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By Diana Divecha

In the months leading up to birth, a pregnant woman begins to read about childrearing, including a book called Attachment Parenting by pediatrician William Sears and registered nurse Martha Sears. They advocate for a collection of seven practices they call the Baby Bs: "birth bonding, breastfeeding, baby-wearing, bedding close to the baby, belief in the baby's cry, balance and boundaries, and beware of baby trainers."

The pregnant woman finds their ideas compelling, and so decides to embrace this style of "attachment parenting." But nothing goes according to plan. She begins delivery at home with a midwife, but when the labor doesn't proceed, she's taken to the hospital and given a Caesarean section.

Influenced by Attachment Parenting, she worries that she has missed a critical bonding experience with her baby. Six weeks later, the mother develops a severe breast infection and reluctantly switches to formula. "Make sure you find some other way to bond with your baby," her pediatrician cautions, adding to her distress. At night, the mother pulls the baby from his crib into her bed—even though it makes the baby cry.

Pretty soon, no one is happy—and the new mother wonders if her child is on the road to insecurity and anxiety.

All of these experiences are real; they've happened to mothers I know. And as a developmental psychologist, I know this tension between the ideal and the reality is based on a misunderstanding. Home birth, breastfeeding, and co-sleeping all have benefits—but none of them is related to a baby's secure attachment with her caregiver, nor are they predictive of a baby's future mental health and development.

Simply put, a secure attachment—which does lead to positive child outcomes—is not the same thing as the philosophy called attachment parenting.

What is the scientific view of attachment?

The term attachment parenting was coined by Sears and Sears to refer to a parenting approach that emphasizes responding sensitively to the needs of babies and children. Many of their ideas come from parenting their own eight children, as well as from their pediatric practice; some are from anthropologists' observations of indigenous childrearing practices (thought to be more "natural"); and some (like emotional responsiveness) are consistent with research findings.

Many parents, myself included, have welcomed the Sears' guidance for creating warm, loving relationships, especially in contrast to earlier parenting approaches that were more strict, cold, or distant.

The implication, though—liberally strewn throughout the Sears' writing and the precepts of the related international attachment parenting movement—is that the Baby Bs lead to a secure attachment, which is a specific psychological concept based on 60 years of research. Here we come to the problem: their use of the word attachment and the confusion it creates with the scientific notion of attachment theory.

Attachment theory has its roots in the work of an English psychiatrist, John Bowlby, who in the 1930s worked with children with emotional problems. He noticed that the troubled children in his care were deprived of affection and had disturbed or nonexistent caregiving. He came to believe that a primary caregiver served as a kind of "psychic organizer" to the child, and that the child needed this warm, intimate influence to develop successfully.

According to Bowlby, babies form a "small hierarchy of attachments": The number has to be small for the baby to learn relevant emotional information, but multiples offer the safety of backups. And it's a hierarchy for safety, too—in danger, there's no time to think, so the baby can automatically turn to the person already determined to be the reliable comfort.

In the 1950s, Mary Ainsworth joined Bowlby in England. A decade later, back in the United States, she began to diagnose different kinds of relationship patterns between children and their mothers in the second year of life, based on how babies respond to separations and reunions. When babies have a secure attachment, they play and explore freely from the "secure base" of their mother's presence. When the mother leaves, the baby often becomes distressed, especially when a stranger is nearby. When the mother returns, the baby expresses joy, sometimes from a distance and sometimes reaching to be picked up and held. (Babies vary, depending on their personality and temperament, even within a secure attachment).

Though early researchers studied mothers, current research shows that fathers, co-parents, grandparents, babysitters, and even older siblings can be significant attachment figures. Caregivers who foster a secure attachment are responsive, warm, loving, and emotionally available, and as a result babies grow to be confident in the caregiver's ability to handle feelings. The babies feel free to express their positive and negative feelings openly and don't develop defenses against the unpleasant ones.

Why the confusion about a secure attachment?

The Sears' idea of attachment parenting is not well defined—and certainly has not been scientifically linked to a secure attachment outcome. And this confusion can sow guilt, worry, and misdirection in parents, who (understandably) are not aware of the distinction.

"Attachment [in the scientific sense] is a relationship in the service of a baby's emotion regulation and exploration," explains Alan Sroufe, a developmental psychologist at the Institute for Child Development at the University of Minnesota, where he and his colleagues have studied the attachment relationship for over 40 years. "It is the deep, abiding confidence a baby has in the availability and responsiveness of the caregiver."

A secure attachment has at least three functions:

  • Provides a sense of safety and security
  • Regulates emotions by soothing distress, creating joy, and supporting calm
  • Offers a secure base from which to explore

"Attachment is not a set of tricks," continues Sroufe. "These [attachment parenting principles] are all fine things, but they're not the essential things. There is no evidence that they are predictive of a secure attachment."

Take breastfeeding, for example, touted as key to attachment parenting. Mechanical and insensitive breastfeeding could actually contribute to an insecure attachment, while warm, sensitive, interactive bottle-feeding could help create a secure attachment. It's not the method of feeding but the quality of the interaction that matters for attachment, says Sroufe.

Constant contact, too, can be misunderstood. Certainly, skin-to-skin contact, close physical touch, holding, and carrying are good for infants and can even reduce crying. But again, what matters for attachment is the caregiver's attunement. Are they stressed or calm? Checked out or engaged? Are they reading the baby's signals?

Attachment parenting advises emotional responsiveness, and this practice aligns best with scientific attachment theory. Babies grow best when their feelings are taken seriously. But well-meaning parents can overdo it, believing they need to meet the child's every request, which can be exhausting and counterproductive. In contrast, research on secure attachments shows that, in the flow of everyday life, misattunements happen about 70 percent of the time!

What is important, researchers say, is that the baby develops a generalized trust that their caregiver will respond and meet their needs, or that when mismatches occur, the caregiver will repair them. This flow of attunements, mismatches, and repairs offers the optimal amount of connection and stress for a baby to develop both confidence and coping skills.

"There's a difference between a 'tight' connection and a secure attachment," Sroufe explains. "A tight attachment—together all the time—might actually be an anxious attachment."

The neurobiology of attachment

"Attachment theory is essentially a theory of regulation," explains Allan Schore, a developmental neuroscientist in the Department of Psychiatry at the UCLA David Geffen School of Medicine.

The areas of the brain that process emotional and social information begin to differentiate in the last trimester in-utero (whereas the more "intellectual" regions pick up in the second year of life). By birth, the amygdala, hypothalamus, insula, cingulate cortex, and orbitofrontal cortex—regions important for emotion processing—are present, but the connections among these areas develop in specific patterns over the first years of life. That's where input from the primary relationship is crucial, organizing the hierarchical circuitry that will process, communicate, and regulate social and emotional information. Synaptic connections are pruned, and epigenetic processes modify the expression of genes that regulate stress, depending on input from the environment.

Parents use their own empathy, perspective taking, inference, and intuition to discern the needs of the baby. And the behaviors that parents are inclined to do naturally, like eye contact and face-to-face interaction, baby-talking and holding, are exactly the ones shown to grow the neural regions in the baby that influence emotional life. It is through a "right-brain-to-right-brain" reading of each other that the parent and child synchronize their energy, emotions, and communication.

"What a primary caregiver is doing, in being with the child," explains Schore, "is allowing the child to feel and identify in his own body these different emotional states. By having a caregiver simply 'be with' him while he feels emotions and has experiences, the baby learns how to be," Schore says.

And it's not just about regulating stress. Supporting positive emotional states is equally important to creating a "background state of well-being." If the caregiver's emotions are too high, the stimulation could be intrusive to the baby, Schore explains. Too low, and the baby's "background state" settles at a low or possibly depressive emotional baseline. Just right, from the baby's point of view, is best.

Even then, there's a lot of leeway. As Schore says:

Insecure attachments aren't created just by a caregiver's inattention or missteps. They also come from a failure to repair ruptures. Maybe the caregiver is coming in too fast and needs to back off, or maybe the caregiver hasn't responded and needs to show the baby that she's there. Either way, repair is possible, and it works. Stress is a part of life, and what we're trying to do here is to set up a system by which the baby can learn how to cope with stress.

How important is attachment?

"Nothing is more important than the attachment relationship," says Sroufe, who, together with colleagues, ran a series of landmark studies to discover the long-term impact of a secure attachment.

Over a 35-year period, the Minnesota Longitudinal Study of Risk and Adaptation (MLSRA) revealed that the quality of the early attachment reverberated well into later childhood, adolescence, and adulthood, even when temperament and social class were accounted for.

One of the most important (and paradoxical) findings was that a secure attachment early in life led to greater independence later, whereas an insecure attachment led children to be more dependent later in life.

The MLSRA studies showed that children with a secure attachment history were more likely to develop:

  • A greater sense of self-agency
  • Better emotional regulation
  • Higher self-esteem
  • Better coping under stress
  • Closer friendships in middle childhood
  • Better coordination of friendships and social groups in adolescence
  • More trusting and positive romantic relationships in adulthood
  • Greater social competence
  • More leadership qualities
  • Happier and better relationships with parents and siblings

But attachment is not destiny; it depends on what else comes along. A poor start in life, for example, can be repaired in a subsequent relationship with a good mentor, a healthy romance, or constructive therapy.

As for my new-mother friends, they're bonding successfully with their babies, welcoming and enjoying the moments when connection happens. And if you're concerned about bonding with your own baby, rest assured that you'll have some help—from your baby. Because regardless of their individual personalities—whether they cry a lot or sleep very little, whether they're breastfed or bottle-fed—babies invite adults in with their wide-open gaze, their milky scent, and their tiny fingers that curl around your big ones. They let you know what they need.

Before you know it, they are lighting you up with their full-body smiles and pulling you close with their plump, soft arms. And the sweet elixir of attachment is underway.

Originally posted on Greater Good.

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We spend a lot of time prepping for the arrival of a baby. But when it comes to the arrival of our breast milk (and all the massive adjustments that come with it), it's easy to be caught off guard. Stocking up on a few breastfeeding essentials can make the transition to breastfeeding a lot less stressful, which means more time and energy focusing on what's most important: Your recovery and your brand new baby.

Here are the essential breastfeeding tools you'll need, mama:

1. For covering up: A cute nursing cover

First and foremost, please know that all 50 states in the United States have laws that allow women to breastfeed in public. You do not have to cover yourself if you don't want to—and many mamas choose not to—and we are all for it.

That said, if you do anticipate wanting to take a more modest approach to breastfeeding, a nursing cover is a must. You will find an array of styles to choose from, but we love an infinity scarf, like the LK Baby Infinity Nursing Scarf Nursing Cover. You'll be able to wear the nursing cover instead of stuffing it in your already brimming diaper bag—and it's nice to have it right there when the baby is ready to eat.

Also, in the inevitable event that your baby spits-up on you or you leak some milk through your shirt, having a quick and stylish way to cover up is a total #momwin.

2. For getting comfortable: A cozy glider

Having a comfy spot to nurse can make a huge difference. Bonus points if that comfy place totally brings a room together, like the Delta Children Paris Upholstered Glider!

Get your cozy space ready to go, and when your baby is here, you can retreat from the world and just nurse, bond, and love.

3. For unmatched support: A wire-free nursing bra

It may take trying on several brands to find the perfect match, but finding a nursing bra that you love is 100% worth the effort. Your breasts will be changing and working in ways that are hard to imagine. An excellent supportive bra will make this so much more comfortable.

It is crucial to choose a wireless bra for the first weeks of nursing since underwire can increase the risk of clogged ducts (ouch).The Playtex Maternity Shaping Foam Wirefree Nursing Bra is an awesome pick for this reason, and because it is designed to flex and fit your breasts as they go through all those changes.

4. For maximum hydration: A large reusable water bottle

Nothing can prepare you for the intense thirst that hits when breastfeeding. Quench that thirst (and help keep your milk supply up in the process) by always having a water bottle with a straw nearby, like this Exquis Large Outdoor Water Bottle.

5. For feeding convenience: A supportive nursing tank

Experts recommend that during the first weeks of your baby's life, you breastfeed on-demand, meaning that any time your tiny boss demands milk, you feed them. This will help establish your milk supply and get everything off to a good start.

What does this mean for your life? You will be breastfeeding A LOT. Nursing tanks, like the Loving Moments by Leading Lady, make this so much easier. They have built-in support to keep you comfy, and you can totally wear them around the house, or even out and about. When your baby wants to eat, you'll be able to quickly "pop out" a breast and feed them.

6. For pain prevention: A quality nipple ointment

Breastfeeding shouldn't hurt, but the truth is those first days can be uncomfortable. Your nipples will likely feel raw as they adjust to their new job. This will get better! But until it does, nipple ointment is amazing.

My favorite is the Earth Mama Organic Nipple Butter. We love that it's organic, and it is oh-so-soothing on your hard-at-work nipples.

Psst: If it actually hurts when your baby latches on, something may be up, so call your provider or a lactation consultant for help.

7. For uncomfortable moments: A dual breast therapy pack

As your breasts adjust to their new role, you may experience a few discomforts—applying warmth or cold can help make them feel so much better. The Lansinoh TheraPearl 3-in-1 Breast Therapy Pack is awesome because you can microwave the pads or put them in the freezer, giving you a lot of options when your breasts need some TLC.

Again, if you have any concerns about something being wrong (pain, a bump that may be red or hot, fever, or anything else), call a professional right away.

8. For inevitable leaks: An absorbing breast pad

In today's episode of, "Oh come on, really?" you are going to leak breastmilk. Now, this is entirely natural and you are certainly not required to do anything about this. Still, many moms choose to wear breast pads in their bras to avoid leaking through to their shirts.

You can go the convenient and disposable route with Lansinoh Disposable Stay Dry Nursing Pads, or for a more environmentally friendly option, you can choose washable pads, like these Organic Bamboo Nursing Breast Pads.

9. For flexibility: A breast pump

Many women find that a breast pump becomes one of their most essential mom-tools. The ability to provide breast milk when you are away from your baby (and relieve uncomfortable engorged breasts) will add so much flexibility into your new-mom life.

For quick trips out and super-easy in-your-bag transport, opt for a manual pump like the Lansinoh Manual Breast Pump .

If you will be away from your baby for longer periods of time (traveling or working outside the home, for example) an electric pump is your most efficient bet. The Medela Pump In Style Advanced Double Electric Breast Pump is a classic go-to that will absolutely get the job done, and then some.

10. For quality storage: Breast milk bags

Once you pump your liquid gold, aka breast milk, you'll need a place to store it. The Kiinde Twist Pouches allow you to pump directly into the bags which means one less step (and way less to clean).

11. For keeping cool: A freezer bag

Transport your pumped milk back home to your baby safely in a cooler like the Mommy Knows Best Breast Milk Baby Bottle Cooler Bag. Remember to put the milk in a fridge or freezer as soon as you can to optimize how long it stays usable for.

12. For continued nourishment: Bottles

Nothing beats the peace of mind you get when you know that your baby is being well-taken of care—and well fed—until you can be together again. The Philips Avent Natural Baby Bottle Newborn Starter Gift Set is a fan favorite (mama and baby fans alike).

This article is sponsored by Walmart. Thank you for supporting the brands that support Motherly and mamas.

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Motherly is committed to covering all relevant presidential candidate plans as we approach the 2020 election. We are making efforts to get information from all candidates. Motherly does not endorse any political party or candidate. We stand with and for mothers and advocate for solutions that will reduce maternal stress and benefit women, families and the country.

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A viral video about car seat safety has parents everywhere cracking up and humming Sir-Mix-A-Lot.

"I like safe kids and I cannot lie," raps Norman Regional Health System pediatric hospitalist Dr. Kate Cook (after prefacing her music video with an apology to her children."I'm a doctor tryin' warn you that recs have changed," she continues.

Dr. Cook's rap video is all about the importance of keeping babies facing backward. It's aptly called "Babies Face Back," and uses humor and parody to drive home car seat recommendations from the American Academy of Pediatrics (AAP).

"Switching from rear-facing to forward-facing is a milestone many parents can't wait to reach," Dr. Cook said in a news release about her hilarious video. "But this is one area where you want to delay the transition as long as possible because each one actually reduces the protection to the child."

Last summer the AAP updated its official stance on car seat safety to be more in line with what so many parents were already doing and recommended that kids stay rear-facing for as long as possible. But with so many things to keep track of in life, it is understandable that some parents still don't know about the change. Dr. Cook wants to change that with some cringe-worthy rapping.

The AAP recommends:

  • Babies and toddlers should ride in a rear-facing car safety seat as long as possible, until they reach the highest weight or height allowed by their seat.
  • Once they are facing forward, children should use a forward-facing car safety seat with a harness for as long as possible. Many seats are good up to 65 pounds.
  • When children outgrow their car seat they should use a belt-positioning booster seat until the vehicle's lap and shoulder seat belt fits properly, between 8 and 12 years old.

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[Editor's note: Motherly is committed to covering all relevant presidential candidate plans as we approach the 2020 election. We are making efforts to get information from all candidates. Motherly does not endorse any political party or candidate. We stand with and for mothers and advocate for solutions that will reduce maternal stress and benefit women, families and the country.]

Suicide rates for girls and women in the United States have increased 50% since 2000, according to the CDC and new research indicates a growing number of pregnant and postpartum women are dying by suicide and overdose. Suicide rates for boys and men are up, too.

It's clear there is a mental health crisis in America and it is robbing children of their mothers and mothers of their children.

Medical professionals urge people to get help early, but sometimes getting help is not so simple. For many Americans, the life preserver that is mental health care is out of reach when they are drowning.

Democratic presidential candidate Pete Buttigieg just released a plan he hopes could change that and says the neglect of mental health in the United States must end. "Our plan breaks down the barriers around mental health and builds up a sense of belonging that will help millions of suffering Americans heal," says Buttigieg.

He thinks he can "prevent 1 million deaths of despair by 2028" by giving Americans more access to mental health and addictions services.

In a country where giving birth can put a mother in debt, it's not surprising that while as many as 1 in 5 new moms suffers from perinatal mood and anxiety disorders, more than half of new moms who need mental health treatment don't get it. Stigma, childcare and of course costs are factors in why women aren't seeking help when they are struggling.

Buttigieg's plan is interesting because it could remove some of these barriers. He wants to make mental health care more affordable by ensuring everyone has comprehensive coverage for mental health care and by ensuring that everyone can access a free yearly mental health check-up.

That could make getting help more affordable for some moms, and by increasing reimbursement rates for mental health care delivered through telehealth, this plan could help moms get face time with a medical professional without having to deal with finding childcare first.

Estimates from new research suggest that in some parts of America as many as 14% or 30% of maternal deaths are caused by addiction or suicide. Buttigieg's plan aims to reduce those estimates by fighting the addiction and opioid crisis and increasing access to mental health services in underserved communities and for people of color. He also wants to reduce the stigma and increase support for the next generation by requiring "every school across the country to teach Mental Health First Aid courses."

These are lofty goals with a lofty price tag. It would cost about $300 billion to do what Buttigieg sets out in his plan and the specifics of how the plan would be funded aren't yet known. Neither is how voters will react to this 18-page plan and whether it will help Buttigieg stand out in a crowded field of Democratic candidates.

What we do know is that right now, America is talking about mental health and whether or not that benefits Buttigieg's campaign it will certainly benefit America.

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[Editor's Note: Welcome to It's Science, a Motherly column focusing on evidence-based explanations for the important moments, milestones, and phenomena of motherhood. Because it's not just you—#itsscience.]

If you breastfeed, you know just how magical (and trying) it is, but it has numerous benefits for mama and baby. It is known to reduce the likelihood of developing cardiovascular disease, type 2 diabetes, and rheumatoid arthritis, and cuts the risk of sudden infant death syndrome (SIDS) by half.

If this wasn't powerful enough, scientists have discovered that babies who are fed breast milk have a stomach pH that promotes the formation of HAMLET (Human Alpha-lactalbumin Made Lethal to Tumor cells). HAMLET was discovered by chance when researchers were studying the antibacterial properties of breast milk. This is a combination of proteins and lipids found in breast milk that can work together to kill cancer cells, causing them to pull away from healthy cells, shrink and die, leaving the healthy cells unaffected.

According to researchers at Lund University in Sweden, this mechanism may contribute to the protective effect breast milk has against pediatric tumors and leukemia, which accounts for about 30% of all childhood cancer. Other researchers analyzed 18 different studies, finding that "14% to 19% of all childhood leukemia cases may be prevented by breastfeeding for six months or more."

And recently, doctors in Sweden collaborated with scientists in Prague to find yet another amazing benefit to breast milk. Their research demonstrated that a certain milk sugar called Alpha1H, found only in breast milk, helps in the production of lactose and can transform into a different form that helps break up tumors into microscopic fragments in the body.

Patients who were given a drug based on this milk sugar, rather than a placebo, passed whole tumor fragments in their urine. And there is more laboratory evidence to support that the drug can kill more than 40 different types of cancer cells in animal trials, including brain tumors and colon cancer. These results are inspiring scientists to continue to explore HAMLET as a novel approach to tumor therapy and make Alpha1H available to cancer patients.

Bottom line: If you choose to breastfeed, the breast milk your baby gets from your hard work can be worth every drop of effort.

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