The Maternal Looking Guide: a perinatal clinical tool to support the emerging mother-infant relationship'.

BACKGROUND: This study explores maternal looking - the unidirectional looking by a mother at her newborn - as a precursor to mother-infant gaze.

METHODS: Phase 1 used video as a means of detailed and disciplined observation to examine how mothers look at their newborns (n = 13). Using an iterative design, intensive analysis identified and categorised patterns of looking and looking-related behaviours. This resulted in a typology of looking. Phase 2 subjected the typology to inter-rater reliability testing, with midwives as multiple raters (n = 24), using the typology to rate standardised tapes of mothers and newborns (n = 10).

RESULTS: Phase 1 generated a one-page clinical tool (Maternal Looking Guide). This tool enables the assessment of mothers' looking behaviour over six constructs and allocation to one of three overall categories of looking: those women who are doing well (comfortable), those who need a referral to an expert perinatal service (worrisome) and those to whom something extra could be offered (uncomfortable). In Phase 2 the Maternal Looking Guide achieved moderate reliability.

CONCLUSIONS: The Maternal Looking Guide is a practical, moderately reliable, clinical tool that can assist midwives and other perinatal workers identify those mothers who may need extra support at this critical perinatal window of opportunity. .