Mendizabal-Espinosa, RM; (2017) A critical realist study of neonatal intensive care in Mexico. Doctoral thesis , UCL (University College London).

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Abstract

Neonatal intensive care units (NICU) aim not only to reduce mortality and morbidity but also to promote babies’ future well-being and health. Baby-led (evidence-based) practices take into account babies’ physical and emotional needs. They also consider parents’ needs and, when possible, encourage parental participation. Based on ethnographic field work over the course of ten months, the study examined interactions among healthcare professionals, parents and babies in two Mexican NICUs. Dialectic critical realism underpinned the analysis of data while ideas taken from the new sociology of childhood contributed to an investigation about babies as service users of healthcare facilities in their own right. This thesis contributes to an understanding of why preterm babies in Mexico are cared for as they are and opens ways forward towards changes in practice. Three overarching themes, moral and physical hygiene, dignity and well-being, illuminated discussion of results. I identify theory/practice inconsistencies that arise when discourses about sanitation, breastfeeding and babies’ best interests are used to control and oppress service users of public hospitals (babies and their parents) rather than to protect them. I have found evidence that relationships between healthcare staff and service users were influenced by prejudices about social class, gender and ethnicity, which resulted in deficient care and disrespect of basic human rights. I consider how wider structures such as neoliberal policies, Catholic practices, poverty, corruption and violence influenced the day-to-day life in these hospitals. The thesis concludes by identifying three ways in which practice might be improved: a) to consider nurses as agents of transformational change; b) to create multi-disciplinary teamwork, including parents and babies, in order to enhance communication at all levels; and c) to develop routine procedures and practices in the NICU informed by research evidence of high standards of care. Finally, I identify implications and steps for further research.

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