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A Light of Hope for Preemies: How to Ensure their Attachment and Support

Submitted by on February 20, 2017 – 7:18 PM

preemies 2Many hospitals today are still trapped in the murky ages where they mostly emphasize the medicinal aspect of a newborn’s health, keeping ‘nature and nurture’ aspects firmly on the back-burner.


During my clinical rotations, I once encountered a 27-year-old female, primary gravida (first pregnancy), who had delivered a baby boy through cesarean section three days before. The neonate was kept in the NICU due to premature birth. While taking health history, I ascertained that the patient hadn’t met her baby since after her delivery and was oblivious to her baby’s condition. She expressed her milk regularly to be sent to the NICU for her neonate. Initially, many questions started bothering me.


For instance, why hasn’t the mother met the neonate yet? Doesn’t an infant have the right to meet his mother? How will this hamper their normal attachment process with each other? Literature elucidates that the initial period of birth is deemed as a golden hour whereby the mother-infant dyad fortifies and leads to the development of a closer attachment bond.


Thereupon, I decided to facilitate the mother’s concern as an integral part of my commitment. I took her to visit her baby in the NICU and encouraged her to spend some time with him. Just then, the gracious smile on the mother’s face made me feel very proud that I had been able to facilitate the mother, allowing her to meet her baby after 3 days. Besides this, the baby’s heartbeat also started to improve after initiating Kangaroo Mother Care (KMC).


Mother-neonate attachment is an intricate human bond which begins through physical nearness and early interaction between mother and neonate. This emotional tie is an essential key for the infant’s healthy development and for the establishment of an affectionate parent-infant relationship. However, this normal bonding process often gets hindered, particularly when the neonate is preterm (‘preemie’) and must be shifted to the NICU soon after birth.This eventually impedes meaningful and positive mother-neonate interaction and their ability to bond reciprocally.


Pertaining to this, there emerges a dire need to brace the attachment process for the preemie’s physical and mental development. These motives can be accomplished by encouraging the practice of breastfeeding and Kangaroo Mother Care in an NICU setting. This paper intends to provide a deep insight about the factors affecting the normal bonding process in preemies. Moreover, it will suggest how breastfeeding and Kangaroo Mother Care can enhance mother-infant attachment, in conjunction with the role of nurses to deal with such issues.


Preterm birth is conceded as a very emotional, disturbing and challenging experience for parents. Likewise, during this phase, certain factors greatly contribute to this mounting of stress as well as impeding mother-preemie attachment. Firstly, parents of preemies are often besieged with feelings of despair, apprehension, guilt and helplessness.


Consistent with literature, I believe that these feelings dissuade them from coming closer and cuddling their babies, thus encumbering the attachment bond. Secondly, some personal experiences also imply that parents face complications in interacting with preemies because they are comparatively more irritable, show more sensory-defensive behaviors and are less receptive to parents’ solicitations than mature infants.


These externally visible infant features allied with prematurity cause anxiety among parents and impair bonding. Furthermore, another barrier (presented by the qualitative study by Hopwood) is the parental fear of holding their preemies while they are in incubators with multiple invasive lines. Parents exhibited the apprehension that holding their baby would cause negative circumstances. Thus, emotional detachment in parents consequently results in discriminating neglect for their infant while compromising the parental bond.


In this regard, neonatal nurses can play a crucial role in assisting the attachment process by promoting and encouraging early mother-infant interaction. This can be accomplished by encouraging breastfeeding and Kangaroo Mother Care practices at NICU.


Breastfeeding is one of the critical aspects that bind mother and infant with a sense of physical closeness and attachment. Allowing the mother and neonate to enjoy the breastfeeding experience together always develops intimacy of skin-to-skin contact along with fulfilling dietary requirements. However, due to poor sucking reflexes, a preemie isn’t allowed to breastfeed and is instead put on formula feed through nasogastric intubation. This not only impairs his health status but also wanes the bonding process.


Hence, neonatal nurses should encourage mothers to express their milk for the baby’s feed. Also, they should assess the baby’s sucking reflex to initiate breastfeeding at its earliest. This approach will ultimately develop a sense of intimacy, reciprocal pleasure, comfort and attachment among the dyad.


Additionally, there is an imperative need for prolonged medical support for preemies. Kangaroo Care is an effective method to meets the baby’s demands of breastfeeding, warmth, stimulation, attachment and love. The care encompasses skin-to-skin contact where the baby lies naked on the mother’s bare chest. This triggers the baby’s internal instinct of pleasure and releases the attachment hormone oxytocin, which boosts their attachment process.


In Pakistani context, this care is rarely implemented in healthcare settings because the nurses are unaware of this care. Moreover, they prefer to meet the medical needs of the neonate rather than involving themselves in promoting parental attachment. Therefore, neonatal nurses should firstly acknowledge the importance of KMC and learn its procedures to facilitate their clients. Moreover, they should support the mothers in performing this care at NICU and maintain a soothing environment accordingly.


In a nutshell, mother-infant attachment is a complex process which develops through physical and emotional interaction. These interactions can be endorsed by involving mothers in breastfeeding and Kangaroo Care. In this regard, neonatal nurses must rummage around for possibilities to implement Kangaroo Care at the NICU and explain its technique to mothers.


Also, parents should be involved in neonatal tasks, such as comforting, touching, changing nappies and feeding, to ease parental anxiety. Moreover, breastfeeding must be promoted to develop intimacy and attachment within the dyad. With altruistic support and education, the nurse can strengthen the bond while promoting the child’s well-being and satisfying the ‘nature and nurture’ philosophy to a greater extent.




Flacking, R., Thomson, G., Ekenberg, L., L”owegren, L., & Wallin, L. (2013). Influence of NICU co-care facilities and skin-to-skin contact on maternal stress in mothers of preterm infants. Sexual & Reproductive Healthcare, 4(3), 107–112.


Friesen, M., Hughes, R., & Zorn, M. (2008). Communication: patient safety and the nursing work environment. Tennessee Nurse, 70(1), 6-7.


Hardy, W. (2011). Integration of kangaroo care into routine care giving in the NICU: what is stopping you? Advances in Neonatal Care, 11(2), 119–121.


Hopwood, R. (2013). The role of the neonatal nurse in promoting parental attachment in the NICU. Critical Care Nursing Quarterly, 29(1), 81-85.doi:10.1097/00002727-200601000-00009


Kearvell, H., & Grant, J. (2010).Getting connected: How nurses can support mother/infant attachment in the neonatal intensive care unit. Australian Journal Of Advanced Nursing, The, 27(3), 75.


Obeidat, H., Bond, E., & Callister, L. (2009).The Parental Experience of Having an Infant in the Newborn Intensive Care Unit. Journal of Prenatal Education, 18(3), 23-29. doi:10.1624/105812409×461199



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