Learning the Baby: A Maternal Thinking and Problem-Solving Process
Joan M. Sullivan
PURPOSE. To describe a maternal problem-solving process from new mothers day-to-day experience of caring for and developing a relationship with their babies DESIGN. Qualitative study using grounded theory approach SETTING. Mothers homes (n = 23) and workplaces (n = 2 ) PARTICIPANTS. 25 mothers of babies from 2 weeks to 7 months MAIN OUTCOME MEASURES. Semi-structured interviews RESULTS. Learning the Baby was a major thinking process that emerged. Systematic thinking dominated mothers problem-solving. Even after the babies were comforted, mothers were not certain their efforts alleviated the babies problems, because they usually were not certain of the problem. CONCLUSIONS. Mothers thinking directs their caregiving actions. The findings were related to previous problem-solving and woinens thinking perspectives. Nurses must use planned and unplanned encounters effectively to collaborate with and teach mothers about baby behavior and health care. Key words. Baby caregiving, babys signals, maternal problem-solving, priority of the baby
loan M . Sullivarz, DNS, R N , is Director of Nursing Research and Evaluatioii, Medicd Certter of Louisiana, New Orleans.
M o s t women deliver well babies and are discharged after a short hospital stay. Once at home, they are respon- sible for their babies care. Although this is the most common experience, information is limited about how they experience this responsibility and think about the process. The required maternal thinlung process devel- ops gradually as mothers gain knowledge about and develop a relationship with their babies (Bergum, 1989; Maloni, 1994; Reese, 1992; Rubin, 1984; Williams et al., 1987).
Women bring to mothering certain ways of thinking and problem -solving from their past life experiences, which may or may not have included childrearing. Mothering a particular baby means mothers must add the ability to perceive and then interpret their babies behavior and responses (Blank, Schroeder, & Flynn, 1995; Graham, 1993; Pridham, Lytton, Chang, & Rutledge, 1991). Mothers also must adapt these slulls to include the changes consistent with normally, and possibly abnor- mally, developing babies. Underlying all these activities is the need to establish a relationship with the baby (Michaels & Goldberg, 1993; Williams et al., 1987). Perhaps, because this process is so common an experi- ence, its complexity is overlooked. However, it is evident - from the concerns about infant care, the vital influence that mothers have in childrearing, and the effect that they may have on future generations - that this process should be investigated from the mothers viewpoint (McBride & McBride, 1981; Mercer, 1995; Pridham et al.; Walker, 1984). The purpose of this study was to learn from mothers own words and experiences their think- ing process as they cared for and adapted to their new babies.
Research on maternal thinlung and problem-solving from the mothers point of view is rare. It has developed from two different perspectives. In the logical problem- solving perspective, a problem is identified and thought
JSPN VOI. 2, NO. 1, J a ~ ~ i u y - M ~ c h , 1997 21
Learning the Baby: A Maternal Thinking and Problem-Solving Process
processes are directed by rules toward goal achievement. In the other perspective, women made decisions based on relationships and responsibilities rather than rules.
Logical problem-solving ability has been found to be adequate among different mothers (Chao, 1979; Gennaro, 1985; Holden, 1986; Lindeke, Iverson, & Fisch 1986; Tuck, Litt, Salovey, & Walker, 1985). When pre- sented with the same information, women, more than men, were sensitive to the childs feelings and less inclined to explain failure as the childs fault (McBride, 1985; Michaels & Goldberg, 1993).
Iridham (1984) investigated the types of goal-directed and decision-making rules that primiparas and multi- paras of new infants use to solve day-to-day problems. She found that mothers had difficulty stating rules for naming problems and rules for taking actions. Furthermore, Drummond, McBride, and Wiebe (1993) reported that primiparas and multiparas interpreted and reacted differently to infants cries. Their interpretations and reactions were based on their relationship with this baby and their previous experience.
Gilligan (1 982) found that women make decisions based on their caring responsibilities and relationships with others rather than rules and objectivity. She investi- gated womens development by following their lan- guage, thoughts, and experiences. Gilligans research was a milestone that redirected research efforts to include womens experience of development as valid and different from the way human development had been Illustrated in psychological literature. Lyons (1 983) validated and extended Gilligans research. She found that women consistently demonstrated moral conduct based on caring regardless of intelligence, education, and social class. Several authors (Bergum, 1989; Noddings, 1984; Ruddick, 1980; Shectman, 1980) have proposed that mothers make decisions based on their internal reactions to caring for their children.
Motherhood was a major life event that changed womens understanding and caregiving according to a study of the way women learn by Belenky, Clinchy, Goldberger and Tarule (1986). Their findings supported two important aspects of Ruddicks (1980) theoretical
- . ...
description of maternal thinking. First, mothers ques- tioning of their babies, What are you going through? is central to maternal practice. Second, mothering requires adaptive responding to a constantly changing phe- nomenon, the rapidly growing child.
The research reported here was undertaken to iden- hfy, describe, and construct a theory of maternal tlunking
from the new mothers perspective. Adjusting expecta- tions was the pervading process within four subpro- cesses that emerged. Mothers interpret babies behaviors according to their past experiences and adjust their thinking within the framework of daily caring to rear their growing babies to be responsible adults. The subject of this article, Learning the Baby, was one dominant process of mothers tlunlung as it developed in the day- to-day experience of caring for infants. Occumng simul- taneously were the subprocesses of Letting Go, Being There, and Embracing Responsibility (Sullivan, 1990).
Grounded theory was chosen as the research method to discover the process, sequence, and change of the maternal thinking process of learning the baby. Grounded theory is a method of discovery of theory from everyday experience that is initially interpreted by the subjects who are immersed in the experience (Chenitz & Swanson, 1986; Morse, 1991; Stern & Pyles, 1985). The resulting processes emerge from the subjects experiences and, therefore, are considered grounded in their real life experiences (Glaser & Strauss, 1967).
Mothers were chosen purposely from the community to provide information for generating a theory of think- ing and decision-making from their point of view. They were located by referrals from colleagues, other acquain- tances, and one another. Twenty-five mothers of babies from 2 weeks to 7 months were interviewed. All inter- views, except two, took place in the mothers homes with the babies present. Two mothers were interviewed
22 JSPN Vol. 2, NO. 1, January-March, 1997
at their workplaces. All mothers voluntarily signed a consent form that had been approved by an Institutional Review Board.
Mothers with diverse backgrounds were recruited. All mothers except three reported having some education beyond high school. One mother had not completed high school. All except two were employed and most were employed full time. Seventeen mothers were white, five were black, and three were Asian. Mothers ranged in age from 20 to 37 years. Sixteen mothers were primi- paras and nine were multiparas. The multiparas spoke of and compared their experiences and thinking with this and earlier babies. Thus, the 25 mothers interviewed had experiences with 45 babies.
Focused interview questions were used to discover and understand the nature of the mothers thnking pro- cesses. Examples of initial questions were, How do you know what to do when you sense that your baby needs something?; Can you name a problem you solved in caring for your baby?; Can you recall the way you thought about the problem?; and How did you decide what to do? The answers mothers gave directed the course of the interviews from broad to more specific questions.
Interviews were audiotaped, transcribed, and then analyzed using the constant comparative method described by Glaser and Strauss (1967) and by Chenitz and Swanson (1986). The first interviews were analyzed line by line, and then the statements were converted to concepts. The concepts from previous interviews were compared with the information of incoming interviews to uncover detailed conditions about the events that affected the process of maternal thinking. When several statements were coded under the same or a similar con- cept, a category was identified. Subsequent interviews focused on discovering specific properties and variations of each particular category. Coding and analysis of one category compared to each of the other categories contin- ued to move the statements to a higher level of abstrac-
tion. The relationships of the categories or the proposed hypotheses about the relationships continued to be tested and revised until the surviving categories were linked to the main category.
Learning the baby is trymg to figure out a partic- ular babys needs, actions, and responses to the environ- ment. Mothers learn their babies by talking and listening to them, and questioning and observing their particular babies. Idenhfymg what their babies needs, actions, and responses mean is a major process of maternal thinking. Mothers also talk, question, listen, and observe to gather knowledge from other available resources. Learning the baby is ongoing, because mothers and babies experience rapid and continual growth. Mothers believe that the process they called learning the baby is a major task to which they must attend with each new baby.
The first weeks are particularly perplexing for mothers and new babies. Each has to adapt to the other, and this takes time. Learning the baby continues as babies grow rapidly over the first months. Primiparas told of their expectations and early experi- ences. One said, I just thought he was going to eat, hed stay awake a few minutes, hed go to sleep, wed change diapers and it is really not like that. Another primipara said, I knew what to expect [from past experience], and theres nothing that anyone could have done to prepare me for what its really like. Its so different. A new primipara repeatedly said that she and her baby were still new at this. In spite of their perplexity and anxiety, all mothers expected that they would gradually learn to identify what their babies needed and how to comfort them.
Figuring out is a systematic thinking process that mothers use to solve baby care problems while they try to learn their particular babys behaviors. Mothers believed that babies sent precise signals to them, and
JSPN Vol. 2, NO. 1, January-M~ch, 1997 23
Learning the Baby: A Maternal Thinking and Problem-Solving Process
they had a responsibility to learn what these signals meant. Babies alerted their mothers there was a problem by changing their behavior, often by crying. Mothers observed, listened, and tried to determine a reason for their babies' cries, so they could act to solve the prob- lems. They thought of immediate past events that related to the babies' usual patterns in order to decide on a ten- tative cause for the problems. Mothers took actions based on the tentative cause, while they continued to think systematically and to observe and listen to their babies. The method of identifying problems continued indefinitely until babies were comforted and mothers were satisfied. After the babies were comforted, mothers reviewed the problems and the effects of the actions that they took to solve them.
A primipara with a new baby illustrated the system- atic thinking process that she used to review her baby's immediate past events. She said that she would continue to try to idenhfy the problem until the baby signaled that the problem was over.
When she's crying, I tlunk of all the possibilities. Is she hungry, dirty, gassy, whatever? She cries, sleeps, eats, plays a little. I don't know if there's really any kind of a problem that I have to work through other than figuring out what's bothering her, I guess.
Systematic thinking, as well as questioning, talking, observing, and listening to babies, was common to prim- iparas and multiparas. One multipara acted to solve her baby's problem wlule she thought and checked with her baby to see whether her actions brought comfort. She tried burping and holding her in different positions, and putting her in bed. She said,
Finally, I figured she was tired because she was rubbing her eyes. I put her in the swing and she's sleeping now. So I just try things until I hit on something that works . . . Had it been that she wasn't tired, I would have gone through every- thing again.
Another multipara believed that her previous experi- ence helped her efforts, but this baby behaved differently than her other baby. Mothers' actions to comfort their babies preceded their idenhfying and naming the babies' problems. They expected to begin the same process to solve future problems that the babies would signal.
Primiparas and multiparas had different approaches for learning about new babies' problems. Primiparas often believed that they needed to know the reason for their babies' mponses before they could know what to do. Not knowing the reason for her baby's gas hindered this primi- para from comforting her cryl"g baby: "Once I know what's causing it, I can do something about it. That's why th% gas is still such a worry, because I don't know what's causing it, and I don't know what to do to make it go away."
Multiparas thought that all new babies' cries sounded ahke at first, and feeding and comforting were probably all that was needed. A multipara told how she cared for her new babies (this and previous babies) when they cried. 'They cry mostly in the begintung, because they're hungry. But then when they get a month [of age] or so, they cry dif- ferent when they're sleepy than when they're hungry. You can just sense it. You can just tell the difference."
Another multipara, who worked with babies, believed she could comfort her new baby, but she had a more difficult time learning about older babies. Also, her thinking and her actions were carried out simultane- ously and were affected by learning her baby:
When the baby would cry, I would have a little bit of this idea, when they are newborn. I don't know what they [older babies] want right now. Kind of figuring out a few different things, trying different things and seeing what worked. Trying to analyze it as I go along so that, eventually, I could differen- tiate what they wanted by different cries.
Mothers believed that what they did worked this time, but that next time they would have to start over to try to determine what was happening. There was a lim- ited feeling of accomplishment because every situation and "every baby is different."
24 JSl" Vol. 2, NO. 1, Januq-March, 1997
When mothers did not know their babies' patterns or had exhausted all their alternative actions to solve their babies' problems, they sometimes expected that their babies had to cry. Primiparas spoke of staying with their babies and providing mutual comfort until the problems were over. By soothing their babies, mothers provided comfort to themselves. One primipara spoke soothingly and asked questions of her baby while she tried to diag- nose and resolve the baby's problem. "I couldn't figure out what was wrong. Nothing appeared wrong. I was trying to sort out what was wrong. 'Tell me what is wrong.' Then, I started to say, 'Baby, I know we have had a hard day."' A second primipara soothed her baby and herself by saying, "I didn't know what to do. I just held her and said, 'Mommy's right here. Don't be afraid. You are going to be all right. I love you."'
Mothers of older babies asked questions of their babies while trying to resolve problems. A multipara, speaking to her baby, asked, "'Well, what's wrong?' Then, I will proceed to check and see what satisfies him at that time. Well, I start by omitting the things that shouldn't be wrong."
Primacy of the Baby
Systematic thinking dominated mothers' problem- solving. The systematic thinking that mothers described was t a h g place simultaneously with their actions. After taking action to solve the problem, mothers observed their babies' responses. Mothers were satisfied that the problem was solved when they observed that their babies were comforted. If they were not satisfied with the babies' responses to their actions, they repeated the methodical process of systematic thinking, simultaneous actions, and observation of effects. When mothers thought their actions were ineffective or there was noth- ing that they could do, they stayed with their babies until the problem abated.
Mothers reported using the same problem-solving approach that they had used in previous experiences before having this baby. However, the context of the problem- solving situation was dramatically complicated
by the priority of the baby. A primipara differentiated this from previous problem-solving situations by describing her commitment as "intense and consuming" because of her feelings for the baby. Mothers adjusted their lives and their thinking to accommodate the pri- macy of caring for their babies.
Sometimes, they sought or received help with learn- ing the baby. Primiparas and multiparas received and sought dormation by talking with and listening to oth- ers they considered more knowledgeable than they were. When babies were new, and mothers believed the prob- lems were urgent, they called their mothers or physi- cians. Primiparas, and multiparas to a lesser extent, said they were guided by information from books, physi- cians, and television in learning the baby.
Mothers trusted others who had experience. Anyone who had reared children, had older children, or had written books was considered a valuable resource for general information on behavior. Primiparas and multi- paras used advice from lay and professional experts to prepare for anticipated behaviors. However, mothers used "selective listening" for receiving general informa- tion. They listened for information that was specific to their babies' circumstances and for information that came from credible sources. Multiparas were less likely than primiparas to seek or accept advice, and more likely to believe that they could figure it out or let time take care of situations.
All mothers believed they knew their babies better now than they had previously. In addition, all mothers projected that they would become more attuned to what the baby was trying to tell them as they would spend more time together in the future.
These findings suggest that a relationship must be established between each particular mother and baby. Similarly, Pridham and Chang (1992) said that mothers are challenged to care for the needs of each new baby regardless of previous infant -care experience. The uncer- tainty that mothers feel because they are following their
JSl" Vol. 2, NO. 1, Jmuq-MXch, 1997 25
Learning the Baby: A Maternal Thinking and Problem-Solving Process
babies lead may keep them unsure of preciseness in naming problems, taking actions to solve problems, and realizing the satisfaction of having solved problems.
Mothers ability to problem solve increased as babies grew, and mothers developed a relationship with each baby. However, mothers remained uncertain that takmg the same action would comfort their babies the next time a similar problem arose. Pridham and Chang (1991) sug- gested that mothers of babies up to 3 months may notice a change in their babies behavior signaling a problem and respond without being able to name the problem. Mothers may need help in naming the problem, so once known, they can solve it. Ths may be especially impor- tant when mothers suspect their babies are sick. Nurses need to listen to mothers recount circumstances that indicate problems in order to help identify what the problem is. Furthermore, nurses could encourage and p d e mothers to find their own solutions. Solberg (1989) reported that nurses are not sensitive in encouraging women, especially mothers, to develop their own solu- tions to the problems they encounter.
Mothers need to learn their babies before they can interpret the babies signals, including their cries. Multiparas have a repertoire of soothing techniques to meet or prevent cries from developing or escalating. Primiparas take more time to learn their babies so they can comfort them. In a study by Drummond et al. (19931, multiparas expected they would learn to differentiate their babies cries in time, while primiparas did not appear to appreciate ths fact initially. Nurses could point out to mothers, especially primiparas, the general and specific babies cues and responses they observe while assessing babies in hospitals and community settings. Learning the babies cues and responses could prove pleasurable to mothers and help them develop confi- dence in their abilities to approach their babies intu- itively. Yet, this teaching opportunity is often missed as nurses concentrate their attention on the baby.
Mothers receptivity that depended on questioning, receiving, and learning from the baby is similar to the way that women develop knowledge (Belenky et al., 1986). Primiparas believed that if they knew the reason,
they could solve their babies problems with previously learned procedures. Mothers with older babies seemed to have integrated intuitive and objective knowing. They learned from others, posed questions to themselves, and learned to compromise their previous expectations with their current experiences.
As proposed by Ruddick (19801, mothers abilities to question what was happening to babies and hear the answer developed as mothers relied more on intuitive than formal logical thinking. Bergum (1989), Shectman (19801, and Noddings (1984) theorized that reason and understanding failed mothers at times, so mothers learned to temporarily suspend ways of thinking that were previously valued in order to approach their babies intuitively. Furthermore, Pridham and Chang (1991) found that mothers development of competence was related to intuition and the corresponding growth of their babies. Mothers competence might be enhanced if they realized that not all caregiving requires a rational approach. Papousek and Papousek (1 987) reported that mothers carry out didactic interventions with their babies without conscious awareness of their efforts.
The fatigue that new mothers experience has been rec- o w e d as physiologic and actually related to infant care activities (Milligan & Pugh, 1994). In addition, maternal fatigue could be attributed to the ongoing thinking pm- cess of approaching each problem as i t arises and reviewing the problem-solving process after the baby has been comforted.
More research is needed about maternal thinking. Maternal thinking directs mothers caregiving actions. Nurses cannot plan effective interventions to strengthen problem-solving abilities without knowing the meaning of events regarding caring day-to-day for babies and children from their mothers perspective (Carter- Jessop & Yoos, 1994). Maternal thinking about their children from birth through adolescence has yet to be studied. A closer examination of maternal thinking in relation to womens thinking could be undertaken.
In summary, this study described a problem-solving process based on mothers experiences of developing a relationship with and caring for their babies day-to-day.
26 JSPN Vol. 2, NO. 1, Jmuq-Mxch , 1997
Variations of ways of thinking and experiences among primiparas and multiparas with babies from 2 weeks to 7 months were illustrated. A mother takes action to alle viate the babys discomfort while trying to idenhfy what the cause is. Even after the babies are comforted, mothers are not certain their actions alleviated the babies prob- lems because they usually do not know exactly what the problem was. The way mothers gather and evaluate the usefulness of knowledge from available resources was described. These findings were related to previous prob- lem - solving and womens thinking perspectives.
Nurses are potential collaborators with mothers for the health care of their children. Traditionally, nurses have told mothers how to accomplish tasks and what to do if specific problems arise. TIus traditional approach to teaching is limited because nurses cannot predict every- thing mothers need to know, and limiting because nurses assume they already know what mothers need to learn. An innovation may be to include mothers in the assessment and planning for health or illness care. The innovation could serve as an assessment of or a means of extending problem-solving skills of women who are becoming mothers. Nurses should reconsider their approach to delivering health care, especially patient education, for infants and children and their mothers.
Acknowledgments. The author wishes to acknowledge Drs. Ann Foltz, Patricia Lane, and Nora Stele , Louisiana State University Medical Center, for their thoughtful reviews of tlus article; and Dr. Linda C. Jones, Louisiana State University Medical Center, for her continual and constructive encouragement.
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Author contact: Joan M. Sullivan, DNS, RN Medical Center of Louisiana 1532 Tulane Avenue New Orleans, LA 70112 jjsph&o.edu
Save the Date Society of Pediatric Nurses, Annual Meeting
Caring for Children: Nursing Challenges & Change
April 21-23/1997 Anaheim, CA
Preconference on April 20 Assessing the Child:
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28 JSI" Vol. 2, NO. 1, Jmuq-Mxch , 1997