What is the best way for the nurse to promote and support the maternal infant bonding process?

Publication Date

Spring 4-8-2015

Inhaltsverzeichnis Show

Parental Attachment, Bonding, and Acquaintance
Assessment of Attachment Behaviors
What strategies should the nurse use to promote maternal infant bonding?
What are three 3 actions the nurse can take to facilitate maternal
Which nursing intervention is most beneficial in promoting infant bonding for the new parent of a newborn?
What are three 3 ways the nurse can facilitate bonding between the newborn and father?

Keywords

Maternal Newborn Bonding Postpartum

Disciplines

Medicine and Health Sciences

Recommended Citation

Baber, Kristen L., "Promoting Maternal-Newborn Bonding During the Postpartum Period" (2015). Senior Honors Theses. 538.
https://digitalcommons.liberty.edu/honors/538

Abstract

The bond between a mother and her newborn is one of strength, power, and potential. Several factors take place during the early postpartum period that can have a large influence on the bonding that occurs during this time. Oxytocin plays a vital role in the chemistry aspect of bonding, and its effects can be enhanced by a variety of techniques. Psychological theories such as the John Bowlby and Mary Ainsworth’s Theory of Attachment and Erik Erikson’s developmental stage of trust versus mistrust can be applied to the bonding process. The abundant benefits of bonding for both mother and newborn are of extensive importance. Nurses and childbirth educators can promote the maternal-newborn bond through encouraging skin-to-skin contact, breastfeeding, eye contact, and newborn massage during the first postpartum hour. Common hindrances to the maternal-newborn bonding process include a preterm newborn, lack of support, maternal fatigue, a cesarean birth, and emotional stress. Personal testimonies from families who have experienced these barriers can be used to evaluate strategies for overcoming these barriers in a way that promotes bonding. It is recommended for hospital protocols to include an hour of uninterrupted skin-to-skin contact after vaginal and low-risk cesarean births in order to promote optimal maternal-newborn bonding.

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22. The best way for the nurse to promote and support the maternal-infant bonding process is toa.Help the mother identify her positive feelings toward the newborn.b.Encourage the mother to provide all newborn care.c.Assist the family with rooming-in.d.Return the newborn to the nursery during sleep periods.ANS: CFeedbackAHaving the mother express her feelings is important, but it is not the best way to promotebonding.BThe mother needs time to rest and recuperate; she should not be expected to do all of the care.CClose and frequent interaction between mother and infant, which is facilitated by rooming-in,is important in the bonding process. This is often referred to as the mother-baby care orcouplet care.DThe mother needs to observe the infant during all stages so she will be aware of what toexpect when they go home.Test Bank - Maternal-Child Nursing (5th Edition by McKinney)326MATERNAL CHILD NURSING 5TH EDITION MCKINNEY TEST BANK

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 460OBJ: Nursing Process: Planning MSC: Client Needs: Psychosocial Integrity23. During which phase of maternal adjustment will the mother relinquish the baby of her fantasies and acceptthe real baby?

NURSINGTB.COMFeedbackAAccepting the real infant and relinquishing the fantasy infant occurs during the letting-gophase of maternal adjustment.BDuring the taking-hold phase the mother assumes responsibility for her own care and shiftsher attention to the infant.CIn the taking-in phase the mother is primarily focused on her own needs.DThere is no taking-on phase of maternal adjustment.PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 450OBJ: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity24. A 25-year-old gravida 1 para 1 who had an emergency cesarean birth 3 days ago is scheduled fordischarge. As you prepare her for discharge, she begins to cry. Your initial action should be to

PTS: 1 DIF: Cognitive Level: Application REF: p. 456OBJ: Nursing Process: Implementation MSC: Client Needs: Psychosocial Integrity

Parental Attachment, Bonding, and Acquaintance

The process by which a parent comes to love and accept a child and a child comes to love and accept a parent is known as attachment. Using the terms attachment and bonding, Klaus and Kennell (1976) originally proposed that there is a sensitive period during the first few minutes or hours after birth when mothers and fathers must have close contact with their infant to optimize the child’s later development. Klaus and Kennell (1982) later revised their theory of parent-infant bonding, modifying their claim of the critical nature of immediate contact with the infant after birth. They acknowledged the adaptability of human parents, stating that more than minutes or hours were needed for parents to form an emotional relationship with their infants. The terms attachment and bonding continue to be used interchangeably.

Attachment is developed and maintained by proximity and interaction with the infant through which the parent becomes acquainted with the infant, identifies the infant as an individual, and claims the infant as a member of the family. Attachment is facilitated by positive feedback (i.e., social, verbal, and nonverbal responses, whether real or perceived, that indicate acceptance of one partner by the other). Attachment occurs through a mutually satisfying experience. A mother commented on her son’s grasp reflex, “I put my finger in his hand, and he grabbed right on. It is just a reflex, I know, but it felt good anyway” (Fig. 20-1).

The concept of attachment includes mutuality; that is, the infant’s behaviors and characteristics elicit a corresponding set of maternal behaviors and characteristics. The infant displays signaling behaviors such as crying, smiling, and cooing that initiate the contact and bring the caregiver to the child. These behaviors are followed by executive behaviors such as rooting, grasping, and postural adjustments that maintain the contact. Most caregivers are attracted to an alert, responsive, cuddly infant and repelled by an irritable, apparently disinterested infant. Attachment occurs more readily with the infant whose temperament, social capabilities, appearance, and sex fit the parent’s expectations. If the child does not meet these expectations, the parent’s disappointment can delay the attachment process. Table 20-1 presents a comprehensive list of classic infant behaviors affecting parental attachment. Table 20-2 presents a corresponding list of parental behaviors that affect infant attachment.

TABLE 20-1

Infant Behaviors Affecting Parental Attachment

FACILITATING BEHAVIORS	INHIBITING BEHAVIORS
Visually alert; eye-to-eye contact; tracking or following of parent’s face	Sleepy; eyes closed most of the time; gaze aversion
Appealing facial appearance; randomness of body movements reflecting helplessness	Resemblance to person parent dislikes; hyperirritability or jerky body movements when touched
Smiles	Bland facial expression; infrequent smiles
Vocalization; crying only when hungry or wet	Crying for hours on end; colicky
Grasp reflex	Exaggerated motor reflex
Anticipatory approach behaviors for feedings; sucks well; feeds easily	Feeds poorly; regurgitates; vomits often
Enjoys being cuddled and held	Resists holding and cuddling by crying, stiffening body
Easily consolable	Inconsolable; unresponsive to parenting, caregiving tasks
Activity and regularity somewhat predictable	Unpredictable feeding and sleeping schedule
Attention span sufficient to focus on parents	Inability to attend to parent’s face or offered stimulation
Differential crying, smiling, and vocalizing; recognizes and prefers parents	Shows no preference for parents over others
Approaches through locomotion	Unresponsive to parent’s approaches
Clings to parent; puts arms around parent’s neck	Seeks attention from any adult in room
Lifts arms to parents’ in greeting	Ignores parents

Data from Gerson E: Infant behavior in the first year of life, New York, 1973, Raven Press.

TABLE 20-2

Parental Behaviors Affecting Infant Attachment

FACILITATING BEHAVIORS	INHIBITING BEHAVIORS
Looks; gazes; takes in physical characteristics of infant; assumes en face position; eye contact	Turns away from infant; ignores infant’s presence
Hovers; maintains proximity; directs attention to, points to infant	Avoids infant; does not seek proximity; refuses to hold infant when given opportunity
Identifies infant as unique individual	Identifies infant with someone parent dislikes; fails to recognize any of infant’s unique features
Claims infant as family member; names infant	Fails to place infant in family context or identify infant with family member; has difficulty naming
Touches; progresses from fingertip to fingers to palms to encompassing contact	Fails to move from fingertip touch to palmar contact and holding
Smiles at infant	Maintains bland countenance or frowns at infant
Talks to, coos, or sings to infant	Wakes infant when infant is sleeping; handles roughly; hurries feeding by moving nipple continuously
Expresses pride in infant	Expresses disappointment, displeasure in infant
Relates infant’s behavior to familiar events	Does not incorporate infant into life
Assigns meaning to infant’s actions and sensitively interprets infant’s needs	Makes no effort to interpret infant’s actions or needs
Views infant’s behaviors and appearance in positive light	Views infant’s behavior as exploiting, deliberately uncooperative; views appearance as distasteful, ugly

Data from Mercer R: Parent-infant attachment. In Sonstegard L, Kowalski K, Jennings B, editors: Women’s health (vol 2), New York, 1983, Grune & Stratton.

An important part of attachment is acquaintance. Parents use eye contact (Fig. 20-2), touching, talking, and exploring to become acquainted with their infant during the immediate postpartum period. Adoptive parents undergo the same process when they first meet their new child. During this period, families engage in the claiming process, which is the identification of the new baby (Fig. 20-3). The child is first identified in terms of “likeness” to other family members, then in terms of “differences,” and finally in terms of “uniqueness.” The unique newcomer is thus incorporated into the family. Mother and father examine their infant carefully and point out characteristics that the child shares with other family members and that are indicative of a relationship between them. The claiming process is revealed by maternal comments such as “Daniel held him close and said, ‘He’s the image of his father,’ but I found one part like me—his toes are shaped like mine.”

Conversely, some mothers react negatively. They “claim” the infant in terms of the discomfort or pain the baby causes. The mother interprets the infant’s normal responses as being negative toward her and reacts to her child with dislike or indifference. She does not hold the child close or touch the child to be comforting. For example, “The nurse put the baby into Marie’s arms. She promptly laid him across her knees and glanced up at the television. ‘Stay still until I finish watching—you’ve been enough trouble already.’ ”

Nursing interventions to facilitate parental attachment are numerous and varied (Table 20-3). They can enhance positive parent-infant contacts by heightening parental awareness of an infant’s responses and ability to communicate. As the parent attempts to become competent and loving in that role, nurses can bolster the parent’s self-confidence and ego. Nurses can identify actual and potential problems and collaborate with other health care professionals who will provide care for the parents after discharge. Nursing considerations for fostering maternal-infant bonding among special populations may vary (see Cultural Competence box).

TABLE 20-3

Examples of Parent-Infant Attachment Interventions

INTERVENTION LABEL AND DEFINITION	ACTIVITIES
Attachment Promotion
Facilitating the development of an affective, enduring relationship between infant and parent	Discuss with patient culture-based expressions of attachment prior to and after birth.
Place newborn skin-to-skin with parent immediately after birth.
Provide opportunity for parent or parents to see, hold, and examine newborn immediately after birth (i.e., delay unnecessary procedures and provide privacy).
Discuss infant behavioral characteristic with parent.
Assist parent of multiples in recognizing individuality of each infant.
Instruct parent on attachment development, emphasizing its complexity, ongoing nature, and opportunities.
Family Integrity Promotion: Childbearing Family
Facilitation of the growth of individuals or families who are adding an infant to family unit	Respect and support family’s cultural value system.
Assist family in developing adaptive coping mechanisms to deal with the transition to parenthood.
Prepare parent(s) for expected role changes involved in becoming a parent.
Prepare parent(s) for responsibilities of parenthood.
Reinforce positive parenting behaviors.
Identify effect of newborn on family dynamics and equilibrium.
Lactation Counseling
Assisting in the establishment and maintenance of successful breastfeeding	Correct misconceptions, misinformation, and inaccuracies about breastfeeding.
Provide mother the opportunity to breastfeed after birth, when possible.
Instruct on infant’s feeding cues (e.g., rooting, sucking, and quiet alertness).
Determine frequency of normal feeding patterns, including cluster feedings and growth spurts.
Discuss strategies aimed at optimizing milk supply (e.g., breast massage, frequent milk expression, complete emptying of breasts, kangaroo care, and medications).
Instruct on signs and symptoms warranting reporting to a health care practitioner or lactation consultant.
Parent Education: Infant
Instruction on nurturing and physical care needed during the first year of life	Determine parent(s)’ knowledge and readiness and ability to learn about infant care.
Provide anticipatory guidance about developmental changes during first year of life.
Teach parent(s) skills to care for newborn.
Demonstrate ways in which parent(s) can stimulate infant’s development.
Discuss infant’s capabilities for interaction.
Demonstrate quieting techniques.
Risk Identification: Childbearing Family
Identification of individual or family likely to experience difficulties in parenting, and prioritization of strategies to prevent parenting problems	Ascertain understanding of English or other language used in community.
Determine developmental stage of parent or parents.
Review prenatal history for factors that predispose patient to complications.
Monitor parent-infant interactions, noting behaviors thought to indicate attachment.
Plan for risk-reduction activities, in collaboration with the individual or family.
Refer to the appropriate community agency for follow-up if risk for parent problems or a lag in attachment has been identified.

Data from Bulechek G, Butcher H, Dochterman J, et al: Nursing interventions classification (NIC), ed 6, St Louis, 2013, Mosby.

Cultural Competence

Fostering Bonding in Women of Varying Ethnic and Cultural Groups

Childbearing practices and rituals of other cultures may not be congruent with standard practices associated with bonding in the Anglo-American culture. For example, Chinese families traditionally use extended family members to care for the newborn so that the mother can rest and recover, especially after a cesarean birth. Some Native American, Asian, and Hispanic women do not initiate breastfeeding until their breast milk comes in. Haitian families do not name their babies until after the confinement month. Amount of eye contact varies among cultures, too. Yup’ik Eskimo mothers almost always position their babies so that eye contact can be made.

Nurses should become knowledgeable of the childbearing beliefs and practices of diverse cultural and ethnic groups. Because individual cultural variations exist within groups, nurses need to clarify with the patient and family members or friends what cultural norms the patient follows. Incorrect judgments may be made about mother-infant bonding if nurses do not practice culturally sensitive care.

Adapted from D’Avanzo C: Mosby’s pocket guide to cultural assessment, ed 4, St Louis, 2008, Mosby.

Assessment of Attachment Behaviors

One of the most important areas of assessment is careful observation of specific behaviors thought to indicate the formation of emotional bonds between the newborn and family, especially the mother. Unlike physical assessment of the neonate, which has concrete guidelines to follow, assessment of parent-infant attachment relies more on skillful observation and interviewing. Rooming-in of mother and infant and liberal visiting privileges for father or partner, siblings, and grandparents provide nurses with excellent opportunities to observe interactions and identify behavior that demonstrate positive or negative attachment. Attachment behaviors can be easily observed during infant feeding sessions. Box 20-1 presents guidelines for assessment of attachment behaviors.

Box 20-1 Assessing Attachment Behaviors

• When the infant is brought to the parents, do they reach out for the infant and call the infant by name? (Recognize that in some cultures parents may not name the infant in the early newborn period.)

• Do the parents speak about the infant in terms of identification—whom the infant resembles, and what appears special about their infant over other infants?

• When parents are holding the infant, what kind of body contact is seen—do parents feel at ease in changing the infant’s position, are fingertips or whole hands used, and does the infant have parts of the body they avoid touching or parts of the body they investigate and scrutinize?

• When the infant is awake, what kinds of stimulation do the parents provide—do they talk to the infant, to each other, or to no one, and how do they look at the infant—direct visual contact, avoidance of eye contact, or looking at other people or objects?

• How comfortable do the parents appear in terms of caring for the infant? Do they express any concern regarding their ability or disgust for certain activities, such as changing diapers?

• What type of affection do they demonstrate to the newborn, such as smiling, stroking, kissing, or rocking?

• If the infant is fussy, what kinds of comforting techniques do the parents use, such as rocking, swaddling, talking, or stroking?

During pregnancy and often even before conception, parents develop an image of the “ideal” or “fantasy” infant. At birth, the fantasy infant becomes the real infant. How closely the dream child resembles the real child influences the bonding process. Assessing such expectations during pregnancy and at the time of the infant’s birth allows identification of discrepancies in the parents’ view of the fantasy child and the real child.

The labor process significantly affects the immediate attachment of mothers to their newborn infants. Factors such as a long labor, feeling tired or “drugged” after birth, problems with breastfeeding (Tharner, Luijk, Raat, et al., 2012), premature birth, and being separated from the infant at birth (Flacking, Lehtonen, Thomson, et al., 2012; Hoffenkamp, Tooten, Hall, et al., 2012) can delay the development of initial positive feelings toward the newborn. Referral to groups such as La Leche League International (www.llli.org) or Postpartum Support International (www.postpartum.net) can be useful.

What strategies should the nurse use to promote maternal infant bonding?

Nurses and childbirth educators can promote the maternal-newborn bond through encouraging skin-to-skin contact, breastfeeding, eye contact, and newborn massage during the first postpartum hour.

What are three 3 actions the nurse can take to facilitate maternal

To help facilitate the maternal-newborn bond, the APN and staff nurses can encourage skin-to-skin, breastfeeding, eye contact, encouraging contact between mother and newborn, and promoting a positive environment.

Which nursing intervention is most beneficial in promoting infant bonding for the new parent of a newborn?

Changing diapers, positioning baby comfortably, and maintaining eye-to-eye contact are appropriate behaviors that increase parent-infant attachment. The nurse is caring for a postpartum patient who gave birth recently.