The mental health of the mother will have a significant impact on her postpartum recovery and a dramatic influence on the infant’s well-being. Breastfeeding has a significant impact on the outcome for both mother and infant especially during the first year postpartum.
Although the previous chapters provide more than adequate information to support the preference for breastfeeding in almost every case, the critical impact in the return to breastfeeding in modern cultures rests with the issue of a mother’s role and her perception of breastfeeding as a biologic act. The maternal influences include psychophysiologic reactions during nursing, long-term psychophysiologic effects, maternal behavior, sexual behavior, and attitudes toward men. All professionals providing support care in the perinatal period need to have a clear view, not only of the biologic benefits of breastfeeding, but also of their own psychological attitudes about the breast itself.
“For men, breasts are sexual ornaments—the crown jewels of femininity.” This is not true worldwide, however, and other body parts (e.g., small feet, nape of neck, buttocks) are sexually charged, with much of the fascination resulting from full or partial concealment. Until the fourteenth century, the nursing Madonna was the prevailing image, but in truth, the availability of a mother’s milk meant life or death for every newborn.
The breast has assumed many roles throughout history, moving from sacred to domestic to political to erotic. The definition of the breast has been provided by moralists, historians, poets, pornographers, lovers, and women themselves. Much of the rhetoric today is about the breast in crisis: “The breast is torn between nurturance, eroticism, and the fear of cancer.” In the eyes of the beholder, babies see food, men see sex, physicians see disease, business sees dollar signs, and religion sees spiritual symbols. Psychoanalysis places breasts in the center of the unconscious. The breast has a privileged place in human thought. Perhaps the love affair with science has turned women from being comfortable with their breasts as a source of infant nurturance to being uncomfortable and ashamed of breastfeeding and yet has them searching through science and medicine for the perfect size or shape.
The breast has been regarded as a sex object in the Western world for more than a century, and its biologic benefits have been downplayed. This is clearly demonstrated by the conflicting mores that permit pornographic pictures in newspapers, movies, and nude theaters but insist on the arrest of a mother for indecent exposure who is discreetly nursing her baby in public.
Proponents of breastfeeding have generally accepted, even before the upsurge of interest and research in attachment, that the major reason to breastfeed is to provide the special relationship and closeness that accompany nursing. Conversely, the major contraindication to breastfeeding was lack of desire to do so. This was evidenced by it being considered more appropriate to present breastfeeding as a matter of personal choice with no compelling reasons to urge a mother to consider nursing. The concern about creating guilt in the mother who chooses not to nurse has been significant, and it often resulted in a passive attitude on the part of the clinician so that the mother received no prenatal counseling about infant feeding. As efforts to educate the public in general and women in particular about the benefits of breastfeeding have been increased, guilt is being used as a defense for doing nothing. Far more disturbing have been the aggressive attacks on breastfeeding promotion justified by the fear of producing guilt in the mother who chooses not to breastfeed. Other public health campaigns have not been muted or halted for fear of producing guilt in those who are obese, smoke, or abuse drugs.
Bonding and the Impact of Breastfeeding
The studies performed to understand bonding have largely been done without reference to breastfeeding. A supposedly comprehensive book, Attachment and loss by Bowlby, which reviews early mother-infant interactions extensively, never mentions breastfeeding. In addition, suckling is given extensive treatment without making a distinction between bottle and breast or implying that an alternative to the bottle exists. The emphasis in the 1940s was on the effects of disrupting already-formed attachments. Separation in the neonatal period was ignored, and infant socialization was studied from 6 months of age.
Work by Spitz and others has identified the devastating effects on infants deprived of long-term maternal contact. These investigators demonstrated major deficits in both mental and motor development, as well as general failure to thrive. The impact on the mother had not yet been described. Klaus and Kennell provided those data in their many writings on mother-infant interactions, which are summarized in their book Parent-infant bonding . Evidence indicates that the maternal-infant bond is the strongest human bond when two major facts are considered: an infant’s early growth is within the mother’s body and survival after birth depends on her care. Although the process had not been meticulously described yet, Budin noted in 1907 that when a mother was separated from her infant and was unable to provide the early care of her sick child, she lost interest and even abandoned the infant.
The immediate emotional reactions of mothers to their newborns were studied by Robson and Kumar in 193 women (two groups of primiparas, n = 112 and n = 41, and one group of multiparas, n = 40); 40% of the primiparas and 25% of the multiparas recalled that their predominant emotional reaction when holding their babies for the first time was indifference. Maternal affection was more likely to be lacking if the mother had an amniotomy or painful labor or had received more than one dose of meperidine (pethidine) unrelated to cesarean or forceps delivery. The authors found no difference between mothers who breastfed or bottle fed. The feelings of indifference persisted for a week or longer. This study points out that normal women may be initially indifferent toward their babies, whereas others experience great elation.
The development of positive feelings in primiparous women toward their normal newborns occurred before delivery in a third of women, immediately at birth or on the first day for 42%, and by the second or third day for 19% in a study by Pascoe and French. Mothers who breastfed were more likely to express positive feelings. Labors of less than 9 hours were associated with positive feelings, but no association with social class, infant sex, type of delivery, or duration of initial mother-infant contact was found.
Klaus and Kennell noted that mothers in the United States showed different attachment behavior when permitted early contact with their premature infants compared with mothers who had first contact at 3 weeks of age. Mothers of full-term infants who were allowed contact within the first 2 hours and subsequent extra contact behaved differently at 1 month and 1 year with their babies compared with control subjects. Jackson et al. made similar observations in the Yale Rooming-In Unit from 1945 to 1955 but failed to provide control observations.
In part because of the thought-provoking work of Klaus and Kennell in the 1970s, remarkable changes have taken place in labor, delivery, and postpartum services in hospitals in the United States and around the world. Mothers have been “allowed” to have their infants to hold and cuddle as soon as possible after delivery, and fathers have been “allowed” to participate in the birth experience. The take-charge attitude of health care professionals has relaxed, and gradually hospital perinatal care has been humanized. In the meantime, a number of investigators have challenged the power of bonding. In a critical review of early and extended maternal-infant contact research, Siegel suggests that, although many longitudinal experiences affect parenting behavior in complex ways, reasonable judgment supports early and extended contact whenever possible.
When a normal, healthy infant born to an unmedicated mother is placed on the mother’s abdomen immediately after the cord is cut, the infant crawls to the breast, finds the nipple, and latches on, beginning to suckle. This event takes place unassisted by the mother or an attendant. The warmth of the mother maintains the infant’s body temperature. This is described as a series of events beginning with the infant resting and occasionally looking at the mother, then moving toward the breast with some lip smacking and mouthing. Approaching the breast, the infant turns from one to the other breast before finally moving toward one nipple, bobbing over it, and grasping the areola and suckling ( Figure 6-1 ). Experiments that involve washing one breast demonstrate that the infant chooses the unwashed breast. When the mother has been medicated during labor, the “medicated” infant struggles to find the breast and often fails. Infants who are left with their mothers seldom cry during this awake, alert period. If unimpeded, this process takes 40 to 45 minutes, which suggests the original baby-friendly mandate of initiating breastfeeding within a half hour may have been hasty. Physiologically, the stimulus to the mother’s nipple and the stimulus to the infant’s mouth trigger the release of vital hormones in both mother and infant, beginning the maturation of the intestinal mucosa and enhancing nutrient absorption for both mother and infant.
This awake, alert period immediately after delivery provides an opportunity for receiving the first measure of colostrum, which is not only nourishing but also protective from an immunologic and infectious standpoint.
When a newborn is separated from the mother in the first hours postpartum, crying occurs and stops on reunion. The cry has been studied by sound spectrographic analysis in a group of infants in contact with their mothers for the first 90 minutes compared with those kept in a crib. The separated infants cried 10 times more than the contact infants. On analysis, the cry was characterized as a discomfort cry compared with patterns seen in cries of hunger or pain.
The impact of early mother-infant interaction and breastfeeding on the duration of breastfeeding has been reported; no data appear to be available as to whether mothering is different between mothers who breastfeed and bottle feed in this early period. Sosa et al. reported the effect of early mother-infant contact on breastfeeding, infection, and growth. Breastfeeding mothers who were permitted early contact but not early breastfeeding were compared with mothers without early contact who also breastfed. The mothers with early contact were observed to nurse 50% longer than the control subjects. The early-contact infants were heavier and had fewer infections. Sosa et al. conducted a similar study in Brazil, in which each mother nursed immediately on delivery and the infant was kept beside the mother’s bed until they went home. At home, they had a special nurse make regular visits to help in the breastfeeding. The control subjects had traditional therapy, that is, contact at feeding times after an early glimpse. Infants were housed in a separate nursery. At 2 months, 77% of the early-contact mothers and only 27% of the control mothers were successfully nursing. The early and continued contact may have been accompanied by increased support and assistance from the nursery staff. This added support could facilitate breastfeeding and thus be the cause of the improved outcome.
An additional study of early contact by deCháteau et al. in Sweden investigated a group of 21 mothers with early contact and 19 control mothers, all of whom were breastfeeding in the hospital. The only difference in management was the first 30 minutes of early contact because 24-hour rooming-in was provided for all mothers after 2 hours postpartum. The length of breastfeeding differed: for the early-contact group, 175 days, and for the control subjects, 105 days. Follow-up observations at 3 months showed different mothering behavior. The study group displayed more attachment behavior, fondling, caressing, and kissing than the control group.
Unless heavy medication or difficult delivery intervenes, an infant experiences a period when the eyes are wide open and the infant can see, has visual preferences, turns to the spoken word, and responds to the environment. Similar periods in the state of consciousness of the infant may last only a few seconds or minutes during the next 1 to 2 days.
Although some mothers begin the attachment process when the decision to have an infant is made, after conception the physiologic changes in the maternal body strengthen the developing bond. During pregnancy, listening to the fetal heart and watching echocardiographic images of fetal movements are confirming factors created by modern medicine. The first picture in an infant’s scrapbook may be of the infant as a 12-week fetus. The moment of delivery, the first glimpse, and the first hours are intense opportunities for further “bonding” to occur. For some, however, the process will take a day or a week before the mother feels true love for the infant. Unfortunately, studies investigating this timeline do not distinguish women who breastfeed from those who bottle feed.
As in every area of medicine, new ideas and new theories invite criticism. The best type is neither partisan nor polemical and serves to dispassionately repeat the studies and confirm or disprove. Many investigators have affirmed the “bonding” theory. Other critics, 1
1 References , .
however, have been hostile yet unable to disprove that biologic factors might play a significant role in a mother’s response to her infant. A new group has called the theories “a bogus notion,” reflecting medicine’s need to control women and to enhance market demands and the status of medicine itself. Further, it is argued that bonding is demeaning to women because it rests on the idea of instinct. These critics agree that increased contact between mother and infant in the first few days increases maternal emotional response, that early contact enhances breastfeeding, and that early extended contact decreases the incidence of child abuse, with effects solely on the parents, not the child.Further study is needed, although randomly assigning a mother to a restricted contact control group would be difficult, if not unethical, today. Skin-to-skin versus clothed contact and hormonal components in relationship to behaviors remain to be explored. The father’s and siblings’ roles also deserve additional attention. Despite his criticism of bonding research, Lamb has been supportive of the trend toward humanizing childbirth to provide a rich emotional experience for parents.
Sensitive periods in biologic phenomena are times when events alter later behavior. The existence of a sensitive period in human behavior is disputed, although it has been shown to exist in other species. Human bonding occurs in a longer period of time. The power of attachment enables mother and father to make many sacrifices necessary for their infant. More than 50 years of investigation have confirmed the observations that the human maternal-infant bond can be facilitated, supported, and encouraged by more caring sensitive processes beginning with labor and throughout the perinatal period.
Human relationships are complex. A newborn brings joy, fear, anxiety, frustration, and triumph, reminds Righard. Adaptability and compensation in the developmental processes are part of human existence. The concept of bonding has drawn attention to this period of life and began the process of understanding the mother-infant relationship.
Body Contact and Cultural Tradition
If we look at other mammals, lactation behavior, including the duration and frequency of feedings, is species specific and predictable because it is a genetically controlled behavioral characteristic of the species. Only those animals kept in zoos or laboratories reject their young. Among higher primates, learning plays a significant role; monkeys reared without role models have to be taught how to groom and feed their young. In humans, breastfeeding behavior is highly variable from one culture to the next. Different cultures of the world have different sets of “rules” about lactation as they do about many other aspects of life and death. Cultural tradition dictates the initiation, frequency, and termination of breastfeeding. Learning plays a key role in the lactation process, but the learning is focused on the beliefs, attitudes, and values of the culture.
The degree of body contact permitted by the culture is a fundamental difference. Simpson-Herbert describes the degree of mother-infant body contact as the physical and social distance that mothers keep from their babies. The physical distance is viewed as a reflection of the social distance sanctioned by the culture.
Cultures prescribe how often infants will be held or carried and how they will be carried (e.g., in the arms, a pouch, or a sling, or on a cradleboard). How infants are clothed, where they are placed when not held, and where they spend the night are culturally determined and affect breastfeeding. The cultural constraints that control maternal behavior include those on the kinds and amounts of maternal clothing, acceptability of breast exposure, and beliefs on frequency and length of feedings.
The effect of increased carrying of infants was studied by Hunziker and Barr in a group of primiparous breastfeeding women in Montreal. The crying pattern of normal infants in industrialized societies has been reported to increase until 6 weeks of age, followed by a decline to 4 months, with most crying occurring in the evening. The investigators had the study families increase carrying the infants either in the arms or in a carrier to a minimum of 3 hours per day, whereas control infants were placed in a crib or a seat with a mobile in view. At 6 weeks, significantly less (43%) crying was observed in the “carried” infants, especially in the evening. Similar but smaller differences were noted at 4, 8, and 12 weeks.
When Cunningham et al. randomly provided either soft baby carriers or plastic infant seats to a group of low-income women in a clinic in New York City, they found the infants carried in a soft carrier were more securely attached than those placed in a seat when tested with the Ainsworth Strange-Situation Study. The study and control infant groups had an equal number of mothers who breastfed, and thus the authors found no effect of breastfeeding on study results. They concluded that in low-income groups, mother-infant relationships benefited from early use of soft carriers and “contact comfort.”
Although the mean length of breastfeeding was similar in both groups, the breastfeeding was not defined, that is, as exclusive, partial, or minimal. Also, time spent holding to breastfeed versus time spent holding to bottle feed was not noted. There were 21 women who breastfed and 28 women who bottle fed. Although it is helpful to use carriers with bottle-fed infants, it should not be done to the abandonment of breastfeeding support programs.
Anthropologic studies of 60 societies by Whiting considered mother-infant body contact. He classified these cultures as high or low in contact as shown in Figure 6-2 .
Other factors influence the development of cultural mores, including climate and means of food gathering. Simpson-Herbert points out that when infants are heavily clothed and swaddled, as in cold climates, they are neat packages that can be put down easily. Inuit people are an exception, however, traditionally keeping infants inside mothers’ parkas for warmth and frequent feedings. Breastfeeding is almost axiomatic in warm climates where clothing is loose or absent; frequent holding and carrying are common, and the breast is readily accessible.
The diet of hunter-gatherer societies is not conducive to early weaning because meat, roots, nuts, and berries are difficult for infants to chew and digest, whereas the softer foods of the agricultural societies can be prepared for early infant feeding.
Study of specific world societies reveals that North American and European women are concerned with the beliefs that it is indecent to expose the breast, it is possible to spoil an infant with too much handling, and early weaning is a sign of infant development. Western mothers keep their distance from their babies. Mothers in high-body contact societies spend at least 75% of the time in contact with their babies, whereas low-contact societies spend less than 25%.
Since the 1990s, infant care in Western societies has included carrying infants in carriers close to the parent’s body. Co-sleeping with the infant for easy access to the breast through the night and the concept of the family bed has emerged as more conducive to good parent-infant attachment. Breastfeeding increases sleep duration for new parents according to a study by Doan et al. They demonstrated that supplementing with formula at night resulted in more sleep loss similar to that of bottle-feeding parents. Exclusive breastfeeding resulted in 40 to 45 minutes more of sleep.
The practice of co-sleeping and bed sharing, although customary in many cultures, is rare in industrialized societies. Careful scientific study of co-sleeping has revealed a number of benefits, but present custom is based on the bottle-feeding philosophy that embraces separation of parent and child. Where the infant sleeps is not just a family issue but a medical one according to McKenna, who has performed the seminal studies on co-sleeping and pointed out the benefits of bed sharing. As a result of extensive study on the subject, the Academy of Breastfeeding Medicine has developed “A Guideline on Co-Sleeping and Breastfeeding” ( Box 6-1 ).
Families should be given all the information that is known about safe sleeping environments for their infants, including the following:
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Place babies in a supine position for sleep.
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Use a firm, flat surface and avoid waterbeds, couches, sofas, pillows, soft materials, and loose bedding.
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Use only a thin blanket to cover the infant. Assure the head will not be covered. In a cold room the infant could be kept in an infant sleeper to maintain warmth.
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Avoid the use of quilts, duvets, comforters, pillows, and stuffed animals in the infant’s sleep environment.
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Never put an infant down to sleep on a pillow or adjacent to a pillow.
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Never leave an infant alone on an adult bed.
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Inform families that adult beds have potential risks and are not designed to meet federal safety standards for infants.
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Ensure that there are no spaces between the mattress and headboard, walls, and other surfaces that may entrap the infant and lead to suffocation.
Breastfeeding is often enhanced by bed sharing, and providing that precautions are taken, bed sharing is safe and healthy. Bed sharing has been singled out by the AAP Committee on SIDS as a major cause of SIDS. This is not true when associated with breastfeeding. It is true when associated with drugs, smoking, and alcohol. The alternative to bed sharing while breastfeeding is the very hazardous sofa, lounge chair, or rocker.
Psychological Difference Between Breastfeeding and Bottle-Feeding
Professionals have spent decades reassuring mothers that they can capture the same emotional and behavioral experience by feeding an infant from a bottle as they can feeding with the breast, with the same warmth and love. Technically speaking, the same warmth is not present because lactating breasts have been shown to be warmer than nonlactating breasts. This warmth can be demonstrated by infrared pictures and thermograms. Responses to stress appear to be muted in lactating women. Using graded treadmill exercises, lactating women had significantly decreased plasma levels of adrenocorticotropic hormones, or corticotrophin, cortisol, and epinephrine compared with match-control nonlactating women. Plasma glucose did not rise as it did in nonlactating women.
At 1 to 12 months postpartum Mezzacappa and Katkin examined subjective stress as well as individual differences in both mothers who breastfed and those who bottle fed. They administered the Perceived Stress Scale and the trait component of the State-Trait Personality Inventory. The 10-item Perceived Stress Scale is widely used to index subjective stress, and the State-Trait Personality Inventory is a 30-item questionnaire assessing anxiety, anger, and curiosity. Mothers who breastfed had significantly less perceived stress in the month preceding the test than did the those who bottle fed. No significant differences were seen among groups in anxiety, anger, or curiosity. Maternal age, time postpartum, parity, and work status were controlled for. In a second experiment, the authors examined the acute psychological effects of breastfeeding and bottle-feeding. Positive and negative mood were assessed in the same mother before and after a feeding. They recruited mothers who were both breastfeeding and bottle-feeding, studying them in two sessions a week apart, randomly sequenced. The mothers completed the Positive and Negative Affect Scale, rested 10 minutes, fed the infant, rested 10 minutes, and retook the test. The mood was significantly less positive after bottle-feeding than after breastfeeding. Mood became significantly less negative after breastfeeding than after bottle-feeding. A possible explanation is the surge of oxytocin during let-down. Uvnäs-Moberg , has reported mood effects of breastfeeding mediated by oxytocin. She describes oxytocin levels as inversely related to negative moods and emotions. The higher the levels of oxytocin, the more calm the mother ( Figure 6-3 ).
Mezzacappa and Katkin conclude that the results confirm that breastfeeding buffers mood. They attributed this to psychological effects of breastfeeding itself and not to the differences between women who breastfeed and those who bottle feed because the participants did both and were their own controls.
Newton and Newton suggest that special caution should be used in evaluating statistical associative studies that purport to investigate the hypothesis that breastfeeding and bottle-feeding are psychological equivalents. “Because breastfeeding involves a large measure of personal choice and because it is related to attitudinal and personality factors, no groups of breastfeeders and bottle feeders are likely to be equal in other respects. Therefore the relation of breastfeeding to any particular psychosocial measure may not be cause and effect, but simply the differences due to other uncontrolled covariables.” A human mother’s care of her infant is derived from a complex mixture of her genetic endowment, the response of the infant, a long history of interpersonal relationships, her family constellation, this and previous pregnancies, and the community and culture.
The method chosen to feed a baby is but one item in a whole style of maternal-child interaction. It is unlikely that this style is determined by the method of feeding; according to Righard. Breastfeeding is a different activity when it is carried out by a small minority compared with breastfeeding that is commonplace in the community. After many years of promoting artificial feedings, breastfeeding has become the norm as it had been historically for centuries.
In a study of patterns of variation in breastfeeding behaviors, Quandt offers three explanations: cultural, biologic, and bicultural. Predictions of exclusive breastfeeding duration were most accurate for women with a breastfeeding style of infrequent feedings and therefore early weaning, whereas predictions for women with a style of frequent feeding were confounded by cultural factors that independently affected supplementation.
Before reviewing specific psychological attributes relating to breastfeeding, the distinction between styles of nursing in Western societies should be considered. The Interagency Group for Action on Breastfeeding developed a schema for breastfeeding definitions. Newton and Newton, however, have described two distinct styles—unrestricted breastfeeding and token breastfeeding—that are important to understanding maternal choices.
Unrestricted Breastfeeding
Unrestricted breastfeeding means the infant is put to the breast whenever he or she cries or fusses. Feeding is ad lib and not by the clock, usually leading to 10 or more feedings per day. The infant receives no bottles, and solids are not introduced until the second half of the first year. Breast milk continues to be a major source of nourishment beyond the first year of life. It is interesting that this was routine practice in the United States in the beginning of the twentieth century, as attested by writings on the subject of child rearing. The present recommendation of WHO and major professional organizations (i.e. American Academy of Pediatrics [AAP], American College of Obstetrics/Gynecology [AGOG], American Academy of Family Practice [AAFP]) is unrestricted exclusive breastfeeding for 6 months.
Token Breastfeeding
Token breastfeeding means feeding characterized by rules and regulations. Both frequency and duration of feeding are determined by the clock. It is deemed unnecessary to permit unlimited suckling. Weaning usually occurs by the third month, if not before. Supplementary bottles and solids are not uncommon. As a result, the let-down reflex is never well established. Engorgement may occur. An infant is frequently too frantic from crying or too sleepy to feed well at the appointed times.
New definitions of breastfeeding (i.e., exclusive, partial) have been published to standardize statistical comparisons (see Chapter 1 ) but do not reflect the psychosocial differences between unrestricted and token breastfeeding. The American Academy of Pediatrics Section on Breastfeeding recommends exclusive breastfeeding for 6 months and the gradual inclusion of solids (never before 4 months), preferably at 6 months or later.
A University of Rochester study of urban physicians revealed that those pediatricians who prescribed solids by 3 months or earlier also suggested supplementary bottles and had been in practice 20 years or longer. Most of the physicians in the family medicine program in the same community, however, provided no supplements and no solids until 6 months and had been in practice less than 20 years. More than 50% of mothers in that community who planned to breastfeed had made contact with some childbirth or breastfeeding program and chose their physician according to practice style.
Definition of breastfeeding in the United States has been undertaken by the Breastfeeding Promotion Consortium convened by the U.S. Department of Agriculture semiannually since 1990. The report points out that many definitions (legal, programmatic [for WIC food allotments], surveillance, and monitoring) were used for policies and guidelines and for research. Descriptively, it includes initiation, duration, and intensity. The Breastfeeding Promotion Consortium is concerned about monitoring for surveillance purposes. The clinician needs to know frequency per day, length of a feeding, and the provision of any other liquids or foods. The CDC has assumed the responsibility of monitoring breastfeeding trends annually.
Imprinting, Pacifiers, and Dummies
Scores of infants are being introduced to pacifiers or dummies shortly after birth, all too often by an impatient perinatal staff member who knows a breastfed infant should not be bottle fed. Free pacifiers are being provided as gifts by some formula companies eager to beat the competition. The UNICEF/WHO’s 10 steps to becoming a baby-friendly hospital (see Chapter 1 ) include the exclusion of pacifiers from the hospital’s provisions. Do pacifiers have a long-range impact on infants? For bottle-fed infants, probably not, if possible dental problems are excluded; a pacifier will provide the sucking a bottle-fed infant may not receive during a feeding. For a breastfed infant, the answer may be different.
Human imprinting is little discussed in pediatric textbooks and rarely noted when discussing infant feeding, yet human infants, like any other mammalian newborns, recognize the mother by the oral, tactile, and olfactory modes. “The most sensitive organ and the one over which a newborn mammal has the most control, its mouth, is the organ central to mammalian and human imprinting,” states Mobbs. It is thought that the imprinting process, or “stamping” as it was initially termed, takes place for a brief period early in postnatal development when an animal seeks a particular class of stimuli (i.e., objects of a particular shape). Having found such an object or one resembling it, the animal responds with an unlearned pattern of attachment behavior. The process is innate. Comfort sucking and formation of nipple preference are genetically determined behaviors for imprinting to the mother’s nipple. The recognition of the mother is at first through the distinctive features of the nipple. Although imprinting is multisensory and varies from species to species, it is oral/tactile for humans and other higher mammals.
Mistakes and mishaps can occur in the process when a newborn fixes on a rubber nipple (bottle), thumb, or pacifier ( Table 6-1 ). In birds, innate responses are preferentially selective to supernormal-size stimuli. Nonnutritive sucking on thumbs or pacifiers is displacement activity that would normally be directed at imprinting to mother’s nipple and reflects a tendency toward supernormal size. In other species with multiple births or litters, the offspring imprints to one teat throughout the lactation period. The one nipple preference sometimes reflects emotional attachment to the object rather than a preoccupation with a need for sucking. According to Passman and Halonen, who found 42% of the interaction with the dummy to be nonsucking attachment, the preference for one nipple was maintained.
| Objects of Fixation | ||||
|---|---|---|---|---|
| Human Breast | Filled Nursing Bottle | Thumb/Finger/Knuckles | Empty Bottle/Pacifier (Dummy)/Cloth | |
| Nutritive | Yes | Yes | No | No |
| Animate | Yes | No | Yes | No |
| Nonself | Yes | Yes | No | Yes |
| Infant control | No | No | Yes | No |
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