Parent-Baby Attachment in Premature Infants (Psychology Revivals)

John Davis, Martin Richards, N R C Roberton

• Publisher: Routledge
• Year: 2014
• eBook ISBN: 9781317607434
• Topic: Psychology
• Subtopic: Developmental Psychology
• Index: Psychology

Originally published in 1983, in the two decades prior to publication, specialised neonatal units for the treatment of sick or preterm babies had been set up in most major neonatal centres. In the early years these units did little to prevent separation of parents and babies and evidence accumulated of the ill effects of this situation. In addition, we had gradually become aware of the difficulties of building a relationship with a sick or immature baby even under more ideal circumstances.

This book, in a series of authoritative review chapters, sets out to describe the process by which social relationships develop after birth and the ways in which this process may be distorted by separation, the condition of the baby or by the process of medical treatment. Experienced practitioners describe practical steps which may be taken to support parents and foster their relationship with their babies in treatment situations. The final section of the book examines the organisation of neonatal care in a number of widely different settings and indicates that diverse approaches may be successful in achieving the same ends.

Part One

THEORETICAL BACKGROUND

1	PARENT-CHILD RELATIONSHIPS: SOME GENERAL CONSIDERATIONS
	Martin P. M. Richards

Introduction

The aim of this book is to improve the services that are designed to care for pre-term and other sick babies and their families. In particular, we focus on the relationship of parent¹ and child, its potential vulnerability and the ways in which it may be fostered and supported. Our concern is both with the elimination of medical practices and hospital routines that may distort or inhibit the initial phases of parental relationships and with the development of procedures that may positively encourage their growth and provide good experiences for mother, father and other family members. To have any chance of success, a programme designed to support parenthood must be based on a clear understanding of the nature of relationships between parents and children, their growth and development and the factors that may damage or enhance them. To claim that we have such a-full understanding would be overoptimistic, if not a little arrogant. But I believe that some of the broad principles are reasonably clear and it will be these that I shall describe in this chapter.

In the past decade the discussion of parent-child relationships in the neonatal period has been dominated by the concept of ‘Bonding’. This notion was originally proposed by the American paediatricians Marshall Klaus and John Kennell². From their observations of the unsatisfactory mother-infant relationships that they saw after a period of separation caused by the admission of the baby to a neonatal unit or simply unnecessary limitation of mother-infant contact through maternity hospital routines, they suggested that there may be a sensitive period in which a mother is especially ready to form a good relationship with her baby. If separation keeps the two apart during this time, which they hypothesised lasts a day or so, they thought a permanently damaged relationship might ensue. This dramatic proposal became accepted very widely, though uncritically, and has done much to focus attention on some of the undesirable aspects of hospital rountines for parents and children. While the idea that a mother’s relationship to her baby might be particularly sensitive to separation at birth was not a new one (see Chapter 2), it had not been stated in quite such stark terms in recent times.

The wide acceptance of the idea of bonding also reflected a growing questioning from both parents and some professionals about the ways in which hospital care seemed to disrupt patients’ social relationships. Already there were examples where such questioning had led to improvements in practice; for instance, the acceptance of fathers in the delivery room, the provision for parents to stay with their sick children in hospital, the encouragement of breast feeding and a general relaxation of rigid routines in lying-in wards. Given these changes, it was not surprising that attention was turned to neonatal units (NNUs) and the separation of parents and children that they might bring about. The idea of bonding provided a convenient rallying point for those who wished to improve things for parents and their infants in NNUs. It is unlikely to be an accident that the interest in bonding arose at a time when this form of neonatal care was developing very rapidly and an increasing proportion of babies were being admitted to these units³ (see also Chapter 2).

However, the notion of bonding has not been without its critics.^4–8 As a way of organising the discussion in this chapter I shall first deal with some of the objections to it. Though I believe that the evidence for the existence of a process of bonding is unsatisfactory, there is no reason to assume that separation of parent and child at birth is of no consequence. The concept was simply one attempt to unify a series of observations about the effects of the neonatal separation of mother and child. In putting it forward Klaus and Kennell provided a great stimulus for further research as well as opening up the discussion about the needs of parents and their babies in neonatal units. More recent research may have shown the concept to be over-simple, but it has also demonstrated the vulnerability of social relations in the neonatal period to interference. It is this broader view of growing parent-infant relationships that will form the subject of the final part of the chapter.

Some Criticisms of the Concept of Bonding

As originally proposed by Klaus and Kennell², the support for the concept of bonding came partly by analogy with the behaviour of certain animals. They described observations on sheep and goats which were interpreted as evidence for a brief sensitive period in which a mother learnt the specific characteristics of her kid or lamb. If separation occurred during this sensitive period, the offspring might be permanently rejected.⁹

The main problem about using the analogy between the behaviour of sheep and goats and our own species is that parental behaviour is organised in a quite different way in each case and any similarity is likely to be quite coincidental. Sheep and goats live in herds and their young move around with the group almost immediately they are born. Breeding takes place at a specific season. This means that at certain times of the year there are likely to be a large number of lactating females and of young in the herd. Selection seems to favour a system whereby a mother suckles only her own young. While young are apparently ready to approach any mother, the mothers are selective and only allow their own offspring to feed from them. In order for them to achieve this selectivity they must be able to recognise their own young from birth, hence the need for a system of rapid learning of the individual characteristics and for rejecting ‘alien’ young.

Our own species organises social life and reproduction in quite a different way. As most human generations were passsed in hunting and gathering, it is in that kind of society that our reproductive patterns developed. The evidence suggests that hunter-gatherer groups were small and that births were widely spaced – perhaps by four years if we take the example of surviving hunter-gatherers like the !Kung San.¹⁰ Thus at any time there are unlikely to be more than a couple of newborns in the group so that questions of confusion in identification do not arise, especially as our offspring take many months to develop independent mobility. Furthermore, human fetuses are large and relatively difficult to deliver, so that childbirth was probably the major cause of adult female mortality. If a mother died but the infant survived it would be most maladaptive if the offspring were rejected by other adults.¹¹ Short of a maternal death, a mother might be unable to cope with her baby for some time after delivery; again it would not be advantageous for her to reject her baby permanently after this kind of experience.

It is difficult to think of a plausible reason why our species might have developed a brief sensitive period for the formation of parental relationships. All speculation seems to run in the opposite direction and to suggest that the optimal system would be one in which a mother (or other adult) would build the social relationship at a time and pace which could vary with the particular circumstances. Indeed, the great variety of social arrangements for birth and the neonatal period that may be found around the world is a testament to the adaptability of human behaviour.

The second general point of criticism of the ‘bonding’ concept concerns the process by which a sensitive period – supposing one existed – was produced and then brought to an end. We have no independent evidence that there is such a period and we cannot observe or measure it directly. It is simply a concept postulated to account for the observations made in some of the studies of the consequences of early separation. There are many psychological phenomena that lack any kind of satisfactory explanation. But the bonding concept simply describes a state of affairs – that relationships appear to be inhibited if separation occurs – and it provides no account of why this should be or how such a process occurs. It also, of course, fails to account for cases where good parental relationships arise despite separation after birth and those, for instance, that may form between infants and step or adoptive parents.

Another difficulty with the bonding concept is that it ignores the general human concern for the meaning and interpretation of events and the point that individuals may react to the same external event in widely differing ways. In this sense universal laws may only be found at a level of generality that makes them of little practical utility. Separation at birth may well influence a parent in a numbe...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Original Title Page
• Original Copyright Page
• Table of Contents
• Preface
• Contributors
• Part One: Theoretical Background
• Part Two: Practical Management of Parent-Baby Interaction in Neonatal Units
• Part Three: Case Studies of Routines Used in Neonatal Units
• Part Four: The Future
• Appendix: A Guide for Parents of Babies in the Special Care Baby Unit Joanna T. Hawthorne Amick
• Subject Index
• Author Index