The bonding phenomenon: misinterpretations and their implications

Bonding, postpartum dysphoria, and social ties : A speculative inquiry

Since the late 1970s, disruptions and "failure" of maternal-infant bonding have been causally linked to postpartum depression. Part I of this paper examines the grounds for this connection while tracing the ramifications of bonding theory (Klaus and Kennell 1976) through obstetrics, pediatrics, and psychiatry, as well as in the (mis)representations of it in the popular media. This discussion resolves into a view of maternal attachment as a long-term development progressively established through intensive mother-infant interaction. The forms of this interaction are phylogenetically determined, albeit culturally and personally mediated. Flowing from this premise, Part II of the paper casts postpartum depression as an adaptive response to threat (from whatever cause) to adequate mothering, and develops an argument for the evolutionary role of enacted social ties in the establishment of maternal responsiveness.

Mother-infant bonding : A scientific fiction

A study of the research on postpartum mother-infant bonding shows that results from poorly constructed research programs were published in major journals and became a part of hospital policy because the bonding concept was politically useful in the struggle between advocates of natural childbirth and managers of the medical model of birth. The concept was also uncritically accepted because it was consistent with a longstanding ideology of motherhood that sees women as the prime architects of their children's personalities.

State of the science of maternal-infant bonding: a principle-based concept analysis

OBJECTIVE

to provide a principle-based analysis of the concept of maternal-infant bonding.

DESIGN

principle-based method of concept analysis for which the data set included 44 articles published in the last decade from Pubmed, CINAHL, and PyschINFO/PsychARTICLES.

SETTING

literature inclusion criteria were English language, articles published in the last decade, peer-reviewed journal articles and commentary on published work, and human populations.

MEASUREMENT AND FINDINGS

after a brief review of the history of maternal-infant bonding, a principle-based concept analysis was completed to examine the state of the science with regard to this concept. The concept was critically examined according to the clarity of definition (epistemological principle), applicability of the concept (pragmatic principle), consistency in use and meaning (linguistic principle), and differentiation of the concept from related concepts (logical principle). Analysis of the concept revealed: (1) Maternal-infant bonding describes maternal feelings and emotions towards her infant. Evidence that the concept encompasses behavioural or biological components was limited. (2) The concept is clearly operationalised in the affective domain. (3) Maternal-infant bonding is linguistically confused with attachment, although the boundaries between the concepts are clearly delineated.

KEY CONCLUSION

despite widespread use of the concept, maternal-infant bonding is at times superficially developed and subject to confusion with related concepts. Concept clarification is warranted. A theoretical definition of the concept of maternal-infant bonding was developed to aid in the clarification, but more research is necessary to further clarify and advance the concept.

IMPLICATIONS FOR PRACTICE

nurse midwives and other practitioners should use the theoretical definition of maternal-infant bonding as a preliminary guide to identification and understanding of the concept in clinical practice.

"Becoming a mother'--developing a new theory of early motherhood

This paper explains the methods used in a grounded theory analysis of the experience of 55 first-time mothers in Australia, presented in the first of this series of two papers. The categories identified in the research are realising, readiness, drained, aloneness, loss and working it out, encompassed in the core category becoming a mother. Specifically, this paper extends the analysis and explains the application of a 'paradigm model' and the identification of a Basic Social Process (BSP). The paper links the analysis to the literature on early motherhood from nursing, midwifery, feminist, and sociological research. A substantive theory is proposed to explain women's experience in becoming mothers that demonstrates how, when responsive to the needs of those researched, a grounded theory analysis can provide a framework for nursing and midwifery care.

Early contact and maternal attachment among women using public health care facilities

The relationship between the time of first holding of the infant and the development of feelings of maternal attachment among women using public health care facilities was investigated. A sample of 88 mothers reported holding their infants from 10 minutes to 48 hours after delivery and developing feelings of maternal attachment from 10 minutes to 2.5 days after delivery. A positive relationship between the first holding of the infant and the development of feelings of attachment was supported, which indicated that feelings of attachment began when the infant was first held regardless of how long after delivery the holding was. Opportunities for early contact should be provided, but when appropriate, mothers should be informed that it does not appear that early contact is essential to the development of attachment feelings.

Early patterns of maternal attachment

The relationship between maternal-fetal attachment and maternal-child interaction was examined. The Maternal Fetal Attachment Scale (Cranley, 1981) was administered to 32 women between their 35th and 40th weeks of pregnancy. These mothers were observed again while they fed their infants once on the second and once on the third postpartum days. Their interactive behaviors were then rated on the Nursing Child Assessment Feeding Scale (University of Washington) and the Funke Mother-Infant Interaction Assessment. The findings indicated a positive and significant relationship between maternal fetal attachment behaviors and mother-infant interaction. Qualitative data collected during the research process gave meaning and interpretation to observed behaviors. Implications for nursing practice are discussed.

Developmental psychiatry: a perspective

A brief historical introduction to developmental psychology puts twentieth century views into perspective. The ideas of continuity, critical periods and predictability are examined. The case for a developmental perspective of human development is argued, and the tenets underlying such a model are suggested. The utility of the study of human development is discussed.

The effect of promoting intrauterine attachment in primiparas on postdelivery attachment

Twenty-two women participated in a modified replicate study which examined the effects of prenatal maternal attachment behaviors during first pregnancies. A pretest reflected the degree of maternal-fetal attachment behaviors and attitudes already formed. The women in the experimental group received three interventions aimed at directing the mothers' attentions toward their fetuses. The remaining women received routine prenatal care only. All mothers were observed once in the first few days postpartum to assess maternal attachment behaviors. Data analysis did not substantiate the findings of the earlier study. Factors identified in the added pretest may have accounted for this difference.

Psychological disability in women who relinquish a baby for adoption

During 1986, approximately 2000 women in Australia are likely to relinquish a baby for adoption. A study is presented of 20 relinquishing mothers that demonstrates a very high incidence of pathological grief reactions which have failed to resolve although many years have elapsed since the relinquishment. This group had abnormally high scores for depression and psychosomatic symptoms on the Middlesex Hospital questionnaire. Factors that militate against the resolution of grief after relinquishment are discussed. Guidelines for the medical profession that are aimed at preventing psychological disability in relinquishing mothers are outlined.

Prospective study of antecedents for nonorganic failure to thrive

The cause of nonorganic failure to thrive (NFT) was studied prospectively in 274 low-income pregnant mothers by interviewing them for characteristics that retrospective studies indicated were associated with child maltreatment. After delivery, medical charts of mothers and infants were reviewed for complications of pregnancy, delivery, and postdelivery hospitalization, and the infants were observed for growth failure. The characteristics of 15 families with infants who developed NFT were compared with those of 86 selected randomly from the remaining families. Interview results suggest that NFT correlates significantly with aberrant nurture during the mother's childhood and with conflicts between the parents of the infants. Perinatal events correlating significantly with NFT include complications of pregnancy, short gestation, and residual minor medical problems at discharge from the nursery. We speculate that these events predispose to NFT by disturbing the development of the mother-infant relationship.

Influence of early mother-infant contact on dyadic behaviour during the first month of life

An experimental group of 30 newborn infants had contact with their mothers for half an hour in the delivery room, and a control group followed the usual hospital routine, being shown briefly to their mothers before being taken to the nursery. In both groups permanent rooming-in began from the sixth hour of life. The infants' behaviour was assessed one, three and 28 days after birth by means of the Brazelton scale, and the behaviour of the dyad was observed during feeding on the third and 28th day. Infants in the experimental group interacted significantly better on days three and 28, and their mothers had higher scores for affectionate behaviour on the 28th day.

Short mother-infant separation during first week of life influences the duration of breastfeeding

Thirty term infants, who were separated 1-6 days (mean 3.3 days) from their mothers during the first week of life because of minor illnesses, were compared with 116 term non-separated infants with regard to breastfeeding. At 3 months of age the frequency of entirely breastfed infants was 37% in the separated group versus 72% in the non-separated group, p less than 0.001. Thus a few days of separation between mothers and infants during the first week of life seems to decrease the duration of breastfeeding.