Bonding

Bonding is the process by which parents create an intimate personal relationship with their newborn child.

Studies show that premature babies who are stroked or held in the neonatal intensive care unit (NICU) gain 50% more weight and appear less stressed than those who are not. The act of kangarooing (cuddling premature infants skin to skin), is recommended for parents whose children remain in the NICU after birth or for mothers who choose not to breast-feed their children. Both parents can ensure that their infant is regularly soothed by touch if bottle-fed babies are held so that their skin touches a parent's skin during feeding. Babies who are born addicted to crack, cocaine, or with HIV often remain in the hospital long after birth. The regular touch of nurses or volunteers can help them thrive. Later life adoptions, often problematic, may owe their difficulties to the lack of early bonding of all kinds. The quality of attention that bonding requires is challenging to provide in an orphanage or in overburdened foster care.

The term bonding often is used interchangeably with attachment, a related phenomenon. Bonding, however, is confined to the newborn period. Attachment develops over a longer period of infancy.

The way parents feel about a new child is highly subjective, emotional, and difficult to measure. Some researchers in the United States and elsewhere have attempted to show that there is a sensitive period soon after birth, in which the newborn is quietly alert and interested in engaging the mother. During this time the mother is able to attune to the new child. It is assumed, but not proven, that if mothers are given the opportunity to interact with their infants at this time they are most likely to become bonded to their children—to begin to respond to them, love them, and take care of them. Fathers who are with their partners at the birth also respond to their infants in characteristic ways immediately after birth. Research into the infant bonding in same-sex marriages will yield new data about the maternal role.

American pediatricians John Kennell (1922–2013) and Marshall Klaus (1927–) pioneered research on bonding in the 1970s. Working with infants in a neonatal intensive care unit, they observed that some infants were taken away from their mothers immediately after birth for emergency medical procedures. These babies remained in the nursery for several weeks before being allowed to go home with their families. Although the babies did well in the hospital, a troubling percentage of them seemed not to thrive at home. Some became victims of battering and abuse. Kennell and Klaus noted that the mothers of these babies were often uncomfortable with them and did not seem to believe that their babies had truly survived birth. Even mothers who had successfully raised previous infants had special difficulties with the children who had been treated in the intensive care nursery. Kennell and Klaus surmised that the separation immediately after birth interrupted some fundamental process between mother and baby. They experimented by giving mothers of both premature and healthy fullterm babies extra contact with their infants immediately after birth and in the few days following birth. Mothers who were allowed more access to their babies in the hospital seemed to develop better rapport with them; they held the babies more comfortably, smiled, and talked to them more.

These studies, however, have come under attack since the 1980s. Much of the early research has been difficult to duplicate, and many mitigating factors in parent-child relationships make the lasting effects of early bonding experience difficult to define with scientific rigor.

Nevertheless, bonding research has brought about widespread changes in hospital obstetrical practice in the United States. Fathers and family members are allowed to remain with the mother during labor and delivery. Mothers are allowed to hold their infants immediately after birth. In many cases babies remain with their mothers throughout their hospital stay. Bonding research has led to increased awareness of the natural capabilities of infants at birth and has encouraged many mothers to deliver their babies without anesthesia (which depresses mother and infant responsiveness).

Research has demonstrated that immediately after birth newborns can see and have visual preferences, can hear and turn their head toward a spoken voice, and will move in rhythm to their mother's voice. Mothers and fathers allowed to interact with their newborns in this period often exhibit characteristic behaviors, such as stroking the baby, first with fingertips, then with the palm; looking in their baby's eyes; and speaking to their baby in a high-pitched voice. Researchers have also found that physical changes happen in the mother directly after birth. Most of these are hormonal increases triggered by the infant licking or sucking her nipples or increased blood flow to her breasts when a new mother hears her infant cry. Scientists speculate that there are instinctual behaviors triggered in the mother in response to the infant immediately after birth that facilitate her bonding with the infant and thus promote the infant's survival.

Research on the bonding process has been scrutinized. Detractors call attention to the shoddy research design of early studies and reject bonding as a scientific fallacy foisted on women to make them feel that they must react to their infants in prescribed fashions. Many people misinterpret bonding to mean that if the early sensitive period is missed, they cannot become successful parents. Obviously, parents can form close attachments to infants they did not see at birth, either because of medical emergencies or because their children are adopted. Early experience with the newborn is only one factor in the complex relations of parents to children.

Despite problems with quantifying bonding as a scientific phenomenon, there is a wealth of anecdotal evidence on the positive effects of an after-birth bonding experience. Most hospitals have become much more sensitive to parents' desire to be with their newborn than in the past. Some hospitals reportedly score mothers on how well they seem to bond with their infants, allegedly to flag potential future child abuse. This scoring makes early and rapid bonding a test, with failure potentially criminal, and egregiously violates the spirit of the hospital reform that bonding research brought about. If a hospital admits to testing for bonding, parents may ask if they may decline the test or if they can have access to the test results. Ideally, both the birth and the period immediately after should be handled according to the parents’ wishes and with sensitivity to the mother's wellbeing.

Resources

BOOKS

Eyer, Diane E. Mother-Infant Bonding: A Scientific Fiction. New Haven, CT: Yale University Press, 1992.

Gaskin, Ina May. Babies, Breastfeeding, and Bonding. South Hadley, MA: Bergin & Garvey, 1987.

Klaus, Marshall H., et al. Bonding: Building the Foundations of Secure Attachment and Independence. Reading, MA: Addison-Wesley, 1995.