Date of Award


Degree Type


Degree Name

Doctor of Philosophy (PhD)


Child Development


Parent-child relationships consist of both external and internal components. The external component is the behavioral interaction between mother and child, while the internal components are expectations each member of the dyad has for the both the relationship and of the other partner. These expectations are called internal working models (IWMs) and are blueprints that have been developed from an individual’s childhood experience of sensitive or insensitive parenting. A mother’s IWMs influence how she perceives her child, her relationship with her child and herself as a mother, the sensitivity of her caregiving, and ultimately her child’s IWM of him or her self.

Premature birth presents several challenges to the parent-child relationship and clearly impacts the external relationship features. Labor and delivery are often traumatic and are followed by abrupt separation of the dyad. The baby is taken into an environment that imposes physical separation, and is physiologically unable to participate in typical parent-child interactions. Until now there have been no studies that investigate the internal and external components of the relationship while in the NICU.

Cross-case findings from the study included three themes: (1) mothers experienced trauma; (2) the act of caregiving built the relationship; and (3) protocol-based caregiving at Midwest NICU interfered with the mother-infant relationship. While the research questions yielded the following findings: (1) a larger percentage of distorted internal working models was found in the present study than in previous studies that used the WMCI with preterm samples (Borghini, 2006; Korja, 2009; Meijsen, 2011; Tooten, 2014); (2) the quality of the behavioral interaction between mothers and their preterm infants during feeding was intrusive, regardless of the WMCI rating; (3) meeting the infant’s attachment needs (e.g. successfully providing comfort during distress) in the NICU is what contributed to the participant’s understanding of themselves as “good enough.”

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Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 License.

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