**4. First hour and maternal attachment behaviors**

Maternal attachment and bonding does not start at birth; from psychological point of view, the system has been prepared during the whole pregnancy, when mother imagines her baby and when the baby gets to know the odor, voice and smell of mother [22]. However, after the birth, she encounters him/her for the first time and therefore this time is so crucial for the establishment of the relationship between the baby and the mother/parent. The space for this intimate process must be given to the family and as Gunn et al. [8, p. 765] write: 'the midwife should never undermine the role of the mother who is transitioning into her new role.'

When left undisturbed, mothers demonstrate 'species-specific behavior' [23]. Mother explores her baby with her fingertips, then strokes the child and even then cuddles him/her into her arms, facing her. She establishes eye contact, talks to her baby and then introduces him/her to partner [8]. She progresses through three major steps:

• Her first preoccupation is the survival of the baby.

animals also prolactin is responsible for mothering behaviors [18]. During the first few weeks, the more a baby suckles and stimulates the nipple, the more prolactin is produced, and the more milk is produced. This effect is particularly important at the time when lactation is

Oxytocin is responsible for increasingly strong and effective contractions during the labor. And when, during the labor, levels of oxytocin rise, endorphins (sometimes called natural opiates) are released. Beta-endorphin is secreted by the pituitary gland in times of pain and stress. It activates the mesocorticolimbic dopamine reward system and produces pleasure in association with sex, birth and breastfeeding. It is known by now that after birth, both mother and a baby are saturated with natural opiates if the birth is physiological. They reinforce the mother-infant bond and contribute to ecstatic feelings for both [21]. Endorphins also help make the transition to extrauterine life easier for the baby, facilitating relaxation and calm [18].

As the baby descends during the labor, in fact close to the actual birth also catecholamines are released. Sometimes they are called 'fight or flight' hormones: epinephrine (adrenaline) and norepinephrine (noradrenaline).They are secreted from the adrenal gland above the kidney in response to stresses such as fright, anxiety, hunger or cold, as well as excitement, when they activate the sympathetic nervous system for fight or flight. During birth, when women are scared or have difficulty coping with pain, they can be overproduced and can inhibit production of oxytocin. However, normal values ensure mother is alert when baby is born; also, baby

To our current knowledge, many *different hormones* can *influence* several *types of behavior*, but for the purpose of getting to know the behavioral effects of different hormones involved in the birth process, four most important ones were described. It is known by now that all the different hormones released by the mother and by the baby during labor and delivery are not eliminated immediately. By knowing that, we realize it is essential to promote best practices

Maternal attachment and bonding does not start at birth; from psychological point of view, the system has been prepared during the whole pregnancy, when mother imagines her baby and when the baby gets to know the odor, voice and smell of mother [22]. However, after the birth, she encounters him/her for the first time and therefore this time is so crucial for the establishment of the relationship between the baby and the mother/parent. The space for this intimate process must be given to the family and as Gunn et al. [8, p. 765] write: 'the midwife should never undermine the role of the mother who is transitioning into her new role.'

When left undisturbed, mothers demonstrate 'species-specific behavior' [23]. Mother explores her baby with her fingertips, then strokes the child and even then cuddles him/her into her arms, facing her. She establishes eye contact, talks to her baby and then introduces him/her to

is alert, with eyes wide opened and trying to make eye contact with mother [19].

**4. First hour and maternal attachment behaviors**

partner [8]. She progresses through three major steps:

becoming established, right after the birth.

14 Selected Topics in Neonatal Care

already in labor processes.


These steps are crucial for every new mother; however, this is not yet a relationship [24]; attachment is much more complex and takes more time to be established. The initial emotional connection that mother establishes with her newborn baby is called bonding [25]. It was believed that bonding is one-way relationship (from parents toward child), under the strong influence of important maternal and infant oxytocin that promotes empathy. Other neurotransmitters such as opioids and dopamine also play role in the bonding process [26–28]. It can be therefore concluded that bonding is eased when the birth process is natural and all these hormones are expressed. Within the context of the results of latest research, the experts began to question whether bonding is really a one-way relationship. Feldman et al. [29] found synchronic levels of oxytocin in infants and mothers who interacted with them. These high levels of oxytocin in baby help her/him to adapt to extrauterine life [16]. Despite the fact that babies communicate nonverbal, they respond to parents.

Also, the baby responds facially to mother's voice, especially in the case of physiological birth, right after the birth, when the baby is in a quiet alert state, aware of the surrounding and uses all his/her senses. The baby has competencies to develop ties with parents [24]. Besides voice, his/her strongest sense is scent, necessary to find the mother's breast. After the first feed, baby usually gets to sleep that can last even 6 h [30].

All these (nonverbal, mostly facial) responses of the baby evoke interaction with parents that sets grounds for developing a bond among them. They were acknowledged already by Bowlby [31]. He proposed that there is an attachment system that is biologically based and promotes survival. He claimed that infants have specific behaviors that attract proximity of the caregiver in order to survive or to be emotionally connected, so-called proximity-seeking behavior. Repetitions of such interactions by the caregiver lead to 'internal working model' or internal representation of the attachment relationship [32].

The infant, despite that he/she is not verbal yet, generates these affective, sensorimotor activities from parents. He cannot self-regulate yet, but can learn this capacity through parental care-giving behaviors and his own ability to self-regulate [32]. It is therefore of crucial importance that woman is relaxed and in touch with her own feelings.

Reid and Freer [33] wrote that maternal role develops smoothly when mothers' self-esteem in mothering abilities is enhanced. Midwife can strengthen her perception with different interventions. If they make parents aware of babies' behavioral and autonomic cues, they can be more confident in caring for their newborn, taking into account the child's individual tolerance (for habituation to noise, light, etc.) [34].

Benefits of skin-to-skin for attachment, breastfeeding and thermoregulation are well known, and new insights, however, revealed even other advantages. Colonization of the baby with the mother's microbiome occurs first during vaginal delivery, later on with her skin microbes, and during initial breastfeeding, also the newborn gut is colonized with microbes that built normal gastrointestinal flora.

**3.** Furthermore, in the early postnatal days, current breastfeeding definitions disregard dose. A baby is considered to be breastfed when receiving any amount of mother's milk, however small. Not knowing whether the baby is exclusively breastfed blurs the understanding of

Neonatal Care in the First Hour of Life http://dx.doi.org/10.5772/intechopen.69600 17

**4.** Mothers are often encouraged to swaddle their babies from birth and to keep them in the cot unless they are actively feeding. This practice assumes that the continuity of maternal nutrition ends at birth as in bottle-feeding. Immediate swaddling also accentuates the discontinuity of postnatal transition, as mothers are physically separated from their babies even when they are in the same room. The early physical separation negates the continuity and postnatal effectiveness of the maternal body to maintain a homeostatic neutral/thermal environment from fetus to neonate. Keeping babies in the cot in between feeds instead of holding them during the first three days postpartum may have a negative effect upon early

**5.** Maternal choice rather than physiology provides the framework that underpins midwifery assessment. When there are breastfeeding problems in the first three days postnatal, a bottlefeeding solution is often offered. For example, when the baby demands breastfed and is unsettled, it is often believed that mother's early colostral milk is insufficient. Mothers are often told that they can give the baby a bottle if they want. The irony is that maternal choice then appears to motivate supplementation. One often sees written in the notes 'baby unsettled,

In order to optimize metabolic adaptation, babies and mothers must be kept closely together after birth. Health workers must encourage mothers to maintain close body contact with their

The human body is colonized by a vast number of microbes, collectively referred to as the human microbiota. The average human has over 100 trillion microbes in and on their body, and many of the latest discoveries are challenging previously held ideas about good and bad bacteria. Funkhouser and Bordenstein [39] say that the human microbiota comprises only 1–3% of an individual's total body mass, outnumbering human cells 10 to 1 and adding over 8 million genes to our set of 22,000. At the beginning of the twentieth century, French pediatrician Henry Tissier said that human infants develop within a sterile environment and acquire their initial bacterial inoculum while traveling through the maternal birth canal but now the sterile womb hypothesis remains dogma. The intrauterine environment during healthy pregnancy has been presumed to be free of, although recent evidence of microbes presents in the amniotic fluid, umbilical cord blood, fetal membranes and placenta of healthy term pregnancies after both vaginal and C-section delivery has challenged this belief [40]. It is known by now that human infants are colonized with maternal vaginal and fecal microbes as they exit the birth. The way how is known to have long-term consequences on mothers and child

those clinical characteristics associated with a baby who is wholly breastfed.

nurturing and breastfeeding.

mother requested bottle' (Colson, p. 12).

babies as often as they want in an undisturbed environment [38].

**6. Impacts on infant microbiome assembly**
