Assessing mother-infant interaction should be an integral part of the care of women in the postnatal period. Maternal factors contributing to difficulties with mother-infant attachment include:
Infant factors affecting attachment include medical complications, prolonged separations from the mother, prematurity, developmental disorders and infant temperament. It is important to see the mother and infant together, observe their interaction closely and watch for patterns of interaction — especially whether the infant is able to ‘use’ the mother as a secure base from which to explore, as well as how the mother responds when attachment behaviour is triggered by the infant (see the below table). If any of these indicators are present, consider referral, based on your clinical judgment, to a specialist with perinatal mental health training (e.g. enhanced child and family health nurse, psychologist, psychiatrist, mental health nurse).
Below is a list of prompts to assess difficulties in the mother-infant relationship. The list adapted from Stefan et al (2009) is not exhaustive and is not intended to be used as a checklist or formal assessment tool. Rather, it indicates areas of functioning that are important to the mother‑infant relationship. If any concerns arise, consulting with and/or referring to the appropriate specialist service is a consideration.
Adapted from: Stefan J, Hauck Y, Faulkner D et al (2009) Healthy Mother-infant Relationship: Assessment of Risk in Mothers with Serious Mental Illness. North Metropolitan Area Health Service, Mental Health, WA Department of Health.
If difficulties with the mother-infant interaction as outlined above are observed and/or if the woman has a significant mental health condition, further assessment will be required. Risk of harm to the infant can be related to suicide risk in the mother but can also be a separate issue. Although expressions of fear of harming the baby may be a sign of anxiety rather than intent, these should always be further assessed.
The way in which risk to the fetus or infant is assessed depends on the setting and the extent of the therapeutic relationship. The following are examples of questions that could be asked, taken from the Postpartum Bonding Questionnaire (Brockington et al 2006) and adapted to the perinatal context.
Action will depend on the answers to these questions. It is preferable that the mother and infant remain together but, if there is a perceived risk of harm to the infant, involvement of others (e.g. father or co-parent) in caring for the infant or alternative arrangements are advisable.
Notification to the relevant child protection agency may be necessary. All health professionals should be familiar with the legislation concerning reporting of concerns about children at risk of harm from abuse or neglect in their State or Territory. Health services and child and maternal agencies will generally have internal policies setting out these requirements.
Australian National Suicide Prevention Strategy (NSPS) website— www.livingisforeveryone.com.au
You can download a summary of this information on the Assessing Mother-infant Interaction Factsheet.