Skaidre Brown 11/2/18

Evaluation and management of Maternal Bonding and Attachment

1. Definition or Key Clinical Information: “Bonding is the establishment of the mother/child and
father/child relationship immediately following birth” (Lim, 2001, p. 240). “Healthy emotional
relationships between an infant and his primary caregiver are significant to the lifelong health of all the
family” (Hawkins, 2010, p.356).
2. Assessment
i. Risk Factors History of attachment issues, prenatal or postpartum depression, life stress,
relationship stress, traumatic birth, initial separation from baby after birth.
ii. Subjective Symptoms Mother reports feelings of difficulty with bonding with her baby.
iii. Objective Signs Observing mother with baby and seeing a lack of eye contact, smiling at
baby, talking to baby, or unresponsive to baby’s cues.
iv. Clinical Test Considerations Screen for PPD and thyroiditis.
3. Management plan
i. Therapeutic measures to consider Increase skin-to-skin time with the infant; continue to
breastfeed on demand; spend time gazing into your baby’s eyes; talk, sing, or read to your baby;
give your baby a massage; listen to your baby’s heartbeat; sleep with your baby; wear your baby
ii. Complementary measures to consider Provide continuity of care prenatally to the mother,
ensure skin-to-skin contact for the first hour immediately following the birth, promote
breastfeeding, get adequate sleep and nutrition
iii. Considerations for pregnancy, delivery and breastfeeding Proper bonding and attachment
promote independence and mental health for your baby in the long-term
iv. Client and family education Screen for possible attachment issues early on in pregnancy,
provide education on ways to bond with your baby prenatally and postpartum, make sure the
client knows you can’t spoil a baby and one of their core needs is to be comforted when in
distress.
v. Follow-up When there are bonding issues, follow-up by phone or appointment in 1-2 weeks
to assess client’s feelings after implementing therapeutic and complementary measures.
4. Indications for Consult, Collaboration or Referral Refer to counseling either prenatally or
postpartum if there is a history of attachment issues/childhood trauma, or a traumatic birth. Report
neglect or abuse. Refer if counseling and/or medication is needed for PPD or thyroiditis.
5.References
Hawkins, S. (2010). The midwife’s role in facilitating maternal-infant bonding and attachment. Midwifery
Digest, 20(3): 355-360.

Lim, R. (2001). After the Baby’s Birth: A Complete Guide for Postpartum Women (revised ed.). Berkeley,
CA: Celestial Arts.