Bonding

Guest Post: Psychological benefits of breastfeeding and bonding

Painting by Alex Grey
http://alexgrey.com/
Written by Allison Gamble

In a world so full of scientific and technological advances, there are few things that are more natural than breastfeeding. This beautiful experience that is shared between mother and child has long been known for its many health benefits, but it doesn't take a psychology degree to see the benefits breastfeeding provides mentally. Despite the fact that there are a number of ways to bond with a child, breastfeeding has been proven to not only create a physical connection, but an emotional one as well.

Although the bonding process is said to begin in the womb, many women feel that the true psychological impact begins when skin to skin contact can be made. This impact is usually enforced by the frequent contact and interaction that occurs when a child is breastfed without restrictions or schedules. Though this almost constant contact can have a number of benefits for the child, for the mother, this contact creates a feeling not only of closeness with and affection for her child, but can serve to enhance her desire to be nurturing, and can also foster a feeling of confidence and accomplishment. After all, she is providing sustenance and good health to the life she has helped to create.

Despite the fact that many common psychological aspects are directly related to the physical contact that occurs during breastfeeding, many other mental and emotional responses can be directly linked to the release of hormones. For instance, in order for the milk to drop in the mother's breasts, a hormone known as oxytocin must be released into the system. Although this hormone acts in a number of ways to help the physical process of nursing, it also has a strong influence on emotions, often creating a general sense of well-being, happiness and love. Because of this, it is easy to link the child with this new-found feeling of contentment, and thus, the connection deepens.

Two other hormones that can benefit the psychological health of the mother are prolactin and cholecystokinin. Prolactin is best known as an aid in the production of breast milk. However, it is also thought to have an influence on maternal behavior, and in some animal studies, it is shown to act as a stress reducer and pain reliever. Like prolactin, cholecystokinin is thought to work as a pain reliever, but is also said to have a relaxing effect on both mother and baby. These three hormones work together in harmony, and because of this, mothers who breastfeed are thought to be generally calmer, have lower blood pressure, and are typically more responsive to their baby's needs and emotions.

Breastfeeding is undoubtedly favored by those seeking a more natural approach to child-rearing as it not only enhances the connection between mother and child, but also fits in well with other natural practices. For instance, mothers who breastfeed are more likely to practice co-sleeping. This particular process can further enhance the bond between both the mother and father, and the father and child, as sharing a family bed makes it much easier for the father to interact in an intimate manner with the child, and assist the mother in nursing. It may also aid in fostering feelings of attachment, emotional openness and trust across the entire family.

For babies, the psychological experience of breastfeeding is in many ways similar to that of the mother. For instance, skin to skin contact helps to provide the baby with a feeling of warmth and closeness. Additionally, this contact aids in the release of oxytocin, which in turn, gives the child the same feeling of contentment as the mother. Despite this, there are several psychological factors that differ from the mother. Many of these factors occur directly at the time of nursing, while others have a more long term effect.

In the early stages of the nursing process, while adjusting to the bright, loud external world, the intimacy of breastfeeding helps the child cope with the stress of its new life. It can also help to provide a feeling of safety, continuity and reassurance. Additionally, nursing can help the child to develop the simple feelings of attachment, love and affection through the natural bonding.

Long term effects are frequently the result of the tender experiences that go hand in hand with breastfeeding. In some research studies, it has been found that children who were breastfed were generally more likely to be assertive, confident and mature during their developmental years. Some reports suggest that, in the long term, breastfed children are less likely to develop behavioral, learning and psychological issues. These factors may be due in part to the chemical factors involved in breastfeeding; however, much of the credit can be given to the intimacy and bond that is created through the practice. For example, nursing allows the child to be given undivided attention, which may play a large part in the building of confidence. Mothers who breastfeed are more likely to talk to, hug and stroke their children while feeding, which may aid in the development of a sociable or affectionate nature later in life.

Aside from the numerous nutritional, economic and even societal benefits, nursing offers a natural way to improve the lives of children, mothers and families as a whole. From time immemorial, this nurturing, nourishing practice has been performed; however, in modern times it is beginning to fall by the wayside. Despite this, advocates of breastfeeding can feel secure in the fact that they are giving their children the best possible start in life – both in body and in mind.

Author Bio: Allison Gamble has been a curious student of psychology since high school. She brings her understanding of the mind to work in the weird world of internet marketing.
Birth

International MotherBaby Childbirth Initiative

Below is a document outlining the care YOU should be receiving from your obstetrician, gynecologist, midwife or other health professional throughout your childbearing years. The full PDF of the document below is available here.

The International MotherBaby Childbirth Initiative (IMBCI) is an evidence‐based global effort developed in the early 2000s to:

  • Improve maternal care during birth in order to save lives and prevent harm from the overuse of obstetric technologies.
  • Promote care during labour and birth and breastfeeding that is centered on physiology and normalcy.
  • Emphasize a humanistic women‐ and family‐centered approach and all types of care most conducive to good outcomes, including collaboration among involved professionals, midwifery knowledge and skills, hands‐on support for the mother.

The 10 Steps of the MotherBaby Childbirth Initiative are based on the results of best available evidence about the safety and effectiveness of specific tests, treatments, and other interventions for mothers and babies. "Safe" means that care is provided through evidence-based practices that minimize the risk of error and harm and support the normal physiology of labour and birth. "Effective" means that the care provided achieves expected benefits and is appropriate to the needs of the pregnant woman and her baby based on sound evidence. Safe and effective care of the MotherBaby provides the best possible health outcomes and benefits with the most appropriate and conservative use of resources and technology. Optimal MotherBaby maternity services have written policies, implemented in education and practice, requiring that its health care providers:

Step 1 Treat every woman with respect and dignity, fully informing and involving her in decision making about care for herself and her baby in language that she understands, and providing her the right to informed consent and refusal.

Step 2 Possess and routinely apply midwifery knowledge and skills that enhance and optimize the normal physiology of pregnancy, labour, birth, breastfeeding, and the postpartum period.

Step 3 Inform the mother of the benefits of continuous support during labour and birth, and affirm her right to receive such support from companions of her choice, such as fathers, partners, family members, doulas4, or others. Continuous support has been shown to reduce the need for intrapartum analgesia, decrease the rate of operative births and increase mothers' satisfaction with their birthing experience.

Step 4 Provide drug-free comfort and pain-relief methods during labour, explaining their benefits for facilitating normal birth and avoiding unnecessary harm, and showing women (and their companions) how to use these methods, including touch, holding, massage, labouring in water, and coping/relaxation techniques. Respect women's preferences and choices.

Step 5 Provide specific evidence-based practices proven to be beneficial in supporting the normal physiology of labour, birth, and the postpartum period, including:
  • Allowing labour to unfold at its own pace, while refraining from interventions based on fixed time limits and utilizing the partogram to keep track of labour progress;
  • Offering the mother unrestricted access to food and drink as she wishes during labour;
  • Supporting her to walk and move about freely and assisting her to assume the positions of her choice, including squatting, sitting, and hands-and-knees, and providing tools supportive of upright positions6;
  • Techniques for turning the baby in utero and for vaginal breech delivery;
  • Facilitating immediate and sustained skin-to-skin MotherBaby contact for warmth, attachment, breastfeeding initiation, and developmental stimulation, and ensuring that MotherBaby stay together;
  • Allowing adequate time for the cord blood to transfer to the baby for the blood volume, oxygen, and nutrients it provides;
  • Ensuring the mother's full access to her ill or premature infant, including kangaroo care, and supporting the mother to provide her own milk (or other human milk) to her baby when breastfeeding is not possible.
Step 6 Avoid potentially harmful procedures and practices that have no scientific support for routine or frequent use in normal labour and birth. When considered for a specific situation, their use should be supported by best available evidence that the benefits are likely to outweigh the potential harms and should be fully discussed with the mother to ensure her informed consent. These include:
  • shaving
  • enema
  • sweeping of the membranes
  • artificial rupture of membranes
  • medical induction and/or augmentation of labour
  • repetitive vaginal exams
  • withholding food and water
  • keeping the mother in bed
  • intravenous fluids (IV)
  • continuous electronic fetal monitoring (cardiotocography)
  • pharmacological pain control
  • insertion of a bladder catheter
  • supine or lithotomy (legs-in-stirrups) position
  • caregiver-directed pushing
  • fundal pressure (Kristeller)
  • episiotomy
  • forceps and vacuum extraction
  • manual exploration of the uterus
  • primary and repeat caesarean section
  • suctioning of the newborn
  • immediate cord clamping
  • separation of mother and baby
Step 7 Implement measures that enhance wellness and prevent emergencies, illness, and death of MotherBaby:
  • Provide education about and foster access to good nutrition, clean water, and a clean and safe environment;
  • Provide education in and access to methods of disease prevention, including malaria and HIV/AIDS prevention and treatment, and tetanus toxoid immunization;
  • Provide education in responsible sexuality, family planning, and women's reproductive rights, and provide access to family planning options;
  • Provide supportive prenatal, intrapartum, postpartum, and newborn care that addresses the physical and emotional health of the MotherBaby within the context of family relationships and community environment.
Step 8 Provide access to evidence-based skilled emergency treatment for life-threatening complications. Ensure that all maternal and newborn healthcare providers have adequate and ongoing training in emergency skills for appropriate and timely treatment of mothers and their newborns.

Step 9 Provide a continuum of collaborative maternal and newborn care with all relevant health care providers, institutions and organizations. Include traditional birth attendants and others who attend births out of hospital in this continuum of care. Specifically, individuals within institutions, agencies and organizations offering maternity-related services should:
  • Collaborate across disciplinary, cultural, and institutional boundaries to provide the MotherBaby with the best possible care, recognizing each other's particular competencies and respecting each other's points of view;
  • Foster continuity of care during labour and birth for the MotherBaby from a small number of caregivers;
  • Provide consultations and transfers of care in a timely manner to appropriate institutions and specialists;
  • Ensure that the mother is aware of and can access available community services specific to her needs and those of her newborn.
Step 10 Strive to achieve the 10 Steps to Successful Breastfeeding as described in the WHO/UNICEF Baby-friendly Hospital Initiative:
  1. Have a written breastfeeding policy that is routinely communicated to all health care staff.
  2. Train all health care staff in skills necessary to implement the policy.
  3. Inform all pregnant women about the benefits and management of breastfeeding.
  4. Help mothers initiate breastfeeding within a half-hour of birth. Place babies in skin-to-skin contact with their mothers immediately following birth for at least an hour and encourage mothers to recognize when their babies are ready to breastfeed, offering help if needed.
  5. Show mothers how to breastfeed and how to maintain lactation, even if they should be separated from their infants.
  6. Give newborn infants no food or drink other than breastmilk, unless medically indicated.
  7. Practice "rooming in"-- allow mothers and infants to remain together 24 hours a day.
  8. Encourage breastfeeding on demand.
  9. Give no artificial teats or pacifiers (also called dummies or soothers) to breastfeeding infants.
  10. Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from the hospital or clinic.
The International MotherBaby Childbirth Organization, in collaboration with other organizations, is developing a companion document detailing the extensive scientific evidence supporting the 10 Steps of the IMBCI, and will update both documents over time as needed to reflect the best available research.

Get more info about IMBCI here.
Birth

Protecting the mother-child bond

I still get a rush of energy when I look in my son's eyes (now a toddler), reminiscing the moment I first laid eyes on his beautiful face after he was born. I picture it so vividly and clearly. I don't know how I'd get through the tough times not feeling it – but many mother's don't, and struggle with motherhood because of it. Which is why its imperative to know how the mother-child bond is formed.

 After researching the topic I found the creation of the mother-child bond is initiated by a surge of hormones immediately after birth, known as 'birth euphoria'. Mother and baby are flooded with endorphins – inducing a sense of happiness and wellbeing, and oxytocin – inducing a sense of trust, being in love and a need to nurture. It's vital mother and baby are left for at least 60 minutes, in a quiet, safe and private location to bond while these hormones are coursing through their veins. This experience is powerful, and will later prompt mother and child to repeatedly seek to recreate the initial birth high with close skin to skin contact.

Anything that interferes with the normal progression of birth, such as pain medication, epidurals, cesareans, emergency surgery, removal of infant to the ICU or excessive stress, will disturb the delicate process in which the initial mother-child bond is formed.

Oxytocin will only be produced when the mother feels safe. If the mother feels anxious, stressed, frightened or angry, oxytocin will not be produced. Similarly endorphins will only be produced upon the sensation of pain. If the mother has taken anything to reduce pain, such as medication, or had an epidural or cesarean, endorphins will not be produced. It's like a scale, the more interference, the less critical bonding hormones produced.

In animal studies, animal mothers given pain relief during birth, or deprived of birth euphoria in any other way, simply end up rejecting their young. I have no doubt this correlates to the human birth experience, and our epidemic of post-natal-depression.

Bonding Recommendations
  • Stay comfortable, relaxed and confident.
    Be informed and prepared. Have trust and confidence in your instincts and your body's natural abilities.
  • Give birth in a safe, private environment.
    Free of conflict, unwelcome people, disturbing noises, or painful, disruptive procedures.
  • Have continuous physical and emotional support at the birth.
    Have a knowledgeable, caring woman, such as a doula, in addition to the partner, offering comfort measures, good information, positive words, and any other support needed.
  • Avoid pain medications and epidurals.
    Not only do they totally compromise the bonding process, they pass onto the baby affecting its ability to initiate suckling.
  • Hold off non-urgent hospital procedures.
    If the baby has a good Apgar score and appears normal, the baby should not receive a bath, footprinting, administration of vitamin K or eye medication until after the first hour, to allow mother and baby to bond.
  • Lay undressed baby on the mothers bare chest immediately after birth.
    Use a light blanket for warmth. Allow the baby to slowly crawl to the nipple and initiate suckling. The odor of the nipple guides the newborn to the breast. Remain with baby on mother's chest for at least one hour to allow bonding.
  • Make sure you start breastfeeding within one hour.
    Studies show breastfeeding within this timeframe significantly raises the success of mother-child bonding, the continuation of breastfeeding, and decreases likelihood of abandonment.
  • Avoid the nursery and room-in with baby.
    All babies should room-in with their mothers throughout their hospital stay unless this is prevented by illness of the mother or infant.

References

Bonni Hall: Endorphins, Labour, Pain and Bonding
by Relentless Abundance
Bonding & Undisturbed Attachment 
by Sem Pringpuangkaew M.D., Prawase Wasi M.D,  Dr.Aree Wanyasewi M.D.,  Kaisit TantiSirin M.D., San Singhaphakdee M.D., Rajit Buri M.D.
The Truth About Epidurals
By Carol Gray