Mother-Infant Bonding and Safety Concerns
When assessing a mother’s mental health during the perinatal period, it is important to also assess the mother’s relationship with her baby and the baby’s safety, as mother-infant interactions can be negatively affected by mental health issues, such as postnatal depression. In order to assess mother-infant bonding difficulties, observe the quality of the mother and baby interaction and ask the mother about her baby.
Questions to ask the mother about her perception of her baby:
• “What do you notice your baby likes?”
• “What does your baby need right now?”
• “How does your baby communicate what they want?”
• “How do you know when your baby is happy?”
Observing the Parent-Infant Relationship:
1. Be aware of what is a good enough interaction:
• Parent is attentive and responsive to infant
• Some eye contact between them
• Empathy for and ability to reflect infant’s feelings
• Sensitivity to infant through immediate and appropriate responses to its cues
• Parent’s response is paced to infant’s cues
• Emotional engagement with the infant and enjoyment
• Expectancy of interaction
• Infant is interactive, engaging cries when distressed and settles when comforted.
2. Indications that the mother-infant relationship is compromised:
• Parent cannot sooth and comfort their infant
• Infant is difficult to settle or irritable most of the time
• Infant and mother avoid looking at each other
• Parent states that they do not know what their infant wants or needs and cannot understand their infant’s experience
• Parent is intrusive with their infant: poking, being too close, too rough, or force feeding
• Infant appears to struggle when held of comforted, often aching his/her back
• Infant is experiencing serious and continued feeding problems or are failing to thrive
• There is no joy or mutual reciprocity
• Parent has difficulty keeping her babies at the fore front of her mind.
Assess risk to the infant
If you don’t feel qualified to conduct a full risk assessment for the infant, refer on to a qualified health professional; however, assessment of the woman’s current thoughts and plans would need to be discussed to know if she is safe to leave.
Questions to assess risk to the Infant
• “Have you had thoughts of harming your baby?”
• “Have you felt irritated by your baby?”
• “Have you had significant regrets about having this baby?”
• “Does the baby feel like it’s not yours at times?”
• “Have you wanted to shake or slap your baby?”
• “Have you ever harmed your baby?”
Safety numbers:
a. Crisis Assessment & Treatment Team (CATT) – 9450 9090
b. Lifeline – 131114
c. Suicide Helpline – 1300 651 251
d. Suicide call back – 1300 659 467
e. Mental Health Advice Line – 1300 280 737
f. Parentline (8am – 12am Mon-Fri & 10am-10pm on weekends) – 132289
g. Panda – 1300 726 306
Obtain permission to contact other health professionals involved.