"The baby must be touched and caressed immediately after birth. He must
have the mother's warmth almost continually during this time;
otherwise all the touch in the world will not be enough."
-- Dr. Arthur Janov,
Imprints: The Lifelong Effects of the Birth Experience
the past decades the emphasis in the field of childbirth has been
largely upon those factors which influence the physical health of
mother and child. We therefore welcome the emerging “home birth”
movement, the “family centered childbirth” movement “kangaroo mother
care” and “baby friendly” hospitals, which, while maintaining the
emphasis on safety and high medical standards, regards as equally
important an emphasis on the factors influencing the emotional health
and well-being of the mother and baby.
The importance of
the relationship between a mother and her newborn child can never be
overemphasized. It is from this relationship that all human
relationships grow. Research over the last 25 years has shown that the
contact between mother and the newborn baby during the first few hours
after birth may set down life-long patterns which are extremely
difficult to change later. This is raising serious questions about the
routine policies of many maternity hospitals where separation of the
mother and neonate directly after birth is still often the standard
practice. The aim of this article is to consider the effects of routine
hospital procedures on the mother/child relationship in particular.
During the past decades it has been the standard procedure in most
hospitals to remove the newborn directly after birth, while the mother
is taken to the recovery room to rest. In some more progressive
hospitals the mother may be allowed to nurse briefly on the delivery
table. All too soon however, the baby is taken away to the central
nursery where it is placed alone in a crib. There it has to wait in
isolation till the official hospital schedule allows it to be taken to
the mother to be fed. (This may involve waiting periods of up to three
hours at a time, depending on the hospital policy.) In addition, during
the first day, while the baby is under observation, it is sometimes
kept from the mother for an extended period of many hours. In some
hospitals, mothers who were sedated for the birth may not see their
babies at all till they are up to 12 hours old.
Klaus and Kennell have done extensive research into the phenomenon of
maternal-infant bonding, (Klaus & Kennell, 1976). The results
suggest that a mother's interaction with her baby during the first few
hours of life, critically affects her attitude towards the child for
at least the next five years. It is not yet known exactly how long the
'sensitive' period lasts, but it is believed to lose effectiveness
between three and four hours after the birth, (Spezzano & Waterman,
1977). If there has been no contact between the mother and neonate
during this period, adequate bonding does not occur. If a mother and
infant have almost uninterrupted contact during this period, a strong
maternal-infant bond is created and the resulting maternal feelings in
the mother continue after the 'sensitive' period has elapsed.
After a drug-free delivery, both mother and baby are in a state of
wakefulness and receptivity for the first few hours. During this time
touch and eye contact are vitally important. The mother spends much
time holding the baby in the en face
position, and talks to him in a special tone of voice. The baby looks
up at the mother, following the movement of her eyes. This elicits a
return-response from her. Sound and smell are also important bonding
elements. After hearing her baby's cry only once, a mother who has
bonded with her baby can often recognize it from a group of babies by
the baby’s voice alone. The baby, when first offered the breast, will
also lick and smell the nipple before sucking. Later it will recognize
the mother by her smell.
If early bonding has occurred the baby will cry when handed to a
stranger, quietening down as soon as s/he is returned to its own
mother. For the mother, having the baby in her arms means that the
climax of birth is followed by a time of quiet closeness when she can
get to know her baby. This is described by those who have experienced
it, as deeply fulfilling. It leaves the mother with strong feelings of
attachment to the baby and positive feelings about herself as a mother.
She also has strong feelings that the child is really hers.
Klaus and Kennell (1976) were among the first to suggest a connection
between separation of the mother and baby directly after birth, and
later child abuse. It was found for example that there was a high
incidence of child battering among children who had been premature
infants and had spent the first hours of life in an incubator, away
from the mother. Mothers who had been separated from their newborn
babies were also more likely to put them up for adoption during the
first year of life, even if the pregnancy had been planned and the
mother was looking forward to the birth.
The following statement is typical of what they said when interviewed ,
“It’s a beautiful baby, but somehow I don't feel right about it. It
could belong to anyone. I never really felt this was my own child."
These feelings did not occur if the baby had been placed in the
mother's arms on the delivery table and had spent the first three or
four hours of life in skin-to-skin contact with her.
Bricklin (1975) has suggested that if bonding has not occurred and the
mother is aware of her lack of maternal feelings, she can attempt to
remedy the situation by getting breast-feeding established as soon as
possible and concentrating on the feelings of closeness, which this
interaction brings. She feels that the strong bond created by the
breastfeeding situation may to some extent make up for the deficiency
already created and help to bridge the emotional gap between mother and
infant. The problem here is that many 'low-contact' mothers choose not
'High-contact' mothers on the other hand are usually eager to
breastfeed their babies. Follow-up of a group of such mothers showed
that their babies were less likely to be abused, abandoned, neglected
or to receive inadequate care, (Spezzano & Waterman, 1977). These
mothers were more nurturing and maintained more eye contact with their
babies at one month old than mothers in the control group who had
received standard hospital treatment. The babies in the experimental
group also gained weight better than those in the control group, cried
less and smiled more. By one year of age 'high-contact' mothers were
more likely to be breastfeeding their babies than 'low-contact'
mothers. They also spent more time soothing them in a pediatric
At five years of age the differences between the two groups of children
were still apparent. The 'extended-contact' children were better
adjusted and had higher lQ's than the control group. They also
obtained more advanced scores on language tests than the 'low-contact'
children. As far as can be ascertained, differences shown in the two
groups of children seem to be largely dependent on the fact that
'extended-contact' mothers relate more positively to their children
as a result of adequate early bonding.
It is well known that if the newborn of most animals are removed from
the mother directly after birth and then returned later, the mother is
likely to reject the young, and may even kill them. The same is true if
young animals are born while the mother is under general anesthesia and
presented to the mother after she has regained consciousness. We cannot
generalize these findings to humans without further research, but it
does seem possible that a similar mechanism is at work here.
There is one important distinction however. Human beings are able to
reflect and rationalize. Thus a human mother may not overtly reject or
abandon her baby. Instead, a mother who has expected to feel a rush of
love and maternal pride, may feel let down and disappointed when she
sees her day-old baby for the first time and feels nothing. She may
experience bewilderment and guilt because she does not come up to her
own ideals of what a mother should be. She is often powerless to know
what to do because she does not understand the source of her feelings.
She may even react to the baby with hostility because it is seen as the
cause of her disappointment and self-condemnation. This is a vicious
circle as her hostility towards her child creates more guilt-feelings.
The final outcome is often exhaustion and depression.
It is highly significant that proponents of the 'home birth' movement
which is gaining such momentum worldwide, report that post-partum
depression is almost unknown among mothers who give birth at home.
There the newborn is seldom separated from the mother for lengthy
periods during the first week of life. One of the problems , which
occurs most frequently in the hospital situation where the mother and
baby have been separated and bonding has hot been achieved, is that the
mother seems to lack much of the instinctual knowledge of how to relate
to her baby. This is most likely to reach a crisis when the mother has
to return home and take care of her baby alone. She is more likely to
be unable to cope and feel exhausted and depressed, and may also
reproach herself for being a bad mother.
THE EFFECTS OF SEPARATION ON THE NEW MOTHER
Until the 1970s there was very little subjective information as to how
the baby felt during birth and shortly thereafter, but with the advent
of primal therapy, a large number of patients started reliving early
experiences, including the first day of life. They became able to
describe in great detail those experiences which were painful and
traumatic to them, showing how these factors often created life-long
maladaptive behaviour patterns.
One of the most painful traumas relived by many primal patients, is
being separated from the mother directly after birth. The baby 'knows'
instinctively it cannot stay alive without its mother. It is completely
helpless and totally dependent on her for survival. The baby feels
instinctively that to be separated from her is to die. It cannot be
made to understand that it has not been abandoned, but is simply
waiting in a central nursery, and will be taken to its mother
eventually. The baby has no way of interpreting what is happening to
it, or of knowing that the separation and abandonment it is
experiencing are ever going to end. The only way the baby can shut off
the pain of the long hours without its mother, is by using sleep as a
Primal patients who have relived this particular trauma have often
gained insights into the fact that this became a prototypic defense for
them and that they continued to use sleep as an escape whenever reality
became too painful. Often the trauma of being left lying alone in the
crib was experienced physically when it was relived. For example, one
primaller said, "I felt the pain all over my body, because that was
where I hurt. I needed to feel someone holding me - to let me know I
wasn't going to be left to die all alone. I've tried to get that from
lovers in the present and it's no wonder I couldn't keep a relationship
going. I would cling to people, afraid that they were going to abandon
me. I wasn't acting like an adult at all. I was still that hurt,
abandoned little baby.”
Another patient reported how early in her therapy therapy, she relived
how she had lain in the crib, waiting in a state of desperation for the
sound of the footsteps that would take her to her mother to be held and
fed. The footsteps approached, but instead of stopping, they went
past. And she was left with the terrible loneliness again. All she
could do was scream and hope that she could make someone see her.
Afterwards she realized that she had spent much of her life doing
spectacular things, trying to get people to see her and notice her
needs, afraid that they might overlook her or forget about her. The
feeling underneath was, "I've got to make them see me or I'll die."
In my own therapy I connected to how insecure I had always felt in
close relationships. No matter how well relationships were going for me
in the present, I always felt they could never last. Finally I was able
to connect this to my early experience in the hospital where I was
born. I was kept in the central nursery and taken to my mother only
briefly for feeds. Each time I was handed to her I would feel that the
pain and loneliness were over at last. Just as I was starting to feel
safe and secure in my mother's arms, I was taken away from her and back
to the nursery again. This experience, repeated many times, left me
with the feeling, "It's no use getting close to anyone, because as soon
as I do, they will be snatched away from me again."
Birth is a great upheaval for the newborn. More than at any other time,
in the hours following its birth, the baby needs the warmth and comfort
of being physically close to its mother. The familiar sounds of her
heartbeat and breathing are something the baby knows. They create a
sense of continuity between the baby’s previous experience in the womb
and the new conditions to which it must adjust. Continuous early
contact with its mother will leave the baby secure in the knowledge
that the mother will not abandon it.
The baby also needs to know that the mother will meet all of its needs
as they arise. This means that that she should respond whenever the
baby expresses its needs by crying, and feed the baby whenever it is
hungry. The mother and the mother’s breast are a source of food and
warmth and comfort to a tiny baby – the baby should know that they will
be there for it whenever it needs them. This necessitates 'rooming-in'
facilities if the baby is born in a hospital. It is also important that
the mother have had a drug-free delivery if possible so that she is
awake and able to begin caring for her baby immediately.
THE EFFECTS OF SEPARATION ON THE NEONATE
While separation of the mother and newborn, and other hospital
procedures outlined above, cannot be held solely responsible for the
creation of later neurosis, they do often lay down prototypic
maladaptive patterns upon which later problems are compounded. While
the creation of some of these early traumas may take a few hours or at
most a few days, the resulting problems often take years of intense and
costly therapy to resolve. In primal therapy it has been found that it
can take years to integrate 'first line' pain, i.e. pain laid down in
the system during birth and the first days of life, so prevention is
definitely better than having to try to cure the problem later.
During the past decades the emphasis in the field of childbirth has
been largely upon those factors which influence the physical health of
mother and child. We therefore welcome the emerging “home birth”
movement, the “family centered childbirth” movement, “kangaroo mother
and “baby friendly” hospitals, which, while maintaining the emphasis on
safety and high medical standards, regards as equally important an
emphasis on the factors influencing the emotional health and well-being
of both the mother and her child.
(* For more information on kangaroo mother care, see article on KMC also on this site at:
article is dedicated to my primal friend and buddy, Helmut Viehmann,
who brought the research of Klaus and Kennell to my attention when we
were in therapy in L.A. in 1977. It resulted in a change of career for
me in my mid 30s, and led me to qualify as a Childbirth Educator with
the American Institute of Family Relations. As a result, I was able to
spend many years of my life working with expectant parents, educating
them about how they could meet the very real, and greatly
misunderstood, primal needs of their babies.