Bonding?

On Aug. 27, Dr. John Kennell died at the age of 91. I learned from his obituary in the New York Times that he was the guy who put maternal-infant bonding on the map. It was his observations as a neonatologist, when neonatology was in its infancy, that ended the common and unnatural practice of separating mother and infants for hours and in some sad cases even days, so that each could recover from the ordeal of an uncomplicated hospital childbirth.

In a book coauthored with Dr. Marshall Klaus in 1976 titled "Maternal-Infant Bonding," Dr. Kennell claimed that there was a critical period in the first few hours after delivery during which mothers were biochemically primed to form bonds with their infants. And, that these bonds were crucial for normal development. Over the next few decades, he nuanced his position. In fact, his most recent efforts were in support of doula care, which if poorly done could conceivably interfere with the bonding he had pioneered.

But, the damage was already done. At least two generations of parents still live in dread fear that they didn’t spend enough of the right kind of time with their newborns. For example, 2 years ago, I received a call from a friend whose daughter had recently delivered her second child by C-section. The baby was fine, but the mother nearly died of intrapartum group A beta-hemolytic sepsis. The ordeal included DIC [disseminated intravascular coagulation],multiorgan failure, and the partial amputation of a couple of digits.

Not surprisingly, this young woman was in no condition to interact with anyone for more than 2 weeks. The new grandmother’s call was prompted by the observation that now in the third week postpartum when her daughter was awake she seemed to have little interest in holding or nurturing the baby. And, she was more than willing to have nurses and family members do the hugging and cuddling.

I asked, "Is this about that bonding thing? If your daughter really wanted to have this baby, we could send her to Cleveland for 3 months and the two of them would still form a normal mother-daughter relationship." I could have added, "Let’s remember, we aren’t geese who will imprint on the first adult figure they see after hatching. Even if it is a 6-foot-tall researcher with a beard." This summer I got to meet this young woman and her daughter and could tell that the two made a beautifully adjusted dyad.

It is unfortunate that Dr. Kennell’s early work that was so critical to creating a more humane birthing experience had a dark side that sent a ripple of needless anxiety that still shakes parents 3 decades later. Tragically, there are cases of seriously disordered maternal-infant bonding so severe that they result in infanticide. But, in my experience these incidents are the result of a long or deep mental illness and are not caused by a few hours or days of separation immediately after birth.

Dr. Wilkoff practiced primary care pediatrics in Brunswick, Maine, for nearly 40 years. He is the author of "Coping with a Picky Eater: A Guide for the Perplexed Parent" and several other books. E-mail him at [email protected].

Updated: 10/8/2013

On Aug. 27, Dr. John Kennell died at the age of 91. I learned from his obituary in the New York Times that he was the guy who put maternal-infant bonding on the map. It was his observations as a neonatologist, when neonatology was in its infancy, that ended the common and unnatural practice of separating mother and infants for hours and in some sad cases even days, so that each could recover from the ordeal of an uncomplicated hospital childbirth.

In a book coauthored with Dr. Marshall Klaus in 1976 titled "Maternal-Infant Bonding," Dr. Kennell claimed that there was a critical period in the first few hours after delivery during which mothers were biochemically primed to form bonds with their infants. And, that these bonds were crucial for normal development. Over the next few decades, he nuanced his position. In fact, his most recent efforts were in support of doula care, which if poorly done could conceivably interfere with the bonding he had pioneered.

But, the damage was already done. At least two generations of parents still live in dread fear that they didn’t spend enough of the right kind of time with their newborns. For example, 2 years ago, I received a call from a friend whose daughter had recently delivered her second child by C-section. The baby was fine, but the mother nearly died of intrapartum group A beta-hemolytic sepsis. The ordeal included DIC [disseminated intravascular coagulation],multiorgan failure, and the partial amputation of a couple of digits.

Not surprisingly, this young woman was in no condition to interact with anyone for more than 2 weeks. The new grandmother’s call was prompted by the observation that now in the third week postpartum when her daughter was awake she seemed to have little interest in holding or nurturing the baby. And, she was more than willing to have nurses and family members do the hugging and cuddling.

I asked, "Is this about that bonding thing? If your daughter really wanted to have this baby, we could send her to Cleveland for 3 months and the two of them would still form a normal mother-daughter relationship." I could have added, "Let’s remember, we aren’t geese who will imprint on the first adult figure they see after hatching. Even if it is a 6-foot-tall researcher with a beard." This summer I got to meet this young woman and her daughter and could tell that the two made a beautifully adjusted dyad.

It is unfortunate that Dr. Kennell’s early work that was so critical to creating a more humane birthing experience had a dark side that sent a ripple of needless anxiety that still shakes parents 3 decades later. Tragically, there are cases of seriously disordered maternal-infant bonding so severe that they result in infanticide. But, in my experience these incidents are the result of a long or deep mental illness and are not caused by a few hours or days of separation immediately after birth.

Dr. Wilkoff practiced primary care pediatrics in Brunswick, Maine, for nearly 40 years. He is the author of "Coping with a Picky Eater: A Guide for the Perplexed Parent" and several other books. E-mail him at [email protected].

Updated: 10/8/2013

On Aug. 27, Dr. John Kennell died at the age of 91. I learned from his obituary in the New York Times that he was the guy who put maternal-infant bonding on the map. It was his observations as a neonatologist, when neonatology was in its infancy, that ended the common and unnatural practice of separating mother and infants for hours and in some sad cases even days, so that each could recover from the ordeal of an uncomplicated hospital childbirth.

In a book coauthored with Dr. Marshall Klaus in 1976 titled "Maternal-Infant Bonding," Dr. Kennell claimed that there was a critical period in the first few hours after delivery during which mothers were biochemically primed to form bonds with their infants. And, that these bonds were crucial for normal development. Over the next few decades, he nuanced his position. In fact, his most recent efforts were in support of doula care, which if poorly done could conceivably interfere with the bonding he had pioneered.

But, the damage was already done. At least two generations of parents still live in dread fear that they didn’t spend enough of the right kind of time with their newborns. For example, 2 years ago, I received a call from a friend whose daughter had recently delivered her second child by C-section. The baby was fine, but the mother nearly died of intrapartum group A beta-hemolytic sepsis. The ordeal included DIC [disseminated intravascular coagulation],multiorgan failure, and the partial amputation of a couple of digits.

Not surprisingly, this young woman was in no condition to interact with anyone for more than 2 weeks. The new grandmother’s call was prompted by the observation that now in the third week postpartum when her daughter was awake she seemed to have little interest in holding or nurturing the baby. And, she was more than willing to have nurses and family members do the hugging and cuddling.

I asked, "Is this about that bonding thing? If your daughter really wanted to have this baby, we could send her to Cleveland for 3 months and the two of them would still form a normal mother-daughter relationship." I could have added, "Let’s remember, we aren’t geese who will imprint on the first adult figure they see after hatching. Even if it is a 6-foot-tall researcher with a beard." This summer I got to meet this young woman and her daughter and could tell that the two made a beautifully adjusted dyad.

It is unfortunate that Dr. Kennell’s early work that was so critical to creating a more humane birthing experience had a dark side that sent a ripple of needless anxiety that still shakes parents 3 decades later. Tragically, there are cases of seriously disordered maternal-infant bonding so severe that they result in infanticide. But, in my experience these incidents are the result of a long or deep mental illness and are not caused by a few hours or days of separation immediately after birth.

Dr. Wilkoff practiced primary care pediatrics in Brunswick, Maine, for nearly 40 years. He is the author of "Coping with a Picky Eater: A Guide for the Perplexed Parent" and several other books. E-mail him at [email protected].

Updated: 10/8/2013