Parental Narratives of Bonding and Relational Experiences with Preterm Infants Born at 23 to 24 Weeks-A Qualitative Descriptive Study

Overview

Journal Children (Basel)

Specialty Health Services

Date 2023 May 27

PMID 37238341

Authors

Anniina Valiaho

Liisa Lehtonen

Anna Axelin

Riikka Korja

Affiliations

Soon will be listed here.

Abstract

(1) Background. The birth of an infant at 23 to 24 weeks poses a significant challenge to healthy parent-infant bonding because of the high risk of infant loss and the prolonged separation. The aim of this study was to retrospectively explore the narratives of parents with children born at 23-24 weeks about their bonding formation and relational experiences. (2) Methods. This was a qualitative descriptive study conducted with Finnish parents of children born at 23 or 24 weeks of gestation. Twenty-nine mothers and eight fathers were retrospectively interviewed using a semi-structured interview about the bonding process with their infant during the period in the neonatal intensive care unit (NICU) and their later parent-child relationship. Parents' narratives were deductively analysed according to a framework previously developed for studying parental bonding. (3) Results. Our results showed that several parents described the bonding process as natural or even easy despite the traumatic start to parenthood. Support from NICU staff and providing opportunities for participation in infant care and parent-infant physical closeness were reported to enhance the bonding process. Our study identified earlier parenting experience as a new element supporting bonding. (4) Conclusions. According to our results, essential elements enhancing parent-infant bonding in NICU settings seem to be supporting parents psychologically, promoting parent-infant closeness, and encouraging parental participation in the infants' care, even with the most immature infants.

References

Venkatesh K, Lynch C, Costantine M, Backes C, Slaughter J, Frey H . 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(7):652-662. PMC: 9382444. DOI: 10.1001/jama.2022.12841. View

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. 2019; 109(3):518-526. DOI: 10.1111/apa.14975. View

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 Psychol Rev. 2020; 82:101906. PMC: 7695805. DOI: 10.1016/j.cpr.2020.101906. View

Wraight C, McCoy J, Meadow W . Beyond stress: describing the experiences of families during neonatal intensive care. Acta Paediatr. 2015; 104(10):1012-7. DOI: 10.1111/apa.13071. View

Fernandez Medina I, Granero-Molina J, Fernandez-Sola C, Hernandez-Padilla J, Avila M, Lopez Rodriguez M . Bonding in neonatal intensive care units: Experiences of extremely preterm infants' mothers. Women Birth. 2017; 31(4):325-330. DOI: 10.1016/j.wombi.2017.11.008. View

Leckman J, Mayes L, Feldman R, Evans D, King R, Cohen D . Early parental preoccupations and behaviors and their possible relationship to the symptoms of obsessive-compulsive disorder. Acta Psychiatr Scand Suppl. 1999; 396:1-26. DOI: 10.1111/j.1600-0447.1999.tb10951.x. View

Sandelowski M . Whatever happened to qualitative description?. Res Nurs Health. 2000; 23(4):334-40. DOI: 10.1002/1098-240x(200008)23:4<334::aid-nur9>3.0.co;2-g. View

Malouf R, Harrison S, Burton H, Gale C, Stein A, Franck L . Prevalence of anxiety and post-traumatic stress (PTS) among the parents of babies admitted to neonatal units: A systematic review and meta-analysis. EClinicalMedicine. 2022; 43:101233. PMC: 8713115. DOI: 10.1016/j.eclinm.2021.101233. View

Pyhala R, Raikkonen K, Pesonen A, Heinonen K, Lahti J, Hovi P . Parental bonding after preterm birth: child and parent perspectives in the Helsinki study of very low birth weight adults. J Pediatr. 2010; 158(2):251-6.e1. DOI: 10.1016/j.jpeds.2010.07.059. View

10.

Mendelson T, Cluxton-Keller F, Vullo G, Tandon S, Noazin S . NICU-based Interventions To Reduce Maternal Depressive and Anxiety Symptoms: A Meta-analysis. Pediatrics. 2017; 139(3). DOI: 10.1542/peds.2016-1870. View

11.

Melnyk B, Crean H, Feinstein N, 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(6):383-94. PMC: 2770735. DOI: 10.1097/NNR.0b013e3181906f59. View

12.

Winston R, Chicot R . The importance of early bonding on the long-term mental health and resilience of children. London J Prim Care (Abingdon). 2017; 8(1):12-14. PMC: 5330336. DOI: 10.1080/17571472.2015.1133012. View

13.

Clarke P, Allen E, Atuona S, Cawley P . Delivery room cuddles for extremely preterm babies and parents: concept, practice, safety, parental feedback. Acta Paediatr. 2020; 110(5):1439-1449. PMC: 8246903. DOI: 10.1111/apa.15716. View

14.

Valiaho 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(1):48. PMC: 7825219. DOI: 10.1186/s12887-020-02478-y. View

15.

Lillieskold S, Zwedberg S, Linner A, Jonas W . Parents' Experiences of Immediate Skin-to-Skin Contact After the Birth of Their Very Preterm Neonates. J Obstet Gynecol Neonatal Nurs. 2021; 51(1):53-64. DOI: 10.1016/j.jogn.2021.10.002. View

16.

Flacking R, Ewald U, Nyqvist K, 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. 2005; 62(1):70-80. DOI: 10.1016/j.socscimed.2005.05.026. View

17.

Carton A, 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(12):3258-3272. DOI: 10.1111/jan.14538. View

18.

Feldman R, Weller A, Leckman J, Kuint J, Eidelman A . 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(6):929-39. View

19.

Korja R, Savonlahti E, Haataja L, Lapinleimu H, Manninen H, Piha J . Attachment representations in mothers of preterm infants. Infant Behav Dev. 2009; 32(3):305-11. DOI: 10.1016/j.infbeh.2009.04.003. View

20.

Spinelli M, Frigerio A, Montali L, Fasolo M, Spada M, Mangili G . 'I still have difficulties feeling like a mother': The transition to motherhood of preterm infants mothers. Psychol Health. 2015; 31(2):184-204. DOI: 10.1080/08870446.2015.1088015. View