Chapter Two: Literature Review

Babywearing

Attachment parenting utilizes "babywearing," carrying a baby in a cloth carrier such as a front or back pack or a sling, as a means to promote parent-child bonding and parental responsiveness. Though somewhat unusual in our culture, babywearing has been a common practice throughout human history and is still very common in parts of our world today. As an added bonus, slings and other soft carriers often allow for hands-free baby carrying and breastfeeding, providing the mother with the convenience of caring for her baby while still being able to get various types of work and chores done.

Carrying, crying and attachment.

Babies who are carried cry and fuss less than babies who spend most of their days out of physical contact with their parents. In Hunziker and Barr's (1986) study of increased carrying and its affect on infant crying it was shown that increased carrying throughout the day reduces both the duration and the quality of infant crying. In this study, which included 99 mother-infant pairs, the experimental group (49 pairs) was provided with soft infant carriers and asked to carry their children for a minimum of three non-crying, non-feeding hours a day for eight weeks. It was found that at six weeks of age, the time of normal peak crying for infants in Western society, the supplemented carrying group of infants cried and fussed 43% less than the control group; this was about one hour less of crying per day. These children also fed more frequently, though not for increased duration, and were quiet and alert for more time each day than the control group of babies. This quiet and alert period is typically regarded by child developmentalists and pediatricians as the time when a baby is most capable of learning (Sears, 1995a; Sears & Sears, 1993).
The development of attachment is also affected by infant carrying, as shown in a study of mother-infant dyads by Anisfeld, Casper, Nozyce, and Cunningham (1990). In contrast to the Honziker and Barr (1986) study which enlisted middle-class Canadian mothers, this study was conducted with the participation of lower socioeconomic mothers of minority ethnic backgrounds in a large city of the United States. The Anisfeld et al. study consisted of 49 participating pairs. The study sought to prove that mothers who carried their infants in soft carriers in the first three months of life would be more sensitive and responsive toward their babies after 90 days than mothers who toted their babies in plastic seats and, further, that this responsive behavior would be related to the child's security of attachment at 13 months. Indeed the authors' hypotheses were proven correct. Not only were the cloth carrier moms more responsive towards their babies in infancy, but 83% of their children were securely attached to them at 13 months of age. This was compared to the control group in which only 38% of the children were securely attached to their mothers. Curiously, within the control group, four of the mothers used a soft baby carrier in addition to using the car seat-type carrier and three out of those four mothers and babies had secure attachments. The authors also noted that a high percentage of avoidant relationships within the control group (38.5%) was consistent with existing data on mother-infant attachment for similar inner-city, low-SES populations. It was clear that the increased carrying of the infants in a soft front-pack carrier improved considerably the chances of the mother-infant pairs having a securely attached relationship and was a worthy intervention to be tried with high-risk populations.

Kangaroo mother care.

A great deal of additional research on the importance of physical contact for parents and babies has come out of the use of Kangaroo Mother Care for premature babies. Kangaroo Mother Care (KMC) was initially developed in Guatemalan maternity wards where a shortage of incubators led them to place the babies inside their mother's clothing to keep them warm. KMC has since been found to benefit neonates greatly, allowing them to better regulate their heart rates and breathing, allowing for better sleeping, faster growth, less crying, and earlier hospital release than preemies who do not participate in KMC (Sears, 1995b).
Kangaroo Mother Care has also been shown to benefit parent-infant bonding (Tessier et al., 1998). In a study of 488 premature infants born in Bogota, Columbia it was found that in addition to the physiological benefits of KMC, mothers who cared for their babies in this manner showed not only a stronger bonding effect and a change in their perception of their child, but also a resilience effect, whereby the mothers practicing Kangaroo Mother Care felt more competent to care for the infant even when changes in health developments required a longer hospital stay. Studies have looked at the use of KMC for full-term babies as well and determined that KMC is beneficial in promoting healthy body temperatures and glucose levels as well as reducing crying time in full-term infants (Cash & O'Quinn, 1996). Case studies on the use of KMC with premature twins and their adolescent parents (Dombrowski et al., 2000) and with full-term babies and mothers experiencing breastfeeding difficulties (Meyer & Anderson, 1999) have also shown both physical and emotional benefits for the dyads involved.

Anthropological evidence.

According to Lozoff and Brittenham's (1979) study of the infant care characteristics of hunter-gathering societies and other nonindustrial societies, the human pattern of infant care has long been one of carrying babies. The researchers found that pre-crawling infants were carried over 50% of the time in all hunter-gathering societies studied. These mothers also carry their children into toddlerhood. Among the !Kung of the Kalahari Desert, this carrying allows for almost continuous nursing, while in the other hunter-gathering societies, breastfeeding was on demand. These children received an almost immediate response to crying and were tended with frequent affection. Contrary to the Western idea that children cared for in this manner will be overly dependent, these children were found to develop early independence from the mother, voluntarily spending more than half their days with their fathers or with peers by the age of two to four. In most of the non-industrial societies studied the babies were not carried nearly as much as the hunter-gathering babies, however the mother was still the primary caregiver, she slept in the same bed or room as the child, and the child was nursed for more than 24 months. The researchers observed that under these circumstances crying children were very likely to receive an quick, appropriate, and caring response. The authors noted that the situation for babies in the United States is drastically different from these patterns, with children spending only 25% of a 24 hour period in contact with their mother due to the proliferation of plastic carrying seats, high chairs, swings, and play pens, along with pediatric advice to have a separate sleeping area for the baby, resulting in the unfortunate statistic that over 43% of crying episodes in American babies are ignored (Blackwell, 2000; Lozoff & Brittenham, 1979).
The comparative physiology of the composition of breast milk leads to the belief that humans were meant to carry their infants (Lozoff & Brittenham, 1979; McKenna et al., 1993). Breast milk in mammals who cache, or leave their young in a nest or safe location between feedings, have milk that is high in protein and fat. Milk in mammals which carry their young or those where the young follow or hibernate with the mother, have lower protein and fat. Human breast milk is quite low in protein and low in fat, identifying very frequent feeding and abundant maternal contact as the optimal pattern for human infant care. Whether you believe that humans evolved or that we were designed by God, it is clear from our very milk that mothers were meant to carry their babies with them.

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