The quality of the mother–child relationship in the first year of life has far reaching implications across the life course (Bornstein in Annu Rev Psychol 65:121–158, 2014). Yet little is known about predictors of maternal bonding and emotional availability in early infancy. In this study we examined the extent to which postnatal bonding, maternal mental health, and substance use at 8-weeks postpartum predicted mother–infant bonding (self-report) and mother emotional availability (observational) at 12-months of age.
Data were obtained from an Australian longitudinal cohort study of pregnancy (n = 308). Data were collected during pregnancy, at birth, and postnatally at 8-weeks and 12-months.
The results show strong continuity between postnatal bonding at 8-weeks and 12-months. Early postpartum stress and depression were associated with bonding at 12-months; however, the effect did not persist after adjustment for bonding at 8-weeks. Tobacco use at 8-weeks, but no other indicators of mental health, predicted lower emotional availability scores at 12-months.
Results suggest that the mother’s felt bond to her child is stable across the first year of life and that early bonding is a more robust indicator of bonding at 12-months than a mother’s mental health or substance use. These findings point to the importance of clinical and public health investments in establishing a strong bond between mother and child in the early postpartum period.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Tax calculation will be finalised during checkout.
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
Tax calculation will be finalised during checkout.
The World Health Organization (WHO) recommends pregnant women with high daily caffeine intake (more than 300 mg per day) to lower their caffeine intake during pregnancy (World Health Organization 2016). WHO also recommends that all pregnant women should be advised of the potential health risks to themselves and their babies posed by alcohol and drug use. Health-care providers are advised to routinely offer advice and psychosocial interventions for tobacco cessation for all pregnant women who are either current tobacco users or recent tobacco quitters (strong recommendation based on moderate quality evidence).
Average maternal age in this study was 32.5 years (the average in the population was 30 years), 40.3% of women in this study were nulliparous (42.4% in the population); the average gestational age in our study was 39.4 weeks (the population average was 38.8 weeks); and the average weight of babies in this study was 3.47 kgs (the population average was 3.37 kgs).
1% of women in this study were from an Indigenous background, while 4% of women are indigenous in the general population; 58.4% of women in this study were born in Australia, while 68.8% of women giving birth in the population are Australian-born; 6% of women smoked tobacco in this study, which was half the rate of women smoking during pregnancy in the population.
The ABS Socioeconomic Indexes for Areas (SEIFA) provides a measure of relative advantage and disadvantage (Pink 2008). The present study used SEIFA deciles of relative advantage and disadvantage as an indicator of family SES (Australian Bureau of Statistics 2008). These deciles were collapsed into the following categories for the present analyses: low SES (deciles 1–3); medium SES (deciles 4–7); and high SES (deciles 8–10). Using the SEIFA Index of Relative Socioeconomic Advantage and Disadvantage (IRSAD) score, the mean IRSAD score in the present sample was 1052.4 (SD 56.6).
Caffeine use included: black tea; coffee (instant, brewed, espresso); energy drinks, and; soda drinks.
Please note that actual caffeine content of a cup of coffee or tea can vary due to factors such as origin, processing and preparation method, including brewing time.
Please note that these examples are a guide only.
Ainsworth, M. D. S., & Bell, S. M. (1972). Mother-infant interaction and the development of competence. New York: Academic Press.
Alhusen, J. L. (2008). A literature update on maternal-fetal attachment. Journal of Obstetric, Gynecologic, and Neonatal Nursing, 37(3), 315–328.
Altenhofen, S., Clyman, R., Little, C., Baker, M., & Biringen, Z. (2013). Attachment security in three-year-olds who entered substitute care in infancy. Infant Mental Health Journal, 34(5), 435–445. https://doi.org/10.1002/imhj.21401.
Altenhofen, S., Sutherland, K., & Biringen, Z. (2010). Families experiencing divorce: Age at onset of overnight stays, conflict, and emotional availability as predictors of child attachment. Journal of Divorce & Remarriage, 51(3), 141–156. https://doi.org/10.1080/10502551003597782.
Aviezer, O., Sagi, A., Joels, T., & Ziv, Y. (1999). Emotional availability and attachment representations in kibbutz infants and their mothers. Developmental Psychology, 35(3), 811.
Aviezer, O., Sagi-Schwartz, A., & Koren-Karie, N. (2003). Ecological constraints on the formation of infant–mother attachment relations: When maternal sensitivity becomes ineffective. Infant Behavior and Development, 26(3), 285–299. https://doi.org/10.1016/S0163-6383(03)00032-8.
Biringen, Z. (2000). Emotional Availability: Conceptualization and Research Findings. American Journal of Orthopsychiatry, 70(1), 104–114. https://doi.org/10.1037/h0087711.
Biringen, Z. (2008). Emotional availability (EA) scales manual. Unpublished manual. Boulder: Colorado State University.
Biringen, Z., Damon, J., Grigg, W., Mone, J., Pipp-Siegel, S., Skillern, S., et al. (2005). Emotional availability: Differential predictions to infant attachment and kindergarten adjustment based on observation time and context. Infant Mental Health Journal, 26(4), 295–308. https://doi.org/10.1002/imhj.20054.
Biringen, Z., Derscheid, D., Vliegen, N., Closson, L., & Easterbrooks, M. A. (2014). Emotional availability (EA): Theoretical background, empirical research using the EA Scales, and clinical applications. Developmental Review, 34(2), 114–167. https://doi.org/10.1016/j.dr.2014.01.002.
Biringen, Z., & Easterbrooks, M. A. (2012). Emotional availability: Concept, research, and window on developmental psychopathology. Development and Psychopathology, 24(01), 1–8. https://doi.org/10.1017/S0954579411000617.
Bornstein, M. H. (2002). Parenting infants. Handbook of parenting, 1, 3–43.
Bornstein, M. H. (2014). Human Infancy… and the rest of the lifespan. Annual Review of Psychology, 65, 121–158. https://doi.org/10.1146/annurev-psych-120710-100359.
Bornstein, M. H., Putnick, D. L., Heslington, M., Gini, M., Suwalsky, J. T. D., Venuti, P., et al. (2008). Mother-child emotional availability in ecological perspective: Three countries, two regions, two genders. Developmental Psychology, 44(3), 666–680. https://doi.org/10.1037/0012-16220.127.116.116.
Cannella, B. L. (2005). Maternal–fetal attachment: An integrative review. Journal of Advanced Nursing, 50(1), 60–68. https://doi.org/10.1111/j.1365-2648.2004.03349.x.
Carter, A. S., Garrity-Rokous, F. E., Chazan-Cohen, R., Little, C., & Briggs-Gowan, M. J. (2001). Maternal depression and comorbidity: Predicting early parenting, attachment security, and toddler social-emotional problems and competencies. Journal of the American Academy of Child and Adolescent Psychiatry, 40(1), 18–26. https://doi.org/10.1097/00004583-200101000-00012.
Chen, L.-W., Wu, Y., Neelakantan, N., Chong, M. F.-F., Pan, A., & van Dam, R. M. (2014). Maternal caffeine intake during pregnancy is associated with risk of low birth weight: A systematic review and dose-response meta-analysis. BMC Medicine, 12(1), 174. https://doi.org/10.1186/s12916-014-0174-6.
Chen, L. W., Wu, Y., Neelakantan, N., Chong, M. F., Pan, A., & van Dam, R. M. (2016). Maternal caffeine intake during pregnancy and risk of pregnancy loss: A categorical and dose-response meta-analysis of prospective studies. Public Health Nutrition, 19(7), 1233–1244. https://doi.org/10.1017/s1368980015002463.
Cnattingius, S. (2004). The epidemiology of smoking during pregnancy: Smoking prevalence, maternal characteristics, and pregnancy outcomes. Nicotine & Tobacco Research, 6(Suppl_2), S125–S140.
Condon, J. (2012). Assessing attachment, a work in progress: To look, to listen or both? Journal of Reproductive and Infant Psychology, 30(1), 1–4. https://doi.org/10.1080/02646838.2012.681966.
Condon, J. T., & Corkindale, C. J. (1998). The assessment of parent-to-infant attachment: Development of a self-report questionnaire instrument. Journal of Reproductive and Infant Psychology, 16(1), 57–76. https://doi.org/10.1080/02646839808404558.
Davies, D. (2010). Child development: A practitioner’s guide. New York: Guilford Press.
Easterbrooks, A. M., Biesecker, G., & Lyons-Ruth, K. (2000). Infancy predictors of emotional availability in middle childhood: The roles of attachment security and maternal depressive symptomatology. Attachment & Human Development, 2(2), 170–187. https://doi.org/10.1080/14616730050085545.
Espinet, S. D., Jeong, J. J., Motz, M., Racine, N., Major, D., & Pepler, D. (2013). Multimodal assessment of the mother-chid relationship in a substance-exposed sample: Divergent associations with the emotional availability scales. Infant Mental Health Journal, 34(6), 496–507.
Field, T. (1994). The effects of mother’s physical and emotional unavailability on emotion regulation. Monographs of the Society for Research in Child Development, 59(2–3), 208–227.
Flykt, M., Punamäki, R. L., Belt, R., Biringen, Z., Salo, S., Posa, T., et al. (2012). Maternal representations and emotional availability among drug-abusing and nonusing mothers and their infants. Infant Mental Health Journal, 33(2), 123–138. https://doi.org/10.1002/imhj.21313.
Fonseca, V. R., Silva, G. A., & Otta, E. (2010). The relationship between postpartum depression and maternal emotional availability. Cad Saude Publica, 26(4), 738–746.
Fraser, J. G., Harris-Britt, A., Thakkallapalli, E. L., Kurtz-Costes, B., & Martin, S. (2010). Emotional availability and psychosocial correlates among mothers in substance-abuse treatment and their young infants. Infant Mental Health Journal, 31(1), 1–15. https://doi.org/10.1002/imhj.20239.
Hilder, L., Zhichao, Z., Parker, M., Jahan, S., & Chambers, G. M. (2014). Australia’s mothers and babies 2012. Perinatal statistics series no. 30. Retrieved from Canberra:
Holmgren, S. (2009). Low dose alcohol exposure during pregnancy-does it harm? Statens Folkhälsoinstitut.
Hutchinson, D., Moore, E. A., Breen, C., Burns, L., & Mattick, R. P. (2013). Alcohol use in pregnancy: Prevalence and predictors in the Longitudinal Study of Australian Children. Drug and Alcohol Review, 32(5), 475–482. https://doi.org/10.1111/dar.12027.
Hutchinson, D., Wilson, J., Allsop, S., Elliott, E., Najman, J., Burns, L., et al. (2018). Cohort Profile: The Triple B Pregnancy Cohort Study: A longitudinal study of the relationship between alcohol, tobacco and other substance use during pregnancy and the health and well-being of Australian children and families. International Journal of Epidemiology, 47(1), 26–27m. https://doi.org/10.1093/ije/dyx126.
IBM Corp. (2013). IBM SPSS statistics for Windows, version 22.0. In: IBM Corp Armonk, New York.
Johnson, K. (2013). Maternal-infant bonding: A review of literature. International Journal of Childbirth Education, 28, 17–22.
Koole, S. L. (2009). The psychology of emotion regulation: An integrative review. Cognition and Emotion, 23(1), 4–41.
Lefkovics, E., Baji, I., & Rigó, J. (2014). Impact of maternal depression on pregnancies and on early attachment. Infant Mental Health Journal, 35(4), 354–365.
Li, J., Zhao, H., Song, J. M., Zhang, J., Tang, Y. L., & Xin, C. M. (2015). A meta-analysis of risk of pregnancy loss and caffeine and coffee consumption during pregnancy. International Journal of Gynaecology and Obstetrics, 130(2), 116–122. https://doi.org/10.1016/j.ijgo.2015.03.033.
Lovibond, P. (1995). Manual for the depression anxiety stress scales short-form (DASS-21). Sydney: Sydney Psychology edition.
McCormack, C., Hutchinson, D., Burns, L., Wilson, J., Elliott, E., Allsop, S., et al. (2017). Prenatal alcohol consumption between conception and recognition of pregnancy. Alcoholism, Clinical and Experimental Research, 41(2), 369–378. https://doi.org/10.1111/acer.13305.
McCormack, C., Hutchinson, D., Burns, L., Youssef, G., Wilson, J., Elliott, E., et al. (2018). Maternal and partner prenatal alcohol use and infant cognitive development. Drug and Alcohol Dependence, 185, 330–338. https://doi.org/10.1016/j.drugalcdep.2017.12.038.
Moehler, E., Brunner, R., Wiebel, A., Reck, C., & Resch, F. (2006). Maternal depressive symptoms in the postnatal period are associated with long-term impairment of mother–child bonding. Archives of Women’s Mental Health, 9(5), 273–278. https://doi.org/10.1007/s00737-006-0149-5.
Muggli, E., Matthews, H., Penington, A., et al. (2017). Association between prenatal alcohol exposure and craniofacial shape of children at 12 months of age. JAMA Pediatrics, 171(8), 771–780. https://doi.org/10.1001/jamapediatrics.2017.0778.
O’Higgins, M., Roberts, I. S., Glover, V., & Taylor, A. (2013). Mother-child bonding at 1 year; associations with symptoms of postnatal depression and bonding in the first few weeks. Archives of Women’s Mental Health, 16(5), 381–389. https://doi.org/10.1007/s00737-013-0354-y.
Pajulo, M., Savonlahti, E., Sourander, A., Ahlqvist, S., Helenius, H., & Piha, J. (2001). An early report on the mother–baby interactive capacity of substance-abusing mothers. Journal of Substance Abuse Treatment, 20(2), 143–151.
Peacock, A., Hutchinson, D., Wilson, J., McCormack, C., Bruno, R., Olsson, C. A., et al. (2018). Adherence to the caffeine intake guideline during pregnancy and birth outcomes: A prospective cohort study. Nutrients. https://doi.org/10.3390/nu10030319.
Pink, B. (2008). Information paper: An introduction to Socio-Economic Indexes for Areas (SEIFA) 2006. (ABS Catalogue No. 2039.0.). Canberra, Australia: Australian Bureau of Statistics, Commonwealth of Australia.
Reck, C., Zietlow, A. L., Muller, M., & Dubber, S. (2016). Perceived parenting stress in the course of postpartum depression: The buffering effect of maternal bonding. Archives of Women’s Mental Health, 19(3), 473–482. https://doi.org/10.1007/s00737-015-0590-4.
Rhee, J., Kim, R., Kim, Y., Tam, M., Lai, Y., Keum, N., et al. (2015). Maternal caffeine consumption during pregnancy and risk of low birth weight: A dose-response meta-analysis of observational studies. PLoS ONE, 10(7), e0132334. https://doi.org/10.1371/journal.pone.0132334.
Rossen, L., Hutchinson, D., Wilson, J., Burns, L., Olsson, C. A., Allsop, S., et al. (2016). Predictors of postnatal mother-infant bonding: The role of antenatal bonding, maternal substance use and mental health. Archives of Women’s Mental Health, 19(4), 609–622. https://doi.org/10.1007/s00737-016-0602-z.
Salo, S., Kivistö, K., Korja, R., Biringen, Z., Tupola, S., Kahila, H., et al. (2009). Emotional availability, parental self-efficacy beliefs, and child development in caregiver-child relationships with buprenorphine-exposed 3-year-olds. Parenting, 9(3–4), 244–259. https://doi.org/10.1080/15295190902844563.
Salo, S., Politi, J., Tupola, S., Biringen, Z., Kalland, M., Halmesmäki, E., et al. (2010). Early development of opioid-exposed infants born to mothers in buprenorphine-replacement therapy. Journal of Reproductive and Infant Psychology, 28(2), 161–179. https://doi.org/10.1080/02646830903219109.
Sameroff, A. J., & Fiese, B. H. (2000). Transactional regulation: The developmental ecology of early intervention. Handbook of Early Childhood Intervention, 2, 135–159.
Saunders, H., Kraus, A., Barone, L., & Biringen, Z. (2015). Emotional availability: Theory, research, and intervention. Frontiers in Psychology, 6, 1069.
Sloan, E., Hall, K., Moulding, R., Bryce, S., Mildred, H., & Staiger, P. K. (2017). Emotion regulation as a transdiagnostic treatment construct across anxiety, depression, substance, eating and borderline personality disorders: A systematic review. Clinical Psychology Review, 57, 141–163.
Swanson, K., Beckwith, L., & Howard, J. (2000). Intrusive caregiving and quality of attachment in prenatally drug- exposed toddlers and their primary caregivers. Attachment & Human Development, 2(2), 130–148. https://doi.org/10.1080/14616730050085527.
Thompson, R. A. (2001). Childhood anxiety disorders from the perspective of emotion regulation. The Developmental Psychopathology of Anxiety, 160–182.
Tietz, A., Zietlow, A. L., & Reck, C. (2014). Maternal bonding in mothers with postpartum anxiety disorder: The crucial role of subclinical depressive symptoms and maternal avoidance behaviour. Arch Womens Ment Health, 17(5), 433–442. https://doi.org/10.1007/s00737-014-0423-x.
Timmer, S. G., Ho, L. K., Urquiza, A. J., Zebell, N. M., Fernandez, Y. G. E., & Boys, D. (2011). The effectiveness of parent-child interaction therapy with depressive mothers: The changing relationship as the agent of individual change. Child Psychiatry and Human Development, 42(4), 406–423. https://doi.org/10.1007/s10578-011-0226-5.
Trapolini, T., Ungerer, J. A., & McMahon, C. A. (2008). Maternal depression: Relations with maternal caregiving representations and emotional availability during the preschool years. Attachment & Human Development, 10(1), 73–90. https://doi.org/10.1080/14616730801900712.
Treur, J. L., Taylor, A. E., Ware, J. J., McMahon, G., Hottenga, J. J., Baselmans, B. M., et al. (2016). Associations between smoking and caffeine consumption in two European cohorts. Addiction, 111(6), 1059–1068.
Vliegen, N., Luyten, P., & Biringen, Z. (2009). A multimethod perspective on emotional availability in the postpartum period. Parenting, 9(3–4), 228–243. https://doi.org/10.1080/15295190902844514.
World Health Organization. (2004). Neuroscience of psychoactive substance use and dependence. Geneva: World Health Organization.
World Health Organization. (2016). WHO recommendations on antenatal care for a positive pregnancy experience. Geneva: World Health Organization.
Yarcheski, A., Mahon, N. E., Yarcheski, T. J., Hanks, M. M., & Cannella, B. L. (2009). A meta-analytic study of predictors of maternal-fetal attachment. International Journal of Nursing Studies, 46(5), 708–715.
Zelkowitz, P., Papageorgiou, A., Bardin, C., & Wang, T. (2009). Persistent maternal anxiety affects the interaction between mothers and their very low birthweight children at 24 months. Early Human Development, 85(1), 51–58. https://doi.org/10.1016/j.earlhumdev.2008.06.010.
Ziv, Y., Aviezer, O., Gini, M., Sagi, A., & Karie, N. K. (2000). Emotional availability in the mother infant dyad as related to the quality of infant mother attachment relationship. Attachment & Human Development, 2(2), 149–169. https://doi.org/10.1080/14616730050085536.
The authors wish to acknowledge the investigators not listed as authors, the Bumps, Babies and Beyond (Triple B) research staff who collected the data, the hospitals/antenatal clinics, and the participants. Funding was provided by the Australian National Health and Medical Research Council (Grant Number GNT630517), a NHMRC Principal Research Fellowship Award (Grant Number APP1045318), a UNSW Vice-Chancellor’s Research Fellowship Award, an Australian Research Council Principal Fellowship (Grant Number DORA: LP130101459), and a NHMRC Practitioner Fellowship (Grant Number 1021480).
Conflicts of interest
We do not have any conflicts of interest affecting the conduct or reporting of this research.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
About this article
Cite this article
Rossen, L., Mattick, R.P., Wilson, J. et al. Mother–Infant Bonding and Emotional Availability at 12-Months of Age: The Role of Early Postnatal Bonding, Maternal Substance Use and Mental Health. Matern Child Health J 23, 1686–1698 (2019). https://doi.org/10.1007/s10995-019-02809-1
- Maternal bonding
- Emotional availability
- Postnatal period
- Mental health
- Substance use
- Mother–child relationship