Reviewing the concept analysis of bonding

Dear Editor In the recent article in BJM entitled ‘Maternal-infant bonding: a concept analysis’, Altaweli and Roberts (2010) used the concept analysis method described by Walker and Avant (2005) to provide a better understanding of maternal-infant bonding. I believe that the authors have contributed their efforts to this complex phenomenon, including well structured literature reviews, definition of bonding, and clear implications for practice. Their work also forms a foundation for further studies. However, I would like to raise some questions regarding certain steps in order to contribute to the clarity of the concept. In selecting a concept (step 1), the authors describe the importance of bonding because it may influence the physical and psychological development of the child. However, the maternal-infant bonding is a mutual relationship between the mother and infant. The bonding difficulties might also impact the quality of the mother–infant relationship and later parenting issues. In determining the defining attributes (step 4), the authors identify four critical attributes. Two of them, ‘an emotional response such as kissing, cuddling etc’ and ‘an attachment process that occurs during the sensitive period after birth such as breastfeeding’, remained unclear to readers. The examples of emotional responses, ‘kissing and cuddling etc’, seem to be part of the attachment process. Those are all related to physical contacts that are part of the attachment process. In the literature, most authors define bonding as the mother’s feelings, emotions or affections toward her child and differentiate this process from observable attachment behaviours. Hence, an emotional response may refer to subjective feelings, such as self-reports showing their love or concerns toward her child. An attachment process may refer to objective observational behaviors, such as breastfeeding and skin-to-skin contact. It might be more comprehensive to assess the complex phenomenon from subjective and objective perspectives. In addition, the sensitive period should be further defined so that health professionals could promote the bonding at crucial time periods for optimum development. Based on literature, most authors point out there is a crucial sensitive period in the first few hours and days after birth. In step 5, constructing a model case demonstrated a real-life example of a concept as well as covering all the defining attributes. However, the case may not be a typical example due to the issue of being unable to conceive. A sterile case may mislead to the difficulty of forming the bonding for most of mothers. In identifying antecedents and consequence (step 7), the authors mention the key consequences related to bonding are love and attachment. Both love and attachment have been indentified as characteristics of bonding in the defining attributes step. A defining attribute cannot be either an antecedent or a consequence. In short, consequences are the outcomes of the concept. In my opinion, the child demonstrating optimal growth and cues of security might be the examples of the consequences. On the other hand, the mother might show satisfaction with the bonding relationship. BJM