Bonding in the NICU and Beyond
When a newborn needs intensive care, many mothers and fathers worry about the lack of opportunity to have “bonding experiences”. Where are those Kodak and Hallmark moments of meeting their newborn? What about those "critical" first moments of skin-to-skin closeness and eye contact? Where are those intense feelings of pride, love and devotion? Instead, the post-delivery Kodak moment is reduced to a quick glimpse of an unfamiliar infant, surrounded by people in gloves and gowns. And the Hallmark moment consists of blinding love and hope, coupled with intense disappointment and overwhelming fears. At a time when you want to feel completely connected and in tune with your infant, instead you may be feeling shocked, numb, detached, and terrified. Later, after your baby is installed in the NICU, you may stare in disbelief at a perhaps scrawny, sickly being. You might want to touch, but fear harming such a fragile infant. And you yearn for those typical “bonding moments” such as cradling, feeding and cooing at your precious bundle.
When the term “bonding” was first coined, it referred to the investment mother animals show in their newborn young. For many animals, there is a “critical period” after birth where certain things must happen, or the mother won’t “know” that’s her baby, and her investment evaporates. Many mammals need to be able to smell and lick their newborns in order to feel a connection.
As with other animals, human bonding refers to the investment that parents have in their babies. But for humans, bonding is not an instantaneous superglue event that happens when the parents lay eyes on their baby, preferably within seconds after birth. There is no magic protocol of certain things that must happen in order to cement the parents’ interest in their infant. There is no critical period that you miss out on when your baby is whisked away after delivery. Instead, human bonding is a powerful and complicated process of falling in love with your baby over time. This process often starts before conception, when you imagine holding your future baby in your arms. The process continues throughout the pregnancy and into infancy, and is flexible enough to overcome many obstacles like anxiety, illness, NICU, and separation.
When looking at the situation with your baby, it can help to have a yardstick against which you can measure your feelings of bonding. By knowing more about the “regular” bonding process, you may be reassured by how close to the mark you actually are.
For humans, bonding has peak moments that occur over time: When a couple actually stops using birth control; when they get a positive pregnancy test result; when they see the baby’s image on an ultrasound screen; when they feel the baby move for the first time; when they see and hold their baby after birth; when they gaze upon their baby sleeping peacefully. The father experiences his own special peak called “engrossment”—gazing in wonder at his newborn after birth, as if the rest of the world no longer matters. In general, bonding happens when parents feel a heightened level of commitment, and bonding is reinforced when they think about or spend sweet times with their baby.
While the parental bond may be well established early on, it is not an achievement that remains constant after a certain “critical” point. Rather, it is a dynamic process that rises and falls. During pregnancy and infancy, there will be times when the parents feel great swells of love and devotion and other times when they feel like running away. There will be times when they are so happy to have this child in their lives, and other times when they rue the day they invited him or her in. This is normal.
The parental bond also grows and adjusts over time. As the baby develops his or her own distinct personality and becomes a separate individual, the bond expands to accommodate the otherness of the child. As baby grows and leaves the breast, then leaves the lap, then leaves for school and then leaves home, the bond doesn’t lessen or disintegrate; it simply stretches and becomes more complex. As the child grows and develops, the nature of the attachment becomes richer – it includes more and more of what the child offers to the relationship. If the child remains dependent on caregivers, the bond doesn’t stretch quite so much but it does change as the child grows and the parents adjust their caregiving. And when a baby or child dies, the bond doesn’t disappear—it gradually changes as the parents grieve and adjust to a different relationship with the lost child.
Occasionally the bond can break down a little—when there are more daily stresses and less attention is devoted to the child, or if the child is going through an IMPOSSIBLE STAGE (no doubt similar to one YOU went through.) This breakdown is usually temporary until things get back on track. The parents may wrack their brains for solutions or consult a family therapist to help them get out of a bad rut. When things seem darkest, trying to find answers and getting help are signs that the parental bond is strong. Giving up and throwing in the towel is the only way to dismantle a bond. But remember that all relationships ebb and flow. There are natural times, developmentally, for parents and children to be more distant. But the investment, concern, and interest is what constitutes bonding, not the actual time spent together, or even whether or not you are particularly happy with one another at the moment!
While “regular bonding” can involves picking out baby bunny wallpaper for the nursery and snuggling with the baby after delivery, “NICU bonding” can involve staring at walls lined with blaring monitors and being afraid to touch the baby for days after delivery. Nevertheless, the tenants of bonding that hold true for “regular” parents also hold true for “NICU” parents: Bonding is a process that occurs over time, bonding has peak moments, and bonding is flexible, dynamic and resilient.
It is very important for you to remember that bonding is what happens over time as you get to know your baby. You are not missing out on a critical period for bonding if you don’t have a blissful or fullterm pregnancy, or when you can’t hold your slippery newborn against your body. When your baby is in the NICU, you’re not “missing the boat” and if you feel detached, you are not a “bad” parent. While feelings of detachment can look and feel like you don’t care about or feel anything for your baby, in fact, your detachment is an important feature of how you cope with the trauma of a crisis birth. There is no way your mind can absorb all that has happened, the vast changes in plans, and the future implications of this turn of events. You need time to adjust to this new reality, time to learn how to navigate your new world, and time to emotionally come to terms with it all. If you find yourself avoiding the NICU and/or your baby, particularly early on, this is a normal and natural reaction to the stress and trauma of having a medically compromised baby. Feelings of detachment don’t mean you’re an unfit mother or father. It means you are a new parent adjusting to a new baby and to a different situation than you had planned on.
Also, if the crisis birth was coupled with a medical crisis for the mother, her own physical recovery and medical needs overlap with her concern for her baby and her desire to be in NICU. Some mothers are unconscious or unable to leave their beds for days after a crisis birth. If your baby is born prematurely, it can feel surreal to look at a fuzzy Polaroid picture of an infant who should still be tucked away inside the uterus. If your baby has a serious medical condition, you may feel no connection to the video of a sick infant covered in tubes, wires, and tape, bearing little resemblance to a “regular” newborn. It's absolutely normal to feel detached under such circumstances.
If you yearned to be near your baby and were not able to either because of your medical circumstances or because the NICU staff was still working to stabilize your newborn, remember that the longing, even if coupled with fear, is one element of the attachment that you have to your child.
Although you may be too scared or dazed to appreciate them, you can still experience peak bonding moments. For instance, you may not dare get your hopes up, for fear that any upswings won’t last long. You may not enjoy being with your baby, because it’s hard to see her so sick. You may dread taking your baby home, for fear of being the one to do him in. Nonetheless, in spite of your worries, when you feel so thankful that your baby is alive, when you dress him for the first time, when you start making discharge plans, or when you simply think to yourself how precious she is, you have experienced a peak moment. Sometimes it may feel more like terror than love, but it is still a peak moment.
Bonding during pregnancy doesn’t have to include knitting booties, preparing the nursery, stroking your big belly and childbirth classes. Bonding after birth doesn’t have to include snuggling, feeding, cooing, and smiles. While these activities can be evidence that bonding is occurring, they are not mandatory. Even if you can’t knit, nest, or nuzzle, by simply wanting what is best for your baby, you are bonding.
Remember also that parents bond in different ways. While one parent may spend hours over the isolette, learning every medical term and learning to read the chart, another parent may work overtime to pay the mounting bills, or want time spent with the baby to be jargon-free. One may search medical libraries, and another may want only to count toes and sing silly songs. All of this is bonding.
Although your emotional ebbs and flows will be different from “regular” parents, like them, you will alternate between feeling joy and sadness, hope and dread. Sometimes you may feel too stressed to visit your baby. You may have some deep regrets, or harbor strong feelings of guilt and anger. You may feel overwhelmed by the challenges you face with the prospect of a differently-abled child. Feelings of stress, avoidance, regret, guilt, anger, and being overwhelmed by the demands are all normal parts of parenting. Of course, you probably experience them on a much grander scale than the regular parent, but this only makes your parenting journey more intense, not wrong.
And although fearing death or disability is not usually paramount for regular parents, bonding does include having worries about the health and safety of their babies. So when you worry, this too shows your bond. Your fears and your desire to shield your infant from harm are evidence of your deep emotional investment in this child.
If you feel reluctant to get close to your baby for fear of being devastated, or if you feel detached in general, rest assured that it may take you a while to adjust to the shock and reality that this baby arrived in crisis mode, and may or may not be here to stay. Being withdrawn is a normal reaction to trauma, but it doesn’t mean that you will remain cold-hearted. And staying away doesn’t really serve to protect you; you would be absolutely devastated if this baby died, no matter how much you try to harden your heart. If your baby dies and you had avoided spending time in the NICU, you would always wonder what small but powerful knowledge of your child you missed. And if your baby does end up having long-term problems, you will grieve, regardless. So you might as well reap the benefits you can. Dare to get to know your baby. Dare to feel like a parent.
If you have nagging concerns about your parental feelings, do seek help from a qualified counselor who has experience with new parents. Ask your health care providers, local hospital, support group, or other NICU parents for referrals. And do stay in touch with your grief over your baby’s early birth. If you try to dampen any sad feelings, you also will dampen any joyful ones. Parenting a baby is such a precious time and doesn’t last long. You deserve to experience it with all it’s complexity and richness.
Parental bonding is a wonderfully resilient, flexible, dynamic process. Yes, you can bond during the most anxiety-filled pregnancy and infancy. Yes, you can acquire the full depth and joy of parental love during the months after your baby is born. It can be a challenging road to follow, but the rewards are immeasurable.