The Importance of Resolving Grief after a Preterm Birth

A new study published in Pediatrics shows that the degree to which a mother can resolve the feelings of loss and grief after giving birth prematurely can affect attachment between the mother and infant—a bond that has long-term implications for the infant’s social and emotional development.

“Mothers with resolved grief following a preterm birth are three times as likely to have securely attached infants, compared with mothers with unresolved grief,” said Prachi E. Shah, MD, of the University of Michigan C. S. Mott Children’s Hospital, in a press release.

Adapting to having a preterm infant can be similar to adapting to having a child with a chronic illness, said Shah, adding that resolving grief might mean that the mother has to adjust her expectations and hopes for her child in the face of uncertainties, and mourn the “hoped-for child” while still embracing the child she has.

In this study, researchers from University of Michigan observed 74 infants born prematurely (≤ 36 weeks) and their mothers, who were part of a larger study of high-risk infants conducted by Julie Poehlmann, PhD, professor of Human Development and Family Studies at the University of Wisconsin. They analyzed multiple factors to determine the impact that unresolved grief would have on a child. These included an assessment of neonatal and socioeconomic risks at the time of discharge from the neonatal intensive care unit; an assessment of maternal depression and verbal skills, an interview exploring the mother’s reaction to her preterm birth, the quality of parenting at 9 months; and infant-mother attachment at 16 months.

Resolution of grief following a preterm birth has not been previously studied and was the focus of this investigation, Shah added.

“When a baby is born prematurely, the developmental prognosis is often not known for many years,” Shah said. “How the parent adapts to the birth of a preterm infant has implications for the infant’s attachment security, which can influence social-emotional development over time.”

The study found that resolution of grief was not predicted by maternal age, education, socioeconomic status, depression, verbal ability, marital status, the child’s gender or race, whether it was a multiple birth, or length of hospitalization.

In addition, the study found that the degree of prematurity and the health of the prematurely born infant did not predict a mother’s resolution of grief. “Whether the infant was born very preterm versus slightly preterm, or whether the infant had many medical complications or was relatively healthy did not predict which mothers resolved their grief,” Shah said.

“Because mothers of healthy preterms were just as likely to have unresolved feelings of grief after preterm birth as mothers of sicker preterms, it suggests that the experience of trauma and grief following a preterm birth is very individual, and difficult to predict.” Shah said. “The good news is that for mothers who are able to resolve their feelings of grief following a preterm birth, those infants are three times more likely to develop a secure attachment. In addition, mothers who demonstrated more positive interactions with their infants were also more likely to have securely attached infants.”

To access the Pediatrics study, click here.