Advances in the perinatal care of mothers and infants have inadvertently eliminated practices that encouraged mother and infant interaction and provided a foundation for the child s secure attachment. For centuries, mothers and infants were kept together after birth, with mother and infant supported by a knowledgeable woman who guided the new mother in breastfeeding and infant care techniques. Also, an infant spent much of the first year of life carried close to the mother s body. The proposed study will reintroduce evolutionary perinatal practices and assess their impact on infants secure attachment at 14 months. 330 first-time mothers in the third trimester of an uncomplicated singleton pregnancy will be randomly assigned to a Control (C), Evolutionary Method 1(EM1) or EM2 Perinatal Care group. Women in the Control group will receive routine prenatal, obstetric and postpartum care. Women assigned to the EM1 or EM2 group will be supported by a doula through labor and 2 hours postpartum. The doula will: provide continuous emotional support to the new mother, facilitate early mother-infant interaction, assist the mother with the initiation of breast feeding, and show her the innate interactive skills of her newborn infant. Women in the EM2 group will also be encouraged to hold their infant as much as possible, and will be given a cloth carrier for that purpose. To assess the effect of the evolutionary practices, mothers and infants will be observed during the first two hours, at 24 hours after delivery, and in the home at two and six months to evaluate the mother s behaviors with her infant, breast feeding status, infant development, and amount of time the infant is closely held. At 14 months, attachment of the infants will be measured using the Ainsworth Strange Situation. Restoring long-standing perinatal practices by implementing an evolutionary model of perinatal care within a modern obstetric setting may promote maternal sensitivity and responsiveness, increasing the likelihood that an infant will develop a secure attachment to its mother.
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