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Pregnancy and Birth Sourcebook, Third Edition Scientists suspect that lack of bonding in human babies can cause similar problems.

Most infants are ready to bond immediately. Parents, on the other hand, may have a mixture of feelings about it. Some parents feel an intense attachment within the first minutes or days after their baby's birth. For others-especially if the baby is adopted or has been placed in intensive care-it may take a bit longer.

But bonding is a process, not something that takes place within minutes and not something that has to be limited to happening within a certain time period after birth. For many parents, bonding is a byproduct of everyday caregiving. You may not even know it's happening until you observe your baby's first smile and suddenly realize that you're filled with love and joy.

The Ways Babies Bond When you're a new parent, it often takes a while to understand your newborn's true capabilities and all the ways you can interact: * Touch becomes an early language as babies respond to skin-to-skin contact. It's soothing for both you and your baby while promoting your baby's healthy growth and development.

* Eye-to-eye contact provides meaningful communication at close range.

* Babies can follow moving objects with their eyes.

* Your baby tries-early on-to imitate your facial expressions and gestures.

* Babies prefer human voices and enjoy vocalizing in their first efforts at communication. Babies often enjoy just listening to your conversations, as well as your descriptions of their activities and environments.

Making an Attachment Bonding with your baby is probably one of the most pleasurable aspects of infant care. You can begin by cradling your baby and gently stroking him or her in different patterns. If you and your partner both hold and touch your infant frequently, your little one will soon come to know the difference between your touches. Each of you should also take the opportunity to be "skin to skin" with your newborn by holding him or her against your own skin when feeding or cradling.

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Bonding with Your Baby Babies, especially premature babies and those with medical problems, may respond to infant ma.s.sage. Because babies aren't as strong as adults, you'll need to ma.s.sage your baby gently. Before trying out infant ma.s.sage, be sure to educate yourself on proper techniques by checking out the many books, videos, and websites on the subject. You can also contact your local hospital to find out if there are cla.s.ses in infant ma.s.sage in your area.

Bonding also often occurs naturally almost immediately for a breastfeeding or bottle-feeding mother. Infants respond to the smell and touch of their mothers, as well as the responsiveness of the parents to their needs. In an uncomplicated birth, caregivers try to take advantage of the infant's alert period immediately after birth and encourage feeding and holding of the baby. However, this isn't always possible and, though ideal, immediate contact isn't necessary for the future bonding of the child and parent.

Adoptive parents may be concerned about bonding with their baby.

Although it might happen sooner for some than others, adopted babies and their parents have the opportunity to bond just as well as biological parents and their children.

Bonding with Daddy Men these days spend more time with their infants than dads of past generations did. Although dads frequently yearn for closer contact with their babies, bonding frequently occurs on a different timetable, partially because they don't have the early contact of breastfeeding that many moms have.

But dads should realize, early on, that bonding with their child isn't a matter of being another mom. In many cases, dads share special activities with their infants. And both parents benefit greatly when they can support and encourage one another.

Early bonding activities that both mom and dad can experience together include: * partic.i.p.ating together in labor and delivery; * feeding (breast or bottle); sometimes dad forms a special bond with baby when handling a middle-of-the-night feeding and diaper change; * reading or singing to baby; * sharing a bath with baby; * mirroring baby's movements; 583.

Pregnancy and Birth Sourcebook, Third Edition * mimicking baby's cooing and other vocalizations-the first efforts at communication; * using a front baby carrier during routine activities; * letting baby feel the different textures of dad's face.

Building a Support System Of course, it's easier to bond with your baby if the people around you are supportive and help you develop confidence in your parenting abilities. That's one reason experts recommend having your baby stay in your room at the hospital. While taking care of a baby is overwhelming at first, you can benefit from the emotional support provided by the staff and start becoming more confident in your abilities as a parent. Although rooming-in often is not possible for parents of premature babies or babies with special needs, the support from the hospital staff can make bonding with the infant easier.

At first, caring for a newborn can take nearly all of your attention and energy-especially for a breastfeeding mom. Bonding will be much easier if you aren't exhausted by all of the other things going on at home, such as housework, meals, and laundry. It's helpful if dads can give an extra boost with these everyday ch.o.r.es, as well as offer plenty of general emotional support.

And it's OK to ask family members and friends for help in the days-even weeks-after you bring your baby home. But because having others around during such a transitional period can be uncomfortable, overwhelming, or stressful, you might want to ask people to drop off meals, walk the dog, or watch any of the new baby's siblings outside the home.

Factors That May Affect Bonding Bonding may be delayed for various reasons. Parents-to-be may form a picture of their baby having certain physical and emotional traits. When, at birth or after an adoption, you meet your baby, reality might make you adjust your mental picture. Because a baby's face is the primary tool of communication, it plays a critical role in bonding and attachment.

Hormones can also significantly affect bonding. While nursing a baby in the first hours of life can help with bonding, it also causes the outpouring of many different hormones in mothers. Sometimes mothers have difficulty bonding with their babies if their hormones 584 Bonding with Your Baby are raging or they have postpartum depression. Bonding can also be delayed if a mom's exhausted and in pain following a prolonged, difficult delivery.

If your baby spends some time in intensive care, you may initially be put off by the amount and complexity of equipment. But bonding with your baby is still important. The hospital staff can help you hold and handle your baby through openings in the isolette (a special nursery ba.s.sinet) and will encourage you to spend time watching, touching, and talking with your baby. Soon, your baby will recognize you and respond to your voice and touch.

Nurses will help you learn to bathe and feed your baby. If you're using breast milk you've pumped, the staff, including a lactation consultant, can help you make the transition to breastfeeding before your baby goes home. Some intensive care units also offer rooming-in before you take your baby home to ease the transition.

Is There a Problem?

If you don't feel that you're bonding by the time you take your baby to the first office visit with your child's doctor, discuss your concerns at that appointment. It may be a sign of postpartum depression. Or bonding can be delayed if your baby has had significant, unexpected health issues. It may just be because you feel exhausted and overwhelmed by your child's arrival.

In any event, the sooner a problem is identified, the better. Health care providers are accustomed to dealing with these issues and can help you be better prepared to form a bond with your child.

Also, it often helps to share your feelings about bonding with other new parents. Ask your childbirth educator about parenting cla.s.ses for parents of newborns.

Bonding is a complex, personal experience that takes time. There's no magic formula and it can't be forced. A baby whose basic needs are being met won't suffer if the bond isn't strong at first. As you become more comfortable with your baby and your new routine becomes more predictable, both you and your partner will likely feel more confident about all of the amazing aspects of raising your little one.

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Chapter 74.Working after Birth: Parental Leave Considerations Chapter Contents.Section 74.1-Maternity Leave in the United States ............... 588 Section 74.2-Family and Medical Leave Act ........................... 594 587.

Pregnancy and Birth Sourcebook, Third Edition Section 74.1 Maternity Leave in the United States "Maternity Leave in the United States,"

August 2007. 2007 Inst.i.tute for Women's Policy Research (www.iwpr.org). Reprinted with permission.

Paid Parental Leave Is Still Not Standard, Even among the Best U.S. Employers Nearly one-quarter (24 percent) of the best employers for working mothers provide four or fewer weeks of paid maternity leave, and half (52 percent) provide six weeks or less, according to an Inst.i.tute for Women's Policy Research a.n.a.lysis of data provided by Working Mother Media, Inc., publisher of Working Mother Working Mother magazine. Nearly half of the best companies fail to provide any paid leave for paternity or adoption. Each year magazine. Nearly half of the best companies fail to provide any paid leave for paternity or adoption. Each year Working Mother Working Mother selects the 100 family-friendliest companies in the United States by reviewing employer questionnaires describing their "workforce profile, compensation, child care, flexibil-ity, time off and leaves, family-friendly programs and company culture."1 While more than one-quarter of companies (28 percent) provide nine or more weeks of paid maternity leave, many of the winners' paid parental leave policies fall far short of families' needs. No company provides more than six weeks of paid paternity leave and only 7 of the 100 best companies provide seven weeks or more of paid adoptive leave. selects the 100 family-friendliest companies in the United States by reviewing employer questionnaires describing their "workforce profile, compensation, child care, flexibil-ity, time off and leaves, family-friendly programs and company culture."1 While more than one-quarter of companies (28 percent) provide nine or more weeks of paid maternity leave, many of the winners' paid parental leave policies fall far short of families' needs. No company provides more than six weeks of paid paternity leave and only 7 of the 100 best companies provide seven weeks or more of paid adoptive leave.

An Inst.i.tute for Women's Policy Research review of the Working Mother 2006 100 Best Companies finds that 7 percent of the highest-ranked companies offer no paid maternity leave, and another 7 percent provide only one to two weeks, as shown in Table 74.1. Some companies model more adequate standards, however. Goldman, Sachs & Co.

offers 16 weeks of paid maternity leave, plus 4 weeks for new fathers and 8 for adoptive parents. Eighteen weeks of paid leave is standard for birth mothers at Pillsbury Winthrop Shaw Pittman LLP. New moms with five years of job tenure at Johnson & Johnson, ranked in the top ten of the 100 winners, receive 26 paid weeks of maternity leave.

Half of the 2006 Working Mother 100 Best Companies do not report any paternity leave, and paid leave is much less available for adoptive 588 Working after Birth: Parental Leave Considerations Table 74.1. Working Mother 100 Best Companies, 2006: Percent Offering Paid Maternity Leave for Birth Mothers, by Maximum Leave Length Working Mother 100 Best Companies, 2006: Percent Offering Paid Maternity Leave for Birth Mothers, by Maximum Leave Length Number of weeks Number of weeks Percent of companies c.u.mulative percent of of paid maternity offering specified companies offering some leave number of weeks paid maternity leave more than 12 weeks 8%.

8%.

11 to 12 weeks 11%.

19%.

9 to 10 weeks 9%.

28%.

7 to 8 weeks 20%.

48%.

5 to 6 weeks 28%.

76%.

3 to 4 weeks 10%.

86%.

1 to 2 weeks 7%.

93%.

0 weeks*

7%.

Note: Years on the job influence the amount of paid maternity leave an individual worker may be ent.i.tled to in many establishments. This table shows the longest possible amount of paid leave.

*Zero weeks includes companies for which no data are provided on paid maternity leave.

Source: Inst.i.tute for Women's Policy Research a.n.a.lysis of Working Mother Media, Inc.'s employment survey for the 2006 Working Mother 100 Best Companies, as presented at http://www.workingmother.com/web?service=vpage/77 (copyright 2007; retrieved 7/12/2007).

parents than for birth mothers (Table 74.2). Thirty-five percent of the "100 Best" companies provide only one to two weeks of paternity leave, 8 percent provide three to four paid weeks, and 7 percent provide up to six paid weeks for new fathers. Of the 54 companies that reported paid leave policies for adoptive parents, 17 provide one to two weeks, 13 companies offer three to four weeks, and 16 provide five weeks or more for adoptive parents to bond with their new child.

Paid Maternity Leave Results in Better Health Outcomes for Mothers and Children Research establishes that mothers and children benefit from paid maternity leave.

* Women with any combination of paid vacation or sick time tend to take more time off after childbirth, resulting in positive health effects for both women and children.2 589.

Pregnancy and Birth Sourcebook, Third Edition * Women workers who have some form of paid leave take on average 10.5 weeks off after childbirth, while women without any paid leave take 6.6 weeks.3 * The majority of new mothers report one or more physical side effects five weeks after childbirth, and those who had a cesarean section had significantly more health impacts.4 * Newborns have decreased access to follow-up care, lower rates of immunization, and decreased breast-feeding by four and one-half weeks on average as a result of early returns to work.5 Paid Maternity Leave Is Not Required by Any Federal Law While no federal law requires paid maternity leave, two laws give workers important rights related to pregnancy, parenthood, and taking care of seriously ill family members. The Pregnancy Discrimination Act of 1978 (PDA) requires that employers treat pregnant workers the Table 74.2. Table 74.2. Working Mother 100 Best Companies, 2006: Percent Offering Paid Leave for Fathers and Adoptive Parents, by Maximum Leave Length Working Mother 100 Best Companies, 2006: Percent Offering Paid Leave for Fathers and Adoptive Parents, by Maximum Leave Length Number of weeks Percent of companies Percent of companies of paid paternity offering paid paternity offering paid adoptive leave leave leave more than 12 weeks 0%.

1%.

11 to 12 weeks 0%.

3%.

9 to 10 weeks 0%.

0%.

7 to 8 weeks 0%.

3%.

5 to 6 weeks 7%.

9%.

3 to 4 weeks 8%.

13%.

1 to 2 weeks 35%.

17%.

0 weeks*

50%.

46%.

Note: Years on the job influence the amount of paid leave an individual worker may be ent.i.tled to in many establishments. This table shows the longest possible amount of paid leave.

*Zero weeks includes companies for which no data are provided.

Source: Inst.i.tute for Women's Policy Research a.n.a.lysis of Working Mother Media, Inc.'s employment survey for the 2006 Working Mother 100 Best Companies, as presented at http://www.workingmother.com/web?service=vpage/77 (copyright 2007; retrieved 7/12/2007).

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Working after Birth: Parental Leave Considerations same as other employees with temporary medical disabilities in all conditions of employment, such as pay and fringe benefits, including paid sick days, health insurance coverage, and temporary disability insurance.6 It also forbids employers from discriminating against pregnant women or forcing them to take pregnancy leave. The law does not require employers to provide paid leave, but if they provide it for some medical conditions, they must include pregnancy. (The PDA applies to firms that are subject to the 1964 Civil Rights Act-those with 15 or more workers.) The federal Family and Medical Leave Act of 1993 (FMLA) protects workers' job security during leave taken for the employee's own disability or illness (including pregnancy and childbirth); the care of the employee's newly born, adopted, or fostered child; or to care for an immediate family member (spouse, child, or parent) with a serious health condition. The FMLA applies to employees who work 20 or more weeks in a year and have worked at least 12 months for their current employer and who work for a firm employing at least 50 workers. This federal policy ensures that eligible employees receive: * up to 12 weeks of unpaid leave annually (leave may be taken all at once or intermittently, and for part or all of a day); * continued health insurance benefits (if ordinarily provided by the employer); and * a guarantee of return to the same, or an equivalent, job.

Very Few U.S. Workers Have Paid Family Leave Expanding from the "100 Best" companies to the entire private sector workforce, an even more inadequate picture emerges of access to paid family leave in the United States. The U.S. Department of Labor (DOL) tracks the kinds of leave offered by employers. According to the most recent DOL data, family leave is nearly absent in U.S. workplaces.7 Only 8 percent of workers have paid family leave to care for newborns and other family members. Managerial and professional workers and those in larger establishments have a distinct advantage over service and blue-collar workers and those employed in smaller firms. Full-time workers are nearly twice as likely as part-timers to have paid family leave. Workers in the Pacific Northwest and New England are also more likely to have paid family leave. Only 5 percent of the lowest-earning workers (earning less than $15 per home) have paid family leave. Even the federal government, which is typically thought of as a model employer, fails to give its employees paid parental leave. Instead, federal employees who become parents must use paid vacation or sick days or unpaid time off.8 591.

Pregnancy and Birth Sourcebook, Third Edition State-Level Initiatives Improve on the FMLA Several states have enacted policies to provide workers with family leave above the Family and Medical Leave Act requirements. These policies provide eligible workers in covered establishments with pay and/or more time to care for a newly born or adopted child or to care for an ill parent, child or spouse.

* Temporary Disability Insurance (TDI) is offered to all workers in California, Hawaii, New Jersey, New York, Rhode Island, and Puerto Rico, by state mandate. These programs provide temporary income to workers with non-work related, short-term disabilities, including pregnancy and childbirth. Funded by employee or employer contributions, or both, TDI ranges in coverage from 26 to 52 weeks.9 * The State of California gives workers in all firm sizes the right to six weeks of partially paid family leave to care for a newborn, an adoptive child, or an ill family member. The payment amounts to 55% of wages, to a maximum of $728 per week.10 This provision was enacted in 2002 by expanding the state's TDI program.

* Washington State's 2007 Family Leave Insurance Law (S 5659) instructed a task force to form a Leave Insurance program to begin October 1, 2009. The program will provide $250 per week for up to five weeks to a full-time worker (pro-rated for part-time workers) to care for a newborn or newly adopted child.11 * Some states have elected to mandate family leave policies for firms smaller than the federal FMLA guideline of 50 employees or more. The family and medical leave policy of the District of Columbia covers employees of all firm sizes. Maine covers establishment with 15 or more employees, and Minnesota covers those with 21 or more, though the ent.i.tled length of leave is less than the FMLA 12-week period. Oregon covers firms with 25 or more employees and requires more than the 12-week federal minimum.12 Congress Is Considering New Proposals to Support Working Parents Two bills have been introduced in the 110th Congress to provide paid time off for new parents and other workers. The proposed Family Leave Insurance Act (S 1681) would offer up to eight weeks of paid leave to new parents or those caring for seriously ill family members.

It is co-sponsored by Senators Chris Dodd (CT) and Ted Stevens (AK).

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Working after Birth: Parental Leave Considerations Eligibility criteria mirror the FMLA. Representatives Carolyn Maloney (NY), Steny Hoyer (MD), and Tom Davis (VA) are co-sponsors of the proposed Federal Employees Paid Parental Leave Act (HR 3158), which would give federal employees up to eight weeks of paid parental leave. These bills, if pa.s.sed, would provide U.S. workers with much more paid family leave than they currently have, on average, improving families' economic security and health outcomes for mothers and children.

Resources Information collected by Working Mother Media, Inc. from employers and edited by Working Mother Media, Inc. 2007. (downloaded July 12, 2007).Patricia McGovern, Bryan Dowd, Dwenda Gjerdingen, Ira Moscovice, Laura Kochevar, and Sarah Murphy, 2000. "The Determinants of Time Off Work After Childbirth." Journal of Journal of Health Politics, Policy and Law Health Politics, Policy and Law 25 (June 2000): 528564. 25 (June 2000): 528564.Ibid.Patricia McGovern, Bryan Dowd, Dwenda Gjerdingen, Cynthia R. Gross, Sally Kenney, Laurie Ukestad, David McCaffrey, and Ulf Lundberg, 2006. "Postpartum Health of Employed Mothers 5 Weeks After Childbirth." Annals of Family Medicine. Annals of Family Medicine. 4 4 (March/April 2006): 159167.Lawrence M. Berger, Jennifer Hill, and Jane Waldfogel, 2005."Maternity Leave, Early Maternal Employment and Child Health and Development in the U.S.," The Economic Journal, The Economic Journal, 115 (February 2005): F29F47. 115 (February 2005): F29F47.Roberta M. Spalter-Roth, Claudia Withers, and Sheila R. Gibbs, Improving Employment Opportunities for Women Workers: An Improving Employment Opportunities for Women Workers: An a.s.sessment of The Ten Year Economic and Legal Impact of the a.s.sessment of The Ten Year Economic and Legal Impact of the Pregnancy Discrimination Act of 1978, Pregnancy Discrimination Act of 1978, Publication #A108, Washington, DC: Inst.i.tute for Women's Policy Research, 1990. Publication #A108, Washington, DC: Inst.i.tute for Women's Policy Research, 1990.According to the Bureau of Labor Statistics, the National Compensation Survey considers paid family leave a paid leave given to an employee to care for a family member. The leave may be available to care for a newborn child, an adopted child, a sick child, or a sick adult relative. Paid family leave is granted 593 Pregnancy and Birth Sourcebook, Third Edition in addition to any sick leave, annual leave, vacation, personal leave, or short-term disability leave that is available to the employee. Unpaid family leave is unpaid leave given to an employee to care for a family member. The leave may be for caring for a newborn child, an adopted child, a sick child, or a sick adult relative (personal communication, August 30, 2007).United States Office of Personnel Management. 2001. Report Report to Congress on Paid Parental Leave, to Congress on Paid Parental Leave, http://www.opm.gov/oca/ http://www.opm.gov/oca/ Leave/HTML/ParentalReport.htm (August 29, 2007).Vicky Lovell and Hedieh Rahmanou. Paid Family and Medical Leave: Essential Support for Working Women and Men, Essential Support for Working Women and Men, Publication #A124. Washington, DC: Inst.i.tute for Women's Policy Research, 2000. Publication #A124. Washington, DC: Inst.i.tute for Women's Policy Research, 2000.Employment Standards Administration. Federal vs. State Federal vs. State Family and Medical Leave Laws. Family and Medical Leave Laws. Washington, DC: Department of Labor. (downloaded August 3, 2007).