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Mother-Infant Bonding By Dr. Maher Rashed
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By Dr. Maher Rashed, PhD
Early animal studies on mice and rats were recorded by Rosenblatt et al., (1960). They reported that the rodent mother cared for her young but not skillfully after first few hours' separation.
On the other hand, Harlow, (1963) indicated that viewing alone was not enough stimulus to maintain maternal interest. This study was on rhesus monkeys.
Different studies proved that the effects of early separation on later maternal behavior varied with the species and not all mothers were equally affected by early separation from their infants (Hersher et al., 1963 & Klopfer et at., 1964).
Effect of mother - infant separation was studied on squirrel monkeys by Vogt and his colleague (1980). Mothers showed marked behavioral agitation. Mothers and infants showed increased cortisol values in response to separation.
In agreement with Vogt study Levine and his (1988) reported increased circulating levels of plasma cortisol.
Mother-infant affectional ties can be disturbed easily as reported by Rose and others, (1960). They suggested that minor illnesses in the immediate newborn period appeared to alter the relationship between mother and her infant.
Eye to eye contact was suggested to be one of the innate releasers to maternal care-taking responses. The infant's ability to attend and follow up especially during the first hours, coincided with his mother's interest in his eyes (Robson, 1967).
Early maternal perception was seemed to be related with later child behavior. This is concluded in Broussard study, (1970). The infants in her study were categorized as either high risk or low risk according to whether the mothers rated their infant's behavior. It was found that 45% or more of the high-risk group needed therapeutic intervention for developmental and emotional deviations at age of 4.5 years.
Human maternal behavior at the first postnatal contact was studied by Klaus et al., (1970). They observed 12 mothers with their normal full term infants and 9 other mothers with their premature infants in incubators. Results showed an orderly and predictable pattern of behavior in the first group. This sequence was altered in the second group.
Early contact was also compared with late contact by Klaus et al., (1970). Mothers were separated for 20 days in the late contact group. Observations included care-taking skills as well as measurements of maternal affection. Results proved that late contact mothers held their babies differently, changed position less, burped less, and were not as skillful in feeding as mothers in the early contact group.
In agreement with Klaus et al., (1970), Salk (1970) suggested that prolonged postpartum separation altered the mother-infant responses. This study involved 115 mothers with separation and 286 mothers as a control group.
Extended contact (close physical contact in the first three hours postpartum and daily five hours in the first three days, than a control was studied by Klaus and associates (1972). Extended contact group mothers demonstrated more soothing fondling and eye-to-eye contact during feeding. Observations were made one month, one year and two years after delivery.
Meanwhile, Sosa and others, (1976) studied the effect of immediate postpartum contact on mother-infant bond formation. The control group followed the hospital practice of early separation then the mothers received their infant after "12" or "24" hours. The experimental group received 45 minutes of close physical contact on the delivery table. Follow up observations revealed that the mean numbers of days that the infants were breast-fed were significantly longer with the experimental than the control group. Also weight gain and infection were significantly different. This suggested that the maternal sensitive period is less than 12 hours postpartum.
Extra contact for one hour postpartum was involved by Carlsson and others, (1977). A control group treated as hospital routine as the infant placed in crib next to mother's bed every four hours for feeding. The authors reported that the extra contact mothers showed more physical affection and physical contact during breast feeding than the hospital routine mothers.
The effect of separation of low birth weight infants on the mother-infant relationship was studied by Hansen and his colleague, (1977). The separated infants were nursed in incubators for low birth weight. A control group was full-term infants and was not separated at birth. At seven years old the children of low birth weight showed more psychiatric problems and very difficult to manage compared to the control group.
De Chateau and Wiberg, (1977) had studies long term effect on mother-infant behavior of extra contact during the first hour post partum; observations at 36 hours. An extra skin to skin contact and suckling contact was given to 22 primiparous mothers and their infants. A control group of 20 primiparous mothers and infants and a second one of 20 multiparous mothers and infants were given routine care immediately after birth. In extra contact, after clamping of the cord, 2 -6 mm following delivery. The baby was but onto the mother's abdomen for 5 mm. He was then moved upwards onto the mother's chest to suckle from breast. This extra contact lasted for about 10 to 15 mm. All mothers and infants were healthy with normal pregnancies and deliveries. Primiparae with extra contact showed behavior much more like the behavior of multiparae with routine care. Infants of primiparae with routine care dried more frequently. The mothers of boys differed more from group to group than did those mothers of girls.
Another follow-up study of three months was made by De Chateau and Wiberg (1977). The extra contact group showed more mother-infant personal interaction, more breast-feeding proportions and less cried infants.
The effect of contact timing on maternal behavior was revealed by Hales et al., (1977). Immediate postpartum 45 minutes skin-to-skin contact was compared with delayed skin-to-skin contact 12 hours after delivery. A control group received their nude infants dressed in a crib after 12 hours. The authors demonstrated that mothers who had extra contact demonstrated more affectionate behavior than mothers with routine care did. Early contact did not alter the mother care-giving or physical closeness to the baby. This concluded that the maternal sensitive period is within the first 12 hours after birth.
Meanwhile Gail and others (1978) conducted parental interviews and behavior observation sessions with 46 families in which the woman was pregnant. These families were again interviewed and observed 7 days, one month, two months and six months after the child was born. The authors found that greater attachment was associated with less separation. They also concluded that prenatal preparations had a positive effect on attachment.
On the other hand, Miyake (1981) studied the infant's temperamental disposition; mother's mode of interaction, quality of attachment and infant's receptivity to socialization. This study concerned 29 first born infants through "23" months of age. There was a specific group showed: a) in the neonatal period; cried more at the removal of a nipple. b) At one and three months, was more irritable. c) At seven months, was more interrupted during mother-infant interaction. d) At 16 and 20 months, was less obedient and at 23 months, showed more behavioral signs of fear at the approach of a stranger.
The sensitive period hypothesis, previously described by Klaus and Kennell (197O) was tested again by Sara Rode and others, (1981). "'29"' infants were separated at birth from their mothers. They were admitted to the '"N.I.C.U."" because of prematurity or extreme health problems. They were evaluated for their attachment pattern during their second year of life. The data suggested that attachment patterns were influenced by mother-infant interaction over a period of time. It also was evidenced for the resiliency of infants in their formation of attachment patterns.
On the other hand; Jinadu and others (1982), reported some factors affecting mother-child relationships following low birth weight deliveries. They compared "'20'" mothers with low birth weight babies in an "N.I.C.U" with "20" mothers with full term babies. Results showed delayed postpartum contact, negative reactions; and some delays in maternal attachments in mothers of premature infants.
Meanwhile Ainsfeld and upper, (1983) researched the effects of early contact on mother-infant interaction at "2" days of age. They also explored some of the variables that may interact with early contact to produce varying results. The most important variables were social support and sex of the baby. Twenty-nine mothers experienced extra-contact procedures in which the baby was placed on mother's abdomen for one hour. Thirty mothers received routine care procedures in which the baby was shown to the mother and then taken to the nursery. The authors explored that a period of close contact between mother and infant immediately after birth facilitated the establishment of a close bond. The extra contact treatment produced more affectionate behaviors in mothers who had less social support and in mothers of female infants.
Early mother-infant separation and feeding artificial' formulas were observed by Mata and his colleagues (1983). Interventions such as complete and partial rooming-in and clostrum feeding program were tested. Results showed significant decline in the rate of abandoned infant. Early morbidity measured in the first week of life declined. There was a significant increase in the duration of breast-feeding.
Woolridge and others, (1985) studied the effect of early versus delayed contact for suckling on milk intake in the first week post-partum. Observational study showed that early contact mothers gave more additional breast feeds than delayed contact mothers.
Another similar survey was reported by Mata et al., (1988) confirming the importance of early infant -mother - infant stimulation, rooming-in and clostrum feeding. They observed that such interventions produced dramatic decline in morbidity and mortality of infants. The duration of breast-feeding was longer. They also noted that the highest rates of breast-feeding coincided with infants born by spontaneous deliveries. The lowest rates were recorded for infants born by cesarean section.
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By Dr./ Maher Rashed, Ph.D.
The process of mothering is started before pregnancy when the children are specialized by the powerful process of imitation or modeling. Their behavior is influenced by how they were mothered or what they observed (Brazelton, 1963).
Pregnancy is considered to be a developmental crisis involving two particular adaptive tasks (Caplan, 1960). The first is acceptance of pregnancy. The second is perception of the fetus as a separate individual. Bibring (1959) outlined the first phase for the mother in the early weeks of pregnancy as the acceptance of the growing fetus as an integral part of herself. Also, once fetal movements begin, infants who are unplanned and unwanted by the mother, often become more accepted.
Most pregnant women have hidden fears that the infant may be abnormal. These fears and subsequent effect on mother-infant bond formation had been clarified by Brazelton, (1973).
Cohen, (1966) emphasized that bond formation may be retarded if the mother is felt stressed, unloved or unsupported.
Hypothized change in maternal sensitivity Winnicott, (1971) proposed that a healthy mother goes through a period of "primary maternal preoccupation" (See Figure). This is a state of heightened sensitivity as she provides a setting for the infant's constitution to begin to make himself evident. It is interesting that the timing and course of this "primary maternal preoccupation period" are similar to that described for the maternal sensitive period by klaus and kennell, (1970).
Rose and associates, (1960) and kennell and others, (1975) suggested the affectional ties can be disturbed and may be permanently altered during the immediate postpartum period. Relatively mild illness in the newborn and the need for incubator care in the first 24 hours appeared to affect the relationship between mother and infant.
Steps of mother-infant attachment (Klaus and kennll, 1970) (See Figure) Planning the pregnancy. Confirming the pregnancy. Fetal movement. Birth. Seeing the baby. Touching the baby. Caretaking
Additional time for close contact of the mother and infant in the first minutes, hours and days of life alter the quality of attachment. This additional contact helps the mothers to become attached to their babies. As possible as the parents are permitted to be together with their baby. They establish the sore beneficial and supportive environment for the beginning of bonding process (O'connor et at, 1960).
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