Transition to Parenthood

Transition to Parenthood

Kathryn Rhodes Alden

Key Terms and Definitions

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B ecoming a parent creates a period of change and instability for men and women who decide to have children. This period occurs whether parenthood is biologic or adoptive and whether the parents are married husband-wife couples, cohabiting couples, single mothers, single fathers, lesbian couples with one woman as biologic mother, or gay male couples who adopt a child. Parenting is as a process of role attainment and role transition that begins during pregnancy. The transition is an ongoing process as the parents and infant develop and change.

Parental Attachment, Bonding, and Acquaintance image

The process by which a parent comes to love and accept a child and a child comes to love and accept a parent is known as attachment. Using the terms attachment and bonding, Klaus and Kennell proposed that the period shortly after birth is important to mother-to-infant attachment. They defined the phenomenon of bonding as a sensitive period in the first minutes and hours after birth when mothers and fathers must have close contact with their infants for optimal later development (Klaus & Kennell, 1976). Klaus and Kennell (1982) later revised their theory of parent-infant bonding, modifying their claim of the critical nature of immediate contact with the infant after birth. They acknowledged the adaptability of human parents, stating that more than minutes or hours were needed for parents to form an emotional relationship with their infants. The terms attachment and bonding continue to be used interchangeably.

Attachment is developed and maintained by proximity and interaction with the infant, through which the parent becomes acquainted with the infant, identifies the infant as an individual, and claims the infant as a member of the family. Positive feedback between the parent and the infant through social, verbal, and nonverbal responses (whether real or perceived) facilitates the attachment process. Attachment occurs through a mutually satisfying experience. A mother commented on her son’s grasp reflex, “I put my finger in his hand, and he grabbed right on. It is just a reflex, I know, but it felt good anyway” (Fig. 15-1).

The concept of attachment includes mutuality; that is, the infant’s behaviors and characteristics elicit a corresponding set of parental behaviors and characteristics. The infant displays signaling behaviors such as crying, smiling, and cooing that initiate the contact and bring the caregiver to the child. These behaviors are followed by executive behaviors such as rooting, grasping, and postural adjustments that maintain the contact. Most caregivers are attracted to an alert, responsive, cuddly infant and repelled by an irritable, apparently disinterested infant. Attachment occurs more readily with the infant whose temperament, social capabilities, appearance, and gender fit the parent’s expectations. If the infant does not meet these expectations, the parent’s disappointment can delay the attachment process. Table 15-1 presents a comprehensive list of classic infant behaviors affecting parental attachment. Table 15-2 presents a corresponding list of parental behaviors that affect infant attachment.

TABLE 15-2

Parental Behaviors Affecting Infant Attachment

Looks; gazes; takes in physical characteristics of infant; assumes en face position; eye contact Turns away from infant; ignores infant’s presence
Hovers; maintains proximity; directs attention to, points to infant Avoids infant; does not seek proximity; refuses to hold infant when given opportunity
Identifies infant as unique individual Identifies infant with someone parent dislikes; fails to recognize any of infant’s unique features
Claims infant as family member; names infant Fails to place infant in family context or identify infant with family member; has difficulty naming
Touches; progresses from fingertip to fingers to palms to encompassing contact Fails to move from fingertip touch to palmar contact and holding
Smiles at infant Maintains bland countenance or frowns at infant
Talks to, coos, or sings to infant Wakes infant when infant is sleeping; handles roughly; hurries feeding by moving nipple continuously
Expresses pride in infant Expresses disappointment, displeasure in infant
Relates infant’s behavior to familiar events Does not incorporate infant into life
Assigns meaning to infant’s actions and sensitively interprets infant’s needs Makes no effort to interpret infant’s actions or needs
Views infant’s behaviors and appearance in positive light Views infant’s behavior as exploiting, deliberately uncooperative; views appearance as distasteful, ugly

Source: Mercer, R. (1983). Parent-infant attachment. In L. Sonstegard, K. Kowalski, & B. Jennings (Eds.), Women’s health (Vol. 2), Childbearing. New York: Grune & Stratton.

An important part of attachment is acquaintance. Parents use eye contact (Fig. 15-2), touching, talking, and exploring to become acquainted with their infant during the immediate postpartum period. Adoptive parents undergo the same process when they first meet their new child. During this period, families engage in the claiming process, which is the identification of the new baby (Fig. 15-3). The child is first identified in terms of “likeness” to other family members, then in terms of “differences,” and finally in terms of “uniqueness.” The unique newcomer is thus incorporated into the family. Mothers and fathers examine their infant carefully and point out characteristics that the child shares with other family members and that are indicative of a relationship between them. Maternal comments such as the following reveal the claiming process: “Everyone says, ‘He’s the image of his father,’ but I found one part like me—his toes are shaped like mine.”

On the other hand, some mothers react negatively. They “claim” the infant in terms of the discomfort or pain the baby causes. The mother interprets the infant’s normal responses as being negative toward her and reacts to her child with dislike or indifference. She does not hold the child close or touch the child to be comforting. For example, “The nurse put the baby into Lydia’s arms. She promptly laid him across her knees and glanced up at the television. ‘Stay still until I finish watching; you’ve been enough trouble already.’”

Nursing interventions related to the promotion of parent-infant attachment are numerous and varied (Table 15-3). They can enhance positive parent-infant contacts by heightening parental awareness of an infant’s responses and ability to communicate. As the parent attempts to become competent and loving in that role, nurses can bolster the parent’s self-confidence and ego. Nurses are in prime positions to identify actual and potential problems and collaborate with other health care professionals who will provide care for the parents after discharge. Nursing considerations for fostering maternal-infant bonding among special populations may vary (Cultural Considerations box).

TABLE 15-3

Examples of Parent-Infant Attachment Interventions

Attachment Promotion
Facilitation of development of parent-infant relationship
Environmental Management: Attachment Process
Manipulation of individuals’ surroundings to facilitate development of parent-infant relationship
Family Integrity Promotion: Childbearing Family
Facilitation of growth of individuals or families who are adding infant to family unit
Lactation Counseling
Use of interactive helping process to assist in maintenance of successful breastfeeding
Parent Education: Infant
Instruction on nurturing and physical care needed during first year of life
Risk Identification: Childbearing Family
Identification of individual or family likely to experience difficulties in parenting and assigning priorities to strategies to prevent parenting problems


Modified from Bulechek, G. M., Butcher, H. K., & Dochterman, J. M. (2008). Nursing interventions classification (NIC) (5th ed.). St. Louis: Mosby.

Assessment of Attachment Behaviors

One of the most important areas of assessment is careful observation of specific behaviors thought to indicate the formation of emotional bonds between the newborn and the family, especially the mother. Unlike physical assessment of the neonate, which has concrete guidelines to follow, assessment of parent-infant attachment relies more on skillful observation and interviewing. Rooming-in of mother and infant and liberal visiting privileges for father or partner, siblings, and grandparents provide nurses with excellent opportunities to observe interactions and identify behaviors that demonstrate positive or negative attachment. Attachment behaviors can be easily observed during infant feeding sessions. Box 15-1 presents guidelines for assessment of attachment behaviors.

During pregnancy, and often even before conception occurs, parents develop an image of the “ideal” or “fantasy” infant. At birth the fantasy infant becomes the real infant. How closely the dream child resembles the real child influences the bonding process. Assessing such expectations during pregnancy and at the time of the infant’s birth allows identification of discrepancies in the parents’ view of the fantasy child versus the real child.

The labor process significantly affects the immediate attachment of mothers to their newborn infants. Factors such as a long labor, feeling tired or “drugged” after birth, and problems with breastfeeding can delay the development of initial positive feelings toward the newborn.

Parent-Infant Contact image

Early Contact

Early skin-to-skin contact between the mother and newborn immediately after birth and during the first hour facilitates maternal affectionate and attachment behaviors (Flacking, Lehtonen, Thomson, et al., 2012; Hung & Berg, 2011; Moore, Anderson, Bergman, et al., 2012). It also enhances breastfeeding and is associated with improved thermoregulation.

Parents who are unable to have early contact with their newborn (e.g., the infant was transferred to the intensive care nursery) can be reassured that such contact is not essential for optimal parent-infant interactions. Otherwise, adopted infants would not form affectionate ties with their parents. Nurses need to stress that the parent-infant relationship is a process that occurs over time.

Extended Contact

Rooming-in is common in family-centered care. With this practice the infant stays in the room with the mother. In some facilities the newborn never leaves the mother’s presence; nursery nurses perform the initial assessment and care in the room with the parents. In other hospitals the infant is transferred to the postpartum or mother-baby unit from the transitional nursery (if the facility uses one) after showing satisfactory extrauterine adjustment. Nurses encourage the father or partner to participate in caring for the infant in as active a role as desired. They can also encourage siblings and grandparents to visit and become acquainted with the infant. Whether the method of family-centered care is rooming-in, mother-baby or couplet care, or a family birth unit, mothers and their partners are equal and integral parts of the developing family.

Extended contact with the infant should be available for all parents but especially for those at risk for parenting inadequacies, such as adolescents and low-income women. Postpartum nurses need to consider and encourage activities that optimize family-centered care.

Communication Between Parent and Infant image

The parent-infant relationship is strengthened through the use of sensual responses and abilities by both partners in the interaction. The nurse should keep in mind that cultural variations are often seen in these interactive behaviors.

The Senses


Touch, or the tactile sense, is used extensively by parents as a means of becoming acquainted with the newborn. Many mothers reach out for their infants as soon as they are born and the cord is cut. Mothers lift their infants to their breasts, enfold them in their arms, and cradle them. Once the infant is close, the mother begins the exploration process with her fingertips, one of the most touch-sensitive areas of the body. Within a short time she uses her palm to caress the baby’s trunk and eventually enfolds the infant. Similar progression of touching is demonstrated by fathers, partners, and other caregivers. Gentle stroking motions are used to soothe and quiet the infant; patting or gently rubbing the infant’s back is a comfort after feedings. Infants also pat the mother’s breast as they nurse. Both seem to enjoy sharing each other’s body warmth. Parents seem to have an innate desire to touch, pick up, and hold the infant (Fig. 15-4). They comment on the softness of the baby’s skin and note details of the baby’s appearance. As parents become increasingly sensitive to the infant’s like or dislike for different types of touch, they draw closer to the baby.

Touching behaviors by mothers vary in different cultural groups. For example, minimal touching and cuddling is a traditional Southeast Asian practice thought to protect the infant from evil spirits. Because of tradition and spiritual beliefs, women in India and Bali have practiced infant massage since ancient times (Giger, 2012).

Eye contact

Parents repeatedly demonstrate interest in having eye contact with the baby. Some mothers remark that once their babies have looked at them, they feel much closer to them. Parents spend much time getting their babies to open their eyes and look at them. In the United States, eye contact appears to reinforce the development of a trusting relationship and is an important factor in human relationships at all ages. In other cultures, eye contact is perceived differently. For example, in Mexican culture, sustained direct eye contact is considered rude, immodest, and dangerous for some. This danger may arise from the mal de ojo (evil eye), resulting from excessive admiration. Women and children are thought to be more susceptible to the mal de ojo (Giger, 2012).

As newborns become functionally able to sustain eye contact with their parents, they spend time in mutual gazing, often in the en face position, a position in which the parent’s face and the infant’s face are approximately 20 cm apart and on the same plane (see Fig. 15-2). Nurses and physicians or midwives can facilitate eye contact immediately after birth by positioning the infant on the mother’s abdomen or breasts with the mother’s and the infant’s faces on the same plane. Dimming the lights encourages the infant’s eyes to open. To promote eye contact, instillation of prophylactic antibiotic ointment in the infant’s eyes can be delayed until the infant and parents have had some time together in the first hour after birth.

Reciprocity and Synchrony

Reciprocity is a type of body movement or behavior that provides the observer with cues. The observer or receiver interprets those cues and responds to them. Reciprocity often takes several weeks to develop with a new baby. For example, when the newborn fusses and cries, the mother responds by picking up and cradling the infant; the baby becomes quiet and alert and establishes eye contact; the mother verbalizes, sings, and coos while the baby maintains eye contact. The baby then averts the eyes and yawns; the mother decreases her active response. If the parent continues to stimulate the infant, the baby may become fussy.

The term synchrony refers to the “fit” between the infant’s cues and the parent’s response. When parent and infant experience a synchronous interaction, it is mutually rewarding (Fig. 15-6). Parents need time to interpret the infant’s cues correctly. For example, after a certain time the infant develops a specific cry in response to different situations such as boredom, loneliness, hunger, and discomfort. The parent may need assistance in interpreting these cries, along with trial and error interventions, before synchrony develops.

Parental Role after Childbirth image

Adaptation involves a stabilizing of tasks, a coming to terms with commitments. Parents demonstrate growing competence in child care activities and become increasingly more attuned to their infant’s behavior. Typically, the period from the decision to conceive through the first months of having a child is termed the transition to parenthood.

Transition to Parenthood

Historically, the transition to parenthood was viewed as a crisis. The current perspective is that parenthood is a developmental transition rather than a major life crisis. The transition to parenthood is a time of disorder and disequilibrium, as well as satisfaction, for mothers and their partners. Usual methods of coping often seem ineffective during this time. Some parents are so distressed that they are unable to be supportive of each other. Because men typically identify their spouses as their primary or only source of support, the transition can be comparatively harder for the fathers. They often feel deprived when the mothers, who are also experiencing stress, cannot provide their usual level of support. Many parents are unprepared for the strong emotions such as helplessness, inadequacy, and anger that arise when dealing with a crying infant. On the other hand, parenthood allows adults to develop and display a selfless, warm, and caring side of themselves that may not be expressed in other adult roles.

For the majority of mothers and their partners the transition to parenthood is an opportunity rather than a time of danger. Parents try new coping strategies as they work to master their new roles and reach new developmental levels. As they work through the transition, they often find personal strength and resourcefulness.

Parental Tasks and Responsibilities

Parents need to reconcile the actual child with the fantasy and dream child. This process means coming to terms with the infant’s physical appearance, sex, innate temperament, and physical status. If the real child differs greatly from the fantasy child, some parents delay acceptance of the child. In some instances, they never accept the child.

Many parents know the sex of the infant before birth because of the use of ultrasound assessments. For those who do not have this information, disappointment over the baby’s sex can take time to resolve. The parents may provide adequate physical care but have difficulty in being sincerely involved with the infant until this internal conflict has been resolved. As one mother remarked, “I really wanted a boy. I know it is silly and irrational, but when they said, ‘She’s a lovely little girl,’ I was so disappointed and angry—yes, angry—I could hardly look at her. Oh, I looked after her okay, her feedings and baths and things, but I couldn’t feel excited. To tell the truth, I felt like a monster not liking my child. Then one day, she was lying there and she turned her head and looked right at me. I felt a flooding of love for her come over me, and we looked at each other a long time. It’s okay now. I wouldn’t change her for all the boys in the world.”

The normal appearance of the neonate—size, color, molding of the head, or bowed appearance of the legs—is startling for some parents. Nurses can encourage parents to examine their babies and to ask questions about newborn characteristics.

Parents need to become adept in the care of the infant, including caregiving activities, noting the communication cues given by the infant to indicate needs, and responding appropriately to the infant’s needs. Self-esteem grows with competence. Breastfeeding makes mothers believe that they are contributing in a unique way to the welfare of the infant. The parent may interpret the infant’s response to the parental care and attention as a comment on the quality of that care. Infant behaviors that parents interpret as positive responses to their care include being consoled easily, enjoying being cuddled, and making eye contact. Spitting up frequently after feedings, crying, and being unpredictable are often perceived as negative responses to parental care. Continuation of these infant responses that parents view as negative can result in alienation of parent and infant, which will not benefit the infant.

Some people view assistance, including advice by husbands, partners, wives, mothers, mothers-in-law, and health care professionals, as supportive. Others view advice as criticism or an indication of how inept these people judge the new parents to be. Criticism, real or imagined, of the new parents’ ability to provide adequate physical care, nutrition, or social stimulation for the infant can be devastating. By providing encouragement and praise for parenting efforts, nurses can bolster the new parents’ confidence.

Parents must establish a place for the newborn within the family group. Whether the infant is the firstborn or the last born, all family members must adjust their roles to accommodate the newcomer.

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Oct 8, 2016 | Posted by in NURSING | Comments Off on Transition to Parenthood

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