Document Type : Original Article
Authors
Department of Midwifery, School of Nursing and Midwifery, Qom University of Medical Sciences, Qom, Iran
Abstract
BACKGROUND: Having a baby admitted to a neonatal intensive care unit (NICU) is so stressful, has
a negative impact on mother well‑being, and also disrupts mother‑infant bonding process because
the infant spend the first several weeks or months in the NICU. Previous studies have shown the
positive association of the mindfulness and various health conditions. This study investigated the
relationship between mothers’ dispositional mindfulness and level of stress and bonding in mothers
with infants in the NICU.
MATERIALS AND METHODS: A cross‑sectional study was performed during 2019 on 140 mothers
with newborns admitted to the NICUs in two hospitals in Qom city in Iran. The self‑report measures of
dispositional mindfulness, Parental Stressor Scale: NICU, and the Postpartum Bonding Questionnaire
were administered to mothers on the 2nd–5th day after birth. The data analysis was carried out by
using a stepwise multiple regression model.
RESULTS: The mean scores of mindfulness, stress, and bonding were 3.32 ± 0.52, 2.32 ± 0.77,
and 0.47 ± 0.37, respectively. There was a statistically significant inverse relationship between total
mindfulness score and stress (P < 0.001). Furthermore, high scores of mindfulness were associated
with better bonding (P = 0.04).
CONCLUSIONS: Improvement in mindfulness helps mothers to reduce stress and make better
bonding with infants. It is recommended that mindfulness interventions use during pregnancy also
after birth, especially for mothers that their infants admitted to in the NICUs.
Keywords
preterm infants after discharge from neonatal intensive care unit:
A meta-synthesis of the literature. J Neonatal Nurs 2016;22:27‑51.
2. Petteys AR, Adoumie D. Mindfulness‑based neurodevelopmental
care: Impact on NICU parent stress and infant length of stay;
A randomized controlled pilot study. Adv Neonatal Care
2018;18:E12‑22.
3. Al Maghaireh DF, Abdullah KL, Chan CM, Piaw CY, Al
Kawafha MM. Systematic review of qualitative studies exploring
parental experiences in the Neonatal Intensive Care Unit. J Clin
Nurs 2016;25:2745‑56.
4. Hasanpour M, Alavi M, Azizi F, Als H, Armanian AM. Iranian
parent‑staff communication and parental stress in the neonatal
Intensive Care Unit. J Educ Health Promot 2017;6:49.
5. Mendelson T, McAfee C, Damian AJ, Brar A, Donohue P,
Sibinga E. A mindfulness intervention to reduce maternal distress
in neonatal intensive care: A mixed methods pilot study. Arch
Womens Ment Health 2018;21:791‑9.
6. Woodward LJ, Bora S, Clark CA, Montgomery‑Hönger A,Pritchard VE, Spencer C, et al. Very preterm birth: Maternal
experiences of the neonatal intensive care environment. J Perinatol
2014;34:555‑61.
7. Akbari V, Rahmatinejad P, Shater MM, Vahedian M, Khalajinia Z.
Investigation of the relationship of perceived social support and
spiritual well‑being with postpartum depression. J Educ Health
Promot 2020;9:174.
8. Busse M, Stromgren K, Thorngate L, Thomas KA. Parents’
responses to stress in the neonatal intensive care unit. Crit Care
Nurse 2013;33:52‑9.
9. Lefkowitz DS, Baxt C, Evans JR. Prevalence and correlates of
posttraumatic stress and postpartum depression in parents of
infants in the Neonatal Intensive Care Unit (NICU). J Clin Psychol
Med Settings 2010;17:230‑7.
10. Feeley N, Zelkowitz P, Cormier C, Charbonneau L, Lacroix A,
Papageorgiou A. Posttraumatic stress among mothers of very low
birthweight infants at 6 months after discharge from the neonatal
intensive care unit. Appl Nurs Res 2011;24:114‑7.
11. Holditch-Davis D, White‑Traut RC, Levy JA, O’Shea TM,
Geraldo V, David RJ. Maternally administered interventions for
preterm infants in the NICU: Effects on maternal psychological
distress and mother‑infant relationship. Infant Behav Dev
2014;37:695‑710.
12. Heydarpoor Damanabad Z, Valizadeh L, Mansouri Arani M,
Hosseini M, Jafarabadi MA, Mansourian M, et al. Evaluation of
maternal anxiety in mothers of infants admitted to the neonatal
intensive care unit. Int J Pediatr 2019;7:10215‑24.
13. Welch MG, Halperin MS, Austin J, Stark RI, Hofer MA, Hane AA,
et al. Depression and anxiety symptoms of mothers of preterm
infants are decreased at 4 months corrected age with Family
Nurture Intervention in the NICU. Arch Womens Ment Health
2016;19:51‑61.
14. 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 Ment Health 2010;13:373‑84.
15. Klaus M. Mother and infant: Early emotional ties. Pediatrics
1998;102:1244‑6.
16. Bowlby J. Una base segura; aplicaciones clínicas de una teoría del
apego. InUna base segura; aplicaciones clínicas de una teoría del
apego 1989 (pp. 204‑p).
17. Joyce A. The parent infant relationship and infant mental health.
The Practice of Psychoanalytic Parent Infant Psy chotherapy/ed.
T. Baradon, C. Broughton, I. Gibbs et al.–Lon don: Routledge.
2005:5.
18. Klaus MH, Kennell JH. Mothers separated from their newborn
infants. Pediatr Clin North Am 1970;17:1015‑37.
19. Perry, B. D. (2006). Applying Principles of Neurodevelopment to
Clinical Work with Maltreated and Traumatized Children: The
Neurosequential Model of Therapeutics.In N. B. Webb (Ed.), Social
Work Practice with Children and Families. Working with
traumatized youth in child welfare (p. 27–52). The Guilford Press.
20. Dudek-Shriber L. Parent stress in the neonatal intensive care unit
and the influence of parent and infant characteristics. Am J Occup
Ther 2004;58:509‑20.
21. Hicks LM, Dayton CJ, Brown S, Muzik M, Raveau H. Mindfulness
moderates depression and quality of prenatal attachment in
expectant parents. Mindfulness 2018;9:1604‑14.
22. Baer RA, Smith GT, Hopkins J, Krietemeyer J, Toney L. Using
self‑report assessment methods to explore facets of mindfulness.
Assessment 2006;13:27‑45.
23. Kabat-Zinn J. Mindfulness-based interventions in context: past,
present, and future. Clin Psychol 2003;10:144‑56.
24. Grabovac AD, Lau MA, Willett BR. Mechanisms of mindfulness:
A Buddhist psychological model. Mindfulness 2011;2:154‑66.
25. Mohamadirizi S, Shaygannejad V, Mohamadirizi S. The survey
of mindfulness in multiple sclerosis patients and its association
with attachment style. J Educ Health Promot 2017;6:7.
26. Kordi M, Mohamadirizi S. The relationship between mindfulness
and maternal attachment to the fetus and neonate in prenatal and
postpartum periods: a cross sectional study. Koomesh. 2016;17 (4).
27. Miles MS, Funk SG, Carlson J. Parental stressor scale: Neonatal
intensive care unit. Nurs Res 1993;42:148‑52.
28. Franck LS, Cox S, Allen A, WinterI. Measuring neonatal intensive
care unit-related parental stress. J Adv Nurs 2005;49:608‑15.
29. Sadat HS, Hamideh B, Batool P. Stressors of parents of
hospitalized preterm infants: A study in neonatal intensive care
unit of afzalipour Hospital, Kerman, Iran. J Health development
Winter 2016;4:337‑48.
30. Brockington IF, Oates J, George S, Turner D, Vostanis P,
Sullivan M, et al. A screening questionnaire for mother‑infant
bonding disorders. Arch Women’s Ment Health 2001;3:133‑40.
31. Aflakseir A, Jamali S. Relationship between Mother‑Child
Bonding with Postpartum Depression among a Group of Mothers
in Shiraz‑Iran. Prev Care Nurs Midwifery J 2014;3:61‑9.
32. Galeshi M, Mirghafourvand M, Alizadeh‑Sharajabad F, Sanaati F.
Predictors of mother‑child bonding. Hayat 2016;22:13‑26.
33. Yamamoto N, Naruse T, Sakai M, Nagata S. Relationship between
maternal mindfulness and anxiety 1 month after childbirth. Jpn J
Nurs Sci 2017;14:267‑76.
34. Desrosiers A, Vine V, Klemanski DH, Nolen‑Hoeksema S.
Mindfulness and emotion regulation in depression and anxiety:
Common and distinct mechanisms of action. Depress Anxiety
2013;30:654‑61.
35. Goodall K, Trejnowska A, Darling S. The relationship between
dispositional mindfulness, attachment security and emotion
regulation. Pers Individ Dif 2012;52:622‑6.
36. Dhillon A, Sparkes E, DuarteRV. Mindfulness‑based interventions
during pregnancy: A systematic review and meta‑analysis.
Mindfulness (N Y) 2017;8:1421‑37.
37. Farb NA, Anderson AK, Mayberg H, Bean J, McKeon D, Segal ZV.
Minding one’s emotions: Mindfulness training alters the neural
expression of sadness. Emotion 2010;10:25‑33.
38. Schultz PP, Ryan RM. The “why,”“what,” and “how” of
healthy self‑regulation: Mindfulness and well‑being from
a self‑determination theory perspective. InHandbook of
mindfulness and self‑regulation 2015 (pp. 81‑94). Springer,
New York, NY.
39. Brown KW, Ryan RM. The benefits of being present: Mindfulness
and its role in psychological well‑being. J Pers Soc Psychol
2003;84:822‑48.
40. Duncan LG, Coatsworth JD, Greenberg MT. A model of mindful
parenting: Implications for parent‑child relationships and
prevention research. Clin Child Fam Psychol Rev 2009;12:255‑70.
41. DiSanza CB. Creation of a Mindfulness Program for NICU
Parents (Doctoral dissertation, Drexel University).
)