Breastfeeding and the mother–infant relationship—A review
Introduction
Lactation is a defining characteristic of all mammals. In humans, breastfeeding has been related to improved maternal health (Labbok, 2001) and improved health and development of the infant (Anderson et al., 1999, Caspi et al., 2007, Hanson, 1998). The positive effects of breastfeeding on the mother–infant relationship have also been widely advocated. This relationship can be envisioned as consisting of two complementary facets: the maternal bond, or the mother’s tie to her infant, and infant attachment, defined as the infant’s tie to its caregiver.
Claims that breastfeeding positively affects the maternal bond and/or infant attachment have been put forward by various authors, not always accompanied by references or empirical evidence supporting such a claim. For example, a review on the benefits of breastfeeding concludes that “…breastfeeding enhances maternal–child attachment…” (Anholm, 1986, p. 8) without citing any scientific works relating breastfeeding to the maternal bond or infant attachment. More recent publications have made similar statements without providing empirical evidence (Aguayo, 2001, Leung and Sauve, 2005, Misri et al., 2000). Furthermore, mothers report choosing breastfeeding over bottle-feeding to improve the mother–infant relationship (Arora et al., 2000, Gijsbers et al., 2005). These types of claims and beliefs may have an important psychological impact on mothers who are unable to nurse (due to, for instance, breast surgery or jaw malformation of the infant). In these mothers, assumptions of the positive effects of breastfeeding on the mother–infant relationship put forward by scientists and nursing staff can induce feelings of guilt (Crouch and Manderson, 1995, Zetterström, 1999). In fact, a UK study reported that mothers intending to bottle-feed were, according to self-reports, likely to be charged with being a bad mother (Murphy, 1999). Given these possible psychological consequences for non-breastfeeding mothers, the importance of sound scientific evidence on the relationship between breastfeeding and the mother–infant relationship becomes all the more apparent.
This review aims to clarify the role of breastfeeding in the (development of) the mother–infant relationship. We commence by summarizing current knowledge on the concept, development, and assessment of the maternal bond and infant attachment. We then theorize how endocrine and sensory factors involved in breastfeeding may enhance the maternal bond or infant attachment. We summarize and evaluate the empirical studies on the relations between breastfeeding and the maternal bond and infant attachment. We finish this review with a discussion on general methodological problems and possible future directions for studying breastfeeding and (the development of) the mother–infant relationship.
Section snippets
The maternal bond and infant attachment: Definitions
We consider the mother–infant relationship as consisting of two complementary facets: the maternal bond, or the tie from mother to infant, and infant attachment, or the tie from infant to mother. Infant attachment entails the tie between infant and mother that develops from a distinct innate behavioral system, promoting mother–infant proximity (Bowlby, 1969/1982). The definition of the maternal bond is less clear. Klaus and Kennell (1976) introduced the term ‘maternal bonding’, defined as a
Theoretical support for a role of breastfeeding in the mother–infant relationship
Breastfeeding differs from bottle-feeding in a variety of ways. The hormones that stimulate milk production and milk ejection have, in animal models, been shown to affect maternal caregiving behavior and pair bonding. Furthermore, non-nutritive features of the mother–infant interaction during breastfeeding may promote infant attachment. Thus, breastfeeding may, in theory, affect the maternal bond or infant attachment.
In this section, we will discuss how factors inherent to breastfeeding may
Empirical studies on breastfeeding and the mother–infant relationship
A literature search was carried out in PsychInfo, Medline, and the International Bibliography for the Social Sciences for papers published after 1985 and written in English, combining the terms “bond∗” and/or “attachment” with “breast?feed∗”. The initial search yielded 328 papers, which, after reading the abstract of each paper and eliminating duplicate results, was reduced to 41 papers mentioning a relation between breastfeeding and the maternal bond or attachment. Out of these 41 papers, 22
General methodological constraints
As previously shown, there are theoretical mechanisms through which breastfeeding may promote the maternal bond or attachment. However, scientific support of this assumption is scarce. Again, this could indicate that breastfeeding does not affect the maternal bond or infant attachment, but may also be the result of the general lack of empirical studies on the subject and of methodological problems of these studies. In this section, we will further discuss general methodological issues
Conclusion
The scientific research carried out to date does not support the general assumption that breastfeeding has a positive effect on the quality of the mother–child relationship. When propagated, such an assumption may create unnecessary feelings of guilt in mothers unable to breastfeed. Recommendation of breastfeeding should therefore solely be based on its well-documented positive effects on infant and maternal health.
References (163)
Maternal lactation for preterm newborn infants
Early Human Development
(2001)- et al.
Suppression of prolactin does not reduce infant care by parentally experienced male common marmosets (Callithrix jacchus)
Hormones and Behavior
(2006) - et al.
Breast-feeding and cognitive development: A meta-analysis
American Journal of Clinical Nutrition
(1999) - et al.
The neural correlates of maternal and romantic love
NeuroImage
(2004) - et al.
Peripherally administered non-peptide oxytocin antagonist, L368,899, accumulates in limbic brain areas: A new pharmacological tool for the study of social motivation in non-human primates
Hormones and Behavior
(2007) Endocrinology of lactation
Obstetrics and Gynecology Clinics of North America
(2004)- et al.
The neurobiology of social affiliation and pair bonding
- et al.
Where is the locus in opioid withdrawal?
Trends in Pharmacological Sciences
(1997) - et al.
The social life of bonding theory
Social Science and Medicine
(1995) Breastfeeding initiation and duration: A 1990–2000 literature review
Journal of Obstetric, Gynecologic, and Neonatal Nursing
(2002)
Testosterone and prolactin are associated with emotional responses to infant cries in new fathers
Hormones & Behavior
Factors influencing breastfeeding practices and postponement of solid food to prevent allergic disease in high-risk children: Results from an explorative study
Patient Education and Counseling
Parental care in mammals: Immediate internal and sensory factors of control
Social support and oxytocin interact to suppress cortisol and subjective responses to psychosocial stress
Biological Psychiatry
Is social attachment an addictive disorder?
Physiology & Behavior
Vasopressin, oxytocin and neurophysins in the human brain and spinal cord
Brain Research
Neural control of maternal behaviour and olfactory recognition of offspring
Brain Research Bulletin
Parent to infant bonding: Setting the record straight
Journal of pediatrics
More on parent–infant bonding [Letter to the Editor]
Journal of Pediatrics
Effects of breastfeeding on the mother
Pediatric clinics of North America
The bonding phenomenon: Misinterpretations and their implications
Journal of pediatrics
More on mother–infant bonding [Letter to the Editor]
Journal of Pediatrics
Reply to Sugarman and Goldberg [Letter to the Editor]
Journal of Pediatrics
Oxytocin during pregnancy and early postpartum: individual patterns and maternal–fetal attachment
Peptides
A potential role for thalamocingulate circuitry in human maternal caretaking behavior
Biological Psychiatry
Is there mother–infant bonding in primates?
Developmental Review
Parenting Stress Index manual
Parenting and alloparenting: The impact on attachment in humans bonding and attachment
Transition to child-care: Associations with infant–mother attachment, infant negative emotion, and cortisol elevation
Child Development
Patterns of attachment: A psychological study of the strange situation
Suppression of hypothalamic–pituitary–adrenal axis responses to stress in lactating women
Journal of Clinical Endocrinology and Metabolism
Suckling-induced attenuation of plasma cortisol concentrations in postpartum lactating women
Endocrine Research
Breastfeeding: A preventive approach to health care in infancy
Issues in Comprehensive Pediatric Nursing
Major factors influencing breastfeeding rates: Mother’s perception of father’s attitude and milk supply
Pediatrics
Comparative aspects of mother–child contact
Non-peptide oxytocin antagonist, L368,899®, reduces interest in infants and sexual behavior in rhesus monkeys when administered peripherally
Biological psychiatry
The origins of attachment theory: John Bowlby and Mary Ainsworth
Developmental Psychology
Prolactin stimulation of maternal caretaking behavior in female rats
Science
Central prolactin infusions stimulate maternal caretaking behavior in steroid-treated, nulliparous female rats
Proceedings of the National Academy of Sciences of the United States of America
Central infusions of the recombinant human prolactin receptor antagonist, S179D-PRL, delay the onset of maternal caretaking behavior in steroid-primed, nulliparous female rats
Endocrinology
Breastfeeding, sensitivity, and attachment
Pediatrics
A screening questionnaire for mother–infant bonding disorders
Archives of Women’s Mental Health
Neuroendocrine perspectives on social attachment and love
Psychoneuroendocrinology
Moderation of breastfeeding effects on the IQ by genetic variation in fatty acid metabolism
Proceedings of the National Academy of Sciences of the United States of America
Maternal and perinatal factors influencing the duration of exclusive breastfeeding during the first 6 months of life
Journal of Human Lactation
Naturally occurring variations in maternal caretaking behavior in the rat are associated with differences in estrogen-inducible central oxytocin receptors
Proceedings of the National Academy of Sciences of the United States of America
Psychobiology of maternal behavior in human beings
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2022, Sages-FemmesPreterm birth and maternal sensitivity: Findings from a non-western country
2020, Infant Behavior and DevelopmentCitation Excerpt :However, it should be noted that the underlying reason for this significant correlation could be that problem scores were already higher in the preterm group than in the term group, since problem scores were not found as a predictor of maternal sensitivity in hierarchical regression analysis. Finally, regarding the link between breastfeeding and maternal sensitivity and mother-child interactions, the literature has been inconclusive (Jansen, de Weerth, & Riksen-Walraven, 2008; Tharner et al., 2012). In this study, while the sensitivity scores of mothers who breastfed over six months were higher compared to ones breastfed less than six months, breastfeeding was not found as a predictor of maternal sensitivity in hierarchical regression analysis.
The association between breastfeeding and attachment: A systematic review
2020, MidwiferyCitation Excerpt :However, these results are not robust and small sample sizes could have played a role (Britton et al., 2006). Based on theoretical assumptions breastfeeding affects the endocrine system leading to the release of the hormones oxytocin and prolactin, which may promote maternal caregiving and indirectly improve the maternal bond and infant attachment (Jansen et al., 2008). Furthermore, breastfeeding is associated with reduced perceived stress and negative mood (Mezzacappa and Katlin, 2002) and increased calmness in mothers (Heinrichs et al., 2001).