ABE Survey Results Part 1: Bonding Disruptions in Mothers

Adverse babyhood experiences (ABEs) are about events you and your parents experienced before your 3rd birthday. I developed the ABEs survey from research and bodies of evidence about risk factors for chronic illness. I wondered if we would see evidence for one particular aspect of early trauma that is not yet widely recognized or understood. The ABE survey results highlighted indicators of this form of trauma. I think of it as Bonding Disruptions. In today’s post I’ll introduce bonding and risk factors for disruptions, explain why this observation offers hope, show you ABE survey results in graphs and the most well recognized indications, and share tools and resources that support healing chronic illness and other symptoms in children and adults at the bottom of this post.

100 of you have taken the survey since it was published in July 2024 and 70% of you have completed all or most of this lengthy survey. All of your responses, both submitted and in draft form, contributed to the results below.

The ABE Survey results appear to be relevant and potentially validating for many of you:

• 60% of responders live with a chronic illness or physical health condition
• 40% live with a mental health condition on its own or combined with a physical condition or chronic illness

A heart felt thank you for your contributions. I have read everything you’ve written, with great curiosity, including your detailed comments that give me context for what was happening. I continue to be very moved as I learn what you have experienced. Here are initial observations from looking at graphs of the results.

I. Bonding

Bonding is the innate capacity we all have to connect and fall in love with our babies ⁽¹⁾Klaus, M. H., & Kennell, J. H. (1982). Parent-infant bonding (2nd ed.). Mosby.

Two encouraging contributions from our knowledge about Bonding Disruptions:

1. Evidence that bonding can be repaired for parents, children and adult children.
2. Bonding repair has helped people recover from chronic illnesses including asthma ⁽²⁾Nyaki, E., & Levine, P. A. (2023). Healing Trauma through Family Constellations and Somatic Experiencing: Ancestral Wisdom from the Snail Clan of Tanzania, ⁽³⁾Madrid, A., Ames, R., Horner, D., Brown, G., & Navarrette, L. (2004). Improving asthma symptoms in children by repairing the maternal-infant bond. Journal of Prenatal and Perinatal Psychology and Health, 18(3), 221-231, autoimmune diseases such as inflammatory bowel disease, autoimmune related kidney disease, as well as addictions, depression, ADHD, and beyond ⁽⁴⁾Hausner, S. (2011). Even if it costs me my life. Routledge.

Bonding is a state of relationship that supports and optimizes regulation for a baby’s development including their immature nervous system and organ systems. Bonding facilitates parents’ natural and innate behaviors and feelings. Parents who are more bonded do more of the following with their babies ⁽⁵⁾Klaus, M. H., & Kennell, J. H. (1982). Parent-infant bonding (2nd ed.). Mosby:

• gaze at them more
• talk more
• hold, fondle, caress, kiss and cuddle them more
• soothe and nurture more
• smile at their babies more
• stay closer to them at doctor visits

Babies whose parents are more bonded to them:

• smile and laugh more
• cry less
• are calmer and easier to please
• are easier to soothe
• sleep better
• have less colic
• have fewer infections
• have more regulation in heart rate, breathing and temperature

Bonding Disruptions

Bonding can be disrupted, however, by stressors. In the 1970s, pediatricians Marshall Klaus and John Kennell learned that when a mother is separated from her baby she is at greater risk of having trouble bonding ⁽⁶⁾Klaus, M. H., & Kennell, J. H. (1984). Parent-infant bonding. Mosby. Bonding disruptions have also been associated with chronic illness such as asthma ⁽⁷⁾Madrid, A. (2005, October). Helping children with asthma by repairing maternal-infant bonding problems. American Journal of Clinical Hypnosis, 48(3-4), 199-211.

One of the biggest contributors to bonding disruptions discovered by Klaus and Kennell and later confirmed by Madrid, among others, happens when a mother is separated from her baby. This can happen in two ways:

• emotional separation
• physical separation

Physical separation, such as when a baby needs incubator care or a mother is too sick to be with her baby, can interfere with bonding.

Emotional separation for a mother may be even more common. It can happen when something is too emotionally painful or overwhelming, such as from grief after the death of a parent or other loved one during pregnancy or during a child’s early life.

The following ABE survey results provide examples and evidence of events associated with increased risk for emotional or physical separation and bonding disruptions. There is also evidence of an increase in symptoms associated with bonding disruptions.

II. Evidence for Bonding Disruptions

1. Conception and Unwanted Pregnancy

This graph, which is also in the image at the top of this post, highlights the poignant finding that 32% of you were the result of a pregnancy that was not wanted. This may be one of the most important contributions to risk for bonding disruptions and increases risk for later events that further compound that risk. It was also by far the most common stressor before birth. The missing / blank areas are for responses that were “none of the above,” “I don’t know,” and “other.”

The research suggests that approximately 60% of pregnancies in the US in the 1990s were unintended ⁽⁸⁾Institute of Medicine (US) Committee on Unintended Pregnancy; Brown SS, E. L. (Ed.). (1995). The Best Intentions: Unintended Pregnancy and the Well-Being of Children and Families. https://www.ncbi.nlm.nih.gov/books/NBK232124/. . In 2019 the rate was 35% (CDC). The term “unintended” includes unplanned and accidental pregnancies that may have been welcome, sometimes after a period of adjustment to the idea. The research, however, has trouble identifying whether a pregnancy that was unintended was ultimately wanted by the time you were born.

Reasons that pregnancies were not wanted are complex yet often easy to understand. Mothers experiences included:

• pregnant at 14, family very disapproving and recommending abortion
• pregnant at 42, unanticipated and long after the other kids, embarrassed
• moved to a new country with no support system when became pregnant
• forced to marry the father or someone else once she became pregnant
• shamed, judged, or otherwise accused rather than supported
• not enough financial stability, sometimes because there were a number of other children already
• attempts to abort you
• having had one or more miscarriages or the death of a child before you

When conception was difficult

Others were very much wanted but conceiving was difficult or may have taken a long time. When conception is difficult, mothers may go through losses such as miscarriages. Or they may experience significant stress and grief from repeated cycles of trying, waiting and not succeeding. These can make it more difficult for a mother to bond out of worry that you might not make it if other babies haven’t, and from unprocessed grief for past losses.

2. The Greatest Indicator of Bonding Disruptions

23% of mothers are observed to have experienced the biggest indicator of bonding disruptions: not feeling love for her baby. About 20% of parents don’t feel a bond in the first week or two after birth ⁽⁹⁾WebMd 2024, Forming a Bond With Your Baby — Why It Isn’t Always Immediate but the context provided in the ABE survey suggests the lack of love lasted much longer, often throughout childhood. Recognizing this as a symptom helps not only to alleviate blame given that bonding disruptions are out of a parent’s control, it also indicates the need and opportunity for repair and support. The other responses in this graph are known risk factors for bonding disruptions such as worry for the baby or separation ⁽¹⁰⁾Klaus, M. H., & Kennell, J. H. (1982). Parent-infant bonding (2nd ed.). Mosby.

3. Higher Rates of Premature Birth

The finding that appears to be the most potentially statistically significant in the ABE survey results is premature birth.

Premature births make up about 9% to 12% of births in the US ⁽¹¹⁾CDC, 2022 Statistics, ⁽¹²⁾Joyce A. Martin, M. P. H., & Michelle J.K. Osterman, M. H. S. (2024). Shifts in the Distribution of Births by Gestational Age: United States, 2014–2022. National Vital Statistics January 31, 2024. 73(1), ⁽¹³⁾Schroth, G. (2015). Prenatal bonding (Bindungsanalyse by Raffai)* – An introduction. J Pediatr Neonatal Care, 3(1), 1-3, so this rate of 19% in the ABE survey results is about double that of the general population. Stress and trauma, including a mother or father’s history of trauma, are risk factors for premature birth. Babies influence the timing of birth and may also play an important role for early birth and for late birth below.

A mother’s or parent’s disappointment with their baby is another important indicator of a bonding disruption.

Other events identified in this question and relatively common in this graph of ABE survey responses involve birth complications, all of which can increase risk for bonding disruptions. About 6 to 7% of births occur after 42 weeks ⁽¹⁴⁾Joyce A. Martin, M. P. H., & Michelle J.K. Osterman, M. H. S. (2024). Shifts in the Distribution of Births by Gestational Age: United States, 2014–2022. National Vital Statistics January 31, 2024. 73(1).

4. Mothers’ Experiences of Prenatal Stress

This Mother ABEs question asks about different kinds of stressors mothers experienced during their pregnancies. While all of the events in this question can increase the risk of emotional distress to interfere with bonding the most common here are consistent with those identified in studies previously mentioned ⁽¹⁵⁾Klaus & Kennell; Madrid. Observations in the ABE study include high rates of being significantly stressed during pregnancy (44%), feeling alone or not having enough support (30% of mothers in this ABE survey) and also feeling frightened, experiencing relationship and/or financial stress, and crying a lot.

5. Labor and Birth Complications

Rates of birth complications in this survey appear to be about the same as for the general population. Complications, and being frightened are risk factors for bonding disruptions. Some of these events, such as cesarean births, may be higher in the ABE survey, depending on when you were born. The rate of cesarean sections in the 1960s, for example, was 5% compared to 30% and higher in the 2020s.

6. Father’s Experiences

Fathers’ age may be higher than fathers in the general population although this is unclear at the moment. We know from the research that fathers ages have increased in the past few decades. Financial stress, low support and relationship stress were high for fathers like they were for mothers. I have added questions about stress for fathers and whether they felt love for you after you were born. Self soothing with alcohol and tobacco, and mental illness were also notable for fathers. These are indicators of trauma in a person’s past. 22% of fathers were abusive to mothers, which is another indicator of past trauma as well as an important risk factor for bonding disruptions and distress for the entire family. There are two graphs for responses about fathers in the Supplement to this post.

7. Supplemental Graphs

I’ve added 2 graphs on ABE Survey results for fathers and 1 more graph for mothers in a Supplement to Part 1. The page provides a few more examples of risk factors for bonding disruptions and includes observations about abuse. Abuse is increased after bonding disruptions and when a parent doesn’t feel love for their baby ⁽¹⁶⁾Klaus, M. H., & Kennell, J. H. (1984). Parent-infant bonding. Mosby.

8. ABE Survey results Part 2 & “BEN” Coming Soon

Part 2 of the ABE Survey results will look at symptoms and indicators of bonding disruptions in babies. It also introduces Babyhood Emotional Neglect (BEN) and an intriguing observation about the 15 item “BEN score.”

III. Resources for Healing & Working with ABEs

Here are important resources for ABEs and for addressing bonding disruptions.

Reversing asthma in kids through bonding therapy with mothers

ABEs and the ABEs Survey draw from the work and research of Psychologist Dr. Tony Madrid with mothers of children with asthma ⁽¹⁷⁾Madrid, A., Ames, R., Horner, D., Brown, G., & Navarrette, L. (2004). Improving asthma symptoms in children by repairing the maternal-infant bond. Journal of Prenatal and Perinatal Psychology and Health, 18(3), 221-231. Learn more about bonding, bonding disruptions and Tony’s work with asthma in this blog post, or with his resources below.

• Tony’s book The Mother and Child Reunion with stories and tips for healing
• website AsthmaBusters
• Video for therapists on how to implement bonding therapy 
• Training Manual
• Maternal Infant Bonding Survey (MIBS) with questions to ask mothers

Reversing asthma in adults with SE and Multigenerational Healing

• Efu Nyaki’s Healing Trauma through Family Constellations and Somatic Experiencing provides a case example of asthma recovery in an adult in Chapter 8 and other examples in which helping mothers heal from trauma, grief, guilt and events that affected their bond with their children also helps their children and adult children.
• Stephan Hausner’s Even If it Costs Me My Life includes the role of separation in examples of asthma (p. 100), lupus (p. 61), scoliosis (p. 102), Crohn’s disease, fibromyalgia, chronic headaches, allergies, cancer and other health conditions. There are many stories of recovery achieved by addressing bonding disruptions in a group process of working with the adult with the chronic health condition (and not the mother).

Other resources

• Introduction to ABEs and Comprehensive Guide with the research
• The Science behind Bonding Disruptions with examples of asthma recovery
• Resources for ABEs, including a book with exercises, and a course
• 2.5 hour course by Pre and Perinatal Professional Kate White on the role of early events with tips on how to work with it. The course is $25. You can get a $10 guest discount. Sign up here with this code: usabpmemberguest

IV. 3 ABE Survey Actions You Can Do to Help

Your responses to the ABE Survey are valuable and are helping to assess for potential patterns, such as bonding disruptions identified here. They will help develop norms and to potentially offer guidance in the future, including for the possibility of treatment and prevention. I made significant updates to the ABE survey in December from your input, and provided the option to skip sections.

Here are three things you can do that will help:

1. Take or Update the ABE Survey: I invite you to take the ABE survey if you haven’t already or to *** update your survey *** to respond to new questions (your survey should still have your previous responses):

2. Health Conditions: Add your state of health, chronic illness and other health conditions to the Health Conditions Survey:

3. Good Health: Invite someone to take the ABE and Health Conditions surveys who is in good health, which will help us with establishing norms and guidance. You can share this post or the link to the following page, which is specifically designed for people in good health and has all the surveys:

Thank you! See you again soon with Part 2 of the ABE Survey Results and “BEN.”