This is an important statement made by a much-loved midwife and is based on research conducted by John Bowlby, Marshal Klaus, Lloyd De Mause, Dr Arthur Janov, Allan N. Schore, Dr Michel Odent and Dr David Chamberlain, among others. The research investigates the attachment and neurobiological effects of experiences before, during and after birth and explores how these first experiences prime the baby’s brain and body responses for a lifetime. Evidence suggests that traumatic events and prolonged stress and/or separation during pregnancy, birth and the postpartum period may permanently affect a baby’s developing brain structures and patterns of behaviour.
Conversely, a baby whose mother is happy, well prepared for her labour, allows her labour to progress with confidence and courage and gives birth spontaneously, without drugs or pain relief, ensures that her baby is biologically primed for adaptation and social responsiveness after birth. This is as a result of the release of a cocktail of what Dr Michel Odent calls the “Love Hormones”, namely oxytocin, prolactin, relaxin, endorphins, and a smattering of adrenalin for alertness. Love hormones are released during labour in ever-increasing spurts, so that immediately after birth, ‘love hormone’ concentrations in the blood stream are at their peak and a woman is primed for attachment, as is her baby. This period straight after birth is recognised as a biologically “sensitive period” when mother and baby are alert and awake so that they recognise and bond with each other. These early interactions lay the foundation for social communication patterns and early personality development. In fact Dr Michel Odent goes so far as to ask the question about elective caesarian operations, when a woman does not have these ‘love hormones’ in high concentrations in her body: how does the elective caesarian section prime a mother and baby for attachment? In animal research ( rats, sheep), when labour is interfered with, mothers reject their young; for example, when a ewe is given an epidural or chloroform, this ewe will ignore her offspring after birth. It is essential for the survival of the young of any species that a mother is attached and motivated to care for her progeny. This necessity is an imperative in human beings, because our offspring are helpless and dependent on our care for survival for approximately 13-18 years. Human babies do not walk or swim like other mammals straight after birth; it will be at least a year before a human baby will toddle teeteringly on his two legs!
During most caesarian sections, a newborn baby is separated at birth from his mother, sometimes for hours, even days. The incidence of breastfeeding difficulties between mother and baby rises sharply when a woman has an epidural or elective caesarian section. It is also cumbersome for the mother to handle her baby confidently, because she is in pain from the uterine and abdominal scar.
Early attachment deficits and impaired bonding may lead to misattuned communication between mother and baby, as a result of what Bowlby terms ‘dissociation’ after separation and loss. The psychobiological structures of the baby’s brain are highly susceptible to imprints and experiences from conception to 2yrs old, and no less at the time of birth. Brain changes occur and synapses are connected during a traumatic birth and /or separation. A dissociated and unresponsive baby will also be unable to elicit responses from the mother by being aware and opening his eyes, touching the mother with his hands and responding to her voice. This in turn may result in lack of responsiveness from the mother, leading to problems in communication within the mother-infant dyad and possible developmental delays in the growing baby. A baby is exposed to the mother’s neuro-hormonal and neuro-chemical status in the womb via her bloodstream through the placenta. When a human being is stressed for long periods of time, the body produces a steroid hormone called cortisol. High levels of cortisol in the body eventually damage organs and healthy body functions.We also know that high levels of cortisol for long periods of time damage the cells in the hippocampal region of the brain, shown to be part of the emotional centre of the brain. In animal research, the death of cells in the hippocampal region of the brain leads to aggressive behaviour and less socially co-operative behaviour.
Trauma experienced by a pregnant woman will affect the unborn child in the womb. Women who are unsupported socially experience high stress levels and this is turn affects the fetus. A teenage pregnancy, alcohol abuse, violence int the family or community, malnutrition and /or famine are a few of the scenarios that can have negative consequneces on the unborn baby.
Caesarian section, while absolutely necessary as a life-saving intervention in medical emergencies, is a violent operation for both mother and baby. Major abdominal surgery is a shock to the mother’s body and is monitored carefully by an anaesthetist for the duration of the operation, and post operatively for several hours. The baby is pushed out of the womb, within a few minutes, into a brightly lit, noisy environment and roughly wiped by strangers before being whisked off for an examination and injections by the pediatrician and nurses. This means loss and separation for the baby and an overwhelming sensory experience that, if prolonged, could have adverse influences on limbic system brain reponses. How do we prevent fetal and neonatal trauma, separation and loss experiences around the birth process? It is possible to facilitate kangaroo mother care in theatre and minimize separation of the family members. The skin to skin contact elicits the release of oxytocin for both mother and infant and assists the bonding process, mitigating the effects of surgical birth.
Trauma, loss and separation must be avoided as far as possible during pregnancy, birth and the postpartum period. When trauma and loss occur the effects can be mitigated through ensuring reflective and caring social support and encouraging skin-to- skin contact between mother and baby as soon as possible after birth. Pregnant women need to be surrounded by loving people, need to be supported and helped when they experience stressful circumstances, and need to be allowed and encouraged to give birth without disturbances and unnecessary interventions. Labour is a normal, physiological and biological process and works well for 85% of women. The baby should not be separated from the mother for at least the first hour after birth, even more so when a caesarian section is medically necessary,- babies can be handed to the mother in theatre and kept warm next to her body. Effort should be made to refrain from administering drugs and epidurals, as these negatively affect the baby and subsequent breastfeeding and attachment processes. Instead, giving women tools and information that will empower them such as Antenatal workshops, Birth Preparation Classes, Assistance of Doulas during labour, Midwife Assistance at Birth, Homebirth, Gentle Birth, Water Birth are all vehicles that teach the parents how to protect the integrity of the baby-mother dyad. Every effort should be made to treat women giving birth with reverence and respect, providing guidance and encouragement and the right environment for birth.
Having said all this, it is important to remember that attachment and bonding are flexible. When a woman is well supported and loved, she is able to bond with her baby deeply in the pregnancy and the attachment between them will be minimally affected if there is a traumatic intervention such as an emergency caesarian section or separation of the baby. Many mothers vigilate next to the incubator when their babies are ill and in need of medical care, and sustain the attachment in small ways that assist with later recovery of closeness.
To conclude, a society that respects women and their role in childbearing respects the baby. A society that reveres natural birth and encourages women to approach birth with confidence and love accentuates and underscores her capabilities as a mother and gives her the best possible start to mothering and communication with the baby. This confidence in turn helps protect the baby’s developing brain from assault and neurological deficits.
Bowlby, J. (1969). Attachment and Loss. Vol 1. Attachment. New York: Basic Books.
Bowlby, J. (1973). Attachment and Loss. Vol 2, Separation, anxiety and anger. New York: Basic Books.
Bowlby, J. (1981). Attachment and Loss Vol 3: Loss, sadness and depression. New York: Basic Books
Field, Tiffany (Ed). (1995). Touch in Early Development. New Jersey: Lawrence Erlbaum Associates.
Janov, A. (2000). The Biology of Love. New York: Prometheus Books
Klaus, M.H., & Kennell, J. H. (1982). Parent-infant bonding. St Louis: Mosby.
Klaus, M.H., Kennell, J.H., Plum, N., & Zuehlke, S. (1970) Human maternal behaviour at first contact with her young. Pediatrics, 46, 187-192.
Klaus, M.H., Kennell, J.H., Robertson, S., & Sosa, R. (1989). Effects of Social support during parturition on maternal and infant morbidity. British medical Journal, 293, 585-587.
Schore, A. N. (2003). Affect Regulation and the Repair of the Self. New York. W.W. Norton and Company.Inc.
Odent, M. (2001). The Scientification of Love. London: free Association Books.