Benefits of mylittleone
The majority of the participants believed the development and deployment of mylittleone was an important advancement in the provision of neonatal care. The manner in which the technology had enhanced the parents’ experience was central in the accounts of both the parents and professionals. Themes that emerged from the data included: Being present when you’re not; Keeping mums (and dads) on an even keel; Helping mums to take care of themselves; and, “Showing off” the new baby.
Being present when you’re not
Mothers in the post-natal care environment most commonly have their babies with them immediately following the birth and throughout their hospital stay. However, when a baby is admitted to a neonatal care unit, periods of separation result and, depending on the mother’s physical health, these periods can be lengthy. The impact of separation from their child was discussed at length in the interviews, by both the mothers and fathers and, as exemplified in the following quotes, mylittleone was reported as helping them ‘feel closer’ to their babies when they could not be with them:
[Mother 1; baby 6 weeks premature] Oh, it was brilliant, absolutely brilliant … I was so tired, that I couldn’t sit for longer than half an hour [in neonatal care] … I didn’t feel well, I was sick and I was dizzy, so when I got up the stairs [to post-natal ward], I put [mylittleone] right next to the bed, and even though I fell asleep pretty quick, it was like … it was like she was near me, because I could see her. Instead of being completely cut off from her, she was still there.
[Mother 12; baby 4 weeks premature] [It’s hard] when you’ve not got your baby with you, when everybody else does.
[Father 12] [But] you actually feel like you’re with them basically because you’re getting a live feed.
[Mother 12] Yes, so you’re present even when…
[Father 12] Even when you’re not.
In addition to the increased feeling of proximity, there was a belief that mylittleone helped the mothers, in particular, to be more responsive to their baby’s needs and this included responding physically through the production of breast milk. As indicated below, mothers who had had previous experience of the neonatal environment were able to make useful comparisons.
[Mother 2; baby 8+ weeks premature] It’s so different this time. With my little boy [also admitted to a neonatal unit] I couldn’t see him straightaway … whereas this time having the mylittleone camera … I can see her constantly, she’s right beside my bed, really. [Also], I’ve found with things like expressing milk, I’ve found that a lot easier.
[Professional interview 5, post-natal ward] I think it’s excellent … it’s like [the mothers] are really close to their babies … A lot of the mums…when the baby’s upset will go down the nursery. You know, they’ll say, the baby’s really upset I’m away down to see if it’s needing fed or what’s wrong with it. So, they’ll toddle away down and see.
The feelings of ‘closeness’ and ‘responsiveness’ that mylittleone engendered appeared to be important in facilitating the process of ‘transitioning to parenthood’, and relatedly, to encourage the early bonding process between the parents (both mothers and fathers), and their babies, which, from what was described, would have been more challenging had the physical separation not been bridged by the technology.
Keeping mums (and dads) on an even keel
There was much discussion of the positive emotions associated with parents seeing their baby for the first time using the mylittleone technology.
[Mother 24; baby 15+ weeks premature] You couldn’t wipe the smile off [husband’s] face when the doctor brought the tablet round.
[Father 24] It was like an overwhelming thing. I was just so happy and proud that I could see her, if that makes sense.
[Mother 2; baby 8+ weeks premature] As soon as the doctor [gave me the tablet] … I couldn’t speak, I just kept crying … it was amazing just to see this tiny little baby that you knew was yours, but there she was.
The parents also discussed how the technology had enabled them to keep more stable emotionally in the days following the delivery. A key benefit appeared to be the reassurance connected with being able to see their baby was ‘okay’, that is, there had been no worsening of their condition. The comfort associated with this is clear in the narratives below.
[Mother 1; baby 6 weeks premature] I’m not just saying this, but if I didn’t have the camera … I think I would have cracked up, because it’s been…I’ve been waking up during the night and kind of looking and being able to see that she was there and that she was sleeping, and I would be able to fall back asleep again.
[Father 19; baby full-term] It provides reassurance. You can see her snoozing and, as long as you can see the quilt going up and down, you know she’s breathing okay. We don’t fret when we are away from her because we can see her.
Discussions of emotions extended to the low emotional state, commonly referred to as the ‘baby blues’, that mothers may experience a few days after the birth of their baby.
[Mother 16, baby 5 weeks premature, also low birth weight] Everyone was kind of saying I would have a ‘baby blue day’ and I think I didn’t get that because I knew she was okay and I was able to see her … So I was waiting on that and I think that having [mylittleone] and watching her probably helped quite a bit, I didn’t ever have down days … I don’t quite know what I would’ve done without it.
Also, seeing their baby on the tablet device allowed parents to prepare themselves emotionally for visiting the neonatal unit for the first time.
[Mother 23; baby 9+ weeks premature] He was born at 11 min past four and my boyfriend went to see him about five and then brought [mylittleone] straight down, and I got to come up at about 11 to see him, so it was really good because I got to prepare myself by looking on the screen of what I was coming up to see, like the tubes and stuff, so it was quite nice.
The continuous ability to monitor their baby’s progress was also reported by some as giving them ‘hope’ in terms of the immediate and longer-term health and development of their child. The baby referred to in the quote below had had a serious respiratory problem at birth and this had required intensive and prolonged medical interventions.
[Father 21; baby full-term] Just little things isn’t it [to mother]? Because where we are it’s little steps, really little steps at a time, just like her hand moving and she’s trying to grab things and you can see.
[Mother 21] Or she’s trying to touch her face or things like that … It’s just these things that’s giving us that wee bit of hope.
Finally, staff in the neonatal care unit stressed the almost ‘gift like’ quality of mylittleone, something which again appeared to enhance the emotional well-being of the parents.
[Professional interview 8; neonatal unit] You get such a great reaction the minute the baby’s stable ... if I’ve had to take the [tablet] round, the mum’s just so happy, you know, she knows she wasn’t going to see her baby for [maybe] another 12 h and you have appeared and said, here she is here and you can watch her.
From what was described, the positive impact on the parents’ emotional well-being appeared to be an important outcome associated with their use of mylittleone. Use of the technology allowed them to feel more connected to their baby, monitoring their welfare and progress, and thus to function in a parenting role, despite periods of separation imposed by the location of the baby in the NNU. Also, the ability to view their baby on the tablet device, in what they commonly perceived as the ‘alien’ environment of the neonatal unit, was considered important as it allowed parents to prepare themselves for an unanticipated transition, that of being the parent of a sick and/or premature baby.
Helping mums to take care of themselves
Another benefit related to the scope mylittleone provided in assisting the physical recovery of the mothers following the birth of their baby. The main issues discussed were sleep, rest, nourishment and the reduction of pain/discomfort.
[Mother 25; baby 8+ weeks premature] After having a C-section, and being on a lot of medication ... I was in a wheelchair, and I had my lovely catheter bag, and everything … I managed to sit with her for five minutes, but it’s more comfortable sitting in your own room ... You’re very sore, and things.
[Mother 19; baby full-term] I would definitely have got less sleep if I couldn’t see her on the tablet.
[Father 19] And that’s not good because you need to rest, as part of the recovery process.
Mothers who had had a baby in neonatal care previously were able to compare their experiences.
[Mother 24; baby 15+ weeks premature] This time [with mylittleone] it felt much better, like going back up to the ward, you know like you weren’t so…I wasn’t so reluctant to leave her … So, if you had to go for painkillers or…lunch or food or anything like that it was easier to do that than you would have found it previously.
The professionals also emphasised the importance of mylittleone in assisting the mothers’ recovery, and similar to the mother above, commented on the situation prior to the technology being available.
[Professional interview 5, post-natal ward] Before [mylittleone], they would go down to the unit and they would sit there for hours and hours and they would have to really pull themselves away to come back, but now they’re coming back and having a rest in the afternoon or coming back for lunch. Before, we used to have to really chase ladies to say, you need to come back for your lunch, you know? But now, because they’ve got the [tablet], they’re quite happy to come back because their baby is almost in the room with them, really. … So, that’s helping.
The ability of the mothers to address their own physical needs was perceived as important in aiding their early postnatal recovery, thus enabling them to better care for their babies. Use of the mylittleone technology was reported as being important in easing/facilitating the early process of transition to motherhood by giving the mothers time and space to take care of themselves. The ability to care of themselves whilst also monitoring their baby appeared to be important in supporting the early bonding process.
“Showing off” the new baby
Finally, the parents discussed the benefits that mylittleone afforded in allowing them to share ‘real-time’ pictures of the baby with their wider family and friends. This was important as restrictions on visiting, linked to infection control measures, meant that siblings, members of the extended family, such as grandparents, and/or friends of the family, were not permitted entry to the neonatal care unit to see the baby.
[Mother 4; baby 5+ weeks premature] [My partner] loves [mylittleone] … just being able to see her all the time … and my mum and dad, they were up visiting yesterday and they thought it was a fantastic idea as well … because she’s in neonatal and they can’t [go in] and they can’t touch her or anything like that but it meant they didn’t have to wait to see her sort of thing.
[Mother 21; baby full-term] Our son was able to have a look at her on the tablet when he visited.
[Father 21] He was upset, because he’s only four, and he wasn’t allowed in to the neonatal unit.
[Mother 21] So seeing her on the tablet helped.
Being able to introduce/show the baby off (via mylittleone) to their wider family and friends appeared to be important in ‘normalising’ the situation for parents. The ability to view and discuss moving images of the baby helped create a shared experience that was valued.
In sum, most parents and professionals talked about the mylittleone technology as a positive development in the neonatal care environment. From what was discussed, the relationship with their new baby and the parents’ emotional wellbeing appeared to have been enhanced by addressing feelings of ‘closeness’, the ability to identify and respond to the baby’s needs and by engendering a shared experience among the parents and their wider family and friends, including siblings.
Potential disadvantages of using mylittleone
Importantly, while most parents believed that mylittleone was a positive development, for a small minority, its use had not enhanced their experience of parenting in the neonatal care environment. While they could see some benefits in its use, a few parents had decided not to use it for the duration of their hospital stay and/or would not use it again if they found themselves in a similar circumstance. The central issue was that for some, rather than providing reassurance, the ability to see the baby whenever they wanted appeared to increase anxiety levels. The themes that emerged from the parents’ and professionals’ narratives focused on: Dealing with dilemmas; Interpreting what was being seen on screen; Wondering if there was something to be concerned about; and, Parents seeing something they would rather have not.
Dealing with dilemmas
The following account, which is necessarily long, demonstrates some of the tensions associated with seeking to be responsive to a baby’s needs, particularly when these needs were highlighted by use of the mylittleone technology and might otherwise have gone unnoticed.
[Mother 17; baby full-term] I remember at one point that I got quite upset and the reason was it was night time and I’d just been down to breastfeed him, and .......... and by the time I got back up the stairs I could see that he was crying on the screen and it really upset me … and … the staff member that was on that night, she … sort of kept putting his dummy back in and, you know, and sort of trying to shoogle the cot as it were, but you … could tell he wasn’t settling. … And it just, yeah, it really upset me because I was kind of in two minds … can I go back down again, can I not, you know, even though they’ve said that I can come and go whenever I please … would it be a case that, you know, would she not think, “Oh you’ve just been here why are you here again?”, you know, so you were in that awkward sort of stage of will I or won’t I type of thing. What I had to do was literally just put the tablet down so that I could go to sleep.
[Interviewer] And did you feel you could have turned the tablet off?
[Mother 17] Yeah but again it was almost like the sort of curiosity killed the cat, so it was like I don’t want to turn it off but I just don’t want to see it just now … And … you would almost feel like you were … like sort of not being a mother if you turned it off. You know it was almost like you don’t care enough.
The issue of not feeling it was ‘appropriate’ to turn off the tablet device was discussed by a small number of the mothers. Concerns seemed to be linked to feeling that they were not fulfilling expectations associated with their parenting role i.e. identifying and being responsive to their baby’s needs, if they did not constantly ‘observe’ their baby.
Interpreting what was being seen on screen
Other concerns raised by a small number of parents, linked to their ability to make sense of what they we seeing on the tablet device.
[Father 9; baby 6 weeks premature] It’s a double edged sword [using mylittleone], I would say.
[Mother 9] Yeah.
[Father 9] You can see what’s happening but you don’t know what’s happening. … So every time they’re doing something [to the baby], it might be routine, it either gets switched off or you see a pair of hands coming in [to the incubator/cot] with the gloves and then it gets switched off and you think, is it just something routine, is it not? And then you’d wait for maybe ten, fifteen minutes and it would come back on … and then you might see five minutes later something else happening again. As I say, you’re never quite sure … It wasn’t for us, no; it wasn’t for us.
The ability of parents to interpret what they were seeing was also discussed by the professionals.
[Professional interview 2; neoanatal unit; Participant A] I think for the anxious mums it [can] make them even more anxious.
[Professional interview 2; neoanatal unit; Participant B] I think a lot of the interpretation of [what they see on the tablet] and certainly where mum’s anxiety comes from, comes from mum’s experience, whether she’s a first time mum or not, whether she’s had a complicated pregnancy or not, whether there’s been pre or post anxiety or complications and things. I think that alters their interpretation of what they see on the tablet.
Again, what was discussed demonstrates that for some, albeit a small number of parents, use of the technology was not perceived as beneficial, and in some instances, not desirable. Use of the technology appeared to give them access to information about the care of their baby that they were either not able to make sense of or they were struggling to deal with, having found themselves unexpectedly taking on the role of parent to a sick and/or premature.
Wondering if there is something to be concerned about
The switching off and on of the mylittleone camera by staff was the focus of much discussion and some debate among the parents and professionals. As noted above, when staff were undertaking a medical/nursing procedure, the policy was that the camera should be switched off. When the camera was switched off a notice appeared on the tablet device letting the parents know a procedure was underway. However, the notice was a standardised message that did not indicate what the procedure was or why it was being undertaken and there was no indication of how long the procedure would last. Procedures could vary from the changing of a nappy to resuscitation of the baby.
It was not uncommon for parents to report delays in the camera being switched back on after a procedure. For some this raised concern as they began to wonder if there was ‘something wrong’ with their baby.
[Mother 11] One thing I didn’t like was sometimes they turned the camera off … and they would forget to turn it on again … and you had a sense of anxiousness when you couldn’t see him … I didn’t want to make a fuss and be like a neurotic mother … but I was like please can you turn it on [so I can see he’s okay].
Parents seeing something they would rather have not
A final concern was that staff occasionally forgot to switch the camera off when undertaking a procedure. This meant that a small number of parents had seen procedures that had the potential to cause stress and anxiety. This issue was discussed by both the parents and professionals.
[Mother 9; baby 6 weeks premature] Sometimes you see stuff you don’t want to see. I saw them taking blood from his heel and he was screaming the place down, he wasn’t happy.
[Father 9] Then he got a blockage in his oxygen tube so they started putting another tube in to suck things out.
[Professional interview 7; post-natal ward] I know of two instances where the mum got upset because someone had taken bloods and forgotten to turn the camera off.
Linked to the above, there was discussion in all of the interviews with staff about what would happen in relation to the switching off of mylittleone in an emergency situation, where a baby required immediate attention. The scenario of an emergency clearly caused staff concern thinking about the possibility and (perceived/assumed negative) consequences of forgetting to turn off mylittleone as they sought to ensure the safety and well-being of the baby in their care.
In sum, while parents framed the ‘downsides’ of using mylittleone in different ways, there was a commonality in relation to the situations discussed. Most often the downsides related to witnessing something on screen which they otherwise would not have seen, for example, their baby crying or a medical procedure being undertaken. Importantly, some parents downplayed the significance of any negative aspects of mylittleone in light of their overall positive experience and other parents talked about similar events as having been more problematic for them.
Staff agreed that while for most parents, use of mylittleone reduced their anxiety levels, for a small number it had the opposite effect. Some had observed that it was often late at night that they would receive calls from parents about what they had seen on mylittleone. Similarly, they often received calls immediately the camera was switched off to undertake a procedure. The professionals felt the hyper-vigilance that could be associated with the constant ability to monitor the baby had the potential to impact negatively on the well-being of a small number of the mothers. The staff were aware that they needed to be able to identify these mothers and take appropriate action (e.g. encouraging the mothers to switch the tablet off for periods of time; asking if they wished not to use it).
The findings on the benefits and disadvantages of the mylittleone technology clearly demonstrate that the parents reacted differently to the same or similar events, when taking into account the health and developmental progress of their baby. Contextual factors that appears to be influential included: the health of the mother in the early post-natal period; the level of parenting experience, including experience of parenting a child in the neonatal care environment previously; and, relatedly, levels of stress and associated coping resources. For the majority, use of the technology brought with it a level of comfort and reassurance that impacted positively on their relationship with their newborn baby. However, there were two sides to the use of the new technology, for a small minority of parents mylittleone did not reduce and may have increased anxiety levels by providing 24/7 access to their sick and/or premature child that they did not feel they benefitted from and/or could cope with.
Extending mylittleone’s reach to the home environment
At the time the interviews were conducted the mylittleone technology could only be used in the hospital setting. However, as it was anticipated that, in the future, video images of the baby could be transmitted to family homes when, for example, the mother had been discharged and her baby remained in hospital; parents and professionals were asked to share their views on this potential development. The two themes that emerged from the parent and professional accounts were: Going home without the baby; and, Mothers taking matters into their own hands.
Going home without the baby
The majority of parents felt that being able to use mylittleone at home would be beneficial and desirable.
[Parent 19; baby full-term] I [am] starting to get really anxious about going home without her and thinking when I’ve been here I’ve had this camera that I’ve been able to just use all the time. Whereas at home I’m going to have absolutely nothing and I can’t imagine having like a night’s sleep. I [will] be having to phone the unit, like two or three times a night just to check on her.
[Mother 19] You’ve had the experience of having to go home and not being able to see her [to partner], how did you find that?
[Father 19] It was really tough, especially after seeing her for like the first 48 h [stayed in the hospital with mother]. It’s tough when you go home and can’t see them anymore.
The majority of the parents had other children and they discussed the difficulty associated with being with the new baby whilst caring for older siblings. Again, the mylittleone technology was believed to be something that could assist.
[Father 24; baby 15+ weeks premature] We’ve not been able to be there very much for them [older children], they have been minded by somebody else. If we were able to have mylittleone at home we would be able to work things better and they would be able to see her.
[Mother 24] And I wouldn’t be sat at home anxious all of the time, you could see if she was settled.
Although parents were mostly positive about such a development, the possibility of not being able to respond to their baby’s needs from the distance of home was raised as an issue.
Staff in the post-natal ward were well-positioned to comment on the potential for mylittleone to be used at home as they frequently witnessed mothers being discharged before their baby.
[Professional interview 5; post-natal ward] Ideally, the mothers would like to know that they could take it home and then see their baby from home. None of the mothers want to go home [leaving] their baby in the hospital.
The fact that the mothers were not able to able to have regular contact via the mylittleone technology following their discharge was something that the professionals felt was a barrier to the continued establishment of the relationship between the parents and their baby. While parents were encouraged to visit as much as possible, the ability to connect with their baby whenever they wanted, included first thing in the morning and last thing at night, was considered to be important. The professionals also emphasised that mothers are often discharged weeks or even months in advance of their baby.
Mothers taking matters into their own hands
Interestingly, some of the mothers had used FaceTime® while in the post-natal care environment as a way of involving the baby’s father in seeing what they could see on the tablet device.
[Mother 16; baby 5 weeks premature + low birth weight] [When I was in hospital] I would FaceTime® my husband [from my phone when he was at home] so he could watch her as well. So we could watch it at the same time. … Yeah, it would basically be, like, look what she’s doing now or did you see that? … And she made good improvements all the time, you know, we’d see a difference in her and she would have a bit of equipment removed and things like that and we’d just talk about her, what will happen next and how soon until she gets out and things like that.
[Interviewer] So it was like a wee, sort of, bonding session between the three of you?
[Mother 16] Yeah, [a] three way conversation, except you couldn’t talk [of course].
Hence mothers, to an extent, had already extended the use of the mylittleone technology to enable their partners to ‘view’ the baby from home.
In sum, the ability to extend use of mylittleone to the home environment was generally viewed positively by parents and professionals. The technology appeared to have an important potential in helping parents to feel closer to their baby following the mothers’ discharge from hospital and thus to assist the ongoing transition process.