Chapter 1
The process of producing human life is an event that most people experience in their lifetime. While many emotions and reactions occur alongside the birth of a child, the establishment of a bond between the mother and the infant may be considered as one of the most vital. The process of maternal-infant bonding is significant in the development of a trusting relationship between the mother and the infant immediately after the delivery period. Studies show that development of the maternal-infant bonding process between a mother and infant plays an influential role in the growth and development of the child (Kinsey & Hupcey, 2013). Any impairment in this process can lead to a diminished relationship between the mother and child (Kinsey et al., 2013). Negative effects on the child’s development may also result from an altered maternal-infant bonding process (Kinsey et al., 2013).
Research studies have been conducted in the past to discover factors that cause an impairment in the maternal-infant bonding process. For the purpose of this research, factors that have been found to cause an impairment in this process include: post-partum depression, mode of delivery, and the need for special care in the neonatal intensive care unit (Abbasi, Chuang, Dagher, Zhu, & Kjerulff, 2013; Kinsey, Baptiste-Roberts, Junjia, & Kjerulff, 2013; Reck, Zietlow, Muller, & Dubber, 2015; Noyman-Veksler, Herishanu-Gilutz, Kofman, Holchberg, & Shahar, 2015; Baylis et al., 2014). This research study will examine parental feedback and the common factors that lead to an altered maternal-infant bonding process.
Background of the Study
A study involving 14,000 children in the United States found that 40 percent lack bonding with caregivers (Huber, 2014). Interactions between a mother and infant provide the infant with enhanced socialization, while infants who do not have this interaction may experience despair (Hirsch, 2015). A strong bond established between a mother and an infant promotes social and emotional development for the child, producing a child more likely to be resilient to poverty, unstable family dynamics, depression, and parental tension (Huber, 2014).
Poor development of a secure bond may also play a role later in the child’s life. For example, children who experience a lack in the bonding process are less likely to complete their education (Huber, 2014). The mother may also experience consequences as a result of poor bonding (Kinsey & Hupcey, 2013). Adverse effects that may be experienced by the mother include the absence of maternal feelings, irritability, and rejection of the infant (Kinsey & Hupcey, 2013). The development of these characteristics by the mother may lead to neglect and child abuse throughout his/her life (Kinsey & Hupcey, 2013).
Statement of the problem. The purpose of the research study was to identify barriers to the maternal-infant bonding process. Three factors that were found to affect maternal-infant bonding include the occurrence of post-partum depression, the mode in which the child is delivered, and the need for specialized care in neonatal intensive care units. According to the Centers for Disease Control and Prevention, one in nine women in the United States experience post-partum depression (Centers for Disease Control and Prevention [CDC], 2018). Mothers who experience post-partum depression are more likely to face problems with placing the infant in correct sleeping positions, fail to use home safety devices, and are less likely to ensure that the child has a complete immunization series (O’Hara & McCabe, 2013).
In 2016, 31.9% of all deliveries in the United States were through the mode of cesarean delivery (CDC, 2018). In a study of 573 births, 81 required emergency cesarean delivery (Zanardo et al., 2016). According to Zanardo et al. (2016), situations which required emergent change in the standard method of vaginal delivery produced altered feelings aimed at the newborn and negative emotions. In 2012, 77.9 infants out of 1000 live births in the United States were admitted to the neonatal intensive care unit (Harrison & Goodman, 2015). Delayed bonding may be experienced when infants require special services from the neonatal intensive care unit (Flacking, Lehtonen, Thomson, Axelin, Ahlqvist, & Moran, 2012). Parents or caregivers may experience increased levels of stress due to the child’s appearance and lack of ability to provide care for the infant, which may contribute to uncertainty in the parenting role (Cross, 2016).
Furthermore, bonding between the infant and the primary caregiver is imperative and should not be underestimated. Impaired bond contributes to effects on the development through the child’s lifespan (Steinfeld, 2018). The inability to form successful, healthy relationships in adulthood could serve as a result of a poorly established bond between a mother and infant at the beginning of the individual’s life (Steinfeld, 2018). Minimal research has been conducted in rural areas regarding specific factors that impact the maternal-infant bonding process. The goal of this research study is to identify specific factors that impact the bonding process among primiparous women in rural, northwest Tennessee.
Significance of the problem. Maternal-infant bonding produces significant impact to a child’s growth and development and maternal feelings for the infant. An impairment in the bonding process can lead to neglect and long-term effects carrying over into adulthood. By recognizing some barriers related to the maternal-infant bonding process, positive health-related outcomes for mothers, infants, and families may result from the increased knowledge and recognition (Reck et al., 2015). Identifying specific factors that impact this process among primiparous women in rural, northwest Tennessee will allow for intervention to facilitate a healthy bond between the mother and the infant and prevent further impairment.
Purpose Statement
The purpose of this study is to identify some of the major barriers to the maternal-infant bonding process among primiparous women in northwest Tennessee.
Research Question
What are some of the major barriers to maternal-infant bonding?
Conceptual Framework
The authors of this study adapted John Bowlby’s Attachment Theory to create the AliBro conceptual framework that identified the literature findings and how they correlate with a sufficient bonding process between the mother and her infant. The Attachment Theory states that infants and children create attachment early on in life with people that are in his/her life long term (“Attachment Theory,” 2011). During the research, variables found to impact the bonding between a mother and her infant were mothers having postpartum depression, the mode of which child was delivered, and infants being admitted to the NICU. The conceptual framework is shown in Figure 1.
Conceptual and Operational Definitions.
Maternal-infant bonding. Conceptually, maternal-infant bonding is defined as the relationship that a mother forms with her infant and vice versa (Spinner, 1978). It is often thought that the bonding process between a mother and her baby is a precursor to future relationships and future personality characteristics of the child (Spinner, 1978). Operationally, researchers will study the relationship between mothers and infants in northwest Tennessee, how it progresses over six months post-delivery and what barriers the mothers experience.
Infants. Conceptually, the Centers for Disease Control and Prevention (CDC) defines infants as ages zero to one year (2018). The bonding process between a mother and her infant begins at different times for all pregnancies and is impacted by many different factors. Operationally, researchers will study the bonding of the mothers with her infant.
Primiparous. Conceptually, Miriam Webster lists the medical definition of primiparous as bearing young for the first time (2018). Operationally, researchers will study the barriers to maternal-infant bonding in first time moms.
Neonatal intensive care unit (NICU). Conceptually, the neonatal intensive care unit (NICU) is a highly specialized area of some hospitals that are designed to care for infants that are extremely sick and/or premature at birth (“The neonatal intensive care unit,” 2018). The NICUs contain advanced technology and specially trained individuals to care for the fragile infants (“The neonatal intensive care unit,” 2018). Operationally, researchers will be identifying participants that had babies that spent time in a NICU and how long their baby stayed in the NICU.
Postpartum depression (PPD). The Diagnostic and Statistical Manual of Mental Health Disorders (DSM) fifth edition defines postpartum depression as onset of depressive symptoms within six months of delivery (O’Hara & McCabe, 2013). Symptoms can include: excess crying without knowing why, exhaustion and not being able to sleep, irritable with no reason, excess anger and/or anxiety, feeling out of control, disinterest in things you used to find enjoyable, inability to concentrate, feeling disconnected from baby, and internal thoughts about harming self or baby (Pietrangalo, 2016). Operationally, the researchers will be identifying mothers that experienced any of the associated symptoms. They will also be looking at the bonding relationship between the mother-infant pair based on the PBQ and AliBro Open Response.
AliBro Conceptual Model
Figure 1. AliBro Conceptual model displaying the factors found to have significant influence on the maternal-infant bonding process. Adapted from John Bowlby’s Attachment Theory.
Summary
Chapter one serves as an introduction into the foundation of the research study. Topics included in this chapter are: background of the study, problem statement, significance of the problem, purpose statement, research question, conceptual and operational definitions, and conceptual framework. The relationship between how postpartum depression, mode of delivery, and need for care in a specialized unit is discussed using statistical information found throughout the literature. The information found in the literature review correlating the three main points of this research study and their effects on maternal-infant bonding supports the notion that this process is very influential in a child’s life and can be easily impaired. Chapter two discusses findings from review of the literature used for the research study. The literature review examines the influence that postpartum depression, mode of delivery, and need for specialized care in a neonatal unit have on the bonding process between a mother and her baby. Chapter three outlines the methods used to organize the study and analysis of the data collected.
Chapter 2 Literature Review
The literature reviewed was done to find barriers related to bonding between mothers and infants. The research investigated different barriers that had been studied but was narrowed to the barriers that had the strongest correlation to negative maternal-infant bonding. The databases used to obtain data were as follows: EBSCOhost, CINAHL, and Academic Search Premier. Thousands of articles were found related to maternal-infant bonding. Many articles read were dated within the past 5 years, but the research was expanded to find more research on some barriers. Research was also expanded to include global studies to broaden the scope of results. The focus of the results found were postpartum depression, mode of delivery, and NICU.
Synthesis of the Literature
Postpartum depression. Postpartum bonding between a mother and an infant is an important part of the development of the relationship between a mother and her child. This process does not typically pose a problem for most mothers, however there are a select few women that deal with difficulties during this process. Many barriers to positive maternal-infant bonding have been identified through research (Kinsey et al., 2013; Abbasi et al., 2013).
One category that has been identified as a barrier to maternal-infant bonding is postpartum depression (PPD). PPD is different from postpartum blues and postpartum psychosis. Postpartum blues is a mild form of mood changes that occur a few days after delivery and is common, occurring in 40-80% of births (O’Hara & McCabe, 2013). Postpartum psychosis, which is a rare and severe form of postpartum mood changes and psychotic episodes that occurs after less than 1% of births (O’Hara & McCabe, 2013).
In 2012, 17% of mothers in Tennessee reported having symptoms of PPD (Ko, Rockhill, Tong, Morrow, & Farr, 2017). Mothers with postpartum depression often experience depression before she gets pregnant and has her baby (Ohoka et al., 2014; Abbasi et al., 2013). The depressive episodes can last for long periods of time and mothers experience higher levels of negative emotions and lower levels of positive emotions related to the depressive symptoms (O’Hara & McCabe, 2013). Several studies have shown that postpartum depression results in lower scores on the Postpartum Bonding Questionnaire, higher scores on the Maternal Infant Bonding assessment tool, and more negative bonding between mothers and their babies (Kinsey et al., 2013; Ohoka et al., 2014).
Assessment tools. Some researchers have been known to use the Postpartum Bonding Questionnaire (PBQ) and a Maternal Infant Bonding (MIB) assessment tool to get maternal feedback on the mother’s interpretation of her bonding experience (Kinsey et al., 2013; Reck et al., 2015; Ohoka et al., 2014). The PBQ is a 25-question survey that looks at four factors (Brockington, Fraser, & Wilson, 2006; Kinsey et al., 2013). The four factors that it looks at are: a general factor, rejection and pathological anger, anxiety related to the infant, and abuse (Brockington, Fraser, & Wilson, 2006). The MIB is a tool with eight questions that is used to assess any difficulties that mothers may experience regarding emotions to her baby (Kinsey et al., 2013; Ohoka et al., 2014). The total scores can range from 0 to 24 with lower scores being associated with higher levels of bonding (Kinsey et al., 2013; Ohoka et al., 2014).
Maternal stressors. Postpartum depression is linked to maternal stressors that can predispose mothers to developing this phenomenon. Mothers with postpartum depression have been shown to have higher rates of maternal stress during pregnancy and after delivery (Reck et al., 2015). In comparison, mothers that showed higher levels of stress were also more likely to show signs of depression postpartum (Reck et al., 2015). Some studies show that mothers that show depressive symptoms are less attentive, possibly withdrawn, and the infants learn to comfort themselves more than infants and mothers that had positive bonding (Reck et al., 2015).
Mode of delivery. The effect that mode of delivery in which an infant is born has shown to provide mixed results on its influence on maternal-infant bonding. Childbirth is a significant event occurring in the lifespan. This event can be intensified when emergency situations arise, or plans do not unfold quite like they were intended. In 2016, 31.9% of births in the United States were reported to be cesarean sections (Martin, Hamilton, Osterman, Driscoll, & Drake, 2018). A cesarean section entails a more physically demanding recovery due to the invasiveness of the procedure for safe delivery of an infant and is associated with a longer stay in the hospital (Noyman-Veksler et al., 2015).
Emergency cesarean sections have also been found to result in higher levels of post-traumatic stress disorder (PTSD) than compared to an elective cesarean or vaginal delivery (Noyman-Veksler et al., 2015). Fatigue in the postpartum period has been found to be significantly increased in women who delivered by cesarean section compared to women who deliver vaginally (Ya-Ling, Chich-Hsiu, Stocker, Te-Fu, & Yi, 2015). Fatigue associated with post-partum recovery can be very influential in the provision of necessary infant care and could potentially impede important learning that takes place in the time before discharge to the home (Ya-Ling et al., 2015). Initiation of breastfeeding can be complicated by cesarean delivery and post-partum fatigue, which can interrupt the maternal-infant bonding process (Noyman-Veksler et al., 2015; Ya-ling et al., 2015).
NICU. After delivery, it is vital for the caregiver to have visual contact with the infant so that they may be able to learn and be able to recognize the different behaviors and cues the infant performs to be able to provide sufficient response that may enhance the development of trust by the infant (Baylis et al., 2014). This process of bonding can be interrupted by the necessity of intensive care for the infant and the mother having to receive care on another floor designed for care during the post-partum (Baylis et al., 2014). Harrison and Goodman found that the United States had 64.0 NICU admissions per 1000 births in 2007 (2015). Five years later in 2012, the U.S. had 77.9 NICU admissions per 1000 live births (Harrison & Goodman, 2015).
Caregiver stress can be intensified due to the infant needing more intensive care in a specialized unit and decreased ability for close interaction and typical parental care following delivery (Baylis et al., 2014; Bialoskurski, Cox, & Hayes, 1999). Bialoskurski et al. (1999) found, “Mothers of sick and low birthweight infants feel less confident in parenting because they must cope with infants who are more difficult to care for because of prematurity and illness.” Feelings of caregiver strain and inability to care for the infant independently can provide significant interruptions in the bonding process (Bialoskurski et al., 1999).
Summary
Chapter two is a summary of barriers found in literature that impact maternal-infant bonding. The barriers identified to have the strongest correlation to negative maternal-infant bonding are postpartum depression, mode of delivery, and the need for the neonatal intensive care unit. All these categories are barriers to maternal-infant bonding and have been known to possibly create a negative maternal-infant bonding process. Chapter three will discuss the participants, research design, instruments, procedures, limitations, and the data analysis of the study.
Chapter 3 Methodology
Introduction
The methodology of this research study will be discussed in this chapter. Sections within this chapter include the research design, population, sample feasibility of recruitment, setting, instrumentation, procedures, human subject approval, ethical considerations, data collection, data analysis, and limitations of the study. To acquire participants for this study, two health departments, two pediatric clinics, and one women’s health clinic will be used to gain access to primiparous mothers. A postpartum bonding questionnaire will be administered to identify common impediments in the mother-infant bonding process among primiparous women in the rural, northwest Tennessee region. These results will aid in developing further interventions in the future to improve the mother-infant bonding process in mothers who experience factors identified in this research.
Research Design
This study will be focused around a descriptive, non-experimental, and mixed method design. The purpose of descriptive studies is to gather information about the subject’s characteristics, circumstances, and the frequency that certain events occur (Polit & Beck, 2018). Non-experimental research involves an analysis of data in which an intervention is not implemented following the conclusion of the study (Polit & Beck, 2018). An advantage of non-experimental research is that many phenomena occur, but do require intervention (Polit &Beck, 2018). However, a disadvantage to non-experimental research is that is does not yield persuasive evidence for causal inferences (Polit & Beck, 2018). Mixed method research allows for the use of both qualitative and quantitative data to establish a broad variety or data to be collected from different questions used in the study (Polit & Beck, 2018). Researchers will be collecting data from the participants over a series of months. This type of data collection is referred to as repeated measures ANOVA (Polit & Beck, 2018). Polit and Beck define this research as analyzing data through more than one measurement of the dependent variable over time (2018). For this study, the researchers will analyze the data provided by the mothers via surveys at six weeks, three months, and six months.
Selection of Participants
Population. Participants in this study will include primiparas that have delivered in rural Northwest Tennessee. Participants must be able to read, write, understand English, or have some form of language interpretation, and women that gave birth within six months of the beginning of the study. Exclusions from this study would include women that are unable to read, write, or understand English, primiparas that opted to place her baby for adoption, and mothers whose babies spent longer than six weeks in a specialized care unit after birth.
Sample. The desired sample size for this study would be to give out 500 surveys divided among five healthcare facilities. A minimum of 25 participants will be required for the data to be analyze, but the goal is to have 100 to 150 mothers participate, and surveys would be returned completed. If the desired amount of surveys is not collected in the six-month time frame, then the collection will continue until the goal was reached. 200 surveys would be divided between two health departments, another 200 surveys would be divided between two pediatric clinics, and 100 surveys would be given to the women’s health clinic. The sample would be chosen by convenience sampling. This sampling design involves choosing the most accessible participants (Polit & Beck, 2018). The disadvantage of convenience sampling is that participants that are easily accessible may not be a true picture of the population and there is the risk of bias (Polit & Beck, 2018). Even though it has been identified to be the weakest type of sampling, it is still the most commonly used (Polit & Beck, 2018).
Feasibility of recruitment. Access to participants will be obtained through five locations. These locations will include: two health departments, two pediatric clinics, and one women’s health care center. Collection of data from health departments will enhance the research study because it would provide access to mothers that are of lower socioeconomic status. Data from pediatric clinics allow for inclusion of middle and upper-class mothers and a more consistent participation in the study. Lastly, choosing a women’s health center allows more accurate results because it will provide more immediate access to the mothers and eliminate any potential third parties. All health departments in the Northwest Tennessee region will be put into a computerized system that will generate a random selection. The same procedure would be carried out for pediatric clinics and women’s health centers in the specified area.
Surveys will be administered postpartum at six weeks, three months, and six months. The surveys would be administered by the facility’s faculty and completed at home by the mother and returned within one week of administration. Mothers will be informed that once a completed survey is returned to the facility, her name will be entered in a drawing for a $150 gift card to a local grocery store. Researchers will collect the surveys to analyze the data weekly. The mother-baby pairs will be followed through his/her six-month checkup. This would result in one year of data collection and interpretation.
Setting. The setting for this study is two health departments, two pediatric clinics, and one women’s health center. Each facility will be used to administer and collect surveys. Each survey will be done with paper and pencil and returned within one week of administration. Allowing participants to complete surveys in the setting of their choice will increase reliability because they will not feel pressured to complete it under a short time frame and will be able to complete the survey in a place they feel the most comfortable.
Instrumentation
The instrumentation used in this study is a pencil and paper version of the Postpartum Bonding Questionnaire (PBQ) by Brockington and Dr. Oates (See Appendix A). The PBQ is a 25-question survey that covers four different topics. The topics covered by the survey are as follows: a general factor, rejection and pathological anger, anxiety about the child, and emerging abuse (Brockington, Fraser, & Wilson, 2006). All questions are ranked from always to never and scored zero to five (Brockington, Fraser, & Wilson, 2006). Among the 25 questions there are positive and negative statements. Positive statements such as, “I feel close to my baby,” zero equals the response always (Brockington, Fraser, & Wilson, 2006). Negative statements such as, “I feel distant from my baby,” zero equals the response never (Brockington, Fraser, & Wilson, 2006).
A study was done by Brockington, Fraser, and Wilson to compare the PBQ to the Birmingham Interview for Maternal Mental Health or Birmingham Interview (2006). This study helped prove the worth of the PBQ (Brockington, Fraser, & Wilson, 2006). The PBQ showed the highest value with questions regarding the general factor, rejection, and pathological anger (Brockington, Fraser, & Wilson, 2006).
Accompanying the PBQ will be a combination of open-ended questions regarding experiencing postpartum depression, babies spending time in the NICU, and the mode in which the child was delivered. It will also include mother’s age, and child’s birth month. There will also be a comments section to give the participants an opportunity to provide her thoughts on the bonding process (See Appendix B). This section was created by the authors and is called the AliBro Open Response Questionnaire. It will be used for the participants to write down which factors she thinks are causing her to have a positive or negative bonding experience with her infant. For instance, if a mother has been experiencing extreme mood swings, crying, or other symptoms of postpartum depression she would be encouraged to provide this information in the comments section. It will be required for each participant to complete the open-ended questions for the survey to be considered complete. Researchers will look at this section to identify all trends associated with negative maternal-infant bonding with special attention on NICU, postpartum depression, and mode of delivery.
Procedures
Human subject approval. Prior to starting this study, the Institutional Review Board (IRB) at the University of Tennessee must be contacted. The IRB for all chosen healthcare facilities would also have to be contacted and approve the research study. In the United States, the IRB is a group that uses ethics when reviewing proposed and continuing studies (Polit & Beck, 2018). The study must be reviewed by the university and healthcare facilities’ IRB and permitted before the study can officially begin.
Ethical considerations. Before giving the mothers the blank survey, they would be informed that the research study is looking at trends in the bonding process, and when the surveys are to be completed and returned. By agreeing to complete the survey, the mothers would be giving their verbal implied consent. By voluntarily participating in the study, mothers are agreeing to be as honest as possible about her relationship with her baby when answering questions. She is also agreeing to let researchers use her answers when presenting the results of the study and that she understands what the study is being done for. All mothers interested in participating will also be informed that participation is voluntary and that they can drop out of the study at any time without penalty. However, to be considered for the incentive, she must complete all three surveys and return them within one week of receiving it.
To maintain confidentiality, no patient identifiers, but an assigned number will be written on the top of the surveys. In order to keep track of which mothers had which number on her survey, a list will be made with the mother’s name and the month of her child’s birth correlating with a number. The list will be kept on a password protected computer and the researchers will be the only people to know the password. The surveys will be kept in a lock box in one of the researcher’s homes and protected with a code that only the researchers will know. The lock box will have files labeled by visit (six weeks, three months, and six months) and then subcategorized by month of birth. To ensure patient privacy until the weekly pick up by the researchers, the surveys will be put in a locked filing cabinet and the keys will be kept by the day manager of each facility. Passwords will be changed every eight weeks to maintain the greatest possible chance of ensuring privacy possible. The information will be kept for three years for a thorough data collection, analysis of the findings, and time for the researchers to create a conclusion of the results. After the two years, the paper surveys will be shredded, and the information stored on the computer will be destroyed
Data collection. Data collection will begin the on the first day of the month following approval. Before beginning the data collection, each facility will have a conference with the researchers to make sure that all faculty members know about the study, how data is being collected, and why the research is being done. Surveys will be distributed to each facility on the same day as the pick up for the previous week’s surveys. The same surveys will be given out each time.
Data Analysis
After collecting the data, it will be analyzed by researchers by using frequency distributions. Polit and Beck define frequency distribution as listing things from lowest to highest value and identifying how many times each event occurred (2018). Using central tendencies will be another way to analyze the data on a broader spectrum. Central tendencies are how typical or common a factor is seen in a score distribution (Polit & Beck, 2018). Mean, median, and mode are the three central tendencies identified by Polit and Beck (2018). Mean is the average of a set of numbers or the sum of numbers divided by the amount of numbers (Polit & Beck, 2018). Median identifies the middle number is a score distribution (Polit & Beck, 2018). Finally, Polit and Beck define mode as the number that appears most frequently in a score distribution (2018).
Limitations of the Study
The selection of a small number of health departments, pediatric clinics, and women’s health clinics may present a limitation to this study. Random selection of these facilities may not include a population that accurately represents the majority of women in the specified region. Surveys may not be collected from the same participants through each time frame if another caregiver or spouse brings the infant to the healthcare facility during one of the appointments in the sequence. The participants may also take their child to a facility not participating in this study which could pose a limitation to this research. The use of incentive in the form of a $150 gift card to a local supermarket may be an influential factor in how the participants answer in hopes that answering in the favor of the researchers to increase their chances for winning. Participants may not truthfully answer the questions on the survey due to hurrying to return the survey to be entered in the drawing. Mothers that had infants in a specialized care unit for longer than six weeks are a limitation because it could potentially limit the sample size. Another limitation of the study is if the anticipated amount of surveys takes longer than the expected time frame. Limitations present in this research study are not expected to pose significant effects on the results of this study.
Summary
Chapter three discusses research design, participant selection, instrumentation, procedures, data analysis, and limitations of the study. It is a descriptive, non-experimental, mixed method study. Participants will be chosen based on inclusion standards using convenience sampling. Data collection will begin the on the first day of the month after receiving approval from the Institutional Review Board. Data will be collected for a full year, but only at six weeks, three months, and six months for each participant. The survey given to participating mothers will be a copy of the Postpartum Bonding Questionnaire created by Brockington and will have the AliBro Open Response Questionnaire and comment section added to it. This combination will determine either positive or negative bonding between the mother and infant while also identifying the main barriers associated with the maternal-infant bonding process.
A password protected computer and filing system will be implemented by researchers and participating healthcare facilities to guarantee participant’s confidentiality is maintained throughout the duration of the study. The International Review Board at the University of Tennessee at Martin will have to approve of the study before data collection can begin in the following month. The IRB of the chosen healthcare facilities will also be required to give approval before beginning. The data collection will be ongoing for one year for babies born within six months of starting the study at six weeks, three months, and six months intervals. Frequency distributions and central tendencies will be used as the sources for the study’s data analysis.
Conclusion
Impairments in the maternal-infant bonding process pose a threat to normal development throughout the lifespan (Kinsey et al., 2013). The results of this study will reveal impediments to the mother-infant bonding process in primiparous mothers in the rural, northwest Tennessee region. The barriers to the maternal-infant bonding process that were revealed from the literature review were postpartum depression, mode of delivery, and infants having to spend some amount of time in a neonatal intensive care unit. Based on the results of this research study, screening methods may need to be implemented to identify mothers who may experience an alteration in the bonding process. Implementation of a screening method will allow for aiding at risk mothers with a goal of improving the bonding process to prevent developmental consequences throughout the lifespan.