Ira Hillman -

Nov 16, 2021

Healing the Trauma of Premature Birth

mother holding a tiny preterm babys hand

My husband and I remember the phone call vividly.

“We were contacted by your son’s birth mother. She gave birth again and reached out to us about placing the child with an adoptive family. We told her that you were already working with us to adopt a second child, and she was happy to hear that this might work. The baby is a girl. She was born in July. At 26 weeks.”

Our jaws dropped. We knew nothing about premature birth other than that it wasn’t ideal. We soon found out that the baby girl who would become our daughter had actually been born at 28 weeks and 5 days. Her birth weight was 2.5 pounds.

The panic, fear, and anxiety we felt is what many families experience in association with the birth of their child. In fact, nearly 1 in 10 children each year in the US are born before 37 weeks gestation.

Since 2008, an alliance of health organizations from around the world has commemorated World Prematurity Day on November 17 in order to shine a light on preterm birth and support the families and communities affected by it.

Premature babies are often born with immediate health issues that require special care in a Neonatal Intensive Care Unit (NICU). They also face developmental challenges that lead to long-term neurological, mental, behavioral, and physical health risks, like cerebral palsy, asthma, and hearing or vision loss.

When babies are born, they need the nurturing relationships of parents and caregivers in order to thrive. But, because their fragile bodies need medical support, babies in the NICU are by necessity separated from their families. And it’s not just physical separation that gets between infants and parents; the sadness, fear, and guilt parents may be experiencing after a premature birth can make it even more challenging for them to provide nurturing care to their babies.

Family Nurture Intervention

All of these challenges can be addressed through a new approach to NICU care known as Family Nurture Intervention (FNI). Developed by the Nurture Science Program at Columbia University, FNI is a novel approach that centers emotional expression and the mother-child relationship.

The goal of FNI is to get a mother and baby connected so they can regulate each other’s bodies, in spite of the obstacles created by the NICU environment.

The approach, facilitated by a trained Nurture Specialist, involves a combination of sensory calming activities between the two while emotional communication happens. This means that while engaging in activities such as kangaroo care, eye contact, and scent cloth exchange (activities fairly common in the NICU), mothers are also encouraged to express their feelings to their babies.

When the mothers express their feelings – often in response to prompts like, “Tell your baby the story of your pregnancy and birth,” or “Tell your baby the story of how you chose their name” – they notice that their child’s attention turns to them, and they feel connected. The combined approach is not just about improving physiological outcomes, it is about building the kind of parent-child relationship that is crucial for lifelong health and wellbeing.

The feelings expressed by a mother of twin boys born at 26 weeks are similar to those felt by many parents, who often bear the burden of commuting an hour or more each way to visit their newborn children, in addition to the emotional trauma they have experienced.

“I didn’t feel like they were my babies because they were in the hospital, and I didn’t know if they were going to make it or not,” the mother of twins confessed.

Another mother of a girl born three months early said, “It took us months before I actually even saw her face, because she had so many tubes in. And when your baby is in that kind of situation, it’s almost like you can’t let your guard down to really bond with them. Because you’re scared of losing them.”

But, after experiencing Family Nurture Intervention, that same mother shared, “It’s like therapy for both of us. I’m telling you, that was the first time I felt like I could breathe, and I could bond with my baby.” And another mother agreed, “I actually come in now, and I can take a deep breath and be like, ‘I’m alright. And she’s alright.’”

Positive effects for babies and mothers

A clinical trial of FNI was conducted in the NICU at Columbia University with 150 preterm infants and their mothers, and it showed that they indeed are “alright.”

Compared to families who received standard care in the NICU, the babies who were part of FNI showed better sleep and improved brain development, particularly in the prefrontal cortex which is critical for executive function. They also showed better physiological regulation, which is an important marker of stress resilience.

At 18 months of age, those same children also scored better on measures of language, attention, and cognition, and had lower risks for behavioral and socio-emotional problems.

Importantly, given the dyadic nature of the intervention, there were benefits for the mothers as well, including reduced maternal depression and anxiety four months after giving birth, compared to mothers who did not receive the intervention, as well as healthier cardiac function.

The clinical trial is also the first NICU study to demonstrate long-term positive effects on both the mother and child; a recent follow-up study documents improved cardiac function and stress resilience, even five years later – for both the child and the mother.

My husband and I weren’t a part of this study. We weren’t even in the NICU or in contact with our daughter for the first two months of her life. But the lasting effects of FNI showed us that there’s no time limit on the healing power of nurture and emotional connection. Through emotional expression and mutual calming, we are moving through the developmental challenges that came from our daughter’s premature birth, together. On top of that, the emotional connection shared by each of us with her has helped all of us heal from the traumas of premature birth and its effects on our whole family.

Ira Hillman leads Einhorn Collaborative’s Bonding strategy. Learn more about our work in Bonding and more about Ira. Sign up to receive our monthly newsletter and be the first to read Ira’s blog posts.