Maternal Care

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MATERNAL CARE

Maternal care covers all aspects of the mother's caretaking activity from her child's birth until it reaches the age of twelve to fifteen months, or, in the view of some authors, such as John Bowlby, the age of three years. Primarily, it is the quality of the relationship established by the mother with her infant and maintained throughout this period. While "the mother" usually means the woman who has carried the child to term and looks after it after birth, in the present context it may also denote any person who fulfils the maternal role in a continuous fashion from birth on (mother substitute).

The concept of maternal care is essentially post-Freudian. Freud assigned the mother no primary structuring role in the mental development of the child, nor did he view the loss of the mother as a traumatic event of particular import when it occurred in the child's earliest years. He did, however, make mention of maternal care in a footnote on the "autistic" fiction of a shell in his paper on the "Two Principles of Mental Functioning" (1911b, pp. 219-220n). And towards the end of his life, he intuited the importance of the mother-infant relationship, describing it as "unique," and as "the prototype of all later love-relations" (1940a [1938], p. 188), and suggesting the existence of an early sexualized relationship centered in particular on the oral satisfactions the infant obtains from feeding.

The idea of maternal care was developed during the 1950s, starting from two different, if overlapping, areas. The first was a concern with the fact that the mother's extended absence—the effective loss of the mother—could lead to a depressive response on the part of the child (Spitz, 1946), to anxiety reactions, or to developmental delays. The term was used in the same sense but in a somewhat more official way in John Bowlby's report to the World Health Organization (1951), which provided a critical review of clinical studies and research on the harmful results of deficiencies in maternal care. Bowlby's monograph precipitated major changes in the practices of institutions and childcare centers in many countries.

In the second place, the pediatrician and psychoanalyst Donald Winnicott contributed much to the establishment of the idea of maternal care by describing a particular state that he called "primary maternal preoccupation" (1956/1958): a hyperacute state that allowed the mother to respond with sensitivity and delicacy to the very first demands of her infant. Winnicott also placed great stress on the need to recognize and describe what he called the "good-enough mother," who by virtue of her constant presence was able to meet the child's basic needs, present the world to it in acceptable doses, and protect it from stimuli, whether of internal or of external provenance, that were too intense. And lastly he underscored the reciprocal nature of mother-infant interaction.

Before long, since a "lack" or "deprivation" of maternal care came to connote a great variety of situations, it was necessary to distinguish between inadequate of interaction with the mother (and the specific shortcomings of such interaction), and discontinuities within the mother-child relationship caused by frequent or permanent separations (Ainsworth, 1962).

This early work addressed both the failures of maternal care and the importance of high-quality mother-infant interaction. Subsequent research increasingly focused on the systematic observation of day-to-day relations between mother and infant. The outcome was a characterization of various well-defined phases. Thus the first three months of life were said to see the development of a synchronicity between mother and child founded upon waking and sleeping patterns, while the period between three and six months of age witnessed the emergence of reciprocal exchanges pleasurable to both parties, and the six-to-nine-month stage was marked by much more initiative by the child in its interaction with the mother (Sander, 1964).

Following the path opened up by Bowlby's theory of attachment (1969), numerous studies were made of various behaviors indicating the child's attachment to the maternal figure: smiling, vocalization, tears at moments of separation, the tendency to follow the mother no matter how little she moved, and so on. Little by little, the notion of maternal care was defined more precisely in terms of the availability of the mother figure, her accessibility to the expressed needs of the child, and her degree of sensitivity to, and comprehension of, those needs (Ainsworth et al, 1978). Daniel Stern (1985) has employed the word attunement to describe the bond made between mother and child in the first months. Regularity, continuity, and consistency seem to be the qualities essential to the satisfactory unfolding of mother—infant interaction.

It has become clear that a close correlation exists between the quality of the maternal care received in the first year of life and the quality of the attachment manifested by the child on reaching the age of one. A young child is "secure" when the mother has managed to be sensitive to its needs and respond to them in an adequate and consistent manner, "insecure-resistant" when the mother has generally responded erratically to its needs and signals, and "insecure-avoiding" when its care has been mediocre or where it has been simply rejected. (Ainsworth et al., 1978).

Several studies have observed that, as the child becomes more sociable, mother and infant react a great deal to each other's affective states. Because mother-child interaction seems so emotional, studies emphasize the major role played by positive and negative affects in the child's overall development.

Research since the 1990s (Fonagy et al., 1993) seems to show quite clearly that the quality of maternal care throughout the first year of life is largely determined by the quality of the mother's attachment to her own mother.

Yvon Gauthier

See also: Maternal.

Bibliography

Ainsworth, Mary D. Salter. (1962). The effects of maternal deprivation: A review of findings and controversy in the context of research strategy. In Mary D. Ainsworth and R. G. Andry, Deprivation of maternal care. Geneva: World Health Organization.

Ainsworth, Mary D. Salter, Blehar, M. C., Waters, E., and Wall, S. (1978). Patterns of attachment: A psychological study of the strange situation. Hillsdale, NJ: Lawrence Erlbaum.

Bowlby, John. (1951). Maternal care and mental health. Geneva: World Health Organization.

——. (1969). Attachment and loss, Vol. I: Attachment. New York: Basic Books.

Fonagy, Peter, Steele, Miriam, Moran, George S., et al. (1993). Measuring the ghost in the nursery: An empirical study of the relation between parents' mental representations of childhood experiences and their infants' security of attachment. Journal of the American Psychoanalytic Association 41, 957-989.

Freud, Sigmund. (1911b). Formulations on the two principles of mental functioning. SE, 12: 213-226.

——. (1940a [1938]). An outline of psycho-analysis. SE, 23: 139-207.

Sander, Louis W. (1964). Adapative relationships in early mother-child interaction. Journal of the American Academy of Child Psychiatry, 3, 231-64.

Spitz, René A. (1946). Anaclitic depression. Psychoanalytic Study of the Child, 2, 313-42.

Stern, Daniel N. (1985). The interpersonal world of the infant: A view from psychoanalysis and developmental psychology. New York: Basic Books.

Winnicott, Donald W. (1958). Primary maternal preoccupation. In Collected papers: Through paediatrics to psychoanalysis (pp. 300-305). London: Tavistock. (Original work published 1956)