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Mother-infant interaction
3. Lieberman BA, Rosenblatt DB, Belsey E et al. The effects of maternally administered pethidine or epidural bupivacaine on the fetus and newborn. Brit J Obstet Gynaec 1979; 86: 598. 4. Stefani SJ, Hughes SC, Shnider SM et al. Neonatal neurobehavioral effects of inhalational analgesia for delivery. Anesthesiology 1979; 53: S314. 5. McGuinness GA, Merkow AJ, Kennedy RL et al. Epidural anesthesia with bupivacaine for cesarean section: neonatal blood levels and neurobehavioral responses. Anesthesiology 1978; 49: 270-273. 6. Datta S, Corke BC, Alper MH et al. Epidural anesthesia for cesarean section: a comparison of bupivacaine, chloroprocaine and etidocaine. Anesthesiology 1980; 52: 48-51. 7. Abboud TK, Williams V, Miller F et al. Comparative fetal, maternal and neonatal responses following epidural analgesia with bupivacaine, chloroprocaine and lidocaine. Anesthesiology 198I ; 53: A315. 8. Scanlon JW, Brown WU, Weiss JB et al. Neurobehavioral responses of newborn infants after maternal epidural anesthesia. Anesthesiology 1974; 40: 121. 9. Hughes SC, Rosen MA, Stefani SJ et al. Maternal and neonatal effects of epidural morphine for labor. Abstract of the annual meeting of the Society for Obstetric Anesthesia and Perinatology, San Diego 1981; 31. 10. Palahniuk, RJ, Scatliff J, Biehl D et al. Maternal and neonatal effects of methoxyflurane, nitrous oxide and lumbar epidural anaesthesia for caesarean section. Can Anaesth Sot J 1977; 24: 586-596. 1I. Shnider SM, Abboud T, Levinson G et al. General anesthesia for cesarean section: maternal and fetal norepinephrine levels and neonatal neurobehavioral status. Anesthesiology, 1979; 53: S302. 12. Ounsted M. Pain relief during childbirth and development at 4 years. J R Sot Med. 1980; 74: 629-630.
Mother-infant interaction M. Orzalesi and B. de Caro, Zstituto di Puericultura e Patologia Neonatale, Viale S. Pietro 12, Z-07100 Sassari, Ztalia Introduction During the past decade many investigators from various disciplines (obstetrics, pediatrics, psychology, psychiatry, ethology, etc.) have stressed the importance of early mother-infant interactions for the future mothering behavior and child development [l-3]. These studies have indicated that human mothers, like other mammals, exhibit an ‘attachment’ behavior in the immediate post-partum period, which is essential for the future bonding to their infants, The presence of the baby is an important determinant for optimal attachment, and early prolonged mother-infant separation can lead to severe disturbances of the subsequent maternal and/or infant behavior. Part of this new knowledge has not remained confined to the medical literature and has been publicized in the lay press, becoming an integral part of the cultural background of many women. As a consequence, some of the usual routines of perinatal care have been (or are in the process of being) changed in order to take into consideration this new reality [2,4]. Furthermore, any old or new modality of maternal and child care must now be (re-)evaluated in relation to its effects on the mother-infant relationship. The components of mother-infant interaction The major components of the maternal-neonatal infant and the environment.
interaction are the mother, the
365
The mother
Some of the factors that determine the mother’s action and responses to her new baby are already ingrained at the time of birth. They include the mother’s genetic endowement, her history of interpersonal relations with her family and husband, her past experience with the present and previous pregnancies, the way she has assimilated the practices and values of her culture and the kind of care she has received by her own parents. Other factors come into play at the time of birth, such as the course of labor and delivery, the behavior of doctors, nurses and other hospital personnel and, most importantly, the presence, appearance, personality, and behavior of the new baby and the way he responds to the mother. In this regard it is important that the mother can touch the baby and establish eye-to-eye contact with him. The newborn The baby is a very active component of the early mother-infant interaction. During the first hour after birth he is particularly alert and responsive and this stimulates the mother’s attention and encourages her attempts to establish a relationship with him. He can send a variety of signals to the mother and is capable of responding to the messages sent by her. He will rapidly recognize her voice, face, odor and touch, and modify his behavior according to her manipulations. This broad spectrum of sensory and motor abilities of the newborn and the consequent responses evoked in the mother initiate a series of reciprocal interactions, which are important for the development of an adequate maternal attachment and bonding. The environment Many environmental factors can significantly affect the quality and quantity of early interactions between mother and infant. Separation or physical proximity of the baby and the amount of time that the mother can spend with him are probably the most important factors, and are often dependent upon the local hospital practices and routines. The overall atmosphere of the place where the first encounter occurs and the presence and attitudes of other people, such as doctors, nurses, relatives, and particularly the father of the baby, are also relevant. Finally, the level of consciousness and the degree of responsiveness of mother and infant, and their possible alterations by the drugs used for obstetric anesthesia or analgesia are other important aspects to be considered. Neurobehauioral effects of anesthetics and analgesics The recent literature is very rich of scientific contributions
concerning the effects on the fetus and newborn of various drugs used for pain relief in labor (be it analgesia or local or general anesthesia) [5,6]. With a few exceptions, practically all these drugs have been reported to decrease a variety of neurobehavioral performances of the neonate, including respiration, muscle tone, sleep, cry, motor activity, visual attentiveness, sucking and feeding ability, habituation and orienting reflexes, EEG evoked responses, etc. The ultimate sedative effect on the newborn has proved to be dependent upon a number of variables, including the type of drug used, the dose, the route of administration, the time interval between administration and birth. Usually, however, these neurobehavioral effects are slight and short-lived (a few hours or a few days). On the other hand, the data on the post-partum behavior of the mother are scarce, particularly in relation to the mother-infant interaction. Obviously, the period of post-partum separation between mother and infant can be increased when recovery from general anesthesia is prolonged. More important,
366
however, appears the possibility of a ‘chemical separation’ between mother and baby, with a decreased capacity of both for sending and receiving those signals that are so important for their initial communication. Therefore, there is no question that the use of drugs for pain relief- in l’abor can interfere with early mother-infant interactions. The severity of this interference will depend upon the degree and duration of the sedative effects on mother and baby. Discussion and Conclusions
The ultimate significance of the above-mentioned findings is still undetermined. The few studies performed so far have failed to show any significant long-term effect of obstetric anesthesia and analgesia on the mother-infant relationship and child development. However, it must be emphasized that there are no good prospective studies performed after proper randomization and stratification for all the other variables that can independently affect the mother-infant relationship. Furthermore, it is important to consider that the administration (or not) of a drug, for the relief of pain in labor is not simply a ‘chemical manipulation’ of the mother and the fetus, but is a complex ‘modality of care’, with many implications and possible effects, besides the pharmacological action of the drug. The reasons and motivation for anesthesia (or analgesia), the participation of the woman in the decision process, the choice of the method used, and the environmental context where it is carried out, are only some of the most important variables that can profoundly affect the expectations and attitudes of the mother towards the new baby and hence how she will eventually interact with him. References 1. Klaus MH, Kennel1 JH. Maternal-infant
bonding. St. Louis: The C.V. Mosby Co; 1976. 2. Macfarlane JA, Smith DM, Garrow DH. The relationship between mother and neonate. In: The Place of Birth, Kitzinger, S. and Davis, JA eds. Oxford: Oxford University Press, 1978; 185-200. 3. Taylor PM. (Guest Editor) Parent-Infant Relationships. Sem Perinat 1979; 3: 1. 4 Kennel J. Are we in the midst of a revolution? (The Geroge Armstrong Award Lecture). Amer J Dis Child 1980; 134: 303-310. 5. Scanlon JW. Effects of obstetric anesthesia and analgesia on the newborn: a select, annotated bibliography for the clinician. Clin Obstet Gynec 1981; 24: 649-670. 6. Dailey PA, Baysinger CL, Levinson G, Shnider SM. Neurobehavioural testing of the newborn infant. Effects of obstetric anesthesia. Clinics in Perinat 1982; 9: 191-214.
Mother-infant interaction M. Orzalesi and B. de Caro, Zstituto di Puericultura e Patologia Neonatale, Viale S. Pietro 12, Z-07100 Sassari, Ztalia Introduction During the past decade many investigators from various disciplines (obstetrics, pediatrics, psychology, psychiatry, ethology, etc.) have stressed the importance of early mother-infant interactions for the future mothering behavior and child development [l-3]. These studies have indicated that human mothers, like other mammals, exhibit an ‘attachment’ behavior in the immediate post-partum period, which is essential for the future bonding to their infants, The presence of the baby is an important determinant for optimal attachment, and early prolonged mother-infant separation can lead to severe disturbances of the subsequent maternal and/or infant behavior. Part of this new knowledge has not remained confined to the medical literature and has been publicized in the lay press, becoming an integral part of the cultural background of many women. As a consequence, some of the usual routines of perinatal care have been (or are in the process of being) changed in order to take into consideration this new reality [2,4]. Furthermore, any old or new modality of maternal and child care must now be (re-)evaluated in relation to its effects on the mother-infant relationship. The components of mother-infant interaction The major components of the maternal-neonatal infant and the environment.
interaction are the mother, the
365
The mother
Some of the factors that determine the mother’s action and responses to her new baby are already ingrained at the time of birth. They include the mother’s genetic endowement, her history of interpersonal relations with her family and husband, her past experience with the present and previous pregnancies, the way she has assimilated the practices and values of her culture and the kind of care she has received by her own parents. Other factors come into play at the time of birth, such as the course of labor and delivery, the behavior of doctors, nurses and other hospital personnel and, most importantly, the presence, appearance, personality, and behavior of the new baby and the way he responds to the mother. In this regard it is important that the mother can touch the baby and establish eye-to-eye contact with him. The newborn The baby is a very active component of the early mother-infant interaction. During the first hour after birth he is particularly alert and responsive and this stimulates the mother’s attention and encourages her attempts to establish a relationship with him. He can send a variety of signals to the mother and is capable of responding to the messages sent by her. He will rapidly recognize her voice, face, odor and touch, and modify his behavior according to her manipulations. This broad spectrum of sensory and motor abilities of the newborn and the consequent responses evoked in the mother initiate a series of reciprocal interactions, which are important for the development of an adequate maternal attachment and bonding. The environment Many environmental factors can significantly affect the quality and quantity of early interactions between mother and infant. Separation or physical proximity of the baby and the amount of time that the mother can spend with him are probably the most important factors, and are often dependent upon the local hospital practices and routines. The overall atmosphere of the place where the first encounter occurs and the presence and attitudes of other people, such as doctors, nurses, relatives, and particularly the father of the baby, are also relevant. Finally, the level of consciousness and the degree of responsiveness of mother and infant, and their possible alterations by the drugs used for obstetric anesthesia or analgesia are other important aspects to be considered. Neurobehauioral effects of anesthetics and analgesics The recent literature is very rich of scientific contributions
concerning the effects on the fetus and newborn of various drugs used for pain relief in labor (be it analgesia or local or general anesthesia) [5,6]. With a few exceptions, practically all these drugs have been reported to decrease a variety of neurobehavioral performances of the neonate, including respiration, muscle tone, sleep, cry, motor activity, visual attentiveness, sucking and feeding ability, habituation and orienting reflexes, EEG evoked responses, etc. The ultimate sedative effect on the newborn has proved to be dependent upon a number of variables, including the type of drug used, the dose, the route of administration, the time interval between administration and birth. Usually, however, these neurobehavioral effects are slight and short-lived (a few hours or a few days). On the other hand, the data on the post-partum behavior of the mother are scarce, particularly in relation to the mother-infant interaction. Obviously, the period of post-partum separation between mother and infant can be increased when recovery from general anesthesia is prolonged. More important,
366
however, appears the possibility of a ‘chemical separation’ between mother and baby, with a decreased capacity of both for sending and receiving those signals that are so important for their initial communication. Therefore, there is no question that the use of drugs for pain relief- in l’abor can interfere with early mother-infant interactions. The severity of this interference will depend upon the degree and duration of the sedative effects on mother and baby. Discussion and Conclusions
The ultimate significance of the above-mentioned findings is still undetermined. The few studies performed so far have failed to show any significant long-term effect of obstetric anesthesia and analgesia on the mother-infant relationship and child development. However, it must be emphasized that there are no good prospective studies performed after proper randomization and stratification for all the other variables that can independently affect the mother-infant relationship. Furthermore, it is important to consider that the administration (or not) of a drug, for the relief of pain in labor is not simply a ‘chemical manipulation’ of the mother and the fetus, but is a complex ‘modality of care’, with many implications and possible effects, besides the pharmacological action of the drug. The reasons and motivation for anesthesia (or analgesia), the participation of the woman in the decision process, the choice of the method used, and the environmental context where it is carried out, are only some of the most important variables that can profoundly affect the expectations and attitudes of the mother towards the new baby and hence how she will eventually interact with him. References 1. Klaus MH, Kennel1 JH. Maternal-infant
bonding. St. Louis: The C.V. Mosby Co; 1976. 2. Macfarlane JA, Smith DM, Garrow DH. The relationship between mother and neonate. In: The Place of Birth, Kitzinger, S. and Davis, JA eds. Oxford: Oxford University Press, 1978; 185-200. 3. Taylor PM. (Guest Editor) Parent-Infant Relationships. Sem Perinat 1979; 3: 1. 4 Kennel J. Are we in the midst of a revolution? (The Geroge Armstrong Award Lecture). Amer J Dis Child 1980; 134: 303-310. 5. Scanlon JW. Effects of obstetric anesthesia and analgesia on the newborn: a select, annotated bibliography for the clinician. Clin Obstet Gynec 1981; 24: 649-670. 6. Dailey PA, Baysinger CL, Levinson G, Shnider SM. Neurobehavioural testing of the newborn infant. Effects of obstetric anesthesia. Clinics in Perinat 1982; 9: 191-214.