Bonding after birth

“Natural births ‘create a closer bond with the baby‘”, is the headline in the Daily Mail . A natural birth can strengthen the maternal bond, making natural birth mothers “more emotionally responsive to the cries of babies” than mothers who have had a caesarean, the newspaper says. The effects may be due to a decrease in oxytocin hormone levels, it adds.

The story is based on a study that carried out brain scans on 12 mothers to look at the areas that became active when their baby cried. As this was a very small study, it is highly possible that any differences found are due to chance only. The brain responses occurred when listening to a recording of a baby crying during a nappy change, not to a real-life baby and it is unclear whether the changes seen on the brain scan would have any effect on the mother or baby’s experience of bonding.

Caesareans are carried out for a wide range of medical reasons when it is in the best interests for the health of either the mother or the baby. It is unlikely that these mothers will be any less able to bond with their baby or respond to their baby’s needs than a mother that has undergone a natural delivery.

Where did the story come from?

Dr James Swain of Yale Child Study Center, Program for Risk, Resilience and Recovery, US and colleagues from institutions in UK, Turkey and Israel, carried out this research. The study was funded by the Institute for Research on Unlimited Love, and Young Investigator Awards from the National Alliance of Research on Schizophrenia and Depression. It was published in the peer-reviewed medical journal: The Journal of Child Psychology and Psychiatry .

What kind of scientific study was this?

This was an experimental study in which the researchers aimed to investigate the idea that, in the early post-delivery period, mothers who had undergone a caesarean section would be less responsive to their baby’s cry than mothers who had a normal vaginal delivery.

The researchers recruited a group of 12 first-time mothers from Yale New Haven Hospital in the US. Six had undergone natural vaginal delivery, and six had undergone caesarean for “convenience reasons”. All were breastfeeding mothers and there was no significant difference in age, educational level or social status between the women. There had been no pregnancy complications among any of the women and none had self-reported psychiatric diagnoses or was taking medications. All the women completed a validated questionnaire about their parental concerns and anxieties.

Each mother was given an audio recorder to record their babies’ cries (during nappy change only) in the first two weeks after birth. The women received MRI brain scans 2–4 weeks after the birth. They wore headphones during the scan and listened to 30-second recordings of their own baby’s cry, another baby’s cry and a control noise. While listening, the women had to press buttons on a keypad to indicate their emotional response. Their options were none, little, a lot or maximal. The researchers used complex software and statistical methods to compare the areas of activity in the brains of the women during the experiment.

What were the results of the study?

The researchers found that there was no difference in the emotional scores given between the women in response to either their own baby’s cry, another baby’s cry or control noise between vaginal delivery and caesarean delivery mothers. There was also no difference within each woman in her response to her own baby’s cry or another baby’s cry. In both groups of mothers, there was a greater emotional response to the baby cries than to a control noise.

However, on MRI, the researchers found that when compared with the caesarean group, the women in the vaginal delivery group showed more response to their own baby’s crying in several areas of the brain, including those that process sensory information, motor and emotional response. Within the vaginal delivery group, they also found that the activity in certain areas of the brain (left and right lenticular nuclei) correlated with their responses to the questionnaire about parenting and activity in another area (the superior frontal cortex) correlated with their depression scores assessed on another scale.

What interpretations did the researchers draw from these results?

The researchers say that their findings “suggest” that vaginal delivery mothers are more sensitive than caesarean delivery mothers to their own baby’s cry in terms of sensory processing, arousal, empathy and motivation; additionally that independent of type of birth, parental anxieties and mood are related to activation in specific areas of the brain.

What does the NHS Knowledge Service make of this study?

It is important that results from this study are not over-interpreted.

• This was a very small experimental study and it is highly possible that any differences found are due to chance only. 
• The measure of using a brain scan response to a recording made of the baby’s cry is a highly arbitrary estimation of maternal bonding. Just because certain “emotional areas” of the mother’s brain were not activated in response to a recording made of the baby crying at a previous time (when the mother also knew that the baby was not in much distress) does not imply that she would feel emotionally different, any less responsive or less inclined to respond to the baby’s needs. Of importance is the fact that the vaginal delivery and caesarean delivery mothers subjectively gave no difference in emotional response to their baby cries.
• Women who had had caesareans in this small group had all received them for “convenience reasons”. Caesareans in the UK are very rarely performed for this reason and are carried out for a wide range of medical reasons when it is in the best interests for the health of either the mother or the baby. The underlying psychological or social issues surrounding the mother’s choice for a caesarean have not been investigated by this study, but they may also have an effect upon their responsiveness to the baby, that is, it may not be the caesarean section in itself that caused the different brain activity response to the baby cries. In any case, these women should not be compared with the vast majority of women who undergo a medically indicated caesarean.

Mothers undergoing elective or emergency caesarean sections should not be led to believe that they will be any less able to bond with their baby or respond to their baby’s needs than a mother who has undergone a natural delivery.

There are a wide variety of medical, psychological, social and personal reasons why any mother can experience some difficulty in adjusting to a new baby, which this study has not investigated. Any new mother who is concerned over her bond with her baby should receive full support and care.

Sir Muir Gray adds... 

They need to compare natural births with a caesarean followed by immediate plonking of the baby on the mothers bare breast, blood sweat tears and all; that can help bonding after a caesarean.