Family structure affects individual function. Understanding the structure of the woman’s family as she defines it will help clinicians provide culturally sensitive and realistic information and care. Family structure has evolved to include a wider variety of configurations over the last half century. In 1960, almost 90% of families fell into the nuclear family category, while in 2014 this was down to 68% (Cavanagh, 2015). Categories of families can include the nuclear family of a couple and their children, single‐parent family, unmarried biological or adoptive family, cohabiting family, extended family, and blended family. Do not assume family structure. Ask the woman directly whom she includes in her family. Regardless of family structure, adjustments will be made to accommodate a new family member and bonding with the new baby will remain an essential feature of this adjustment.

Bonding is the emotional tie that the mother develops with her unborn baby, and later her newborn (see Chapter 20, Psychosocial Adaptations in Pregnancy). Bonding can occur between other important members of the family and the newborn, such as father or partner, grandparents, and siblings. This process develops over time and provides a powerful source of motivation for ongoing care‐taking activities. The capabilities of parents to recognize their baby’s behavioral cues and respond appropriately are influenced by numerous factors and can have lasting ramifications on parent‐child bonding (Kerstis et al., 2016). Strong parent–child bonds can persist throughout a lifetime, despite separation of time and distance.

The stage is set immediately after birth for attachment to the newborn to begin. A cascade of hormones is generated during the labor and birth process. Endorphins promote an exhilarated sense of achievement about the birth, while prolactin and oxytocin facilitate a peaceful and deepening love for the neonate. However, routine interventions done without medical indication, such as induction of labor, cesarean section, or epidural anesthesia, can mute the hormonal response and influence the bonding process.

A healthy newborn should not be separated from the mother after birth. Becoming acquainted with the newly born baby immediately after birth typically proceeds in a progressive journey using gaze, proximity, fingertips, palms, voice, embrace, and movement. The en face position allows optimal eye contact, so mother and child can fixate on the other’s features. Women communicate with a high‐pitched voice suited to the newborn’s hearing range, while babies imitate with mouth and tongue movement (Kennell & Klaus, 1998). This process requires close physical contact and should not be interrupted by hospital procedures, all of which can be done at a later time for a normal healthy newborn.

Many factors can affect bonding. Parents’ perceptions of their own abilities and skills to care for their newborn can shape their interactions with the baby and each other. Parents are influenced by the way they were parented, both consciously and unconsciously. Parents who are made more aware of their baby’s competencies and abilities can optimize opportunities for bonding and mutuality. Past experiences with infants influence their expectations and motivation to parent and shape their efforts to nurture, love, and provide for their baby. The personality of the baby and any special needs the baby has can also play a part. Some factors that influence parental behaviors are unalterable but important to appreciate, such as the baby’s sex, birth order, weight, interfamilial and cultural background, and child‐rearing practices they experienced from their own parents. The healthcare provider can positively influence modifiable factors, such as parenting knowledge and confidence, by providing education, supportive care, and affirming the abilities of both baby and parents.

Fathers and mothers tend to interact differently with their babies. Traditionally, fathers were removed from the daily work of caring for the infant and provided discipline or playtime as the child grew, while mothers assumed primary care of the baby. A man’s relationship with his own father influences his confidence as a parent (Singley, 2015). Many fathers in contemporary society want to be involved with the daily aspects of newborn care and are creating the space in their lives to do so (Habib, 2012; Singley, 2015).