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Predictors of Maternal Bonding and Responsiveness for Mothers of Very Preterm Infants

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Abstract

Identify predictors of maternal bonding and responsiveness for mothers of very preterm infants (< 32 weeks gestational age) at 6 weeks and 12 months corrected-age (CA). Cross-sectional and longitudinal study containing 39 mothers of very preterm infants. At 6 weeks CA maternal self-efficacy made a significant unique contribution to the variance in self-reported maternal bonding and responsiveness (21% and 26%, respectively). At 12 months CA maternal trauma symptoms, depressive symptoms and self-efficacy made a significant unique contribution to the variance in bonding (14%, 9% and 9%, respectively). Maternal self-efficacy made a significant 31% unique contribution to the variance in responsiveness. The combined effects of maternal trauma symptoms, depressive symptoms and self-efficacy at 6 weeks CA predicted maternal responsiveness at 12 months CA (p = .042). Supporting maternal self-efficacy is key to facilitating bonding and responsiveness up to 12 months CA following a very preterm birth.

Trial registration: Australian New Zealand Clinical Trials Registry: ACTRN12612000194864.

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References

  • Abidin, R. R. (1986). Parenting stress index. Pediatric Psychology Press.

    Google Scholar 

  • Agostini, F., Neri, E., Dellabartola, S., Biasini, A., & Monti, F. (2014). Early interactive behaviours in preterm infants and their mothers: Influences of maternal depressive symptomatology and neonatal birth weight. Infant Behavior and Development, 37(1), 86–93.

    Article  PubMed  Google Scholar 

  • Amankwaa, L., & Pickler, R. (2006). Measuring maternal responsiveness. Association of Black Nursing Faculty, 18(1), 4–15.

    Google Scholar 

  • Amankwaa, L., Pickler, R., & Boonmee, J. (2007). Maternal responsiveness in mothers of preterm infants. Newborn and Infant Nursing Reviews, 71(1), 25–30. https://doi.org/10.1053/j.nainr.2006.12.001

    Article  Google Scholar 

  • Baker, F., & Mackinlay, E. (2006). Sing, soothe and sleep: A lullaby education programme for first-time mothers. British Journal of Music Education, 23(02), 147–160.

    Article  Google Scholar 

  • Bandura, A. (1994). Self-efficacy. In V. S. Ramachaudran (Ed.), Encyclopedia of human behavior (Vol. 4, pp. 71–81). Academic Press.

    Google Scholar 

  • Bandura, A., Jeffery, R. W., & Gajdos, E. (1975). Generalizing change through participant modeling with self-directed mastery. Behaviour Research and Therapy, 13(2), 141–152.

    Article  CAS  PubMed  Google Scholar 

  • Baylis, R., Ewald, U., Gradin, M., Hedberg Nyqvist, K., Rubertsson, C., & Thernström Blomqvist, Y. (2014). First-time events between parents and preterm infants are affected by the designs and routines of neonatal intensive care units. Acta Paediatrica, 103(10), 1045–1052.

    Article  PubMed  Google Scholar 

  • Beckwith, L., & Rodning, C. (1996). Dyadic processes between mothers and preterm infants: Development at ages 2 to 5 years. Infant Mental Health Journal, 17(4), 322–333.

    Article  Google Scholar 

  • Berryhill, M. B. (2016). Mothers’ parenting stress and engagement: Mediating role of parental competence. Marriage &amp; Family Review, 52(5), 461–480.

    Article  Google Scholar 

  • Blanch D’Souza, S. R., Karkada, S., Lewis, L. E., Mayya, S., & Guddattu, V. (2009). Relationship between stress, coping and nursing support of parents of preterm infants admitted to tertiary level neonatal intensive care units of Karnataka, India: A cross-sectional survey. Journal of Neonatal Nursing, 15(5), 152–158.

    Article  Google Scholar 

  • Bogenschneider, K., Small, S. A., & Tsay, J. C. (1997). Child, parent, and contextual influences on perceived parenting competence among parents of adolescents. Journal of Marriage and the Family, 59, 345–362.

    Article  Google Scholar 

  • Borghini, A., Pierrehumbert, B., Miljkovitch, R., Muller-Nix, C., Forcada-Guex, M., & Ansermet, F. (2006). Mother’s attachment representations of their premature infant at 6 and 18 months after birth. Infant Mental Health Journal, 27(5), 494–508. https://doi.org/10.1002/imhj.20103

    Article  PubMed  Google Scholar 

  • Brandon, D., Tully, K., Silva, S., Malcolm, W., Murtha, A., Turner, B., & Holditch-Davis, D. (2011). Emotional responses of mothers of late-preterm and term infants. Journal of Obstetric, Gynecologic, &amp; Neonatal Nursing, 40(6), 719–731.

    Article  Google Scholar 

  • Breivold, K., Hjaelmhult, E., Sjöström-Strand, A., & Hallström, I. K. (2019). Mothers’ experiences after coming home from the hospital with a moderately to late preterm infant: A qualitative study. Scandinavian Journal of Caring Sciences, 33(3), 632–640.

    Article  PubMed  Google Scholar 

  • Broedsgaard, A., & Wagner, L. (2005). How to facilitate parents and their premature infant for the transition home. International Nursing Review, 52(3), 196–203. https://doi.org/10.1111/j.1466-7657.2005.00414.x

    Article  CAS  PubMed  Google Scholar 

  • Buehler, D. M., Als, H., Duffy, F. H., McAnulty, G. B., & Liederman, J. (1995). Effectiveness of individualized developmental care for low-risk preterm infants: Behavioral and electrophysiologic evidence. Pediatrics, 96(5), 923–932.

    Article  CAS  PubMed  Google Scholar 

  • Carlin, J. B., Gurrin, L. C., Sterne, J. A., Morley, R., & Dwyer, T. (2005). Regression models for twin studies: A critical review. International Journal of Epidemiology, 34(5), 1089–1099.

    Article  PubMed  Google Scholar 

  • Condon, J. T., & Corkindale, C. J. (1998). The assessment of parent-to-infant attachment: Development of a self-report questionnaire instrument. Journal of Reproductive and Infant Psychology, 16(1), 57–76.

    Article  Google Scholar 

  • Cox, J. L., Holden, J. M., & Sagovsky, R. (1987). Detection of postnatal depression. Development of the 10-item Edinburgh Postnatal Depression Scale. The British Journal of Psychiatry, 150(6), 782–786.

    Article  CAS  PubMed  Google Scholar 

  • Davis, M., Morina, N., Powers, M., Smits, J., & Emmelkamp, P. (2015). A meta-analysis of the efficacy of acceptance and commitment therapy for clinically relevant mental and physical health problems. Psychotherapy and Psychosomatics, 84(1), 30–36.

    Article  PubMed  Google Scholar 

  • Evans, T., Whittingham, K., & Boyd, R. (2012). What helps the mother of a preterm infant become securely attached, responsive and well-adjusted? Infant Behavior &amp; Development, 35(1), 1–11. https://doi.org/10.1016/j.infbeh.2011.10.002

    Article  Google Scholar 

  • Evans, T., Boyd, R. N., Colditz, P., Sanders, M., & Whittingham, K. (2017). Mother-very preterm infant relationship quality: RCT of baby triple P. Journal of Child and Family Studies, 26(1), 284–295.

    Article  CAS  Google Scholar 

  • Faul, F., Erdfelder, E., Buchner, A., & Lang, A. G. (2009). Statistical power analyses using G* Power 3.1: Tests for correlation and regression analyses. Behavior Research Methods, 41(4), 1149–1160.

    Article  PubMed  Google Scholar 

  • Figueiredo, B., & Costa, R. (2009). Mother’s stress, mood and emotional involvement with the infant: 3 months before and 3 months after childbirth. Archives of Women’s Mental Health, 12(3), 143–153.

    Article  PubMed  Google Scholar 

  • Forcada-Guex, M., Borghini, A., Pierrehumbert, B., Ansermet, F., & Muller-Nix, C. (2011). Prematurity, maternal posttraumatic stress and consequences on the mother–infant relationship. Early Human Development, 87(1), 21–26. https://doi.org/10.1016/j.earlhumdev.2010.09.006

    Article  PubMed  Google Scholar 

  • Fowler, C., Green, J., Elliott, D., Petty, J., & Whiting, L. (2019). The forgotten mothers of extremely preterm babies: A qualitative study. Journal of Clinical Nursing, 28(11–12), 2124–2134.

    Article  PubMed  PubMed Central  Google Scholar 

  • Fuertes, M., Lopes-dos-Santos, P., Beeghly, M., & Tronick, E. (2009). Infant coping and maternal interactive behavior predict attachment in a Portuguese sample of healthy preterm infants. European Psychologist, 14(4), 320–331.

    Article  Google Scholar 

  • Gale, G., Franck, L. S., Kools, S., & Lynch, M. (2004). Parents’ perceptions of their infant’s pain experience in the NICU. International Journal of Nursing Studies, 41(1), 51–58. https://doi.org/10.1016/s0020-7489(03)00096-8

    Article  PubMed  Google Scholar 

  • Gangi, S., Dente, D., Bacchio, E., Giampietro, S., Terrin, G., & De Curtis, M. (2013). Posttraumatic stress disorder in parents of premature birth neonates. Procedia-Social and Behavioral Sciences, 82, 882–885.

    Article  Google Scholar 

  • Gerstein, E. D., Njoroge, W. F., Paul, R. A., Smyser, C. D., & Rogers, C. E. (2019). Maternal Depression and Stress in the Neonatal Intensive Care Unit: Associations with mother− child interactions at age 5 years. Journal of the American Academy of Child &amp; Adolescent Psychiatry, 58(3), 350–358.

    Article  Google Scholar 

  • Gondoli, D. M., & Silverberg, S. B. (1997). Maternal emotional distress and diminished responsiveness: The mediating role of parenting efficacy and parental perspective taking. Developmental Psychology, 33(5), 861.

    Article  CAS  PubMed  Google Scholar 

  • Goutaudier, N., Lopez, A., Séjourné, N., Denis, A., & Chabrol, H. (2011). Premature birth: Subjective and psychological experiences in the first weeks following childbirth, a mixed-methods study. Journal of Reproductive and Infant Psychology, 29(4), 364–373. https://doi.org/10.1080/02646838.2011.623227

    Article  Google Scholar 

  • Greco, L. A., Heffner, M., Poe, S., Ritchie, S., Polak, M., & Lynch, S. K. (2005). Maternal adjustment following preterm birth: Contributions of experiential avoidance. Behavior Therapy, 36(2), 177–184. https://doi.org/10.1016/S0005-7894(05)80066-8

    Article  Google Scholar 

  • Holditch-Davis, D., White-Traut, R., Levy, J., O’Shea, T., Geraldo, V., & David, R. (2014). Maternally administered interventions for preterm infants in the NICU: Effects on maternal psychological distress and mother–infant relationship. Infant Behavior and Development, 37(4), 695–710.

    Article  PubMed  Google Scholar 

  • Horowitz, J., Murphy, C., Gregory, K., Wojcik, J., Pulcini, J., & Solon, L. (2013). Nurse home visits improve maternal/infant interaction and decrease severity of postpartum depression. Journal of Obstetric, Gynecologic, &amp; Neonatal Nursing, 42(3), 287–300.

    Article  Google Scholar 

  • Horowitz, M., Wilner, N., & Alvarez, W. (1979). Impact of Event Scale: A measure of subjective stress. Psychosomatic Medicine, 41(3), 209–218.

    Article  CAS  PubMed  Google Scholar 

  • Horwitz, S. M., Storfer-Isser, A., Kerker, B. D., Lilo, E., Leibovitz, A., John, N. S., & Shaw, R. J. (2015). A model for the development of mothers’ perceived vulnerability of preterm infants. Journal of Developmental and Behavioral Pediatrics, 36(5), 371–380.

    Article  PubMed  PubMed Central  Google Scholar 

  • Jaekel, J., Wolke, D., & Chernova, J. (2012). Mother and child behaviour in very preterm and term dyads at 6 and 8 years. Developmental Medicine &amp; Child Neurology, 54(8), 716–723.

    Article  Google Scholar 

  • Kerr, M. L., Rasmussen, H. F., Buttitta, K. V., Smiley, P. A., & Borelli, J. L. (2020). Exploring the complexity of mothers’ real-time emotions while caregiving. Emotion, 21(3), 545–556.

    Article  PubMed  Google Scholar 

  • Kim, A. R., Tak, Y. R., Shin, Y. S., Yun, E. H., Park, H. K., & Lee, H. J. (2020). Mothers’ perceptions of quality of family-centered care and environmental stressors in neonatal intensive care units: Predictors of and relationships with psycho-emotional outcomes and postpartum attachment. Maternal and Child Health Journal, 24(5), 601–611.

    Article  PubMed  Google Scholar 

  • Jones, T. L., & Prinz, R. J. (2005). Potential roles of parental self-efficacy in parent and child adjustment: A review. Clinical Psychology Review, 25(3), 341–363.

    Article  PubMed  Google Scholar 

  • Landry, S. H., Smith, K. E., Swank, P. R., Assel, M. A., & Vellet, S. (2001). Does early responsive parenting have a special importance for children’s development or is consistency across childhood necessary? Developmental Psychology, 37(3), 387–403. https://doi.org/10.1037///0012-1649.37.3.387

    Article  CAS  PubMed  Google Scholar 

  • Liu, C. H., Chao, Y. H., Huang, C. M., Wei, F. C., & Chien, L. Y. (2010). Effectiveness of applying empowerment strategies when establishing a support group for parents of preterm infants. Journal of Clinical Nursing, 19(11–12), 1729–1737.

    Article  PubMed  Google Scholar 

  • Liu, S., Yan, Y., Gao, X., Xiang, S., Sha, T., Zeng, G., & He, Q. (2017). Risk factors for postpartum depression among Chinese women: Path model analysis. BMC Pregnancy and Childbirth, 17(1), 133.

    Article  PubMed  PubMed Central  Google Scholar 

  • McFadden, K. E., & Tamis-Lemonda, C. S. (2013). Maternal responsiveness, intrusiveness, and negativity during play with infants: Contextual associations and infant cognitive status in a low-income sample. Infant Mental Health Journal, 34(1), 80–92.

    Article  Google Scholar 

  • Miles, M., Holditch-Davis, D., & Burchinal, P. (1999). Distress and growth in mothers of medically fragile infants. Nursing Research, 48(3), 129–138.

    Article  CAS  PubMed  Google Scholar 

  • Muller-Nix, C., Forcada-Guex, M., Pierrehumbert, B., Jaunin, L., Borghini, A., & Ansermet, F. (2004). Prematurity, maternal stress and mother-child interactions. Early Human Development, 79(2), 145–158. https://doi.org/10.1016/j.earlhumdev.2004.05.002

    Article  PubMed  Google Scholar 

  • Nelson, S. K., Kushlev, K., English, T., Dunn, E. W., & Lyubomirsky, S. (2013). In defense of parenthood: Children are associated with more joy than misery. Psychological Science, 24(1), 3–10.

    Article  PubMed  Google Scholar 

  • Neu, M., & Robinson, J. (2010). Maternal holding of preterm infants during the early weeks after birth and dyad interaction at six months. Journal of Obstetric, Gynecologic &amp; Neonatal Nursing, 39(4), 401–414.

    Article  Google Scholar 

  • Pace, C. C., Anderson, P. J., Lee, K. J., Spittle, A. J., & Treyvaud, K. (2020). Posttraumatic stress symptoms in mothers and fathers of very preterm infants over the first 2 years. Journal of Developmental &amp; Behavioral Pediatrics, 41(8), 612–618.

    Article  Google Scholar 

  • Pace, C. C., Spittle, A. J., Molesworth, C. M. L., Lee, K. J., Northam, E. A., Cheong, J. L., ⋯ Anderson, P. J. (2016). Evolution of depression and anxiety symptoms in parents of very preterm infants during the newborn period. JAMA Pediatrics, 170(9), 863–870.

    Article  PubMed  Google Scholar 

  • Palmquist, A. E., Holdren, S. M., & Fair, C. D. (2020). “It was all taken away”: Lactation, embodiment, and resistance among mothers caring for their very-low-birth-weight infants in the neonatal intensive care unit. Social Science &amp; Medicine, 244, 112648.

    Article  Google Scholar 

  • Petit, A. C., Eutrope, J., Thierry, A., Bednarek, N., Aupetit, L., Saad, S., ⋯ Rolland, A. C. (2016). Mother’s emotional and posttraumatic reactions after a preterm birth: The mother-infant interaction is at stake 12 months after birth. PLoS ONE, 11(3), e0151091.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  • Pierrehumbert, B., Nicole, A., Muller-Nix, C., Forcada-Guex, M., & Ansermet, F. (2003). Parental post-traumatic reactions after premature birth: Implications for sleeping and eating problems in the infant. Archives of Disease in Childhood-Fetal and Neonatal Edition, 88(5), F400–F404.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Shrout, P. E., & Bolger, N. (2002). Mediation in experimental and nonexperimental studies: New procedures and recommendations. Psychological Methods, 7(4), 422.

    Article  PubMed  Google Scholar 

  • Swanson, V., Nicol, H., McInnes, R., Cheyne, H., Mactier, H., & Callander, E. (2012). Developing maternal self-efficacy for feeding preterm babies in the neonatal unit. Qualitative Health Research, 22(10), 1369–1382. https://doi.org/10.1177/1049732312451872

    Article  PubMed  Google Scholar 

  • Tabachnick, B. G., & Fidell, L. S. (2007). Using multivariate statistics (5th ed.). Allyn and Bacon.

    Google Scholar 

  • Teti, D. M., Black, M. M., Viscardi, R., Glass, P., O’Connell, M. A., Baker, L., Cusson, R., & Hess, C. R. (2009). Intervention with African American premature infants four-month results of an Early intervention program. Journal of Early Intervention, 31(2), 146–166.

    Article  Google Scholar 

  • Teti, D. M., & Gelfand, D. M. (1991). Behavioral competence among mothers of infants in the first year: The mediational role of maternal self-efficacy. Child Development, 62(5), 918–929.

    Article  CAS  PubMed  Google Scholar 

  • Tichelman, E., Westerneng, M., Witteveen, A. B., Van Baar, A. L., Van Der Horst, H. E., De Jonge, A., ⋯Peters, L. L. (2019). Correlates of prenatal and postnatal mother-to-infant bonding quality: A systematic review. PLoS ONE, 14(9), e0222998.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Tideman, E., Nilsson, A., Smith, G., & Stjernqvist, K. (2002). Longitudinal follow-up of children born preterm: The mother-child relationship in a 19-year perspective. Journal of Reproductive and Infant Psychology, 20(1), 43–55. https://doi.org/10.1080/02646830220106785

    Article  Google Scholar 

  • Vedova, A. M. D., Dabrassi, F., & Imbasciati, A. (2008). Assessing prenatal attachment in a sample of Italian women. Journal of Reproductive and Infant Psychology, 26(2), 86–98.

    Article  Google Scholar 

  • Wolff, M. S. D., & Ijzendoorn, M. H. V. (1997). Sensitivity and attachment: A meta-analysis on parental antecedents of infant attachment. Child Development, 68(4), 571–591.

    Article  PubMed  Google Scholar 

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Funding

This work was supported by the National Health and Medical Research Council of Australia (Project Grant Number: 1024345); Research Higher Degree Scholarship, The University of Queensland (Grant 2106924) (TE); National Health and Medical Research Council of Australia, Career Development Fellowship (Grant 1037220) (RB); National Health and Medical Research Council of Australia Post-Doctoral Fellow (Grant 631712) (KW). The sources did not have involvement in the research or preparation of the article.

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Authors and Affiliations

  1. Queensland Cerebral Palsy and Rehabilitation Research Centre, Faculty of Medicine, The University of Queensland, Level 6, 62 Graham St, South Brisbane, QLD, 4101, Australia

    Tracey Evans, Roslyn N. Boyd & Koa Whittingham

  2. Perinatal Research Centre, School of Medicine and Biomedical Sciences, University of Queensland, Brisbane, Australia

    Paul B. Colditz

  3. The University of Queensland Centre for Clinical Research, The University of Queensland, Brisbane, Australia

    Paul B. Colditz

  4. Parenting and Family Support Centre, The University of Queensland, Brisbane, Australia

    Matthew Sanders

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  1. Tracey Evans
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  2. Roslyn N. Boyd
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  3. Paul B. Colditz
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Contributions

TE: Conception and design, analysis and interpretation of data, drafted the paper, approved the version to be published, agree to be accountable. RB: Conception and design, critical revision of paper, approved the version to be published, agree to be accountable. PC: Conception and design, critical revision of paper, approved the version to be published, agree to be accountable. MS: Conception and design, critical revision of paper, approved the version to be published, agree to be accountable. KW: Conception and design, critical revision of paper, approved the version to be published, agree to be accountable.

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Correspondence to Tracey Evans.

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Conflict of interest

The authors declare they have the following competing interests: The Triple P-Positive Parenting Program is owned by the University of Queensland (UQ). The University through its main technology transfer company UniQuest Pty Limited has licensed Triple P International Pty Ltd to disseminate the program worldwide. Matthew Sanders is on academic staff at the Parenting and Family Support Centre, The University of Queensland and is an author of Triple P programs. Koa Whittingham, Roslyn Boyd and Paul Colditz are academic staff at The University of Queensland within the School of Medicine. Royalties stemming from the dissemination of the Triple P-Positive Parenting Program are distributed in accordance with the University’s intellectual property policy and flow to the Parenting and Family Support Centre, School of Psychology, UQ; Faculty of Health and Behavioral Sciences; and contributory authors. No author has any share or ownership in Triple P International Pty Ltd. At time of publishing Baby Triple P has not been disseminated.

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Human research ethics committees: Queensland Children’s Health Services (HREC/08/QRCH/114). The University of Queensland (2008002268).

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This study included human participants. The procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000 and 2008.

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Informed consent was obtained from families to participate in the research prior to them completing baseline questionnaires either online or by hard copy.

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Evans, T., Boyd, R.N., Colditz, P.B. et al. Predictors of Maternal Bonding and Responsiveness for Mothers of Very Preterm Infants. J Clin Psychol Med Settings 29, 391–402 (2022). https://doi.org/10.1007/s10880-021-09833-w

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