The birth of a newborn initiates a series of interactions with parents (particularly the mother) designed to initiate attachment and ensure survival. Human development is sufficiently resilient to withstand some disturbance of the normal postpartum sequence of events that initiate attachment; however, significant problems of either the infant (prematurity; congenital anomalies; transitional problems such as asphyxia, trauma, or peripartum infection) or the mother (complications of pregnancy, depression) have more substantial capacity to disrupt normal processes. These complications carry a risk for adverse effects on long-term neurodevelopment9 in addition to risks related to prematurity or underlying anomalies. Emotional and psychological groundwork for secure attachment begins in pregnancy. The quality of a woman’s own early maternal care may influence her capacity to provide maternal care. Life stresses that leave the mother feeling unloved or unsupported or that precipitate concern for the health and survival of either her infant or herself may delay preparation for the infant and retard bond formation.5 Oxytocin plays a key role in initiation and regulation of maternal behavior. Increased level of oxytocin throughout pregnancy facilitates the formation of an emotional bond between mother and infant in humans by acting to reduce anxiety and to ameliorate responses to external stresses. Mothers who have a less anxious state of mind are more able to increase their focus on infant care and recognize and respond effectively to nonverbal infant cues.8 Hospital care practices that reduce anxiety, such as avoiding unnecessary separation of an infant from parents, can contribute greatly to early attachment. Figure 45-1 is a schematic diagram of the major influences on parental behavior and the resulting disturbances that may arise from them. Experiences during labor, parent-infant separation, and hospital practices during the first hours and days of life are the most easily manipulated variables in this scheme. Once childbirth moved from the home to the hospital, continuous support of the mother during labor became the exception rather than the routine. Although husbands/partners and female relatives routinely accompany the mother to the delivery room, they usually have little experience in providing labor support and may need support themselves. The clinical value of continuous emotional and physical care during childbirth by a trained woman called a doula is supported by the results of the 22 randomized clinical trials conducted over more than two decades.10 Women allocated to continuous support were more likely to have a shorter labor and a spontaneous vaginal birth. In addition, they were less likely to have intrapartum analgesia or a baby with a low 5-minute Apgar score. Beneficial findings are consistent across the studies despite different cultural, medical, and social practices. Nearly 90% of newborns require no special intervention at birth. Suctioning is not typically required with clear amniotic fluid, and clearing of the upper airway can be accomplished by simply wiping the infant’s mouth and nose (see Chapter 32). Vigorous infants with meconium-stained amniotic fluid may need suctioning of the mouth and nose with only a soft bulb syringe.1 Separating the newborn from the mother to administer the initial steps in stabilization is not needed. The newborn should be placed on the mother’s skin immediately after birth, covered by a blanket. The mother’s body provides thermoregulation as effective as a radiant warmer.4 The sensory stimuli of touch, warmth, and odor between the mother and infant are a powerful vagal stimulant resulting in release of maternal oxytocin, which aids in breastfeeding and mother-infant attachment.14 A healthy newborn has the ability to find the mother’s breast and to decide when to take the first feeding.18 During the first minutes of life the infant experiences a time of rest and quiet alertness, rarely crying. Around 30 to 40 minutes after birth (sometimes longer), the newborn begins making mouthing movements and will self-maneuver from the mother’s abdomen to reach the nipple. Many abilities enable an infant to do these tasks. Stepping reflexes help the newborn push against the mother’s abdomen to propel him or her toward the breast. The ability to move a hand in a reaching motion enables the infant to claim the nipple. Taste, smell, and vision all help the newborn find the breast.12 Muscular strength in the neck, shoulders, and arms helps newborns bob their heads and do small pushups to inch forward and from side to side. Human infants, similar to other infant mammals, apparently know how to find their mother’s breast. Figure 45-2 shows a newborn successfully navigating. At 10 minutes of age, the newborn first begins to move toward the left breast. Repeated mouthing and sucking of the hands and fingers is commonly observed (see Figure 45-2A). With a series of pushups and rest periods, the infant gets to the right breast completely unassisted (see Figure 45-2B). The infant, with lips on the areola, now begins to suckle effectively while closely observing the mother’s face (see Figure 45-2C).
Normal Mother-Infant Attachment
Formation of Mother-Infant Attachment
Pregnancy
Labor
First Hours after Birth
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
Normal Mother-Infant Attachment
