Newborn Behavioral Observation, maternal stress, depressive symptoms and the mother-infant relationship: results from the Northern Babies Longitudinal Study (NorBaby)

Ragnhild Sørensen Høifødt, Dag Nordahl, Inger Pauline Landsem, Gábor Csifcsák, Agnes Bohne, Gerit Pfuhl, Kamilla Rognmo, Hanne C Braarud, Arnold Goksøyr, Vibeke Moe, Kari Slinning, Catharina Elisabeth Arfwedson Wang, Ragnhild Sørensen Høifødt, Dag Nordahl, Inger Pauline Landsem, Gábor Csifcsák, Agnes Bohne, Gerit Pfuhl, Kamilla Rognmo, Hanne C Braarud, Arnold Goksøyr, Vibeke Moe, Kari Slinning, Catharina Elisabeth Arfwedson Wang

Abstract

Background: Families can experience the postpartum period as overwhelming and many report a special need for support. The Newborn Behavioral Observation (NBO) aims to promote a positive parent-infant relationship by sensitising parents to the infant's signals. This article evaluates the NBO as a universal preventive intervention within the regular well-baby clinic service on measures of maternal depressive symptoms, parental stress, the mother-infant relationship and satisfaction/benefit of the postpartum follow-up.

Methods: This investigation is part of a larger longitudinal study comprising 220 women and 130 of their partners recruited between 2015 and 2017. The study had a non-randomised cluster-controlled design with 6 measurement points. This article is based on a sample of 196 women using data from T1 (gestational weeks 13-39), T4 (5-15 weeks postpartum) and T5 (3-9 months postpartum). Participants were allocated to a group receiving the NBO (n = 82) and a care as usual comparison group (n = 114). We measured maternal depressive symptoms and parental stress using the Edinburgh Postnatal Depression Scale (EPDS) and the Parenting Stress Index (PSI). The mother-infant relationship was assessed with the Parental Reflective Functioning Questionnaire (PRFQ), the Maternal Postnatal Attachment Scale (MPAS) and the Maternal Confidence Questionnaire (MCQ). Participants also answered questions about satisfaction/benefit of the postpartum follow-up.

Results: A Mann-Whitney U test indicated that participants in the NBO-group learned significantly more than the comparison group from the follow-up about the baby's signals in relation to sleep/sleep patterns, social interaction and crying/fuzziness. Multivariate analyses of covariance (MANCOVA) and repeated measures ANCOVA found no significant differences between the groups for the mother-infant relationship domain and few differences in depressive symptoms and parental stress. The repeated measures ANCOVA found that participants in the NBO-group scored slightly higher on parental stress, although the difference was small.

Conclusions: The results indicate that the NBO-group learned more than the comparison group about reading their child's signals in important everyday situations. However, the benefits of the NBO were limited for depressive symptoms, parental stress and self-reported mother-infant relationship. The study sample was generally well-functioning, and the results indicate that the benefits of the NBO may be limited within a well-functioning sample.

Trial registration: ClinicalTrials, NCT02538497, Registered 2 September 2015.

Keywords: Intervention; Mother-infant relationship; Newborn behavioral observation; Parenting stress; Postpartum depression.

Conflict of interest statement

The authors declare that they have no competing interests.

References

    1. O’Hara MW, Mc Cabe JE. Postpartum depression: Current status and future directions. Annu Rev Clin Psychol. 2013;9:379–407. doi: 10.1146/annurev-clinpsy-050212-185612.
    1. Carvalho JMN, Gaspar MFRF, Cardoso AMR. Challenges of motherhood in the voice of primiparous mothers: initial difficulties. Investigacion y Educacion en Enfermeria. 2017;35(3):285–294.
    1. Nelson AM. Transition to motherhood. J Obstet Gynecol Neonatal Nurs. 2003;32(4):465–477.
    1. Nyström K, Öhrling K. Parenthood experiences during the child's first year: literature review. J Adv Nurs. 2004;46(3):319–330.
    1. Nugent JK, Keefer CH, Minear S, Johnson LC, Blanchard Y. Understanding newborn behavior & early relationships: the newborn behavioral observations (NBO) system handbook. Baltimore: Brookes Publishing Co.; 2007.
    1. Trevarthen C. What is it like to be a person who knows nothing? Defining the active intersubjective mind of a newborn human being. Infant Child Dev. 2011;20(1):119–135.
    1. Tronick EZ. Emotions and emotional communication in infants. Am Psychol. 1989;44(2):112–119.
    1. Biringen Z, Derscheid D, Vliegen N, Closson L, Easterbrooks MA. Emotional availability (EA): theoretical background, empirical research using the EA scales, and clinical applications. Dev Rev. 2014;34(2):114–167.
    1. Jones TL, Prinz RJ. Potential roles of parental self-efficacy in parent and child adjustment: a review. Clin Psychol Rev. 2005;25(3):341–363.
    1. Teti DM, O'Connell MA, Reiner CD. Parenting sensitivity, parental depression and child health: the mediational role of parental self-efficacy. Early Dev Parenting. 1996;5(4):237–250.
    1. Fonagy P, Target M. Bridging the transmission gap: an end to an important mystery of attachment research? Attach Hum Dev. 2005;7(3):333–343.
    1. Kelly K, Slade A, Grienenberger JF. Maternal reflective functioning, mother–infant affective communication, and infant attachment: exploring the link between mental states and observed caregiving behavior in the intergenerational transmission of attachment. Attach Hum Dev. 2005;7(3):299–311.
    1. Slade A. Parental reflective functioning: an introduction. Attach Hum Dev. 2005;7(3):269–281.
    1. Condon JT, Corkindale CJ. The assessment of parent-to-infant attachment: development of a self-report questionnaire instrument. J Reprod Infant Psychol. 1998;16(1):57–76.
    1. de Cock ESA, Henrichs J, Vreeswijk CMJM, Maas AJBM, Rijk CHAM, van Bakel HJA. Continuous feelings of love? The parental bond from pregnancy to toddlerhood. J Fam Psychol. 2016;30(1):125–134.
    1. Maas AJBM, de Cock ESA, Vreeswijk CMJM, Vingerhoets AJJM, van Bakel HJA. A longitudinal study on the maternal–fetal relationship and postnatal maternal sensitivity. J Reprod Infant Psychol. 2016;34(2):110–121.
    1. Schore AN. Effects of a secure attachment relationship on right brain development, affect regulation, and infant mental health. Infant Ment Health J. 2001;22(1–2):7–66.
    1. Gunnar MR, Donzella B. Social regulation of the cortisol levels in early human development. Psychoneuroendocrinology. 2002;27(1–2):199–220.
    1. Bernier A, Carlson SM, Whipple N. From external regulation to self-regulation: early parenting precursors of young children’s executive functioning. Child Dev. 2010;81(1):326–339.
    1. Fish M, Stifter CA. Patterns of mother-infant interaction and attachment: a cluster-analytic approach. Infant Behav Dev. 1995;18(4):435–446.
    1. Bigelow AE, MacLean K, Proctor J, Myatt T, Gillis R, Power M. Maternal sensitivity throughout infancy: continuity and relation to attachment security. Infant Behav Dev. 2010;33(1):50–60.
    1. Groh AM, Roisman GI, van Ijzendoorn MH, Bakermans-Kranenburg MJ, Fearon RP. The significance of insecure and disorganized attachment for children’s internalizing symptoms: a meta-analytic study. Child Dev. 2012;83(2):591–610.
    1. Rostad AM, Nyberg P, Sivberg B. Predicting developmental deficiencies at the age of four based on data from the first seven months of life. Infant Ment Health J. 2008;29(6):588–608.
    1. Fearon RP, Bakermans-Kranenburg MJ, van Ijzendoorn MH, Lapsley AM, Roisman GI. The significance of insecure attachment and disorganization in the development of children's externalizing behavior: a meta-analytic study. Child Dev. 2010;81(2):435–456.
    1. Belsky J, Fearon RMP. Early attachment security, subsequent maternal sensitivity, and later development: does continuity in development depend upon continuity of caregiving? Attach Hum Dev. 2002;4(3):361–387.
    1. Fredriksen E, von Soest T, Smith L, Moe V. Parenting stress plays a mediating role in the prediction of early child development from both parents’ perinatal depressive symptoms. J Abnorm Child Psychol. 2018;47:1–16.
    1. de Cock ESA, Henrichs J, Klimstra TA, Janneke BM, Maas A, Vreeswijk CMJM, Meeus WHJ, et al. Longitudinal associations between parental bonding, parenting stress, and executive functioning in toddlerhood. J Child Fam Stud. 2017;26(6):1723–1733.
    1. Reck C, Zietlow A-L, Müller M, Dubber S. Perceived parenting stress in the course of postpartum depression: the buffering effect of maternal bonding. Arch Womens Mental Health. 2016;19(3):473–482.
    1. Mason ZS, Briggs RD, Silver EJ. Maternal attachment feelings mediate between maternal reports of depression, infant social–emotional development, and parenting stress. J Reprod Infant Psychol. 2011;29(4):382–394.
    1. Cowan CP, Cowan PA. Interventions to ease the transition to parenthood: why they are needed and what they can do. Fam Relat. 1995;44(4):412–423.
    1. Deater-Deckard K. Parenting stress and child adjustment: some old hypotheses and new questions. Clin Psychol Sci Pract. 1998;5(3):314–332.
    1. Crnic KA, Gaze C, Hoffman C. Cumulative parenting stress across the preschool period: relations to maternal parenting and child behaviour at age 5. Infant Child Dev. 2005;14(2):117–132.
    1. Tharner A, Luijk MPCM, van Ijzendoorn MH, Bakermans-Kranenburg MJ, Jaddoe VWV, Hofman A, et al. Infant attachment, parenting stress, and child emotional and behavioral problems at age 3 years. Parenting. 2012;12(4):261–281.
    1. Dørheim SK, Bondevik GT, Eberhard-Gran M, Bjorvatn B. Sleep and depression in postpartum women: a population-based study. Sleep. 2009;32(7):847.
    1. Howard LM, Molyneaux E, Dennis C-L, Rochat T, Stein A, Milgrom J. Non-psychotic mental disorders in the perinatal period. Lancet. 2014;384(9956):1775–1788.
    1. Hornstein C, Trautmann-Villalba P, Hohm E, Rave E, Wortmann-Fleischer S, Schwarz M. Maternal bond and mother–child interaction in severe postpartum psychiatric disorders: is there a link? Arch Womens Mental Health. 2006;9(5):279–284.
    1. Murray L, Halligan SL, Cooper P. Effects of postnatal depression on mother-infant interactions and child development. In: Bremner JG, Wachs TD, editors. The Wiley-Blackwell handbook of infant development. 2. Oxford: Wiley-Blackwell; 2010. pp. 192–220.
    1. Field T. Postpartum depression effects on early interactions, parenting, and safety practices: a review. Infant Behav Dev. 2010;33(1):1–6.
    1. Stein A, Pearson RM, Goodman SH, Rapa E, Rahman A, McCallum M, et al. Effects of perinatal mental disorders on the fetus and child. Lancet. 2014;384(9956):1800–1819.
    1. Sanders LW, Buckner EB. The newborn behavioral observations system as a nursing intervention to enhance engagement in first-time mothers: feasibility and desirability. Pediatr Nurs. 2006;32(5):455–459.
    1. Nugent JK, Bartlett JD, Von Ende A, Valim C. The effects of the newborn behavioral observations (NBO) system on sensitivity in mother-infant interactions. Infants Young Child. 2017;30(4):257–268.
    1. Nugent JK, Bartlett JD, Valim C. Effects of an infant-focused relationship-based hospital and home visiting intervention on reducing symptoms of postpartum maternal depression: a pilot study. Infants Young Child. 2014;27(4):292–304.
    1. Cheetham NB. Hvordan erfares veiledning ved hjelp av Neonatal Behavioral Observation for førstegangsfødende mødre med friske barn? Tromsø: Universitetet i Tromsø; 2011.
    1. Greve RA, Braarud H, Skotheim S, Slinning K. Feasibility and acceptability of an early home visit intervention aimed at supporting a positive mother-infant relationship for mothers at risk of postpartum depression. Scand J Caring Sci. 2018;32(4):1437–1446.
    1. Høifødt RS, Nordahl D, Pfuhl G, Landsem IP, Thimm JC, Ilstad LKK, et al. Protocol for the Northern babies longitudinal study: Predicting postpartum depression and improving parent-infant interaction with The Newborn Behavioral Observation. BMJ Open. 2017;7(9):e016005.
    1. Nordahl D, Høifødt RS, Bohne A, Landsem IP, Wang CEA, Thimm JC. Early maladaptive schemas as predictors of maternal bonding to the unborn child. BMC Psychology. 2019;7(1):23.
    1. The Norwegian Directorate of Health . National guideline for health promotion and preventive work in the child and youth health centres and school health service, 0–20 years. 2. Oslo: The Norwegian Directorate of Health; 2019.
    1. Huizink AC, Mulder EJ, de Medina PGR, Visser GH, Buitelaar JK. Is pregnancy anxiety a distinctive syndrome? Early Hum Dev. 2004;79(2):81–91.
    1. Felitti VJ, Anda RF, Nordenberg D, Williamson DF, Spitz AM, Edwards V, et al. Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: the adverse childhood experiences (ACE) study. Am J Prev Med. 1998;14(4):245–258.
    1. Beck AT, Steer RA, Brown GK. Beck depression inventory-II. San Antonio. 1996;78(2):490–498.
    1. Condon JT. The assessment of antenatal emotional attachment: development of a questionnaire instrument. Br J Med Psychol. 1993;66(2):167–183.
    1. Cox JL, Holden JM, Sagovsky R. Detection of postnatal depression: development of the 10 item Edinburgh postnatal depression scale. Br J Psychiatry. 1987;150(6):782–786.
    1. Eberhard-Gran M, Eskild A, Tambs K, Schei B, Opjordsmoen S. The Edinburgh postnatal depression scale: validation in a Norwegian community sample. Nordic J Psychiatry. 2001;55(2):113–117.
    1. Abidin RR. Parenting stress index 3rd edition: professional manual. Odessa: Psychological Assessment Resources Inc.; 1995.
    1. Kaaresen PI, Rønning JA, Ulvund SE, Dahl LB. A randomized, controlled trial of the effectiveness of an early-intervention program in reducing parenting stress after preterm birth. Pediatrics. 2006;118(1):e9–e19.
    1. Luyten P, Mayes LC, Nijssens L, Fonagy P. The parental reflective functioning questionnaire: development and preliminary validation. PLoS One. 2017;12(5):e0176218.
    1. Parker S, Zahr L. The maternal confidence questionnaire. Boston: Boston City Hospital; 1985.
    1. Olafsen KS, Rønning JA, Bredrup Dahl L, Ulvund SE, Handegård BH, Kaaresen PI. Infant responsiveness and maternal confidence in the neonatal period. Scand J Psychol. 2007;48(6):499–509.
    1. IBM Corp I . SPSS Statistics for Windows. Version 25.0 ed. Armonk: IBM Corp; 2017.
    1. Field A. Discovering statistics using IBM SPSS statistics. London: SAGE; 2018.
    1. Misri S, Reebye P, Milis L, Shah S. The impact of treatment intervention on parenting stress in postpartum depressed mothers: a prospective study. Am J Orthopsychiatry. 2006;76(1):115–119.
    1. Bakermans-Kranenburg MJ, Van Ijzendoorn MH, Juffer F. Less is more: meta-analyses of sensitivity and attachment interventions in early childhood. Psychol Bull. 2003;129(2):195–215.
    1. Høivik MS, Lydersen S, Drugli MB, Onsøien R, Hansen MB, Berg-Nielsen TS. Video feedback compared to treatment as usual in families with parent–child interactions problems: a randomized controlled trial. Child Adolesc Psychiatry Ment Health. 2015;9(1):3.
    1. Rayce SB, Rasmussen IS, Klest SK, Patras J, Pontoppidan M. Effects of parenting interventions for at-risk parents with infants: a systematic review and meta-analyses. BMJ Open. 2017;7(12):e015707.
    1. Badr LK. Further psychometric testing and use of the maternal confidence questionnaire. Issues Comp Pediatr Nurs. 2005;28(3):163–174.
    1. Blower SL, Gridley N, Dunn A, Bywater T, Hindson Z, Bryant M. Psychometric properties of parent outcome measures used in RCTs of antenatal and early years parent programs: a systematic review. Clin Child Fam Psychol Rev. 2019;22:367–387.
    1. Van Bussel JC, Spitz B, Demyttenaere K. Three self-report questionnaires of the early mother-to-infant bond: reliability and validity of the Dutch version of the MPAS, PBQ and MIBS. Arch Womens Mental Health. 2010;13(5):373–384.
    1. Krink S, Muehlhan C, Luyten P, Romer G, Ramsauer B. Parental reflective functioning affects sensitivity to distress in mothers with postpartum depression. J Child Fam Stud. 2018;27(5):1671–1681.
    1. Nordhov SM, Rønning JA, Dahl LB, Ulvund SE, Tunby J, Kaaresen PI. Early intervention improves cognitive outcomes for preterm infants: randomized controlled trial. Pediatrics. 2010;126(5):e1088.

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