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Column Editor's Note: We gratefully acknowledge anthropologist
Robbie Davis-Floyd for this contribution to The Powerful Parent-Infant
Connection. It is from her path-breaking book, Birth as an American
Rite of Passage (University of California Press, 1992). "Bonding
Period" is a portion from the chapter "Messages"
designed for the web by Ed Goldberg. The full chapter is at
birthscene/messages. This article contains an in-depth discussion of
the work of bonding pioneers Marshall Klaus and John Kennell as well
as an overview of the concept of a "sensitive period" after
birth. For more information about her ideas and writings, see her
illuminating website.
Description and Official Rationale
There is no mention of bonding in the 984 pages of Williams
Obstetrics, and only one short paragraph about "rooming-in"
(1989:243). Nevertheless, most of the women in my study were handed
their babies in the delivery room so that they could experience a
short "bonding period," usually after the babies had been
washed, weighed, wrapped, and given their shots and their eye drops,
but sometimes immediately after the birth. Bonding became part of
normal birth routine in many hospitals due to the combined efforts of
La Leche League and other childbirth activists, and to the concerted
pleas of two pediatricians, Marshall Klaus and John Kennell. In
Parent-Infant Bonding, first published in 1976, Klaus and Kennell
point out the existence of a "sensitive period" immediately
after birth during which maternal-infant attachment seems to occur
much more readily than if mother and child are separated after the
birth, as used to be standard hospital practice: "We believe that
there is strong evidence that at least 30-60 minutes of early contact
in privacy should be provided for every parent and infant to enhance
the bonding experience" (Klaus and Kennell 1982:56).
Physiological Effects
Some researchers believe that there are no physiological effects of
early bonding, that it is in fact a "scientific fiction"
(Eyer 1992). On the other hand, proponents of bonding suggest that the
physiological benefits of early "bonding" may be numerous.
These potential benefits are eloquently summarized by Wenda Trevathan,
who provides an exhaustive analysis of bonding research in Human
Birth: An Evolutionary Perspective (1987:193-220):
Touching and massaging the infant stimulates breathing, provides
warmth, and serves to rub the fatty vernix caseosa into the skin,
which may prevent dehydration. If she holds it over her heart, on the
left side of her body, the mother may be quieting the infant with the
rhythmic beat that was an important part of its intrauterine
environment. Holding it on the left may also facilitate eye contact,
in that most infants prefer to turn their heads and look to the
right....The infant may lick, nuzzle, or even suckle the mother's
breast in the immediate postpartum period. Nipple contact stimulates
release of oxytocin into her bloodstream, which results in uterine
contractions, expulsion of the placenta, and inhibition of postpartum
bleeding. The colostrum that the infant ingests provides immunological
protection and is the only natural source of Vitamin K, a substance
essential for normal clotting of blood, necessary, for example, for
preventing hemorrhage at the site of the umbilical cord. In addition,
this early suckling may enhance later breastfeeding success.
Other benefits may possibly include growth of healthy maternal
bacteria in the infant's system, instead of the hospital bacteria she
would have absorbed in the nursery (where strep and other bacterial
epidemics are frequent occurrences), and "entrainment" of
the bodily rhythms of mother and baby:
Detailed studies (Condon and Sander 1974) of the amazing behavioral
capacities of the normal neonate have shown that the infant sees,
hears and moves in rhythm to his mother's voice in the first minutes
and hours of life, resulting in a beautiful linking of the reactions
of the two and a synchronized "dance" between the mother and
the infant (Klaus and Kennell 1982:63).
Klaus and Kennell also stress that fathers who were observed
interacting with their newborn infants went through the same sort of
exploratory and synchronizing process as the mothers. Benefits to the
infant of early bonding with parents involve taking advantage of the "quiet-alert
state," relatively rare in the first few days of life, which most
normal newborns remain in for about 43 minutes immediately after
birth, and in which rapid learning takes place. (Marshall Klaus
postulates an evolutionary advantage to mothers and babies utilizing
this period to get to know each other immediately after birth
[personal communication], as does Trevathan [1987: 214-235].
Over the longer term, and more controversially, Klaus and Kennell
postulate the value of uninterrupted bonding for the mother's
integration of her "mental picture" of the baby with the
real child; they hypothesize an increased incidence of child abuse if
such integration does not take place (1982:66-67). (The mental images
held by mothers who batter their infants are often radically different
in appearance and behavior from the actual child.) Long-term
psychological benefits may include increased ease of parent-child
relationships (O'Connor et al. 1978, 1980; Siegel 1982). There is some
evidence to indicate that child abuse is statistically slightly more
likely to occur when no opportunity for early bonding is provided,
although good data are very difficult to procure. A well-controlled
study of 301 mothers and babies (O'Connor et al. 1980) found a
significantly decreased incidence of child abuse and neglect and
parenting disorders among mothers who received 12 extra hours of
contact with their newborns during the first two days after delivery.
But it is important to note that other researchers have taken great
issue with the research methods used in such studies (Amighi 1990;
Eyer 1992; Lamb et al. 1985; Tronick et al. 1985, 1987). In fact,
serious methodological problems with most of the bonding studies done
to date have rendered them inconclusive in their attempts to
demonstrate any long-term results of early bonding or of early
maternal-infant separation (Laughlin 1990:43; Trevathan 1987:212).
Addressing earlier research on mammalian bonding behavior that
seemed to indicate the biological necessity of immediate attachment,
Trevathan concludes that
extremely rapid bond formation, such as has been described for
goats and sheep, is "unnecessary" unless there is a good
chance that the young will be mixed with others in the first few
minutes or hours after birth. This is...certainly not the case for
higher primates and human beings who live in groups too small for
synchronous deliveries to be common and who have a level of awareness
that would preclude great confusion over individual indentity during
the postpartum period. Thus it is untenable to argue for a rapidly
forming bond in most mammalian species including our own....[but] a
strong and specific bond must ultimately form so that the mother is
motivated to provide the high level of care needed by the helpless
infant. Such attachment and motivation can develop in an adoptive
mother as well, so neither the experience of parturition nor close
biological relatedness is necessary for a strong mother-infant bond in
human beings.
-Trevathan (1987:202)
Trevathan also notes that there are unusually high levels of
endorphins present in mothers and infants during and immediately after
delivery (1987:204); Odent (1984) suggests that these natural opiates
contribute to maternal-infant bonding. Other researchers have also
suggested that various hormones play roles in the maternal-infant
attachment process, but, as Trevathan again points out, "Thousands
of cesarean-delivered, bottle-feeding, and/or adoptive mothers offer
proof of the ability of maternal solicitude to develop in the absence
of hormonal precursors" (1987:205).
Women's Responses
Jack helped cut the cord, and they gave the baby to me right
away and never took him away from me. They wrapped him up and put him
on my stomach and--they did not put the drops in his eyes immediately.
He looked at me...I do feel that this baby has good eye contact with
me. And I wonder if it's because we looked into each other's eyes for
several minutes before the drops were put into his eyes. You know,
before they get all blurry. I think that does make a difference.
-July Sanders
I had herpes, and they whisked the baby away to intensive care
for observation and wouldn't even let me touch him for three whole
days. I grieved. I felt that he had died. Finally on the third day I
went to the nursery and demanded him. But I felt very little when I
got him. I know it's nonsensical, but my emotional feeling was that he
had died, and this was someone else. I wanted desperately to love him,
and I knew that nursing would be the fastest way to make up for the
bonding I had missed, so I made myself nurse him and I hated it for a
long time. When I would sit down to nurse him I would feel so
impatient I could scream. It took months for me to feel that I was
really his mother, and he was really my baby. Finally it did happen,
but it was awful for a long time.
-Jean Johnson
The miracle of the birth was so fantastic that I think I was in
awe of the whole experience. It was beautiful and I'll never forget it
or lose the powerful emotion of it. The fact that my husband was there
made it even more wonderful and he feels closer to me and his son
because he helped and shared in the whole event, and we held our baby
together. I don't think any couple should have to be apart during
labor and delivery if they have an alternative. I think that because
we were together my postpartum depression has always been instead
postpartum ecstasy and all my tears those of joy.
-Carmen Fisher, from her Lamaze story-report
They put the baby on my tummy but they told me not to touch it.
They didn't want my hands down anywhere near there....then they took
it away, and I just turned off like a clam. It was awful....I didn't
want to have anything to do with it....I finally told my mother--she
was the only one I felt I could admit it to--I just came out and told
her that I just wanted to give it away. It sounds terrible but it was
an honest feeling. It was six weeks before I felt like I really loved
him....And now I wouldn't part with him--he's great. Well and the next
time--it was really weird. I put my hand down on him and I didn't
expect to feel that way, I thought well it won't be as bad as last
time but you know it might take some time to get to love him. But the
second he came out, they put him on my skin and I reached down and I
felt him and it was something about having that sticky stuff on my
fingers....it was like gosh, it's almost like part of him or
something-- I don't know what it was but it was really important to
feel that waxy stuff....and they covered him up and he was crying and
I made soothing sounds to him....and he started calming down and
somehow that makes you feel--like he already knows you, he knows who
you are--like animals or something, perhaps the smell of each
other....but it was marvelous to hold him and I just touched him for a
really long time and then they took him over but something had already
happened. But it was much more than I ever felt or thought I would
feel. Just instant love. And I can remember when they would bring him
into the room afterwards--it didn't diminish at all. It just always
seemed to be there--I was crazy about him right from the beginning.
-Anne Mallone
Ritual Purposes
Throughout most of human history, mothers and babies have stayed
together after birth. 12 It would seem that today's "bonding
period" might simply represent a commonsensical return to a
formerly universal human practice, but few human customs are that
straightforward. Although birthing women are no longer routinely put
to sleep, institutional interests are still better served when mothers
and babies are separated (see below), so general acceptance of the
importance of a bonding period has been far from automatic.
Since the original research on bonding in the 1970s, a great deal of
controversy has erupted over the long-term effects of this simple
practice. Many medical personnel, and many mothers, felt that Klaus
and Kennell were "way off base" to suggest that when mothers
missed this "sensitive period," their relationships with
their babies had somehow been impaired. Yet proponents of bonding
theory have consistently stressed that, even if the initial contact is
not experienced, long-term attachment can and usually does occur. A
primary goal of the publications by these two pediatricians was to
eliminate (1) the practice of denying new parents of premature babies
access to intensive care units; (2) the whisking away of all babies to
the nursery immediately after birth; (3) the practice of keeping
parents and even healthy newborns separated for hours after birth. All
these were standard procedure in most American hospitals before the
research of Klaus and Kennell on the attachment process--and that of
many others--gained such wide recognition. Their point has been that
this initial contact in the sensitive period facilitates, but is not
essential to, the development of a strong maternal-infant attachment:
Some misinterpretations of studies of parent-to-infant
attachment may have resulted from a too literal acceptance of the word
bonding and so have suggested that the speed of this reaction
resembles that of epoxy materials....The human is highly adaptable,
and there are many fail-safe routes to attachment. Sadly, some parents
who missed the bonding experience have felt that all was lost for
their future relationship. This was (and is) completely incorrect.
-Kennell and Klaus 1989:281
Social scientists Arney and Martin present interpretations of
bonding that deplore its ideological underpinnings. Arney feels that
bonding, "like so many other ideologies that pose as social
theories, turns social issues into individuals' problems" because
it "lends legitimacy to the notion that women are the only
appropriate attendants for children" and so justifies keeping
women at home (1982:171).
Martin suggests that the focus on bonding diverts our attention from
how the whole process of birth has been sundered by the application of
the production metaphor. To put it baldly, if a worker feels lack of
involvement with a product when she does not feel she made it and when
her work is regimented and controlled, think how a woman would feel if
in her view her baby's birth was taken away from her by the exertion
of control over her body? Surely restoring contact between mothers and
babies immediately after birth could not restore automatically a sense
of engrossment with the baby when the process of birth has been so
deeply interrupted. (1987:86)
Yet the statements of the women in my study indicate that it can and
often does restore such a sense--perhaps in part because that sense is
not new. Birthing mothers--and fathers--have been "bonding"
with their babies for months before birth in myriad ways. The strength
of this prenatal bond is indicated by the devastation both parents can
experience when they miscarry or choose to abort:
For two weeks, Mike and I breathed as one person. His distress,
loss and concern were never one whit less than my own. But we were
sometimes upset and angered by unconscious cultural attitudes which
precluded acknowledgment of his loss. He was expected to "cope,"
while I was nurtured through my "need." We've struggled for
male responsibility in birth control, sexual mutuality, childbirth and
childrearing, and I think we need to acknlowledge that those men who
do engage in such transformed practices have mourning rights during a
pregnancy loss as well. And yet, having spent fifteen years arguing
against biological determinism in my intellectual and political life,
I'm compelled to recognize the material reality of this experience.
Because it happened in my body, a woman's body, I recovered much more
slowly than Mike did. By whatever mysterious process, he was able to
damp back the pain and throw himself back into work after several
weeks. For me, it took months. As long as I had the 14 pounds of
pregnancy weight to lose, as long as my aching breasts, filled with
milk, couldn't squeeze into bras, as long as my tummy muscles
protruded, I was confronted with the physical reality of being
post-pregnant, without a child. Mike's support seemed inadequate. I
was in deep mourning while he seemed distant and cured.
-Rapp 1984:323
The intensity of grief Rapp experienced--biological, psychological,
and social--is mirrored by the intensity of joy--biological,
psychological and social--that parents experience when they hold their
newborn babies. Marshall Klaus reports that in the early work on
bonding that he and others carried out:
We put the mother, when she was ready, in a private room after
the birth with plenty of heat provided. There she spent uninterrupted
time alone with the baby. We found from studying the videotapes we
made that the mother's behavior when alone with the baby differed
radically from her behavior when handed the baby in a crowded and busy
delivery room for "bonding." For example, on the videos we
saw lots of mothers gazing at their babies and saying, "Look into
my eyes," which we did not observe them doing in the delivery
room. The 10-minute bonding period was the result of an AMA meeting in
the 1970s to which we were not invited. It was never our intention to
institutionalize 10 minutes--the whole thing very quickly got taken
out of our hands. (personal communication).
As Klaus indicates, the routinization of "here's your baby--now
bond!" demonstrates the rapid ideological co-option of attachment
theory by institutional interests: it directly conveys the message
that society gives the baby (produced by its technology) to the
mother. At the same time, the handing of the baby to the mother
constitutes a powerful ritual acknowledgment on the part of society
that she is now a mother, that her transformation is complete: that
the child she carried, nurtured, and loved inside her for so long is
now in physical union with her in a new and thrilling way. As the
statements of the women in my study and Rapp's eloquent testimony make
clear, there are emotions involved in the "bonding" process
that are simply not co-optable. Even if bonding as ideology serves
patriarchy (Arney 1982) or the economic interests of the hospital
(Eyer 1992), or fails to redress the wounds of the baby's
technological production (Martin 1987), bonding as experience offers
profound joy and meaning to mothers, fathers, and babies.
Immediately after birth, the mother is still physically and
psychologically at her most open. Her baby constitutes for her a
powerful symbol of her motherhood, her individuality, her new family,
the beauty and wonder of nature, and the perfection of her own body
and her procreative powers. To hold, touch, gaze at her newborn
unhindered is to internalize these messages, to incorporate her
newborn through all her sensory channels into the transformed identity
with which the mother will emerge from her initiation experience.
Often this bonding experience is powerful and positive enough to
entirely override, in the mother's conscious perception of her birth
experience, any negative feelings of powerlessness, humiliation, or
pain she may have been experiencing before her baby's birth.
The presence of the father at these very special moments of highest
affectivity ensures that he too will be incorporated into the mother's
new sense of her identity, and she and the baby into his. True
bonding, when it is allowed to occur in the hospital, conveys an
extremely potent message of the integrity and worth of the family in
relation to science, technology, patriarchy, and institutions--a
message so powerful that it will often override all others in both
parents' memories of their birth. Given the perceived threats to the
American family as the fundamental social unit posed by the high
divorce rate, it would seem to be in society's interest to foster this
process, send this message. As with the routinization of father's
presence in the delivery room, routine bonding, insofar as it
strengthens the beleaguered American family, strengthens society as
well.
Nevertheless, some recent research that denies anything special
about the period immediately after birth (Lamb 1982, 1983; Lamb and
Hwang 1982; Myers 1984) is now being used to undo the work of the
1970s, so that in some hospitals that used routinely to provide such a
period of togetherness, the baby is once again whisked away. The
readiness of such institutions to do away with the bonding period
seems to reflect an acknowledgment of its symbolic and psychological
mystique and power. As I stated above, the symbolic ramifications of
bonding are profound for both the mother and the father: all the
efforts at conceptual separation of mother-machine from child-product
made in hospital birth rituals can be completely undone in the
mother's psyche at that integrating contact. Time and again I heard
women describe highly technocratic labor experiences that were
alienating up until the moment of birth as "positive" and "wonderful"
because of the intensity of the joy they experienced upon touching and
gazing at their newborn babes.
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