Hug the Monkey

How Breastfeeding Helps Mothers Bond

Scientists at Warwick University have modeled the way breastfeeding creates an oxytocin feedback loop that creates the waves of love and peace that many mothers report enjoying while they suckle their babies.

According to the the UK's Mail Online,

... the research team, led by Warwick University scientists, has shown using computer models that when a baby suckles, the mother's neurons respond by churning out the hormone from their dendrites - the part of the cell that usually receives, rather than transmits information.

This extra release of oxytocin creates much stronger links between nerve cells - creating a 'positive-feedback' loop, where the greater the concentration of the chemical, the faster it is produced.

This allows massive, intense, bursts of the love hormone to sweep through the brain at intervals of around five minutes. The findings could shed light on other chemical changes in the brain linked to mood.

Professor Jianfeng Feng, who demonstrated the effect, said: 'We knew that these pulses arise because, during suckling, oxytocin neurons fire together in dramatic synchronised bursts.

'But exactly how these bursts arise has been a major problem that has until now eluded explanation.

This must be an amazing feeling, and I can see how it would create a very deep connection to the baby. I think those of us who haven't experienced this cannot imagine the feeling. I also have to wonder -- just a little? -- about how not experiencing this affects the bonding between mother and baby.

See also, The Mother/Baby Attachment Gap.

A Paradoxical Reaction to Oxytocin?

A new blog from Alia Macrina Heise identifies a syndrome she calls depressive milk ejection reflex, or D-MER. She defines it thus:

"Depressive Milk Ejection Reflex is a condition that causes a prodromal effect of negative emotions that emerge only before the milk ejection reflex, or letdown, in a lactating mother."

According to her blog, she's the mother of three -- and a lactation counselor. Although breastfeeding is supposed to be a peak experience -- deeply rewarding, sensual and soothing, thanks to oxytocin -- she experienced something quite different.

Go to her blog, D-MER.org, to read more about her experiences and those of other women.

One theory Alicia has for the cause of this syndrome, which involves discomfort and depression during breastfeeding, is a paradoxical reaction to oxytocin. A paradoxical reaction is when someone has not the expected reaction to a drug, but a different one, often the opposite.

I would guess that, rather than a paradoxical reaction to oxytocin, D-MER might be caused by an excess of prolactin. Prolactin is involved in milk letdown, but it's also involved in sexual satiety. It's the hormone, released at orgasm, that tells our bodies we've had enough sex, so give it a rest.

People sometimes talk about a feeling of letdown following sex, a sense of depression and even of distaste for one's partner. I think this, too, is the result of a bit too much of prolactin's satiating ability. It makes sense to me that an excess of prolactin, or too intense a response to its effects, could be the cause of D-MER.

Here are studies indicating prolactin's effect on sexual satiety:

Krueger, Tilmann H.C.; Haake, Philip; Hartmann, Uwe; Schedlowski, Manfred; and Exton, Michael S., Orgasm-induced prolactin secretion: feedback control of sexual drive? (Neuroscience and Biobehavioral Reviews 26 2002) 31-44)

Krueger, Tilmann H.C.; Haake, Philip; Haverkamp, J.; Krämer, M .; Exton, Michael S.; Saller, B; Leygraf, N.; Hartmann, Uwe; and Schedlowski, Manfred, Effects of acute prolactin manipulation on sexual drive and function in males (Journal of Endocrinology (2003) 179, 357–365)

Oxytocin Therapy for Indifferent Moms?

Oxytocin is being tested as a treatment for autism and social phobia, and it's under consideration for treating a variety of other disorders.

What about a mother who doesn't love her baby enough?

Despite the myth of the absoluteness of mother love, many new mothers don't feel attached to or excited about their newborns. There are myriad reasons for this, from the mother's inability to attach to anyone -- because of her own abuse or neglect as a child -- to a problematic or stressed pregnancy to that poorly understood neurochemical state known as post-partum depression.

Craig Kinsley, Professor of Neuroscience at the University of Richmond's Department of Psychology, has shown, in research with Kelly Lambert, how motherhood remodels the brains of rats. It increases the number of oxytocin receptors, increases the sensitivity of the receptors and also improves their memory.

Kinsley has begun to apply this research to human mothers. At the International Congress on Women's Mental Health, he suggested that this  research could lead to  interventions  aimed at helping new moms form a  secure bond.

According to the article in News in Science,

It may be possible, he says, with this template to then identify potential 'bad' mothers by examining how their brains behave when the mother is first interacting with the baby.

Kinsley says if females with a deficit of a critical neurochemical, such as oxytocin, can be identified, then "when they are first interacting with the baby you can give them a boost of oxytocin at a critical time".

The Women's Bioethics Blog predicted  this back in August 2007. See my post, Will Bad Mothering Become the Latest Disorder?

Kinsley's collaborator, Kelly Lambert, has found that fatherhood creates changes in the brains of male deer mice, as well. Maybe they could also give oxytocin to deadbeat dads.

Try the Middle Ground between Natural and Hospital Birth

Many things about a hospital birth have the potential to rupture or impede the first bonding between mother and child. For example, epidurals and anesthetic do seem to get into the baby's blood stream, so that both mother and baby are groggy and sickish following the birth. Babies delivered without anesthetic are alert and soon naturally begin to look for the breast, stimulating the release of oxytocin in mom and, likely, in baby.

Some think that the steady drip of pitocin, an artificial form of oxytocin, given to the laboring woman can create a sort of allergic reaction, or oversensitivity, in the baby. Later, according to this theory, that child may reject experiences that cause the oxytocin release. Some people think this may be part of the explanation for autism.

In any case, this article from Mother Earth News lays out a middle ground. Sharon Maehl suggests having the baby in the hospital, but staying there for as short a time as possible. She takes you through all the decision points and wraps up with the account of the birth of her second child.

The key to this way of giving birth, along with finding the right doctor and hospital, is making your mind up ahead of time that you won't stay, according to Maehl. She says,

Somewhere along the line you should tell the staff that you'll have to be running along soon (you left a cake in the oven?) Whatever you do, though, don't mention this to anyone in the hospital until the baby is born. If you tell the doctor during your pregnancy, he may even refuse to accept you for pre-natal care. Doctors are not known for their flexibility. Best wait until the baby is born and safely in your arms before you tell anyone your plans.

Her idea minimizes the time in hospital and the pressure from doctors and nurses for medical interventions, while making sure that if anything does go wrong, help is right there.

Oxytocin Withdrawal

In The Truth about Mamahood, Claire writes about depression after she stopped breastfeeding.

The first few days, I felt super sad ending the long era of our nursing relationship. I missed seeing her little face nursing, my little baby happily suckling. Then I started to feel extremely light-headed and got some headaches, which was weird- but then depression hit me like a ton of bricks. I was in my dance class (my first without Uma in a long time) and just started bawling over the loss of my mother.

It does seem that, as she implied in her title, that the intensity of these feelings may be due to the sudden lowering of her oxytocin after weaning. I wonder if it's possible to taper off breastfeeding, so your body wouldn't go through such an abrupt withdrawal?

Validation for "Tend and Befriend"

In 2000, Shelly Taylor, a social psychologist at UCLA proposed an alternative model to the well-known fight-or-flight response.

Based on an analysis of a wide range of research by others, Taylor hypothesized that women faced with threat might have evolved a different response, something she called "tend and befriend." The idea is that females in ancient times had to protect the children while the men fought off the danger. So, they gathered together in groups to defend the youngsters.

This tendency would likely be influenced by oxytocin, the neurochemical that, among other things, drives us to connect with others. Sue Carter of the University of Illinois,  has done work with prairie voles showing that when they're isolated and stressed, their oxytocin levels rise. She thinks this causes them to seek out others -- in human terms, you could say, for support.

Many have pooh-poohed Taylor's ideas, possibly because she's a psychologist, not a neuroscientist, possibly because she's a woman.

But now, researchers at the University of Pennsylvania have done a brain imaging study that supports her hypothesis.

In the study led by J.J. Wang, men  and women were stressed by being asked to do arithmetic in front of a panel of strangers who constantly asked them to go faster or start over if they made a mistake. According to Science Daily:

The researchers measured heart rate, cortisol levels (a stress hormone), subjects' perceived stress levels throughout the experiments, and regional cerebral blood flow (CBF), which provides a marker of regional brain function. In men, it was found that stress was associated with increased CBF in the right prefrontal cortex and CBF reduction in the left orbitofrontal cortex. In women, the limbic system -- a part of the brain primarily involved in emotion -- was activated when they were under stress.

In other words, under stress, the men got busy thinking harder, while the women  increased their emotional activity. The hypothalamus, producer of oxytocin, is part of the limbic system. It's possible that these women's brains secreted extra oxytocin, which may have calmed them.

Taylor, S.E., Klein, L.C., Lewis, B.P., Gruenewald, T.L., Gurung, R.A.R., & Updegraff, J.A. (2000).  Biobehavioral responses to stress in females: Tend-and-befriend, not fight-or-flight.  Psychological Review,107, 411-429.

Neglected Kids More Likely to Be Obese

A study at Temple University found that kids who are neglected are more likely to be obese. Abuse or maltreatment, on the other hand, didn't seem to affect their weight.

Temple's Robert Whitaker looked at data from the Fragile Families and Child Wellbeing Study of nearly 5,000 children. At age three, children'sheight and weight were measured, while mothers answered a questionnaire about three types of child maltreatment in the prior year: neglect (such as not providing proper supervision for the child), corporal punishment (such as spanking the child on the bottom with a bare hand) and psychological aggression (such as threatening to spank the child but not actually doing it).

According to the article,

Eighteen percent of the children were obese, and the prevalence of any episode of neglect, corporal punishment or psychological aggression was 11 percent, 84 percent and 93 percent, respectively.

The odds of obesity were 50 percent greater in children who had experienced neglect, after controlling for the income and number of children in the household, the mothers' race/ethnicity, education, marital status, body mass index, prenatal smoking and age, and the children's sex and birth weight.

On the other hand, there was no correlation between corporal punishment or psychological aggression and overweight.

This makes sense if you look at overeating as a way to compensate for oxytocin deprivation. We tend to see overeating as a reaction to stress, which it is. But the stress of isolation is the lack of the ability to connect in an oxytocin-producing interaction with another person. (Although in prairie voles, isolated animals actually produce more oxytocin;  researchers at University of Illinois who did these experiments think this oxytocin production drives the animal to try harder to connect.  See The Amazing Vagus Nerve and The Sex/Food/Love Connection.

Eating -- or rather digesting food, especially fatty food -- sends signals from the gut to the brain via the vagus nerve. Those signals cause the hypothalamus to release oxytocin, which travels to the gut and creates the sensation of satiety.

It seems very likely that this oxytocin release also tweaks the neurons in the brain that create the pleasure in social interactions. So, it makes perfect sense that kids who are lonely for their mothers -- or for anyone to pay attention to them -- could use eating to take the place of social relationship.

Higher Oxytocin Predicts a Better Mother/Child Bond

A just-published study is the very first to connect oyxtocin in humans to the bond between mother and child.

Numerous animal studies -- in mice, rats and prairie voles -- have shown a strong connection between oxytocin and maternal behavior, while Kerstin Uvnas-Moberg did a series of studies of human mothers showing a relationship between breastfeeding and a mother's feelings of calm and connectedness. But cautious scientists have been reluctant to say what feels so true -- that oxytocin bonds humans in all the ways it does animals.

This study from Bar-Ilan University led by Ruth Feldman found a strong correlation between oxytocin levels and mothers' feelings toward their babies during pregnancy and after birth. From the APS story posted on Scientific Blogging:

Initial levels of oxytocin at the first trimester predicted bonding behavior. Therefore, mothers with a high level of the hormone at the beginning of the pregnancy engaged in more of the aforementioned bonding behaviors after birth.

Additionally, mothers who had higher levels of oxytocin across the pregnancy and the postpartum month also reported more behaviors that support the formation of an exclusive relationship (i.e. singing a special song to the infant, or bathing and feeding them in a special way). These mothers were also more preoccupied by thoughts of checking on the infant, the infant’s safety when they are not around, and the infant’s future.

I reported on this study in my book, ahead of its publication the journal, and corresponded with one of th researchers, Ari Levine. He told me something a bit different -- that it wasn't a mother's oxytocin level, but how much her oxytocin level increased that predicted bonding.

In fact, that's what the study showed:

The increase in OT from early to late pregnancy correlated with higher maternal-fetal bonding.

The Foster System Damages Kids' Brains

The CBS affiliate in Miami, Florida, has an excellent story today about the problems created by our foster care system.

Reporter Michelle Gillen writes about  the growing awareness in the Miami court system that efforts to help kids by taking them out of abusive or danger situations can be permanently damaging their brain development, and to conditions such as reactive attachment disorder, or RAD.

Cindy Lederman and Steven Leifman, two Miami court judges, are using new information about brain development and how important connection with the mother or other primary caregiver is, to help kids at risk for this.  According to the story:

Leifman says the latest research is staggering because it means juvenile court systems around the country have unwittingly damaged children in foster care by purposely preventing attachments.

“It is particularly acute in the foster care system and one of the things that we realized, again, the court in advertently contributed to the problem, because we felt that we didn’t want children to become too attached, that it would do more harm than good if they got attached then we’d move them. So for a long time we kept moving the kids around the foster care system.”

Miami is trying to intervene early to help kids at risk that come through the court system with an early intervention center. It's opened the the Linda Ray Intervention Center, a therapeutic home where babies up and toddlers up to three years old can attach to a warm and caring person.

In Miami alone, some 9,000 children enter the foster care system each year.  And 27 percent of the children in foster care are under five years old.  As the article points out, this is many more children than can be helped by the Center but at least it's a start.

How to Avoid Cesarean Birth

One of the most mainstream media outlets in the United States has come out against the indiscriminate use of cesarean section and labor induction. In addition to putting mother and baby at risk with unnecessary surgery, C-sections can disrupt the bond between them. It eliminates the mother's natural release of oxytocin during labor, birth and the first contact with the newborn, and it makes both of them too sick to enjoy that natural connection that occurs when the baby, left to her own instincts, makes her way to her mother's breast for the first time.

In this column on CNN, Elizabeth Cohen suggests Five Ways to Avoid a C-Section. More important, she begins this good advice with information about how C-sections can harm the health of mother and baby. And, she touches on the bonding problems that can result from interfering with the natural release of oxytocin during labor, birth and immediately afterwards.

Cohen quotes a mom who's angry that she had an unnecessary C-section: "It affected the quality of my mothering. I had trouble bonding with my son."

This anecdote is backed by scientific studies:

Women who undergo cesareans feel less positive about the experience and have less physical and emotional energy for mothering.[i]

They're less likely ever to breast-feed. They take longer to begin to interact with their babies, and tend to interact less with them once they're back home. In fact, they don't feel as positive about their newborns at all.[ii]

This negativity lingers. In one study, a month after cesarean birth, the mothers had much less eye-to-eye contact with their babies.[iii]

Mothers who give birth vaginally, on the other hand, tend to be more emotionally involved in taking care of their babies and more attached to them.[iv]

See also, The Mother/Baby Attachment Gap.

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[i] Marut J.S., Mercer R.T., The cesarean birth experience: implications for nursing. Birth Defects Orig Artic Ser. 1981;17(6):129-52.

[ii] DiMatteo, M. Robin; Morton, Sally C.; Lepper, Heidi S.; Damush, Teresa M.; et al., Cesarean childbirth and psychosocial outcomes: A meta-analysis. Health Psychology. 15(4), Jul 1996, 303-314.

[iii] Trowell J., Possible effects of emergency caesarian section on the mother--child relationship. Early Hum Dev. 1982 Oct;7(1):41-51.

[iv] Gathwala G, Narayanan I., Influence of cesarean section on mother-baby interaction. Indian Pediatr. 1991 Jan;28(1):45-50.