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.
For science, the idea of maternal sensitivity has only arrived in the last fifty years or so, when people have been talking about attachment and attachment disorders. And maternal sensitivity is thought to be a way you could measure the quality of the interaction between the mother and the infant and grade it.
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 to have something done by her. She must also understand a little bit of what the child may need. So, she needs to say: “That is the cry I cannot ignore”, and it could be the child is hungry or has a dirty nappy, or is in pain, has a tummy ache, or is tired. It could be many different things.
And a sensitive mother should not only pick up that message, but also make the right decision and respond appropriately. If the nappy is dirty, a sensitive mother should change it. This is all a part of a sensitive response.
What the science is trying to do is understand what goes wrong in maternal care behavior and in the quality of the care she provides.
So, we rate the individual bits of what makes up maternal sensitivity: Whether the mother responds? Whether she responds enough in quantity? And whether the quality of her response is appropriate? Does she do the right thing? Does she do the right thing in a kind way and in a timely way? And timely means not waiting for hours. The baby’s hungry — you need to feed the baby now or as soon as you are able.
Maternal sensitivity is a very specific measurement which includes the elements of appropriateness, timeliness, and the quality and quantity of responses.
The measurement of maternal sensitivity also includes an element we refer to in the quality of a mother’s speech towards her infant known as maternal directiveness or non-directiveness.
Whilst it is important for mothers to direct their speech appropriately to the child’s age in tone and content, sometimes a mother can be found repeatedly directing or redirecting the child's focus of attention and attempting to command and control the child's behavior.
This has become termed 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 utterances which may be negative.
That means if you were to see a mother who tells the baby or the child what to do, or what to look at or what to pay attention to, rather than responding to the child’s own focus or interest, if you like, tries to influence the child too much, this implies that the mother is intrusive.
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 because, say, 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 for example when infants are trying to sleep and the mother is always fussing or trying to make the child respond.
So, there’s too much activity from the mother to the child; and/or it’s not appropriate.
Although it may seem odd, sometimes care can be inappropriate; this kind of care is the care the child does not need.
Most women are good enough mothers, not too sensitive, not too insensitive.
We could say that evolution has worked it out so this proportion of maternal sensitivity lies within the ‘normal’ distribution of care across women: Most have maternal sensitivity rated or graded in the middle or normal range of a distribution and some are high sensitivity and some are low sensitivity.
So, if you say to yourself: “Well, that’s strange. Why do we see this? Why does evolution not have all mothers in the high or normal range of measured sensitivity?” And it’s not exclusive to women; we see it in all mammals; it’s not just humans where we see this pattern of a normal distribution in maternal sensitivity.
So, people asked: “What does high sensitivity mean? What does that mean for the mother?” They’ve also said: “It must be very good to have a very sensitive mother”.
But of course, if there are many children, she cannot pay that much attention to all of the children. So, either she has to neglect some of the children and just pay a lot of attention to one or two, or she becomes exhausted and nobody gets attention.
When you look at low-sensitivity mothers, then you see that they pay less attention. And you think: “Why would that be? Why would you have low sensitivity mothers still in the population; why has natural selection within evolution not meant they are no longer selected within the species?” The likelihood is that there must be an advantage to each style of sensitivity: so it’s a strategy.
If you say: “I want to have lots of children, but I can’t afford to give them all 100% of my attention, so I give them all 10%”. And 10 children get 10% each, as opposed to having 1 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 the care giving behavior plays out in a population.
Every woman probably has some understanding of what we mean by maternal instinct. But I am going to talk about maternal instinct from the brain and behavior perspective.
The brain has a lot to do with maternal instinct - what happens to a woman and her emotions and her behaviors as a result of going through pregnancy and becoming a mother. In other words, the transition from being a woman who’s never had children to becoming a mother for the first time.
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 in a woman across pregnancy and labor, breastfeeding and subsequently interacting and bonding with the baby.
If you look at the brain of a woman who is a non-mother - let’s say a 30-year-old woman or a 20-year-old woman who has not given birth and does not have children - when she looks at pictures of infants, her ‘instinct’, her response in her brain is very different from that of a woman of the same age who is a mother; and you can see it readily.
Compared to men, women respond more strongly overall in their brains, as well as in specific areas related to processing emotion and driving motivation to infant stimuli.
Healthy mothers’ 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 mothers, even with infants who are not their own, respond more strongly to infant cues than non-mothers of the same age.
So, this is what we call ‘maternal instinct’, a phenomenon or process that is happening in 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 pregnancy and continues across childbirth, breastfeeding and as the child grows and is cared for by the mother.
But, of course, as we’ve just learnt, it happens differently with different women. Sometimes you hear a woman 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, other mums may be hypersensitive. So, they ‘hyper’ respond, like very anxious people do – over appraise the danger of a situation for example. And it means they can’t think straight, they don’t know what to do. So, it’s not a pleasurable experience, they don’t derive pleasure from the infant, especially when it is in distress.
The emotional tie is what most people think of as the attachment bond, or mother-infant bond. This represents the quality of what we term the ‘dyadic relationship’. So, it’s not just the mother and how she feels about the baby. It’s about something to do with what the baby is doing to the mother as well; i.e. what happens between the mother 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 maybe, perhaps they have many babies because they may also be more likely to lose one or two.
In humans, most women 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.
That is because, if you like, 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.
Like maternal instinct, the mother-child bond that develops during the transition to maternity means going through pregnancy, having a baby, breastfeeding, being with your baby, getting lots of feedback from your baby, developing the attachment bond. That is doing something to the brain. It’s doing something to the brain of the child and it’s doing something to the brain of the mother.
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 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 mother-child bond.
One of the saddest things we see in mothers who become depressed is that their ability to develop this bond can be limited; they are 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.
Other depressed mothers feel they can’t have a bond with their child; and they don’t even know if they want to because sometimes they feel they are a bad influence on their baby, so they feel they need to distance themselves physically from the 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 gain eye contact; this happens long before the baby is able to speak.
The baby may be trying to use the eyes and trying to get the mother’s attention; and the depressed mother is staring neutrally, or looking away, or not responding. 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 them making noises or trying to get attention because they know, their experience is, that they won’t get a response. It is a very painful thing to see in clinical practice, or when we’re assessing the quality of maternal care, maternal sensitivity.
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 from their own mothers, the brain circuitry needed to respond appropriately to infants can’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.
There is a lot of information linking early life experiences and child development. However, there is a lack of high-quality information showing us how or whether it is the emotional tie between a mother and child which acts to influence development. Most children are very resilient.
However, 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 that if girls have early adversity, poor attachment, suffer neglect or insecure attachment, they are more likely to develop personality disorder, 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, then often this occurs with a mental illness in the mother, alongside deprivation and poverty and, indeed, many other things that are going on in the lives of those women such as domestic violence or substance misuse.
A new mother may, herself, have had a mother who did not attach to her; who neglected or abused her. 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.
What I am saying is that we are, in part, taught about being a mother by our own mothers. And, when we try to make links between the quality of the emotional tie between mother and child and the subsequent child outcomes, or indeed outcomes in later life, many other elements are likely to be involved in the pathway from birth to adulthood. And so, to say that it is just about the quality of the attachment that causes mental illness or the behavioral problems in the children, in the offspring, is too simplistic.
Yes, the quality of the maternal care, maternal sensitivity and also the quality of the attachment bond, the emotional tie — that is all important, but it is one of a number of factors associated with good and bad outcomes in people’s lives.
One very important study does shed light on what happens when there are extreme adverse circumstances in early infancy and childhood. This is called the Romanian Orphanage Study.
In 1966, Romanian President Ceaușescu invoked a Stalinist ideology to grow the 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 which was resolved by building state orphanages where hundreds of babies were housed All their basic physical needs were provided: they were kept clean, warm, fed, given milk; in fact, they were given everything thought necessary to survive, but they were given no emotional one-to one care or attention; no one saying, “I’m your mother, you’re my baby”. So these infants were emotionally neglected.
What we see in these adults, now in their 30 and 40s are high rates of suicide, of serious mental illness and psychosis, lots of learning delay, lots of problems with reading, very poor physical growth, they’re small, the brains of these adults are small. What we see here is that something we call an emotional tie, which we call also love, maternal love or parental love, has a very powerful physical effect on brain and behavior, and indeed life expectancy.
It’s one element of it.
Let’s go back to what we were saying about maternal sensitivity. It is about the quantity and the quality of maternal care; the timeliness and the appropriateness of a mother’s responses to her infant.
We talked about being overdirective or non-directive. Non-directive is good if you’re not always directing your infant to do stuff, if you’re allowing the infant to be part of the play, for example.
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 know, 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, or maltreatment. It’s also about all of those other, more subtle qualities of how appropriate the care you give is.
Neglect is a passive phenomenon, withdrawing something from the child. Maltreatment is an active phenomenon where you are actively doing something malevolent and harmful, cruel often.
Neglect and maltreatment are very extreme.
What is much more common is poor sensitivity. It’s less extreme, it’s more subtle; and it could be to do with things the mother doesn’t notice, like being overintrusive like an anxious mother; overdirective, stifling the child, not letting the child express themselves; or it could just be being depressed and unable to respond and that is also neglectful.
The worst thing to do is to say to a parent: “You’re a bad parent”.
We’ve been working for many years with mothers with serious mental illness like schizophrenia, bipolar disorder and depression. We show them videos of their play interaction with their infants and we explain to them about what the crying may mean; and 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.
And it’s very sad for some of these mothers, because they love their children, but they’re neglecting them simply because they don’t know what to do or how to do it.
Schizophrenia and bipolar disorder are relatively rare. Mothers with poor sensitivity are far more common and also need our help.
Some of the ways to address the problems include:
Strengthening the supportive network around mothers.
We always talk about women having children as if they do it on their own, because, of course, these days it feels a bit like that. But, of course, people have children.
And often, when there are lots of people around, a mother can be more readily supported and the child also has alternative care providers when the mother needs, say, 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, who can also act as ‘parental adults’; and who don’t have to be the biological mother. That’s why we can adopt children successfully and have very good outcomes.
Another important thing we can do for mothers is to reassure them and say: “You know, the fact that you’re concerned about your parenting or your infant suggests to me you’re a pretty good mom.”
Indeed, if she’s worried about her parenting, that’s a good sign that she’s sensitive to a need. The mother who’s concerned about the quality of her parenting is a mother we should probably be slightly less worried about.
Preventing isolation, getting peer support and advice from other moms.
In the past, women parented in groups of women of different generations: including other children and sisters and grandmothers, all helping to care for the young of the group.
Nowadays, people are both more and less isolated in parenthood. Now, women are often on their own even if they have a partner, as the partner will be at work.
But they can turn to others for advice through the internet: to Flo, or to Mumsnet, But family (her own mother or sister) and friends are very important along with community groups like mother and baby and toddler groups. If a woman is religious, the local church or other religious communities provide lots of support; or if she is at a school picking up older kids, she can talk to other moms.
Reassurance, social support, social contact is key whether it comes these days through social media, or through apps, or through TV, or through reading advice, guidance or going to a local clinic.
Sometimes all you need is a good piece of advice
Flo helps to go through a pregnancy journey, offers stage-by-stage content and expert advice to new moms and moms-to-be.
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 these days.
One problem is that mothers with a mental illness may be less likely to access available supports, so they may need particular consideration when planning help to address their needs.
Ask for professional help.
If mothers have particular concerns about the quality of their care, or indeed their own mental health, they need to go and talk to professionals, whether it’s their doctor, their GP, their primary care specialist; because it may be that that there is a mental illness that can be treated. What a mother may need to say is - “I’ve got a problem, I can’t deal with this”.
Get enough sleep.
The other thing you hear a lot is when women aren’t sleeping especially in the first three months postnatally. That is the time when there’s highest risk of maternal suicide and it’s also the time there’s highest risk of maternal serious mental illness. That, of course, coincides with the greatest amount of sleep disruption.
You’ve just had a baby and it is exhausting, even if your partner gives them a bottle sometimes, it’s still exhausting. And women 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 are demand-feeding.
One of the most important things, I think, is to try to protect mothers’ sleep. Of course, some people are more susceptible and more vulnerable to poor sleep. If women are too anxious, they can’t get back to sleep rapidly. So, women need support and to train themselves to get back to sleep after nighttime feeds.
Fathers may get a bad deal. Sometimes, they‘re told they’re not as important as mothers; they can’t breastfeed; they didn't go through pregnancy; and they can feel they’re not good enough. And sometimes they are pushed away by anxious mothers saying: “No, don’t do it like that, do it like this. No, you’re holding the baby wrong”.
So, they need a lot of encouragement, too. And there’s nothing more helpful for the baby and for the mother than an involved father.
For example, it’s perfectly reasonable if a father can feed at night sometimes to protect the mother’s sleep. Or take the baby for a walk and let the mother rest in the day, give her a break. In other words, be involved in the day to day care.
Again, modern life, what does it do? Most men take two weeks of parental leave. Sweden is the only country where there’s a law that says that women and men have to be allowed to have the same amount of parental leave and pay. And if men don’t take it, then the family doesn’t get the money. So, parental leave is really important to allow the father to become involved and the family to be supported by the father; and to allow the child to have a more balanced upbringing.
Men also tend to be less anxious than women and, postnatally, maybe more emotionally robust because they haven’t just been pregnant and had a baby, had their bodies ripped open and aren’t exhausted and expected to feed another creature; and they don’t get mastitis or experience difficulties with breast milk coming through etc. Often men feel helpless and left out. I think they need a lot of encouragement and to be praised and given confidence, too, to get involved.
A lot of the time women need someone to sit down and listen to their story. Every woman will be slightly different. Most women are good enough moms and they don’t need to change anything. They need to be less worried and to be reassured.
A lot of pressure is put on women to be perfect; to look gorgeous, be happy and smiling and have a perfect child all the time and then go back to work and, you know, it’s a little crazy.
I think there are a lot of difficulties in today’s society for women and that we need to get back to promoting the truth which is that people have babies, people have children; and that includes the fathers; that includes the grandparents. We need all to be involved in supporting new mothers.