‘they’ve forgotten that i’m the mum’: constructing and practising motherhood in special care...

Social Science & Medicine 53 (2001) 1011–1021

‘They’ve forgotten that I’m the mum’: constructing andpractising motherhood in special care nurseries

Deborah Luptona,*, Jennifer Fenwickb

aSchool of Social Sciences and Liberal Studies, Charles Sturt University, AustraliabCentre for Family Health and Midwifery, University of Technology, Sydney, Australia

Abstract

Little sociological research has sought to investigate the ways in which women with hospitalized newborn infants

construct and practice motherhood. This article seeks to address this lacuna, using data from a qualitative researchproject based in two Australian neonatal nurseries. Thirty-one mothers of hospitalized newborns and 20 neonatalnurses were interviewed, and other data were obtained via observations of the nurseries, tape-recorded verbal

interactions between parents and nursery staff and casual conversations with mothers and nurses. The data revealedthat while the mothers’ and nurses’ discourses on what makes a ‘good mother’ in the context of the neonatal nurseryconverged to some extent, there were important differences. The mothers particularly emphasized the importance of

physical contact with their infants and breastfeeding, while the nurses privileged presence in the nursery and willingnessto learn about the infant’s condition and treatment. There was evidence of power struggles between the mothers andnurses over the handling and treatment of the infants, which had implications for how the mothers constructed andpractised motherhood. The mothers attempted to construct themselves as ‘real mothers’, which involved establishing

connection with their infants and normalizing them. In time, many of the mothers sought to position themselves as the‘experts’ on their infants. For their part, the nurses attempted to position themselves as ‘teachers and monitors of theparents’, ‘protectors of the infants’ and ‘experts’ by virtue of their medical training and experience. Differences in

defining the situation resulted in frustration, resentment and anger on the part of the mothers and disciplinary andsurveillance actions on the part of many of the nurses, both covert and overt. The nurses’ attitude to and treatment ofthe mothers was integral in the development of the mothers’ relationship with their infants in the nurseries, and this

influence extended beyond discharge of the infants. # 2001 Elsevier Science Ltd. All rights reserved.

Keywords: Motherhood; Nurses; Neonatal nurseries; Australia

Introduction

There is a substantial sociological literature exploringthe experiences of mothers for newborns, the transitionto motherhood of new mothers and the ways in which

‘good mothers’ are defined, both by women themselvesand by experts and texts on parenting. Previous researchinto motherhood has shown how certain dominant

discourses pervade notions of what is considered to be a

‘good mother’ (see, for example, Woollett & Phoenix,1991; Marshall, 1991; Crouch & Manderson, 1993;

Brown, Lumley, Small, & Astbury, 1994; McMahon,1995; Hays, 1996; Lupton, 2000). These include thequalities of patience, unconditional love and kindness

concerning how women relate to their children. ‘Good’mothers are expected to ‘be there’ for their children andto develop a strong ‘bond’ with them. Specifically in

relation to infants, ‘good mothers’ are expected to placetheir infant’s needs above their own and deal cheerfullyand patiently with the loss of sleep and time for oneselfand other privations that caring for a baby entails. The

practice of breastfeeding is also associated with the

*Correspondence address. 14 Arnold Street, Killara, 2071,

Australia. Fax: +61-2-6338-4401.

E-mail address: [email protected] (D. Lupton).

0277-9536/01/$ - see front matter # 2001 Elsevier Science Ltd. All rights reserved.

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‘good mother’ ideal, as dominant discourses on infantfeeding insist that ‘breast is best’ for infants’ physical

and emotional wellbeing.These perspectives on ‘good motherhood’ invariably

tend to refer to the construction and practice of

motherhood on the part of women whose infants areborn in good health and without disability. Thus far, fewsociologists have turned their attention to the experi-ences of women whose infants are hospitalized immedi-

ately following birth. In such a situation, women areforced to practice motherhood within a setting in whichthere are significant constraints upon how they can

interact with their newborn. Their infant’s hospitaliza-tion has major implications for how women seethemselves as mothers and how they construct and

relate to notions of the ‘good mother’.In this article, we address the question of how women

who have given birth to infants requiring care in

neonatal nurseries practise motherhood and constructthemselves as mothers. Drawing on an empirical study,we focus specifically upon how such women, as well asthe nursing staff who care for their infants, construct

notions of motherhood. The latter were included in thestudy because they play a significant role in structuringand shaping women’s experiences of being ‘nursery

mothers’. Most women in western societies get to knowtheir newborn infants and learn about the practice ofmotherhood in the highly privatized setting of their

home, having spent only a few days in a hospital settingfollowing the birth. In contrast, the mothers ofhospitalized newborns must practice motherhood in anextremely public arena over a period of days, weeks or

even months under the watchful eyes of the nursing staffin the nurseries to which their infants are admitted.Our approach is interested in the power dynamics

inherent in the experiences of ‘nursery mothers’. Weadopt a Foucauldian approach to power in acknowl-edging that power is not necessarily always repressive

but also productive, bringing into being forms ofknowledge, subjectivity and social relations (Armstrong,1997; Lupton, 1997). We were interested both in the

material practices and technologies (such as the nurseryrules and regulations, the practices around caring for theinfants, the layout of the nurseries) and the discursivepractices shaping women’s experiences and their sense of

self as a mother in the nursery.According to the Foucauldian perspective, power

relations are dynamic, produced and reproduced

through the everyday activities and social encountersin the nursery. The material conditions of the nurseryare important in reproducing and structuring these

activities and encounters, but so too are the words(grouped in certain specific discourses) that are used todescribe and give meaning to them. Discourses are

generated and reproduced in a material context thatshapes these discourses and privilege some over others.

It is via these discourses, as well as others that they bringto the setting, that the mothers seek to make sense of

their experiences and perform mothering actions in thecontext of the nursery. Nursing staff, for their part, drawon a limited range of discourses in their communication

with the mothers when discussing the infants, their careand appropriate behavior on the part of mothers, andwhen interacting with and caring for the infantsthemselves. They also use certain discourses in making

judgements about the mothers and their behavior. Thesemay, in turn, have implications for the mothers’experiences within the nursery and the meanings that

they give to their mothering. Discourses, thus, areinterrelated with practices, and both contribute to theconstruction of meaning.

The study

The data for the study were collected over a 9-monthperiod in 1997 and 1998 in two major hospitals with

neonatal nurseries in the Australian state of New SouthWales: one in Sydney and the other in a smaller regionalcity. There were a number of sources of data, all ofwhich were collected by the second author, who is a

trained and experienced midwife. One source was one-to-one qualitative interviews with mothers who hadinfants in neonatal nurseries and nursing staff working

there. Additional data were derived from observations,informal ‘chats’ with parents and nursing staff anddetailed field notes made by the second author in both

nurseries, as well as from crib-side tape-recordedinteractions between the parents and nurses.Our study focused on the mothers of the infants

because they tend to spend far more time in the nursery

than do the fathers. Thirty-one mothers participated inthe study: 16 from the Sydney hospital and 15 from theregional hospital. The mothers were recruited in most

instances via the nurseries with assistance from thenursery staff. In one hospital a number of women wereapproached in the antenatal ward after discussion with

the nursing unit manager. In both hospitals, posters andinformation brochures regarding the study were placedin accessible areas, resulting in a number of women

making inquires about the study and requesting toparticipate. All prospective participants were told thatthe study was about the experiences of parents withinfants in neonatal nurseries, with a focus on the

interactions between health care professionals andparents.The mothers who participated in our study were

representative, in terms of age, marital status andsocioeconomic background, of women with hospitalizedinfants in the nurseries involved. They ranged in age

from 19 to 41, with the average age 28.2 years. Twenty-one women were first-time mothers, and three had given

D. Lupton, J. Fenwick / Social Science & Medicine 53 (2001) 1011–10211012

birth to twins. Twenty-three women were married, whilesix lived with a de facto partner, one with her family and

one woman was single and lived alone. Nineteen womenwere employed in the paid workforce before the birth.Twelve were employed in skilled positions requiring

formal qualifications or tertiary education or both, suchas nursing, physiotherapy, business management andaccountancy. The remaining seven were employed inunskilled positions (for example, shop assistant, pizza

deliverer). Of those who were not in paid employment,six women gave ‘home duties’ as their occupation, fivesaid they were unemployed and one was a university

student.All of these women’s infants save two had been

hospitalized because of health problems associated with

prematurity. The remaining two infants were born after37 weeks and admitted to the nursery for otherconditions. Nineteen infants had been born at 31 or

more weeks of gestation and the remainder had beenborn between 24 and 30 weeks of gestation. The infantsspent between 3 days and 14 weeks in the nursery, withthe average length of stay 6.4 weeks.

Of the 31 mother participants, 28 participated both inthe crib-side recorded interactions and nursery observa-tion and in two loosely structured qualitative interviews.

The other three participated in the crib-side recordedinteractions and observations but had been dischargedfrom the nursery before we were able to interview them.

One interview was held just before the woman’s infantwas discharged from the nursery and a second interviewtook place between 8 and 12 weeks. The first interviewswere between 45 and 90min long and took place in the

hospitals. The interviews commenced with the mothersbeing asked to ‘tell their story’ (of their infant’shospitalization). The mothers were then asked to

elaborate on their mothering role within the nurseryand the ‘kinds of things’ that helped them feel like amother. Second interviews were longer, lasting on

average between 90 and 120min long, and wereconducted in the participants’ homes. In this interviewthe mothers were asked to reflect on their experience in

the nursery, the relationship they shared with nurserystaff and their feelings towards their infant.Twenty nurses from both hospitals were also ap-

proached to undertake an interview, following a

presentation on the study to the staff of the neonatalnurseries by the second author. All those approachedagreed to participate. The interviews with the nurses

were between 30 and 90min long and took place in thehospitals. Nurses who had involvement in caring for theinfants of the mothers participating in the study were

particularly sought, as we were interested in elicitingviews from both ‘sides’ of the mother–nurse dyad. Theseinterviews were similarly loosely structured, but key

questions were used to stimulate discussion, such as:What do you see as the most important things you do in

a day at work? What are the biggest challenges andrewards of your work? Issues arising from the nursery

observations or informal conversations with nurses andwomen were also raised in these interviews.Eighteen of the nurse participants, all of but one of

whom were female, were registered nurses (17 heldformal midwifery qualifications), with between one and20 years’ neonatal nursing experience. The remainingtwo were student midwives who had recently completed

a 6-week clinical practice block in the nursery. Theaverage period spent working in the nursery by thoseinterviewed was 7.5 years.

The recording of spontaneous verbal exchangestaking place between parents and nursery staff wasundertaken using voice-activated tape recorders. These

were placed by the cribs of those infants whose parentshad agreed to participate in the research. The consent ofnursery staff was also obtained. The audio recorders

were set up and activated after the parents arrived in thenursery. The recorders were not hidden, and signs weredisplayed near them to warn that taping was underwayso that all those approaching the recording site knew

that their voices would be taped. Taping was conductedtwice a week, for 5 or 6 h each time, and continued fromthe time of consent to the discharge or transfer of the

infant. On average there were two to three familiesparticipating in the study at any one time. The secondauthor remained in the nursery while the tape recorders

were on, observing interactions and taking field-notes.This allowed her to provide the context later for thetaped interactions. All participants in the study wereaware of her presence and knew that she was observing

them.The findings presented in the present article draw

mainly from the transcribed interviews with the mothers

and nurses but are also informed by the other dataforms obtained. Our analysis of all forms of the datasought to look for recurring patterns in the discourses

employed in the interviewees’ accounts, includingidentifying commonly used words, phrases and arche-types, as well as noting common practices on the part of

both the mothers and the nurses. The analysis for thepresent article was organized around the followingquestions: How do the material conditions and practicesof the neonatal nursery shape mother–infant and

mother–nurse interactions? How do the mothers andnurses define ‘good motherhood’? What is the nature ofthe power relations between mothers and nurses? How

do all these aspects affect the mothers’ construction andpractice of mothering?

The study setting

Before embarking upon our main discussion, it isimportant to provide some details of the environment to

D. Lupton, J. Fenwick / Social Science & Medicine 53 (2001) 1011–1021 1013

which the interviews refer: that of the neonatal nursery.These details, derived from the observations of the

nurseries over the study period, will serve to contextua-lize the views and experiences of both the mothers andthe nurses who were interviewed and observed.

The general environment of the neonatal nurseries isfar from tranquil, with nurses bustling and chatting,bright lights, medical staff coming and going, andparents and other visitors visiting the infants. The

infants cared for in the nurseries are surrounded by andattached to a variety of intrusive medical technologies.In the early stages of treatment they are placed in ‘open

plan cribs’ covered with plastic or housed in humidi-cribs, comprised of a perspex box with holes in the sideto allow access. The infants have many wires and tubes

entering or attached to their faces and bodies. Manyhave tubes inserted in their nose attached to respiratorsto assist breathing as well as tubes in their mouths

leading down their oesophagus for feeding. They havewires entering their umbilicus and attached to otherparts of their abdomens which are attached to machinesthat monitor such aspects of their condition as their

blood oxygen level, temperature and respiration rate.Other tubes enter veins in their hands and feet,delivering drugs.

Numerous machines that display numerical or graphicdata or deliver drugs or oxygen surround each infant.These often emit loud beeping noises, in some cases to

signal that something is awry with the infant’s condition.As the infants’ health improves and they grow biggerand stronger, they are transferred from one type of cribto another, attached to fewer and fewer machines and

often moved around the neonatal nursery in a pre-determined fashion that demonstrates their progress‘towards the door’ (discharge home). The criteria for

making decisions about the discharge of the infant,however, often vary from nursery to nursery due todiffering policies and protocols. For example, some

nurseries require infants to weigh over 2000 g beforedischarge, regardless of other factors. Other neonatalnurseries are more flexible and will individually assess

infants based on their ability to successfully suck eitherat the breast or bottle, gain weight and maintain anormal body temperature. Judgements on the part ofmedical and nursing staff about the parents’ ‘readiness’

or ‘willingness’ to take their baby home may also be acontributing factor to decisions about discharge.The nursing staff maintain a constant presence in the

nurseries and, unlike the medical staff, interact withparents at every visit. The nurses therefore act as ‘gate-keepers’, mediating the relationship between the parents

and their infants. Throughout the period of their infant’shospitalization the mothers and their partners mustinevitably discuss and negotiate issues of their infant’s

care with these nurses. Mothers are forced to engage in adynamic in which the nurses, at least initially, have the

upper hand by virtue of being familiar with the setting,its routines, technologies and specialized argot, which

parents often find alienating and frightening.

Establishing connection and striving to be a ‘real mother’:the mothers’ perspective

The experience of giving birth to a premature or illinfant that required care in a neonatal nursery was one

that produced feelings of alienation, despair and grieffor the women we interviewed. Those women who hadgiven birth prematurely were not prepared for mother-

hood to have arrived so quickly. The mothers were facedwith conditions in which they were not able to spendtime with their baby immediately following the birth andcould not hold them. When the infants were first

hospitalized, their mothers were not able to breastfeedthem or care for their physical needs. Some women hadto deal with the initial possibility that their babies might

not survive, and all had to cope with the distress ofseeing their tiny infants connected to wires andsurrounded by machines.

It was not surprising, therefore, that all of the womenspoke of their first few days of motherhood as highlytraumatic and distressing, in stark contrast to the rosy

images of joyous early motherhood that pervadepopular culture. As Sarah put it:

I was worried, the first couple of days I was justwondering [what would happen]. The nurses kept

reassuring me that everything was fine, but, youknow, not being familiar with premmie babies, Ithought what was going on was terrible. I was really

emotional, crying a lot}crying all the time I guess.

In this situation, most of the women found the notionof ‘being a mother’ difficult in the early days. They

constantly referred to ‘not feeling like a mother’, to ‘notbeing prepared’ for motherhood and to feeling‘distanced’ from their baby. The bond of love that they

expected would come with giving birth was absent, aswas the opportunity to interact with and freely touchand cuddle their infants. The enforced separation fromtheir babies was particularly difficult for first-time

mothers in their construction of a mothering identity.Experienced mothers at least possessed knowledge andconfidence in dealing with infants and had already a firm

identity as an ‘established mother’ to help them cope.According to Katrina, a first-time mother who gavebirth prematurely to twins:

I wasn’t mentally prepared}the fact that you don’tget to see them very much and when you do you’renot feeding them, it’s very distancing. I felt very odd

about the whole thing. It didn’t feel real ‘cause ithappened so quickly. I didn’t feel like they were my


babies. You’re not looking after them and you can’tsort of do anything. I think it inhibits your reactions

with them and what you do with them. You feelguilty because you are not feeling the way youshould, you’re feeling distant and you’re not feeling

overwhelming feelings of affection.

When talking about these early days, women often

spoke of being ‘allowed’ or ‘not allowed’ to handle theirown infants in certain ways. The nurses’ comments oractions made them aware that the nursery had certainroutines and regulations with which they were expected

to comply. They felt constantly ‘supervised’ by the staff,and that they had to ‘gain permission’ from the nursingstaff whenever they wished to touch or care for their

infant. As Tracey noted when she described the first timeshe gave her daughter a bottle: ‘I felt like I was beingtested. I felt like I was being watched, you know, I just

felt on edge’. These constraints and constant supervisionagain contributed to feelings of ‘not being a normalmother’. As Bronwyn said: ‘Because they’re not letting

you do what a normal mother would do, if it were theirbaby, you don’t feel as though you’re his mother. You’renot there, you’re not part of it’. Dianne was even morenegative, noting that: ‘It’s a battle, a battle. I’m

searching for control. Here [in the nursery] I don’t havecontrol. I just want things done my way. It’s my child. Idon’t want to be given this child to take home like an

adopted mother’.As time wore on, these feelings of ‘distance’ and

‘detachment’ from their babies gradually began to give

way to a strong urge to reclaim the role of mother. Thewomen engaged in several strategies to achieve this. Onedominant strategy was to learn as much as they couldabout their infant’s medical condition and the monitor-

ing equipment and therapies that were used upon them.As one mother said, ‘being a mother is knowing yourchild’. In the context of the neonatal nursery, ‘knowing

one’s child’ was a highly medicalized phenomenon.Through regularly observing what went on in thenursery and asking questions of the nursing and medical

staff and of other mothers, most of the mothers quicklybegan to become familiar with the medical terms andequipment that were relevant to their infant’s care.

Indeed, many of the women talked about being‘desperate’ to acquire knowledge. As Kylie put it: ‘Youwant to know how to deal with things, all you’rewanting is information. You’re wanting to soak it up.

You’re like a big fat sponge. You’re wanting to askquestions, even down to what does their normal poolook like?’ Many of the women quickly began using

specialized medical terms when referring to their baby’sprogress and treatment. This knowledge at least partlysubstituted for the knowledge of one’s child’s wants and

needs that other new mothers learn through the every-day handling of and caring for their infant.

Another strategy to reclaim motherhood employed bymany of the women was to seek physical interaction

with their infants as often as possible. Although to beginwith the women could not pick up, cuddle or breastfeedtheir babies, they spent time touching or stroking them

as they lay in the humidicribs. All but one of the womeninterviewed was keen to attempt to breastfeed, andwanted to establish breastfeeding as soon as possible. Inthe meantime they expressed their milk so that it could

be given to their infant via the oesophageal feeding tube.The provision of breast milk was seen as particularlyimportant as it was a uniquely maternal practice that

could not be provided by anyone else. These practiceshelped the women feel that they were establishing arelationship with their babies and that they were

‘connecting’ and ‘bonding’ with them. As Mary put it:‘You want to get a bond with your child so you can lovethem, let them know how much you love them’. Several

women also rang the nursery several times during theday when they were absent, seeking information on howtheir infant had been faring. This also helped to givethem a greater sense of connection. As Mary added:

‘When I asked, and they told me what they’d done, I sortof felt connected’.When it was felt by the nursery staff that their infants

were well enough, the mothers were encouraged to ‘dothe cares’, or carry out routine caring practices such aschanging their babies’ nappies, sponging their bodies

and feeding them. They were also encouraged toconduct simple procedures such as taking the infant’stemperature, weighing them and, for some in the finalstages of hospitalization, administering medications

such as vitamins. Being able to ‘do the cares’ contributedvastly to the women’s sense of ‘being a mother’,particularly for first-time mothers. Some women talked

about the importance of establishing a sense of ‘control’over their baby’s wellbeing, and how becoming practisedin ‘doing the cares’ allowed them to re-establish this

control. They no longer had to ask permission everytime they performed a caring action on their babies.Sarah put it this way:

[My daughter] got out of the oxygen and off all themonitors. And when I could start holding her andnot be told, ‘Would you like to hold her?’ or ‘Would

you like a cuddle?’}like being able to come in andpick her up myself and sort of start managing itmyself, making more decisions rather than waiting

for the nurses}I think that’s when I started feelingmore like a mother.

As a greater sense of competence in caring for theirbaby and knowledge about her or his condition wasestablished, the women began to feel that they knew

their baby better than the nursing staff, and couldobserve changes in their condition because of this. Many


times women described detecting subtle changes in theirinfant’s appearance and or behavior before they were

recognized or acknowledged by the nursing staff. Oftenwomen were able to suggest to the nursing staff whatthey considered to be the probable cause of their baby’s

discomfort or illness as well as being able to identifypossible diagnostic and treatment procedures. Theexamples given by women in interviews included beingable to settle the infant where no one else could,

ascertaining feed and oxygen consumption, awareness ofcrib temperature changes or the need for recommencingoxygen therapy and the detection of fits. Being able to

demonstrate skill in assessing their infant’s welfare insuch a manner assisted the mothers in gaining andestablishing competence and a sense of connection with

their infants.While they had been initially shocked and concerned

about the tiny size of their infants, most of the mothers

began to see their infants as ‘normal’ once they hadspent some time in the nursery and their condition hadstabilized, and particularly as the mothers had started tospend more time caring for them. Some women began to

feel surprised, for example, when visitors commented onthe tiny size of their babies compared with full-terminfants. Once a greater sense of competence had been

established and the infant had become ‘normalized’,some of the mothers sought to negotiate issues of carewith the nursing staff. They challenged some practices or

suggest changed to the infant’s care. This was ofteneasier for women who had other children, and who thusfelt more confident in their role as ‘real mothers’. AsStacey, who had two older children, stated: ‘I don’t give

a shit what [the nurses] think of me, I want it done myway. He’s my baby’. Dianne was one of the moreassertive women. As noted above, she desperately

wanted to establish control over the situation, and saidthat she constantly tried to ‘push things along’ to ‘getout of here’. She decided, for example, that she wanted

her baby’s bottle feeds increased in frequency, and tooksteps to ensure that this would happen.In some cases women acted against a nurse’s

instructions. This was far more likely to occur aftertheir infant had been in the nursery for some time. Onthe eve of her twins’ discharge from hospital, forexample, Danielle noted that:

Like, today we’re going home. The nurses, they kindof said, ‘Oh, you really should stay, you have to stay

two nights, it’s our policy’. I said ‘Well look, that’stoo bad’. Because I just don’t like hospitals, numberone, and I’ve got everything ready for [the twins], my

mum’s staying over.

At the same time, however, many of the women were

wary of being labelled as ‘difficult’ or ‘pushy’ by thenursing staff. Several noted that they attempted not to

ask ‘too many questions’ for fear of such labelling. Somewomen were simply too timid to act assertively, or felt as

they did not have the right to do so. Tracey recounted anexperience where she had observed a nurse makingseveral unsuccessful attempts to take blood from her

baby daughter. She thought later that she should havebeen more assertive, asking for someone else to carryout the procedure, but noted that ‘you don’t want tosound like a whinger’. Fiona similarly worried about

‘pushing the issues. I guess I feel sort of a bit bossy andimpatient trying to move things along’. Indeed, a smallnumber of women did not seek out information or

challenge the nursing staff in any way. They felt that itwas up to the nursing and medical staff to take andmaintain control of their infant’s care while she or he

was ill and hospitalized.Many women soon realized that they needed to be

‘nice’ to nursing staff to facilitate good relations. This

meant that sometimes they could not voice objectionsand that they swallowed resentments. They understoodthe importance of conforming to the ‘good mother’ roleas constructed by the nurses. This demanded of them

that they fit in with the nursery’s routines, control theirtemper and avoid being overtly assertive in challengingnurses’ opinions or directives. Sonia summed up this

situation by describing the fact that she felt she had to‘jump through hoops’ in order to demonstrate hermothering ability. These efforts she said, ‘‘gained her a

tick in the ‘good mother’ box’’, after which the nursesallowed her some flexibility in how she interacted withher child.The mothers’ efforts to ‘fit in’ and not provoke

discord with the nursing staff were sometimes sorelytested. Several of the interviewees described occasionswhen they had arrived at the nursery to ‘do the cares’,

following a pre-arrangement that they would do so at acertain time, only to find that these had already beenperformed by the nurses. Some women recounted

experiences of turning up to breastfeed their baby butfinding that the nurses had already tube or bottle-fed thebaby. Jackie, for example, recounted how she had

arrived in the nursery to breastfeed her daughter andattend to her cares, only to be told by a nurse, ‘Oh, I’vealready done her cares’. Then indicating that she would‘at least’ like to breastfeed her infant, the nurse replied,

‘Well I don’t think she is going to have anything off you,‘cause I’ve already fed her’. Jackie became very upsetand was forced to leave the nursery to recover her

composure.Many women also told stories of how the nurses

actively sought to manage and exert control over their

interactions with their infants. For example, havingasked a nurse whether she would be able to hold herdaughter (who was at the time 34 weeks of gestational

age and in a very stable condition) Andrea was told,‘No, you’ve had your cuddle today’. Bronwyn and Kim


both recounted incidents whereupon arriving in thenursery to visit and care for their infants they were

bluntly and loudly told by a nurse, ‘Nursery’s closed’.These experiences evoked the feelings of anger andfrustration for the mothers, and they spoke bitterly of

these feelings when recounting them. The experiencesemphasized for the women their continuing lack ofcontrol over their infants’ care and destabilized theirprecious and hard-won sense that they were finally

becoming ‘real mothers’. As Jackie commented of suchinstances, ‘[The nurses] are not considering our wishes. Ithink they’ve forgotten that I’m the mum’.

Teaching the mothers and protecting the infants: the

nurses’ perspective

The nurses we interviewed, regardless of the length of

time they had spent working in neonatal nurseries,tended to hold very similar views about the ‘nurserymothers’. Most of them had definite expectations of how

women should care for their infant and behave in thenursery. Most also held firm views on what theyconsidered to be the qualities of a ‘good mother’. Ifmothers did not fit into this category or meet these

expectations, they were often labelled as ‘difficult’. Thenurses suggested that it was much ‘easier’ to buildrapport and develop a relationship with particular

women and or parents. They commented that womenwho appeared ‘happy’ and ‘friendly’, and who providedthem with positive feedback, were ‘easy to talk to’.

Mothers who demonstrated their ‘appreciativeness’ ofthe nurses’ work and ‘reciprocated’ friendship, when itwas offered, made nurses ‘feel better about the job’ theydid and engendered feeling of familiarity and rapport.

When the nurses were asked to describe a ‘goodmother’, most described one who always ‘put her babyfirst’. Often nurses qualified this statement by adding

that ‘good mothers’ were those who showed immense‘interest’ in their infant. Nurses believed that a womanmaking an effort to spend as much time in the nursery

‘as physically possible’ demonstrated such attributes.For example, Annette said that she based her judgementof whether a woman was a ‘good mother’ or not

according to whether she thought ‘they have got theirbaby as a high priority’ and ‘the amount of time theyspend with the baby’. Judy saw a ‘good mother’ as‘someone who is punctual, here and keen, communicates

with us. They’re involved in wanting to know moreabout their baby’.Nurses seemed to take the responsibility of teaching

parents, particularly mothers, extremely seriously. Theybelieved that through their established expertise, theymust ‘make parents competent and confident’. As Karen

said, ‘I feel that I’m responsible for how these womenand men parent’. The data suggested that many nurses

used a didactic approach to educating, believing theyneeded to instruct parents in the correct way to care for

their infants. This was coupled with the belief that theymust ensure that parents thought very carefully ‘aboutwhat they were going to do’ with their infants following

discharge from the nursery. The importance nursesplaced on their role as parent educators meant thatmany nurses even perceived mothers of prematureinfants to be ‘lucky’, stating that having an infant in

the nursery provided women with an opportunity toreceive continuing education about infant care.One nurse, Anne, associated ‘educating’ with

‘reminding and reinforcing. Anne expressed the beliefthat it was inappropriate for parents to start treatingtheir infants as ‘normal’, which, according to her, they

did after a period of time. (As we noted above, our datafrom the mothers suggest that this is indeed the case.)She commented that parents then often wanted to ‘take

control’ of the daily care routines and began to flout the‘rules’ of the nursery. In these circumstances, the processof ‘educating’ the parents focused on reminding them ofthe importance of caring for their child in the way

suggested by the staff.The nurses often discussed and were at times overtly

judgemental about the length of time the mothers spent

in the nursery. Commonly women with other childrenwere deemed the only people to have an ‘excuse’ as towhy they were not in the nursery most of the day, or at

least at the times requested by the staff. Sue’s commentdemonstrates this point:

I mean there’s times when you stand around andwe’ll say, ‘Gee, that mother hasn’t been here for threedays’. You wonder whether it’s just that she can’t bebothered. Or is there a good reason? Like, you know,

she’s sick or something has happened with her otherchildren.

The nurses also often positioned themselves, bothin discourse and in their material practices, as‘protectors’ of the infants. This included positioning

their infants’ mothers as potentially harmful to theirown infants’ health. While women were deemed tobe ‘good mothers’ if they spent a lot of time in the

nursery and were ‘keen’, there was evidence in theinterviews with nurses that there were limitations to this.Several nurses commented that they sought to discou-rage the mothers from handling their infants too often,

as this was seen to be ‘over-stimulating’ and thereforedetrimental to the infant. As was indicated in themothers’ accounts (and as we noted in the observations

of the nurseries), nurses often hovered over mothers asthey tended to their infants, constantly advising themabout how to handle the infants. In several cases they

directly prevented mothers and their partners fromtouching their infants by admonishing them. Some


mothers earned themselves a reputation and recrimina-tions by spending what was considered by nurses to be

‘too long’ in the nursery: for example, being in thenursery for extended periods of time when the dischargeof the infant was still some time away. Women who

refused to heed nursing advice or accept assistance werealso considered by the nurses to be engaging ininappropriate behavior.Those mothers who were judged by the nurses as

‘good mothers’ were treated differently from othermothers. Mothers who ‘asked lots of questions’,appeared eager to learn ‘everything’ and ‘could be

reasoned with’ were perceived to be ‘keen’ and worthy ofthe nurse’s added effort. The nurses tended to be morerelaxed and friendly in their interactions with these

women, and spent more time engaging in informal chatand banter with them. Their questions were answeredmore readily and the nurses were more amenable to

allowing these women access to their infants withoutclose supervision. As Pauline commented of such amother, ‘you tend to give her special attention, you goout of your way. You are definitely more open to giving

them extra help and information’.One young couple moved house during their son’s

nursery stay and as a result was out of contact with the

staff. On a number of occasions several nurses expressedtheir disapproval of this behavior. They perceived thiscouple to lack the appropriate interest in coming in to

feed their infant and do her cares. This resulted in theinfant being kept in the nursery for an extended periodof time. As Ellen, a nurse, said of this situation, thenurses ‘sort of like punished her. We’re keeping the baby

here because [the parents] haven’t sort of made aneffort’.Women described by the nurses as ‘quiet’ and

‘introverted’ were often regarded as ‘not wanting toshare’ and ‘not volunteering information’. These womenwere deemed more difficult to ‘get to know’. Commonly

the impression created in the nurse’s mind was that thesewomen were not as ‘interested’ as the nurse believed theyshould be. As Robyn said: ‘they just tend to want to

come in and do what they do with their babies and leave.They appear not to want}well, they feel they don’t needto know or want to know’. Some nurses remarked thatthey were ‘pleasant’ but ‘more formal’ in their daily

interactions with these women. The perceived aloofnessof the mothers prevented these nurses from developing asense of ‘ease’ with them. For other nurses, the lack of

positive response from some mothers created a situationin which they perceived that they and the mothers‘didn’t get on’. Interacting or conversing with such a

woman, other than when providing direct infant care,was deemed something that ‘you would never do’.Women whose value systems were considered to be

different from those of the nurse were also often deemed‘difficult’ to relate to. For example, Leanne was known

to have consulted the ‘tarot cards and other bizarrethings’ to assist her to make decisions about her son’s

care. This approach, contrasting strongly with thebiomedical perspective on decision-making that domi-nated among the nurses, resulted in her being label-

led by several nurses as ‘loopy’, ‘a fruitcake’ andpotentially ‘harmful’ to her infant. Some nurses choseto blatantly ignore Leanne, while others simply relatedto her solely on a formal level. As Elizabeth commented:

‘I was nice but I wouldn’t say I formed a closerelationship with her. I couldn’t relate to her. I wouldn’t{’}}tsayanyonebondedwithher’:Several nurses also commented that they found it

difficult to build rapport or develop a relationship whenconfronted by women who were ‘loud’, ‘demanding’ or

were perceived as ‘not wanting [the nurses’] help’. Inthese situations nurses would ‘walk away’, ‘stand back’or have an ‘altercation’. Indeed, parents who were

identified as ‘aggressive’ were the subjects of particularcriticism and dislike on the part of the nurses. A numberof nurses recounted stories about mothers or fatherswho ‘stood up’ for their rights or demonstrated some

control or ‘authority’ over the decisions regarding theirinfant’s care routine. One of the nurses, Margaret, notedthat ‘mothers who don’t conform, who want to do one

particular thing their way and a good reason for whythey can’t do it are labelled aggressive’. Such motherswere often labelled ‘troublemakers’. Dianne, for exam-

ple, was described by nurses as ‘particular’, ‘very picky’,‘ungrateful’ and a ‘drama queen’. Elizabeth commentedthat Dianne was ‘loud, strong willed, a bit aggressivewhen she spoke, demanding things’, causing her to feel

‘threatened’ and ‘stay away from her’.Most nurses admitted that it was ‘easier’ not to look

after a particular family who was labelled by the staff as

difficult. Statements such as ‘I don’t want to look afterthe baby because I can’t stand the mother’ werecommon. Some nurses commented that they didn’t feel

confident enough and lacked the skills to handle such asituation. They usually responded by ‘standing back’,‘withdrawing’ or ‘letting the mothers do exactly what

they wanted’. One nurse commented that ‘I treat themlike they’re in a psychiatric hospital’.Another example of the negative labelling of nursery

mothers and its consequences is the way in which some

nurses interacted with and spoke about Katrina.Katrina had found the experience of undergoing anemergency Caesarean section and the subsequent birth

of premature twins totally overwhelming. It was evidentfrom our interviews with this mother that she wasphysically and mentally exhausted. She expressed great

difficulty in coming to terms with her experiences, andfelt emotionally detached from her infants. She hadpreviously held a senior administrative position and

found the lack of control over her life and the situationin which she found herself very difficult.


Katrina had felt depressed and guilty after the birth.One morning at the end of her hospital stay, after one of

the nurses confirmed by phone that Katrina would not bedown to attend the cares, she expressed her exasperationand disapproval, saying, ‘God, I don’t need the practice,

she does’. A second nurse made the passing comment, ‘Ibet she gets postnatal depression’. No attempt wasmade to follow up this statement, to better understandwhat was happening to Katrina or refer her to some

other supportive resource. While Katrina believed thatshe did everything in her power to meet her responsi-bilities, the staff often compared her progress to other

‘competent’ mothers in the nursery and eventuallylabelled her as ‘difficult’ and ‘weird’. By the time herdaughters were ready for discharge, most nurses were

keeping their interactions with her to a bare minimum.

Discussion

Our data revealed that several dominant discourses

concerning the qualities of a ‘good mother’ emerged inboth the mothers’ and the nurses’ accounts. In somecases there were strong convergences in both groups’accounts. Both the mothers and the nurses agreed that,

in the context of the neonatal nursery, a ‘good mother’should be physically present in the nursery with herbaby, interested in and concerned about her baby, eager

to seek out information about the baby’s state of healthand care, come to terms and be familiar with relevantarcane medical terms and eager to ‘do the cares’ for the

baby when she or he was well enough.A major difference between the mothers’ and nurses’

views on ‘good motherhood’ is the priority placed on‘being there’ for one’s infant, constantly engaging in

loving touching and bodily care of the infant anddeveloping a close emotional connection or bond withher or him. Like other mothers, the nursery mothers

considered these practices vital to ‘good mothering’.They were subsequently distressed when they feltrestricted in their interactions with their infant and that

they were unable to develop this bond. Their feelings ofgrief and distress was very strong even for those womenwhose infants were hospitalized for short periods of

time. The nurses seemed not to place as muchimportance on loving touching and bonding, but ratherwere more concerned with the mothers’ ‘showinginterest’ in their infants’ wellbeing and learning all they

could about the infant’s condition and care. While thenurses agreed that it was important for the mothers tobe present and to ‘do the cares’ when the nurses deemed

it appropriate, they sought to control and restrict thisaccess. So too, the mothers placed more emphasis onbreastfeeding as part of ‘good mothering’ than did the

nurses, largely because the mothers saw this practice asuniquely maternal, an act of love and nurturing that no

other person could provide to their infants. The nursesrarely mentioned this practice in relation to their views

on ‘good mothering’.Our data point to a gulf in meaning and power

struggles that other studies have shown often exist

between health care professionals and the parents ofhospitalized children (see, for example, research byMorse, 1991; Price, 1993; Darbyshire, 1994; Lawlor &Mattingly, 1998). The mothers struggled to establish

control over the situation in which they found them-selves, overcome their feelings of grief and alienationand become a ‘real mother’. Their notions of ‘good

motherhood’ were brought into play as part of theseattempts. Like many other mothers, they found itdifficult to achieve the ideals of ‘good motherhood’.

The material circumstances of the nursery, in which thenurses were constantly present and attempting tocontrol the mothers’ access to their infants’, made the

achievement of ‘good motherhood’ extremely difficult.So too did the conflicts in the nurses’ viewpoints on‘good motherhood’ and those of the mothers, particu-larly in relation to the mothers’ desire to have as much

physical contact with their infants as possible.For their part, the nurses attempted to present a

professional demeanour as part of their working day, to

supervise and ‘teach’ the mothers and maintain theroutines of the nursery as well as possible. Their notionsof ‘good motherhood’ were related to these goals. As

other researchers have found of health careprofessionals’ responses to patients in their care (see,for example, Stein, 1990; Smith & Hart, 1994; Treweek,1996), the nurses demonstrated a propensity to label

patients (or in this case, patients’ parents) as either‘good’ or ‘difficult’. Such labelling has importantimplications for the experience of patients or parents

in hospital. It is an integral part of the subtle ways inwhich nurses attempt to discipline patients or theirparents. Some coercive strategies were in evidence, such

as refusing mothers access to the nursery by stating thatthe nursery was closed or telling them that they had ‘hadtheir cuddle for the day’. In most cases, however, rather

than seeking to directly coerce the mothers, nursesattempted to persuade them to adopt a standard ofbehavior and a moral framework associated with the‘good mother’ ideal. This invited the mothers to

conform voluntarily and to discipline themselves ac-cording to the nurses’ views of how they deportthemselves as ‘nursery mothers’.

Members of both groups felt that they engaged in adegree of emotional management in their dealings witheach other. Many of mothers felt that they needed to

suppress expressing anger or frustration at the nurses’behavior to keep relations cordial, recognizing that poorrelations with the nurses could have a negative impact

on their experiences in the nursery. The nurses tended toposition themselves as having to deal with emotionally


volatile women who required careful ‘handling’ so as toreduce the possibility of open conflict in the nursery.

It is clear from our data that in most cases, andespecially at the beginning of their relationship, thenurses were able to exert far more control over the

situation than did the nursery mothers, by virtue of theirprofessional status and experience within the neonatalnursery setting. The nurses tended to set the limits,supervise the mothers and in some cases reprimand

them. They positioned themselves as the ‘experts’ interms of knowledge about and care of the infants. Themothers were highly aware of this, and most of them

sought to conform to the nurses’ expectations even whilesometimes resenting them. For their part, the mothersoften sought to ‘normalize’ their infants as part of the

process of coming to terms with their prematurity andhospitalization. In response, the nurses resisted thisprocess, attempting to re-establish the notion of the

infants as extraordinary because of their prematurityand the mothers as therefore requiring continuingeducation and supervision when handling their infantsright up until the time of discharge from hospital. They

positioned themselves as ‘protectors’ of the infants, inopposition to their mothers, who were regarded asseeking, in some cases, too much contact with or

inappropriate handling of their children. Rather thanrecognize and acknowledge the process of acquiringknowledge, competence and confidence in caring for

their infants that many of the mothers accomplished astime went on, the nurses tended to continue to treat themothers as lacking knowledge and competence, aspassive recipients rather than as partners in the care of

the infants.However, as Foucauldian scholarship has demon-

strated, power dynamics are rarely completely one-way,

and often fluctuate. This was true of the power dynamicsbetween the ‘nursery mothers’ and the nursing staff.Many of the mothers often made attempts, subtle or

overt, to exert greater control and resist the nurses’attempts to control the situation. As they developed astronger sense of being a ‘real mother’, some of the

mothers found it easier to assert themselves and seekgreater access to their infants and a voice in their care.They saw themselves as taking on the ‘expert’ role inrelation to their own infant, and felt that they under-

stood and ‘knew’ their own baby better than anyoneelse, including the nurses. Such women were able tosuccessfully challenge the powerful role of the nurses by

gaining the role of ‘expert’ and asserting their position asthe ‘mother’.

Conclusion

To conclude, our research has indicated the extremeimportance of mother–nurse interactions within the

neonatal nursery in relation to how the mothersconstruct and practise their mothering. The differences

between the mothers and the nurses’ definitions of thesituation had implications for the mothers’ emotionalwell-being and for the care of the infants. Most nurses

were adamant that the relationship they shared with theparent did not affect the care they provided to the infant.Our data, however, clearly contest such a perception. Itwas evident that those women experiencing a positive

nurse–mother relationship were greatly facilitated in theprocess of seeking connection with their infants.Opportunities for maternal–infant interactions were

enhanced. As a result, these women established compe-tence, felt more prepared for life at home with a newbaby and felt a greater sense of connection with their

infant. On the other hand, poor nurse–mother relation-ships resulted in women feeling disenfranchised in thenursery. Their ability to mother and interact with their

infants was restricted. For some women, this resulted intheir infant being discharged while they were stillattempting to establish a sense of ‘being the baby’smother’. They left the nursery feeling less confident in

providing care for their infant and stating that they feltdisconnected from their child. The nature of the mother-nurse relationship, therefore, potentially had an impact

for the mother that reached far beyond her experience inthe nursery.

Acknowledgements

This research was funded by a National Health and

Medical Research Council (Australia) grant awarded toLesley Barclay, Deborah Lupton, Virginia Schmied andTom Grattan-Smith.

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