Secondary Logo

Journal Logo

Institutional members access full text with Ovid®

Trying to Do What Is Best

A Qualitative Study of Maternal–Infant Bonding and Neonatal Abstinence Syndrome

Rockefeller, Katherin MD; Macken, Lynda C. PhD, RN; Craig, Alexa MD, MSc

Section Editor(s): Dowling, Donna PhD, RN; ; Thibeau, Shelley PhD, RNC-NIC;

doi: 10.1097/ANC.0000000000000616
Original Research

Background: The maternal experience of caring for and bonding with infants affected by neonatal abstinence syndrome (NAS) has not been adequately characterized.

Purpose: This study was designed to describe mothers' experiences of, supports for, and barriers to bonding with infants with NAS.

Methods: Semistructured interviews were coded using computer-assisted thematic content analysis. A code co-occurrence model was used to visualize the relationships between themes.

Results: Thirteen mothers of infants with NAS participated. Trying to Do What Is Best emerged as the overarching theme with which several subthemes co-occurred. Subthemes that captured mothers loving their infants and bonding, feeling supported by the infants' fathers, feeling supported in the community, and receiving information from hospital staff were associated with mothers' trying to do what is best. Barriers to trying to do what is best included feeling unsupported in the community, guilt about taking medications or substances during pregnancy, feeling judged, and infant withdrawal.

Implications for Practice: Specific implications for practice may be derived from the mothers' criticisms of NAS assessment tools. Mothers highlighted the value of reassurance and education from providers and the uniquely nonjudgmental support received from peers and male coparents.

Implications for Research: There is a lack of information about maternal–infant bonding in dyads affected by NAS and factors that contribute to parental loss of custody. Qualitative, quantitative, and mixed-methods studies in diverse populations might help researchers better understand the long-term outcomes of NAS and develop interventions that decrease family separation.

Department of Psychiatry, Center for Autism and Developmental Disorders, Maine Behavioral Healthcare, South Portland (Dr Rockefeller); Department of Nursing, Center for Nursing Research and Quality Outcomes, Maine Medical Center, Portland (Dr Macken); and Department of Pediatric Neurology, Maine Medical Center, Portland (Dr Craig).

Correspondence: Katherin Rockefeller, MD, Department of Psychiatry, Center for Autism and Developmental Disorders, Maine Behavioral Healthcare, 236 Gannett Dr, South Portland, ME 04106 (

This research was supported by funding for transcription costs from the Department of Pediatrics and the Neurosciences Service Line at Maine Medical Center. Dr Craig was supported by the National Center for Advancing Translational Sciences, National Institutes of Health, grant number KL2TR001063.

The authors declare no conflicts of interest.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (

© 2019 by The National Association of Neonatal Nurses