Parenting preterm infants: implications for mothers and mother- infant relationship

Prematurity and the associated neonatal complications are identified as risk factors that may bring psychological complications both for the baby’s development and for the early mother-infant relationship. The birth of a preterm infant, the sudden end of the pregnancy, and infant’s hospitalization, often represent stressful experiences for parents. Therefore, premature birth may affect parental perceptions and attitudes, thereby distorting parent-child interactions and relationship. The present dissertation aims to examine the complex experience of parenting a preterm infant from a transactional perspective with a mixed method design. The theoretical framework integrates the transactional model of development, attachment theory and recent theories of infant research. Three studies, analyzing the phenomenon from different perspectives and using different methodological frameworks, are reported. The first study qualitatively analyzed narratives of 30 preterm infant mothers. Mothers were interviewed during infant hospitalization on the experiences of pregnancy, delivery and infant recovery. The thematic analysis revealed three major themes relevant for mothers: The construction of maternal identity, The construction of the representation of the bond with the child; The relationship with the healthcare providers and external world. The second study is a microanalysis of mother-infant’s emotion regulation and play during free play interactions at 3 and 6 months of infant’s age. Comparisons between 22 preterm and 20 full-term infant dyads revealed more differences at a maternal and dyadic level than at the infant’s level. Mother-premature infant dyads presented a typical interactive style characterized by maternal overstimulation and the tendency to lead the interaction. These dyads showed more difficulties to adjust their interaction to infant’s growth and more interactive risk indicators emerged at 6 months. The role of infant and maternal characteristics and maternal attachment models as protective and risk factors was explored. The third study examined perinatal Post-Traumatic Stress Disorder and the levels of parenting stress in 156 mothers of full-term children and 87 mothers of preterm children. This study proposed a mediating role of PTSD symptoms between preterm/full-term birth and levels of parenting stress. The mothers were asked to complete a Web survey assessing perinatal PTSD symptoms, parenting stress and social support. The findings showed that mothers of preterm children experienced more post-traumatic symptoms and parenting stress than did mothers of full-term children. Levels of PTSD symptoms were higher for mothers with infants born at lower gestational age. The relationship between preterm/full-term birth and levels of parenting stress was mediated by PTSD symptoms. Moreover, the child’s age moderated the association between maternal PTSD and parenting stress. The discussions of the three studies are integrated in the final conclusions. Findings suggest that prematurity have implications for mothers’ transition to parenthood and for the development of mother-infant relationship confirming the need to examine the phenomenon from a transactional perspective. Implications for preventive interventions are addressed.