Introduction
Over the last decade, and especially since the outbreak of coronavirus disease 2019 (COVID-19), digital tools
—as an umbrella term for different technological sources, such as applications, websites, podcasts, forums, social media groups, and specialized professional websites
—have been increasingly used in health care [
1], and the field of obstetrics is no exception [
2]. For example, digital parental support tools have been proposed as a complement to standard antenatal care [
3,
4]. However, the use of these digital tools does not automatically imply that healthcare professionals have answers to some important questions, such as
What kind of support are expecting parents searching for? and
What needs during pregnancy and early parenting periods do parents really have? For example, midwives in antenatal care have generally ambivalent views on the use of digital technology. On the one hand, they describe benefits (i.e., modern antenatal care with opportunities for expecting mothers to make informed decisions); on the other, they describe limitations and risks (i.e., conveys unreliable information and has negative impacts on the relationship between midwives and expecting mothers) [
5].
While accessing relevant information using digital tools, parents may find, on the one hand, material obtained from professional sources, and, on other, personal opinions and experiences that may vary in quality. Furthermore, digital tools are not just a source of information that should provide support when concerns arise. They might serve higher purposes just fulfilling basic needs for parental support. For example, with a technological design that accounts for and resolves discrepancies in communication between parent and child, and the complex emotions attributable to parents’ daily life schedules, digital tools may support parent–child relations [
2]. Therefore, digital tools may provide a virtual space that invites future parents to “weave together an unusually fine fabric that will embrace their children, a matrix or a nest in which the newborn can then land softly, warmly and safely” ( [
6], p 7). This metaphor is more than just an illustration of interpersonal space between two adults; it may also serve as a metaphor for their own transition to parental roles. Importantly, this matrix must be built on a solid foundation of not only the perceived quality of a parental couple’s relationship and social support but also professional guidance. In order for digital tools to be able to ensure this higher level of meaning, they must first be capable of comprehending expecting parents’ fundamental needs. To broaden knowledge about such needs, further research is required.
Expecting parents, especially first-time parents, sometimes undergo a delicate and sensitive process of adaptation to changes that accompany parenting. Feelings of insecurity are an understandable phenomenon that also accompanies the life changes related to parental transition [
7]. Changes occur at different paces, and everyone has a different capacity to quickly adapt to new situations. Mercer [
8] described, in a theoretical model, adaptation to the maternal role as a multi-phased and leveled process that may be hindered by poor health, for example. Pregnancy is a temporally limited period and, considered as the parents’ preparation time, it can sometimes be even shorter than expected (as in cases of premature birth). Just as well, during the COVID-19 pandemic, women have described their pregnancy experiences as “in the shadow of the unknown,” balancing an information echo and social isolation [
9], which is alarming as expectant parents need to learn from those in their social network, such as peers and/or other new parents [
10]. Therefore, certain external pressures regarding limited (available) time or social contextual circumstances for adaptation are unavoidable.
No matter how well expecting parents prepare themselves, pregnancy, birth, and parenting may easily be perceived as beyond their control. Unsurprisingly, therefore, concerns may be almost constantly present during pregnancy but also during early parenthood. These concerns may represent a whole spectrum of worries—from restlessness, insecurity, and hesitation to fear, anxiety, and panic—that might significantly influence expecting parents’ lives [
11].
During pregnancy, expecting parents face many, sometimes small, choices. However, ultimately, each of these small choices may be greatly important to the outcome of the pregnancy and, later, the health/welfare of a child or mother. Accordingly, expecting parents are likely to question themselves. For instance, they might wonder,
“Is how I feel okay, or should I do something about it? Should I act on my feelings and seek care?” When first-time expecting parents especially cannot relate or compare their pregnancy experiences with familiar situations, they might request information ahead of time concerning possible changes in their relationship and related coping strategies [
10]. Parents may feel a heavy burden of responsibility alongside an awareness that some of their choices may be completely wrong; in the worst-case scenario, such wrong decisions could even result in illness or death. Moreover, first-time parents usually lack relevant knowledge as well as experience, so their worries, anxieties, and fears are unsurprising. They must grapple with not only knowledge gaps but also the lack of a frame of reference. In moments of insecurity, unable to rely on their own knowledge, they might feel an urge to seek guidance, and such guidance may be sought via digital tools [
4,
12]. Digital tools that allow expecting mothers to ask questions in various parenting forums could facilitate their feelings of calmness [
13] and reduce feelings of depression or anxiety [
14]. However, such a search may not be positively experienced by all expecting parents. Research has shown, for example, that lesbian, gay, bisexual, transgender, and queer (LGBTQ) persons may find online forums to be oppressive or exclusive when navigating pregnancy-related issues [
15].
Theoretical Approach
Transition theory
Adaptation to life changes, and to health transitions, has been theorized within transition theory in health [
11]. Transition theory as used by, for example, Meleis et al. [
11], explores the meaning of transitory processes for those undergoing them, as follows, “Change may be related to critical or disequilibrating events, to disruptions in relationships and routines, or to ideas, perceptions, and identities” ( [
11], p 20). Change in transition theory refer to community and societal conditions, with a focus on the transitioning of persons.
To theoretically approach parents’ experiences of digital tools and search for guidance concerning transitory processes and practices, through variations of insecurity, of the unknown, and of responsibility of social structures known and enacted, a discussion employing the concepts of liminality and communitas will be attempted and compared to parental transition theory.
The concepts of liminality and communitas
The concepts of liminality and communitas have been developed within the social science field [
16], although the possibility of their transfer to other fields of research has been questioned [
17]. However, these concepts have been applied recently within nursing [
18], education [
19], and psychology [
20], and have even been applied to phenomena such as the current COVID-19 pandemic [
21,
22] and the intersections of parenthood, gender, and digital, social worlds [
23].
Liminality, for example, as discussed from the perspectives of van Gennep and Turner [
16], is the middle of a ritual process in which persons are separated from everyday social structures and undergo a phase of change: liminality [
16]. The word
anti-structure has been used to describe the otherness of the phase, but the transferred meaning of anti-structure outside religious practice has been debated [
17]. In later research, liminality has been described as “ambiguity and disorientation” ( [
21], p 81), uncertainty, status, ambiguity in relation to structure and communitas, obedience [
18], disequilibrium [
19], or as a transformative space within arts and music [
20].
The concept of communitas [
16] reads as a group of persons who share a social bond and friendship and have a common experience of liminality, undergone together, or, as phrased by Buechner et al. ( [
19], p 87), “a shared feeling” and a “sense of belonging.” The members of the communitas are, after the liminality, reincorporated into the social structure, into norms and social positions, with an acceptance and embodiment of the new role and status bestowed upon them by the passage [
16].
Liminality and communitas may serve as concepts of parental passage from being two partners, secure in their identities as individuals, to being parents and sharing a familial responsibility, via the transformation of pregnancy and childbirth, for whom a possible digital communitas could be explored.
To broaden knowledge, further research is needed on parents’ experiences that can in turn be utilized in the future planning and development of digital tools for parental support. By interviewing parents themselves, we can provide professionals with additional knowledge that, in turn, may help them guide expecting and new parents through the exponentially growing field of digital resources. By addressing parents’ real experiences, and problematizing them from a theoretical perspective, healthcare professionals may be better able to comprehend parents’ needs and provide appropriate guidance. Therefore, the aim of this study was to explore parents’ experiences using digital tools in relation to pregnancy, labor and birth, and the child’s first 18 months.
Discussion
Each pregnancy milestone can evoke anxiety concerning, for instance, the potential consequences of wrong choices or the failure to take urgent action when needed. Most of the time, expecting parents face such anxiety—and feelings of insecurity—on their own, often accompanied by the sense of lacking sufficient knowledge and/or competence. Previous literature on mothers describes parental roles and changes. Mercer’s [
8] theoretical model of adaptation to the maternal role suggests that most of the mother’s role-taking activities occur after the baby’s arrival—in particular, between three and ten months after birth. This adaptation is described on three levels: biological (i.e., physical recovery for the mother and her adaptation to her baby’s growth and development), psychological (i.e., the mother’s reactions to and perceptions of motherhood), and social (i.e., changes in the mother’s own life and social surroundings). Adaptation may be hindered if the mother suffers from poor health or unresolved problems from earlier phases. Mercer stressed the importance of midwives in helping mothers adjust to the maternal role [
8].
The parental adaptation to the life-changing process entering parenthood highlights the need for support and structure to experience health, exemplified when the interviewed parents described, insecurity, entering the role of becoming parents. Bearing the independent knowledge and responsibilities of the past as partners, transitioning to parenthood and shouldering the responsibilities of a family and the knowledge of what small children need. The interviews showed that digital support during this interlude of the parental transition—especially regarding insecurity, knowledge, and responsibilities—was important.
Because parents fear making mistakes due to their choices, they seek knowledge and decision support from resources that can guide their actions. The foremost guide may be the midwife or CHC nurse, but modern parents—including those interviewed in this study—also use digital tools. Previous research has described various factors that either facilitate or inhibit the parental transition [
27]. Facilitating factors include having pertinent knowledge and feeling prepared for parenting, as well as access to both social and professional support. Such factors were evident in the interviews in this study, with participants describing them (i.e., social connections leading to emotional support, and digital tools recommended by professionals) as crucial to feeling that they benefited from using digital tools. Inhibiting factors were a lack of credible information or professional support, as well as anxiety and loss of control [
27]. Such factors were also clear in the interviews in this study and could be understood as a source for feelings of insecurity. Thus, parents likely search for answers to their many questions as they arise, and they often conduct these searches with digital tools that provide immediate answers. Ideally, they should consult with competent and trustworthy coaches or guides, but such access is not always possible. Despite possessing a reasonable understanding of expecting parents’ psychological needs, especially during their first pregnancy, digital coaches, to the best of our knowledge, have not yet been examined in the context of pregnancy.
Therefore, our data, together with the theory of parental transition, from various theoretical paradigms, could add an existential dimension to the parental transition. Such existential dimensions of the parental transition have been described elsewhere [
28,
29]. The interviewed parents’ experience of digital tools involved a digital community beyond the everyday physical world. Such communities seem to act in ways that transcend the role of facilitator or inhibitor, as in transition theory [
11,
27], but are similar to communitas in a community performing the liminal phase together reintegrating into the family. Family, as a social institution, is embedded within a diversity of socially formalized and structured behaviors and ideas. The findings of the current study highlight insecurity, a concept that may describe being in-between roles, where parents search for a community with others by digital means. Therefore, the concepts of liminality and communitas could be employed in future studies on parental transitions, as discussed below.
The results from the interviews highlighted not only insecurity but also responsibility and knowledge in the search for digital guidance throughout the parental transition. As a modern social phenomenon in a digital society, searching for digital support could present a solution when everyday practice does not. As a life transition, embodying social relations, statuses as well as roles and obligations, the findings can be read as an essential need for parents, feeling safe and secure in parenthood, embodying a new social role. Digital tools may thus provide a virtual space in a reciprocal relation to the matrix of love for the newborn, built on a solid foundation of the perceived quality of a parental couple’s relationship, social support, and professional guidance.
But digital tools also presented a virtual timeline when the interviewed parents searched for knowledge any time they wanted, experiencing control over their knowledge search and the choices they made from the digital information available according to their individual needs. The search for guidance through a life change may be existential or, similar to Bell’s [
21] discussion of liminality in relation to the pandemic, may concern “temporality, embodiment, intermediation, mobility, relationships, and identity” ( [
21], p 81).
However, instead of reassuring parents, digital information might instead sometimes incite or increase feelings of insecurity and anxiety, and pregnancy may easily be perceived as beyond their control. This contradiction, and the possible need for support, may be challenging in everyday life and thus insecurity could be described in relation to the concept of liminality. Parental support as a contradictory, complementary search during a transitory process could thus be a search for a shared way to undergo the process of the transition, of the passage, and of the community within digital support as a communitas of social responsibility and embodied knowledge.
The interviewed parents used digital tools for social communication with family, friends, or other parents not familiar to them before. By connecting with other expectant and new parents, and appreciating these new social ties and established friendships online, the shared experiences could be interpreted as a digital communitas in the process of guidance. These feelings of belonging are in line with previous research that has found that social contextual circumstances have an impact on the parental transition [
7,
9,
27,
30] and could be of importance for the professions of midwives, CHC nurses, and health workers to consider when offering support. A community undergoing such a transition together could manifest as in-person meetings or virtual meetings online. By considering the possibility of a need for a communitas between parents-to-be, further research areas may be identified.
From the context of the parental transition, the dialectic relation between family structures of past society and contemporary parenthood is in dialogue through, for example, images and norms of parenthood of families, parenthood among friends and wider society, and personal experiences of becoming a parent. Similarly, norms and ideals expressed online may contribute to how parents chose to live parenthood [
31].
Easing insecurity was an aspect of the interviewed parents’ descriptions, as was the search for ways and structures rebuilt through parental transitions in need of reliable and flexible parental support. However, one part of Stephenson’s [
17] descriptive critique concerns liminality as a transition and points to major life-cycle events, such as birth, focusing on the sacred. Stephensson [
17] noted that theoretical comparisons between digital spheres and liminality have been made and must be treated with a great deal of skepticism. However, of interest for the current study was whether parents’ search for a digital cicerone concerning changes characteristic of the parental transition, or even life crises, was, rather than existential in a sacred sense, a dimension of liminality referring to ambivalence or chaos reminiscent of the insecurity evoked from the findings. With detachment or separation from the pre-liminal two-partner life, and a post-liminal constructive reintegration with the social structure but with new roles and responsibilities of family building and parenthood, the liminal reach for digital support may suggest an existential dimension of digital health.
Parents—likely unconsciously—seek to shift the responsibility for their concerns and choices to external resources. This shift is understandable, and it leads to another important phenomenon in this context: responsibility for one’s choices. Responsibility, whether personally managed or referred to professionals, seems to be shouldered again when parents become confident in the new parental role. Responsibility could thus be a further dimension of digital health.
By performing the transition together, by forming a family and a communitas with other parents online and in person, by shouldering responsibilities for insecurities and knowledge, those identifying the need for a digital communitas may make valuable contributions to professional practice, supporting parents in search of a reintegrated place in the social structure.
Professional digital parental support also needs to be inclusive of everyone. The interviewed parents needed digital parental support in their mother tongue, to prevent insecurity from being excluded from information, and experiences of being unprepared for childbirth and parenthood. To feel secure during the parental transition, and to enhance the possibility of communitas and feelings of belonging, it is important for digital parental support to be inclusive and open to various languages. All parents should experience being included in professional parental support for such support to be socially sustainable, which is in line with the Swedish law that mandates that patients should receive information to promote participation and consent in care [
32].
Another related aspect is the possible link between liminality and the parental experience of insecurity stemming from frustration and feelings of injustice when available digital tools present the norms, ideals, and language of the majority population. Is exclusion from society a starting point for searching for a digital community, forming a communitas, to feel secure and included in the transition? This could relate to features of uncertainty and status as discussed by Underwood and Rhodes [
18]. Future research could, therefore, explore the dimension of insecurity from social exclusion and how communitas, and comfort with social support, can build inclusive and sustainable relations and communities through the shared experience of parents undergoing the parental transition together. Can digital communitas be a possibility for shouldering the new responsibilities of parenthood, for building on knowledge and experiences, and for integrating them into the future life of parents?
The interviewed parents derived meaning and entertainment from advice given by other parents, which was intended to provide guidance in their own parenting. They took part in other parents’ private experiences of giving birth. Parents could experience similar problems, reassuring one another, providing safety and reducing anxiety, and preparing for birth. This may imply the need to appreciate the concept of communitas in transitory processes, and could inspire parental transition theory to include and foreground the need for social relations and community during liminality.
In a communitas-inspired framework, we assume that trustworthy pregnancy cicerones, who guide parents as partners or companions during their pregnancies and are aware of the wider community of parents, are what parents need most. This assumption leads us back to the following questions: Do expecting parents seek information, knowledge, or reassurance in making the right decisions and/or shifting responsibility, which may diminish their insecurity? Could digital parental support tools from trustworthy resources offer the answers and security that new parents likely need? Our study provided answers to these questions.
The interviewed parents turned to professionals when they did not find reliable answers to their questions, which has been demonstrated previously [
33]. Additionally, they felt that digital tools could not replace in-person meetings with healthcare professionals, in which non-verbal communication and trustworthiness reflected secure and safe guidance. Besides, the interviewed parents valued the credibility of information sources, and healthcare professionals represented quality and reliability. This may also illustrate the dialectic relation between the structure of professional knowledgeability, the liminality of private personal experiences and stories, and feelings of insecurity.
Shifting the responsibility for expecting parents’ choices to a third party may diminish their insecurity and bring about a feeling of relief. Naturally, they expect to assess the trustworthiness of third parties so that they can rely as much as possible on such resources. Choosing a reliable resource is itself a parental choice, and the responsibility for this decision lies with parents themselves. If the quality of these resources is important to parents, understanding which parameters they consider important in their evaluation process would be useful. Given the importance of this process and its parameters, an open question remains: How do expecting parents evaluate the quality of retrieved information and perceive the reliability of sources? Do parents and professionals have the same expectations for or perceptions of digital tools/information? When expecting parents search for information through digital channels, do they seek content, emotional support, or both? These questions seem to be important for aligning parents’ own views of the importance of information with those of professionals in order to provide optimal guidance through a variety of informational resources.
Grounded in the above discussion, the contribution of the current study is threefold. Its contribution to the field of knowledge on expecting parents’ experiences of digital tools during parental transition is that (1) insecurity can be both eased and enhanced from using digital tools, (2) that parents could take responsibility for both their feelings of insecurity and their search for knowledge, and that (3) parents need appropriate knowledge to make the right choices and feel more secure in making these choices in the best interest of their new family.
The study’s contribution to theory is its suggestion that, in the context of becoming a parent, with its existential, life-changing dimension, transition theory may need to further study ritual theory. From the context of the current study, the concepts of liminality and communitas could inspire the development of a theory that allows for contradictions, that processes are not always linear but can be dialectic or oscillating. Even more important is the awareness that community is not only a force affecting the transition but may also be a pattern within the transition itself, one in which the transition becomes ritualized together with others.
The contribution to professions suggests that parents need professional support, for both knowledge and guidance in insecurity, both digitally and in person. However, there also seems to be a need for greater awareness that parents are involved with family, friends, and other parents, online and in person, and that these social relations with others may not only be entertaining but may also constitute a way to undergo change. Greater recognition that all kinds of parents and types of parenthood are needed to build socially sustainable parental support is also warranted.
Strength and limitations
In the present study, the participants were limited to parents living in two regions in Sweden. However, as they were diverse in terms of age, cultural background, and parental experiences, they could be considered as representative of parents living in Sweden. In some of the interviews, a professional interpreter was used, which might have influenced the participants’ ability to feel relaxed and understood during the interviews. However, the researchers agreed that the resulting narratives were rich and that using an interpreter afforded the opportunity to include non-Swedish-speaking parents in the study. Applying two-step qualitative analysis through inductive content analysis, and thematic analysis, could have risked cementing themes in the eyes of the beholder. However, both methods are structured, and include an interpretative thread. The alternate between empirical transcripts and analyzed themes, could instead support a rigorous analysis.