Parental Narratives of Bonding and Relational Experiences with Preterm Infants Born at 23 to 24 Weeks—A Qualitative Descriptive Study
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Approach, Setting, and Participants
2.2. Data Collection
2.3. Data Analysis
3. Results
3.1. AB: Thoughts, Worries, and Distress
“The constant fear of death. And the worry. You are living with that fear 24/7, and you sleep holding your phone, in case you get a call from the NICU, and you are afraid of that call.”M12
“[The attachment] didn’t form at once, of course not, it couldn’t have, when it wasn’t possible to hold him … though I could touch him, he was my son, the emotional bond was strong even then.”M19
3.2. C: Distress Management
“I am really grateful to the NICU staff. They were very capable in taking care of premature babies, but they also took care of us parents.”M4
“In general, I am a positive person. I will always believe in the good.”F25
3.3. D: Compulsive Checking
“The few times I was at home, taking a break from the NICU, felt really hard. I was pressurized to go by the hospital staff, they told me to go as I had an older son there … but it didn’t do me good. I felt I should be there with the baby, all the time.”M31
“Perhaps the most difficult time period was just after discharge from the NICU, at least for me. Because she still had times when her breathing was bad, and […] it was supposed to be our job to assess when it might be [more serious].”F29
“I’m still anxious. Now I worry about her starting day care, although I realise that I’m overprotective.”M37
3.4. E: Affiliative Behaviour and Caretaking
“Thinking back, I feel it was the most important thing, that I got to be with him and do some of those [caretaking] things and to hold him.”M13
“Kangaroo care was really important. It made me feel at once that [my daughter] was my child.”F24
3.5. F: Parental Representations
M24: Perhaps it pinned us together, or like … The bond with the child became especially tight because we went through stuff like that in the beginning with her. Somehow, for me it was more that way that it felt really easy to bond with my child, and like, to fall in love with the child at once.M24
“She’s a very positive, an amazingly tenacious girl.[…] And that’s what she’s always been. She’ll never give up trying.”M17
3.6. Z: Earlier Parental Experience
“I didn’t find [bonding with my son] difficult. I have wondered if that might be because he was my second child.”M13
“My first child, and a preemie. I didn’t know what I should do.”M30
“Growing into motherhood with [my firstborn daughter] hasn’t been an easy task.”M27
4. Discussion
4.1. Strengths and Limitations
4.2. Future Studies and Clinical Implications
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
- Venkatesh, K.K.; Lynch, C.D.; Costantine, M.M. Trends in Active Treatment of Live-born Neonates between 22 Weeks 0 Days and 25 Weeks 6 Days by Gestational Age and Maternal Race and Ethnicity in the US, 2014 to 2020. JAMA 2022, 328, 652–662. [Google Scholar] [CrossRef]
- Helenius, K.; Sjörs, G.; Shah, P.S.; Modi, N.; Reichman, B.; Morisaki, N.; Kusuda, S.; Lui, K.; Darlow, B.A.; Bassler, D.; et al. International Network for Evaluating Outcomes (iNeo) of Neonates. Survival in Very Preterm Infants: An International Comparison of 10 National Neonatal Networks. Pediatrics 2017, 140, e20171264. [Google Scholar] [CrossRef] [PubMed]
- Wittkowski, A.; Vatter, S.; Muhinyi, A.; Garrett, C.; Henderson, M. Measuring bonding or attachment in the parent-infant-relationship: A systematic review of parent-report assessment measures, their psychometric properties and clinical utility. Clin. Psych. Rev. 2020, 82, 101906. [Google Scholar] [CrossRef] [PubMed]
- Winston, R.; Chicot, R. The importance of early bonding on the long-term mental health and resilience of children. London J. Prim. Care 2016, 8, 12–14. [Google Scholar] [CrossRef] [PubMed]
- Bowlby, J. Attachment and Loss; Basic Books: New York, NY, USA, 1969; Volume 1. [Google Scholar]
- Stern, D.N. Maternal representations: A clinical and subjective phenomenological view. Infant Ment. Health J. 1991, 12, 174–186. [Google Scholar] [CrossRef]
- Ammaniti, M.; Tambelli, R.; Odorisio, F. Exploring Maternal Representations during Pregnancy in Normal and At-Risk Samples: The Use of the Interview of Maternal Representations during Pregnancy. Infant Ment. Health J. 2013, 34, 1–10. [Google Scholar] [CrossRef]
- Foley, S.; Hughes, C. Great expectations? Do mothers’ and fathers’ prenatal thoughts and feelings about the infant predict parent-infant interaction quality? A meta-analytic review. Devel. Rev. 2018, 48, 40–54. [Google Scholar] [CrossRef]
- Feldman, R.; Braun, K.; Champagne, F.A. The neural mechanisms and consequences of paternal caregiving. Nat. Rev. Neurosci. 2019, 20, 205–224. [Google Scholar] [CrossRef]
- Feldman, R. The neurobiology of mammalian parenting and the biosocial context of human caregiving. Horm Behav. 2016, 77, 3–17. [Google Scholar] [CrossRef]
- Winnicott, D.W. Collected Papers: Through Pediatrics to Psychoanalysis; Basic Books: New York, NY, USA, 1956. [Google Scholar]
- Feldman, R.; Weller, A.; Leckman, J.F.; Kuint, J.; Eidelman, A.I. The nature of the mother’s tie to her infant: Maternal bonding under conditions of proximity, separation, and potential loss. J. Child Psychol. Psychiatry 1999, 40, 929–939. [Google Scholar] [CrossRef]
- Leckman, J.F.; Mayes, L.C.; Feldman, R.; Evans, D.W.; King, R.A.; Cohen, D.J. Early parental preoccupations and behaviors and their possible relationship to the symptoms of obsessive-compulsive disorder. Acta Psych. Scand. 1999, 396, 1–26. [Google Scholar] [CrossRef] [PubMed]
- Carton, A.M.; Cordwell, J.; Steinhardt, K. A framework synthesis reviewing the impact of neonatal care unit admission on early caregiver-infant relationships. J. Adv. Nurs. 2020, 76, 3258–3272. [Google Scholar] [CrossRef]
- Fernández Medina, I.M.; Granero-Molina, J.; Fernández-Sola, C.; Hernández-Padilla, J.M.; Ávila, M.C.; Rodríguez, M.D.M.L. Bonding in neonatal intensive care units: Experiences of extremely preterm infants’ mothers. Women Birth 2018, 31, 325–330. [Google Scholar] [CrossRef]
- Spinelli, M.; Frigerio, A.; Montali, L.; Fasolo, M.; Spada, M.S.; Mangili, G. ‘I still have difficulties feeling like a mother’: The transition to motherhood of preterm infants’ mothers. Psychol. Health 2016, 31, 184–204. [Google Scholar] [CrossRef]
- Al-Maghaireh, D.; Abdullah, K.; Chong, M.; Piaw, C.Y.; Al Kawafha, M.M. Systematic review of qualitative studies exploring parental experiences in the Neonatal Intensive Care Unit. J. Clin. Nurs. 2016, 25, 2745–2756. [Google Scholar] [CrossRef]
- Flacking, R.; Ewald, U.; Nyqvist, K.H.; Starrin, B. Trustful bonds: A key to “becoming a mother” and to reciprocal breastfeeding. Stories of mothers of very preterm infants at a neonatal unit. Soc. Sci. Med. 2006, 62, 70–80. [Google Scholar] [CrossRef] [PubMed]
- Provenzi, L.; Santoro, E. The lived experience of fathers of preterm infants in the Neonatal Intensive Care Unit: A systematic review of qualitative studies. J. Clin. Nurs. 2015, 24, 1784–1794. [Google Scholar] [CrossRef] [PubMed]
- Sandelowski, M. Whatever happened to qualitative description? Res. Nurs. Health 2000, 23, 334–340. [Google Scholar] [CrossRef]
- Tong, A.; Sainsbury, P.; Craig, J. Consolidated criteria for reporting qualitative research (COREQ): A 32-item checklist for interviews and focus groups. Int. J. Qual. Health Care 2007, 19, 349–357. [Google Scholar] [CrossRef]
- Ahlqvist-Björkroth, S.; Boukydis, Z.; Axelin, A.M.; Lehtonen, L. Close Collaboration with Parents™ intervention to improve parents’ psychological well-being and child development: Description of the intervention and study protocol. Behav. Brain Res. 2017, 325 (Pt B), 303–310. [Google Scholar] [CrossRef]
- Ministry of Economic Affairs and Employment in Finland: Financial Assistance for Families with Children—Ministry of Social Affairs and Health (stm.fi). Available online: https://stm.fi/en/income-security/financial-assistance-familiesFamilybenefits. (accessed on 27 June 2022).
- Väliaho, A.; Lehtonen, L.; Axelin, A.; Korja, R. Mothers’ experiences of parenting and everyday life of children born at 23 weeks of gestation—A qualitative descriptive study. BMC Pediatr. 2021, 21, 48. [Google Scholar] [CrossRef]
- Braun, V.; Clarke, V. Using thematic analysis in psychology. Qual. Res. Psychol. 2006, 3, 77–101. [Google Scholar] [CrossRef]
- Janvier, A.; Lantos, J.; Aschner, J.; Barrington, K.; Batton, B.; Batton, D.; Berg, S.F.; Carter, B.; Campbell, D.; Cohn, F.; et al. Stronger and More Vulnerable: A Balanced View of the Impacts of the NICU Experience on Parents. Pediatrics 2016, 138, e20160655. [Google Scholar] [CrossRef] [PubMed]
- Wraight, C.L.; McCoy, J.; Meadow, W. Beyond stress: Describing the experiences of families during neonatal intensive care. Acta Paediatr. 2015, 104, 1012–1017. [Google Scholar] [CrossRef]
- Pyhälä, R.; Räikkönen, K.; Pesonen, A.K.; Heinonen, K.; Lahti, J.; Hovi, P.; Strang-Karlsson, S.; Andersson, S.; Eriksson, J.; Järvenpää, A.-L.; et al. Parental bonding after preterm birth: Child and parent perspectives in the Helsinki study of very low birth weight adults. J. Pediatr. 2011, 158, 251–256.e1, Epub 2010. [Google Scholar] [CrossRef] [PubMed]
- Korja, R.; Savonlahti, E.; Haataja, L.; Lapinleimu, H.; Manninen, H.; Piha, J.; Lehtonen, L. Attachment representations in mothers of preterm infants. Infant Behav. Dev. 2009, 32, 305–311, Epub 2009 May 14. [Google Scholar] [CrossRef] [PubMed]
- Malouf, R.; Harrison, S.; Burton, H.A.L.; Gale, C.; Stein, A.; Franck, L.S.; Alderdice, F. Prevalence of anxiety and post-traumatic stress (PTS) among the parents of babies admitted to neonatal units: A systematic review and meta-analysis. Clin. Med. 2021, 43, 101233. [Google Scholar] [CrossRef]
- Stern, D. The Motherhood Constellation: A Unified View of Parent–Infant Psychotherapy; Basic Books: New York, NY, USA, 1995. [Google Scholar]
- Gooding, J.S.; Cooper, L.G.; Blaine, A.I.; Franck, L.S.; Howse, J.L.; Berns, S.D. Family support and family-centered care in the neonatal intensive care unit: Origins, advances, impact. Semin. Perinatol. 2011, 35, 20–28. [Google Scholar] [CrossRef] [PubMed]
- Mendelsohn, T.; Cluxton-Keller, F.; Vullo, G.; Tandon, S.D.; Noazin, S. NICU-Based Interventions to Reduce Maternal Depressive and Anxiety Symptoms: A Meta-analysis. Pediatrics 2017, 139, e20161870. [Google Scholar] [CrossRef]
- Kutahyalioglu, N.S.; Scafide, K.N. Effects of family-centered care on bonding: A systematic review. J. Child Health Care 2022, 17, 13674935221085799. [Google Scholar] [CrossRef]
- Melnyk, B.M.; Crean, H.F.; Feinstein, N.F.; Fairbanks, E. Maternal anxiety and depression after a premature infant’s discharge from the neonatal intensive care unit: Explanatory effects of the creating opportunities for parent empowerment program. Nurs. Res. 2008, 57, 383–394. [Google Scholar] [CrossRef] [PubMed]
- Lilliesköld, S.; Zwedberg, S.; Linnér, A.; Jonas, W. Parents’ experiences of immediate skin-to-skin contact after birth of their very preterm infants. J. Obstet. Gynecol. Neonatal. Nurs. 2022, 51, 53–64. [Google Scholar] [CrossRef] [PubMed]
- Kimkool, P.; Huang, S.; Gibbs, D.; Banerjee, J.; Deierl, A. Cuddling very and extremely preterm babies in the delivery room is a positive and normal experience for mothers after the birth. Acta Paediatr. 2022, 111, 952–960. [Google Scholar] [CrossRef] [PubMed]
- Clarke, P.; Allen, E.; Atuona, S.; Cawley, P. Delivery room cuddles for extremely preterm babies and parents: Concept, practice, safety, parental feedback. Acta Paediatr. 2021, 110, 1439–1449. [Google Scholar] [CrossRef]
- Edwards, G.; Hoyle, E.; Patino, F.; Paize, F.; Heuchan, A.M.; Still, L.; O’Shea, J. Delivery room cuddles: Family-centred care from delivery. Acta Paediatr. 2022, 111, 1712–1714. [Google Scholar] [CrossRef]
- Mehler, K.; Hucklenbruch-Rother, E.; Trautmann-Villalba, P.; Becker, I.; Roth, B.; Kribs, A. Delivery room skin-to-skin contact for preterm infants-A randomized clinical trial. Acta Paediatr. 2020, 109, 518–526. [Google Scholar] [CrossRef]
|
Name of Category in the YIPTA | Content of Category in the YIPTA (Feldman et al., 1999 [12]) | Name of Category in Our Study | Content of Category in Our Study |
---|---|---|---|
A: Frequency of Thoughts and Worries | typical thoughts and worries mothers experience in the immediate post-partum period | Combined category AB: Thoughts, worries, and distress |
|
B: Distress Caused by Thoughts and Worries 1 | level of distress caused by thoughts and worries in the immediate post-partum period | ||
C: Distress Management | strategies for managing the distress caused by thoughts and worries | Distress Management | strategies parents had to deal with their distress during the neonatal care period, after discharge, and later in the child’s life |
D: Compulsive Checking |
| Compulsive checking |
|
E: Affiliative Behaviour |
| Affiliate Behaviour and Caretaking |
|
F: Attachment Representations |
| Parental representations |
|
H: Frequency of Caretaking behaviour |
| - | [not applicable retrospectively] |
- | - | Z: Earlier parental experience |
|
Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content. |
© 2023 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Share and Cite
Väliaho, A.; Lehtonen, L.; Axelin, A.; Korja, R. Parental Narratives of Bonding and Relational Experiences with Preterm Infants Born at 23 to 24 Weeks—A Qualitative Descriptive Study. Children 2023, 10, 793. https://doi.org/10.3390/children10050793
Väliaho A, Lehtonen L, Axelin A, Korja R. Parental Narratives of Bonding and Relational Experiences with Preterm Infants Born at 23 to 24 Weeks—A Qualitative Descriptive Study. Children. 2023; 10(5):793. https://doi.org/10.3390/children10050793
Chicago/Turabian StyleVäliaho, Anniina, Liisa Lehtonen, Anna Axelin, and Riikka Korja. 2023. "Parental Narratives of Bonding and Relational Experiences with Preterm Infants Born at 23 to 24 Weeks—A Qualitative Descriptive Study" Children 10, no. 5: 793. https://doi.org/10.3390/children10050793