PPD and Attachment

By Kate Kripke, LCSW

Each woman who becomes a mother wants to have a solid, strong, and healthy attachment with her baby.  And with that, I think it’s fair to assume, each mother fears on some level that this will not occur.   Some moms worry that they won’t have the tools to bond and attach appropriately because their own relationships with their parents are conflicted.  Others fear that they won’t be able to create an attachment as strong as the one that they had with their own mom or dad.  Others find that their histories have contributed to a sort of “overcompensation” with their own kids, and they feel that the only way to attach is to give all of themselves.  And some moms may feel that they don’t have the knowledge or experience to attach appropriately with their little ones. Almost every mom who struggles with a mood and anxiety disorder like PPD worries about attachment.  Attachment, it seems, is one of those hidden dilemmas that makes early mothering feel overwhelming for most of us.

And so I thought that today I would talk a bit about what we know regarding healthy attachments between moms and babies.  Please know that while I will be highlighting mom-baby attachment specifically, I also recognize how valuable and important dad and baby, 2nd mom and baby, partner and baby, extended family and baby, and care provider and baby attachments are.  In most situations, babies and children are fortunate to be loved and cared for by many individuals with whom their bonds are secure and valuable.  And in most situations it requires many caregivers to ensure that little people get what they need to thrive.

For the sake of this post today, let me give you two definitions:

1. Attachment: refers to the emotional connection that babies form with their caregivers.  Attachments are built on shared experiences over time that contribute to a sense of trust and connection.
2. Healthy attachment: supports a baby’s social and emotional development throughout his or her life.  Healthy attachments develop when a mom (or other primary care taker) is able to respond to a baby’s cues in a dependable way.

Moms who are depressed and/or anxious in the first few weeks, months or years of motherhood get caught in a bind around forming healthy attachments.  Often these moms feel immense guilt about not feeling well. They assume that they will have difficulty attaching with their babies because of their PPD, and they overcompensate for this by feeling an even greater need to give all of themselves all of the time (or, in some instances, stepping away entirely).  This backfires.  These moms, who believe that they need to be with their babies more to form strong attachments, become depleted and less able to be present and stay attuned to their baby’s cues and needs.  And then they feel more guilty and put more pressure on themselves to be there.  Or they fear that their symptoms will destroy their little ones and so they withdraw completely.  Depression and anxiety complicates the already confusing picture around attachment and leaves many women feeling unsure about what the relationship with their baby holds.

And so here are a few things to keep in mind when it comes to healthy attachment:

1.  For an attachment to be strong, a mom does not need to be with her baby all of the time.

What matters most in a strong mom-baby attachment is the “quality” of time moms spend with their babies, and not the quantity.  Babies thrive in relationships in which their caregivers are able to be present enough to validate emotions, respond to both emotional and physical needs, and understand the cues that suggest distress, need, contentment and happiness.  Sometimes a mom’s perceived need to be with her baby all of the time depletes her in a way that makes this kind of presence impossible.  Being present all of the time just isn’t realistic.  When babies feel that their moms are “seeing” them, even in small doses, their attachment and bond grows.

2.  Mistakes are an important part of healthy attachments.  

The idea that a mom needs to be perfect does not pan out when it comes to research.  What helps build a strong attachment between mom and baby is mom’s ability to acknowledge her own mistakes and to initiate what is called “repair” in the relationship.  When a mom never makes a mistake, her baby (or child) misses out on the opportunity to learn about unconditional love, forgiveness, and being human.  Strong bonds are not those that occur when mistakes are not made, but are those that occur when mistakes are made and then repair of those mistakes follows.  Moms who are able to acknowledge their shortcomings offer a key piece to relationship building.

3.  There will be plenty of disappointment in healthy attachments.

I cannot tell you how many times I work with women who are hugely worried about disappointing their children or making their children angry.  These are often the moms who have a difficult time tolerating disappointment themselves and so worry that if they disappoint their own children they will push them away.  Again, what matters in strong attachments is that mom can acknowledge her inability to be perfect and that she can balance this (very human!) imperfection with an appropriate effort to make sure that her child’s needs are met by someone else (remember, what matters in forming healthy attachment is that you can read and respond to your child’s cues, not necessarily that you are the one to meet those needs all of the time).  This example refers to the mom who has her partner put her baby to bed so that she can get out to see a friend or take a break, to the mom whose baby is in childcare so that she can work or take time for herself, and to the mom who is unable to breast feed or chooses to formula feed so that she can be well.

4.  Responding appropriately to your baby’s needs does not always mean that you will respond immediately. 

As most of you probably know by now, it is not always possible to respond immediately to our baby or children’s needs.  But, again, what matters in healthy attachment is that your kiddo feels that his or her need is being seen and recognized.   Sometimes this response is not immediate.  Sometimes you will need to acknowledge with your little one that you aren’t able to meet a specific want (or need) in the moment.  When moms are able to let their babies know that they hear them and that they understand there is a need, attachment is being formed even when this need is not met right away.

Often, moms set expectations of themselves that are based on misconceptions around attachment and that are insurmountable and unrealistic.  Often, moms assume that in order to be attached to their babies (and for their babies to be attached to them), they need to, literally, be attached all of the time.  Here are some examples that I see in my office:

• The mom who, despite her fatigue, growing impatience and depletion tells herself that she has to be the one to feed her baby, put her baby to bed, and comfort her baby when he/she is distressed.  This mom feels immense guilt when she is away from her baby, and yet feels disastrously tired when she is with her.
• The mom who feels pressure to continue breast feeding her baby even when this process is making her physically or emotionally sick.  
• The mom who feels uncontrollable anxiety around making mistakes or not getting it right the first time.

These moms fear that not being able to achieve the above is a determining factor in how attached she will be to her baby.  Sound familiar?

So here is the deal, inspiring moms: Struggling with a postpartum mood or anxiety disorder like postpartum depression does not mean that you will not attach with your baby.  But it does mean that without breaks, time to heal, rest and support, giving your baby what he or she needs to form a healthy attachment with you will be difficult.  In order to be dependable, to read your baby’s cues, and do be consistent (we are focusing on quality NOT quantity, remember…) you will need to reach out for support and begin the process of getting well.  Sometimes this will mean stepping away.  Or sharing the load with someone else. Or being less than perfect.

In helping to strengthen the healthy attachment with your baby, ask yourself the following:

• Can I let my baby know that I hear him/her when there is a need that I can’t respond to right away?
• Do I have a sense of my baby’s unique ways of communicating his/her needs?
• Can I spend at least one, short, specific period of time each day looking into my baby’s eyes, playing, and encouraging laughter?
• Can I bring in support when I notice that my baby has a need that I cannot meet?
• What do I need to do to take care of myself so that I can be as present and consistent with my baby as possible?