Positive Mother-infant Interactions Research Articles

Quality of mother-infant interaction, breastfeeding, and perinatal mental health

IntroductionThe quality of mother-infant interactions is crucial for child development. Studies show that breastfeeding contributes to maternal sensitivity and the development of a positive mother-infant bond. Maternal mental health difficulties negatively impact both maternal sensitivity and breastfeeding. Thus, it is unclear whether breastfeeding contributes to the quality of mother-infant interactions independent from mental health. The purpose of this study is to examine the contribution of exclusive breastfeeding at 3 months postpartum to the quality of the mother-infant relationship at 6 months postpartum, controlling for maternal mental health in a community sample of mothers in Chile. Materials and methodEighty women completed self-report measures of mental health and breastfeeding during the third trimester of pregnancy and 3 and 6 months postpartum. At 6 months after childbirth, the mother-infant interaction was assessed by coding a free-play session between mothers and infants. Logistic regression analysis was used to examine the contribution of breastfeeding practices and mental health to the quality of mother-infant interactions. ResultsExclusive breastfeeding at 3 months postpartum increased the likelihood of displaying positive mother-infant interactions controlling for maternal mental health. Mothers who continued to breastfeed at 6 months postpartum reported less symptoms of antenatal depression and anxiety and higher levels of sensitivity and cooperation towards their infants. ConclusionBreastfeeding contributes to maternal sensitivity and cooperation even when controlling for maternal mental health. Implications for health practitioners and limitations due to the sample characteristics are discussed.

Traumatic childbirth during COVID-19 triggers maternal psychological growth and in turn better mother-infant bonding

BackgroundAlthough posttraumatic psychological growth (PTG) occurs following stressful events, knowledge of maternal psychological growth as a result of giving birth during the novel coronavirus (COVID-19) pandemic is lacking. MethodsWe assessed PTG associated with recent childbirth (Posttraumatic Growth Inventory) in a sample of 2205 women who gave birth during the pandemic and 540 who gave birth before. They also provided information about birth-related traumatic stress (Peritraumatic Distress Inventory; PTSD Checklist), mother-infant bonding (Maternal Attachment Inventory), and breastfeeding. ResultsClose to two thirds (60.45 %) of participants reported childbirth-related PTG with greater appreciation of life endorsed most frequently. No group differences in PTG prevalence were noted between deliveries during or before COVID-19 (χ2 = 0.35, p = 0.84). A multigroup mediation model revealed that in deliveries during the pandemic, childbirth-related acute stress was linked with elevated PTG (β = 0.07, p < 0.01); in turn, PTG was associated with lower posttraumatic stress symptoms (β = −0.06, p < 0.05) and better mother-infant bonding (β = 0.22, p < 0.001). These indirect paths via PTG were not significant in deliveries before the pandemic. LimitationsReliance on a convenient sample, self-reports, and cross-sectional design may introduce bias. ConclusionsPerceived positive maternal psychological changes as a result of childbirth are endorsed by a significant portion of women during the pandemic and can ensue in response to traumatic childbirth. Maternal growth is further implicated in successful postpartum adjustment and positive mother-infant interactions during an important period. Hence, directing clinical attention to opportunities of maternal psychological growth may have benefits especially for women at risk for the adverse outcomes of exposure to traumatic experiences of childbirth.

Monochorionic Twins and the Early Mother-Infant Relationship: An Exploratory Observational Study of Mother-Infant Interaction in the Post-Partum Period.

The extraordinary increase in twin rates and specifically monochorionic twin pregnancies represents a major public health issue due to the associated increased risks for the mother, the child and their relationship. The aim of the present study was to examine the quality of mothers’ behaviour during mother–infant interaction in the early postpartum period by comparing mothers of twins and mothers of singletons during face-to-face interaction with their infants. Demographic and clinical information was collected by trained research psychologists from the mothers’ and the childrens’ clinical records and from interviews with the mothers. At three months (corrected for prematurity), the interactions of the dyads (11 mother-twin infant dyads and 11 mother-singleton dyads) were filmed at participants’ homes in accordance with the procedure of the Global Rating Scales. Maternal behaviour during interactions was assessed and rated by two trained research psychologists. With regard to the mothers’ interaction with each twin, no differences were found between mothers’ scores in every GRS subscale, indicating that mothers did not interact differently with their twins. Comparisons between mothers of MC twins and mothers of singletons showed that the quality of maternal sensitive behaviour during the interactions were lower in mothers of twins (0.35) Mothers of twins were also more distant during interactions with their babies and more likely to experience depression symptoms than mothers of singletons (0.05). Future research should examine mother-infant relationships following twin birth with larger samples. Such research will be especially useful in evaluating the potential benefits of interventions to promote positive mother-infant interactions.

Music therapy enhances preterm infant’s signs of engagement and sustains maternal singing in the NICU

Hospitalized preterm infants are exposed to stressful stimuli and early parental separation, which can undermine their long-term development and mother-infant bonding. Family-centered music therapy can enable positive mother-infant interactions, mediated by maternal infant-directed singing. This study aimed to investigate the effects of music therapy on preterm infant’s signs of engagement, namely Eye Opening (EO) and Smiling (SM), and maternal vocalizations. Participants were 30 mother-preterm infant dyads in a Brazilian Neonatal Intensive Care Unit (NICU), divided into a Music Therapy Group (MTG) and a Comparison Group (CG). The MTG participated in 6 sessions of the Music Therapy Intervention for the Mother-Preterm Infant Dyad (MUSIP), with the aim of supporting maternal singing with the infant. Prior to discharge, all mothers were filmed during a Non-singing (NS) and Singing (S) interactional condition; in the S condition, mothers were explicitly asked to address their infants by singing. Results of video and audio analysis showed that infants in the MTG displayed greater Eye Opening (EO) frequency compared to CG, but only when they were in an initial awake state at test, suggesting that music therapy can potentialize infants’ alertness, by increasing their disposition and chances of being engaged in the interaction with the mother. Non-religious mothers appeared to sing significantly more in the MTG than in the CG. These preliminary findings indicate that music therapy in the NICU could promote infant’s signs of engagement during interactions and can sustain maternal singing, especially with non-religious mothers in Brazil.

An Observational Study on Early Dyadic Interactive Behaviors of Mothers With Early-Preterm, Late-Preterm, and Full-Term Infants in Malawi.

Mother-infant interactions are necessary for infant growth and development. However, preterm birth is associated with less positive mother-infant interactions than full-term birth. Malawi has the highest preterm birth rate in the world, but studies of the mother-infant relationship in Malawi are limited and studies that observed mother-infant interactions could not be located. This study explored mother-infant interactions among Malawian mothers of early-preterm, late-preterm, and full-term infants. This observational study explored maternal and infant interactive behaviors. We recruited 83 mother-infant dyads (27 early-preterm, 29 late-preterm, and 27 full-term dyads). Mothers of early-preterm infants looked at and rocked their infants less, and their infants looked at their mothers less, than mothers of either late-preterm infants or full-term infants. The infants in all groups were asleep most of the time, which contributed to low levels of interactive behaviors. Factors that were related to infant behaviors included marital status, maternal occupation, maternal education, infant medical complications, infant gender, history of neonatal deaths, and multiple births. Our findings provide evidence about the need to encourage mothers to engage interactive behaviors with their infants. Future studies of factors that contribute to positive interactions in Malawi are needed.

Early Nonfood Parent-Infant Interactions and Development of Obesity in a High-Risk, Diverse Sample.

This study aimed to understand the protective role of positive mother-infant interactions in the context of food and nonfood behaviors against obesity risk later in life among a cohort of low-income children at high prenatal risk due to maternal substance use during pregnancy. The sample consisted of 216 mother-infant dyads (49% boys) participating in an ongoing longitudinal study. Mother-infant interactions during a feeding episode and a free-play task were measured at child age 1 and 7 months, respectively. Children's length/height and weight were measured at 1, 7, 13, 24, 36, and 48 monthsof age; at kindergarten age (approximately 60 months); and in second grade (approximately 84months). BMI growth trajectories were modeled. No significant associations were found between mother-child feeding interactions and child BMI trajectories. Maternal warmth (95% CI: -0.020 to -0.0005; P = 0.04) and child positive affect (95% CI: -0.020 to -0.002; P = 0.014) during free play were associated with a more normative child BMI trajectory. Results from this study indicated that high maternal warmth and child positive affect during play, but not feeding interactions, are associated with reduced obesity risk from infancy to middle childhood in the context of high pre- and postnatal risks.

The role of sociodemographic factors in maternal psychological distress and mother-preterm infant interactions.

Preterm birth has been associated with greater psychological distress and less positive mother infant interactions than were experienced by mothers of full-term infants. Maternal and infant sociodemographic factors have also shown a strong association with psychological distress and the mother-infant relationship. However, findings on their effects over time are limited. In this longitudinal analysis, we explored the relationship of maternal and infant sociodemographic variables (maternal age, maternal education, marital status, being on social assistance, maternal race, infant birth weight, and infant gender) to maternal psychological distress (depressive, posttraumatic stress, anxiety, parenting stress symptoms, and maternal worry about child's health) through 12 months corrected age for prematurity, and on the home environment, and mother-infant interactions through 6 months corrected age for prematurity. We also explored differences related to maternal obstetrical characteristics (gestational age at birth, parity, mode of delivery, and multiple birth) and severity of infant conditions (Apgar scores, need for mechanical ventilation, and infant medical complications). Although the relationship of maternal and infant characteristics with these outcomes did not change over time, psychological distress differed based on marital status, maternal education, infant gender, and infant medical complications. Older mothers provided more a positive home environment. Mother-infant interactions differed by maternal age, being on public assistance, maternal race, infant gender, and infant medical complications. More longitudinal research is needed to better understand these effects over time in order to identify and support at-risk mothers.

Disposable diaper use promotes consolidated nighttime sleep and positive mother-infant interactions in Chinese 6-month-olds.

The emergence of consolidated nighttime sleep and the formation and maintenance of parent-infant relationships are 2 primary developmental achievements of the infancy period. Despite the development of a transactional model that links parenting behaviors to infant sleep, limited attention has been devoted to examining experimental manipulations of infant sleep that may impact the discrete parent-infant interactions that may form the foundation for emerging attachment relationships. In the present study, infants were randomly assigned to wear high-absorbency disposable diapers or to continue using traditional low-absorbency cloth diapers that necessitate frequent changes and associated disruptions of nighttime sleep. Parents reported on infant sleep before and during the 6-week experimental manipulation; a subset of infants also wore actigraphs. Parents and infants also participated in a parent-infant interaction task both before and near the end of the experimental manipulation. Infants who wore cloth diapers experienced more frequent sleep disruptions overall as well as a greater number of disruptions that did and did not wake the infant from sleep. Infants who wore disposable diapers were rated as experiencing more engagement and positive affect near the end of the intervention relative to infants who wore cloth diapers; mothers of infants who wore disposable diapers were rated as more engaged and sensitive near the end of the intervention relative to mothers of infants who wore cloth diapers. These findings suggest that the disposable diaper manipulation was causally related to characteristics of mother-infant interactions that may form the foundation for emerging attachment relationships.

Perinatal Dyadic Psychotherapy for postpartum depression: a randomized controlled pilot trial.

An integrated approach addressing maternal depression and associated mother-infant relationship dysfunction may improve outcomes. This study tested Perinatal Dyadic Psychotherapy (PDP), a dual-focused mother-infant intervention to prevent/decrease maternal postpartum depression and improve aspects of the mother-infant relationship related to child development. Women recruited from hospital postpartum units were screened using a three-stage process. Forty-two depressed first-time mothers and their 6-week-old infants were enrolled and randomized to receive the PDP intervention or usual care plus depression monitoring by phone. The intervention consisted of eight home-based, nurse-delivered mother-infant sessions consisting of (a) supportive, relationship-based, mother-infant psychotherapy, and (b) a developmentally based infant-oriented component focused on promoting positive mother-infant interactions. Data collected at baseline, post-intervention, and three-month follow-up included measures of maternal depression, anxiety, maternal self-esteem, parenting stress, and mother-infant interaction. Depression and anxiety symptoms and diagnoses decreased significantly, and maternal self-esteem increased significantly across the study time frame with no between-group differences. There were no significant differences between groups on parenting stress or mother-infant interaction at post-intervention and follow-up. No participants developed onset of postpartum depression during the course of the study. PDP holds potential for treating depression in the context of the mother-infant relationship; however, usual care plus depression monitoring showed equal benefit. Further research is needed to explore using low-intensity interventions as a first step in a stepped care approach and to determine what subset of at-risk or depressed postpartum mothers might benefit most from the PDP intervention.

Integrative Review of Nursing Intervention Studies on Mother-Infant Interactions.

PURPOSE: The purpose of this study was to describe the components and content of nursing intervention studies on mother-infant interactions and to present strategies for future studies.METHODS: Four electronic databases in the Korean language were searched to identify studies done between January 1998 and December 2011. The search yielded 145 articles. From these articles, 19 studies met the inclusion criteria.RESULTS: Mother-infant interactions in these studies were found to include verbal and non-verbal communication basic for optimal growth and development of the child. Six kinds of interventions for mother-infant interactions were identified as follows: sensory stimulation, education program, whole body massage, kangaroo care, visiting support, and music therapy.CONCLUSION: Further studies with well designed clinical trials need to be done in the area of child nursing to provide evidence based data for the development of strategies to promote positive mother-infant interactions.

Infant Communicative Behaviors and Maternal Responsiveness

This study applies attachment and transactional theories in evaluating the dyadic interactions observed between a mother and her infant. Infant communication and maternal responsivity are highlighted as the medium for positive interaction. The impact of individualized maternal training on mother infant communicative interaction is proposed to be positive. A sample of three mothers and their infants were observed during 10 min free play sessions before and after a training intervention. The focus of the training was the principles of parenting contained in the Right-from-Birth: a Parenting Series (Grace and Lindsey in Right from birth: a parenting series guide for facilitators, Educational Broadcasting and Early Childhood Institute, Mississippi, 2003) training. A multiple baseline design was used to measure maternal responsiveness to infant communication. Positive and negative maternal responses, as well as the rate of infant communication were also measured. Results showed an increase in positive maternal responses, a decrease in negative maternal responses as well as an increase in the rate of infant communication. These findings underscore the importance of training on correct interpretation of and appropriate maternal responses to infant’s communicative cues, in order to encourage positive mother-infant interactions.

The influence of maternal optimality and infant temperament on parenting stress at 12 months among mothers with substance abuse and psychiatric problems

The present prospective longitudinal study aimed to investigate the long-term impact of maternal optimality assessed during pregnancy on parenting stress at infant age 12 months. In this study the concept of optimality was utilized to investigate maternal variations regarding resources during pregnancy in relation to later parenting stress, among three different groups of mothers that were recruited from substance abuse treatment, psychiatric outpatient treatment and well-baby clinics respectively. The influence of infant temperament on parenting stress was also examined. All mothers were interviewed during pregnancy. At 12 months, infant temperament (Colorado Childhood Temperament Inventory; Rowe & Plomin, 1977) and stress in the parent and child domain (Parenting Stress Index; Abidin, 1955) were assessed. Results demonstrated higher levels of parenting stress among mothers in the clinical groups, compared to the non-clinical group. Furthermore, it was the maternal psychiatric optimality index in combination with child temperament characteristics (child emotionality) that contributed uniquely to stress in the parent domain, while stress in the child domain was significantly associated only with child temperament characteristics (both child emotionality and soothability). The association between maternal psychiatric optimality assessed in pregnancy, infant temperament and parenting stress when the infants were 12 months old, points to the importance of simultaneously addressing the mothers' own psychological distress, and to support positive mother-infant interactions. Each woman's individual optimality profile may be used to display needs of follow-up in order to prevent enduring effects of non-optimality on parenting stress.

Mothers' experiences of interacting with their premature infants

Positive mother–infant interactions are important for child development, particularly for premature infants who are at greater risk of developmental delay. Research suggests that maternal interactions with premature infants may be compromised, but there has been little research into mothers' perceptions of interacting with infants following discharge from neonatal care. This qualitative study examined the experiences of mothers of interacting with their premature infants and explored their perceived support and information needs. Semi‐structured telephone interviews were conducted with twenty mothers which were audio taped and transcribed verbatim. Median gestational age of infants at birth was 27 weeks (23–34). Transcripts were thematically analysed and nine themes emerged from the data. Mothers reported feeling unsure and anxious about interacting with their infants in the early periods after discharge. Babies were perceived as sleepy and unresponsive. Many participants recalled that information about taking infants home had focused on physical care with little guidance about interactions and play. Participants felt supported in the neonatal unit, but health professionals in the community were perceived as lacking necessary expertise in the care of premature infants. There is a clear need for informational support for parents at discharge which focuses on helping them to promote their premature infant's development.

Effects of perinatal coaching on mother-infant interaction.

Perinatal coaching, a skill-training program designed to promote and enhance parent-infant interactions, was evaluated through a controlled design. Forty-two first-time mothers and their clinically well newborns from one private pediatric practice in central Michigan were the sample. Twenty-one of the mothers received perinatal coaching on days 1, 2, and 7 post partum, while the remaining 21 served as the control group. At 28 days post partum, two standardized self-report instruments on parental stress and maternal adaptation, videotaped recordings of mother-infant interactions, and demographic and background data were collected. The groups were comparable on all demographic/background variables assessed. Perinatal coaching was effective in promoting positive mother-infant interactions as demonstrated in five of nine videotaped behavioral assessments, indicating improved interactions for both mother and infant. Some support was found that showed decreased stress in the coached mothers.