Parenting an Infant with a Birth Defect—The Regulation of Self-Esteem

The birth of an infant with a defect was experienced by the parents in this study as a substantial trauma with intrapsychic and reality-based aspects. Their reactions were influenced by a complex interplay of factors: the severity and correctability of the defect, how they were told about it, and the nature of the medical procedures required; previous expectations for the child and their view of themselves as parents; their prior means of coping with stress; the nature of the marital relationship and their own experiences in the parent-child relationship; the infants' temperament and capacity to interact and be organized; the uncertainty about the short- and long-range implications of the defect and its impact on the child and the family; and the role of environmental supports. The parents experienced a series of assaults to their sense of self that affected self-esteem and interfered with the parenting process. We observed three distinct stages in parents' reactions: an initial sense of shock, disappointment, anger, and self-esteem injury; a period of painful intrapsychic disequilibrium; and the gradual restoration of the intrapsychic equilibrium and robustness. During the period of disequilibrium, the parents' capacity to parent may be compromised by their viewing the infant as a negative part of their own self. The adaptive tasks for the parents are to restore their self-esteem,

to view the infant as a separate individual, and to find ways to experience pleasure in being parent to this infant.