Analysing young mothers’ experiences of their relationships with their infants and how to engage

January 2025

Elizabeth Milne conducted a study based on an interpretative phenomenological analysis of young mothers’ views of their relationships with their infants, and offers recommendations for healthcare practitioners.

Introduction

Researchers have emphasised the importance mother-infant relationships, linking insecure and disorganised attachment patterns to negative outcomes in childhood (O’Hara et al, 2019). Some researchers refer to mothers having a predisposition to form an emotional connection and positive relationship with their young infant (Hallstein et al, 2019). Yet the infant as a relational person is not well recognised by families or professionals (Milne et al, 2018). Moreover, there is a lack of research on mothers’ subjective experiences of the mother-infant relationship, especially among less privileged groups.

To inform interventions, the author explored maternal experiences of the mother-infant relationship using an IPA. The study focused on young mothers with low socioeconomic status (SES).

Aims

Most infant mental health issues are associated with disturbances in caregiver relationships (Zeanah et al, 2000). As mothers are commonly infants’ primary caregivers, they are particularly influential. Infants adapt their attachment style based on their mother-infant relationship (McGingley et al, 2021). These styles can be categorised as secure, insecure or disorganised. Secure attachment is linked to consistent, sensitive care, while insecure attachment is associated with unpredictable or insensitive care (O’Hara et al, 2019). Disorganised attachment is linked to chaotic or frightening types of caregiving (O’Hara et al, 2019). Attachment styles are associated with infant outcomes, with secure attachment promoting positive emotional, social, behavioural and academic outcomes, with insecure attachment patterns being correlated with more negative outcomes (McGingley et al, 2021). Disorganised attachment is a strong predictor of psychopathology in adulthood (O’Hara et al, 2019).

Research has focused on the links between attachment styles and neurodevelopmental patterns (Kok et al, 2015; Moutsiana et al, 2015; Teicher and Samson, 2016), suggesting that attachment may influence neurodevelopment, affecting interactions with subsequent life experiences. While attachment styles may not directly cause outcomes, their influence is likely to be indirect (Sroufe et al, 2010). Sroufe et al (2010) proposed the ‘double mediation model,’ in which secure attachment in infancy can predict childhood social competence. This, in turn, predicts friendships in adolescence, which then predict emotional and conflict resolution in young adult relationships. Promoting secure attachment is an aim of the Healthy Child Programme (Department of Health and Social Care, 2009), with HVs playing a central role in supporting parent-infant relationships.

Methods

Appropriate NHS ethical approval was granted for the study. We opted to use IPA, a qualitative research methodology that prizes people’s subjective meaning (Smith and Nizza, 2021). Purposive sampling was undertaken as IPA recommends a small, relatively homogenous participant group (Smith and Nizza, 2021). Participants were identified by HVs as having low SES and being from a deprived ward.

Six participants were recruited, whose ages ranged from 19-22 years and whose infants were aged from six-12 weeks. They included multiparous and primiparous mothers as multiparous mothers are no more likely to recognise their infants as being responsive than primiparous ones (Delight et al, 1991). Prady et al (2014) found little differences in parenting practices among mothers with British White and Pakistani origins. One British-Pakistani mother was recruited. The participants’ anonymity was protected.

Semi-structured interviews were held at two to six weeks post-partum and one to four weeks later. IPA analysis (Smith and Nizza, 2021) of verbatim transcriptions included:

• Immersion within each participant’s data.
• Noting against the text, including descriptive, linguistic and conceptual comments.
• Developing initial experiential statements.
• Identifying connections to identify personal experiential themes.
• Moving to the next case, repeating the process.
• Identifying patterns across cases, enabling group experiential themes to be identified.
• Using an interpretive lens to enable deeper analysis.

Results

Three group experiential themes were identified as being key to the formation of the mother-infant relationship:

1. A transgressive experience
2. Making sense within a constraining paradigm
3. Feeling-knowing

A transgressive experience

The mother-infant relationship forms within the crucible of a transgressive experience – a time where norms are violated. For example, pregnancy and birth were portrayed as ordeals. They were referred to as being ‘weird’, ‘strange’ and ‘bizarre’. The extremity of childbirth – whether ‘brilliant’ or dangerous – left mothers feeling out of control. Mothers identified the pressure of intensive domesticity. An extensive realm of domestic labour required mastery, with housework and motherhood appearing inextricable. Even when exhausted, housework was an unquestioned obligation for mothers.

Maternal vigilantia, a heightened state of alertness, was a prominent theme. Mothers focused intensely on their infants, with small periods of time taking on greater importance. Respondents did not turn to practitioners for support regarding the mother-infant relationship. The mothers assumed the role of facilitator to their partners as they interacted with the infants. In their vulnerable state, these women found solace and companionship in their enduring and confiding relationships with their primary caregivers, usually their mothers.

The traditional baby

Into this transgressive locale, mother-infant relationships were forming. Universally, mothers found their infants to be incomprehensible in the early weeks, but they were highly motivated to make sense of their infant. To do so, mothers relied on the construct of the ‘traditional baby’, characterised by bodily functions such as crying, feeding and sleeping. These functions influenced mothers’ perceptions and relationships with their infants (Milne et al, 2018) and were used as checklists to make sense of their infants.

Mothers invested considerable energy in trying to stop their infants crying, as this action epitomised the infant’s incomprehensibility for them.

The desire for a ‘happy baby’ drove mothers to focus on the infant’s smile, which provided momentary relief and reward.

Feeling-known

Alongside using the traditional baby construct, mothers seemed to engage in a process of feeling-knowing their infants. Being asked direct questions about their relationship with their infant was something new to them. Gradually, mothers had a sense of being special to the infant and this was prized. The mothers relied on the construct of love to explain the intensity of their subjective experience. Rich description unfolded when mothers recounted sharing pleasure with their baby. Understanding their infant’s communication, including the need for reassurance, was associated with connection. Eyes conveyed emotions, adoration, pleasure, concern and fear and were powerful conduits for connection.

The mothers described quiet times when they felt most connected with their infants. Despite the deep pleasure in this companionship, it could seem to be perceived as a treat.

Discussion

Mothers experienced the early postnatal period as a bizarre and stressful ordeal. In addition to the challenges of pregnancy and birth, rather than ‘intensive mothering’ (Hays, 1996), they grappled with the burden of intensive domesticity. Domesticity may offer a semblance of purpose and competency during a time of vulnerability and anxiety (Gentile, 2011), but the mothers in this study did not view housework positively; rather it was burdensome and oppressive, subsuming motherhood. Notably, mothers spoke about allowing themselves time with their babies only once chores were completed, treating it as an indulgence.

Mothers existed in a heighted state of vigilantia [alertness or wakefulness] and initially found their infant to be incomprehensible. In vigilantia, mothers appeared to focus on details: the minutiae mattered. Vigilantia expands Winnicott’s (1967) concept of primary maternal preoccupation. However, the paradigm also confers benefits; the construct with associated checklist, may provide a sense of control at a time of huge vulnerability. However, the checklist frequently failed, resulting in feelings of maternal disillusionment which could increase vulnerability (Phoenix and Woollett, 1991).

Mothers turned to the language of love to explain their profound feelings. However, even the language of love seemed insufficient. Maternal love has been widely debated (Rich, 1977; Wolf, 2003). Given the stress and anxiety mothers felt, love, with its valuable evolutionary, societal and cultural functions, may promote investment in the relationship (Hrdy, 2001; Van Manen, 2018) and despite the neo-liberal focus on separation and individualism, love was powerfully felt-known by these mothers. However, maternal love does not necessarily depict the infant as relational.

Making sense of the infant as a person was relationally potent. The infant’s need and preference for the mother provided insight into the infant’s internal world. Understanding their infant was crucial to connection and companionship (Trevarthen, 2001), including in moments of pleasure and reassurance. The infant’s eyes were perceived as a powerful communicative force. Human eyes are expressive: for example, their exposed sclera facilitates communication of gaze direction (Kobayashi and Kobayashi and Kohshima, 2001; Trevarthen, 2005). Mutual gaze is a phenomenon that facilitates the connection between mother and infant, creating an intense shared experience (Baradon et al, 2016; Schore, 2001; Trevarthen and Aitkin, 2001; Winnicott, 1967). The ‘touch’ (Van Manen, 2018) of the eyes seemed to provide a mutual sense of ‘being known’ (Beebe and Lachmann, 1994; Van Manen, 2018).

Implications and recommendations

Practitioners can:

• Show empathy for the transgressive experiences that mothers experience in the perinatal period.
• Engage with maternal mother and primary caregivers to support better sense making of the infant within a relational framework.
• Challenge the focus on housework and promote with families the importance of connecting with baby
• Encourage pleasure and interest with baby.
• Bring a relational discourse into their work, promoting the understanding of the infant as a relational being, born ready to relate.

Conclusion

Early postnatal life is challenging and triggers a heightened state for mothers in which the mother-infant relationship forms. Being vulnerable, mothers seek solace from primary caregivers. Perceiving infants as being incomprehensible, mothers rely on the ‘traditional baby’ model, which neglects the relational, impacting their ‘sense-making’ of the infant (Milne et al, 2018). Despite this, intersubjectivity emerges, offering valuable moments of companionship. Companionship and connection are important aspects of social and cultural development (Trevarthen, 2001; Stern, 2004). Yet, these moments, while subjectively meaningful, are undervalued compared to domestic duties. Practitioners can play a vital role in supporting parents and caregivers, fostering understanding and enhancing wellbeing while reshaping societal norms.

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