Keywords: prematurity, stress, parental stress, attachment, extreme prematurity
Context of the study: this research is part of Ramona Sandnès’ thesis (with Isabelle Nocus’ direction and Fabien Bacro’ supervision) which consists study children born very preterm and the parental stress inside this population, attachment representations of the mother and those of child. This thesis is part of a larger research project (named “amplify”) carried out in collaboration with the teams of the network “Grandir Ensemble”. The purpose of this network is to medically follow children born very prematurely to the age of 7 years. For this investigation the population is composed of 150 mother-child dyads, whose children were born very preterm and have followed from birth in the Nantes and Angers Hospitals. At the time of data collect the children will be 3 years old.
In my study, I made the choice to focuse on the influence of maternal stress on the attachment representations of very premature born child when aged 3 years old.
What is attachment? According to Bowlby (1969), attachment is a primary need and corresponds to the fact that the infant, dependent and immature, seeking instinctively his parental figures to be protected him from external aggressions. The construction of the attachment system therefore begins at birth and is constructed on interactions between child and his primary caregiver. It results from a regulation in the dyad : the baby adapts his attachment behaviours according to the responses of his attachment figure and vice versa (Lahouel-Zaier, 2017). There are four attachment patterns: secure attachment, ambivalent-insecure attachment, insecure-avoidant attachment, desorganised-disorienting attachment (Ainsworth & Witting, 1969 ; Main & Solomon, 1988). A child who is securely attached will be comfortable exploring his environment and will be able to regulate his emotions. This will not necessarily for a child whose attachment is insecure.
What significate born very preterm? A birth is considered very preterm when child born before 28 weeks of pregnancy, namely before 6 months of pregnancy. These babies have particular characteristics: weighting between 500 and 1000 grams and exposed to medical complications that potentially impact their later development and their survival. Immediately after their birth infants are separated from their mothers and placed in intensive neonatal care units. The conditions of the parent-child encounter don’t look like of a full-term birth. Psychological repercussions like post-traumatic stress disorder, anxiety or depression are very frequently found in the mother (Treyvaud, Spittle, Anderson & O’Brien, 2019). These repercussions impact the sensitivity and availability of the mother (Zelkowitz, Papageorgiou, Bardin & Tongtong, 2009). In other words, the mother would not be able to provide the necessary
attention to the infant which promote the building of the dyadic relationship. This may have repercussions on the way in which the attachment relationships will develop.
Many studies demonstrate the parental stress of premature infants is higher than parental stress of full-term infants (Schappin, Wijnroks, Uniken Venema & Jongmans, 2013). Stress level also appears to be higher among parents of children who are most medically risk (Schappin et al., 2013). That parental stress in the context of prematurity increases progressively until the age of 3 years (Singer et al., 2007). Stress is an indicator of dysfunction in the parent-child system (Bigras, Lafreniere & Abidin, 1996). A study by Laganière, Tessier and Nadeau (2003), showed the security of attachment of the 1.5 years old child was weaker in child was borned preterm than child was borned full-term. The attachment security of child’s in relation to birth status was influenced by parental stress, particularly by the mother’s perception of her child. Maternal perceptions were related to the child’s gestational age, the older the age is associated to better maternal perceptions. The mother’s perception of her child seems to be the most related to the level of maternal stress (Laganière et al., 2003; Singer et al., 2007; Gray, Edwards & Gibbons., 2018).
The type of attachment that children develop is profoundly linked to their emotional regulation (Bowlby, 1969), their exploration of the environment and their social relationships throughout life (Miljkovitch, 2015). Parental stress can be a risk factor in the development of inadequate parental behavior (Bigras et al., 1996). In this direction, it seems essential to take account parental stress who seems higher in the context of very prematurity. Moreover, this parental stress can impact the relation between mother and her child. The objective of present study is demonstrating a link between maternal stress and the attachment representations in very preterm infants aged 3 years.
We can hypothesize:
- Low gestational age is associated with negative maternal perceptions of the child.
- Low gestational age is associated with low attachment security of the child.
- Maternal perceptions of the child’s are correlated at the child’s attachment.
If these hypotheses are validated, we will test a mediation hypothesis: - Negatives maternal perceptions of the child’s mediatize relationship between birth status and low security of attachment representations in the 3 years old child.
To check these hypotheses, will use the stories to complete (Bretherton, Ridgeway & Cassidy, 1990) and the Parental Stress Index (Bigras et al., 1996). Stories to Complete allow obtain degree of resemblance of the child with each attachment style. The Parental Stress Index measures, among other, maternal perceptions of child.
Due to the Covid-19 pandemic and novelty of research “Amplify” we have unfortunately not yet to collect our data.
Bibliography:
Ainsworth, M. D. S., & Wittig, B. A. (1969). Attachment and exploratory behavior of one-year-olds in a strange situation. In B. M. Foss (Ed.), Determinants of Infant Behavior, 4 (1), 111-136. London: Methuen.
Bigras, M., LaFreniere, P.J., & Abidin, R.R. (1996). Indice de stress parental, manuel francophone en complément à l’édition américaine. Toronto, Canada: Multi Health System Inc.
Bowlby, J. (1969). Attachment, Attachment and loss. (vol. 1). New York, NY: Basic Books.
Gray, P., Edwards, D.M., & Gibbons, K. (2017). Parenting stress trajectories in mothers of very preterm infants to 2 years. Arch Dis Child Fetal Neonatal, 0 (1). doi:10.1136/archdischild-2016-312141.
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