

Most mothers reported feeling fortunate that they “got along” with their partners and that their partners were “involved” in parenting. When it came to their extended families, on one hand they acknowledged the help they receive, especially from their own mothers, but on the other they generally agreed that this help is often accompanied by some criticism of their parenting style, which often makes them “feel bad”.

This “pressure” is compounded by the pressure that comes from paediatricians. It appears that when mothers are informed that their children are developing well, they tend to interpret this as an indirect statement that they are doing a good job, so these interactions are experienced in a positive light³⁴. On the other hand, when the opposite occurs, that is, when mothers learn that their children are not growing as expected or desired, the interaction may become a negative experience resulting from the perception that their performance as mothers is being evaluated.

The accounts we obtained were consistent with those reported in previous studies^34,35, where mothers expressed the social pressure that they felt subjected to.

DISCUSSION

As was the case in previous studies^13,14,32, the women who participated acknowledged the joy they derive from motherhood, and identified the difficulty in achieving an adequate work-family balance as a barrier to it. Thus, many women, especially those who are actively employed, seem constantly torn between how they would like to approach motherhood and the reality of what they can actually do. Therefore, it would be beneficial to share with them the conclusions of the available literature^36,37, which suggest that in this day and age maternal employment does not have a negative impact on the developmental outcomes of children, as fathers are more involved in parenting than they were before and the quality of child care services has increased substantially.

As others did in the past¹⁴, our study revealed that women experience motherhood from a state of constant alarm, worry, doubt, uncertainty and fear due to the considerable demands and responsibility associated with it. Alleviating this anguish could be one of the tasks of PPC professionals. Establishing the doctor-patient dynamic from the awareness of the ethic of care developed by women may be key in achieving this goal³³. Furthermore, paediatricians can try to help mothers identify the individual needs of their children, freeing them from the yoke of rigid beliefs that do not acknowledge the existence of this diversity⁶.

The narratives of the mothers were homogeneous when it came to the role of fathers in parenting and the social pressure they were subjected to. This complaint has also been reported in other studies^34,35, where, as occurred in ours, paediatricians were identified as agents that compounded the perceived external demands. To discourage this perception, it would be useful to consider the demands made by mothers, who express the need to feel understood, receive emotional support and think about childrearing without feeling judged^15,38.

However, this type of doctor-patient relationship is not the most prevalent, as different studies show that doctors frequently give recommendations and directives, whether they are requested or not^16,39. Therefore, the identification of practices that push the boundaries of the traditional technical and evaluative model of care could be a way to develop new approaches fitting the needs expressed by mothers. Education seems to be the key to facilitate this change. If greater emphasis is placed on the influence of the personal background of each paediatrician⁴⁰ and on interpersonal communication¹⁶, it is possible to make paediatricians competent in addressing developmental difficulties while avoiding blaming mothers and helping them deconstruct the fantasy of the perfect mother⁴¹ to ensure greater and better adherence to paediatric recommendations^8,42, thus promoting child health.

Lastly, while it may be considered sufficient on account of the homogeneity of participants⁴³, the small size of the sample limits the generalizability of the results of this study. This suggests that future studies should have samples that are not only larger but also more heterogeneous in order to explore the diversity that exists in the experience of motherhood. This would allow us to better fit our approach to the needs of the diverse mothers that seek PPC services.

CONFLICTS OF INTEREST

The authors have no conflicts of interest to declare in relation to the preparation and publication of this article.

ABBREVIATIONS

MIR: medical resident • PCP: primary care paediatrics.

ACKNOWLEDGMENTS

We want to thank the Department of Youth and Education of the City Council of Escoriaza (Guipuzcoa), which collaborated in the study by helping us recruit the sample and providing a space to hold the discussion groups.

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