1. The Influence of Space and Place on Parent-Baby Relationship and Feeding in NICUs in Sweden and England Renée Flacking, RN, PhD School of Health, University of Central Lancashire; School of Health and Social Studies, Dalarna University; Dep of Womens and Childrens Health, Uppsala University

2. The preterm baby One year survival: 22 gw = 10% 23 gw = 52% 24 gw = 67% 25 gw = 82% 26 gw = 85% 45% - no sign of significant morbidity The EXPRESS Group. One-year survival of extremely preterm infants after active perinatal care in Sweden. JAMA. 2009; 301: 2225-33

3. Becoming a mother – in a NICU? Thrown into a situation not prepared for Experiences of loss Life on hold Thrown into a situation not prepared for Experiences of loss Life on hold

5. Percentage of infants born very preterm – breastfeeding at discharge

7. Aim To explore in-depth the breastfeeding/ feeding process in mothers of preterm infants at NICUs in Sweden and England, with a special focus on relationality. Today: influences of space and place on relationships and feeding To explore in-depth the breastfeeding/ feeding process in mothers of preterm infants at NICUs in Sweden and England, with a special focus on relationality. Today: influences of space and place on relationships and feeding

8. Grounded in data? 2 Neonatal Intensive Care Units in each country 11 months of fieldwork 600 hours of observations – 300 hours of direct observations/interviews 52 mothers, 19 fathers and 102 staff 2 Neonatal Intensive Care Units in each country 11 months of fieldwork 600 hours of observations – 300 hours of direct observations/interviews 52 mothers, 19 fathers and 102 staff

10. The Womb Complete ownership No separation, no interruption At-homeness Ability to regulate socialising Identity as a parent Enables a focus within Shared awareness attunement

11. The Womb The big difference is that these parents care for their babies immediately after birth and then they move into a room and we have never interrupted the presence. They have a total togetherness. They never leave their infant, they take turns. Its amazing.

12. The Hotel Room Negotiated ownership Varying at-homeness Door as a shield against watchers protects the infant facilitates a focus within enables reflection

13. The Hotel room Ive had this room for 2 weeks now. Its building my confidence up. Having them and getting to know the cues. So that I wont be standing there when I come home and wont have the nurses telling me that its time for a feed. I have them with me in the room all the time. Its been invaluable. When I didnt have the room, I felt distanced from them. I couldnt be a proper career.

14. A safe corner Ownership of space/place Type signals level of importance and expected presence

15. A safe corner Ownership of space/place Type signals level of importance and expected presence

16. A safe corner Ownership of space/place Type signals level of importance and expected presence

17. A safe corner Ownership of space/place Type signals level of importance and expected presence

18. A safe corner Ownership of space/place Type signals level of importance Actual shield or not Others entering Varying privacy Intermittent focus within Socialization +/–

19. A safe corner MB6Hows it going? MB2Its going fine. Shes breastfeeding on demand now and shes gained weight. Hows it going for him? MB6He has just started to suck… hes not breastfeeding on demand.. MB2And they were born practically at the same time, werent they? MB6Yeah, but boys are a bit slow arent they.

20. A musical chair No ownership subordinated visitor No door Everyone can see you No focus within Less socialization

21. A musical chair Its difficult with breastfeeding cause the mums arent here that much and they need to be here…with their breasts…to make it happen. But theyre not. A lot of mums have a lot of social problems. And they have older children at home…. And they havent established a relational bond. Theyve had their mothering interrupted and they dont feel its their baby. They might think theyre in the way and there isnt really a place for them. They dont even have comfy chairs. So its not easy.

22. Impacts Support for relational aspects of feeding Feeding part of mothering Feeding not only nutrative but relational Supportive care routines

23. In breastfeeding – there is everything. Worries, fear, love, joy, sadness, the present... the physical closeness that has so many expressions. But also hopes, future, but most of all love and non- demanding. The love that doesnt demand anything back. If a mother at this unit has the chance to see her baby and feel trust in herself, then weve enabled the start of the bonding. Breastfeeding starts when the father carries the baby to the unit or when they can take care of their baby the first day and we stand behind, but not too close. Its such things that sticks with you and facilitate the bonding. Its a process. When you talk about breastfeeding you talk about emotions… Emotions affect everything, the rest happens as a result! In breastfeeding – there is everything. Worries, fear, love, joy, sadness, the present... the physical closeness that has so many expressions. But also hopes, future, but most of all love and non- demanding. The love that doesnt demand anything back. If a mother at this unit has the chance to see her baby and feel trust in herself, then weve enabled the start of the bonding. Breastfeeding starts when the father carries the baby to the unit or when they can take care of their baby the first day and we stand behind, but not too close. Its such things that sticks with you and facilitate the bonding. Its a process. When you talk about breastfeeding you talk about emotions… Emotions affect everything, the rest happens as a result!