More on parent-infant bonding

Abstract

THE WORK OF KLAUS AND KENNELL on parent-infant bonding has become focus of a great deal of discussion and also subject of heated controversy. Believers and disciples have often been so dogmatic and evangelical that they did a disservice to their cause. Critics react as much to exaggerated practices triggered by teaching of Klaus and Kennell as to ideas presented originally. That work of Klaus and Kennell has made a significant contribution to happiness and welfare of many mothers, and indirectly to their infants, is beyond doubt. In many instances childbirth and delivery had been so dehumanized in name of technology and asepsis that joy and fulfillment were replaced by fear and fatalism for mother and a sense of exclusion for rest of family. With enthusiastic support of their patients and community, Klaus and Kennell served as important agents of change in restoring a nurturing environment to this critical human experience. They made extensive observations in an effort to document shortand long-term beneficial effects for mothers and infants that could be attributed to specific changes in practice. Others have followed their example in attempting controlled studies to explore impact of selected changes in experiences for mother and child during delivery and during immediate postpartum period. As noted in recent critical review by Lamb, l which had been summarized in a more pejorative form in this Journal] results of these studies have not been consistent; analogies from ethologic animal studies, although suggestive, also have limited application to human experience. Klaus and Kennell, 3 in more recent edition of their book on parent-infant bonding (which it would appear Lamb did not consider in his review) take a much more conservative view in drawing inferences from their observations and use incendiary terms, such as critical, sensitive period, bonding, and attachment behavior, in a more discriminating fashion. At this time it would not be enlightening to present another critical analysis of individual studies relevant to observations and recommendations of Klaus and Kennell; however, it seems appropriate to reemphasize that many of studies are methodologically flawed, which is not surprising, because childbirth, mothering practices, mother-child relationships, and child development are complex human phenomena for which we have few appropriate measures. Moreover, it seems unlikely that infant's cognitive development, individual molecular behaviors and interactions between mother and infant, length of breast-feeding, or risk of child abuse would be outcome variables that would reflect most sensitively experiences for mother and infant in first few hours and days of life. There may be measurable shortand long-term differences between infant-mother pairs that can be attributed to variations in experience around and shortly after birth, but so far, evidence is not compelling. Nevertheless, the absence of evidence is not evidence of absence, and we have a great deal to learn. It is curious that mental health interventions are always subject to special scrutiny for long-term impact. Observers are not satisfied to note that mothers, who have demanded right to relate to their newborn infants and to their families in a more humane and more intimate way, are clearly more satisfied and happy when they are allowed to do so. lnstead, there is a search for specific long-term changes that can be credited to altered mother-infant experience. Many other interventions by health professionals are accepted if they relieve suffering, if they satisfy, if they give pleasure, and if they improve functioning, even if there is no demonstratable effect months, years, or decades later, yet mental health practices (as well as educational interventions, at times) are often considered invalid unless there are significant measurable effects over long periods of time.