Ineffective Postpartum MaternalInfant Bonding
Jennifer Kirtley Naruta
Background
• Infants are dependent upon family
members, especially mother, for care and
nurturing.
• Newborns send cues to bid for attention
– Signs of discomfort, bids for interaction or
other needs like hunger and discomfort
(Amankwaa & Pickler, 2007).
• Postpartum bonding occurs via skin-toskin contact, breastfeeding, simple touch
and voice from the mother.
Background
Positive Outcomes of Effective Bonding
Infant
• Decreased crying, increased warmth,
opportunity to breastfeed,
thermoregulation, pain management,
easier transition to extra-uterine life
(Bystrova, Widstrom, et al., 2003;
Dabrowski, 2007).
Mother
• Increased oxytocin release (UnvasMoberg, 1998), opportunity to breastfeed
and learn nonverbal cues from infant.
Background
Ineffective Bonding
Repercussions for the infant (As cited in Leitch, 1999; Ip,
Chung, et al., 2007)
•
Developmental delays
•
Social, cognitive and linguistic limitations
•
Child abuse and neglect
•
Failure to thrive (FTT)
•
Health problems
–
Otitis media
–
Respiratory tract infections
–
Type 2 diabetes and obesity
–
SIDS
Background
The United States of
America has the
lowest initiation rates
of breastfeeding at 27
to 69.5% (Callen &
Pinelli, 2004).
Problem Statement
Ineffective maternal-infant bonding can
lead to poor cognitive and developmental
outcomes for the infant as well as a
decrease in the immediate and future
relationship of the mother and infant.
Significance
Nurses are typically the primary
caregivers during the postpartum
period and are “in perfect position to
initiate interventions to enhance the
activities of engagement that are so
important to maternal role transition”
(Sanders & Buckner, 2006).
Significance
Maternal-Infant bonding in the hospital
• Infant should be placed on mother’s
chest immediately following delivery,
regardless of route of delivery.
• “Apgar scores, initial assessment and
placement of newborn identification
bands, may be performed immediately
after birth while the newborn is in skinto-skin contact with its mother”
(Dabrowski, 2007).
Significance
• Cost to healthcare for children that are
abused, neglected or have FTT.
• Breastfeeding seminars/classes offered to
mothers
– Allows for continued bonding between mother
and infant
– Creates new jobs for nurses
– Allows for professional stability of nursing.
Specific Aims
• Apply Kolcaba’s Theory of
Comfort
• Help assist mothers and
newborns transition effectively
from intrauterine to extra-uterine
life.
Theory
• Kolcaba’s Theory of Comfort
– Developed in 1994
– “Can be “adapted to any patient or age group”
(Kolcaba, 2004).
– Concepts (McEwin & Wills, 2007)
• Comfort, comfort measures, comfort care, comfort
needs, institutional integrity, health-seeking
behaviors and intervening variables.
– Patients need comfort in stressful times,
especially times that are healthcare related
(McEwin & Wills, 2007).
Application of Theory
• Therapeutic use of self by nurses
– Encouraging effective bonding
• Increases comfort between mother
and infant.
Summary & Conclusions
• Maternal-infant bonding is important
– Negative outcomes can result, for mother and
baby, if not done effectively.
• Nurses should be proactive for effective
bonding between mother and baby
– Encourage breastfeeding and skin-to-skin
contact
– Educate mothers and assist where needed
• Theory of Comfort assists with an easier
transition for both mother and baby
References
Amankwaa, L., & Pickler, R. (2007). Measuring maternal responsiveness. Association of Black
Nursing Faculty Journal, 18(1), 4-15.
Bystrova, K., Widstrom, A.M., Matthiesen, A.S., Ransjo-Arvidson, A.B., Welles-Nystrom, B., &
Wassberg, C., et al. (2003). Skin-to-skin contact may reduce negative consequences of “the
stress of being born”: A study on temperature in newborn infants subjected to different ward
routines in St. Petersburg. Acta Paediatrica, 92(3), 320-326.
Callen, J., & Pinelli, J. (2004). Incidence and duration of breastfeeding for term infants in Canada,
Unitied States, Europe, and Austrailia: A literature review. Birth, 31(4), 285-292.
Ip, S., Chung, M., Raman, G., et al. (2007). Breastfeeding and maternal and infant health
outcomes in developed countries. Rockville, MD: US Department of Health and Human
Services. Retrieved April 10, 2009, from
http://www.ahrq.gov/downloads/pub/evidence/pdf/brfout/brfout.pdf
Kolcaba, K. (2004) Comfort. In S.J. Peterson & T.S. Bredow (Eds.), Middle range theories:
Application to nursing research (p 255-273). Philadelphia: Lippincott Williams & Wilkins.
Leitch, D.B. (1999). Mother-infant interaction: Achieving synchrony. Nursing Research, 48(1), 5558.
McEwen, M., & Wills, E.M. (2007). Theoretical Basis for Nursing (2nd ed.). Philadelphia: Lippincott
Williams & Wilkins.
Sanders, L.W., & Buckner, E.B. (2006). The newborn behavioral observations system as a nursing
intervention to enhance engagement in first-time mothers: Feasibility and desirability. Pediatric
Nursing, 32(5), 455-459.
Unvas-Moberg, K. (1998). Oxytocin may mediate the benefits of positive social interactions and
emotions. Psychoneuroendocrinology, 23(8), 819-838.