Using Colazzie Analysis: Experience of Mother with Premature Twins and Neonatal Intensive Care Unit

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Universal Journal of Public Health 12(2): 271-276, 2024 http://www.hrpub.org
DOI: 10.13189/ujph.2024.120211
Using Colazzie Analysis: Experience of Mother with
Premature Twins and Neonatal Intensive Care Unit
Sheela Upendra*, Jasneet Kaur, Sheetal Barde
Symbiosis College of Nursing, Symbiosis International (Deemed) University, India
Received November 24, 2023; Revised December 28, 2023; Accepted February 17, 2024
Cite This Paper in the Following Citation Styles
(a): [1] Sheela Upendra, Jasneet Kaur, Sheetal Barde , "Using Colazzie Analysis: Experience of Mother with Premature
Twins and Neonatal Intensive Care Unit," Universal Journal of Public Health, Vol. 12, No. 2, pp. 271 - 276, 2024. DOI:
10.13189/ujph.2024.120211.
(b): Sheela Upendra, Jasneet Kaur, Sheetal Barde (2024). Using Colazzie Analysis: Experience of Mother with Premature
Twins and Neonatal Intensive Care Unit. Universal Journal of Public Health, 12(2), 271 - 276. DOI:
10.13189/ujph.2024.120211.
Copyright©2024 by authors, all rights reserved. Authors agree that this article remains permanently open access under
the terms of the Creative Commons Attribution License 4.0 International License
Abstract The most frequent, expensive, and
devastating pregnancy problem is delivery occurring prior
to the completion of 37 weeks of pregnancy. The major
cause of infant death and a significant fraction of all birth-
related short- and long-term illnesses is preterm birth. A
descriptive phenomenological approach was adopted.
Mothers of new-borns admitted to neonatal units, as well
as having premature twins babies delivered before 37
weeks of gestation, were eligible to participate in the
research. The mothers of premature children with
congenital defects or severe illnesses were not included in
the investigation. Up to data saturation, seven mothers were
included in a purposeful sampling. Information was
verified by reading the transcripts while listening to the
audio after each tape was transcribed. Significant measures
were made to safeguard the anonymity of participants and
the information they submitted. By utilizing methods like
reflexivity, triangulation, peer debriefing, and member
checks, the validity and reliability of the data acquired were
enhanced. The criteria of credibility, confirmability,
dependability, and transferability were used to assure
trustworthiness. The lived experiences of the participants
are described under four themes namely: emotional state,
parenting concern, need for Help and Desire. Under
Emotional state – Uneasiness, Anxiety and unpreparedness,
and fear of health issues of the new-born were the
subthemes. Mother-baby relationship subtheme was under
the parenting concern theme. Under the need for help
theme, three subthemes emerged: need for help from the
health team professional, need for help from family
members, and spiritual support. Constantly monitoring the
babies was the subtheme under the Desire theme. Mothers
of premature twins reported feeling anxious, fearful, and
helpless for both babies and babies’ admission at the NICU.
Mothers required a lot of encouragement and support from
the medical team to begin caring for their infants’ basic
needs.
Keywords Premature, Twins, Neonatal Intensive Care
Unit, Mother, Experience, Colazzie Analysis
1. Introduction
The womb is the ideal environment for a baby's
development. Babies that are born too soon have
undeveloped organs that are not prepared to work in "the
outside world". The most frequent, expensive, and
devastating pregnancy problem is delivery occurring prior
to the completion of 37 weeks of pregnancy. The major
cause of infant death and a significant fraction of all birth-
related short- and long-term illness is preterm birth. More
than half of premature deliveries result from spontaneous
preterm labour [1]. Preterm births are unplanned and
sometimes distressing for the parents [2].
The development of the parents' mental images and
expectations is abruptly interrupted by the baby's preterm
delivery. Additionally, the possibility of the mother's and
baby's critical conditions shocking the parents can make
preterm birth a highly stressful or traumatic experience for
both the mother and the father [3].

272 Using Colazzie Analysis: Experience of Mother with Premature Twins and Neonatal Intensive Care Unit
Mothers indicate that their expectations were not met,
and that the experience of connecting with twins was
challenging and took longer than expected. Both mothers
and the professionals who work with them would benefit
from having a better knowledge of the difficulties of
connecting with twins [4].
Mothers who were holding their preterm for the first time
reported conflicting feelings. Due to the emergency
Neonatal Intensive Care Unit admission, they experienced
emotional detachment. Mothers were concerned about the
baby's unpredictability in life and held themselves
responsible for an early delivery. They received assistance
from their family despite having a difficult time paying for
their prolonged stay in the Neonatal Intensive Care Unit
(NICU) [5].
1.1. Objective
To describe the experiences of mothers with premature
twins and Neonatal intensive care units.
1.2. Significance of Problem
A preterm birth can have a profound emotional impact
on the whole family especially the mother. According to
research, parents of preterm new-borns are more likely to
struggle with their mental health than parents whose babies
were born at term. People who go into preterm labor are
more likely to have anxiety, sadness, helplessness, fear,
confusion or post-traumatic stress disorder. It's crucial to
get assistance when it appears that things are getting out of
control.
Mothers of preterm twin’s new-borns are more likely
than mothers of full-term kids to face acute stress and
mental health issues.
The risk of morbidity and death increases with an infant's
prematurity. Parental uncertainty early in a child's life is
exacerbated by the large range and difficulty of long-term
results [6].
To comprehend mothers with early twins and find traits
for future research, study results can enhance neonatology,
neurology, and group psychotherapy. This helps us
understand the effects on mothers better. The health care
team may benefit from knowing more about the results and
potential difficulties from this research. This study aims to
give pertinent information to support future judgements on
the effective approaches for educating mothers on mental
health.
The planning and delivery of maternal and neonatal
critical care services can be guided by research. But there
hasn't been much research on parents' initial perceptions
and responses to preterm birth.
When a baby is born, there is a separation from him/her,
and the infant is put in an incubator; handling the infant
calls for extreme caution. Since they must rely on Neonatal
Intensive Care Unit staff for access to their child as well as
information and instructions on how to care for him or her,
parents may feel as though their child is not truly theirs.
The fact that very preterm children appear and behave quite
differently from ordinary babies may hinder the growth of
parent-child bonds. The parent-child attachment bond may
suffer long-term harm as a result of the early abnormalities
in parent-child interaction experienced by extremely
preterm newborns as well as the posttraumatic stress
experienced by the parents after the baby is born [7].
Particularly if there are issues with the delivery, the
family may find the sudden arrival of a preterm new-born
distressing and emotionally tax the mother and father.
Despite the fact that many new-borns in serious condition
can survive thanks to modern technologies in Neonatal
Intensive Care Units [8].
Additionally, there haven't been any reported studies that
specifically look at mothers' experiences when twins and
prematurity conditions arise.
1.3. Purpose
This phenomenological study set out to investigate the
mother's experiences with neonatal intensive care units and
preterm twins. Mother's experiences, attitudes, views, and
personal responses to the period she has been through were
the focus of this study.
1.4. Research Question
1. What are the experiences of mothers who had
prematurity twin pregnancy?
2. Explain your feeling when you first saw babies in the
neonatal intensive care unit?
1.5. Rational for Qualitative Research Design
When a group or population with difficulties or issues
has to be studied, qualitative inquiry is the most suitable
method. The current study aimed to explore the experience
of mother. In this study, data were gathered using semi-
structured interviews and document collection, both of
which are qualitative research techniques. Qualitative
approaches promote high depth and detail in data collecting
and offer a substantial quantity of information about a small
number of individuals. The scope of the emerging data
from this study, in the opinion of the researcher, accurately
reflects the participants' actual experiences.
2. Methodology
2.1. Research Design
A descriptive phenomenological approach was adopted.
The study population was made up of mothers whose
babies were on admission at neonatal units with babies born
before 37 weeks of gestation and twins were eligible to take
part in the study. The study excluded mothers whose

Universal Journal of Public Health 12(2): 271-276, 2024 273
preterm children had congenital abnormalities and/or were
seriously unwell. Purposive sampling of seven mothers was
continued until data saturation was reached. Mothers in the
new-born units were contacted by the researchers, who
described the study's nature and goal to them. Mothers who
agreed to participate in the study were scheduled for one-
on-one, in-depth interviews. Institutional Research
Committee (IRC) approval was obtained before
participants were asked to participate in this study.
Participants who met the inclusion criteria were recruited
requesting voluntary participation. Mothers were recruited
until the point of theoretical saturation of data was met.
2.2. Tool and Technique
A demographic survey, a semi-structured interview, and
a follow-up member check interview were all required of
the participants. Semi-structured interviews were
conducted, and each session lasted between 40 and 45
minutes. Participants were urged to express themselves
freely and in their own terms. The researcher examined the
need for a second contact at the conclusion of each
interview to go over the meaning of the data and make sure
the participants' stated experiences were accurately
reflected. After seven interviews, the data saturation
threshold was reached.
Every interview was recorded and then written down.
Researchers carefully examined, categorized, and coded
the interview-related data to search for themes and related
ideas.
Demographic information obtained includes questions
regarding age, educational status, parity, mode of delivery,
gestational age and neonatal birth weights of both babies.
The purpose of the interview questions was to learn more
about the attitudes, views, and experiences of premature
twin and neonatal intensive care units. The semi-structured
interview guide, which is a schematic presentation of the
questions or topics that the interviewer must cover, is the
cornerstone of semi-structured interviews.
Interview guidelines are a useful technique for
maximizing interview time since they serve to keep the
interview focusing on the anticipated course of action while
also thoroughly and systematically examining multiple
replies [9]. By clarifying answers to the questions posed in
the first interview and gathering any extra information
relevant to the study, the member check in this study was
utilized to assist increase the correctness, credibility, and
trustworthiness of the research.
This study adopted Colaizzi's (1978) descriptive
phenomenological methodology, which includes a
recommended member check that takes place close to the
conclusion of the research project and involves presenting
the basic framework to participants and comparing the
findings to their own experiences. The subjects of this
study were given the opportunity to critically evaluate and
remark on the results and evaluated to see whether a "true"
or genuine portrayal of what they said during the interview
was created. This study utilized measures to minimize bias
in the purposeful participant selection and interpretation of
interview data, including member checks and peer
debriefing approaches. The validity and reliability of the
data obtained were improved through the use of techniques
including reflexivity, triangulation, peer debriefing, and
member checks.
2.3. Quality Control
The criteria of credibility, confirmability, dependability,
and transferability were used to assure trustworthiness. To
ensure the credibility and confirmability of the established
themes, member and peer review of transcripts and themes
were conducted. Through thorough field notes and
descriptions of study procedures, dependability, and
transferability were obtained.
3. Result
Section I: Demographic Variable
Table 1. Description of Demographic variables.
Variables
Frequency
Percentage
Age (years)
19-25
01
14.3%
26-30
06
85.7%
31-40
0
0%
Parity
01
01
14.3%
02-05
06
85.7%
More than 05
0
0%
Mode of delivery
Normal vaginal delivery
0
0%
Caesarean delivery
07
100%
Gestational Age (Weeks)
28 Weeks and less
01
14.3%
More than 28 Weeks
06
85.7%
Neonate Birth weight (first
baby in kg)
Less than 2.5Kg
07
100%
2.5Kg
0
0%
Neonate birth weight (Second
baby in Kg)
Less than 2.5Kg
07
100%
2.5kg
0
0%
Themes generated through analysis were:
The lived experiences of the participants were described
under four themes namely: emotional state, parenting

274 Using Colazzie Analysis: Experience of Mother with Premature Twins and Neonatal Intensive Care Unit
concern, need for help and desire:
Table 2. Themes and Sub-themes
Themes
Sub-themes
Emotional state
Uneasiness
Anxiety and Unpreparedness
Fear of health issues of newborn
Parenting concern
Mother baby relationship
Need for help
Need for help from the health team
professional
Need for help from family members
Spiritual support
Desire
Constantly monitor the babies
Theme I: Emotional State
Uneasiness: The mothers were uneasy since they were
unaware of the baby's development updates and were just
sitting there clueless. The fear is growing since babies are
so little and in incubators.
I believe that in some ways, I am still powerless since I
am not sure what to do for my babies. (M03)
“Because I couldn't provide them with care, I felt
helpless.” (M06)
Anxiety and Unpreparedness: When mothers found
preterm baby needed NICU care, the mothers were shocked
and unprepared, especially after noticing the baby's short
size and learning of unanticipated medical difficulties.
Mothers of babies have higher levels of anxiety.
I feel anxious and unable to function on any work, this
situation is really stressful and I cannot take any more.
(M07)
Fear of health issues of new-born: While their
premature neonates were in the NICU, mothers felt terror.
Mothers were seen to be feeling fear and worry as they
worried about the future health and potential difficulties of
their babies.
I constantly and uncontrollably fear that my baby may
develop new medical issues… (M01)
Theme II: Parenting concern
Mother baby relationship: Relationships between
mothers and their babies require trust, safety, care, and
respect. Mothers wanted to make sure their babies were in
safe hands, in a safe atmosphere, and that their needs were
being met with respect, having realistic expectations for
them and establishing boundaries
Admission of my baby in Neonatal Intensive care unit
disturbs the mother and baby bond (M02)
Theme III: Need for help
Need for help from the health care professional: In
particular, nurses' emotional assistance was requested by
mothers. They stated that they needed to feel as though the
members of the healthcare team understood and valued
their anxiety and emotional distress rather than dismissing
it or ignoring it as if it were unimportant or undesirable.
When the ICU nurse sat with me and explained the
progress and the condition of my both babies and also
supported by saying that she is also having twins and
narrated her journey … (M03)
Need for help from family members: Mothers
described their spouses as pillars of strength during this
critical period. Two mothers indicated that their maternal
and paternal grandmothers offered assistance, especially
after giving birth. Mothers occasionally experience
additional help from family members, particularly the
spouse.
There are moments when I feel that my spouse doesn't
appreciate and understand my emotions; as a result, he
prevents me from expressing my opinions. (M04)
Spiritual Support: Positive neonatal intensive care unit
surroundings, parental support, and a network of spiritual
support were constructive factors that helped to provide
assistance to mothers of premature twin babies.
Even occasionally, I feel as though God is testing me and
not paying attention to my prayers (M06)
God is my strength and my savior. He is with them even
if I am not with my babies (M02).
Theme IV: Desire
Constantly monitor the babies: Few mothers thought
that professionals had given them little attention or seemed
to minimize their emotional issues. They emphasized that
infants were in the NICU and expressed a desire to be with
infants since they believed their current emotional
struggles as parents persisted.
It is really unfair that NICU staff are not allowing
parents to be with their newborns all the time at this
point, since I firmly believe the baby needs me. (M03)
4. Discussion
The study's results showed that women described
preterm birth as traumatic and the surroundings of the
neonatal intensive care unit as scary and foreign. These
mothers described feeling powerless, nervous, and
apprehensive.
It might be challenging to establish contact between
mother and child when the infant requires treatment in a
neonatal intensive care unit (NICU). The most challenging
part for mothers when their newborn child is hospitalized
in a NICU is determined to be being separated from the
infant [10].
The most crucial steps in helping mothers manage the
stress of having their child hospitalized in the NICU are to
pay attention to them, communicate with them about their
needs, and inform them, preferably at the outset of their
stay, and of the types of support that are available to them.

Universal Journal of Public Health 12(2): 271-276, 2024 275
In the setting of a newborn facility, women find it
especially difficult to control their expectations and form a
feeling of their own motherhood. Clear communication and
close relationships with family and staff were shown to be
crucial in assisting moms in managing their stay in the
hospital. In order to meet their specific demands, mothers
emphasized the value of knowledge and used a range of
information-seeking strategies [11].
All of the women spoke about how tough it was to
become mothers, crying over premature births and taking
care of both babies. Because everything seemed to happen
so rapidly and the young ones were so little and premature.
Mothers saw a gap between the anticipated and actual
assistance provided by medical staff. Although the medical
staff saw the need for mothers' assistance, it was not their
top concern, and they believed that the workload prevented
mothers from providing care in the Neonatal Intensive Care
Unit [12].
5. Implications for Practice and
Education
Experiencing a premature birth with twins is incredibly
challenging and has a strong emotional impact. For these
women to complete this challenging journey, it is essential
to offer them emotional support, resources, and
information. Early intervention programs and
developmental evaluations can also assist in addressing any
possible developmental issues or concerns.
6. Conclusions
The Mothers of premature twins in the NICU have
extensive needs for emotional support, which differ from
family to family. It should be acknowledged that
addressing these demands is a crucial problem that the
NICU and its staff must overcome.
The study demonstrated mothers of premature twin’s
baby reported feeling anxious, fearful, and helpless for both
babies and babies’ admission at the NICU. Mothers
required a lot of encouragement and support from the
medical team to begin caring for their infants’ basic needs.
Parents would want professional assistance to balance
these responsibilities with their desire to be close to their
hospitalized infant, and such assistance necessitates a
realistic knowledge of how much time parents are capable
of spending at the NICU. Maybe there should be more
emphasis on the quality of the time parents spend with their
NICU baby than quantity.
Mothers were unprepared for the baby's early birth. They
therefore faced issues including emotional distance and
financial difficulty as a result of the emergency NICU stay.
Therefore, health team members should focus more on
easing mothers' concern by keeping them updated on the
development of the child.
Further, the study concluded that although a mother-
child attachment cannot be formed in the NICU, it can be
achieved with the support of committed NICU health
professionals who are committed to altering normal NICU
nursing practice to take mothers' feelings into account.
Acknowledgements
I thank the coinvestigators for their expertise and
assistance throughout the study. I also thank the hospital
authority for permission and I also would like to thank the
participants who helped us to share the experience.
Conflict of Interest
There is no conflict of interest.
Ethical Consideration
The Institutional Research Committee (IRC) gave its
approval for this study to be carried out (IRC No SCON/07-
19/02/2023). Both verbal affirmation and informed consent
were used to notify research participants of the steps taken
to preserve their privacy. Results from either individual or
aggregated data cannot be traced back to a specific person.
An ID tag that conceals the participant's identity was
embedded into every piece of data that was gathered. This
code cannot be identified by the participants' first names,
last names, ages, or sexes. There is no information in the
demographic questionnaire that might be used to identify
any reader or user of the data. Additionally, the research
subjects were informed of their ability to terminate the
interview or leave the study at any moment.
Funding
Self-funding.
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