Our Newest Study Finds: Birth Experience Helps Shape the Mom-Baby Relationship, with Potential Lifelong Implications for Both

A new study from the Center for Early Relational Health and Dr. Jennifer Warmingham shows that birth experience can shape the beginnings of the relationship between a parent and their new baby—and potentially influence lifelong outcomes for both

The study found that higher birth satisfaction correlates with higher levels of bonding and emotional connection in the first year after birth. 

This remarkable finding shows us that the perinatal experience is a key factor in how the mother-baby relationship develops through the first year. That has crucial implications for the way we support both parents and children—especially today’s young families, many of whom had their children during a time of tremendous stress and social isolation.

“The experience of labor and delivery is how mom meets her baby,” says Dr. Warmingham. “So the context of that first meeting is the entire start of Early Relational Health. This study shows, through scientific data, that birth is not just a medical experience; it’s also an emotional experience—and that’s an important step toward understanding how we can better support the transition to parenthood through practice and policy.”

Our earliest relationships have unique potential to sculpt pathways of healthy child development and parental well-being. This study moves us one vital step closer to understanding the origins of the mother-child relationship, and how practice and policy might help promote long term well-being through that relationship, starting from birth. 

How does birth impact the mother-child relationship?

Birth can be joyous and empowering. But it can also be complicated, overwhelming, and sometimes even scary. What happens during labor and delivery can directly impact the experience of birth and the tender transition to parenthood. 

This new study shows that birth experience can also shape the beginnings of Early Relational Health between a parent and their new baby—with the potential to influence outcomes for both, throughout their lives.

Early Relational Health (ERH) is an umbrella term for the many ways in which relationships form between children and their parents/caregivers (such as bonding or attachment), and how those connections influence a child’s development and a parent’s physical & mental health, stress levels, and well-being. 

Jennifer Warmingham, PhD, a clinical psychologist and COMBO researcher, wanted to get to the heart of what helps establish ERH between a new mother and baby. Together with Center director Dani Dumitriu, MD, PhD, Center faculty Andréane Lavallée, PhD, and key affiliate Catherine Monk, PhD, Dr. Warmingham looked at the relationship between birth satisfaction and two key measures of future ERH: bonding (a mother’s feelings toward her baby) and emotional connection (the mutual approach behavior and reciprocity between a parent and baby/child). 

“Birth is a relational experience,” she says. “Mom is in relationship with her providers, her support people, her baby. So it makes sense for us to look at relationship-building after that as a product of how that delivery went.”

Understanding this unique generation of children and their families

The study used data from our COMBO Initiative, which attached key relational research to the unprecedented social disruption of 2020. Because this was an especially stressful time for pregnant and new moms, this study gives us crucial insights into implications for the families raising young children right now:

In an effort to protect families during so much uncertainty, prenatal care and hospital policies changed dramatically in 2020. That led to disruptions, both in clinical care and in support from key figures like partners and doulas. This study found that birth satisfaction suffered as a result of disrupted care, but the implications aren’t limited to the pandemic.

“Birth is both a medical and a subjective experience,” says Dr. Warmingham. “Mom's voice and experience, her feelings of safety, really matter during labor and delivery. There's a lot that can happen fast in labor, and communication can help bridge medical decision-making with mom's understanding of what's going on. Because the way she experiences those changes matters a lot for her well-being and the transition to parenthood—and, it turns out, her relationship with her baby.”

What’s crucial about these findings is that it wasn’t actually medical risk (like an unplanned cesarean or a NICU stay for baby) that impacted ERH outcomes: mom could have a high-risk birth, or there could be complications for the baby, but it was her subjective experience of communication and feelings of safety that most strongly affected ERH. At the same time, mom and baby could have a low-risk, uncomplicated birth, but if she had a negative birth experience, that was associated with lower ERH in the first year. 

“That’s an encouraging finding with major implications for practice and policy, because while we might not be able to control whether a mom experiences pre-eclampsia, for instance, birth satisfaction is related to factors we may be able to influence,” says Center Director Dr. Dani Dumitriu. These relational levers might include feeling supported and in control, a provider’s communication style, earned provider trust, and feeling respected by those around you. 

The study confirms that care, communication, and support during labor & delivery have downstream effects—not only on emotional well-being, but on the developing relationship with a new baby. 

One reason this study is so poignant is that it shows the validity of these experiential aspects of birth in the data. Dr. Warmingham says she hopes this helps validate the experience of birth impacting parenthood. For example, someone may realize: wow, I actually really did feel heard even though things were scary, because I had a great nurse who talked me through everything. “That experience doesn't just end when they leave the hospital,” Dr. Warmingham says. “It may influence how they feel about being a parent or how they feel about interacting with their baby.”

There are many facets of the transition to parenthood, and more research needs to be done to understand them all. But this paper puts two crucial pieces of the puzzle together: considering mom’s medical experience in the same study that considers mom’s subjective experience is vital. Because both are happening simultaneously. 

“There’s so much pressure on parents to have it all together. But two things are true at the same time: what happens early matters, and people develop over the course of their whole lives,” Dr. Warmingham says. Indeed, this study helps confirm that birth satisfaction has implications for two-generation health: by influencing Early Relational Health outcomes, which in turn help shape important aspects of well-being, like postpartum mental health and child development. 

“We know that bonding, for example, is associated with key long-term outcomes for both mother and child, including postpartum depression and socio-emotional development,” says Dr. Lavallée, who recently validated a strengths-based screen to measure bonding in the U.S. “Maternal mental health and mom’s feelings about her baby are important aspects of understanding early relationships, and how they shape well-being.”

What might a future of impactful support for moms and babies look like?

To comprehensively promote mom-baby health, Dr. Warmingham envisions widespread integrated care models that bring together experts in different aspects of perinatal support. One such model is led by Dr. Catherine Monk in the Columbia University Department of Obstetrics & Gynecology, where she serves as Division Chief of Women’s Mental Health.  

“Across health care, it is increasingly recognized that unexpected and/or complicated births can undermine mental well-being, which in turn can adversely affect the transition to parenthood and the relationship with the future child,” Dr. Monk says. “Enhancing obstetrical care with access to psychologists, social workers, doulas, peer and faith-based support—whole person care—is possible, and leads to optimal outcomes for families from the start." 

Dr. Warmingham adds, “Getting these experts across disciplines really talking to each other—that generates new ideas on the research side and leads to better care for parents and for kids.” 

For this paper, the Center for Early Relational Health brought together a team of interdisciplinary researchers with wide-ranging clinical expertise in the perinatal space—including, but certainly not limited to Dr. Warmingham, a clinical psychologist whose research focuses on parental mental health; Dr. Dumitriu, a pediatrician specializing in newborns, who researches resiliency and connection; Dr. Lavallée, who has a background as a NICU nurse and currently studies parent-child synchrony; and Dr. Monk, a clinical psychologist in obstetrics and gynecology, whose novel integrated care model aims to embed mental and behavioral health supports into perinatal clinical practice. 

Dr. Warmingham says integrated care models can also help increase access to additional services we know work, like insurance reimbursement for doula support. “These models exist. And they can go further.” 

While they weren't able to look at doula care specifically in this study, research has previously shown that doulas help improve birth outcomes. “We can’t always control the medical events that happen during birth,” says Dr. Warmingham, “but what we can control is whether mom understands what’s happening to her. It’s all about communication during clinical interactions, and that’s one of the many things doulas do to support families. Having someone there who can be an advocate, who can help bridge what's going on medically with mom's headspace and understanding—that could be a really good intervention target, and something to study next, specifically in the context of supporting ERH through improving the birth experience. If we have the evidence that doula services matter to birth satisfaction, and we’ve now shown in this paper that birth satisfaction matters for ERH, the logic is then: policies to support the things that improve birth satisfaction, like access to doula services, would be good for moms and babies long-term.”

How can science about ERH at birth make a long-term difference for families?

To support families with evidence-based practice and policy, we need to continue generating concrete science on how early relationships form, what helps the process, and what might get in the way. At the Center for Early Relational Health, we do comprehensive research on how early relationships shape lifelong outcomes for children and their families. 

We’re still learning which ERH constructs (like bonding and emotional connection) matter for which specific outcomes (like postpartum depression and school readiness)—that’s information we need for evidence-based care and policy change. Research like Dr. Warmingham’s helps us understand what’s at the heart of how these foundational relationships develop, and where interventions to support ERH might be most useful for families and the clinicians who care for them.

This study affirms that both the medical and emotional aspects of the birth experience matter for ERH. More research needs to be done to continue exploring the relational impacts of the transition to parenthood, and to deepen our understanding of how each construct of ERH shapes lifelong outcomes (including and beyond bonding and emotional connection). 

But we know enough to say: supporting the birth experience is important—for moms, for babies, and for the relationships between them. And that matters in how we implement interdisciplinary, patient-centered care for every new family.

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