“The relationship between mothers and infants is critical for child development. For whatever reason, in some cases, that relationship doesn’t develop normally. Neglect and abuse can result, with devastating effects on a child’s development” (Strathearn, 2008)
A psychological perspective of attachment is a term to describe a reciprocal emotional tie that develops over time. There are many developmental theories relating themselves to attachment and deprivation and many arguments over the nature-nurture debate. However, the name that comes to the forefront of most minds when speaking of this topic is John Bowlby, the pioneer in relationship research. From the 1950’s Bowlbys work revolutionised the way in which people thought about a child and the tie to its mother, it made people look at how separation, deprivation and bereavement affected them.
Bowlbys work went on to generate an abundance of research and have a great deal of impact on the emotional care of young children. This essay will explore the evolutionary theory of attachment exemplified by Bowlby, along with his maternal deprivation hypothesis and investigate studies that support and challenge his theories. The essay will follow a pattern of questions: What is attachment and when does it commence? How and why is it established? And what happens if no attachment is formed? The conclusion will look at how these theories help in the understanding of midwifery practice.
When you become attached to someone, you have formed a special bond or relationship with that person, and he or she with you. It is a strong emotional bond or respective tie that develops over time between an infant and their primary caregiver. (Maurer and Maurer 1989) “Attachments are welded in the heat of interactions”
(Maurer and Maurer 1989, 227)
Maccoby (1980) identified four characteristics of this bond; seeking proximity, distress upon separation, pleasure when reunited and general orientation of behaviour towards the primary caregiver. Maccoby was inspired by Schaffer and Emerson’s (cited in Cardwell et al 2008) study of 60 Glaswegian infants. As part of this study they hoped to find the age at which attachments start and how intense these were by observations of separation and stranger anxiety. Their findings were that unique attachments appear to develop at 7months with multiple attachments developing soon after; they also found that attachments were formed with those who would interact and were responsive with the infant rather than those that were present most often.
Schaffer and Emerson believed that this showed attachment as developmental stages. (Cardwell et al 2008) Bowlby (1969) also proposed there were different stages of development, beginning with ‘pre-attachment’ at 0-2 months where infants produce similar responses to all things, objects or people. His second stage between 2-6 months, ‘attachment in the making’ is when the infant starts to recognise familiar people. Bowlby (1969) believed ‘real’ attachment begins at around 6 months when the infant starts to show signs of separation and stranger anxiety. In contrast, more recent research shows that attachment could begin much earlier.
Bushnell et al. (1989) found that at less than 24 hours old, infants would look for longer at their mother than another woman. Another study using an operant sucking procedure shows that new-borns, ranging from 12 to 36 hours of age, produced significantly more responses to their mothers’ faces as opposed to a stranger’. (Walton et al. 1992) Although impossible to measure from the infants’ perspective, and classified as bonding, it is believed that attachment could even begin in pregnancy. (Friedman and Gradstein 1982)
“Soon after conception the psychological and physiological processes of pregnancy are set in motion.” (Friedman and Gradstein 1982, 7)
There is support for the views of the likes of Bowlby that an attachment is made between 6-7 months, but more modern research is less supportive of this and shows that a different kind of attachment, bonding, is linked to pregnancy. Parents in a study using ultrasound scans explained their natural desire to see, and know their baby before birth. In addition to receiving reassurance of the baby’s health, the majority of the mothers felt that seeing their baby on the screen or looking at pictures, created a closer relationship between them and their unborn child. (Pretorious 2005) It is also clear from the emotional and psychological effects of miscarriage, termination and stillbirth that attachments are formed with the fetus. (Friedman and Gradstein 1982)
What attachment is, and when it commences, has been encapsulated, the next logical step is to look at how and why attachments are made. Bowlby (1969) believed that attachment is innate. Infants who form attachments are more likely to survive and reproduce and so, through evolution, the attachment gene is naturally selected and infants are born with an innate programming. Bowlby argued that something similar to the imprinting Konrad Lorenz (1952) discovered in hand reared goslings might occur in humans. Babies cannot follow their mothers everywhere but they do follow with their eyes, smile, cling, suck and cry, he believed that using this adaptive behaviour is how attachment is promoted.
These social releasers elicit a care giving reaction from others around them and the infant becomes uniquely attached to the person who responds most sensitively, this is usually the mother. This one person is known as the infants’ primary care giver, Bowlby called this monotropy and recognised this unique relationship as extremely important as the infant internalises a blue print of all future relationships based on their relationship with the primary caregiver. (Bowlby 1969) However, Ainsworth & Bell are cited by Cardwell (2008) to show quality of the attachment is dependent upon the quality of the interaction, Bowlby agreed and added that this special attachment must occur in what he called, the critical period, the infant’s first 2 ½ years, after this the child would not be capable of doing so and it would lead to long term irreversible consequences. (Cardwell 2008)
In contrast, learning theorists believe humans are a blank slate at birth and attachment behaviours are learnt through conditioning. Pavlov’s (cited in Cardwell 2008) area of expertise was classical conditioning, learning through association. Whoever feeds the baby becomes associated with food and the feeling of pleasure. Dollard & Millar (cited in Cardwell 2008) considered operant conditioning, learning through reinforcement. Babies feel discomfort when hungry and find if they cry their mother will feed them and the discomfort is removed. Therefore, the mother is associated with food and the baby will want to be close to her. These theories correspond with Freud’s approach that food is the motivating force in the attachment development and they are identified as cupboard love theories. (Cardwell 2008)
The famous study by Harlow and Harlow (cited in Bellur et al. 2003) using baby Rhesus monkeys contradicted the theory of food being the source of attachment. The results of experiments showed that the monkeys spent most time with the material covered surrogate, who gave them comfort and a base for exploration, rather than the wire surrogate, which produced food. Harlow concluded the monkeys have an innate need for comfort, which is as basic as their need for food. (Bellur et al. 2003) The Glasgow babies study from Schaffer and Emerson (cited in Cardwell et al 2008) showed that 39% of the babies formed their first attachment with someone other than the person who fed them, again suggesting that food is not the main requirement for forming attachments.
Regarding Monotropy, Bowlby (1953, 240) believed fathers were not of any direct emotional importance and stated: “Mother love in infancy is as important for mental health as vitamins and proteins for physical health”
Schaffer & Emmersons (cited in Cardwell et al 2008), study showed over 80% of the Glasgow babies formed multiple attachments and over 30% had no attachment to the mother or a stronger attachment to someone else, mainly the father. These findings concur with Bowlbys rejection of cupboard love theories but challenge his notion that multiple attachments are the exception and it shows fathers are attachment figures in their own right. (Cardwell 2008) Another opposition to Monotropy came from Freud & Dann (cited in Bellur et al. 2003) in a case study of 6 orphaned, 3 year old children brought up in a concentration camp from the age of 6-12 months.
They had little opportunity to form attachments with any adults and as a result they showed intense attachments to each other. (Bellur et al. 2003) Hazan & Shavers (1987) Love Quiz presented results that supported the theory that early attachment acts as a template for future relationships. Infants who were securely attached were now in lasting and trusting relationships. Those who were resistant-insecure in childhood showed jealousy, obsessive behaviours and felt they were not loved. Those who were avoidant infants presented fears of intimacy and believed they did not need to be loved to be happy.
There are many situations whereby an attachment can be broken or not formed at all; hospitalisation, incarceration or death. This disruption of attachment is known as deprivation. The pioneer of this theory is again Bowlby (1953) with his maternal deprivation hypothesis, which came about some 20 years previous to his publication of his attachment theory. The hypothesis focuses on the significance of a continuous relationship. Relationships that are discontinuous become less predictable and unstable.
The hypothesis stated
“if an infant is unable to develop a warm, intimate and continuous relationship with his mother then the child would have difficulty forming relationships with other people and be at risk of behavioural disorders” (Bowlby 1953, 120-3)
There is support for the maternal deprivation hypothesis. Harlow & Harlow (cited in Bellur et al. 2003) found the monkeys in their study went on to be extremely aggressive adults and failed to develop normal relationships or parent well. Spitz & Wolf (cited in Cardwell 2008) found children raised in institutions with poor quality care and rare interaction were developmentally inferior, depressed, withdrawn and helpless compared to those raised in a prison where their mother cared for them. Bowlbys own study of 44 thieves found that a high percentage were diagnosed as being affectionless psychopaths and most of these had experienced separation before the age of 5. (Cardwell 2008) Later studies show however, that many of the effects of deprivation can be overcome. Roberston & Robertson (cited in Cardwell 2008) showed that if substitute emotional care is provided in separation then the effects (deprivation) can be avoided.
In Midwifery terms, attachment is known as bonding and there are numerous ways in which a midwife can help the mother and family bond with their baby and these can be related to attachment theories. For instance, the social releasers which Bowlby talks about may be inhibited when the baby has an abnormality, for example, blindness or a cleft pallet. This may at first shock the mother who may not react in the sensitive way which is important for the quality of attachment. For a midwife, careful consideration needs to go into the communication with the parents in the post natal period. (Prince and Adams 1987) “physical appearance is an important element of interpersonal relations, and in the last two decades there have been several studies demonstrating the psychological importance of physical appearance” (Clifford and Bull, cited in Prince and Adams 1987, 163)
A disfigured baby may shock the mother deeply and while she may not want to look at him, Kennell & Klaus (cited in Prince and Adams 1987) believe that the tactile experience and bodily contact is just as important for the development of attachment. The way in which a mother handles her baby is obviously affected by her feelings in the perperium and a midwife will need to be there to help the mother through this time with encouragement, answers to the many questions and picking up on any non-verbal signs which are extremely important.
There is mixed evidence for claims of a critical period in attachment, the age of a child may be important but there is no conclusive evidence to show it must be 2 ½ years. It is shown, however, that mothers who have immediate contact are more likely to be more responsive and yielding and spend a longer period of time looking at their babies. (The Biological Impetus to Attachment 2008) Klaus & Kennel (cited in Prince and Adams 1987) believed that skin to skin contact between mother and baby is essential for bonding. They found that mothers who cuddled their baby in a critical period after birth enjoyed better relationships with their child than those mothers who did not have the opportunity. This can be related to caesarean sections where mother and baby are sometimes separated immediately at birth.
A midwife who is present can be of upmost importance, they can ensure that trauma and separation be avoided and encourage the same skin to skin contact that is encouraged in a normal birth. It is also an opportunity for the father or partner to be heavily involved as the mother will have limited mobility and be uncomfortable. It has been noticed that hands on fathers or partners find attachment much easier and sometimes it takes a caesarean section for this to happen, in a normal vaginal birth, the mother tends to have the immediate contact and involvement. Midwives can encourage the fathers and partners to get more hands on in the vaginal birth, an example of this would be to allow them to cut the cord after delivery. (Mutryn 1993)
Another aspect of Bowlbys theory which is criticised is the Monotropy theory. Midwives see this in twins, especially those that are pre-term. Complications and problems related to multiple birth and prematurity challenge the maternal attachment. Twins stimulate each other and have an indescribable bond to each other which is rarely seen in other siblings. (Noble 2003)
There is certainly evidence that Midwifery practice can relate to the theories discussed, however, it is apparent that more research needs to be looked into, especially Biological theories and the release of hormones in a natural birth versus a caesarean section. Do attachments in these births differ? Furthermore, no consideration is taken in any of the theories as to the temperament of the infant or the fact this may make it easier or harder for them to make attachments.
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