The recent discussions on maternal and paternal interactions, attachment theory,bonding and paternal maternal interaction have induced me to finally write to LACTNET. 
 
Since this is my first time posting , I will  introduce myself. I have been involved with the breastfeeding world for nearly two decades as a mother, registered nurse,  retired La Leche League Leader, lactation consultant, childbirth educator, birth support person and psychotherapist. My Master's degree is in counselling and applied psychology. I am presently in the last stages of completing a PhD in developmental psychology and family relations. I have published research on maternal infant interaction during breastfeeding (1993) and my present doctoral dissertation is on interactions in breastfeeding families. This is an extension of my research on nursing dyads and reflects post graduate training in family and couple therapy.

Hence, as you can see the discussions on interaction, attachment, fathers and breastfeeding and similar issues, apply directly to my work and research. 

Some of you have mentioned attachment theory so I will provide you with a very brief review of this theory and how this pertains to nursing. The basic premise of attachment theories (there are different theorists within this model each presents a specific perspective of attachment) is that the early relationship between an infant and a primary caregiver will have an impact on ability to form relationships.  A central component of attachment theory is the capacity of the caregiver to sensitively respond to infant cues. It is proposed that infants whose cues have been answered sensitively will develop secure attachment styles and will be able to form appropriate relationships with others outside of the primary attachment system.  

How does this fit into nursing. As many of you are aware, interactions with nursing babies are based on infant cues and essentially the infant tells the mother when he/she wants to nurse and for how long. The proximity and physicality of nursing also allows for the appearance of unique interactional components through which mothers and infants may convey emotional messages. Nursing is an event that requires mom and baby to be very close to one another so that as they engage in nursing they also see, hear, touch, smell and even taste each other (especially the baby). So, as infants' gain access to the essential life enhancing breastmilk they concurrently display and are exposed to a variety of interactional components through which emotional messages i.e. cues are expressed. Hence the frequency of nursing sessions provides  parents,(particularly mothers, but also involved fathers ) and their nursing infants with many opportunities to experience and develop sensitive interactional styles.  It appears that nursing increases chances for the development of a process that leads to secure attachment styles that are extended to all family members.   

If indeed nursing facilitates the capacity for sensitive parenting, then one can not emphasize enough the importance of nursing for mothers at risk for attachment difficulties. Many of you have already mentioned the anti depressant affects of lactation hormones. I wish to add that the interactional components of nursing also seem to help mothers with attachment difficulties relate to their infants. While some mothers do gain a sense of increased self worth by providing their infants with their own milk, expresssing milk does not help mothers relate to their infants in the same way that nursing does. Thus, the encouragement of actual nursing is critical for mothers with emotional difficulties, be they chronic or acute.

Many of the concepts proposed by attachment theory concur with other relational models. Object relations theory, for example, provides insight into maternal ability to withstand infant expressions and to be able to react sensitively. An object relations theorist, Winnicott,  emphasizes the need for mothers to receive support in their efforts to sensitively answer their infants and to be 'good enough mothers."  Object relations theorists, particulary Klein and also Weininger, describe the internal mental world of the infant and the role of infant emotional thoughts in the formation of early relationships. Optimally early infant experience will be a accumulation of events that enable infants to see the world i.e. relationships, as good, giving and safe rather than as attacking.

The idea that infants develop mental models of the world is also demonstrated by other theories. There are theories that proposes that infants initially perceive themselves as one with mother.  Theories about the emotional connection between mothers and fetuses help us understand the possible origin of these infantile perceptions.  These theories suggest that infants need to gradually transfer from a state of physical oneness with mother that was established in utero, to the separateness that is a consequence of being born. 

As I am sure most of you are aware, the nursing relationship is an extension of the physical symbiosis of the mother and infant in utero.   The concurrent sense of reducing the pain of hunger, cold or other while simultaneously engaging in fulfilling interactions reminiscent of the uterine symbiotic state, lead to a perception of relationships as safe, warm and not attacking.  This sense of well being while relating  is extended and facilitates the establishment of other relationships. 

If we respect the infant mind, we begin to understand that the feeding of any substance including expressed breast milk, in any form other than directly from the body that the the infant initially perceives as his/her  own (i.e. mother's warm and familiar body), does not have the same emotional meaning for the infant as does nursing. A father for example, who wishes to enrich the attachment process to his child, should take this into account and try and create an infant focused scenario.  The father, for example, might engage in skin to skin events with the baby that do not include the provision of a substance through a plastic object that might be perceived by the infant as invasive. From an infant's perspective, paternal provision of substances does not help infants attach to their fathers. On the contrary, infants  might perceive the father as an object that takes away or denies the infant the cherished nursing relationship.  

The opposite might also be true. We all understand the concept of nipple confusion or preference from a physiological point of view. From a psychological perspective, infants might refuse to nurse after receiving a quick flowing bottle, cup or whatever because the proportionally slow flowing breast then becomes perceived as a witholding breast.  The infant who refuses to nurse is stating that he/she wants the good fast flowing breast i.e. bottle, cup etc. Thus, suggesting to parents that fathers or other family members participate in the feeding of a nursing baby simply does not make sense from an infant's perspective. If infants could talk in adult tongue that would reiterate time and time again that nursing is not about feeding, it is about an relationship.  Similarly, many mothers would agree with their infants. 

Theoris of female and male psychological development indicate that mothers and fathers do not take the same route to parenthood. Thus, mothers and fathers should not be expected to develop relationships with their children in similar manners. Research on paternal development has clearly indicated that fathers and mothers do indeed have diverse parenting patterns. 

So how then do fathers or other family members take part in the nursing infants' life and how do they develop attachments to this child? First of all by realizing that the development of relationships is a process and not a one time event. Activities that might be central to the fathering role at the one stage of development might not be relevant at different developmental stages. By respecting the developmental needs of the nursing couple and by integrating the  the interactional abilities of the nursing into interactions outside of nursing, fathers will find ways to engage in mutually satisfying interactions with their infants that need not take the infant away from nursing. 

Keren Epstein-Gilboa MEd, BScN,RN,LCCE,IBCLC
(PhD student)
 

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