The Postpartum Brain: The Science Behind Caring for Your Newborn

_{Interview has been edited for clarity.}

Maternal sensitivity: What does it really mean?

If you say “She’s a very sensitive mother,” most people will have some understanding of what that means. “But in science, maternal sensitivity means something very particular,” says Dr. Abel. 

She explains that the scientific idea of maternal sensitivity has only been around for the last fifty years or so, since people started talking about attachment and attachment disorders. And maternal sensitivity is thought to be a way you could measure and grade the quality of the interaction between a postpartum parent and their infant. 

“If you talk about a mother who is sensitive, generally that refers to her ability to recognize the needs of her infant and to respond to them in an appropriate and timely manner. 

“She must recognize that the child needs her to do something. She must also understand a little bit of what the child may need. So, she needs to say, ‘That’s a cry I cannot ignore,’ and it could be the child is hungry or has a dirty nappy, is in pain, has a tummy ache, or is tired. It could be many different things.”

Maternal sensitivity, according to Dr. Abel, is more than picking up on that message — also making the right decision and responding appropriately. “If the nappy is dirty, a sensitive mother changes it. This is all a part of a sensitive response.” 

How maternal sensitivity influences maternal care

Dr. Abel says that science is trying to understand what goes wrong in maternal care behavior and in the quality of the care a postpartum parent provides. 

“So, we rate the individual bits of what makes up maternal sensitivity: whether they respond and if their response is sufficient and appropriate. We also ask if they do the right thing in a way that’s kind and timely. And timely means not waiting for hours. If the baby’s hungry, you need to feed the baby now or as soon as you are able,” Dr. Abel says. 

“Maternal sensitivity is a very specific measurement that includes the elements of appropriateness, timeliness, and the quality and quantity of responses.”

Dr. Abel says that the measurement of maternal sensitivity also includes an element we refer to in the quality of a postpartum parent’s speech towards their infant that’s known as maternal directiveness or non-directiveness. 

She explains that while it’s important for speech to be appropriate in tone and content for the child’s age, repeatedly directing or redirecting the child’s focus of attention and attempting to command and control the child’s behavior through language is a problem.

“This is called a “directive interactive style.” Sometimes such behavioral directives are used to support an ongoing activity, and therefore they do not necessarily have the intrusive quality of attention-directing speech that may be negative.” 

That means if you were to see a mother who tells their baby or child what to do, what to look at, or what to pay attention to, rather than responding to the child’s own focus or interest, or tries to influence the child too much, it implies that they’re intrusive, according to Dr. Abel. 

“This can happen when you have a mother who is very anxious; sometimes what you see in the mother-infant interaction is that there is a lot of response, but it’s not appropriate. For example, the baby is trying to play with a toy, but the mother ignores this and is trying to clean their face. Intrusiveness is also seen when infants are trying to sleep, and the mother is always fussing or trying to make the child respond.” 

This indicates that there’s too much activity from the parent to the child, and/or it’s not appropriate. 

“Although it may seem odd, sometimes care can be inappropriate — this kind of care is care the child doesn’t need.”

How maternal sensitivity helps babies survive

“Most new parents are not too sensitive, not too insensitive, which is good,” says Dr. Abel.

According to her, we could say that evolution has worked it out so this proportion of maternal sensitivity lies within the “normal” distribution of care across the population. Most have maternal sensitivity rated or graded in the middle or normal range of a distribution, while some are high-sensitivity and others are low-sensitivity. 

And this distribution isn’t exclusive to humans — all mammals have a similar pattern of maternal sensitivity.

Dr. Abel says that, of course, if someone has many children, it’s impossible to give all of them too much attention. So, either some of them are neglected and only a few get attention, or the parent becomes exhausted, and nobody gets attention.

“When you look at low-sensitivity mothers, you see that they pay less attention. Why would that be? Why would you have low sensitivity mothers still in the population; why have they made it past natural selection? The likelihood is that there must be an advantage to each style of sensitivity, so it’s an evolutionary strategy,” explains Dr. Abel. 

“For instance, if you want to have lots of children, you can’t afford to give them all 100% of your attention, so you give them all 10%. And 10 children get 10% each, as opposed to having a single child who gets 100% maternal attention. 

“So, this would explain how we see a very different, if you like, strategy for survival of the fittest in terms of maternal sensitivity and the way that caregiving behavior plays out in a population.”

What is maternal instinct?

Many people probably have some understanding of what is implied by maternal instinct. But Dr. Abel explains it from physiological and behavioral perspectives. 

She says that the brain has a lot to do with maternal instinct — going through pregnancy and becoming a parent affects both emotions and behaviors. Going from someone who’s never had a baby to becoming a parent for the first time is a major transition. 

“I call this the transition to maternity; and maternal instinct is probably the result of the brain changes that occur through this transition by hormonal and other biological mechanisms that develop across pregnancy and labor, breastfeeding, and subsequently interacting and bonding with the baby,” explains Dr. Abel. 

“If you look at the brain of someone who has never given birth and doesn’t have children, when they look at pictures of infants, their instinct and the response in their brain is very different from that of someone of the same age who has had children, and you can see it readily.”

Dr. Abel also says that comparatively, the female response in the brain is stronger overall and in specific areas related to processing emotion and driving motivation to infant stimuli. 

According to her, healthy postpartum brains respond more strongly to infant cues like cries and distress signals, and, of course, they respond most strongly to cues from their own infants. But even with infants who aren’t their own, people who’ve had children respond more strongly to infant cues than people of the same age who haven’t. 

“So, this is what we call maternal instinct — a phenomenon or process that happens in the brain. This reflex to respond to infant stimuli in the maternal brain networks is the driver for sensitive maternal behavior. This maternal brain circuitry or network begins to develop over the course of pregnancy and continues across childbirth, breastfeeding, and as the child grows and is cared for.” 

But, Dr. Abel mentioned that it happens differently for different people. “Sometimes you’ll hear someone say, ‘I have poor maternal instinct.’ I don’t think it’s true. I think they have some difficulties with maternal sensitivity, and that sometimes those difficulties may be because their maternal brain circuitry is less developed, differently developed, and less responsive.”

On the other hand, others may be hypersensitive, explains Dr. Abel —“So, they ‘hyper’ respond, like very anxious people do. They might over-appraise the danger of a situation for example. And this means they can’t think straight, so they don’t know what to do. It’s not a pleasurable experience, so they don’t derive pleasure from their infant, especially when the baby is in distress.”

Attachment bonding as a mechanism to safeguard your genes

The emotional tie is what most people think of as the attachment bond, often called the mother-infant bond. According to Dr. Abel, this represents the quality of what’s called the “dyadic relationship.” This is more than just how the postpartum parent feels about their baby. It’s also the effect the baby has on them, or what happens between them and the infant.

“Some mammals that produce lots and lots of babies develop less of a strong bond with their young. They don’t need to have such a strong attachment. Perhaps they have many babies because they may also be more likely to lose one or two,” says Dr. Abel.

“In humans, most people only have one infant at a time. It may be that you’ve got to develop a very strong bond with that one infant because you’ve got to know exactly what’s going on at all times to keep that single, “high-investment” child safe.

“In a way, it’s your only chance at keeping your genes in the gene pool. So, we think that, like maternal sensitivity, the attachment bond in human reproduction is an evolutionary mechanism that has developed to safeguard the gene pool.”

How depression affects parenting

Dr. Abel explains that like maternal instinct, the attachment bond that develops during the transition to maternity involves going through pregnancy, having a baby, nursing, being with your baby, getting lots of feedback from your baby, and finally developing the attachment bond. These experiences affect both the baby’s and the parent’s brain. 

“One thing that is happening in the transition to maternity is the production of the hormone oxytocin and a change in the number and distribution of oxytocin receptors in the brain. The numbers of those receptors and where they are in the brain is linked to the strength of maternal sensitivity, the quality of the care, and the strength of the bond,” says Dr. Abel.

“One of the things we see in mothers who become depressed is that their ability to develop this bond can be limited. They’re often painfully aware. They know they want to have a bond with their baby, and they want to feel ‘maternal instinct,’ but they lack the ability or feelings to do so.”

Dr. Abel says that others who are depressed feel they can’t have a bond with their child; and they sometimes don’t even know if they want to because they think they’re a bad influence on their baby and want to distance themselves physically from their baby.

“So, you’ll see the depressed mother who does not want to hold her baby; or the depressed mother who sits still and quiet in front of her baby while the baby desperately tries to make eye contact — this happens long before the baby is able to speak.

“Then you may see something very painful in the interaction — we see that the child, the baby, gives up. Those infants become very quiet because there’s no point in making noises or trying to get attention because their experience is that they won’t get a response,” says Dr. Abel.

“What we think is happening is that, as a consequence of the depressive process, and perhaps because of associated experiences like early adversity and poor parenting in their own childhood, the brain circuitry needed to respond appropriately to infants doesn’t work properly. In some, where there is prominent anxiety, the circuits may be too sensitive; in others, they may be blunted or under-responsive.” 

How important is the attachment bond?

Dr. Abel says there’s a lot of information linking early life experiences and child development. However, there’s also a lack of high-quality information showing us how or whether the attachment between a mother and child acts to influence development. Most children are very resilient.

However, she says that boys with early adversity are more likely to have difficulties with language and intellectual development, attention deficit disorder (ADD), behavioral problems, conduct disorder, violence, future substance misuse, and criminality. 

There is also evidence, according to Dr. Abel, that if girls have early adversity, poor attachment, or experience neglect or insecure attachment, they are more likely to develop personality disorders, depression, anxiety, and self-harming behavior. 

“And, of course, it’s not just about the attachment, because when you see a mother who has low sensitivity and there is also poor attachment, the mother is often dealing with many things, including mental illness, deprivation, poverty, and possibly even domestic violence or substance misuse,” says Dr. Abel. 

“And we know that the quality of your own maternal care — your perception of the bond with your own mother — can also influence your own ability to bond with your child, which, of course, again seems very natural.” 

Dr. Abel says that we, in part, learn about maternal care from our own experience. And, when we try to make links between the quality of the attachment bond and the subsequent child outcomes and outcomes in later life, many other elements are likely to be involved along the way. So it’s too simplistic to say that it’s just the quality of the attachment that causes mental illness or the behavioral problems in children.

“Yes, the quality of the maternal care, maternal sensitivity, and also the quality of the attachment bond — the emotional tie — is all important, but it’s only one of a number of factors associated with good and bad life outcomes.”

How early neglect affects the brain

One very important study does shed light on what happens when there are extreme adverse circumstances in early infancy and childhood. It’s called the Romanian Orphanage Study. 

Dr. Abel tells that in 1966, Romanian President Ceaușescu invoked a Stalinist ideology to increase the country’s population in order to grow the economy. His government issued Decree 770, making abortion illegal for women under 40 who had less than four children. 

As a result, thousands of unwanted children were born, creating a care crisis that was resolved by building state orphanages where hundreds of babies were housed. All their basic physical needs were met: They were kept clean, warm, fed, and given milk; in fact, they were given everything thought necessary to survive. But they were given no emotional one-to-one care or attention. So these infants were emotionally neglected. 

“What we see in these adults, now in their 30 and 40s, are high rates of suicide, serious mental illness, and psychosis, lots of learning delays, lots of problems with reading, very poor physical growth. They’re small — the brains of these adults are small,” says Dr. Abel. “What we see here is that something we call an emotional tie, which we also call love, maternal love, or parental love, has a very powerful physical effect on the brain, behavior, and life expectancy.” 

Is lack of parental attention or neglect a sign that the caregiving environment is disruptive?

According to Dr. Abel, it’s one element of it. 

“Let’s go back to maternal sensitivity. It is about the quantity and quality — the timeliness and appropriateness — of care.” 

Previously, we talked about being overdirective or non-directive. Dr. Abel says that a non-directive style can be good because you’re not always directing your infant to do stuff. You allow the infant to participate in play by holding a ball or putting it in their mouth, rather than just throwing it at them, for example. Or maybe they’re not interested in the ball, so you facilitate rather than directing their attention somewhere else. In essence, you allow them to explore. 

If you’re playing with your infant, you don’t just throw the ball at them all the time, you get them to throw the ball or hold the ball, or put it in their mouth or you allow them to explore. Or if they are less interested in the ball, you facilitate rather than direct their attention to alternatives. 

“So, it’s not just about presence or absence, or neglect — withholding something from the child — or maltreatment — actively harming the child. It’s also about all of those other, more subtle qualities of how appropriate the care you give is.” 

“Neglect and maltreatment are very extreme,” says Dr. Abel. 

“What is much more common is poor sensitivity. It’s more subtle. Sometimes, it’s things a parent doesn’t even notice, like being overly intrusive and anxious; being overly directive and stifling the child so they can’t express themselves; or it could just be being depressed and unable to respond, and that is also neglectful.”

How to optimize parental care

According to Dr. Abel, the worst thing to say to a parent is, “You’re a bad parent.”

“We’ve been working for many years with mothers with serious mental illnesses, like schizophrenia, bipolar disorder, and depression. We show them videos of their play interaction with their infants, and we explain to them what the crying may mean. We try to help them understand how they can change their behavior by giving them lots of positive feedback about what they’re doing well,” says Dr. Abel.

And, as she explains, some of these mothers love their children, but they’re neglecting them simply because they don’t know what to do or how to do it.

Dr. Abel says that schizophrenia and bipolar disorder are relatively rare. Mothers with poor sensitivity are far more common, and they also need help.

So here, Dr. Abel suggests ways to address parenting problems:

Strengthening your supportive network

“We always talk about people having children as if they do it on their own, because, of course, these days it feels a bit like that,” says Dr. Abel.

And often, when there are lots of people around after a child is born, it’s easier to be readily supported, and the child also has alternative care providers when the parent needs to rest or simply take a break.

“So, a healthy emotional environment for a child can include good parenting from biological parents as well as from other benevolent adults looking after them. That’s why we can adopt children successfully and have very good outcomes.”

Reassurance

Another important thing we can do to support postpartum people, according to Dr. Abel, is to reassure them by telling them their concern about their parenting suggests they’re doing a pretty good job.

“Indeed, if someone is worried about their parenting, that’s a good sign that they’re sensitive to a need. Someone who’s concerned about the quality of their parenting is someone we should probably be slightly less worried about,” says Dr. Abel.

Preventing isolation and getting peer support and advice from others

In the past, groups of women of different generations, including other children and sisters and grandmothers, all helped to care for the young of the group. 

“Nowadays, people are both more and less isolated in parenthood. Now, even if you have a partner, you’re often alone with your baby, as the partner will be at work,” says Dr. Abel. 

“While they can turn to others for advice through the internet, family and friends are very important. As are community groups like mother and baby and toddler groups. A local church or other religious community can provide lots of support for religious parents. And there are other parents to talk to when you pick up older kids from school,” suggests Dr. Abel.

Reassurance, social support, and social contact is key, whether it comes from social media, apps, TV, reading advice, or going to a local clinic.

“In the UK, we have health visitors who visit mothers in the first three months regularly. Making sure women aren’t isolated is important. So there’s a lot of help available here these days,” says Dr. Abel.

One problem is that people with a mental illness may be less likely to access available support, so they may need particular consideration when planning to address their needs.

Ask for professional help

If someone has particular concerns about the quality of their care or their mental health, Dr. Abel says that it’s important to talk to professionals, whether it’s their doctor, their GP, or their primary care provider, because there may be a mental illness that can be treated. Sometimes, all it takes is asking for help.

Get enough sleep

“The other thing you hear a lot is when postpartum people aren’t sleeping, especially in the first three months after delivery. That’s the time when there’s highest risk of maternal suicide, and it’s also the time there’s highest risk of serious maternal mental illness. That, of course, coincides with the greatest amount of sleep disruption.” 

Dr. Abel says, “You’ve just had a baby, and it is exhausting. And people are being told to breastfeed exclusively for six months by the WHO. It’s exhausting, perhaps especially if the baby is in bed with you, and you’re demand-feeding.”  

Dr. Abel believes that one of the most important things is to try to get enough quality sleep. This can be especially challenging for people who are susceptible to poor sleep or who have anxiety. It’s very important to ask for support and to train yourself to get back to sleep after nighttime feeds.

What can a partner do to help?

Dr. Abel says that sometimes a partner may need a lot of encouragement. “I think they need a lot of encouragement and to be praised and given confidence, too, to get involved.” 

She says that it’s more than reasonable for a partner to feed the baby at night or take them for a walk and to be involved in their day-to-day care. 

Dr. Abel also mentions that parental leave is really important to allow the other parent to become involved and support the family. 

Also, as Dr. Abel explains, the other parent has a bit of an advantage, in that they haven’t just been pregnant and had a baby, so they might not be as physically and emotionally drained. They won’t get mastitis or have breastfeeding difficulties to deal with. It's important to make sure they’re involved, because they can feel helpless and left out.

Summing up

Dr. Abel says that a lot of the time a parent needs to sit down with someone who’ll listen to their story. “Everyone will be slightly different. Most don’t even need to change anything. They need to be more relaxed and to be reassured.” 

Dr. Abel says: “I think there are a lot of difficulties in today’s society for postpartum people, and we need to get back to promoting the truth, which is that raising a baby isn’t a one-person job; other people who are close need to participate too.”