THE PROCESS OF ATTACHMENT Attachment (bonding) is a special lifelong process (Žvelc and Žvelc, 2006) between parents or other significant individuals and the child, which, under optimal circumstances, forms and strengthens during pregnancy, at birth, and especially during the crucial period of the newborn and infant (Truden Dobrin et al., 2010). The term “bonding” is used to describe the establishment of a relationship between parents and child in the early neonatal period (Hamilton, 2009), but attachment can also be defined as an active, strongly affectionate reciprocal relationship between two individuals (Zupančič, 2004). Bonding is the first and most fundamental sequential need, forming the basis for the development of other fundamental biopsychological needs: the need for attachment, autonomy, self-confidence, identity, well-being, and meaning in life. It is a fundamental biological and psychological need. From the perspective of early childhood, especially the first months of life, bonding is essential for communication between the child and their mother. Through skin-to-skin contact (physical contact between child and mother), through the mother’s facial expressions, her voice, and emotional intonation, the child receives the first and most important bio-psychological message in their life: that they are loved (Stauss and Ellis, 2007).

Immediately after birth, the newborn responds to the new environment. The most common response of a child after birth is crying, as it communicates everything. As soon as parents respond correctly, the child calms down. Parents feel distress when their child cries, which tells them that the child needs something. By calming the child, parents also calm themselves (Siegel and Hartwell, 2004). The first sources of satisfaction are smell, touch, and sound, so it is essential for parents to hold the child gently and relaxed. In doing so, the child’s breathing and heart rate synchronize, muscles relax, as the child’s nervous system is connected to the parents’ nervous system. In their arms, the child feels safe (Kompan Erzar and Poljanec, 2009).

Attachment helps infants adapt by ensuring that their parents will meet their psychosocial and physical needs. Both the mother and the child contribute to secure attachment by responding to each other. It has been shown that by eight weeks of age, infants direct certain behaviors more towards their mother than towards other people. Attempts at closeness are successful if the mother responds warmly to these child behaviors, expresses enthusiasm, has frequent physical contact with the infant, and allows them to freely explore the environment (Papalia and Wendkos Olds, 2002).

After the infant has tested countless times how their signals (hunger, boredom, fear, and warmth) will be responded to, they store mental images of these scenes in their brain. Over time, they fill a ‘brain library’ of connecting scenes, which mark the beginning of a sense of self and of the world of caregivers. This library of associative patterns helps the infant anticipate a response to their needs. When the scene is replayed and their expectations are met, their sense of well-being is strengthened, which will forever influence their ability to trust others (Sears and Sears, 2008).

Factors influencing successful bonding

The assumption that gazing into a child’s eyes while the mother lovingly holds them will establish a lifelong mutual bond is, of course, misleading, as bonding does not work so simply. Relationships are much more complex. These are extraordinary moments for parents, and for that reason alone, they should be enabled, if not encouraged. It is essential that parents have the opportunity to attune to their child as early and as simply as possible, as undisturbed as possible. However, the working methods in maternity hospitals and established routines often do not facilitate this at all (Drglin, 2003).

Bonding between parents and child in the first months is easier if it starts well. The hours and days after birth are a sensitive period when the mother prepares to care for the newborn, and the newborn has an almost magical effect on attentive caregivers. The newborn and mother should spend as much time together as possible after birth to allow the infant’s natural behavior, which itself contributes to bonding, and intuitive, instinctive maternal care to emerge. This biological pair will thrive if they remain continuously together for the first six weeks (Sears and Sears, 2008).

Edwards (2004) states that the following prerequisites must be met to facilitate the bonding process between parents and children:

• emotional health of parents (including the ability to trust another person);
• social support systems in the environment, including partners, friends, and families;
• an appropriate level of communication and child care skills;
• parental proximity to children;
• parental adaptability to children (including the child’s condition, temperament, and gender).

Attachment develops and is maintained through closeness and mutual interaction with the child, through which parents get to know the child, understand and perceive the child as an individual, and consider them a family member. The bonding process is facilitated by positive feedback, such as social, verbal, and non-verbal responses, whether real or perceived, that indicate acceptance by both partners. Attachment arises through mutually satisfying experiences (Edwards, 2004).

Siddiqui and Hägglöf (2000) state that a mother’s attachment to her unborn child is a good predictor of the early establishment of the mother-child relationship. Wong and her colleagues (2006) emphasize that attachment depends primarily on a close and lasting relationship in early life and the mutual influence between a mother and her child. Edwards (2004) adds that the mother-child synchrony indicates an adaptation between the child’s cues and parental responses.

Based on decades of experience, Sears and Sears (2008) established a new parenting method called “attachment parenting,” which highlights the importance of instinctive, primal care for the child and emphasizes the importance of parenting by intuition. They describe attachment parenting as an educational approach rather than a set of strictly defined rules. Parents who raise children using this method commonly breastfeed their children, hold them frequently, and raise them with positive encouragement. This approach has many advantages, as it promotes mental development, contributes to stronger health, influences faster child growth, fosters intimacy and compassion, and thus strengthens the bond between the child and their parents.

The following are the most important factors contributing to successful mother-child bonding: breastfeeding, skin-to-skin contact, co-sleeping of mother and child, and the role of the hormone oxytocin.

Breastfeeding

Breastfeeding is the most natural way to feed infants and young children (Bratanič et al., 2010) and one of the important indicators of the mother-child relationship (Pavšič Mrevlje, 2006). Brazelton (2006) explains that for a newborn, breastfeeding is very similar to the feeling the child knows from the womb. This is why many stimuli and sensations experienced during breastfeeding give the child a sense of security and positively influence the development of the central nervous system (Pajtnar, 2004b). The first feeding and skin-to-skin contact between mother and newborn after birth are very important for both mother and child (Bratanič et al., 2010). The first feeding with colostrum is crucial for the development of the child’s physical immunity, the later success of breastfeeding, and the harmony between the mother and her child (Bratanič, 2007).

Šoster Olmerjeva (1999) compares breastfeeding to an invisible umbilical cord that reconnects the child and mother after birth. The best time to put a newborn to the mother’s breast is within thirty minutes after birth, as this is when the child’s sucking instinct is strongest. If this opportunity for the first latch immediately after birth is missed, it is harder to encourage the newborn to breastfeed later, for example, after one or two days. Palmer (2002) states that after birth, the child already has an imprinted memory of the amniotic fluid’s scent. This memory helps them find the mother’s nipple after birth, which has a very similar scent. In the first days after birth, the child calms down most quickly during breastfeeding, as the familiar scent soothes them.

Lactation is a physiological period of the female reproductive cycle during which, due to hormonal changes during pregnancy and after childbirth, milk is secreted (Riordan and Wambach, 2010). Mother’s milk is the most suitable food for an infant. The young of all mammal species thrive best on their mother’s milk (Felc, 2008). Coordinated action of hormones, prolactin and oxytocin, is necessary for lactation and breastfeeding. Oxytocin is a highly psychosomatic hormone, and its role is to secrete milk from the breast. It is released intensely and rapidly while the mother observes, touches, smells, hears, or even just thinks about her child. Its release is inhibited by stress and pain, and sometimes by certain medical conditions. Prolactin is a hormone that allows the breasts to refill with milk; its quantity is conditioned by the child’s sucking (Lawrence and Lawrence, 2011).

Breastfeeding benefits not only the child but also nursing mothers, families, and society at large. The health benefits of breastfeeding for the child are numerous. Immediately after birth, the ideal food, colostrum, is already prepared in the mother’s breasts. While formula feeding for newborns is merely a means of nutrition for the child, breast milk, in addition to fats, carbohydrates, and proteins, also contains various protective substances that are the child’s main defense against various infections (Hoddindot et al., 2012). It has been proven that breast milk protects the child from gastrointestinal, urinary, and respiratory infections, as well as middle ear infections (Howie et al., 1990; Marild et al., 2004). It also protects the child from atopic disease if present in the family (Burr et al., 1989; Fewtrell, 2004) and from type I diabetes (Sadauskaite-Kuehne et al., 2004); similarly, the risk of obesity is significantly reduced in breastfed children (Arenz et al., 2004). Breastfeeding immediately after birth reduces postpartum hemorrhage and thus aids uterine contraction, lactational amenorrhea protects the woman from potential anemia, breastfeeding promotes genuine contact between mother and infant, and encourages bonding (Gartner et al., 2005). It also contributes to faster weight loss gained during pregnancy (Fidler Mis, 2011) and reduces the likelihood of postpartum depression (Figueiredo et al., 2014). The benefits of breastfeeding for the mother also include a reduced risk of developing premenopausal breast cancer and certain forms of ovarian cancer, and it reduces the risk of osteoporosis in the premenopausal period (Ip et al., 2007).

The success of lactation and breastfeeding largely depends on numerous ecological, clinical, and sociological factors, some of which are already at play in the maternity hospital, while others emerge later (Velikonja, 2004). In the maternity hospital, the separation of the mother from her family (husband and other children) and especially the separation from her newborn in the first hours after birth can negatively affect breastfeeding success. Early contact between mother and newborn immediately after birth accelerates the establishment of lactation (Lawrence and Lawrence, 2011), but does not affect the duration of breastfeeding (Bratanič et al., 2010). If the birth proceeded without major complications and the child is healthy and able to suckle, mothers in all maternity hospitals in Slovenia are enabled to have their first breastfeeding immediately after birth (Hoyer, 2007).

Skin-to-skin contact

Trček (1998) states that touch is a fundamental human need. The sense begins to develop already in the embryonic period, and immediately after birth, the child begins to perceive and learn about the world around them through touch (Sweeney, 2007), which has been proven to promote normal mental development (Kida and Shinohara, 2012).

Touch represents the most intimate form of communication for a newborn, providing a sense of love, security, and comfort (Barram et al., 2012). Parents get to know and understand their newborn through touch. Some exhibit anticipated and defined patterns of touching. These are believed to consciously and unconsciously follow a specific sequence in the process of getting acquainted. First, the mother or other caregiver touches the child’s head and limbs with their fingertips. This is followed by stroking the child’s torso with the palm and embracing (Rubin, 1963; Klaus and Kennell, 1982; Tulman, 1985 cited by Edwards, 2004).

Physical contact between mother and newborn is a natural process (Stern, 2002). The naked baby, without a diaper, is placed on the mother’s bare chest and covered with a warm blanket. Ideally, skin-to-skin contact should begin immediately after birth and continue uninterrupted at least until the end of the first feeding (Velandia et al., 2012). Babies who experience physical contact with their mother immediately after birth cry less (Moore et al., 2008), their bodies more easily regulate optimal body temperature, and it has also been proven that they have higher blood glucose levels (Moore and Anderson, 2007); their heart rate also slows down, and the body’s oxygen supply improves (Winberg, 2005). Physical contact awakens the maternal instinct in the mother and strengthens the mother’s bond with the newborn (Phillips, 2013).

Touching and massaging the baby stimulate breathing, provide warmth, and help rub vernix into the skin, preventing dehydration. If the mother holds the baby close to her heart, on the left side of her body, she can soothe the baby with the rhythmic heartbeat that was an important part of the intrauterine environment. Holding the baby on the left can provide eye contact, as many babies turn to the right. The baby can lick and smell the mother’s breast or even suckle immediately after birth (Drglin, 2003). Nipple stimulation releases the hormone oxytocin into the bloodstream, helping to stimulate uterine contractions, aiding in placental expulsion in the third stage of labor, and preventing postpartum hemorrhage (Lawrence and Lawrence, 2011). Early contact between mother and child allows beneficial bacteria to grow in the child, thus preventing the growth of hospital bacteria (Collado et al., 2012). Through physical contact, the rhythms of mother and child synchronize, and fathers also synchronize (Drglin, 2003).

The World Health Organization (WHO) and UNICEF, 2009, in the “Baby-Friendly Hospital Initiative,” recommend that, if both mother and newborn are healthy, the child’s first physical contact with the mother should occur within the first thirty minutes after birth. Mothers who establish physical contact with their child early after birth become more sensitive to the child’s needs immediately postpartum (Bystrova et al., 2009) and less sensitive to postpartum pain (Phillips, 2013).

Rooming-in of mother and child

Rooming-in allows for continuous cohabitation of mother and child after birth (Jaafar et al., 2011). For many women, it is important that the child stays with them after birth for as long as they wish. Mother and child sleep and wake together (or the mother adapts to the child’s rhythm) and get to know each other; the child can breastfeed whenever they want. All children benefit from being close to their families, even when they need medical observation or treatment (Drglin, 2003).

During rooming-in, the newborn and mother have ample opportunities to practice communication. Because the mother is always with the baby, she notices what is happening with them even before they cry. She picks them up when they wake, whimper, and grimace, and calms them without them having to cry, and certainly before they erupt into an inconsolable cry that is difficult to stop. The mother learns to understand pre-cry signals and responds to them appropriately. And because the infant achieves a response with even a slight hint that something is amiss, they use these signals more and more frequently. The infant thus becomes increasingly skilled with signals, and the mother’s response becomes increasingly appropriate (Sears and Sears, 2008).

Bystrova and colleagues (2009), in their study on mother-child relationships, demonstrate that co-sleeping of mother and newborn in the first hours after birth promotes maternal behavior and strongly influences the later bond between mother and adolescent. Rapley (2002) adds that co-sleeping positively affects the breastfeeding process, as a mother who co-sleeps with her child can calmly, confidently, and relaxed respond to the child’s signals, and consequently has fewer breastfeeding difficulties (Jaafar et al., 2011).

During co-sleeping, even the mother’s hormone levels regulate. Co-sleeping of mother and child after birth and frequent physical contact between them stimulate the secretion of oxytocin, a hormone important for the formation of maternal instinct (Palmer, 2002). Already in the 1980s, Lavrič and colleagues (1985) found that infants who spent most of their time in the room with their mother gained weight faster than those separated from their mother, that breastfeeding was more frequent and timely, and that co-sleeping in the same room also influenced a closer and more genuine relationship between mother and child, and that the newborn’s presence with the mother in the first days after birth also has other deep and long-lasting positive consequences. A mother who continuously co-sleeps with her child postpartum becomes more caring and sensitive to the child’s needs, which she also recognizes more quickly (Palmer, 2002).

The hormone oxytocin

Oxytocin is one of the many substances nature uses to provide the child with the love, warmth, and care needed for survival. Its main task is to shape the maternal instinct in the mother after the child’s birth. Oxytocin levels in the mother’s body increase at the end of pregnancy, and its value further rises during the child’s passage through the birth canal. Psychological studies have shown that the type of attachment between child and parents depends precisely on oxytocin levels (Verdult, 2009). The higher the oxytocin concentration, the greater the likelihood of “secure” attachment, and the lower the oxytocin level, the greater the likelihood of “insecure” attachment, which can have lasting consequences for adolescents and adults. Consequences of insecure attachment include: insecure, asocial behavior, aggression, difficulties in maintaining lasting bonds with the mother and others, mental illnesses, and inability to cope with stress (Palmer, 2002).

Oxytocin enables the mother to recognize her child through scent. The hormone oxytocin thus plays an important role in shaping the mother’s attachment to her child (Verdult, 2009). In the first hour after birth, oxytocin levels in the mother’s and child’s bodies are extremely high, allowing them to recognize and love each other and immediately begin forming long-lasting emotional bonds. Mothers who delay the first feeding, or are not able to do so during this time, lose precious time. Although mother and child are separated during this time, the opportunity for bonding and loving is not lost. Elevated oxytocin levels remain in the mother’s body for some time after birth, but its sustained presence is maintained through physical contact between the mother and newborn (Palmer, 2002).

Felc (2011) states that many factors can inhibit oxytocin secretion. Therefore, it is important for the mother to have an undisturbed postpartum period so that she can breastfeed. Oxytocin release can be temporarily interrupted due to the mother’s severe pain, the release of stress hormones (doubt, anxiety, confusion), excessive alcohol consumption, and smoking. Cesarean section can alter the neurohormonal experience of birth, thereby reducing the responsiveness of the mother’s brain postpartum (Swain et al., 2007) and thus inhibiting the development of attachment between mother and newborn (Skrundz et al., 2011).

Father’s presence at birth and his bonding with the child

A caring father is involved in life with his child. His presence at birth only strengthens the connection between him, the child, and his partner. At that time, taking on the responsibilities of parenthood is self-evident. The connection with the newborn is established through the closest possible involvement in all tasks. A father’s warmth and affection are extremely important for the child’s development (Horvat Kuhar, 2010). Invisible bonds are forged between child and father from the very beginning; the sooner, the stronger they are. Fathers who have the opportunity to witness the miracle of their child’s birth and can hold, touch, and get to know them after birth, bond with them more quickly and are prepared to take on greater care and responsibility (Šoster Olmer, 1999). The father’s involvement in the child’s birth, cutting the umbilical cord, and the first bath also contributes to the early establishment of the father-child relationship (Hamilton, 2009).

If the father is present at birth and actively involved in childcare, his oxytocin hormone levels increase. Elevated levels of this hormone in the blood increase the desire for physical (not necessarily sexual) contact with the partner. Nature thus also enables the father to become an active, dedicated, and satisfied part of the newly formed family. Vasopressin is the hormone that helps the father in the bonding process. It stimulates the father’s desire for family life, shapes paternal instinct, and awakens the desire to care for his family members (Palmer, 2002).

In the first months after birth, the bond between mother and infant is generally more evident and closer than with the father in most families. However, this does not mean that fathers are not genuinely connected to their child. It is simply a different type of connection, neither worse nor better than the bond between mother and infant. Fathers respond to newborns just as strongly as mothers after birth. A father’s response to the child is called engrossment. The father’s emotions are very strong, and the child completely captivates the father. Men can be just as loving as women, especially if they get the opportunity to enjoy time with the newborn immediately after birth and in the following days (Sears and Sears, 2008). The father also plays an important role in breastfeeding the child, as most women who are supported by their partners in this decision successfully breastfeed. Many fathers realize that this method of feeding is better for the child’s physical and emotional health. It is also known that mothers whose partners have a negative attitude towards breastfeeding quickly give up breastfeeding or do not even decide to breastfeed (Felc, 2011).

Unmet need for attachment

The foundation of survival is for a child to recognize what is safe and what is dangerous; therefore, there are broadly two types of attachment: secure and insecure. It is precisely the recognition of danger that allows the child to survive in the world and among people. To avoid situations that are threatening to them and to seek refuge in the warm embrace of an adult. All brain processes later develop based on this ability. Therefore, insecure attachment (which is a distorted ability to recognize danger) strongly contributes to the development of psychopathology, while secure attachment (i.e., the appropriate ability to recognize and respond appropriately to “danger”) is the foundation for the development of psychological resilience (Jones, 1996, cited by Kompan Erzar and Poljanec, 2009).

The foundations of childhood attachment are what adults use to choose potential partners, with whom they repeat the familiar attachment pattern from their early relationship with their mother (Jurič, 2009). Securely attached adults desire intimacy, do not wish to be dependent on others, and are characterized by reciprocity and trust (Crowell and Treboux, 1995). In adults, attachment is primarily manifested as emotional responsiveness, the ability to feel, become aware of, regulate, and recognize individual emotions in others, and the capacity for empathy (Belsky et al., 2002). The choice of a partner one falls in love with is largely conditioned by their attachment style, as the way an adult establishes an intimate relationship will resemble the way they maintained contact with their mother as a child (Pines, 1999 cited by Jurič, 2009).

Unmet bonding needs lead to dysfunctional behavior, negative beliefs, unhealthy relationship styles, and numerous disorders and illnesses. An unmet need for bonding primarily prevents healthy personality development from the perspective of the ability to successfully meet other sequential fundamental biosocial needs, most often resulting in a person’s inability to show emotional warmth to themselves and others, an inability to give and/or receive love, to express anger, to accept anger from other people, and numerous other basic emotional disorders (Stauss and Ellis, 2007).