The Effect of Psychological Intervention on Mother-Infant Bonding and Breastfeeding

Document Type: Original Article


1 Department of Pediatrics, Maternal Pediatric Health Specialist, Institute of Family Health, Maternal, Fetal and Neonatal Health Research Center, Vali ASR Hospital, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences (TUMS), Tehran, Iran

2 Clinical Psychologist, Institute of Family Health, Maternal, Fetal and Neonatal Health Research Center, Vali Asr Hospital, Iranian Research Centers of HIV/AIDS Imam Khomeini Hospital Complex, Tehran University of Medical Sciences (TUMS), Tehran, Iran


Background: The emotional bond that a mother feels towards her infant is critical to their social, emotional, and cognitive development. This concept has a major influence on an infant’s future health, and growth, so the assessment of parental-fetal attachment and related factors is of great importance. This study aimed to examine the effect of psychological intervention on attachment and persistency of lactation.
Methods: This clinical trial was carried out on 71 pregnant women who visited Milad and Vali-Asr hospitals in Tehran, Iran. The subjects were selected by convenience sampling method and randomly divided into control (n=36) and intervention (n=35) groups. In the intervention group, the subjects received three sessions of supportive group psychotherapy supplemented by training packages. Avant’s mother-infant attachment behavior questionnaire, Maternal Attachment Inventory, 28-item General Health Questionnaire, and the short form of the Coopersmith Self-Esteem Inventory were used to evaluate attachment behaviors and related factors. Attachment of mothers was examined at six different times. Statistical data was analyzed using independent t-test, Fisher’s exact test.
Results: The findings indicated that the intervention group had increased attachment and breastfeeding persistency (P˂0.001). Regression test also showed that maternal attachment was significantly influenced by psychological interventions, self-esteem, and depression (P˂0.001).
Conclusion: According to the results, psychological interventions are suggested during pregnancy to increase attachment and breastfeeding persistency, and thereby, improve mental health of both mother and newborn.


1. Toosi M, Akbarzadeh M, Shariff F, Zare N. Effect of training attachment behaviors on maternal-fetal attachment in primipara mothers visiting selected obstetric-clinics of Shiraz City -2010. Iran J Obstet Gynecol Infertil. 2012; 15(5):15-23 (Persian).
2. Nematbakhsh F, Kordi M, Sahebi A, Esmaeeli H. The effect of mother–infant skin to skin contact on mother’s attachment. Quart J Fundament Ment Health. 2007; 8(33-34):25-32 (Persian).
3. Saastad E, Ahlborg T, Froen JF. Low maternal awareness of fetal movement is associated with small for gestational age infants. J Midwifery Womens Health. 2008; 53(4):345-52.
4. Verhults JM. Relational problem. In: Sadok BA, Sadok VA, editors. Comprehensive text book of psychiatry. 7th ed. Philadelphia: Williams and Wilkins; 2000. P. 1888.
5. Edwards LD. Adaptation to parenthood. In: Lowdermilk BP, Perry SE, Cashion MC, editors. Maternity nursing. 5th ed. St. Lois: Mosby; 1999. P. 450.
6. Furman L, Breastmilk K. Breastmilk and skin-to-skin kangaroo care for premature infants. Avoiding bonding failure. Acta Pdiatricts. 2000; 89(11):1280-3.
7. Lundington-Hoe SM, Anderson GC, Simpson S, Hollingsead A, Argote LA, Rey H. Brith-related fatigue in 34-36-week preterm neonates: rapid recovery with very early kangaroo (skin-to-skin) care. J Gynocol Neonatal Nurs. 1999; 28(1):94-103.
8. Prodromidis M, Field T, Arendt R, Singer L, Yando R, Bendell D. Mothers touching newborns: a comparison of rooming– in versus minimal contact. Birth. 1995; 22(4):196-200.
9. Curry MA. Maternal attachment behavior mother´s self concept: the effect of skin-to-skin contact. Nurs Res. 1982; 31(2):73-8.
10. Messmer PR, Rodriguez S, Adams J, Well-Gentry J, Washburn K, Zabaleta I, et al. Effect of kangaroo care on sleep time for neonates. Pediatr Nurs. 1997; 23(4):408-14.
11. Cranley MS. Development of a tool for the measurement of maternal attachment during pregnancy. Nurs Res. 1981; 30(5):281–4.
12. Shieh C, Kravitz M, Wang HH. What do we know about maternal-fetal attachment? Kaohsiung J Med Sci. 2001; 17(9):448–54.
13. Sandbrook SP, Adamson-Macedo EN. Maternal-fetal attachment: searching for a new definition. Neuro Endorcinol Lett. 2004; 25(1):169–82.
14. Alhusen JL. A literature update on maternal-fetal attachment. J Obstet Gynecol Neonatal Nurs. 2008; 37(3):315-28.
15. Solchany JE. Promoting maternal mental health during pregnancy. 1st ed. Theory. Practice & Intervention. Seattle: NCAST Publications; 2001. P. 289-95.
16. Pillitteri A. Maternal & child health nursing: care of the childbearing & childrearing family. 4th ed. Philadelphia: Lippincott Williams & Wilkins; 2003. P. 201-26.
17. Facello DC. Maternal/fetal attachment: associations among family relationships, maternal health practices, and antenatal attachment. Michigan: ProQuest; 2008.
18. Yarcheski A, Mahon NE, Yarcheski TJ, Hanks MM, Cannella BL. A meta-analytic study of predictors of maternal-fetal attachment. Int J Nurs Stud. 2009; 46(5):708-15.
19. Shiremadar2. Shiraz Health Center. Available at: URL:; 2015.
20. Toosi M, Akbarzadeh M, Zare N, Sharif F. Effect of attachment training on anxiety and attachment behaviors of first-time mothers. J Hayat. 2011; 17(3):69-79 (Persian).
21. Hoseini VM, Nejhad FJ, Soltanifar A. Impact of maternal attachment style on mother to infant attachment. Qom Univ Med Sci J. 2011; 5(3):87-92 (Persian).
22. Noorbala AA, Mohammad K. The validation of general health questionnaire- 28 as a psychiatric screening tool. Hakim Res J. 2009; 11(4):47-53 (Persian).
23. Taghavi SM. The normalization of general health questionnaire for Shiraz University students (GHQ-28). Daneshvar Raftar. 2008; 15(28):1-12 (Persian).
24. Basiratniea S. Self Questionnaire of Qoper Esteem. New Ideas in the Field of Consulting. Family Counselor. Available at: URL:; 2005.
25. Akbarzadeh M, Toosi M, Zare N, Sharif F. Effect of learning attachment behaviors on anxiety and maternal fetal attachment in first pregnant women. Evid Based Care 2011; 1(1):21-34 (Persian).
26. Kim JS, Cho KJ. The effect of mother-fetus interaction promotion program of talking and tactile stimulation on maternal-fetal attachment. Korean J Child Health Nurs. 2004; 10(2):153-64.
27. Abasi E, Tafazoli M, Esmaeili H. The effect of foetal movement counting on primipara maternal foetal attachment. J Mazandaran Univ Med Sci. 2010; 20(77):53-60 (Persian).
28. Nagata M, Nagai Y, Sobajima H, Ando T, Honjo S. Depression in mother and maternal attachment--results from a follow-up study at 1years postpartum. Psychopathology. 2003; 36(3):142-51.
29. Yarcheski A, Mahon NE, Yarcheski TJ, Hanks MM, Cannella BL. A meta-analytic study of predictors of maternal-fetal attachment. Int J Nurs Stud. 2009; 46(5):708–15.

Torshizi M. Different dimensions of maternal-fetal attachment behaviors and associated factors in pregnant women referred to health centers of Birjand, Iran, 2012. Iran J Obstet Gynecol Infertil. 2013; 16(72):13-21 (Persian). 31. Lefkovics E, Baji I, Rigó J. Impact of maternal depression on pregnancies and on early attachment. Infant Ment Health J. 2014; 35(4):354-65. 32. Tharner A, Luijk MP, van Ijzendoorn MH, Bakermans-Kranenburg MJ, Jaddoe VW, Hofman A, et al. Maternal lifetime history of depression and depressive symptoms in the prenatal and early postnatal period do not predict infant-mother attachment quality in a large, population-based Dutch cohort study. Attach Hum Dev. 2012; 14(1):63-81. 33. Perry DF, Ettinger AK, Mendelson T, Le HN. Prenatal depression predicts postpartum maternal attachment in low-income Latina mothers with infants. Infant Behav Dev. 2011; 34(2):339-50. 34. Cinar N, Köse D, Altinkaynak S. The relationship between maternal attachment, perceived social support and breast-feeding sufficiency. J Coll Physicians Surg Pak. 2015; 25(4):271-5. 35. Ozlüses E, Celebioglu A. Educating fathers to improve breastfeeding rates and paternal-infant attachment. Indian Pediatr. 2014; 51(8):654-7.