Ecological momentary assessment of postpartum outcomes in mothers of multiples: lower maternal-infant bonding, higher stress, and more disrupted sleep

Abstract

Research on mental health in mothers of multiples has neglected important outcomes like postpartum bonding and relationship satisfaction and is limited by reliance on single-administration, retrospective measures. This study fills these gaps by assessing previously unexamined variables and using ecological momentary assessment (EMA), wherein participants answer repeated, brief surveys to measure real-world, real-time outcomes. This online study recruited 221 women and compared outcomes in those who birthed multiples ( n = 127, 57.47%) vs. singletons ( n = 94, 42.53%). When recruited, participants were either 6–12 ( n = 129, 58.37%) or 18–24 ( n = 83, 37.56%) weeks postpartum. All 221 participants completed baseline measures of self-reported depression, anxiety, stress, sleep, relationship satisfaction, and maternal-infant bonding. One hundred thirty participants (58.82%) engaged in 7 days of EMA assessing self-reported momentary mood, stress, fatigue, bonding, and sleep. Data were analyzed using two-by-two ANOVAs and hierarchical linear modeling. Mothers of multiples reported more baseline parenting stress and less maternal-infant bonding than mothers of singletons ( p s < .05). Mothers of multiples who were 6–12 weeks postpartum reported the lowest bonding ( p = .03). Mothers of multiples also reported more momentary stress, overwhelm, nighttime awakenings, and wake time after sleep onset ( p s < .05). The latter two variables positively correlated with momentary fatigue, stress, and worse mood ( p s < .05). Mothers of multiples experienced worse postpartum bonding, more stress, and more interrupted sleep than mothers of singletons. This population may benefit from tailored postpartum interventions to decrease stress, increase bonding, and improve sleep. Supplementary information The online version contains supplementary material available at 10.1007/s00737-023-01317-0.

Two babies, two bonds: Frequency and correlates of differential maternal‐infant bonding in mothers of twins

“…The Lafayette College Institutional Review Board reviewed and approved the study. Please see Wenze et al (2023) and our Open Science Framework (OSF) project (Wenze, 2022) for additional details regarding study materials and methods. Participants were recruited between January, 2019 and March, 2020 from virtual postpartum support forums, websites, and listservs of mothers of multiples clubs around the United States, local in-person new moms' groups, and local lactation consultants.…”

“…Prior work suggests that self-reported maternal-infant bonding is, on average, lower in mothers of twins than in mothers of singletons (Wenze et al, 2023), and behavioral observation has found that mothers of twins demonstrate lower sensitivity and more distant behaviors while interacting with their babies (Ionio et al, 2022). Mothers of twins commonly report feelings of loss, grief, and guilt over insufficient time to bond individually with both of their babies (Gowling et al, 2021;Holditch-Davis et al, 1999;Wenze et al, 2020).…”

“…Although no research has explicitly tested potential mechanisms, there are many possible reasons for lower average maternal-infant bonding in mothers of twins. Higher levels of stress (Wenze et al, 2023), resulting from increased caregiving burden, time demands, sleep disruption, medical complications (Wenze et al, 2020), and the unique challenge of attempting to connect simultaneously with both babies (Bryan, 2003) could contribute; links between maternal parenting stress and poor maternal-infant bonding are well-established (Lutkiewicz et al, 2020;O'Dea et al, 2023). Parents of twins often express concern that the need to be highly task-focused interferes with opportunities to bond with their babies (Gowling et al, 2021;Holditch-Davis et al, 1999).…”

“…In particular, symptoms of postpartum depression (Liu et al, 2022;Lutkiewicz et al, 2020;O'Dea et al, 2023;Rusanen et al, 2021;Sockol et al, 2014;Tichelman et al, 2019), stress (Lutkiewicz et al, 2020;O'Dea et al, 2023;Rusanen et al, 2021), and anxiety (Doster et al, 2018;Lutkiewicz et al, 2020;O'Dea et al, 2023) have been linked with poor maternal-infant bonding, as has maternal postpartum sleep disruption (Kalmbach et al, 2022). Such symptomsall of which are more common in mothers of multiples than in mothers of singletons (Wenze et al, 2015(Wenze et al, , 2023)might make it harder to build a bond with two babies at once. Conversely, given twin mothers' strong desire to treat their babies equitably and their sense of shame and guilt when they do not (e.g., Gowling et al, 2021), the experience of differential bonding might contribute to maternal psychological distress and poor sleep.…”

“…Participants were drawn from a larger sample of 221 women, for a separate investigation of real-time, real-world mood, stress, and sleep in postpartum mothers of singletons versus multiples (Wenze et al, 2023). For the current investigation, we eliminated mothers of singletons (n = 94) and triplets (n = 1), as well as mothers of twins who did not complete the postpartum bonding measure for one or both babies (n = 18).…”