[Dr Serena Gomirato, doctor of neonatology at Ca’ Foncello Hospital, Treviso (Italy), and Dr Federica Vagnarelli, doctor of neonatology at Danat Al Emarat Hospital, Abudhabi (United Arab Emirates)].
A special thanks goes to Dr. Francesca Intini, Neonatologist of great professional capacity and amazing human qualities who bequeathed us her enormous passion for Narrative Medicine and encouraged us to embark on this fantastic journey, through the union of different realities thousands of miles apart. Thank you Francesca with all my heart!
This project work stems from the desire to learn more about the world of women who become mothers, also trying to understand whether belonging to different cultures – we work in two different countries, Italy and the United Arab Emirates – affects their experience. We wanted to question some of our new mothers in care, giving them a semi-structured outline with a first part of socio-demographic data collection and a second part with narrative stimuli that could help them to tell their Needs and Feelings during Pregnancy and after childbirth, both in case of preterm and full-term birth. In this preliminary phase of our work, which is still in progress, we examined the first 20 narrations, 12 from Italian mothers and 8 from foreign mothers (of which 4 Arab and 2 from Eastern Europe), with an overall average age of 34.5 years; the babies of 17 of these mothers had already been discharged.
Starting from EMOTIONS during pregnancy and childbirth, both in physiological pregnancies and in those that end prematurely, there is always a very strong sense of Fear towards the outcome (which is always potentially uncertain) as well as a lot of physical fatigue: “the first days after childbirth were the worst… instead of feeling happy, I was so traumatised and afraid of the possibility that something bad could happen to her…”; “I would like more energy. After the caesarean my energy level went down a lot’. Physical fatigue sometimes becomes for the woman a real physical trauma in seeing her body modified: “sometimes I had the impression that the baby was taking too much from my body … stretch marks … the weight increasing”; “My husband says I was sweating, my mouth was open, my lips were very chapped and my eyes were completely red and crossed …”.
To the sense of wonder at the new arrival – “the first moment I saw my baby girl…. she was beautiful! – is often accompanied, in the background, by a feeling of Loneliness, either because one feels misunderstood, or because one’s family has remained far away, for example due to the restrictions caused by the Pandemic: “now that I’m at home, I feel tired and sometimes alone”; “I was far from my family and my husband’s family … and this made me feel lonely”. and this made me feel even more scared and alone. Online is not the same…’.
The Pandemic has not really been a protagonist in our interviews, as we would have expected at this time, confirming that Pregnancy and Childbirth are more personal than social events.
The most frequently expressed NEEDS in pregnancy go hand in hand with emotions. The Need of Rest is expressed by almost all the interviewees to support the moments of Fear and physical tiredness: “everything is centred on the baby and the mother goes in the background but if the mother is not well, if she does not feel supported, if she does not have an hour for herself a day to ease the tiredness… she cannot take care of the baby in the best way…”; “in the first weeks at home I needed to rest…. I needed someone to take care of the house for me …’.
In the narrations we also read about women’s need for intimacy both during pregnancy and after childbirth, and we read about inappropriate questions, unsolicited gestures, superficial statements: “in the first days at home, I felt the need to be alone with my baby, I needed to know him and to be known …”; “My belly was my own, I never liked anyone to touch it … only the health staff allowed it without feeling a shiver of discomfort and alertness down my spine …”.
In the period after childbirth, then, emerged as fundamental needs the support to breastfeeding and also, very interestingly, not to feel stigmatized by society in case of not being able to give birth naturally and/or not being able to breastfeed: “it took some time … months … before I understood that I could really stay at home. before I really understood that I could be safe if my baby needed formula milk in case I “did not have enough …”; “at the beginning I was sad because I was not able to give my baby enough milk”.
Among the narrative stimuli included in the narrative trace, we have included the cue concerning the family, which in most cases is considered an important support, but in others turns out to be an entity that struggles to understand the situation, and in 3 of the 20 narrations is not mentioned. Also the husband/partner, sometimes is a reference, other times is at the margin of the narration, as to imply a scarce presence and closeness.
Examining the language used in the narratives, we found a variability between more didactic and descriptive styles, others more tragic-dramatic – “My baby girl was born prematurely with a low birth weight. When I saw her for the first time, I started crying, I was afraid she wouldn’t make it. The first days after her birth were the worst”; “the baby was born … and after … contractions again … terrible … I broke my teeth with the effort. Terrible” – others even more spiritual: “The most beautiful thought I have about my pregnancy is to think what a blessing it is to have a body give life to another perfect human being”; “I am truly blessed to have a child who is well”.
Sometimes the stories contained interesting and very evocative metaphors: “I dive professionally and I’ve always thought that being born is for a child a bit like emerging from a fantastic night dive …”; “I felt my body being pulled on all sides, as if I were on a ship in a stormy sea where it is impossible to stay balanced”.
Among the most recurrent words and expressions, the use of the possessive adjective my (mia, miei), the verb sentire (in the sense of perceive), the adverbs non and prima, the noun moment and the pronoun qualcuno.
The analysis through some classifications of narrative medicine confirmed these initial observations of ours, supplementing them with new insights. According to Kleinmann’s classification, we found both elements of Disease, i.e. of detailed description of strictly clinical events – “At first my baby had low sugar levels. Before the birth I was asked to collect some colostrum to take with me when I gave birth. That amount (160 ml) was immediately given to the baby after delivery” – and elements of Illness, more open to the emotional experience – “During the hospitalisation I felt lost, with a lot of anxiety and constant fear, terrible thoughts. I was fine only when I went to see her” – and both elements of Sickness, representative of a socially influenced experience on the theme of motherhood – “a good thing in my case would have been to have someone to educate the Husband to give the maximum support to the Wife…to explain to the Husband what a Woman feels when she gives birth to twins and finds herself at home alone to take care of them”; “We forget that the mother is also a woman with her own ambitions, aspirations, desires, desires, which go beyond the care of children. That the mother absolutely needs to have time for herself. The risk is that sometimes the woman and the professional are sacrificed on the altar of motherhood, and that is not right”.
We also used Frank’s narrative classification, finding elements of Chaos in the narratives – “Initially I felt lost in my darkest thoughts of worry, fear, guilt about not carrying the pregnancy to term, grief”; “I felt sad, upset, not understood by the outside world, not a mother” – of Restitution, i.e. expectation of a resolution – “I feel very confident that everything will work out from the evening of the third day in the NICU”; “For tomorrow I would like all the best for my baby and that she will come home soon” – and Quest, which represents the element of reflection, research and gaining new knowledge – “We have become stronger; we know how to deal with every problem with her. It is a miracle that God has sent us to explain to us well what the word “Mother” means and what the word “Daughter” means”; “That sadness and pain has served me as growth and as further knowledge of my being a woman and now also a mother, which is useful for the growth of my children as well”.
At the end of the narration, we invited the mothers to make a drawing that was representative for them. Not all of them did, but among those received, we found the Sun, the Heart (as a single large drawing, between two elephant twins, pulsating on a mother doing kangaroo-care, inside a belly that could also be a breast…), the House (with the child in the garden lifted by two balloons called “hope” and “family”).
Collecting these interviews we felt honoured to humbly welcome precious stories that tell intimate aspects and reflections never before shared. We felt shaken by the loneliness that emerges from many of the stories, even for women who had a partner or family by their side during pregnancy.
It is interesting to note that Arab women are much more reluctant to tell their stories than European women. It is beautiful to see how, in the two groups, the Needs and Emotions in Pregnancy and Childbirth are the same regardless of education and cultural background.
Pregnancy did not appear as a social event but as an extremely intimate one. Although feeling alone, however, the woman never appears in our stories as “fragile” but as a being wonderfully aware of her own needs and determined to bring all her physical and mental resources to bear. We realised how important the support of the NICU staff is for the family: fear of the unexpected and concern for the unspoken are always present, regardless of the seriousness of the child’s clinical condition.
Many concrete proposals emerge from the analysis of our interviews. These include
- the need to continue collecting stories, so as to give voice to as many women as possible from different cultures and backgrounds.
- the need to train Doctors and Nurses to take more care of Communication at Childbirth and in the Neonatal Intensive Care Unit, leaving nothing unsaid or unintended.
- the need to organise Listening Groups for Mothers, Support Groups for breastfeeding, Help Groups in general for the post-partum period. The event of birth, especially if it involves a premature baby, appears from our interviews to be a “naturally complex” event, whose many facets must be known and reknowned with respect by Care Workers and Representatives of Institutions.
In the NICU ward in Treviso, a project was launched a few years ago to give the parents of young children in hospital a diary that they can fill in with stories, emotions, drawings, and which they can decide whether or not to share with the staff. We would like to conclude with a sentence taken from the testimony of a mother: “WRITING SAVED ME…MY DIARY KEEP ME COMPANY AND KEEPS ME TO THIS DAY…”.