Bonding With Baby: Tips for New Moms

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Bonding is a big, and sometimes scary, word for new parents. Are there right and wrong ways to connect with Baby? Is breastfeeding a 'must'? Can dads bond as well as moms? We brought our questions to WebMD Live and found out when Brazelton Institute child development expert Connie Keefer, MD, was our guest on June 17, 2004.

The opinions expressed herein are the guests' alone and have not been reviewed by a WebMD physician. If you have questions about your health, you should consult your personal physician. This event is meant for informational purposes only.

MODERATOR:
Welcome Dr. Keefer. What is your definition of bonding?

KEEFER:
Well, my definition of bonding is the process by which a parent and a young infant make a connection with each other, and start to build a relationship that will be very unique to them, and will be the basis for that young infant developing her sense of self and the ability to bond in the future with her own child and with other people in her life.

MEMBER QUESTION:
Doesn't that just happen naturally?

KEEFER:
Yes. Fortunately, that's a process that happens naturally in virtually every normal, reasonably healthy parent infant pair. There are a lot of triggers in a newborn infant, in particular, that bring out the strong positive feelings from the parent -- even the shape of the newborn face and head. The newborn comes ready to physically make the connection.

A newborn infant actually can see well enough, at about 8 or 12 inches distance, to make out facial features. We know this because we'll show infants a picture of a human face and a picture of anything else, and the infant, even at a few hours of age, will look longer at the face. The infant is kind of timed to favor turning towards sounds like the human voice. In addition, the human infant has a keen sense of smell, and within a few days of birth the infant will be turning preferentially to the smell of its mother or other close caregiver.

So when we have a healthy baby, and a healthy parent, they are ready to connect, and it's those naturally occurring behaviors that ensure, for most babies, that they and their parents start a boding process in the early days and weeks of life.

I'd like to point out that this process is not a simple switch that turns on or off. That's the kind of bonding that maybe a duckling does with its mother. That's very simple; they see her feet or beak, and that's what they'll follow. But the human process takes a little longer to develop and mesh the two. The bond is not so automatic, and there can be long periods in the first week where perhaps a parent doesn't feel so wonderfully happy about the baby, and we know there are babies born with problems that will prevent them being close to the parent, or having the parent hold them. But those delays can be overcome.

It's not like the baby has to do it within some very short period of time. The more time together, probably the sooner the relationship will begin to form. But there really are days and weeks, for sure, in which it can happen and be interrupted and then happen.

MEMBER QUESTION:
So I'm not awful for not falling madly in love with my baby at first sight?

KEEFER:
Many mothers -- and this is based on interviewing large numbers of women, particularly in the Western culture -- that show something similar -- many women do not feel immediately what they think they should feel. They may feel it intensely in the first day, then may wane. In one study, it wasn't until about six weeks of age that the majority of mothers most of the time reported that they loved -- they felt feelings of love for their baby. So that's an example of what I mean by process. It has ups and downs, and it does take time and contact to mature the relationship so that it can go on growing. But there's nothing abnormal about not having those feelings right away.

MEMBER QUESTION:
How important are the first few hours after delivery for bonding? My sister-in-law always tells about how the nurses whisked her baby away to be cleaned up and made "pretty" before she could hold him. I want to hold my baby right away! Should I insist?

KEEFER:
Well, I think you should insist to have that happen, to be able to receive your baby on your chest to hold, to look at, immediately after the birth. It's a wonderful time, and that's what most mothers will tell you. We don't have words for the feeling, but that contact is a wonderful pleasurable experience for most people. And the medical profession shouldn't interrupt it unless they must. If the mother is so ill or distressed from the labor or delivery, or the baby is very distressed and requires medical attention, that contact might not occur. That contact is wonderful and extremely pleasurable, it's the first building block in the path to developing strong bonding -- but when it doesn't happen, mothers and babies do make up for it.

We try in our hospital, and I write and talk about this, that we should not be separating mothers and babies, unless it is a must. A lot of procedures in delivery rooms have changed in stages during the past 25 or 30 years. And those changes have been in the direction of allowing mothers to be awake for delivery, and to have contact with their baby, and to have a significant other person with them. Or more than one, even. But the reason these steps have been able to be made has been parents, lay people we call them, speaking up loudly that they want things to be different. That combination of parents knowing there was something wrong with being separated from baby, some professionals recognizing and reporting that, I think that has made things better.

It's not the professional alone who can make that change. It requires the voice of the people. But when working together, it can be very powerful changes. Speak up to your obstetrician and/or hospital, and find one who will allow that to happen.

MEMBER QUESTION:
My nephew was born very premature and had to spend weeks in the NICU. He couldn't be held and was hooked up to machines. How will this affect his bonding with his parents?

KEEFER:
It's hard for me to say exactly how it will affect their bonding. At this point, I might introduce another term, and that's relationships. I'd like to get away from the implication of the word bonding of it being automatic and there's a critical time for it.

How it will vary depends on parents, and the baby, given the conditions in the nursery. Certainly, having that happen, having your baby born so early and not able to have contact affects development of the relationship but doesn't prevent it. The strong loving relationship can and will develop. Certainly the more time the parents can have in the nursery with the baby, probably the better they'll feel. As soon as the condition of the baby changes that will allow some contact, that would be good. But the parents should be prepared, certainly as much as and maybe more than the full-term delivered mother, for some very probably steep ups and downs in how they feel about the baby, and how they feel about themselves as parents. And that, just like with the full-term delivery, is normal. Ups and downs are normal.

I hope that your nephew's parents will have a chance as this process moves forward to meet with and talk to parents of other children who have gone through this same experience. Most of those parents are going to be able to describe very loving relationships, a very loving child, certainly as strong as they might have had with any of their other children. The beauty of the human relationship, is that they can be varied and still be normal.

When we started talking, and I defined bonding, I said that in defining it, it is a process that is going to lead to this relationship out of which the baby will develop a sense of self, and self-worth, and an ability to bond with and develop loving relationships with other people in her life, eventually with a mate, and eventually with her own children. So if we take that as the measure of bonding, we see successful bonding between prematurely born infants and their parents on each of those dimensions.

We see babies who have spent months in an intensive care unit, and now they have loving relationships with their parents. They enter playgroups and school with a positive attitude about themselves. I am meeting mothers who have been very premature themselves. And they are forming loving relationships with their babies. If we keep our eye on the slightly longer-term measure of bonding, or of how it's affected, then we have a lot of evidence that shows it doesn't necessarily have to be adversely affected. The process of getting there will feel different when your baby weighs a pound and you can't hold them until it's a pound and a half, but it's still a normal human bonding relationship.

MEMBER QUESTION:
I have to go back to work six weeks after I give birth. I have to work full time to support us and keep medical benefits. My baby will be in the care of a home daycare sitter. The baby will spend so much time with the sitter I'm afraid of how it will affect her relationship with me. Will she bond more with her sitter than me?

KEEFER:
Well, this is a question that virtually every mother asks. There are so many mothers in this predicament. It's a crime in this country that we can't afford families better. Your baby will form a positive bonding with her daycare provider. In fact, we will want her to because, again, it's out of these relationships that the baby with healthy development and sense of self come. But the baby will not love the sitter more than the parent. Even if the sitter is spending more hours of the day in contact with the baby, the mother and baby, the father and the baby, can develop a normal, healthy, strong relationship. They can go through the process of bonding. What the mother is feeling is natural and common.

At the Brazelton Touchpoints Center where I work, we are actually actively engaged in working with childcare providers to assist them in understanding what parents are going through when they do have to leave their baby. We're doing that because we know there is strong evidence that the children, in terms of development, behavior, and sense of self -- those outcomes are significantly improved when the childcare worker and parents have a good relationship with each other. In our work with providers, and with people who train childcare providers, we are enhancing their understanding of parents, and we are helping them form more positive relationships with the parents of the children they serve.

So if you can take the time, or try to work your childcare person towards this, if you can make having a relationship with the childcare person -- meaning you can talk about these things, first of all -- you should be able to say, "I feel bad leaving him with you, and I'm afraid he'll love you more than me." The care provider should be able to say that they will love them as much as they can, but want to care for him for you, and he will love you more and know you as his mother. So when parents and childcare workers can be open with each other, it's almost like they're trying to help them see themselves as making up a system of caring for the infant.

We're trying to set up a model where the care providers and parents see themselves as part of a system of care for the infant, and are not competitors. They each bring requirements for their relationship with the baby. They each bring their own special ways with being with the baby, and the baby will strive. It takes some work to get to that position to really like each other, the parent and child care provider. Just like the relationship with the infant, the relationship with the childcare provider may take some time.

I would suggest to anyone who is interested in this, you are welcome to contact the Brazelton Institute. Anyone facing this, you can go to the Brazelton Touchpoint Center web site, and find out if there's childcare in your area, your town, that has been alerted to this kind of process, or get other information on how to help your own childcare provider move in this direction. Another organization called Zero to Three, and it is a national organization, based in Washington, and is invested in supporting parents and professionals who deal with families with young children from age 0 to 3. They may have information about how to choose or find a childcare person.

MEMBER QUESTION:
Just because my baby sometimes makes me want to scream in frustration doesn't mean I'm not bonded to her, right? I feel so guilty when I have those feelings, but the crying and constant feeding can really get to you.

KEEFER:
Right. Most parents have those feelings, at times. This can happen at any age. Every parent feels that they're angry with the baby, and have moments that they wonder why they did this. Those early weeks and months are a tremendous bit of work, where you get little or no sleep and little reward at that time. We do know that it's very important for the mother to be able to turn to someone or cry about it or hand the baby off; maybe that's why there's often two parents or extended family. So hopefully she has that.

If, in fact, a mother of a young infant, if she's feeling that all the time, which some mothers do, if she's thinking thoughts like, 'I don't want to be with this baby,' again, it's normal when they are brief, and in the early weeks. But if those feelings or thoughts last throughout the day or a number of days, the mother may be suffering an illness, a real disease, postpartum depression, and should seek help through her pediatrician or her obstetrician. Most are very aware of this.

But for sure, the mother who feels that intermittently in the first couple of weeks has joined a great sisterhood. And she and her baby will grow to love her baby very much.

MEMBER QUESTION:
I am adopting a baby who will be about 5 months old when she joins our family. Do you have any advice for bonding with her? I'm afraid she won't think of me as mommy!

KEEFER:
Wonderful question, and a wonderful experience that this family is entering into. Thank you for doing this family creation. The baby will think of you as mommy, no question about it if that's how you act with her. She will love you -- at almost any age, a loving relationship can develop. Certainly at five months it will develop. In terms of what you do, just try to be with the baby initially. Try to watch her, try to learn what kind of little person she is. You want to fall back on trusting yourself as a normal, healthy parent, a parent who can get to know this baby.

A 5-month-old will be going through an adjustment to this new care giving setting. That's one thing the parents need to realize and respect, and realize that the baby may be somewhat disorganized and may cry a lot, maybe seem to sleep too much or not enough. Those initial behaviors are part of the adjustment and not to be read as the baby not thinking of her as mommy. These adjustment behaviors are normal on the part of the baby. She has to go through them. It's almost like she's disconnecting from one set of environmental triggers, and she must shake them up a little so she can connect to this new set of care giving.

So the big thing for a lot of adoptive parents is that they're looking at any difficult behavior within the first weeks, and interpreting it, but it's just a normal transition. Just be with the baby, hold her and love her, as much as she seems to want. I wouldn't be afraid to give her lots of contact and cuddling. Let her sleep beside you. Respond to her cries. I don't think you'll spoil her. You will be showing her you are there for her, and she will find a way to connect with you.

MEMBER QUESTION:
Is there any research that shows breastfed babies bond easier than bottle-fed?

KEEFER:
I'm not aware of any research that shows differences between bottle-fed and breastfed babies, in terms of the child's sense of self, the child's ability to form loving relationships. I'm not aware of any difference in bottle-fed and breastfed babies on that. Breast is certainly best in many ways for babies and mothers, but that's not an outcome that one expects to watch for in a bottle-fed baby.

MEMBER QUESTION:
What are some ways dad can bond with his newborn baby?

KEEFER:
Like I was saying, the baby will learn to recognize and then want to look for and hear the face and voice that he's seeing. So it's reinforcing. In the newborn hospital and at pediatric checkups at two or three weeks, we demonstrate that the baby can and will hear the parent's voice when they call his name. Just with the voice close to the baby, they will turn to the father's eyes. Most fathers who have that experience are very moved by it. And it reinforces the sense of pleasure with being with the baby.

I talk to a lot of fathers who enjoy having the baby lie on their chest. Even in the ICU we have babies lie on father's bare chest to get skin-to-skin contact. This is very healthy and very helpful to these premature babies in the NICU. We also encourage in the full-term babies the same contact. Having the contact in the first days and weeks seems to be helpful for parents and babies to get in sync with each other. That's part of the bonding process.

MEMBER QUESTION:
I never worried about "bonding" with my older children. I just fed them, held them, talked to them, made faces ... It seems like it's a new buzzword now, and I wonder if there is something different I should do with a new baby.

KEEFER:
This brings us back to the first question, which is, isn't this natural? Yes. When a mother feeds, loves, and responds to the baby's distress, they will bond and attach to her. When she's doing those things, these other little things are happening anyway. I'm glad you did that with your children.

We do know more of the specifics these days about the process, and we do find parents who are under a lot of stress that maybe they weren't under in the past, that maybe our society distances parents from their children, and this information is so important for professionals to keep in mind more than healthy parents to learn.

MODERATOR:
Unfortunately, we are out of time. Thanks to Connie Keefer, MD, for sharing her expertise and experience with us.

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