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Posts Tagged ‘attachment’

I had an article published today on mamamia.com.au – you can read it here.

I wrote the post not long after my first child was born – over two years ago now, and finally submitted it a few months ago to mamamia. It’s essentially the story of an experience I had on one night in hospital after my daughter was born, and my feelings of powerlessness after an interaction with one particular night nurse. It’s been really interesting reading the comments on the article, particulalry to hear about others’ experiences – good and bad. I do want to point out that I am definitely not ‘anti’ hospitals or ‘anti’ midwives at all, but rather I wanted to share one experience that I had to highlight how hard it can be to ‘speak up’ and follow your instincts when you are exhausted and vulnerable.

I have had lots of positive experiences too and with my second child, my experience was far better. The midwives caring for me at the moment with my third pregnancy are great and I am having my third child in a hospital too. With each child though, I am of course more experienced and secure with my plans and choices.

Do feel free to comment – it’s an important area to discuss I think…

 

 

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In dealing with newborn infants, I have found the concept of the fourth trimester very helpful. This is a phrase that I associate with Dr Harvey Karp, who has previously commented on this blog. He talks about the need to create an atmosphere similar to that of the womb while the newborn adjusts to life in the outside world, and his suggestions include swaddling, settling the infant on their side, suckling, and white noise. This phase lasts for the first few months of the infant’s life.

I also like the ideas of Dr William Sears, who advocates for attachment parenting. I have previously discussed his book ‘Nighttime Parenting’ on this blog, and his suggestions include frequent breastfeeding and co-sleeping, both of which I have used (note: co-sleeping is not recommended by ‘Sids and Kids’ or the health department.)

From an evolutionary point of view, it makes perfect sense that a newborn baby wants to be held all the time. I have blogged before about mother-infant attachment, and this is linked to the belief that infants are hard wired for survival. Survival for a tiny baby means being close to their mother. Being alone in a quiet room would be frightening for an infant, as they have absolutely no means of surviving on their own – their only chance is to display attachment behaviour which allows them to be in close proximity to their mother. My number one piece of baby equipment, and the one I recommend to everyone I know, is a sling: these help infants to feel safe and secure, and also allows the parent’s hands to be free to get things done around the house.

There is a perception in our culture that things like feeding/rocking/cuddling babies to sleep, responding to every cry, holding them all the time, or co sleeping creates ‘bad habits’ or ‘spoils’ babies, which is ridiculous. They are not infants for very long and our job is to help them transition from being completely dependant to secure children and adults.

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Kangaroo care refers to early skin to skin contact between a mother and her newborn infant. It involves the newborn infant being placed straight onto the mother’s chest immediately after birth. The infant is covered with a blanket on top, but has bare skin to skin contact with mum for as long as the mother and infant are happy.

There seems to be a culture in our society of taking the baby away to be weighed and examined, cleaned up and wrapped before being given to the parents to hold. Obviously if there is any concern about the infant’s health, then they need to be given the appropriate treatment, but in healthy babies, there is now evidence of the positive benefits of early skin to skin contact.

The Cochrane Library publishes systematic reviews of existing studies on particualr topics. By collating all the data and assessing the methodological merit of the studies, they aim to provide evidence based papers. They have a review, last updated in 2007, on early skin to skin contact (Moore ER, Anderson GC, Bergman N. Early skin-to-skin contact for mothers and their healthy newborn infants. Cochrane Database of Systematic Reviews 2007, Issue 3. Art. No.: CD003519. DOI: 10.1002/14651858.CD003519.pub2).

This review found statistically significant evidence that early skin to skin contact had positive effects on the success and duration of breastfeeding, and trends towards positive effects on maternal affection behaviour during feeding and attachment. The infants also cried less and one group (late preterm infants) showed more stable cardiorespiratory function.The authors  also commented that there were no negative associations found.

It is completely natural and instinctive for mothers and their young to be in close contact after birth, and it makes sense that this creates the optimal physiological state for the pair. I am not against hospital births at all; both my children have been born under obstetric care in modern hospitals and personally, I wouldn’t have had it any other way. However, within that medical system, there are ways to make sure that you and your infant start your relationship in the best way possible, and one way is to make sure you have early skin to skin contact.

 

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Yesterday, I had two experiences which would have been beautiful to catch on film to highlight the attachment system at work. In the morning, A was playing and I went to the next room to vacuum. When I switched the vacuum cleaner on, I heard a squeal over the noise and A appeared in the doorway crying and speed crawling towards me. She must have been very quick to cover the distance so rapidly. She avoided the machine and reached me quickly, then stood up holding on my legs and reached up to be picked up.

In the afternoon, a plumber came to fix the tap. When she heard the door, she smiled as I think she was expecting her dad to come in, but when she saw it was a stranger, she clung to me.

The attachment system is activated at times of fear. As I’ve mentioned before, the  ‘strange situation’ scenario demonstrates attachment behaviour because it places infants under increasing levels of stress. Yesterday at home, A felt stressed. In attachment terms, she was proximity seeking: coming close to me for security. It is easy to see the evolutionary benefits of this, and it can also be seen in the animal kingdom. Bowlby developed attachment theory based on observations in the animal kingdom, and Harry Harlow in the 1960s did some experiments with monkeys to show some principals of attachment.

Infants are vulnerable: they can’t move very quickly; they can’t climb trees to get away from a predator; they can’t defend themselves. Their best chance of survival, be it from a lion or a vacuum cleaner, is to get close to mum and up in her arms. And we need to pick them up and let them know that they are safe.

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Can you tell us how we should be going about developing a secure attachment? I’m also interested to read how the insecure – avoidant and insecure – ambivalent types come about.

This question was posted in response to my blog post on attachment, and I wanted to respond to this, as it’s probably a question that all parents who read about attachment theory are interested in.

Studies show that the attachment style that we had with our own mother (again, mother can be substituted for primary caregiver) is generally predictive of the attachment style that we have with our own children. We generally parent in the way in which we were parented. There is evidence of neurobiological brain changes in infants and children which relate to their early experiences, and there is therefore an argument that our attachment style is hard- wired from a very early age.

Most children — and adults — are securely attached, so for the majority of people, we can just do what comes naturally when it comes to parenting and our children will develop secure internal working models. The factors which help this are parents being warm, empathic and consistently responsive. Parents respond to their children when their attachment behaviour is activated (crying, trying to get close to mother), and are able to empathise ie put themselves in the child’s shoes and recognise what they need at that time, and provide it.

Parents with insecure attachment styles  with their infants will generally have had that pattern with their own parents(analysed with an interview called the Adult Attachment Interview). Other factors which may influence the development of an insecure attachment include maternal mental illness (postnatal depression, psychosis), trauma, illness of the child, separation of the pair in early life etc – basically anything which affects a parent’s ability to respond to their child as above.

For this group of parents, there are things that can be done to promote secure attachment at-risk groups and individuals. The aim is to help parents develop an awareness of both their own and their child’s internal mental experiences — their reflective functioning –(Slade, 2005); to be able to put themselves in their child’s shoes; and to help with basic parenting skills.

I think that the most important thing to remember that the vast majority of parents are doing the best that they can with what they have. It’s such an important area of intervention for infants that has huge implications for the future health of our communities., and is still under-recognised and under-funded.

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At work, I use attachment theory to guide my clinical practice, and in my new work as a mother, I have been observing this every day, so I thought it was about time that I wrote about it.

Attachment, in child psychiatry, refers to a quality of the relationship beytween an infant and her mother (I’ll say mother as that is the usual attachment figure, but it could be the father or other primary caregiver). John Bowlby and Mary Ainsworth are the two people most associated with this.

                                                                                                                                                                                                                                         Bowlby studied juvenile delinquents in the early 1950s and believed that delinquency (antisocial/psychopathic traits) was associated with maternal deprivation, or being separated from their mothers at an early age. He also looked to work that had been done in the animal kingdom such as baby animals following adult animals around to ensure survival (imprinting). He concluded that infants have an inbuilt attachment system — activated at times of stress — to ensure that they stay close to their mother for physical survival.  

The idea is that the mother’s response to an infant gives the baby an internal working model of relationships. It’s as if they file away the expectation of what will happen when they are distressed and how their mother will respond. A mother who is warm, empathic and responsive to her baby’s cries teaches that baby trust and security.

Mary Ainsworth worked under Bowlby, mainly at the Tavistock clinic, and developed a laboratory ‘test’ called the strange situation to categorise attachment styles. This involves a room with video cameras, a 12 month old infant, her mother, and a ‘stranger’. The infant is exposed to increasingly stressful situations while being filmed, eg being left alone with the stranger. The child’s reaction to this stress, and behaviour on reunion with their mother, is analysed to put them into one of 3 categories:

Secure

The infant gets upset when mum leaves the room, seeks comfort when they are reunited, settles quickly with mum, and goes back to play.

Insecure – avoidant

The infant doesn’t show she’s upset when mum leaves the room, is distant when mum comes back in and doesn’t cling to her.

Insecure – ambivalent

This infant is often anxious even before  mum leaves, and becomes very upset when she goes and doesn’t settle. When they are reunited, the child is angry yet clingy and difficult to console.

What is the significance of this?

Studies have shown that the attachment style at 12 months is predictive of the attachment relationship throughout childhood and into adulthood. Our own attachment style generally predicts the attachment relationship that we will have with our own children. Insecurely attached children/adults have higher rates of mental health disturbance and social and emotional difficulties; a secure attachment is protective.

At the moment, I can’t leave the room without A crying, crawling after me and clinging to my leg. Last week, we went to dinner at a friend’s house. When we first got there, A took a look around and cried while clinging to me. AFter 5 or 10 minutes, she settled and started to explore, though if she became too stressed, she’d crawl back over to me for some reassurance. When A cries, and I respond, I know that I am teaching her that I am a secure base for her. Sadly, in our society, we seem to value children who don’t cry or protest – those with avoidant attachment styles. How many times have you heard “Oh, she’s a good baby – she’ll go to anyone, she hardly cries!” It is normal and desirable for babies to cry, and they should be clingy and wary of strangers. This is the way they have been designed so that they can survive. This is attachment at work.

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