The Newborn

Prenatal Factors

Pregnancy is a period of psychologic preparation for the profound demands of parenting. Women may experience ambivalence, particularly (but not exclusively) if the pregnancy was unplanned. If financial concerns, physical illness, prior miscarriages or stillbirths, or other crises interfere with psychologic preparation, the neonate may not be welcomed. For adolescent mothers, the demand that they relinquish their own developmental agenda, such as an active social life, may be especially burdensome.

The early experience of being mothered may establish unconsciously held expectations about nurturing relationships that permit mothers to “tune in” to their infants. These expectations are linked with the quality of later infant–parent interactions. Mothers whose early childhoods were marked by traumatic separations, abuse, or neglect may find it especially difficult to provide consistent, responsive care. Instead, they may reenact their childhood experiences with their own infants, as if unable to conceive of the mother–child relationship in any other way. Bonding may be adversely affected by several risk factors during pregnancy and in the postpartum period that undermine the mother–child relationship and may threaten the infant's cognitive and emotional development ( Table 21.1 ).

Social support during pregnancy, particularly support from the father and close family members, is also important. Conversely, conflict with or abandonment by the father during pregnancy may diminish the mother's ability to become absorbed with her infant. Anticipation of an early return to work may make some women reluctant to fall in love with their babies because of anticipated separation. Returning to work should be delayed for at least 6 wk, by which time feeding and basic behavioral adjustments have been established.

Many decisions have to be made by parents in anticipation of the birth of their child. One important choice is that of how the infant will be nourished. Among the important benefits of breastfeeding is its promotion of bonding. Providing breastfeeding education for the parents at the prenatal visit by the pediatrician and by the obstetrician during prenatal care can increase maternal confidence in breastfeeding after delivery and reduce stress during the newborn period (see Chapter 56 ).

Peripartum and Postpartum Influences

The continuous presence during labor of a woman trained to offer friendly support and encouragement (a doula ) results in shorter labor, fewer obstetric complications (including cesarean section), and reduced postpartum hospital stays. Early skin-to-skin contact between mothers and infants immediately after birth may correlate with an increased rate and longer duration of breastfeeding. Most new parents value even a brief period of uninterrupted time in which to get to know their new infant, and increased mother–infant contact over the 1st days of life may improve long-term mother–child interactions. Nonetheless, early separation, although predictably very stressful, does not inevitably impair a mother's ability to bond with her infant. Early discharge home from the maternity ward may undermine bonding, particularly when a new mother is required to resume full responsibility for a busy household.

Postpartum depression may occur in the 1st wk or up to 6 mo after delivery and can adversely affect neonatal growth and development. Screening tools, such as the Edinburgh Postnatal Depression Scale (EPDS) , are available for use during neonatal and infant visits to the pediatric provider. On the EPDS, scores of 0-8 indicate a low likelihood of depression ( Table 21.2 ). Cutoff-score recommendations for further evaluation of depression have ranged from 9 to 13; thus any woman scoring 9 or above should be evaluated further. If postpartum depression is present, referral for mental healthcare will greatly accelerate recovery.