Bonding
A review of 17 controlled studies conducted between 1975
and 1985 compared newborn infants in the hospital who had routine contact
with their mothers with those receiving additional contact. In 13 studies
the additional contact occurred only during the first hour of life;
9 of these noted significant positive differences in the later behaviour
of the mothers toward their infants. In the four studies in which the
extra contact extended through the first three days of life, the mother-child
relationship was measurably better in quality for the extra-contact
infants than for the control infants at one month, one year and two
years of age. Increased contact at any time during the first three days
after birth (when the mother and baby spend this time in the hospital)
produces a long-term improvement in the quality of the relationship
between mother and child. Increased contact may in part make up for
the marked deprivation that is a part of current routines in modern
hospitals. There is some evidence that this, with the additional deprivation
of insufficient contact, can have serious consequences for the child--both
child abuse and failure to thrive without organic cause are found more
frequently in infants who have been separated from their parents immediately
after birth. A more recent review of 29 random control trials between
1972 and 1985 of restrictive versus unrestrictive mother-infant contact
in the immediate postpartum period found strong evidence that restricting
contact significantly reduced both subsequent maternal affectionate
behaviour and subsequent breastfeeding.
- Marsden Wagner, Pursuing
the Birth Machine, Ace Graphics, 1994.
Do fragile babies need incubators at all? One doctor working
in an African hospital, where there were none, found that the mother
herself made a perfect incubator--warm, soft, food on tap, the ever
present comfort of the familiar heartbeat. This doctor saved 90% of
babies as small as 4 pounds. Contrast this with the well-established
research findings that mothers of babies spending time in neonatal care
units find it more difficult to bond with their babies, suffer more
postnatal depression, are still talking to their babies less a year
later, and are more likely to batter those children.
Medicalised childbirth itself fills the intensive care cots
by creating damaged babies: for example, babies born with respiratory
distress syndrome caused by premature induction; ceasarean babies denied
the positive benefits of the stress of vaginal birth; babies starved
of oxygen--induced contractions; babies born floppy and full of artificial
drugs. Babies deprived of the stress of normal birth are also deprived
of B-endorphin needed to fall in love with their mother and learn their
new environment.
- Margaret Jowitt, Childbirth Unmasked, Hartnolls Ltd. 1993.
The newborn can serve as a caregiver to its mother in a
most essential and critical way. The mother and infant share a common
need for generalized peristalsis during the first days following delivery,
but particularly during the first few hours. If the newborn is permitted
to nurse shortly after delivery, the flow of oxytocin is released, which
in turn stimulates the letdown process, a form of peristalsis. Oxytocin
is well known to stimulate uterine contractions, which are necessary
to minimize the danger of postpartum hemorrhage and facilitate involution
of the uterus. Sucking also promotes prolactin. Thus the nursing activity
of the newborn not only facilitates the establishment of lactation but
also serves to promote a state of equilibrium and physiological heaing
in the mother.
- Ruth D. Rice, Ph.D. in 21st Century Obstetrics Now! NAPSAC, 1977.
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Question of the Week
Does anyone know the story on short umbilical cords? And how short is
too short to deliver vaginally? Is it genetic, does it run in families,
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E-News Readers Speak Out on Bonding
Following are a question about bonding sent in by an E-News
reader and answers offered by other readers.
A pregnant friend believes that if she cannot stay home all of the first
6 years of a child's life, she should work the first, and stay home the
next 3 because the baby won't notice that she's gone in the first years
of life. My response is emotional and moral, not scientific at all. I
hesitated to tell her my opinion, deferring instead to what studies may
have been done on the impact of leaving a child in early years. Have you
heard anything, read any books or studies on this topic?
- Margaret Wallis
I once had a discussion with a friend who was the director of a private
school. She said many parents put their children into private school for
their high school years, hoping to get them into a good college. She felt
this was going backward. If they were in private school for the lower
grades, they would get a good base, good study skills and do well in the
higher grades where ever they were. Well, I took that advice with my second
daughter. She was in private school through 8th grade. She is now in public
high school and tells me that in some classes, she is the only one who
does homework. She has seen the difference.
Where am I going with this? If this mom stays home during the first three
years when this baby is developing faster than she/he ever will again,
her baby will have a stronger bond with its mom. The baby will develop
a strong sense of trust, a solid base, so that when the mom does return
to work, the baby will have grown to the stage where he/she wants to be
more independent.
- Roni M. Chastain, RN, LCCE, FACCE
Long Island, New York
I would recommend reading psychological writing by John Bowlby and other
attachment theorists. These researchers have studied early bonding and
infant deprivation. Specifically, I suggest the book "A
Secure Base" by Bowlby. Research done by Mary Ainsworth, Ana
Freud, and Bowlby clearly indicates that the first years are the critical
years in bonding and maternal infant bonding. Also share with this mother
that three-year-old children are developmentally ready for socialization
and some early peer relationships much as they would get in a daycare
situation; infants are not. Most developmental psych research will get
you to this point.
- christinaburden@hotmail.com
Please see two articles: Mothering Magazine Issue No. 74 "The Needs
of Children" by Paul Klein, and "The Infant Daycare Experiment"
in Mothering Magazine (don't know the issue number). Find them at www.mothering.com
- Anon.
The study of how babies experience pregnancy and birth has been ongoing
for many years now: Otto Rank published "The Trauma of Birth"
in 1929, in which he explored the long-term impacts of the experiences
of pregnancy and birth on the psyche, and many other psychologists, psychiatrists
and researchers have continued to explore this realm. There is now quite
a body of solid scientific research demonstrating, for example, that twins
develop a relationship style in utero that continues through their childhood,
that fetuses whose eyelids are fused shut can either evade or bat away
the amniocentesis needle, that children act out their births in their
play and develop lifestyles into adulthood that, to the trained eye and
mind, clearly echo patterns laid down in birth.
Psychologist David Chamberlain has done a magnificent job of gathering
the majority of the research from various areas of science into over 40
publications: I would refer you to his valuable book, "The
Mind of Your Newborn Baby." Dr. William Emerson has spent a lifetime
studying and treating infants, children and adults for prenatal and birth
traumas that include abortion attempts, conception through forced sex,
drug/alcohol-addicted mothers, family crises, prior pregnancy losses,
etc., and those displaying signs or symptoms of having suffered from interventive,
complicated and/or traumatic births.
If this woman believes her baby remembers none of its first year, she
will presumably be treating the little person she is growing inside her
as a non-person also, and such a welcome doesn't bode well for bonding
postpartum. I wouldn't just recommend books such as Chamberlain's (and
his articles "The Sentient Prenate," "The Outer Limits
of Memory" and "The Cognitive Newborn: A Scientific Update"--all
of which are extremely well-referenced) and Aletha Solter's "The
Aware Baby," but John Kennell and Marshall Klaus's book
on bonding and the video from Johnson & Johnson on "the amazing
newborn."
It sounds as though she knows very little about what she's getting herself
into, and maybe isn't interested, which is scary! Studies have demonstrated
that babies can distinguish their mother's face from other women's faces
virtually from birth; that they turn toward pads soaked in their mother's
breastmilk and not toward those of other women; that adopted babies know
very well that their adoptive mothers are not their biological mothers
and struggle with their emotions when this is not acknowledged by the
adoptive parents, especially those who assume that because they are ready
to love their new baby, their baby will be equally ready to love them--rather
than crying inconsolably and grieving the loss of the mother s/he has
spent nine months bonding with, experiencing every emotion of the biological
mother (transmitted via hormones through the blood supply).
I'm sure there are a gazillion studies out there demonstrating the suitability
of breastmilk for the nourishment of infants and the inferiority of artificial
substitutes. Is she planning to pump all day? And the reason human breastmilk
is so low in protein and fat is to ensure that human infants are fed frequently,
thereby keeping them physically close to mother and in skin-to-skin contact
many times per day, thus regulating their respiratory, heart and brain
rhythms by proximity to their mothers' rhythms. It is no accident that
infants develop the ability to digest foods other than breastmilk at around
the same time that they become more mobile and less completely dependent
on their mothers--human infants need an "in-arms" period that
is approximately as long again as pregnancy because they are born so early
in the gestational cycle because of our erect posture and relatively small
pelvises.
The primary developmental task of the newborn is to bond with its parents
and siblings: to learn that it can count on its caregivers to meet its
needs--not only the biological needs, but the emotional, developmental
and spiritual needs of the first stage of life outside the womb. Joseph
Chilton Pearce, in "Evolution's
End," says: "The intelligence of the heart is not some sweet
sentiment but a primary biological necessity and the foundation of all
bonding.... The mother is the first teacher of the heart...." Newborn
humans are not able to regulate these systems well when at a distance
from their mothers, and thrive when carried or "worn" by their
mothers during the first six-plus months of life. The more contact, love,
and appropriate stimulation they receive, the more their neurological
systems develop, the smarter, more coordinated and more "contactful"
they become.
Any parent who thinks a child won't remember its experiences of pregnancy,
birth and the first years of life is deluding herself and doing the child
she brings into the world a horrendous disservice loaded with long-term
consequences. This mom could even be setting herself up for a traumatic
birth: what baby would be eager to be born to a mother who's planning
to leave her/him to the care of others on a daily basis from day one?
It sounds to me, as a pre- and perinatal psychotherapist, that this mom
needs to take a hard look at her own prenatal and early history and resolve
issues that are already affecting the life of her unborn child through
her unconsciousness about the personhood of her baby.
She needs some basic education in child development, at the very least,
in order to understand that breastfeeding, the production of oxytocin--the
"cuddle" hormone--the introduction of solid foods and the increasing
mobility and sociability of a young child are perfectly designed by nature
to allow for an initial period of intense, one-on-one bonding with parents,
and then increasingly long separations from mother and in the care of
other familiar caregivers (day care, pre-school, kindergarten, first grade)
as the child gets older. If she will read them, there is quite a list
of books out there on attachment parenting that explain the rationale
for this approach to new parents. If she is unwilling to be educated,
she may yet surprise herself after giving birth--all that oxytocin may
put a whole different spin on her willingness to leave her baby to the
care of others, so it would be a shame if she prearranged her postpartum
life around plans for an early return to work.
An extensive website details a lot of what I've written above and more,
and provides links to authors such as David Chamberlain. The site has
an extensive listing of books, journals and videotapes in the field of
prenatal and birth psychology. It is at www.birthpsychology.com.
- Claire Winstone, M.A., R.C.C.
claire@speaking4baby.com
www.speaking4baby.com
The book "Being
There: The benefits of a stay-at-home parent" by Isabelle Fox,
Ph.D. with Norman M. Lobsenz, ISBN 0-8120-9490-5, specifically addresses
the subject of childcare based on a number of studies. The basic point
of the book is that children who have substitute caregivers during the
first three years of life tend to lack the ability to bond with other
people for the rest of their life. The book goes into detail about many
specific problems this can cause.
- Kathy, Renton, WA
Look into brain-based learning. It is fascinating and "scientific."
It explains why all the things mothers do in the first few years are so
important for a child's social, emotional, educational development. There
are certain windows of time for children to sort of set up the connections
in their brains to prepare them for future learning, relationships, etc.
It is scary that most of these windows virtually close by age two to three.
Encourage this friend to stay home!
- Amy D.
QUESTION OF THE QUARTER for Midwifery Today
magazine
Mamatoto: Motherbaby
How can midwives best facilitate the bonding process of motherbaby in pregnancy, birth and postpartum?
Deadline: March 31, 2001
Send your response to:
Switchboard
More on apprenticeship:
There is a new organization formed to support apprenticeships. MATA's
mission: Support Apprenticeship. Mission statement: To gather together
and share the wisdom of those training midwives through apprenticeship;
to champion apprenticeship on the institutional level; and to provide
other services for apprenticeship preceptors and apprentices to help make
the midwifery apprenticeship training route successful and accessible.
Interested folks can join the egroup by going to www.egroups.com
and looking up Midwifery Apprenticeship Training Alliance.
- Jenny Dempsey
There should be a Midwives of North America
(MANA) board position that represents the interests of apprentices, like
an apprentice advocate, to be a liason for serious problems that can occur
in the preceptor/apprentice relationship. MANA can't get involved in every
little scrabble, but if the problem is serious enough, and especially
if the apprentice has already invested a year or two into the apprenticeship,
she should have some recourse if she is about to get dumped. I would also
like to see the recent Midwifery Student Bill of Rights be re-worked for
apprentices too.
As part of the CPM credential, the preceptor should be required to have
something in writing with the apprentice after the potential apprentice
has attended a few births and it looks like a relationship is developing.
NARM can offer guidelines on what to include in the "contract."
It should include concerns like:
Money: Is the preceptor paying the apprentice? At what point does
that start and how much? Or does the apprentice have to pay the preceptor
for her education, like going to school?
Responsibilities: Does the apprentice get to go to all births?
Must she attend all prenatal and postpartum checks? Let the preceptor
know when she won't be available. What if the preceptor has several apprentices
competing for work--who gets to do what?
Education: When does the preceptor sign the CPM application? Does
the apprentice have to get her own "primary" clients, or does
she use the preceptor's clients? What didactic requirements are there?
How and when will these be assessed and "graded"? Does the apprentice
have to get outside training, such as college classes, EMT training, childbirth
education or LLL training?
Time frame: When will the apprentice know she is done? Only when
her preceptor says so, after her numbers are complete? What if there is
a conflict here?
Are there ethical requirements for the preceptor/CPM? Can her CPM be
pulled or put on probation for unethical behaviour? There needs to be
some kind of consequence to both preceptor and apprentice for misconduct.
Currently everything favors the preceptor. If she gets mad, the apprentice
can be "dumped" from the apprenticeship for anything or nothing
at all, even after several years of work. What is her recourse? There
should be a grievance procedure in place for serious situations. And the
apprentice should expect a fair hearing and equal playing field to air
her complaints.
NARM wants to encourage future midwives to work toward and achieve their
CPM credential. I think they need to be more mindful of where the future
midwives and CPMs come from. Mostly, from apprenticeships. It would be
helpful to these apprentices and the future of direct-entry midwifery
if that special and sometimes volatile relationship could be handled more
fairly.
- Vicki Johnson, former apprentice, now midwife
More on excessive bleed:
I have found that a postpartum tea brewed with shepherd's purse, false
unicorn root, and a little licorice for flavor helps the mother bleed
less in the weeks following delivery. However, we have to remember that
often in our culture new moms do not get the support and help they need
after giving birth. Most women who are bleeding for weeks and weeks after
their birth are simply doing too much and need help in figuring out how
to get more rest. Sometimes this means getting outside help; sometimes
it is just a matter of helping them get organized and learn to let go
of doing it all. Another thing I have learned is to check the mom's labwork
prenatally for the platelet count. This is directly linked to her blood
clotting ability. I worked with a vegan woman with a very low platelet
count. She bled for a prolonged amount of time when she got a cut. We
worked on her diet. She increased her protein intake and began eating
eggs. Her platelet count went up and she had a beautiful homebirth with
a minimum of blood loss. The best source of information on this subject
was Anne Frye's book, Understanding
Diagnostic Tests in the Childbearing Year. I have also used the Chinese
herb yunan piao for postpartum bleeding with very good results.
- Lori Land
I was intrigued by the discussion of excessive post birth bleeding and
was glad to see that someone mentioned the power of suggestion. Please
do not scoff; when I first heard of this I thought "no way!"
But I've used it and it has worked every time. You can tailor your approach
to the personality of the woman. For those open to "alternative/complementary
therapies" I look closely into the woman's eyes and say "stop
your bleeding." For those more hesitant about such things I will
walk her through a visualization of her uterus as a ball that can expand
and contract, and I have her concentrate on having it contract, etc. Those
more in tune with their bodies are often more successful in stopping the
bleeding and keeping it stopped; with others it may start up again if
they don't stay tuned in. You may need to resort to herbs or stronger
meds. but I believe suggestion should always be the first line with excessive
postpartum bleeding.
- Cathryn
I have used shepherd's purse for a particular woman and it has not been
successful. I would appreciate hearing other suggestions, preferably for
herbs.
- Anon.
What is meant by bleeding excessively? For some women 1/2 cup could lead
to shock but for some losing even 3 cups can be well tolerated. Maybe
she's really good at making extra blood supply in pregnancy. How does
this woman tolerate the bleeding that occurs? Does she have problems with
shock symptoms, recovery, or breastmilk supply postpartum? The standard
"2 cups" is only a guide; look at the woman herself.
Bleeding "excessively" may be the result of an imbalance of the woman's physiology which seeks to eliminate excess heat (called Pitta
in Ayurveda) from her body. Have you heard the old midwives' tale that
redheaded women bleed more? They are also more likely to have excesses
of pitta. The very blood building supplements which she took to prevent
hemorrhage COULD actually increase the chance of bleeding if they increase
that fire in her that wants to come out. In Ayurveda and in Chinese medicine,
balancing an individual according to her particular constitution will
reduce this kind of situation. Other more complex factors can also lead
to excess bleeding, such as apana prana disorder. If there is a practitioner
of Ayurveda or Chinese medicine available, this woman may greatly benefit
from their help.
- Terra Richardson, Ayurvedic practitioner & midwife
Boulder, CO
resourcing@earthlink.net
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