Infant Massage, Bonding, Babywearing and Attachment

The Fourth Trimester

During my time of research in 1975-1976, I made many trips to the medical library, studying everything I could find regarding the effects of touch between parents and infants. I read through anatomy books and edited some of my massage routines, working with the babies’ internal organs.

For example, the tummy strokes follow the intestinal tract and colon, which helps strengthen these organs and they begin to do their work earlier than they might have; I discovered that many researchers and physicians called the first few months of life the “fourth trimester.” Newborns are helpless; they cannot get up and walk like many animals.

We are like kangaroos in this way; our babies need a few months more with the soothing touch of a parent’s massage, skin-to-skin contact, and carrying. Their gastrointestinal systems are not yet mature, and many infants experience “colic,” or painful gas and digestion. The elements of massage that help babies eliminate fecal matter and gas are the sweeping of palms down from rib cage to pelvis, and the clockwise strokes over the stomach that move trapped matter down and out.

Parent-Infant Bonding – A New Concept in 1976

In 1976, Dr.s Kennel and Klaus published their groundbreaking research on bonding. Their work inspired me so much, along with what I read in Montague’s research, I decided to massage my baby every day from the beginning. It was just the right timing — in our culture there was a kind of explosion of interest in, and acceptance of the importance of the elements of bonding and good birth practices. In September of 1976, I gave birth to my first child. I began massaging him, starting with the massage I had learned in India and gradually adding and revising strokes and the order of the strokes, and writing information that would become handouts in my classes later on. I took the notes that would be the foundation of my book, Infant Massage, a Handbook for Loving Parents

What is Bonding?

Bonding is a basic phenomenon that occurs throughout the universe. In terms of physics, it is established within the energy field from which particles arise. Two particles of energy brought into proximity spin and polarize identically, even when separated. Two living cells of a human heart brought into proximity begin to beat together. Throughout the animal kingdom and in human life as well, affectionate and tactile bonds between mother and young ensure healthy interaction and development for time to come. Proximity between parent and infant, via sensory experiences and loving interactions, brings them into an important synchrony with each other.

Imprinting

Animal researchers discovered imprinting long ago, when ethologist Konrad Lorenz showed that ducklings were biologically programmed to follow and bond with the first moving object they saw. Meanwhile, Harry Harlow and his associates studied monkeys and goats and found critical bonding times and elements that were important not only for the infant’s physical survival but for what we might call emotional health as well. Monkeys would abuse their infants if their own bonds as infants were disturbed.

In animals, the crucial period for bonding is usually a matter of minutes or hours after birth. The mother bonds with her infant through licking and touching, a type of massage, which in turn helps the infant to adjust physically to life outside the womb. If mother and infant are separated during this time and are subsequently reunited, the mother will often reject or neglect her young. As a result, the newborn may die for lack of the mother’s stimulation, even if fed by other means.  

The Elements of the Bonding Process

I was determined to include as many of the elements of bonding in our massage as possible: eye-to-eye contact, skin-to-skin contact, singing or humming to my baby, allowing natural odors, adding movements to maintain flexibility. The closeness of mother and baby allows the baby to smell the mother; a newborn baby can distinguish the smell of his or her mother from that of another mother. Parents can also recognize their baby from smell alone. Because of this important aspect of bonding, I decided to emphasize the use of unscented oil.

Resilience, as it relates to massage, is an indication of the quality of the bonding/attachment the baby develops with the parent or caregiver. It is through the elements of bonding that babies learn to be resilient, to bounce back from intense experiences.

MOMKISS2_m

The Difference Between Bonding and Attachment

In studies paralleling animal research, doctors John Kennell and Marshall Klaus, among others, have revealed that there is also a sensitive period for bonding in humans. The critical period seems less rigidly defined and may continue for months, even years, after childbirth. Another word often used in connection with bonding is attachment. While bonding is specific to birth and our connection with the animal kingdom, attachment happens over time and can occur between any two beings. 

Frank Bolton, in his book When Bonding Fails describes bonding as a one-directional process that begins in the biological mother during pregnancy and continues through birth and the first days of her baby’s life. Conversely, attachment is an interaction between parents and children, biological or not, that develops during the first year they are together and is reinforced throughout life. He describes it as the feeling that the other is “irreplaceable.”

Often these two terms are interchangeable, because in humans the bonding period is so loosely defined as to merge into the attachment process. Kennel and Klaus define bonding as “a unique relationship between two people that is specific and endures through time.” That definition could also apply to the word attachment.

Kennel and Klaus cited cuddling, kissing, and prolonged gazing as indicators of a developing bond. Dramatic evidence in their studies and others correlates the lack of early bonding and attachment with later abuse, neglect, and failure to thrive. Mothers who are separated from their babies during the newborn period are often more hesitant to learn and unskilled in basic mothering tasks. Even very short separations sometimes adversely affect the relationship between mothers and infants.

Lack of Bond Affects Babies in U.S.

Shockingly, new studies confirm that four out of ten babies born in the U.S. do not form a strong bond with either parent. In the early 70s, there was an upsurge of interest in birth and bonding, with parents choosing home births, rooming-in at hospital births, and learning infant massage and other things that brought parents and infants together. But unfortunately, that progress has decreased as time went on, in spite of the upsurge of programs like infant massage.

According to a study at Princeton University, 40 percent of infants in the U.S. live in fear or distrust of their parents, and that translates into aggressiveness, defiance and hyperactivity as they grow into adults. Of that number, 25 percent don’t bond with their parents because the parents aren’t responding to their needs. A tragic 14 percent find their parents so distressing that they avoid them whenever possible.

Sociologist Sophie Moullin of Princeton, lead author of the study, along with coauthors from Columbia University, analyzed more than 100 research projects, including data collected by a U.S. longitudinal study of 14,000 children born in 2001, to reach their conclusions. Yet critical, bonding, the researchers contend, is amazingly simple to achieve. The study notes,“When a parent responds to a child in a warm, sensitive and responsive way – picking up the child when he cries, and holding and reassuring him – the child feels secure that they can meet their needs.” 

Four Out of Ten Babies Do Not Form a Strong Bond

Incredibly, four out of ten infants born in the U.S. do not form a strong bond with either parent and, according to the authors of an article on the subject, “they will pay for that the rest of their lives.” Other research shows that simply touching, or caressing a newborn is critical to the infant’s sense of security. Infant massage, therefore, becomes an incredibly important art for parents to learn.

Usually it is the mother who is the central focus of studies like these, probably because the mother is often the main caregiver, especially in infancy. But a study at the University of Iowa two years ago concluded that “being attached to dad is just as helpful and being close to mom.” A similar study in 2012 from the Imperial College London found that fathers were especially important in helping the infant avoid behavioral problems later in life. If the father is remote or distracted, the child is more likely to be aggressive.

Infant Massage, Bonding, Babywearing and Attachment

The Fourth Trimester

During my time of research in 1975-1976, I made many trips to the medical library, studying everything I could find regarding the effects of touch between parents and infants. I read through anatomy books and edited some of my massage routine, working with the babies’ internal organs.

For example, the tummy strokes follow the intestinal tract and colon, which helps strengthen these organs and they begin to do their work earlier than they might have; I discovered that many researchers and physicians called the first few months of life the “fourth trimester.” Newborns are helpless; they cannot get up and walk like many animals.

We are like kangaroos in this way; our babies need a few months more with the soothing touch of a parent’s massage, skin-to-skin contact, and carrying. Their gastrointestinal systems are not yet mature, and many infants experience “colic,” or painful gas and digestion. The elements of massage that help babies eliminate fecal matter and gas are the sweeping of palms down from rib cage to pelvis, and the clockwise strokes over the stomach that move trapped matter down and out.

Parent-Infant Bonding – A New Concept in 1976

In 1976, Dr.s Kennel and Klaus published their groundbreaking research on bonding. Their work inspired me so much, along with what I read in Montague’s research, I decided to massage my baby every day from the beginning. It was just the right timing — in our culture there was a kind of explosion of interest in, and acceptance of the importance of the elements of bonding and good birth practices. In September of 1976, I gave birth to my first child. I began massaging him, starting with the massage I had learned in India and gradually adding and revising strokes and the order of the strokes, and writing information that would become handouts in my classes later on. I took the notes that would be the foundation of my book, Infant Massage, a Handbook for Loving Parents

What is Bonding?

Bonding is a basic phenomenon that occurs throughout the universe. In terms of physics, it is established within the energy field from which particles arise. Two particles of energy brought into proximity spin and polarize identically, even when separated. Two living cells of a human heart brought into proximity begin to beat together. Throughout the animal kingdom and in human life as well, affectionate and tactile bonds between mother and young ensure healthy interaction and development for time to come. Proximity between parent and infant, via sensory experiences and loving interactions, brings them into an important synchrony with each other.

Imprinting

Animal researchers discovered imprinting long ago, when ethologist Konrad Lorenz showed that ducklings were biologically programmed to follow and bond with the first moving object they saw. Meanwhile, Harry Harlow and his associates studied monkeys and goats and found critical bonding times and elements that were important not only for the infant’s physical survival but for what we might call emotional health as well. Monkeys would abuse their infants if their own bonds as infants were disturbed.

In animals, the crucial period for bonding is usually a matter of minutes or hours after birth. The mother bonds with her infant through licking and touching, a type of massage, which in turn helps the infant to adjust physically to life outside the womb. If mother and infant are separated during this time and are subsequently reunited, the mother will often reject or neglect her young. As a result, the newborn may die for lack of the mother’s stimulation, even if fed by other means.  

The Elements of the Bonding Process

I was determined to include as many of the elements of bonding in our massage as possible: eye-to-eye contact, skin-to-skin contact, singing or humming to my baby, allowing natural odors, adding movements to maintain flexibility. The closeness of mother and baby allows the baby to smell the mother; a newborn baby can distinguish the smell of his or her mother from that of another mother. Parents can also recognize their baby from smell alone. Because of this important aspect of bonding, I decided to emphasize the use of unscented oil.

Resilience, as it relates to massage, is an indication of the quality of the bonding/attachment the baby develops with the parent or caregiver. It is through the elements of bonding that babies learn to be resilient, to bounce back from intense experiences.

MOMKISS2_m

The Difference Between Bonding and Attachment

In studies paralleling animal research, doctors John Kennell and Marshall Klaus, among others, have revealed that there is also a sensitive period for bonding in humans. The critical period seems less rigidly defined and may continue for months, even years, after childbirth. Another word often used in connection with bonding is attachment. While bonding is specific to birth and our connection with the animal kingdom, attachment happens over time and can occur between any two beings. 

Frank Bolton, in his book When Bonding Fails describes bonding as a one-directional process that begins in the biological mother during pregnancy and continues through birth and the first days of her baby’s life. Conversely, attachment is an interaction between parents and children, biological or not, that develops during the first year they are together and is reinforced throughout life. He describes it as the feeling that the other is “irreplaceable.”

Often these two terms are interchangeable, because in humans the bonding period is so loosely defined as to merge into the attachment process. Kennel and Klaus define bonding as “a unique relationship between two people that is specific and endures through time.” That definition could also apply to the word attachment.

Kennel and Klaus cited cuddling, kissing, and prolonged gazing as indicators of a developing bond. Dramatic evidence in their studies and others correlates the lack of early bonding and attachment with later abuse, neglect, and failure to thrive. Mothers who are separated from their babies during the newborn period are often more hesitant to learn and unskilled in basic mothering tasks. Even very short separations sometimes adversely affect the relationship between mothers and infants.

Lack of Bond Affects Babies in U.S.

Shockingly, new studies confirm that four out of ten babies born in the U.S. do not form a strong bond with either parent. In the early 70s, there was an upsurge of interest in birth and bonding, with parents choosing home births, rooming-in at hospital births, and learning infant massage and other things that brought parents and infants together. But unfortunately, that progress has decreased as time went on, in spite of the upsurge of programs like infant massage.

According to a study at Princeton University, 40 percent of infants in the U.S. live in fear or distrust of their parents, and that translates into aggressiveness, defiance and hyperactivity as they grow into adults. Of that number, 25 percent don’t bond with their parents because the parents aren’t responding to their needs. A tragic 14 percent find their parents so distressing that they avoid them whenever possible.

Sociologist Sophie Moullin of Princeton, lead author of the study, along with coauthors from Columbia University, analyzed more than 100 research projects, including data collected by a U.S. longitudinal study of 14,000 children born in 2001, to reach their conclusions. Yet critical, bonding, the researchers contend, is amazingly simple to achieve. The study notes,“When a parent responds to a child in a warm, sensitive and responsive way – picking up the child when he cries, and holding and reassuring him – the child feels secure that they can meet their needs.” 

Four Out of Ten Babies Do Not Form a Strong Bond

Incredibly, four out of ten infants born in the U.S. do not form a strong bond with either parent and, according to the authors of an article on the subject, “they will pay for that the rest of their lives.” Other research shows that simply touching, or caressing a newborn is critical to the infant’s sense of security. Infant massage, therefore, becomes an incredibly important art for parents to learn.

Usually it is the mother who is the central focus of studies like these, probably because the mother is often the main caregiver, especially in infancy. But a study at the University of Iowa two years ago concluded that “being attached to dad is just as helpful and being close to mom.” A similar study in 2012 from the Imperial College London found that fathers were especially important in helping the infant avoid behavioral problems later in life. If the father is remote or distracted, the child is more likely to be aggressive.

THE EFFECTS OF BABY MASSAGE ON ATTACHMENT BETWEEN MOTHER AND THEIR INFANTS

A study was made from June 2008 to February 2010 in Turkey. There were 57 in the experimental group, 60 in the control group. Between the dates of the study, all healthy mothers giving birth for the first time and their healthy babies were included. Data were collected about their demographic characteristics and by using the Maternal Attachment Inventory (MAI). All mothers were assessed on the first and the last days of the 38-day study period. In the experimental group, the babies received a 15-minute massage therapy session everyday during the 38 days.

The MAI was developed to measure maternal affectionate attachment. This is the unique, affectionate relationship that develops between a woman and her infant. It persists over time, and is a key element of maternal adaptation (Muller, 1994). The MAI consists of 26 items representing maternal activities and feelings that indicate affection. Before development of the MAI, maternal affectionate attachment had been most frequently determined by observing the rate or pattern of maternal attachment behaviors (Muller). Observational measures, however, are time-consuming and generally difficult to apply in a clinical setting. In addition, there is little agreement that one behavior or group of behaviors constitutes evidence of maternal attachment. By direct measurement of mothers’ feelings through the MAI, these validity concerns in relation to interpreting mothers’ behaviors can be avoided. Although mothers’ feelings about their infants are not sufficient to define the complexity of mother–infant attachment, they are thought to be indicators of the probable presence of attachment.

For the study, massage techniques were a combination of effleurage and petrissage to the baby’s face, neck, shoulders, arms, chest, back, waist and legs. The effleurage consisted of smooth, long, rhythmic strokes up either side of the spine and out across the shoulders, with both hands working simultaneously, while the petrissage consisted of gentle kneading. Additionally, slow steady pressure was applied intermittently to the shoulders, neck, face, and lower back. All massages were demonstrated by the same trained person and mothers were advised to choose a moment when both she and her child are relaxed and calm; a half hour after the baby had eaten was recommended.

Baby massage education was given twice at the first home visit and the second home visit (15th day). The mother’s application of baby massage was observed at the second home visit and evaluated for correct technique. These babies received 15-minute massage sessions every day of the week for 38 days; the number of massage sessions are a minimum of 30 and a maximum of 38. The researcher followed a detailed visit-by-visit protocol to help women improve their health-related behaviors, the care of their baby, and observed the status of baby massage application. On the last day of the study, the MAI was filled out on the last home visit in the experimental group.

There was no significant difference found in the pretest mean value baseline of the MAI score in both groups. The posttest mean values of the MAI of the experimental group mothers were significantly higher than those of control group. There was a significant difference between groups. The results of the study have shown that baby massage is effective in increasing the mother–infant attachment.

When maternal attachment levels of experimental group mothers applying massage to their babies and control group mothers not applying massage to their babies were compared in posttest measurements, it was found that the maternal attachment of the group applying massage significantly higher. Maternal attachment of the control group also increased in the posttest measurement; however, this increase was very low when compared to the experimental group.

The relative youth of the mothers and the fact that they were undertaking the primary care of their first baby increased compliance with the study and attachment. This may explain the minor increase in maternal attachment behavior of mothers in the control group.

In Turkish culture, children are very precious and important. Women want to have a child as soon as they get married. If a woman does not have a baby, she is exposed to negative reactions from her husband and his family. Being a mother is very important, in particular, to have a male baby is extremely important. For this reason, it is expected that maternal attachment level naturally increases. The aim of this study was to determine how baby massage affects this increase. This result confirms the hypothesis of the study—baby massage strengthens the attachment between mother and baby. Most of the mothers in both groups were 26–35 years of age group, who are graduates of secondary school and not working. Traditionally, these women’s common goal is to get married and give birth to a child in the eastern part of Turkey. However, educated women have more roles than being a partner or a mother.

The first year of life is extremely important in terms of the baby’s psychological development. It is during this period, that the sense of basic trust is formed. The relationship between the mother and the baby has been the subject of several research studies (Muller-Nix et al., 2004; Zeanah, Borris, & Larrieu, 1997). Attachment is an emotional and expected condition between the mother and the baby that begins in the first days of life.

Attachment theory is an assessment of the response to the baby’s physical and emotional needs (Mills-Koonce et al., 2007). According to Mercer, maternal attachment begins during pregnancy and continues with delivery. Maternal attachment is a unique, tender loving relationship that develops between the mother and the baby; its consistency leads to the development of feelings of trust in the infant as a result. Postpartum attachment and care between the mother and the baby is important for the baby to lead a physical, spiritual, and emotional health in life.

Mothers have an important role as the primary caregiver. If the relationship between mother and baby is inadequate, the baby may have severe developmental and psychological problems (Brandt, Andrews, & Kvale, 1998). Attachment is therefore accepted as one of the fundamental processes in order to improve psychological development and to establish the baby’s relationship to the outside world (Wilson et al., 2000).

A healthy attachment is also of great importance in the determination of the baby’s character and habits. The first touches greatly strengthen attachment behavior (Kavlak & Şirin, 2007). The sense of touch is very important in the newborn period and infanthood for perceiving the environment. Proper stimulation of the baby’s sense of touch affects psychosocial development positively.

Massage is one of the easiest and most natural ways of establishing a sense of touch and eye contact which improves attachment between mothers and babies. The early contact between mother and her newborn gives confidence to the mother’s breastfeeding, in addition to developing the mother’s attachment behavior (Matthiesen, Ransjö-Arvidson, Nissen, & Uvnäs-Moberg, 2001).

Ferber et al. (2005) determined that mothers who applied massage to their premature infants achieved an easier interaction. Lee (2006) also reported that baby massage encourages the interaction between mother and baby. Moore and Anderson (2007) found that skin-to-skin contact between mother and infant affects the infants’ health, decreases their crying, and increases the mother–infant interaction. Onozawa, Glover, Adams, Modi, and Kumar (2001) reported that the mother–infant interaction was increased among those mothers who had performed massage on their infants.

In 2009, Kavlak and Şirin studied healthy babies and mothers to evaluate and determine validity and reliability of the Maternal Attachment Inventory (MAI) scale for the Turkish population. Moreover, Bal Yilmaz and Conk (2009) studied mothers who had 15-day-old healthy babies to investigate the effect of four months of massage application on sleep duration, growth and development of babies, and mothers’ anxiety levels. Bal Yılmaz and Conk reported that infants’ sleep duration was increased when their mothers spent more time with them and massaged them. In a study conducted with mothers who recently delivered healthy babies, İnal and Yıldız (2005) investigated the effect of massage applied for 6 months on the babies’ growth and mental-motor development. Inal and Yildiz found statistically significant results that infants who received massage gained more weight and increased their mental–motor development. In a study conducted with premature and low birthweight babies and their mothers, Sarıkaya Karabudak and Öztürk (2008) reported that regularly applied baby massage positively affected weight gain and the mental–motor development of babies.

Massage is one of the oldest forms of treatment in the world, having first been described in China during the second century B.C. and soon after in India and Egypt. Maternal attachment depends on two important factors; (a) interaction between mother and her baby and (b) sensual contact between them. Baby massage is the simplest and easiest way of communication, that makes contact between mother and her baby. In eastern Anatolia, Turkey, the families have many children. The mothers who live in this region generally avoid touching their babies. The main reasons are cold weather conditions, socioeconomic conditions, and swaddling. In addition, there is no work regarding the effects of massage on mother-infant attachment in Turkey up to now. For this reason, this work has been carried out to determine the applicability of baby massage in Turkish families and its effects on the level of maternal attachment. It is of note that the Turkish edition of Infant Massage, a Handbook for Loving Parents (Vimala McClure, Bantam/Random House, NY) has been in production in 2018.

Infant massage for primary caregivers and high-risk babies is now used more often. It is reported that massage regulates the baby’s sleep, respiration and urinary requirements; decreases colic and stress; and affects mother–infant interaction in a positive way. Studies have determined that mothers giving massage to premature babies have more interaction with their babies. In their studies, Moore and Anderson (2007) found that skin-to-skin contact between the mother and the baby in the early period affected the health status of baby, decreased crying and increased mother–infant interaction.

Infant massage is a simple, cheap and effective technique supporting infant development. It is accepted as a new practice that is gradually gaining popularity by being applicable to both the babies and their mothers; it can be performed independently. However, many mothers do not know that they can communicate with their babies by touch as they think that they may easily hurt their babies. Those mothers should be instructed by using various interactive methods such as tactile, visual, auditory contact. For those families who cannot have direct early contact with their baby for various reasons, nurses should advise them that this situation would not directly cause a problem. Their concerns should be alleviated because although early contact is a factor that strengthens attachment development, it is not an essential prerequisite.

The effects of massage in terms of mother–infant attachment and other general benefits for baby health should be considered; all medical personnel, especially nurses, should encourage mothers to apply massage to their babies. Encouraging the use of massage provides an important contribution to healthy babies. In the literature, the effects of baby massage on the maternal attachment levels in mothers with healthy infants and weight gain of preterm infants have been investigated. Mothers with babies who were born prematurely or had some defects or illness, have more risk of attachment deprivation. Accordingly, it might be suggested that nurses include baby massage among the routines of mother and baby care in both healthy and ill babies, and that facilitating baby massage and mother–infant attachment should be included in the internal training given to neonatal nurses as well as providing counseling to the mothers in this regard.

Infant Massage, Bonding, Babywearing and Attachment

The Fourth Trimester

During my time of research in 1975-1976, I made many trips to the medical library, studying everything I could find regarding the effects of touch between parents and infants. I read through anatomy books and edited some of my massage routine, working with the babies’ internal organs.

For example, the tummy strokes follow the intestinal tract and colon, which helps strengthen these organs and they begin to do their work earlier than they might have; I discovered that many researchers and physicians called the first few months of life the “fourth trimester.” Newborns are helpless; they cannot get up and walk like many animals.

We are like kangaroos in this way; our babies need a few months more with the soothing touch of a parent’s massage, skin-to-skin contact, and carrying. Their gastrointestinal systems are not yet mature, and many infants experience “colic,” or painful gas and digestion. The elements of massage that help babies eliminate fecal matter and gas are the sweeping of palms down from rib cage to pelvis, and the clockwise strokes over the stomach that move trapped matter down and out.

Parent-Infant Bonding – A New Concept in 1976

In 1976, Dr.s Kennel and Klaus published their groundbreaking research on bonding. Their work inspired me so much, along with what I read in Montague’s research, I decided to massage my baby every day from the beginning. It was just the right timing — in our culture there was a kind of explosion of interest in, and acceptance of the importance of the elements of bonding and good birth practices. In September of 1976, I gave birth to my first child. I began massaging him, starting with the massage I had learned in India and gradually adding and revising strokes and the order of the strokes, and writing information that would become handouts in my classes later on. I took the notes that would be the foundation of my book, Infant Massage, a Handbook for Loving Parents

What is Bonding?

Bonding is a basic phenomenon that occurs throughout the universe. In terms of physics, it is established within the energy field from which particles arise. Two particles of energy brought into proximity spin and polarize identically, even when separated. Two living cells of a human heart brought into proximity begin to beat together. Throughout the animal kingdom and in human life as well, affectionate and tactile bonds between mother and young ensure healthy interaction and development for time to come. Proximity between parent and infant, via sensory experiences and loving interactions, brings them into an important synchrony with each other.

Imprinting

Animal researchers discovered imprinting long ago, when ethologist Konrad Lorenz showed that ducklings were biologically programmed to follow and bond with the first moving object they saw. Meanwhile, Harry Harlow and his associates studied monkeys and goats and found critical bonding times and elements that were important not only for the infant’s physical survival but for what we might call emotional health as well. Monkeys would abuse their infants if their own bonds as infants were disturbed.

In animals, the crucial period for bonding is usually a matter of minutes or hours after birth. The mother bonds with her infant through licking and touching, a type of massage, which in turn helps the infant to adjust physically to life outside the womb. If mother and infant are separated during this time and are subsequently reunited, the mother will often reject or neglect her young. As a result, the newborn may die for lack of the mother’s stimulation, even if fed by other means.  

The Elements of the Bonding Process

I was determined to include as many of the elements of bonding in our massage as possible: eye-to-eye contact, skin-to-skin contact, singing or humming to my baby, allowing natural odors, adding movements to maintain flexibility. The closeness of mother and baby allows the baby to smell the mother; a newborn baby can distinguish the smell of his or her mother from that of another mother. Parents can also recognize their baby from smell alone. Because of this important aspect of bonding, I decided to emphasize the use of unscented oil.

Resilience, as it relates to massage, is an indication of the quality of the bonding/attachment the baby develops with the parent or caregiver. It is through the elements of bonding that babies learn to be resilient, to bounce back from intense experiences.

MOMKISS2_m

The Difference Between Bonding and Attachment

In studies paralleling animal research, doctors John Kennell and Marshall Klaus, among others, have revealed that there is also a sensitive period for bonding in humans. The critical period seems less rigidly defined and may continue for months, even years, after childbirth. Another word often used in connection with bonding is attachment. While bonding is specific to birth and our connection with the animal kingdom, attachment happens over time and can occur between any two beings. 

Frank Bolton, in his book When Bonding Fails describes bonding as a one-directional process that begins in the biological mother during pregnancy and continues through birth and the first days of her baby’s life. Conversely, attachment is an interaction between parents and children, biological or not, that develops during the first year they are together and is reinforced throughout life. He describes it as the feeling that the other is “irreplaceable.”

Often these two terms are interchangeable, because in humans the bonding period is so loosely defined as to merge into the attachment process. Kennel and Klaus define bonding as “a unique relationship between two people that is specific and endures through time.” That definition could also apply to the word attachment.

Kennel and Klaus cited cuddling, kissing, and prolonged gazing as indicators of a developing bond. Dramatic evidence in their studies and others correlates the lack of early bonding and attachment with later abuse, neglect, and failure to thrive. Mothers who are separated from their babies during the newborn period are often more hesitant to learn and unskilled in basic mothering tasks. Even very short separations sometimes adversely affect the relationship between mothers and infants.

Lack of Bond Affects Babies in U.S.

Shockingly, new studies confirm that four out of ten babies born in the U.S. do not form a strong bond with either parent. In the early 70s, there was an upsurge of interest in birth and bonding, with parents choosing home births, rooming-in at hospital births, and learning infant massage and other things that brought parents and infants together. But unfortunately, that progress has decreased as time went on, in spite of the upsurge of programs like infant massage.

According to a study at Princeton University, 40 percent of infants in the U.S. live in fear or distrust of their parents, and that translates into aggressiveness, defiance and hyperactivity as they grow into adults. Of that number, 25 percent don’t bond with their parents because the parents aren’t responding to their needs. A tragic 14 percent find their parents so distressing that they avoid them whenever possible.

Sociologist Sophie Moullin of Princeton, lead author of the study, along with coauthors from Columbia University, analyzed more than 100 research projects, including data collected by a U.S. longitudinal study of 14,000 children born in 2001, to reach their conclusions. Yet critical, bonding, the researchers contend, is amazingly simple to achieve. The study notes,“When a parent responds to a child in a warm, sensitive and responsive way – picking up the child when he cries, and holding and reassuring him – the child feels secure that they can meet their needs.” 

Four Out of Ten Babies Do Not Form a Strong Bond

Incredibly, four out of ten infants born in the U.S. do not form a strong bond with either parent and, according to the authors of an article on the subject, “they will pay for that the rest of their lives.” Other research shows that simply touching, or caressing a newborn is critical to the infant’s sense of security. Infant massage, therefore, becomes an incredibly important art for parents to learn.

Usually it is the mother who is the central focus of studies like these, probably because the mother is often the main caregiver, especially in infancy. But a study at the University of Iowa two years ago concluded that “being attached to dad is just as helpful and being close to mom.” A similar study in 2012 from the Imperial College London found that fathers were especially important in helping the infant avoid behavioral problems later in life. If the father is remote or distracted, the child is more likely to be aggressive.

Bring Nurturing Touch Back to Our Families

by JoAnn Lewis

Touch is our first language in life. It is the most developed sense at birth and the last to leave us when we die. We identify ourselves, each other and our world by touching.

Massage as positive touch with respect and permission is among the most powerful forms of communication. Historically, massage has been handed down from family to family in village cultures in some form of daily tradition. In many cultures, this was and remains a standard practice as normal as bathing, sleeping, eating and greeting each other with a handshake, hug or nose rub.

So why have we lost this traditional element to basic health and happiness? And what has this lack of connection done to our society? From old cultures of hourly, daily interaction to our industrialized go-to-a-job and don’t touch anyone culture, attitudes have changed. How do we bring positive interaction back to common sense? We all know we need it. We all know it means love, security and health. Often our fondest memories are of nurturing touches.

Imagine for a moment our children and grandchildren learning and playing in cooperative circle games on the playground. Or are they standing in line, pushing each other over? We can redo the beginnings of negative or even violent reactions by teaching how to touch carefully with gentle strength, permission and respect. Let’s see how we can do this to the best of our ability.

First, ask permission. Sounds simple, yes? When we put our own hands together and rub them to become warm, showing that warmth to each other and asking if we can do massage with someone, similar to shaking an outstretched hand in greeting, it starts the unspoken language of respect and care. Patiently, persistently, we find the way to be together in touch, especially at birth.

Research studies show us that massage for babies (and adults) will calm the nervous system, increasing the myelination (coating) on the nerves and increase IQ, motor skills, hand-eye and right-left coordination. As body-mind connections increase, so does bonding and attachment, social skills with trust and respect to lessen anxiety. As massage regulates digestion to relieve gas, constipation and waste elimination, it builds stronger, toned muscles and ligaments. It stimulates hormones for better growth and immunity, eliciting caring responses of soothing, nurturing behavior, reducing violence and negative reactions. Who wants a healthier, stronger, smarter baby?

Massage reduces pain, relieves aches and soreness, and is the fastest way to reduce inflammation, decrease blood pressure and tone the skin and muscles. To experience this pleasurable, one-to-one interaction of the highest quality of touch builds trust, self-esteem and confidence.

This is life at its best! This is what we can give with just our own two relaxed hands with proper body mechanics (no force) with ease and calm, gentle, playful communication.

Let’s pass massage on and build strong family and community bonds and traditions for generations to come. You and your family deserve massage, to learn it well, and to live truly well-adjusted, healthy, happy lives through the art and science of nurturing touch.

THE EFFECTS OF BABY MASSAGE ON ATTACHMENT BETWEEN MOTHER AND THEIR INFANTS

A study was made from June 2008 to February 2010 in Turkey. There were 57 in the experimental group, 60 in the control group. Between the dates of the study, all healthy mothers giving birth for the first time and their healthy babies were included. Data were collected about their demographic characteristics and by using the Maternal Attachment Inventory (MAI). All mothers were assessed on the first and the last days of the 38-day study period. In the experimental group, the babies received a 15-minute massage therapy session everyday during the 38 days.

The MAI was developed to measure maternal affectionate attachment. This is the unique, affectionate relationship that develops between a woman and her infant. It persists over time, and is a key element of maternal adaptation (Muller, 1994). The MAI consists of 26 items representing maternal activities and feelings that indicate affection. Before development of the MAI, maternal affectionate attachment had been most frequently determined by observing the rate or pattern of maternal attachment behaviors (Muller). Observational measures, however, are time-consuming and generally difficult to apply in a clinical setting. In addition, there is little agreement that one behavior or group of behaviors constitutes evidence of maternal attachment. By direct measurement of mothers’ feelings through the MAI, these validity concerns in relation to interpreting mothers’ behaviors can be avoided. Although mothers’ feelings about their infants are not sufficient to define the complexity of mother–infant attachment, they are thought to be indicators of the probable presence of attachment.

For the study, massage techniques were a combination of effleurage and petrissage to the baby’s face, neck, shoulders, arms, chest, back, waist and legs. The effleurage consisted of smooth, long, rhythmic strokes up either side of the spine and out across the shoulders, with both hands working simultaneously, while the petrissage consisted of gentle kneading. Additionally, slow steady pressure was applied intermittently to the shoulders, neck, face, and lower back. All massages were demonstrated by the same trained person and mothers were advised to choose a moment when both she and her child are relaxed and calm; a half hour after the baby had eaten was recommended.

Baby massage education was given twice at the first home visit and the second home visit (15th day). The mother’s application of baby massage was observed at the second home visit and evaluated for correct technique. These babies received 15-minute massage sessions every day of the week for 38 days; the number of massage sessions are a minimum of 30 and a maximum of 38. The researcher followed a detailed visit-by-visit protocol to help women improve their health-related behaviors, the care of their baby, and observed the status of baby massage application. On the last day of the study, the MAI was filled out on the last home visit in the experimental group.

There was no significant difference found in the pretest mean value baseline of the MAI score in both groups. The posttest mean values of the MAI of the experimental group mothers were significantly higher than those of control group. There was a significant difference between groups. The results of the study have shown that baby massage is effective in increasing the mother–infant attachment.

When maternal attachment levels of experimental group mothers applying massage to their babies and control group mothers not applying massage to their babies were compared in posttest measurements, it was found that the maternal attachment of the group applying massage significantly higher. Maternal attachment of the control group also increased in the posttest measurement; however, this increase was very low when compared to the experimental group.

The relative youth of the mothers and the fact that they were undertaking the primary care of their first baby increased compliance with the study and attachment. This may explain the minor increase in maternal attachment behavior of mothers in the control group.

In Turkish culture, children are very precious and important. Women want to have a child as soon as they get married. If a woman does not have a baby, she is exposed to negative reactions from her husband and his family. Being a mother is very important, in particular, to have a male baby is extremely important. For this reason, it is expected that maternal attachment level naturally increases. The aim of this study was to determine how baby massage affects this increase. This result confirms the hypothesis of the study—baby massage strengthens the attachment between mother and baby. Most of the mothers in both groups were 26–35 years of age group, who are graduates of secondary school and not working. Traditionally, these women’s common goal is to get married and give birth to a child in the eastern part of Turkey. However, educated women have more roles than being a partner or a mother.

The first year of life is extremely important in terms of the baby’s psychological development. It is during this period, that the sense of basic trust is formed. The relationship between the mother and the baby has been the subject of several research studies (Muller-Nix et al., 2004; Zeanah, Borris, & Larrieu, 1997). Attachment is an emotional and expected condition between the mother and the baby that begins in the first days of life.

Attachment theory is an assessment of the response to the baby’s physical and emotional needs (Mills-Koonce et al., 2007). According to Mercer, maternal attachment begins during pregnancy and continues with delivery. Maternal attachment is a unique, tender loving relationship that develops between the mother and the baby; its consistency leads to the development of feelings of trust in the infant as a result. Postpartum attachment and care between the mother and the baby is important for the baby to lead a physical, spiritual, and emotional health in life.

Mothers have an important role as the primary caregiver. If the relationship between mother and baby is inadequate, the baby may have severe developmental and psychological problems (Brandt, Andrews, & Kvale, 1998). Attachment is therefore accepted as one of the fundamental processes in order to improve psychological development and to establish the baby’s relationship to the outside world (Wilson et al., 2000).

A healthy attachment is also of great importance in the determination of the baby’s character and habits. The first touches greatly strengthen attachment behavior (Kavlak & Şirin, 2007). The sense of touch is very important in the newborn period and infanthood for perceiving the environment. Proper stimulation of the baby’s sense of touch affects psychosocial development positively.

Massage is one of the easiest and most natural ways of establishing a sense of touch and eye contact which improves attachment between mothers and babies. The early contact between mother and her newborn gives confidence to the mother’s breastfeeding, in addition to developing the mother’s attachment behavior (Matthiesen, Ransjö-Arvidson, Nissen, & Uvnäs-Moberg, 2001).

Ferber et al. (2005) determined that mothers who applied massage to their premature infants achieved an easier interaction. Lee (2006) also reported that baby massage encourages the interaction between mother and baby. Moore and Anderson (2007) found that skin-to-skin contact between mother and infant affects the infants’ health, decreases their crying, and increases the mother–infant interaction. Onozawa, Glover, Adams, Modi, and Kumar (2001) reported that the mother–infant interaction was increased among those mothers who had performed massage on their infants.

In 2009, Kavlak and Şirin studied healthy babies and mothers to evaluate and determine validity and reliability of the Maternal Attachment Inventory (MAI) scale for the Turkish population. Moreover, Bal Yilmaz and Conk (2009) studied mothers who had 15-day-old healthy babies to investigate the effect of four months of massage application on sleep duration, growth and development of babies, and mothers’ anxiety levels. Bal Yılmaz and Conk reported that infants’ sleep duration was increased when their mothers spent more time with them and massaged them. In a study conducted with mothers who recently delivered healthy babies, İnal and Yıldız (2005) investigated the effect of massage applied for 6 months on the babies’ growth and mental-motor development. Inal and Yildiz found statistically significant results that infants who received massage gained more weight and increased their mental–motor development. In a study conducted with premature and low birthweight babies and their mothers, Sarıkaya Karabudak and Öztürk (2008) reported that regularly applied baby massage positively affected weight gain and the mental–motor development of babies.

Massage is one of the oldest forms of treatment in the world, having first been described in China during the second century B.C. and soon after in India and Egypt. Maternal attachment depends on two important factors; (a) interaction between mother and her baby and (b) sensual contact between them. Baby massage is the simplest and easiest way of communication, that makes contact between mother and her baby. In eastern Anatolia, Turkey, the families have many children. The mothers who live in this region generally avoid touching their babies. The main reasons are cold weather conditions, socioeconomic conditions, and swaddling. In addition, there is no work regarding the effects of massage on mother-infant attachment in Turkey up to now. For this reason, this work has been carried out to determine the applicability of baby massage in Turkish families and its effects on the level of maternal attachment. It is of note that the Turkish edition of Infant Massage, a Handbook for Loving Parents (Vimala McClure, Bantam/Random House, NY) has been in production in 2018.

Infant massage for primary caregivers and high-risk babies is now used more often. It is reported that massage regulates the baby’s sleep, respiration and urinary requirements; decreases colic and stress; and affects mother–infant interaction in a positive way. Studies have determined that mothers giving massage to premature babies have more interaction with their babies. In their studies, Moore and Anderson (2007) found that skin-to-skin contact between the mother and the baby in the early period affected the health status of baby, decreased crying and increased mother–infant interaction.

Infant massage is a simple, cheap and effective technique supporting infant development. It is accepted as a new practice that is gradually gaining popularity by being applicable to both the babies and their mothers; it can be performed independently. However, many mothers do not know that they can communicate with their babies by touch as they think that they may easily hurt their babies. Those mothers should be instructed by using various interactive methods such as tactile, visual, auditory contact. For those families who cannot have direct early contact with their baby for various reasons, nurses should advise them that this situation would not directly cause a problem. Their concerns should be alleviated because although early contact is a factor that strengthens attachment development, it is not an essential prerequisite.

The effects of massage in terms of mother–infant attachment and other general benefits for baby health should be considered; all medical personnel, especially nurses, should encourage mothers to apply massage to their babies. Encouraging the use of massage provides an important contribution to healthy babies. In the literature, the effects of baby massage on the maternal attachment levels in mothers with healthy infants and weight gain of preterm infants have been investigated. Mothers with babies who were born prematurely or had some defects or illness, have more risk of attachment deprivation. Accordingly, it might be suggested that nurses include baby massage among the routines of mother and baby care in both healthy and ill babies, and that facilitating baby massage and mother–infant attachment should be included in the internal training given to neonatal nurses as well as providing counseling to the mothers in this regard.

INFANT MASSAGE: A HANDBOOK FOR LOVING PARENTS – NEW EDITION!

I am happy to announce that the new updated, expanded edition of Infant Massage: a Handbook for Loving Parents has been released by Random House. It is available on Amazon.com and from most bookstores.

CHAPTERS:

  1. Why Massage Your Baby?

  2. Your Baby’s Sensory World

  3. The Importance of Skin Stimulation

  4. Stress and Relaxation

  5. Bonding, Attachment, and Infant Massage

  6. The Elements of Bonding

  7. Attachment and the Benefits of Infant Massage

  8. Especially for Fathers

  9. Helping your Baby (and you) Learn to Relax

  10. Your Baby’s Brain

  11. Music and Massage

  12. Getting Ready

  13. How to Massage Your Baby

  14. Crying, Fussing, and Other Baby Language (including cues, reflexes and behavioral states

  15. Minor Illness and Colic

  16. Your Premature Baby

  17. Your Baby with Special Needs

  18. Your Growing Child and Sibling Bonding through Infant Massage

  19. Your Adopted or Foster Children

  20. A Note to Teen Parents

BACK MATTER INCLUDES:

References and Recommendations

Resources

Author Bio

Infant Massage, Bonding, Baby-Wearing and Attachment – Part One