maternal-infant bonding, the complex process of attachment of a mother to her newborn. Disastrous effects of the disruption or absence of this attachment have long been known. The specific steps in its development and the factors that disturb or encourage it have been identified and described by anthropologists, pediatricians, psychologists, nurses, midwives, and sociologists. The process begins before birth as the parents plan for the pregnancy or discover that the mother is pregnant. The mother feels fetal movement, begins to accept the fetus as an individual, and makes plans for the baby after birth. In the first minutes and hours after birth, a sensitive period occurs during which the baby and the mother become intimately involved with each other through behaviors and stimuli that are complementary and provoke further interactions. The mother touches the baby and holds it en face to achieve eye-to-eye contact. The infant looks back eye to eye. The mother speaks in a quiet high-pitched voice. The mother and the baby move in turn to the voice and sounds of the other, a process known as entrainment, which can be likened to a dance. The infant’s movements constitute a response to the mother’s voice, and she is encouraged to continue the process. The secretion of oxytocin and prolactin by the maternal pituitary gland is stimulated by the baby’s sucking or licking of the mother’s breasts; T and B lymphocytes and macrophages are given to the baby in the mother’s milk, promoting resistance to infection. The child is also colonized by the normal flora of the mother’s skin and nasal passages, improving the baby’s ability to fend off infection. Physically the mother provides her body heat for the baby’s warmth and comfort. Thus the extended contact in the newborn period satisfies physical and emotional needs of the mother and baby. Experts have made the following recommendations to increase the development of maternal-infant bonding: The special needs of the mother are assessed before delivery; the parents attend classes to prepare them for labor, delivery, and the puerperium; and discussions are held regarding the stresses of pregnancy and the postpartum period. In labor and delivery a companion is encouraged to stay with the mother. After the baby is born, silver nitrate drops or other medications are not placed in the baby’s eyes until the mother and the baby have had time to be together en face, with eye contact for an extended period, because the drops cause a film to form over the eyes, dimming vision. During the first hour after birth the parents and the infant are not separated and are given as much privacy as possible. Skin-to-skin contact is encouraged; various methods may be used to maintain an ambient temperature adequate to maintain the baby’s temperature. On the postpartum unit the mother and the baby are kept together for at least 5 hours a day, but optimally for 24 hours a day in a 24-hour rooming-in care unit. The entire family is allowed to visit. The mother has responsibility for the care of her baby, with consultation available from a midwife or a nurse. The staff does not criticize the mother’s performance because it is to the baby’s inestimable benefit that the mother believes that her baby is the best, most beautiful, and most perfect baby in the world and that she feels able to care for her baby.
