Document Type : Review Article
Authors
1 PhD, Department of Theology, School of Humanities and Sciences, Yasouj University, Yasouj, Iran
2 Department of Midwifery, Maternal-fetal Medicine Research Center, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
Abstract
Keywords
Introduction
Pregnancy, delivery, and childbirth are among the important events in women's life. The majority of the women follow the natural pattern of physical and psychological development (1). The dramatic changes occurring in the pregnant women make them very sensitive to emotional stimuli and sometimes cause psychological problems during pregnancy and postpartum (2, 3). In the 20th century, known as the child century, more attention was paid to children. According to Bowlby, warm, close, and constant maternal relationship is required for improved mental health in children.
The mutual maternal-child relationship is one of the important determining factors in children’s normality or abnormality through which the physical, emotional, and psychological needs of the mothers and children would be fulfilled (4). Attachment is the lasting emotional bond between the mother and child, which can be considered as a unique and amazing phenomenon (5). There is evidence of growing attachment between the mother and fetus during pregnancy, which is reflected in maternal behaviors.
Maternal affection (within pregnancy) can cause postpartum satisfaction (6, 7). Many researchers believe that the relationship between mother and child is established long before birth. Particularly, the last three months of pregnancy is the time the mother-child bond reaches its peak due to the fetal sensitivity (in the terms of emotional or physical aspect) to mother. Within this period, the fetus can hear and feel the mother's belly touch or massage. These behaviors will support the flourishment of maternal-fetal bond before birth (8).
Pillitteri stated (according to Moradi et al.) that the bond between mother and child can cause a favorable attachment and promote the children's cognitive, emotional, and social growth (9). The mother has an inevitable role in determining this bond. According to some studies, the maternal influence on determining the child's attachment is to the extent that even the mother’s thinking about her attachment during pregnancy can predict the attachment behaviors in the infant during his/her first 12 months of life (10).
Attachment theory, originated in a study conducted by John Bowlby in psychology, was previously discussed and emphasized in legal doctrines and Islamic teachings. Several studies have been conducted on the effects of spiritual experience and its impact on human character and his performance in various fields (11-18). Moreover, some studies have demonstrated the impact of culture (e.g., race, ethnicity, and religion) on the incidence of diseases and their treatment (19-22).
The Iranian culture is based on Islam. The original Islamic sources contain numerous strategies for nutrition, stress, pregnancy, couple's communication, sexual contact, as well as maternal-fetal and -neonatal attachment (23). However, limited number of studies have been conducted in this domain. With this background in mind, the present study aimed to investigate the importance of maternal-fetal attachment according to the Islamic recommendations.
Materials and Methods
Study design
This review study was conducted on the religious texts, which covered the subject of interest and published within 2000-2017. The texts included in the present study were obtained by searching some databases and search engines, such as Medline and Iran Medex, PubMed, SID, Magiran, and Google. The searching process was performed using the following keywords (in Persian and English): “importance of maternal-fetal attachment”, “importance of attachment in pregnancy”, “maternal factors influencing the fetus attachment”, “neonatal factors affecting the attachment”, “verses and traditions about the importance of maternal-fetal attachment”, “verses and traditions related to pregnancy and childbirth”, and “lactation reward in Islam”. The study design and the type of resources used in this study are illustrated in Figure 1.
Figure 1. Number of the reviewed resources and study design
Results
Attachment is a primary need, which provides the necessary biological preparations in both mother and infant (24). On the other hand, the mothers should have some psychological features beside the biological preparation to fulfill their active role in the attachment
process. According to the reviewed resources, preparation is a required issue for the accomplishment of the attachment (25). Based on the Islamic point of view, there are two main factors, namely infant and maternal factors, affecting the infant’s character and his/her upbringing process. The maternal factors include the mother’s personality features, marriage time factors, marriage partner selection, post-marriage factors, pregnancy, and finally physical and psychological features that are inherited before birth (Table 1).
A-Maternal factors
Spouse’s properties
Marriage dates back to man’s history on earth and is regarded as an important issue in all religions and schools. However, no school of thought or religion has cared about this issue as much as Islam. According to Islam, family foundation is the basis of family progress and development in all aspects of life; accordingly, the Islamic law contains some considerations in this regard.
A person's character is the first important criterion in selecting the marriage partner. The investigation of the criteria for choosing the right partner (according to Islam) revealed the suitable personality criteria directly affecting the child attachment and maternal-fetal relationship (25). That is the reason the selection of a mate has been emphasized in Islam and several traditions. According to Prophet Muhammad (PBUH), individuals’ origin of happiness and misery must be sought in the mothers' womb (26).
Most of the features that people, by their nature and custom, look for in women include soft-heartiness, non-violence, and compassion (according to Islam). The mentioned features prepare a woman to play her motherhood role well and form her desired affection with the infant. The prophet said, "Marry kind and childbearing women as your increasing offspring is my honor over other prophets" (27). Additionally, Imam Sadiq(AS) stated, "Those who love their children will be under God’s mercy" (28).
Mothers' compassion, kindness, good humor, cheerfulness, and forgiveness can lead to some results. These features help the mothers not only avoid the negative emotions rooted in insecure attachment, but also care about their child who is seeking help, which finally results in the enhancement of their involvement in child care. They also improve the child's adaptive behaviors providing the proper condition for his/her secure attachment (25-29). Mothers' role is superior to men; accordingly, the long-term association between the mother and child (weather inside or outside the womb) can be a good reason for this bond. The uterine conditions, such as blood and other chemical aspects, can intensively influence the embryo.
Imam Khomeini says, "Mother's influence on the child’s morale is higher than that of the father; therefore, the mothers are the source of all happiness" (30, 31). The mentioned characteristics also assist the mothers to raise their tolerance threshold, which enable them to care about the crying child with no appealing look (25). On the other hand, the mother’s anger and rejection hinder the child’s attachment; mutually, the child’s anger liability can reduce the child-mother attachment (32).
Mental health in pregnancy
The eager mothers may even face some challenges in early pregnancy, such as gradual
Table 1. Main factors affecting maternal-fetal attachment according to the Islamic recommendations
|
Factors associated with mother |
Factors associated with fetus and neonate |
|
-Spouse’s properties |
-Neonatal appearance |
|
-Mental health in pregnancy |
-Family and social support |
|
-Role of heredity and environment on mothers |
-Islamic emphasis on maternal role |
|
-Mother’s attitude toward pregnancy |
-Nutrition during pregnancy |
|
-Basics of conception |
-Neonate’s mood in attachment process |
pregnancy complications, labor thinking and its related complications, inevitable mother's duties, as well as concern about disease and birth defects. Regarding this, the husband’s sympathy and cooperation are required for a better pregnancy acceptance (31). The prophet Muhammad (PBUH) said, "The best among you is the man who treats well with his wife, and I'm more well-behaved to my wife than you all" (33).
Role of heredity and environment in mothers
Mothers have two sorts of roles and impacts regarding the children. Considering the influence of heredity and environment, God in Surah Nuh (Verses 26 and 27) said (34), "And Noah (supplicated) said, 'My lord, do not leave a single unbeliever upon the earth.
Surely, if you leave him/her, he/she will mislead your worshipers.” Accordingly, Prophet Mohammad (PBUH) said, "Be careful about the generation and ethnicity in which you put your child (the wife you choose) because family foundation and heredity intensively affect children" (35). In addition, the Prophet said, "Avoid the fool women since their companionship is the exact disaster, and they just spoil their children." (36)
These characteristics of mother will accompany the child within pregnancy and lactation period. The mother can influence their children through lactation due to the blood and hereditary association between these pairs. During pregnancy, mother's thinking, behavior, sorrow, and joy can affect the infant. Imam Ali said (AS), "Choose the best nannies (nurse) for breastfeeding your child as you do well in selecting your marriage partner." (37)
Mothers’ attitude toward pregnancy
Women’s attitude toward pregnancy is a matter of fundamental importance. The signs of improper attitude (rejecting pregnancy) include negative belief about motherhood roles, mood fluctuations, neglecting fetal movements, and lack of readiness for his/her birth (38). These feelings may affect the fetus and cause an abnormal mood in the child. The present narratives increase the positive thinking about pregnancy. The importance of motherhood role and mystical reward of tolerating pregnancy hardships can give spiritual color to pregnancy.
The Holy Quran speaks of the mother, as if it is talking about a high official status. When the Quran discuss respecting the parents, honoring the mothers’ dignity is mentioned separately. God in Surah Isra (Verse 23) said, "Your Lord decreed you to serve no one except him and be kind to your parents" (39). Accordingly, regarding the importance of mother’s hugging her infant, God says,"On that day, you will see every one that suckles shall forsake her suckling, and every carrier shall miscarry, and…" (40, 42).
Today, rooming-in is under debate, and the issue of separating the child from her mother after birth and keeping them together in the same room has received attention. Close mother-infant contact, body touching, smelling, looking, and thinking about the infant lead to the secretion of prolactin and oxytocin. According to Imam Ja'far al-Sadiq (AS), a pregnant mother is rewarded as a person fighting for God’s sake, and even the breastfeeding mothers dying during breastfeeding are regarded as a martyr (41).
Basics of conception
Attention to God is recommended at the time of conception. Moreover, the issues like the importance of time, place, parents' mental status at mating, and their diet are highlighted. Accordingly, there are several narratives in this regard (43, 44).
B-Fetal and neonatal factors
When is the baby's attachment pattern formed?
Many theorists have assumed that maternal-fetal and neonatal attachment originates from the early months of the life (45). Attachment is formed before birth and pregnancy (46). The infants are able to both recognize and respond to the ordinary emotions (e.g., love and hate) the same as subtle emotions. Therefore, this psychological attachment (between mother and child) is initiated during pregnancy.
The neonates are ready to perceive and respond to both sensory and environmental stimuli; moreover, this ability increases by time (47). Maternal-fetal interaction during pregnancy is essential for the development of permanent emotional bonds for the rest of life (48). According to the reviewed texts, the necessity of the infants' inherent readiness is under discussion. Imam Sadiq said (AS), "When a baby is born, he/she whatever, "consistency" and "competent" He it is, to bring" (49). However, there are factors influencing the inherent readiness and moods of the infants, which are discussed below.
Infant appearance
Infant appearance is one of the factors influencing maternal attachment. Such charac-teristics as gender, weight, shape, color, and presence or absence of abnormality are the factors affecting the relationship between the mother and newborn. When a mother interacts with her healthy child as he/she laughs, looks, smiles, and makes sounds, she would show increased responses (50). Accordingly, when the child is not ready (mentally and physically) to evoke his/her mother for mutual interaction, or cannot respond well to the environmental and maternal stimulation, the mother cannot form an emotional bond (25).
Family and social support
Family and social support is one of the important factors that intensively impress the mother-child attachment, maternal moods (e.g., maternal anxiety and depression), mother's mental states, as well as social and environmental factors (e.g., stress and lack of social support). Balbie has emphasized the paternal role as an emotional support for his wife. The violence between the couples can deteriorate the fathers’ supportive and protective role and function (51). Some researchers also believe that maternal anxiety and depression during pregnancy can disturb the fetal attachment and reduce the mothers' abilities in role functioning (52).
Nutrition during pregnancy
Islam has emphasized the importance of maternal nutrition during pregnancy. Maternal nutrition affects the fetal growth since the fetus directly feeds from the mother’s body. According to a hadith from Imam Sadeq (AS), the embryo’s food is provided by his mother’s food and drink(49).
Neonate’s mood in attachment process
Some infants cry a lot; therefore, they need more attention in comparison to their peers. Researchers have implied the infant’s mood as the most important factor in child’s attachment (53). When the mother cannot calm the child down (because of child’s physical impairment or distemper), her self-esteem and competence will be impressed negatively. In this regard, the female feels that she may not be the ideal mother for her child. The persistence of infant’s distemper would negatively affect the child-mother attachment.
Our holy Prophet required the pregnant women to eat more dates to have an "easy baby" with more patience, who is less prone to irritability. This trait in the infant would facilitate a better attachment process (25). If the infant has a congenital defect or defects, attachment can be more difficult to establish because families must pass a hard stage, and they may feel guilty in this regard (54).
So, in this condition may be child is not ready (mentally and physically) for maternal interaction, or cannot respond well to the environmental and maternal stimulations and besides the mother cannot form an emotional bond; therefore, she does not meet her needs, and a negative internal model will emerge in the infant.
The infants do not consider themselves as worthy and valuable; moreover, they even do not rely on their nurses as safe references. Consequently, if they receive a negative, insufficient, and unstable care, they may feel insecure (55). Maternal-fetal attachment is the basis of future affections. Therefore,
The lack of formation of maternal-fetal attachment during pregnancy can alarm us about an undesired person's attachment and communications in the future life (56). In the Quran verses and hadiths, accepting the mother’s breast (or rejecting her breast) by Prophet Moses can indicate the infants’ ability to recognize his/her mother’s smell. In this regard, one of the primary abilities of the neonates is the identification of their mothers (57).
One of the limitations of this study was the lack of sufficient studies focusing on maternal-fetal attachment according to the Islamic recommendations, which removed the possibility of generalizing and comparing the results with those of the other papers. Furthermore, there was not enough studies on the recommendations of Islam in medical research. The future studies are suggested to integrate the recommendations of this research into educational programs and workshops and investigate their effects on teaching and learning of pregnant women during pregnancy, labor, and postpartum stages.
Conclusion
Emotional reactions suggest a complex process called mother-infant attachment that plays a fundamental role in the infants’ growth and development. According to the Islamic perspectives, we must consider the importance of personality traits (e.g., kindness and soft-heartiness), healthy family history, maternal heredity and environment, woman’s attitude about her role functioning as a mother and wife, maternal physical and mental relaxation,
and finally conception conditions in the development of maternal-fetal attachment. Moreover, fetal and neonatal factors, including physical appearance, family support, maternal nutrition during pregnancy, and the infants’ mood, can intensively impress the newborns’ innate readiness for the establishment of such attachment. The mentioned features lead to a better role functioning in the attachment process. Therefore, it is suggested to include the Islamic educational programs in the prenatal care to improve maternal-fetal attachment.
Acknowledgements
The authors would like to thank Shiraz University of Medical Sciences, Shiraz, Iran. We also appreciate Clinical Research Development Center of Nemazee Hospital Shiraz, Iran, and Dr. Nasrin Shokrpour for editorial assistance.
Conflicts of interest
The authors declare no conflicts of interest.
10. Fonagy P, Steele H, Steele M. Maternal representations of attachment during pregnancy predict the organization of infant mother attachment at one year of age. Child Development. 1991; 62(5):891-905.
11. Dalmid SG, Robertson B, Carrion MM, Thompso W, Erskin N, Scrugg N, et al. Spirituality, religiousness, psychosocial factors, and maternal-infant outcomes in Latina mother. Southern Online Journal of Nursing Research. 2010; 10(3):12.
12. Boelens PA, Reeves RR, Replogle WH, Koenig HG. The effect of prayer on depression and anxiety: maintenance of positive influence one year after prayer intervention. The International Journal of Psychiatry in Medicine. 2012; 43(1):85-98.
13. Park CL, Edmondson D, Hale-Smith A, Blank TO. Religiousness/spirituality and health behaviors in younger adult cancer survivors: does faith promote a healthier lifestyle? Journal of Behavioral Medicine. 2009; 32(6):582-591.
14. Cohen D, Yoon DP, Johnstone B. Differentiating the impact of spiritual experiences, religious practices, and congregational support on the mental health of individuals with heterogeneous medical disorders. The International Journal for the Psychology of Religion. 2009; 19(2):121-138.
15. Campbell JD, Yoon DP, Johnstone B. Determining relationships between physical health and spiritual experience, religious practices, and congregational support in a heterogeneous medical sample. Journal of Religion and Health. 2010; 49(1):3-17.
16. Mann JR, McKeown RE, Bacon J, Vesselinov R, Bush F. Do antenatal religious and spiritual factors impact the risk of postpartum depressive symptoms? Journal of Women's Health. 2008; 17(5):745-755.
17. Hefti R. Integrating religion and spirituality into mental health care, psychiatry and psychotherapy. Religions. 2011; 2(4):611-627.
18. Da Costa D, Dritsa M, Verreault N, Balaa C, Kudzman J, Khalifé S. Sleep problems and depressed mood negatively impact health-related quality of life during pregnancy. Archives of Women's Mental Health. 2010; 13(3):249-257.
19. Akbarzadeh M, Mokhtaryan T, Amooee S, Moshfeghy Z, Zare N. Investigation of the effect of religious doctrines on religious knowledge and attitude and postpartum blues in primiparous women. Iranian Journal of Nursing and Midwifery Research. 2015; 20(5):570.
20. Ghodrati F, Mokhtariyan T, Akbarzadeh M. Islamic-based preventive strategies for postpartum blues. Scholars Journal of Applied Medical Sciences. 2016; 4(3E):954-958.
21. Jobson L. Drawing current posttraumatic stress disorder models into the cultural sphere: The development of the ‘threat to the conceptual self ‘model. Clinical Psychology Review. 2009; 29(4):368-681.
22. Jobson L, Moradi AR, Rahimi-Movaghar V, Conway MA, Dalgleish T. Culture and the remembering of trauma. Clinical Psychological Science. 2014; 2(6):696-713.
23. Haghighat F, Moradi A, Mazaheri M, Hantoushzade S, Allahyari A, Pasandide A. The effect of Iranian-Islamic mindful motherhood training on maternal-fetal attachmen. Iran Journal of Nursing. 2015; 27(92):33-43.
24. Bowlby J. The nature of the child's tie to his mother. The International Journal of Psycho-Analysis. 1958; 39:350.
25. Agha-Jani Koupai MS, Ahmadi MR, Naroui R. Factors of the formation and evolution of attachment in children based on Islamic sources. Islamic Research Journal of Women and Family. 2014; 2(3):13-43 (Persian).
26. Haghi IM. “Al Bayan” the interpretation of the Quran. Beirut, Lebanon: Dar Al-Feker; 1999. P. 104.
27. Kulayni M. Usul al-Kafi. Qom: Dar Al-Hadith Publisher; 2008. P. 156-157 (Persian).
28. Al-Amili AḤ. Wasael ush-Shia (Wasa’il ush-Shi’a). Beirut: Dar Al-Feker; 1983.
29. Shirazi M. Tafsir nemooneh (Commentary on the Quran). 3rd ed. Tehran: Printing and Publishing Daralktb Islamiyah; 1982 (Persian).
30. Khomeini R .Women from the viewpoint. Tehran: Printing and Publishing Daralktb Islamiyah; 2017 (Persian).
31. Akbarzadeh M. Psychological aspects of pregnancy and childbirth. 1st ed. Shiraz: Persepolis & Qashqai Publications; 2006 (Persian).
32. McElwain NL, Holland AS, Engle JM, Wong MS. Child anger proneness moderates associations between child-mother attachment security and child behavior with mothers at 33 months. Journal of Family Psychology. 2012; 26(1):76-86.
33. Kulayni M. Usul al-Kafi. Qom: Dar Al-Hadith Publisher; 2008. P. 122 (Persian).
34. Gomshai A. The Holy Quran. Qom: Sarmayeh Press; 2001. Surah 71, Versa: 26-27.
35. Khalili AJ, Nahj Alfsahh. Trans: Payandeh AG. Tehran: The Javidan Publications; 1945. P. 266 (Persian).
36. 36. Kulayni M. Usul al-Kafi. Qom: Dar Al-Hadith Publisher; 2008. P. 1429 (Persian).
37. Kulayni. Usul al-Kafi. Qom: Dar Al-Hadith Publisher; 1987. P. 93 (Persian).
38. Jannati Y, Khaki N. Psychiatric in midwifery. 1st ed. Tehran: Jame Negar Publishers; 2005. P. 122-124 (Persian).
39. Gomshai A. The Holy Quran. Qom: Sarmayeh Press; 2001. Surah 17, Versa: 26.
40. Al-Amili AḤ. Wasael ush-Shia (Wasa’il ush-Shi’a). Beirut: Dar Al-Feker; 1983. P. 1427 (Persian).
41. Gomshai A. The Holy Quran. Qom: Sarmayeh Press; 2001. Surah 2, Versa:233, Surah:31, Versa:14, Surah 4, Versa:23, Surah 46, Versa:15, Surah 65, Versa:6, Surah 28, Versa:7.
42. Gomshai A. The Holy Quran. Qom: Sarmayeh Press; 2001. Surah 22, Versa:2.
43. Al-Amili AḤ. Wasael ush-Shia (Wasa’il ush-Shi’a). Beirut: Dar Al-Feker; 1983. P. 175 (Persian).
44. Paknejad R. The first of the Prophets. 1st ed. Yazd: Cultural Foundation Martyr Doctor Paknejad; 1984 (Persian).
45. Lerum CW, LoBiondo-Wood G. The relationship of maternal age, quickening, and physical symptoms of pregnancy to the development of maternal-fetal attachment. Birth. 1989; 16(1):13-17.
46. Nicholes FH. Maternal-newborn nursing: theory and practice. 1st ed. London: WB Saunders; 1997.
47. Akbarzadeh M, Dokuhaki A, Jokar A, Pishva N, Zared N. Teaching attachment behaviors to pregnant women: a randomized controlled trial of effects on infant mental health from birth to the age of three months. Annals of Saudi Medicine. 2016; 36(3):175.
48. Kliegman RM, Behrman RE, Jenson HB, Stanton BM. Nelson textbook of pediatrics e-book. New York: Elsevier Health Sciences; 2007.
49. Majlisi A. Bihar al-Anwar. Beirut: Dârahaya; 1983. P. 253.
50. Olds SB, London ML, Ladewig PW, Free TA. Maternal newborn nursing: a family centered approach. 4th ed. Redwood City: Addison-Wesley Publishers; 1992.
51. Dutton D, Golant S. The batterer: a psychological profile. 2nd ed. NewYork: Basic Books Publishers; 2008.
52. Lee AM, Lam SK, Sze Mun, Chong CS, Chui HW, Fong DY. Prevalence, course, and risk factors for antenatal anxiety and depression. Obstetrics & Gynecology. 2007; 110(5):1102-1112.
53. Sadock BJ, Sadock VA, Ruiz P. Kaplan and Sadock's comprehensive textbook of psychiatry. 9th ed. Philadelphia: Lippincott Williams & Wilkins; 2009.
54. Dawson B. Put the parent and baby first. Nurse/parent relationships in neonatal intensive care. Professional Nurse. 1994; 10(1):30-35.
55. Lyddon WJ, Sherry A. Developmental personality styles: an attachment theory conceptualization of personality disorders. Journal of Counseling & Development. 2001; 79(4):405-414.
56. Oppenheim D, Koren-Karie N, Sagi-Schwartz A. Emotion dialogues between mothers and children at 4.5 and 7.5 years: Relations with children's attachment at 1 year. Child Development. 2007; 78(1):38-52.
57. Shirazi M. Tafsir nemooneh (Commentary on the Quran). Qom: Printing and Publishing Center Islamic Propagation Office of Qom Seminary; 2002 (Persian).
)