Mothers and Fathers in NICU: The Impact of Preterm Birth on Parental Distress

Chiara Ionio, Caterina Colombo, Valeria Brazzoduro, Eleonora Mascheroni, Emanuela Confalonieri, Francesca Castoldi, Gianluca Lista, Chiara Ionio, Caterina Colombo, Valeria Brazzoduro, Eleonora Mascheroni, Emanuela Confalonieri, Francesca Castoldi, Gianluca Lista

Abstract

Preterm birth is a stressful event for families. In particular, the unexpectedly early delivery may cause negative feelings in mothers and fathers. The aim of this study was to examine the relationship between preterm birth, parental stress and negative feelings, and the environmental setting of NICU. 21 mothers (age = 36.00 ± 6.85) and 19 fathers (age = 34.92 ± 4.58) of preterm infants (GA = 30.96 ± 2.97) and 20 mothers (age = 40.08 ± 4.76) and 20 fathers (age = 40.32 ± 6.77) of full-term infants (GA = 39.19 ± 1.42) were involved. All parents filled out the Parental Stressor Scale: Neonatal Intensive Care Unit, the Impact of Event Scale Revised, Profile of Mood States, the Multidimensional Scale of Perceived Social Support and the Post-Partum Bonding Questionnaire. Our data showed differences in emotional reactions between preterm and full-term parents. Results also revealed significant differences between mothers and fathers' responses to preterm birth in terms of stress, negative feelings, and perceptions of social support. A correlation between negative conditions at birth (e.g., birth weight and Neonatal Intensive Care Unit stay) and higher scores in some scales of Impact of Event Scale Revised, Profile of Mood States and Post-Partum Bonding Questionnaire were found. Neonatal Intensive Care Unit may be a stressful place both for mothers and fathers. It might be useful to plan, as soon as possible, interventions to help parents through the experience of the premature birth of their child and to begin an immediately adaptive mode of care.

Keywords: NICU; caring; parental stress; parenting; prematurity.

Conflict of interest statement

The authors have declared that no competing interests exist.

References

    1. Aagaard H., Hall E. O. (2008). Mothers’ experiences of having a preterm infant in the neonatal care unit: A meta-synthesis. Journal of Pediatric Nursing, 23, e26–e36. doi:. 10.1016/j.pedn.2007.02.003
    1. Alkozei A., McMahon E., Lahav A. (2014). Stress levels and depressive symptoms in NICU mothers in the early postpartum period. The Journal of Maternal-Fetal & Neonatal Medicine, 27, 1738–1743. doi:. 10.3109/14767058.2014.942626
    1. Arnold L., Sawyer A., Rabe H., Abbott J., Gyte G., Duley L., Ayers S. (2013). Parents’ first moments with their very preterm babies: A qualitative study. BMJ Open, 3, e002487. 10.1136/bmjopen-2012-002487
    1. Axelin A., Lehtonen L., Pelander T., Salanterä S. (2010). Mothers’ different styles of involvement in preterm infant pain care. Journal of Obstetric, Gynecologic, and Neonatal Nursing, 39, 415–424. doi:. 10.1111/j.1552-6909.2010.01150.x
    1. Brockington I. F., Fraser C., Wilson D. (2006). The Postpartum Bonding Questionnaire: A validation. Archives of Women's Mental Health, 9, 233–242. doi:. 10.1007/s00737-006-0132-1
    1. Brown G. L., McBride B. A., Bost K. K., Shin N. (2011). Parental involvement, child temperament, and parents’ work hours: Differential relations for mothers and fathers. Journal of Applied Developmental Psychology, 32, 313–322. doi:. 10.1016/j.appdev.2011.08.004
    1. Busse M., Stromgren K., Thorngate L., Thomas K. A. (2013). Parents’ responses to stress in the neonatal intensive care unit. Critical Care Nurse, 33, 52–59. doi:. 10.4037/ccn2013715
    1. Candelori C., Trumello C., Babore A., Keren M., Romanelli R. (2015). The experience of premature birth for fathers: The application of the Clinical Interview for Parents of High-Risk Infants (CLIP) to an Italian sample. Frontiers in Psychology, 6, 1444. 10.3389/fpsyg.2015.01444
    1. Cena, L., Imbasciati, A., & Baldoni, F. (2010). La relazione genitore-bambino: Dalla psicoanalisi infantile a nuove prospettive evoluzionistiche dell’attaccamento. Milano, Italy: Springer.
    1. Clottey M., Dillard D. M. (2013). Post-traumatic stress disorder and neonatal intensive care. The International Journal of Childbirth Education, 28, 23–29.
    1. Coppola, G., & Cassibba, R. (2004). La prematurità: Fattori di protezione e di rischio per la relazione madre-bambino. Rome, Italy: Carocci.
    1. Curran S. L., Andrykowski M. A., Studts J. L. (1995). Short form of the Profile of Mood States (POMS-SF): Psychometric information. Psychological Assessment, 7(1), 80–83. 10.1037/1040-3590.7.1.80
    1. de Macedo E. C., Cruvinel F., Lukasova K., D’Antino M. E. F. (2007). The mood variation in mothers of preterm infants in Kangaroo mother care and conventional incubator care. Journal of Tropical Pediatrics, 53, 344–346. doi:. 10.1093/tropej/fmm076
    1. DeMier R. L., Hynan M. T., Hatfield R. F., Varner M. W., Harris H. B., Manniello R. L. (2000). A measurement model of perinatal stressors: Identifying risk for postnatal emotional distress in mothers of high-risk infants. Journal of Clinical Psychology, 56, 89–100. 10.1002/(SICI)1097-4679(200001)56:1<89::AID-JCLP8>;2-6
    1. Diego M. A., Field T., Jones N. A., Hernandez-Reif M. (2006). Withdrawn and intrusive maternal interaction style and infant frontal EEG asymmetry shifts in infants of depressed and non-depressed mothers. Infant Behavior and Development, 29, 220–229. doi:. 10.1016/j.infbeh.2005.12.002
    1. Dudek-Shriber L. (2004). Parental stress in the neonatal intensive care unit and the influence of parent and infant characteristics. The American Journal of Occupational Therapy, 58, 509–520. doi:. 10.5014/ajot.58.5.509
    1. Farnè, M., Sebellico, A., Gnugnoli, D., & Corallo, A. (1991). POMS: Profile of Mood States: Manuale Adattamento Italiano. Firenze, Italy: GiuntiOS.
    1. Feldman R., Eidelman A. I. (2007). Maternal postpartum behavior and the emergence of infant–mother and infant–father synchrony in preterm and full-term infants: The role of neonatal vagal tone. Developmental Psychobiology, 49, 290–302. doi:. 10.1002/dev.20220
    1. Feldman R., Eidelman A. I., Sirota L., Weller A. (2002). Comparison of skin-to-skin (kangaroo) and traditional care: Parenting outcomes and preterm infant development. Pediatrics, 110, 16–26. 10.1542/peds.110.1.16
    1. Feldman R., Weller A., Leckman J. F., Kuint J., Eidelman A. I. (1999). The nature of the mother’s tie to her infant: Maternal bonding under conditions of proximity, separation, and potential loss. Journal of Child Psychology and Psychiatry, 40, 929–939. doi:. 10.1017/S0021963099004308
    1. Franck L. S., Cox S., Allen A., Winter I. (2005). Measuring neonatal intensive care unit-related parental stress. Journal of Advanced Nursing, 49, 608–615. doi:. 10.1111/j.1365-2648.2004.03336.x
    1. Goldberg, S., & DiVitto, B. (2002). Parenting children born preterm In M. H. Bornstein (Ed.), Handbook of Parenting: Vol. 1. Children and parenting (pp. 329-354). Mahwah, NJ, USA: Lawrence Erlbaum.
    1. Green B. L. (1990). Defining trauma: Terminology and generic stressor dimensions. Journal of Applied Social Psychology, 20, 1632–1642. 10.1111/j.1559-1816.1990.tb01498.x
    1. Green S. L., Phipps W. D. (2015). Interactional pattern analysis of mother–baby pairs: Kangaroo mother care versus incubator care. South African Journal of Psychology, 45, 194–206. doi:. 10.1177/0081246314565961
    1. Hildebrandt K. A., Fitzgerald H. E. (1979). Facial feature determinants of perceived infant attractiveness. Infant Behavior and Development, 2, 329–339. 10.1016/S0163-6383(79)80043-0
    1. Hoffenkamp H. N., Braeken J., Hall R. A., Tooten A., Vingerhoets A. J., van Bakel H. J. (2015). Parenting in complex conditions: Does preterm birth provide a context for the development of less optimal parental behavior. Journal of Pediatric Psychology, 40, 559–571. doi:. 10.1093/jpepsy/jsv007
    1. Hoffenkamp H. N., Tooten A., Hall R. A. S., Croon M. A., Braeken J., Winkel F. W., van Bakel H. J. A. (2012). The impact of premature childbirth on parental bonding. Evolutionary Psychology, 10(3), 542–561. doi:. 10.1177/147470491201000311
    1. Holditch-Davis D., Bartlett T. R., Blickman A. L., Miles M. S. (2003). Posttraumatic stress symptoms in mothers of premature infants. Journal of Obstetric, Gynecologic, and Neonatal Nursing, 32, 161–171. doi:. 10.1177/0884217503252035
    1. Howe T. H., Sheu C. F., Wang T. N., Hsu Y. W. (2014). Parenting stress in families with very low birth weight preterm infants in early infancy. Research in Developmental Disabilities, 35, 1748–1756. doi:. 10.1016/j.ridd.2014.02.015
    1. Ionio C., Di Blasio P. (2014). Post-traumatic stress symptoms after childbirth and early mother-child interaction: An exploratory study. Journal of Reproductive and Infant Psychology, 32, 163–181. doi:. 10.1080/02646838.2013.841880
    1. Jackson K., Ternestedt B. M., Schollin J. (2003). From alienation to familiarity: Experiences of mother and father of preterm infants. Journal of Advanced Nursing, 43, 120–129. doi:. 10.1046/j.1365-2648.2003.02686.x
    1. Korja R., Ahlqvist-Bjorkroth S., Savonlaht E., Stolt S., Haataja L., Lapinleimu H., et al. Lehtonen L. (2010). Relations between maternal attachment representations and the quality of mother-infant interaction in preterm and full-term infants. Infant Behavior and Development, 33, 330–336. doi:. 10.1016/j.infbeh.2010.03.010
    1. Lamb, M. E., & Lewis, C. (2010). The development and significance of father-child relationships in two-parent families. In M. E. Lamb (Eds.), The role of the father in child development (5th ed.). Hoboken, NJ, USA: Wiley.
    1. Lefkowitz D. S., Baxt C., Evans J. R. (2010). Prevalence and correlates of posttraumatic stress and postpartum depression in parents of infants in the Neonatal Intensive Care Unit (NICU). Journal of Clinical Psychology in Medical Settings, 17, 230–237. doi:. 10.1007/s10880-010-9202-7
    1. Lindberg B., Axelsson K., Öhrling K. (2007). The birth of premature infants: Experiences from the fathers’ perspective. Journal of Neonatal Nursing, 13, 142–149. doi:. 10.1016/j.jnn.2007.05.004
    1. Lindberg B., Öhrling K. (2008). Experiences of having a prematurely born infant from the perspective of mothers in northern Sweden. International Journal of Circumpolar Health, 67(5), 461–471. 10.3402/ijch.v67i5.18353
    1. Lundqvist P., Jakobsson L. (2003). Swedish men's experiences of becoming fathers to their preterm infants. Neonatal Network, 22, 25–31. doi:. 10.1891/0730-0832.22.6.25
    1. Maroney D. (1994). Helping parents survive the emotional "roller coaster ride" in the newborn intensive care unit. Journal of Perinatology: Official Journal of the California Perinatal Association, 14, 131–133.
    1. Matricardi S., Agostino R., Fedeli C., Montirosso R. (2013). Mothers are not fathers: Differences between parents in the reduction of stress levels after a parental intervention in a NICU. Acta Paediatrica, 102, 8–14. doi:. 10.1111/apa.12058
    1. McNair, D., Lorr, M., & Droppleman, L. F. (1971). Manual for the Profile of Mood States. San Diego, CA, USA: Educational and Industrial Testing Services.
    1. Miles M. S., Funk S. G., Carlson J. (1993). Parental Stressor Scale: Neonatal intensive care unit. Nursing Research, 42, 148–152. 10.1097/00006199-199305000-00005
    1. Miles M. S., Holditch-Davis D., Schwartz T. A., Scher M. (2007). Depressive symptoms in mothers of prematurely born infants. Journal of Developmental and Behavioral Pediatrics, 28, 36–44. doi:. 10.1097/01.DBP.0000257517.52459.7a
    1. Montirosso, R., Fedeli, C., Provenzi, L., & Brockington I. F. (2009). Traduzione italiana del Post Partum Bonding Questionnaire di Brockington. Unpublished document.
    1. Montirosso R., Provenzi L., Calciolari G., Borgatti R., NEO-ACQUA Study Group . (2012). Measuring maternal stress and perceived support in 25 Italian NICUs. Acta Paediatrica, 101, 136–142. doi:. 10.1111/j.1651-2227.2011.02440.x
    1. Müller-Nix, C., & Ansermet, F. (2009). Prematurity, risk and protective factors. In C. H. Zeanah, Jr. (Ed.), Handbook of infant mental health (3rd ed.). New York, NY, USA: The Guilford Press.
    1. Olshtain-Mann O., Auslander G. K. (2008). Parents of preterm infants two months after discharge from the hospital: Are they still at (parental) risk? Health & Social Work, 33, 299–308. doi:. 10.1093/hsw/33.4.299
    1. Orapiriyakul R., Jirapaet V., Rodcumdee B. (2007). Struggling to get connected: The process of maternal attachment to the preterm infant in the neonatal intensive care unit. Thai Journal of Nursing Research, 11, 251–263.
    1. Pallás-Alonso C. R., Losacco V., Maraschini A., Greisen G., Pierrat V., Warren I., et al. Cuttini M. (2012). Parental involvement and kangaroo care in European neonatal intensive care units: A policy survey in eight countries. Pediatric Critical Care Medicine, 13, 568–577. doi:. 10.1097/PCC.0b013e3182417959
    1. Pietrantonio F., De Gennaro L., Di Paolo M. C., Solano L. (2003). The Impact of Event Scale: Validation of an Italian Version. Journal of Psychosomatic Research, 55, 389–393. doi:. 10.1016/S0022-3999(02)00638-4
    1. Pohlman S. (2005). The primacy of work and fathering preterm infants: Findings from an interpretive phenomenological study. Advances in Neonatal Care, 5, 204–216. doi:. 10.1016/j.adnc.2005.03.002
    1. Prezza, M., & Principato, M. P. (2002). La rete sociale e il sostegno sociale. In M. Prezza & M. Santinello (Eds.), Conoscere la comunità. Bologna, Italy: Il Mulino.
    1. Ravn I. H., Smith L., Aarhus Smeby N., Kynoea N. M., Sandvikf L., Bunch E. H., Lindemann R. (2012). Effects of early mother-infant intervention on outcomes in mothers and moderately and late preterm infants at age 1 year: A randomized controlled trial. Infant Behavior and Development, 35, 36–47. doi:. 10.1016/j.infbeh.2011.09.006
    1. Sameroff, A. J., & Chandler, M. J. (1975). Reproductive risk and the continuum of caretaking casualty. In F. D. Horowitz, E. M. Hetherington, S. Scarr-Salapatek, & G. Siegel (Eds.), Review of child development research (Vol. 4, pp. 187-243). Chicago, IL, USA: University of Chicago Press.
    1. Sansavini, A., & Faldella, G. (2013). Lo sviluppo dei bambini nati pretermine: Aspetti neuropsicologici, metodi di valutazione e interventi. Milano, Italy: Franco Angeli.
    1. Singer L. T., Fulton S. M. A., Davillier M. L. S. W., Koshy D. B. S., Salvator A. M. S., Baley J. E. (2003). Effects on infant risk status and maternal psychological distress on maternal–infant interactions during the first year of life. Journal of Developmental and Behavioral Pediatrics, 24, 233–241. doi:. 10.1097/00004703-200308000-00003
    1. Steen M., Downe S., Bamford N., Edozien L. (2012). Not-patient and not-visitor: A metasynthesis fathers’ encounters with pregnancy, birth and maternity care. Midwifery, 28, 422–431. doi:. 10.1016/j.midw.2011.06.009
    1. Teti D. M., Hess C. R., O’Connell M. A. (2005). Parental perceptions of infant vulnerability in a preterm sample: Prediction from maternal adaptation to parenthood during the neonatal period. Journal of Developmental and Behavioral Pediatrics, 26, 283–292. 10.1097/00004703-200508000-00004
    1. Trombini E., Surcinelli P., Piccioni A., Alessandroni R., Faldella G. (2008). Environmental factors associated with stress in mothers of preterm newborns. Acta Paediatrica, 97, 894–898. doi:. 10.1111/j.1651-2227.2008.00849.x
    1. Vigod S. N., Villegas L., Dennis C.-L., Ross L. E. (2010). Prevalence and risk factors for postpartum depression among women with preterm and low-birth-weight infants: A systematic review. BJOG: An International Journal of Obstetrics and Gynaecology, 117, 540–550. doi:. 10.1111/j.1471-0528.2009.02493.x
    1. Watson G. (2011). Parental liminality: A way of understanding the early experiences of parents who have a very preterm infant. Journal of Clinical Nursing, 20, 1462–1471. doi:. 10.1111/j.1365-2702.2010.03311.x
    1. Weiss, D. S., & Marmar, C. R. (1997). The Impact of Event Scale-Revised. In J. P. Wilson & T. M. Keane (Eds.), Assessing psychological trauma and PTSD: A practitioner’s handbook (pp. 399-411). New York, NY, USA: The Guilford Press.
    1. Wigert H., Berg M., Hellström A. (2010). Parental presence when their child is in neonatal intensive care. Scandinavian Journal of Caring Sciences, 24, 139–146. doi:. 10.1111/j.1471-6712.2009.00697.x
    1. Zimet G. D., Dahlem N. W., Zimet S. G., Farley G. K. (1988). The Multidimensional Scale of Perceived Social Support. Journal of Personality Assessment, 52, 30–41. 10.1207/s15327752jpa5201_2

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