Bringing a newborn home is both an exciting and nerve wracking experience for parents. There is excitement in starting or expanding one’s family. There can also be feelings of worry or anxiety about the ability to care for a child. These range of experiences are completely healthy and normal. Sometimes, these feelings can lead to more intense emotions that can be overwhelming, especially to new parents.

In this section, we will focus on the postnatal and postpartum periods. These periods are a time of important bonding and learning but they are also a time of great vulnerability. Cultural and social factors play a major role in what happens to a child and mother after birth. They determine the environment a child will come home to, the type of support mother and child receive, and the level and quality of medical care received. Let’s begin by examining what happens during the first 12 weeks after a child is born.

4.5.2 Understanding the Fourth Trimester

The fourth trimester, or the first 12 weeks of life, represents an important time of bonding and adjustment. Not only is this a crucial time for the newborn to adapt to a new environment, it is also a time for the birth mother to adjust to postpartum life. Much of the patterns and interactions that occur during this time are associated with later patterns of sleep, feeding, and connection. Mothers or primary caregivers who are able to focus on their babies and attune to their needs have a much easier time adjusting during the fourth trimester.

According to Dr. Harvey Karp, the pediatrician who coined the term, we should associate babies in the fourth trimester as fetuses existing outside of the womb (Karp, n.d). Babies have lived in a warm and cozy place for many months and can get overwhelmed with the stimulation of life outside the womb. They will need a lot of love and support to manage the environmental changes. Dr. Karp suggests that caregivers try to mimic the environment in the womb as much as possible to ease the transition. This includes a lot of skin to skin contact time between the newborn and mother.

Caring for a newborn can be a wonderful yet stressful experience due to lack of sleep, individual needs, and family structures. Having a baby changes the brain structure of the mother and has a significant impact on their body. The newborn child also goes through various changes during and after birth. Postpartum women may find that they receive lots of attention during their pregnancy but very little support or care once the baby is born. This gap in service can lead to unintended outcomes such as anxiety and depression or undue stress on the child.

Modern societal expectations and the economic demands of American culture have caused changes to the time mothers spend with their babies after birth. In the past, it was common for mothers to stay at home with their children well into their school aged years. Families could afford to have one financial provider in the home and the cost of living was lower. Nowadays we hear stories of mothers returning to work after a few weeks to a few days postpartum. The separation between a mother and newborn during the fourth trimester can have long lasting effects.

The United States is an outlier when looking at paid parental leave among developed nations. The benefits of paid leave are numerous. The economic benefits for the parents is one obvious advantage but the benefits to the child are more pronounced. Research shows that babies who spend quality time with their caregivers after birth have “increased regularity of well-baby check-ups, greater rates of immunization, increased likelihood and duration of breastfeeding, and increased parental care and engagement” (American Action Forum, 2020).

Figure 4.15. A mother holding her newborn baby.

The fourth trimester is just as important to the well being of the newborn as it is to the mother. Birth mothers are also experiencing many changes during this transition. They will be healing from delivery and may have wounds from tears or a C-section to attend to along with bleeding and cramping. They may experience breast tenderness and pain, pelvic or urinary discomfort, and surging hormones. They may also have other children in the home to take care of or may need to return to work before they are ready to. All of this, combined with the stress and exhaustion associated with caring for a newborn, marks the first 12 weeks after birth as a very challenging time.

4.5.4 Feeding and Bonding

Mothers will spend some time caring for themselves and their needs after labor and delivery. The majority of their energy will be spent caring for their newborn. Newborns occupy much of their early lives sleeping or eating. These two activities serve important functions within the developing child such as providing essential nutrients and allowing time for growth. It is also during these times that newborns form attachments to their mothers or primary caregivers.

The process of attachment, or emotional bonding, starts in the womb when babies hear their mother’s voices and through the release of hormones such as oxytocin during the birthing process (Karakas & Dagli, 2019). Once they are born, a newborn’s skin to skin contact with their mother or primary caregiver further solidifies this bond. This initial bonding contributes to a child’s sense of safety and belonging, which is identified in Maslow’s framework as essential to the foundation of well-being. Close physical contact, and the hormones associated with it, are also beneficial for the mother or primary caregiver. Oxytocin and other hormones prompt the caregiver to care for the child by triggering nurturing feelings and respond to the baby’s needs (Palmer, 2013).

Oxytocin is a vital hormone that also protects the birth mother from depression and anxiety. The release of oxytocin can be disrupted through certain medical interventions or environmental factors within the birthing process. Some people feel a sudden rush of love and bonding towards their newborns while others may take more time. Variation can be typical but if a mother is having a difficult time bonding with their newborn, there could be other issues that need to be addressed. Postpartum visits with medical professionals provide mothers with the opportunity to discuss these concerns and to receive support to ensure a healthy bond with their child.

The hormones and endorphins associated with birth and delivery also play a role in preparing the mother for breastfeeding as well as bonding (Medela, n.d.). Prolactin is a hormone that is released during pregnancy and birth and is necessary for breast milk production. Unfortunately not all birth mothers are able to produce milk once their child is born. There are many reasons for this such as the impact of medical interventions during delivery, medications, maternal health, and certain medical conditions. Some may choose to supplement with donor breast milk or formula.

Chestfeeding, also known as bodyfeeding, is an inclusive term that refers to feeding a child milk from your chest. Anyone can chestfeed but the term is commonly used by transgender men, transgender women, non-binary individuals or cisgender women who prefer the term “chest” over “breast”. Breastfeeding and chestfeeding are essential to the bonding experience between infant and mother because it promotes skin to skin contact, eye contact, and the production of hormones and endorphins. Affectionate bonding during the first weeks of life helps caregivers identify their newborn’s cues and helps a newborn learn to trust their caregiver.

Additionally, breastfeeding and chestfeeding are known to lessen social and behavior problems in children and adults, therefore, shaping a baby’s early behavior. Research shows that children who were breastfed and whose mothers actively engaged with them displayed the lowest risk of internalizing problems, compared to those children who were not exclusively breastfed or exposed to active bonding (Liu et al., 2014). This suggests that the effect of breastfeeding on internalizing behaviors likely represent biosocial and well-rounded effects of physiological, nutritional, and maternal-infant bonding benefits (Liu et al., 2014).

Feeding a newborn is a round the clock process. Most newborns need to feed every two to three hours (Mayo Clinic, 2023). We know that the act of chest or breastfeeding promotes bonding but what about breast milk itself? Research has shown that the components in breast milk provide all of the nutrients babies need. Breast milk is easily digested and provides long term health benefits for the child. We also know that oxytocin is the bonding hormone. Babies are able to produce their own oxytocin in response to feeding but mothers also transfer oxytocin within their breast milk. This creates a calming effect for both the mother and baby, thereby solidifying the bonding experience.

Formula is a good substitute for breast milk when the mother or primary caregiver is unable to produce breast milk or chooses to bottle feed. Newborns who are getting their physical needs met, who remain close to their caregivers, and who are fed (whether through bottle, chest, or breast) are provided with a healthy start to their lives.