Science & Sensibility

With Mother’s Day coming this Sunday, many women will be enjoying their first Mother’s Day celebration.  Hopefully, all mothers will be pampered, celebrated, honored and cherished.  For many women, finding a balance of being the mother and taking care of yourself and meeting your individual needs is often a struggle.  Walker Karraa takes a look at a recent study examining the importance of self care for new mothers and asks how birth professionals can stress the importance of new mothers making time for themselves as they transition to their new role. – Sharon Muza, Science & Sensibility Community Manager

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I have a confession. One year I volunteered over 2,000 hours at my children’s school. Yes, I was one of those moms. From wearing an orange vest directing carpool in the morning, to planting the garden with the green team, Xeroxing homework packets for the teachers, and planning the Spring Auction, I chose to put everything into public displays of affection for motherhood. Selflessness was superior parenting.

Fast forward a few years and I am rounding the corner on my PhD.  I am now one of those moms. I barely know the name of the Principal, miss school functions regularly, never volunteer in the class, and avoid direct eye contact with anyone on the PTA at all cost. I am caring for myself in ways that don’t directly involve caring for my children. Many would perceive it as selfish, or at a minimum, I am recognized as not being “an involved parent”.  I feel the judgment from other parents.

I would imagine anyone reading this right now understands the mine field of guilt, disappointment, and distress we walk through regarding balance between self-care and caring for children. Childbirth professionals often find themselves torn between the demand for caring for clients and the need for self-care.

A paradox for women lies between the need for self-care and the social construct of selflessness as superior in parenting.  Moreover, socio economic stressors regarding childcare and ongoing employment bear critical weight on time and resources for women to engage in self-care in addition to caring for their infant, other children, and family. Women need and deserve physical, intellectual, mental, emotional and spiritual health and well-being—yet engaging in self-care is a social construct that views it as selfish, or a luxury. And dare I say we engage in keeping this paradigm alive by extoling the virtues of some women who display self-sacrifice and dishing about the deviance of others who are not at the PTA meeting. We compare ourselves to both, often rejecting the parts of ourselves that are in desperate need of time, privacy, exercise, prayer, creativity, recovery. For that matter we could all use a nap, a shower, and time to do with as we want, desire, or dream.

New Study Emerges

This push and pull of visions of perfect martyrdom with the need for self-care is at no other time more present than new motherhood.  A recent qualitative study, “The Role of Maternal Self-care in New Motherhood” by Barkin and Wisner (2013) explored women’s perceptions of the role of maternal self-care in postpartum period and the barriers to employing self-care. Critical to postpartum wellness are increasing understandings of the mechanisms of self-care and their importance in the lives of new mothers. In a qualitative study of three focus groups consisting of 31 new mothers (had given birth during the year prior to enrolling in the study), Barkin & Wisner (2013) examined the relationship of 1) women’s perceptions of self-care, 2) how women applied self-care in new motherhood, and 3) the barriers to practicing self-care.

Semi-structured interviews with three focus groups elicited responses regarding the responsibilities associated with new motherhood, changes experienced since the birth of their child, feelings in response to those changes, describing constructs of a ‘good mom’, and the circumstances surrounding their high functioning and low functioning periods.

Transcripts related to maternal functioning were extracted and grouped into one of three categories: (1) women’s valuations of the role of self-care in new motherhood, (2) applications of self-care and (3) barriers to practicing effective self-care.

Barkin & Wisner (2013) noted two conflicting themes where women were both aware of the importance of self-care while holding the belief that good parenting is tantamount to selflessness. Participants described knowing that even the most basic self-care such as good nutrition and rest were of paramount importance, however they experienced barriers to engaging in self-care for themselves. One participant described the dilemma in this way,

“Because I really didn’t pay attention to myself. Like my main focus was on him. Making sure he was eating every hour. And as far as me, when a counselor came in and she was like, ‘Well, are you eating breakfast?’ ‘Are you eating lunch?’ And you really have to stop and look back and think like okay, yes, I need to take care of myself as well as the baby’. But you don’t really think about that until someone brings it to your attention.” (Barkin & Wisner, 2013, p. 5)

Participants described breastfeeding as a source of conflict.  Barkin and Wisner (2013) reported,

There was also substantial discussion of maternal self-care in relation to breastfeeding. For a portion of the women, breastfeeding was physically and mentally uncomfortable. The women described guilty feelings associated with deciding to artificial milk-feed their child. Despite the guilt, some of the mothers made the ultimate determination to transition to formula feeding. This was recognized as an act of self-care. (p. 5)

Conversely, where selflessness was seen as synonymous with motherhood, some participants reported what the authors called “potentially unhealthy degrees of selflessness” (Barkin & Wisner, 2013, p. 5) such as neglecting their hygiene or refusing to let trusted family members care for the baby.

Barriers

While some engaged in self-care shared examples of taking time to exercise, delegating infant care to partner, taking showers, applying cosmetics, socializing with friends, and dining out—many women reported barriers to self-care. Lack of time, limited financial resources, and one’s own inability to set boundaries were reported as significant barriers to self-care.

Implications for Childbirth Educators and Doulas

In addition to a call for more research, the authors concluded:

The development of a behavioral intervention aimed at improved self-care practice among new mothers is the long-term goal of this research. Interventions should be tailored to the mother’s individual circumstances and preferences. Self-care strategies that are both attractive and feasible for the individual woman will be more effective. Additionally, the availability of such an intervention will enable health-care providers to make better recommendations to women who are struggling to care for themselves and their infant concurrently. (Barkin & Wisner, 2013, p. 6)

This is where we share!

How do you cover the topic of self-care in your childbirth education classes, or prenatal sessions?

What do you consider some good examples of feasible and attractive self-care strategies that you suggest to your clients?

What have you learned about self-care strategies from your clients?

What are your thoughts regarding the causes of this paradox between self-care and selflessness?

As we educate our next generations of families to navigate the waters of parenting, how might we offer support, education and support for women to not only practice self-care, but prioritize it?

References

Barkin, J. L., & Wisner, K., L. (2013). The role of maternal self-care in new motherhood. Midwifery, http://dx.doi.org/10.1016/j.midw.2102.10.001

Walker Karraa Babies, Guest Posts, Infant Attachment, Maternal Mental Health, New Research, Newborns, Parenting an Infant, Research Childbirth Education, guest posts, infants, Mother's Day, postpartum, research, self-care, Walker Karraa

Regular contributor Kathy Morelli takes a look at babies and media and technology exposure.  If you are working with expectant families or with families parenting young children, you have an opportunity to share the impact of media on developing brains.  Take a moment to read today’s post and share how you bring up this topic with the families you work with. – Sharon Muza, Community Manager, Science & Sensibility. 

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Today’s babies are definitely digital natives! They grow up in a world saturated by media. The research about the effects of media on child development is in its infancy (no pun intended). 

On one hand, some research suggests when the developing brain is over-exposed to multi-tasking, attentional and learning difficulties can result. On the other hand, other research contradicts this finding. Additionally, there are lots of claims from DVD and TV producers that using their media enhances learning and social growth. 

What’s a parent to believe?

First Off: Parent with Awareness and Moderation

Put some perspective on this issue by reframing parenting around media issues as similar to parenting around other issues. 

Parenting with awareness and moderation through the infant years, around any topic, depends on three important tips.     

Tip One: Parent, Heal Thyself 

Encourage parents to be aware of their own emotional reactions to their baby. Have them own their emotions as their own, not their baby’s.

If the parents themselves have felt abandoned as a child, they may need to do their own hard emotional work, centering on their reactions to their baby’s dependency needs. Feelings around their own issues persist no matter what media is in use in the house. Parents should recognize them as their own feelings and work to own them. 

Tip Two: The Baby is an Individual  

All the statistics and information in the world doesn’t change the fact that each baby is an individual, with individual needs.

All babies need one-on-one attention from their caregivers, but some need more than others. Some babies cry more than others, some have colic, some are calmer and quieter than others. And learning occurs differently in each individual.

Have the parents look for clues. If their baby needs more attention than they think he needs, remember he is an individual and cannot be compared to other babies in their life. If their baby has a negative reaction to some type of media, have the parents either reduce its use or don’t use it at all. It might be a signal that he needs more interactive attention from the parent.  If the baby seems confused, frightened or agitated by some imagery or sounds from media, don’t force him to watch it. Cut it out of the home’s media diet. 

Tip Three: Baby, It’s YOU

There is no substitute for the parents. Have parents plan to spend meaningful time with their baby. A baby’s healthy development depends on attentive, personal, touchable, multisensorial, fully embodied experiences.

Newborn Baby’s Brain – Not So High Tech

First, an infant’s growth is intertwined on all levels; physical, mental and emotional growth are all related. In other words, brain development, movement, emotional development, and language are all inter-related and unfold together, at a biologically prescribed pace.   

Second, in the first three years of life, there are multiple critical periods (windows of opportunity) when a baby must be exposed to particular life experiences in order to learn particular skills. If these windows are missed, it’s extremely hard (or impossible) to learn the skill at a later time in life. The windows of opportunity are biologically based on brain development (Zero to Three, 2012). 

For example, vision and language are two skills dependent on critical windows of time. Acquisition of binocular vision and depth perception depends on a normal early experience with vision in the first few weeks of life.  Language skills must be acquired before five years of age, or there is little chance of developing language later in life (Zero to Three, 2012).  

Third, babies are born with immature brains. Experts estimate in order for the human brain to be fully developed at birth, the gestational period should be 18 months.  But human babies come out in nine months in order to compensate for the size of the human female pelvis (Christakis, 2009).  

Many baby experts refer to the first three months of life as the “fourth trimester” (Karp, 2003).  In the fourth trimester, a baby is still very fetus-like.  At at the beginning of life, a baby’s brain is only a quarter of its adult size and will grow about 20% in just the first three months of life. Her brain structures are in place, but are waiting to grow, based on her experiences. (Stamm, 2007). 

Think of the huge differences between a four day old baby and a four month old baby. That four month old child is cooing and smiling right at their parents, enticing them to connect! That newborn is depending on the parents to connect with her to help her grow (Marvin & Britner, 2008).      

The time between birth and two years old is naturally and biologically a period of extraordinary growth. An infant’s brain naturally grows based on genetics and interactive experience (Zero to Three, 2012; AAP, 2011; Stamm, 2007) 

The Infant Brain – How Babies Learn  

Babies Learn by Social Interaction:  Popular hype says any type of stimulation helps the infant brain grow and learn. But the consensus of child development specialists everywhere is  normal infant development depends on normal social stimulation  involving all the senses (touch, sound, sight, smell) (Vygotsky, 1978; as cited in Fenstermacher et al, 2010).   

What is normal social stimulation with all the senses?

It is responsive care by the parents (caregivers) using all the senses, including skin to skin contact, movement (swaying, walking, gentle dancing), holding, feeding, cuddling, talking,  loving direct eye contact, smiles, gentle play, comforting, and mature acceptance and modulation of your baby’s changing feeling states (angry, happy, sad) (Cozolino, 2006; Wallin, 2007). 

Emotional Attachment Style is Learned: A baby’s emotional template is encoded neurologically based on her earliest experiences with her parents and other caregivers. The biological attachment sequence enacts no matter what type of care a baby receives.

A good quality, secure attachment is created by good quality and consistent interactions between baby and parents. The human brain is plastic, so the attachment template is continuously updated and developed throughout life, but it is much easier on a person to begin life with healthy connectivity patterns, than to correct them as they go along (Wallin, 2007).        

Neglect & Abuse Affect Brain Growth: Research shows children growing up in neglectful and abusive homes, who are rarely spoken to, who do not have the opportunity to explore, may fail to develop the neuronal pathways necessary to learning (Zero to Three, 2012).

No Media vs Hey, It’s Educational!   

Parents of the under two set are understandably concerned by the conflicting messages out there about screen time.

American Academy of Pediatrics (AAP, 2011) strongly discourages any media consumption by children younger than two.

The AAP’s policy statement is based on research findings that media time tends to elbow out time spent in unstructured, creative play time and interactive activities with a parent or caregiver.  High quality, multi-sensorial interactions with a consistent caregiver are essential for healthy child development.

Yet, media is an integral part of our culture. On the average, 100% of children under two watch 1 – 2 hours of media every day and 14% watch over 2 hours a day (AAP, 2011).  40% of all children younger than two years live in households where the TV is on all day long as background noise (Courage & Setcliff, 2009). 

So what’s a parent to believe?

Does media consumption hurt babies?

Many parents say they are comfortable with allowing their under 12 month babies to watch educational media. There are a lot of educational firms pushing DVDs for the under 12 month old set, claiming learning enhancement and improvement for school readiness.

Are their claims substantiated by research?

The Research

What follows are some key points from the research about media consumption, learning and attentional effects on the developing brain.

Media, the Developing Brain and Attentional Difficulties

In 2004, Dimitri Christakis, MD, MPH of the University of Washington, reviewed data from an existing study. He found an association between children under three who watch on average more than two hours a day of television and attentional difficulties. In 2007, further studies by Christakis and his colleague, Fred Zimmerman, found the attentional difficulties were more precisely linked to program content. That is, cartoons and fast paced media seem to be linked to attentional difficulties, but not educational and appropriately paced programs. Christakis theorizes that over-stimulation of the developing brain with flashing and changing sights and sounds might be harmful to the developing brain (Christakis and Zimmerman, 2007; Christakis, 2009; Zimmerman et al, 2009).

On the other hand, there are researchers such as Tara Stevens and Miriam Muslow (2006) who feel the evidence linking media usage and attentional difficulties is highly correlational and Christakis and Zimmerman did not properly account for other factors in their information. Clearly, there is a need for the National Institute of Health to fund a large scale study to see if and how the digital native brain is affected by media saturation.   

How Babies Learn from the Screen 

Video Deficit Effect: Research about screen learning versus live learning indicates infants learn less from video than from live interactions; this is called the “video deficit effect.” The video deficit effect persists to about three years of age (Barr, Muentener, & Garcia, 2007; Zack et al, 2009).

The video deficit effect is mitigated by repetitive viewings, media content design and the context in which the media is used (Barr, 2010).

Repetition: So, babies under 12 months will retain behavior after seeing it performed once by a live model. But it takes repeated viewings for a baby to learn the same behavior from a screen.   

Content design: Retention of information is also enhanced in the under 12 month set by story content. If the story lines are simple, in sequence, and uninterrupted by multiple story lines or commercials, retention is enhanced. (think Teletubbies).

Context: In addition, if the media is in the context of a family situation, that is, if there is an appropriate adult moderator present, to discuss, distract and limit screen use, retention is enhanced and deleterious effects are reduced (Christakis, 2009).

Individual learning differences: In addition, there are differences in how and how fast individual babies learn. In general, at about the age of 12 months, a child becomes capable of seeing something on a screen and then performing it himself. But there are individual variations, and these variations persist into toddlerhood (Barr, 2007).     

But, as discussed above, child development specialists agree infants primarily learn via social-interactional-sensorial methods.

Educational Claims

Let’s take a look at the claims made by current educational DVDs targeted at infants.

In 2010, Susan Fenstermacher and her colleagues conducted an overview of 58 popular DVDs (culled from a total of 218 made between Fall 2007 and Spring 2008) marketed as educational to parents for their infants. A total of 17% of 686 claims made by the producers were that the DVDs provide socio-emotional educational content. However, the researchers found that only 4% of all the scenes were socio-interactional in content and these scenes were not of high quality.

In general, producers of DVDs do not use research-based child development learning principles, despite their claims. Of course this may be changing as these producers begin to use child development experts as content consultants.  

Language Development and Media

Language: Research shows babies learn language from being directly spoken to by their caregivers. Babies don’t learn language from the television or from observing conversations between adults, they need direct attention.

Matthew LaPierre and his colleagues (2012) found that children from eight months to eight years are exposed to over 4 hours of TV a day. This can be reduced by not having a TV in the child’s room.

Studies have shown that having the television on at home all day as background noise causes language delays and reduced interaction between parents and children (Kirkorian et al, 2012; LaPierre, Piotrowski & Linebarger, 2012).

Profoundly, a study of 1000 infants found that babies who watched over 2 hours of DVDs a day had poorer language assessments than babies who did not watch DVDs. Specifically, for each hour of watching a DVD, a baby knew 6 – 8 words less than babies who did not watch DVDs (Christakis & Zimmerman, 2007).

On the other hand, in 2010, Allen and Scofield found that 2 year olds can learn simple words from very simplified content, from a video.  They found the Blues Clues format was good for this.

Again, the research is not yet complete, but still points to the benefits of parental awareness and judicious use of media.   

Reality vs Fantasy in the Young Mind

Remember babies brain structures are not yet developed. The lower brain centers, the emotional centers, with structures such as the amygdala, are fully formed at birth. The amygdala is in charge of emotional designation. But the neo-cortex, the logic center is not fully formed until the early twenties (Cozolino,2006). Thus, the capacity to differentiate between fantasy and reality is limited in babies, toddlers and children. Babies are wired to empathize with the emotions of the people around them and have the capacity to do so. And remember that babies do retain information from repeated viewings.

For an example of how differently children view reality than adults, studies show children believe that many planes hit the World Trade Center, not just two, as the event was shown over and over again on TV.

So keep in mind babies/toddlers and adults have a different understanding about fantasy and reality as applied to what is viewed on the screen and they also can “catch” emotions from the people around them and from the screen. 

Five Tips for Parents: Media & Infants 

So, when it comes to media consumption, think about parenting a young baby with awareness and moderation. Some age appropriate media is ok, and its ok to for parents to take breaks with a TV show, but don’t let it edge out stroller walks, hikes in a baby back pack in the woods, and bonding time. 

Tip One: There is no substitute for the parent.

Studies indicate using media over 2 hours a day steals precious interactional learning time from the baby.  Encourage parents to help their baby grow by being present with her.

Tip Two: Like any parenting decision that needs to be made, make the decision from a place of awareness and in moderation.

Tip Three:   Be aware of how much your TV is on.

Again, research has found that children in the US are exposed to over 4 hours of TV a day. Reduce this time limiting the number of TV’s in the home, and not putting a TV or computer in the child’s bedroom.

Tip Four: Those educational DVDs? Well, research shows they make a lot of claims and the content is not based on research.   

Since some studies have implicated attentional and language deficits in babies who view more than two hours of media per day, limit the amount of media with your infant. A baby’s primitive brain learns socially and with many senses involved: touch, smell, sight, sound. A baby’s early interactions and experiences are encoded in the brain and have lasting effects. Choose media that has child development consultants working on the production.  

Tip Five: Think twice about exposing your young baby/toddler to violent imagery on the screen. Remember repetitive showings increase retention, babies are naturally wired to empathize with emotions and studies show that children have a different perception of reality and fantasy than adults.

 References 

American Academy of Pediatrics, Council on Communication and Media (2012). Policy Statement: Media Use by Children Younger Than 2 Years. May 15, 2012 from  http://pediatrics.aappublications.org/content/128/5/1040.full.html

Barr, R, Muentener, P, and Garcia, A. (2007). Age related changes in deferred imitation from television by 6-18-month-olds.  Developmental Science,10(6), 910-922.  

Christakis, D (2009). The effects of infant media usage: what do we know and what should we learn? Acta Pædiatrica, 98, 8–16.

Christakis, D. and Zimmerman, F. (2007). Associations between content types of early media exposure and subsequent attentional problems. Pediatrics, 120(5), 986 -992. doi: 10.1542/peds.2006-3322

Courage, M. and Setliff, (2009). Debating the impact of television and video material on very young children: Attention, learning, and the developing brain. Society for Research in Child Development, 3(1), 72-78.

Cozolino, L. (2006). The neuroscience of human relationships. New York: W.W. Norton & Company. 

Fenstermacher, S. K., Barr, R., Brey, E., Pempek, T. A., Ryan, M., Calvert, S. L. and Linebarger, D. (2010). Interactional quality depicted in infant and toddler videos: where are the interactions?. Infant & Child Development, 19(6), 594-612. doi:10.1002/icd.714

Field, T., Hernandez-Reif, M., & Diego, M. (2006). Newborns of depressed mothers who received moderate versus light pressure massage during pregnancy. Infant Behavior and Development, 29, 54-58.

Kirkorian, H. L., Pempek, T. A., Murphy, L. A., Schmidt, M. E., & Anderson, D. R. (2009). The Impact of Background Television on Parent–Child Interaction. Child Development, 80(5), 1350-1359. doi:10.1111/j.1467-8624.2009.01337.x. 

LaPierre, M., Piotrowski, J., and Linebarger, D. (2012).  American children exposed to high amounts of harmful TV. Unpublished paper presented at International Communication Association’s annual conference (Phoenix, AZ, May 24-28, 2012).

Marvin, R.S. & Britner, P.A. (2008). Normative Development: The ontogeny of attachment. In J. Cassidy & P.R. Shaw (Eds),  Handbook of Attachment, (pp. 269-294). New York: The Guilford Press.

Stamm, J. (2007). Bright from the start. New York: Penguin Books.

Stevens, T. and Mulsow, M. (2006). There is no meaningful relationship between television exposure and symptoms of attention-deficit/hyperactivity disorder. Pediatrics, 117(3), 665-672. Retrieved May 21, 2012 from http://pediatrics.aappublications.org/content/117/3/665.full.html

Wallin,D.J. (2007).  Attachment in psychotherapy. New York: The Guilford Press.

Zack, E., Barr, R., Gerhardstein, P., Dickerson, K., and Meltzoff, A.N. (2009). Infant imitation from television using novel touchscreen technology. British Journal of Developmental Psychology, 27, 13–26.

Zero to Three (2012). General brain development. Retrieved May 15, 2012 from  http://main.zerotothree.org/site/PageServer?pagename=ter_key_brainFAQ#bybirthZimmerman, F. J., Gilkerson, J., Richards, J. A., Christakis, D. A., Dongxin, X., Gray, S., & Yapanel, U. (2009). Teaching by Listening: The Importance of Adult-Child Conversations to Language Development. Pediatrics, 124(1), 342-349. doi:10.1542/peds.2008-2267 

Kathy Morelli American Academy of Pediatrics, Babies, Childbirth Education, Guest Posts, Infant Attachment, Newborns, Parenting an Infant Childbirth Education, guest posts, iBaby, infants, Kathy Morelli, parenting, technology, Television

by Jeanette McCulloch, IBCLC and Amber McCann, IBCLC

Jeanette McCulloch and Amber McCann recently presented a session at the 8th Breastfeeding and Feminism Symposium on March 21, 2013, speaking about the ways that social media can be used to support breastfeeding by protecting and promoting the WHO code.  They share their presentation today on Science & Sensibility to encourage all of us to be active participants in promoting action steps that help mothers and babies.  Sharon Muza, Community Manager, Science & Sensibility.

© http://flic.kr/p/e2E4Cu

Reaching breastfeeding women today means being savvy about the use of social media. While breastfeeding organizations – long without sufficient marketing resources – are stepping up to increase online efforts, formula companies are better funded and are developing sophisticated tools for reaching mothers using the Internet. Nestle, in particular, has launched a well funded social media center that has the effect of undermining women’s breastfeeding efforts. This “Formula Death Star,” though, is not going unchallenged. Using the unprecedented capacity of social media for advocates to educate and mobilize concerned consumers, a rag-tag group of rebel forces – online WHO code activists – are working to protect the WHO code and breastfeeding mothers everywhere. 

Meeting Women Where They Are At Means Using Social Media

Social media represents a revolution in communications that rivals the introduction of the printing press. Ninety-three percent^[1] of the “Millennial Generation” (those born after 1982, who have come of age in a time of dependence upon technology) are communicating online, and in the United States, for example, nearly 3 of 4 are using a social networking Website, such as Facebook, Twitter, or Pinterest.^[2]  Social media is widely accessed by women 18 – 29, regardless of race, ethnicity, or socio-economic status.

These changes are having a significant impact on how we talk about, learn about, and share information around birth and breastfeeding. More than half of all women responding to one survey expressed their intention to share their birth experience, as it happens, on social media.^[3] Moreover, time online increases after the birth—44% of US women spend more time online after a new baby is born—and the likelihood that a new mother will seek breastfeeding information and support online is high.^[4]

Women Are Seeking Information about Health Care – Including Breastfeeding – Online

Research tell us that health care providers continue to be the “first choice for most people with health concerns, but online resources, including advice from peers, are a significant source of health information in the United States.”^[5] Eighty percent of US Internet users have sought health care information online, and birth and related topics are an area of focus. Consumers using social media are not only seeking information online, but are sharing their knowledge with others. As connectivity soars through increased Internet access and the rise of the smartphone,^[6] so does altruistic sharing of what mothers learn online.^[7]

Formula marketers are fully aware of these changes. As advocates for breastfeeding mothers, we argue that it is our responsibility as advocates to understand these changes. We also can take advantage of unparalleled opportunities social media provides for advocacy organizations to engage in dialogues with mothers and affect change.

What is the WHO Code?

The International Code of Marketing of Breastmilk Substitutes (commonly called the WHO code) was written with the goal of reducing the impact of predatory marketing worldwide of formula and related products to new and expectant mothers.

The code was written and adopted in 1981 by the World Health Organization by a vote of 118 to 1 (United States was the lone dissenting vote). Thirty two countries have adopted the code as national law, with 76 others adopting portions of the code. Ethically and morally, the code should be considered worldwide, even where it has not yet been adopted as law.^[8]

Despite common misconceptions, the code does not limit access to or use of formula or related products. The code addresses marketing. And for good reason. When marketing spending on formula goes up, breastfeeding rates go down.^[9]

Formula Companies Are Making Significant Investments In Social Media

Savvy institutions understand what we’d teach you in any social media 101 presentation: social media is an unprecedented tool for listening to and engaging with an audience. Nestle has become a leading example of the use of social media both to reach consumers and to manage conflict and dissent.

Nestle is the world’s largest food company and also one of the world’s most controversial.^[10] Nestle was founded on the formulation of artificial infant milk, made of cow’s milk, wheat flour and sugar.^[11]

But they are not alone in their use of social media to reach parents. Research conducted in 2011 – before Nestle doubled their social media budget – found that 10 out 11 brands commonly available in the US have a social media presence. Examples of their use included Facebook pages, Twitter accounts, YouTube channels, mobile apps, sponsored reviews on blogs, and interactive web sites.^[12]

How Do the TOP Breastfeeding Profiles Stack Up?

Nestle and other formula companies have built these audiences using significant budgets. While overall marketing budgets are not generally available, at least $50 million was spent on formula advertising in 2004^[13]  and Nestle has been quoted saying they have doubled their social media spending in recent years.^[14] Compare this to the resources of top breastfeeding organizations, groups like La Leche League International, which is by far the best resourced breastfeeding organization in the US. In 2011, LLL International had total revenues of $1.5 million and spent a little over $115,000 on “public relations, external relations, and advocacy.”^[15]

Other organizations, like KellyMom, BestforBabes, and the relatively new Breastfeeding USA have small budgets and rely largely on volunteer efforts. The result? Although all of these organizations make a significant impact on the women they reach, compare the total number of all of their followers on Facebook – about 145,000 as of this writing – to that of Nestle Good Start at five million followers.^[16] 

Rebel Forces vs the Death Star

Nestle has combined its significant financial resources with social media experts and tools that have made it a shining example of how corporations should handle social media. Nestle’s “Digital Acceleration Team” has a trained staff monitoring each and every mention of Nestle’s brands. Team members identify negative “emerging issues” based on the volume of mentions and respond to those with a high level of engagement using a scripted playbook for team members.^[17]

The Formula Death Star, as it has become known to WHO code activists, can feel overwhelming, both because it limits our capacity to reach families and because it can feel impossible to influence change at the world’s largest food company.

However, Nestle developed these tools in response to their inability to manage an onslaught of angry advocates and consumers on social media. In 2010, Greenpeace activists were able to secure significant changes in how Nestle sources palm oil, all thanks to a YouTube video spoof that garnered over 1.5 million views, along with a resulting social media campaign that netted more than 200,000 e-mail complaints.^[18] Policy change at Nestle based on calls from consumers is possible.

Examples of Efforts to Support the WHO code Online

Although Nestle may have the Death Star, rebel forces are pulling together to provide much needed social media support for the WHO code.

A recent campaign demonstrates the power of using social media tools to organize individuals, even without an official organizing body like Greenpeace. A blog post^[19] exposing that Pan American Health Office – the regional representative in the Americas for the World Health Organization – accepted more than $150,000 in donations from Nestle sparked outrage among activists concerned that the fox was helping to buy the hen house. Within days, a private Facebook group experienced rapid growth to 400 members, now at 900 members as of this writing. Each day, members were given specific action steps, including suggested scripts for tweets directed at PAHO and WHO.^[20] Members provided impromptu trainings on Twitter use and etiquette, researched the money trail, and quickly developed strategy, including a decision to target WHO and call for a rejection of the Nestle funding.

The result: A relatively small group of consumers and advocates – through the use of Facebook and Twitter alone – were able to force the World Health Organization to respond. But more importantly, advocates began to organize and mobilize a group of motivated individuals, who will come to the next battle more organized and prepared to engage. 

How The Rebel Forces Can Defeat The Death Star

As the Greenpeace example shows, social media provides advocates with a unique opportunity to influence how companies do business. With ongoing support to the rebel forces, much-needed pressure can be put on Nestle to change their policies. But this will not come without significant work. Some areas that need support:

• Ongoing consumer support and education around the WHO code. In our anecdotal experience, mothers generally are unaware of the WHO code, or if they are aware, think that it limits access to formula (rather than limiting marketing of breastmilk substitutes). The importance of the WHO code needs to be distilled into social media friendly images and infographics to build awareness and support for future efforts.
• Ongoing education of maternal health advocates. The WHO code impacts more than just breastfeeding. Anyone concerned with infant and maternal health should be aware of and providing support for the adoptions and enforcement of the WHO code worldwide.
• Bring even more social media savvy to the table. After Nestle’s run in with Greenpeace, they brought in a top notch social media strategist to revamp their approach and provide training for the digital engagement team. Nestle uses sophisticated tools to monitor and respond to issues. The Friends of the WHO Code – and any group hoping to use social media for impact – needs people on hand who are savvy in the use of social media and the funding for at least some basic tools to help make the job collaborative.
•  Keep doing what we know best. One the greatest impacts of the PAHO/WHO crisis was to bring together the community that will need to continue to take action. This and other groups need to use traditional community organizing strategies, with social media as the tools they use to create a more level playing field.

^[1] Howe N, Strauss W, Matson RJ. Millennials Rising: The Next Great Generation. New York, NY: Vintage Books; 2000.

^[2] Lenhart A, Purcell K, Smith A, Zickuhr K. Social media and mobile Internet use among teens and young adults. Pew Internet and the American Life Project. http://web.pewinternet.org/~/ media/Files/Reports/2010/PIP_Social_Media_and_Young_ Adults_Report_Final_with_toplines.pdf. February 3, 2010.

^[3] Social media giving birth to new generation of parents-to- be. Chicago Tribune Website. http://connect.mayoclinic.org/ news-articles/863-social-media-giving-birth-to-new- generation-of-parents-to-be/portal.

^[4] Bartholomew M, Schoppe-Sullivan S, Glassman M, Kamp Dush C, Sullivan J. New parents’ Facebook use at the transition to parenthood. Fam Relat. 2012;61:455-469.

^[5] Fox S. The social life of health information. Pew Internet and American Life Project. http://www.pewinternet.org/~/media// Files/Reports/2009/PIP_Health_2009.pdf. May 12, 2011.

^[6] Smith A. Cell Internet use 2012. Pew Internet and Ameri- can Life Project. http://www.pewinternet.org/~/media//Files/ Reports/2012/PIP_Cell_Phone_Internet_Access.pdf. June 26, 2012.

^[7] Kibbe D, Kvedar J. Building a research agenda for participatory medicine. J Particip Med. 2009;1:16.

^[8] http://lactationmatters.org/2013/03/12/the-international-code-part-1/

^[9] http://www.bestforbabes.org/what-is-the-who-code

^[10] http://www.corp-research.org/nestle

^[11] http://www.nestle.com/AboutUs/History

^[12] J Hum Lact. 2012 Aug;28(3):400-6. doi: 10.1177/0890334412447080. Epub 2012 Jun 6. Milk and social media: online communities and the International Code of Marketing of Breast-milk Substitutes. Abrahams SW.

^[13] http://www.bestforbabes.org/what-is-the-who-code

^[14] http://uk.reuters.com/article/2012/10/26/uk-nestle-online-water-idUKBRE89P07Q20121026

^[15] La Leche League Annual Report: http://www.llli.org/docs/00000000000000001AnnualReport/llli_ar2011_final.pdf

^[16] www.facebook.com/Gerber

^[17] https://www.youtube.com/watch?v=ktsMa8hfgY0

^[18] http://mashable.com/2010/05/17/nestle-social-media-fallout/

^[19] http://lactationmatters.org/2012/11/08/if-you-dont-advocate-for-mothers-babies-who-will/

^[20] http://lactationmatters.org/2012/11/14/world-wide-impact-in-10-minutes-or-less-using-social-media-for-powerful-change-2/

About Jeanette McCulloch and Amber McCann

© Jeanette McCulloch

Jeanette McCulloch, IBCLC, has been combining communications work and women’s health advocacy for more than 20 years. She is a co-founder of BirthSwell, which is working to improve infant and maternal health – and the way we talk about birth and breastfeeding – by making social media accessible for birth and breastfeeding professionals. She is a board member of Citizens for Midwifery, and is active in local, statewide, and national birth and breastfeeding advocacy projects.

© Amber McCann

Amber McCann, IBCLC is a  board certified lactation consultant with the Breastfeeding Center of Pittsburgh. She is particularly interested in connecting with mothers through social media channels and teaching others in her profession to do the same. In addition to her work as the co-editor of Lactation Matters, the International Lactation Consultant Association’s official blog, she has written for a number of other breastfeeding support blogs including for Hygeia, The Leaky Boob, and Best for Babes and is a regular contributor to The Boob Group, a weekly online radio program for breastfeeding moms. Amber is particularly interested in the impact of the WHO Code and has worked on grass-roots campaigns to support its efforts online.

Sharon Muza Babies, Breastfeeding, Continuing Education, Guest Posts, Healthy Birth Practices, Healthy Care Practices, Infant Attachment, Newborns, Social Media, Uncategorized Amber McCann, breastfeeding, Jeanette McCulloch, power of social media, Social Media, WHO, World Health Organization

Regular contributor Penny Simkin discusses the research around parents’ singing to their babies in utero and the post birth benefits.  She also shares how birth professionals can encourage clients, patients and students to start this practice during pregnancy.  Part one of this two part series can be found here. – Sharon Muza, Community Manager, Science & Sensibility

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What is the research evidence for postnatal benefits to parents or babies  of singing to the baby before birth?

• Fetuses can sense audio vibrations and rhythms early in pregnancy. Later in pregnancy they hear and distinguish various sounds. (4)
• They recognize their parents’ voices after birth (1)
• Newborns prefer their parents’ voices over the voices of strangers (1)
• Repetitive prenatal reading of one story by one parent every day for weeks results in the newborn’s recognition of and preference for that story. (2)
• Fetuses respond to music by calming, becoming active, changes in FHR (depending on the music) 5,6)
• Premature babies are calmed by calming music. (7)
• Newborns and young babies are calmed by familiar music, as demonstrated by the universal use of lullabies.

Combining these findings, a proposal

In light of all that has been learned about babies, I think we can combine it all into a simple approach to enhance bonding, soothe the baby, empower parents with their own unique tool that no one else, even the experts, can do as well as they. (8) I propose that we who provide care and education for expectant parents urge them to do the following at around 30-32 weeks’ gestation (or earlier or later):

Maia sings to her sister in utero ©Penny Simkin

If parents feel they can’t sing or are too embarrassed to do it, I suggest choosing a poem that has a nice rhythmic meter, and recite that to the baby. I recommend Mother Goose Rhymes or poems in books by AA Milne, such as “When We Were Very Young” and “Now We Are Six;” or Shel Silverstein’s “Where the Sidewalk Ends” and others.

Film clips showing baby’s reactions to familiar songs 

Recent students in my birth class took my suggestion to heart, singing “Las Mañanitas,” from their Mexican culture, to their unborn baby frequently. The dad would lie with his head on the mother’s pregnant belly as they sang. They even videotaped sessions while the mother was having a non-stress test that showed the baby’s heart rate steadying when the dad was singing, and rising when he was not.  We also see the dad singing to their sweet little daughter right after the birth. Though she cries pretty hard when being suctioned and rubbed with blanket, she calms down with his singing.

I’ve just completed a film for children (9). In the film, we see 4 year old Maia singing  ”Twinkle, Twinkle, Little Star” to her baby sister before birth and again right after birth. Neve, her sister, calms down when she hears Maia singing the familiar song.

Enjoy these heartwarming scenes in the video below.

Conclusion

Maia sings to her newborn sister ©Penny Simkin

In conclusion, when parents sing one (or possibly a few) songs repeatedly to their child, before and after birth, it is a once in a lifetime opportunity to build a unique, meaningful and fun connection with their baby. The child already knows and loves the song as sung by his/her parents more than any other song, sung by anyone else. Parents always have their voice with them and can use it to comfort, soothe, and play with their child for years to come. Parents have the opportunity prenatally to give their baby a gift that becomes a gift for them as well.

Singing to the baby before and after birth is a lovely and very special thing to do. Would you consider introducing this ritual to your students, clients and patients?  Have you already done so?  How has it been received?  Do you have any stories about parents who have practiced this connection? Please share in the comments section, I would love to hear about it.  If we all get the word out to expectant families, it could have a very positive impact.

References:

1.  Brazelton B. Cramer B. (1991)The Earliest Relationship: Parents, Infants, and The Drama Of Early Attachment . Da Capo Press Cambridge, MA.
2. De Casper A. 1974, as described in Klaus M, Klaus P, Kennell J. 2000. Your Amazing Newborn. Da Capo Press, Cambridge, MA..
3. Odent M. 1984, Birth Reborn. Pantheon Books: New York
4. Klaus M, Klaus P, Kennell J. 2000, Your Amazing Newborn. Da Capo Press, Cambridge, MA.
5. Verny T, Kelly J. (1982)   The Secret Life of the Unborn Child. Dell: NY
6. Chamberlain D. (2013) Windows to the Womb. North Atlantic Books: Berkeley, CA.
7. Lubitzky R, Mimouri F, Dollberg S, Reifen R, Ashbel G, Mandel D. 2010. Effect of music by Mozart on energy expenditure in growing preterm infants. Pediatrics 126;e24-e28. DOI: 10.1542/peds.2009-0990.
8. Simkin P. (2012) Singing to the baby before and after birth.  International Doula 19(3):30-31
9. Simkin P. (2013) “There’s a Baby: A Children’s Film About New Babies.” PassionflowersProductions: Seattle.

Penny Simkin Babies, Childbirth Education, Guest Posts, Infant Attachment, Newborns, Parenting an Infant Childbirth Education, guest post, Infant Attachment, infants, newborns, Penny Simkin, Singing to baby

Regular contributor Penny Simkin shares her experiences with parents who sing to their baby in utero and then continue after birth and looks at what the research says about this practice in this two part blog piece.  Part two can be found here. Join me in reading about some unique situations that Penny shares as she explores this opportunity for parents to bond with their unborn child.  - Sharon Muza, Science & Sensibility Community Manager.

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People have sung to their babies forever. Every culture has lullabies and children’s songs that are passed down through the generations. New ones are written and shared and the custom goes on –a rich part of the fabric of human civilization. These songs are designed to relax babies, calm their fears, or entertain and amuse them throughout childhood. As we have learned more about the life and capabilities of the fetus, we have realized that the fetus can hear clearly for months before birth, and also can discriminate sounds and develop preferences for some sounds over others. Furthermore, at birth, newborns respond to familiar sounds by becoming calm and orienting toward the source of the sound, and even indicate their preferences for familiar voices and words over the unfamiliar.

Newborn babies prefer their parents’ and other familiar voices over those of strangers (1), and they prefer hearing a story that their mother had read frequently in utero rather than an unfamiliar story or the familiar one read by someone other than their mother (2).  Fetuses hear, remember, have preferences, respond to, and discriminate among differences — in sounds, music, voices.

These exciting findings have inspired educators to advocate prenatal learning through recordings played through a mother’s abdomen (of languages, music, and other things). They have inspired birth activists and baby advocates to provide a safe enriching environment for the fetus. Advocates of prenatal bonding emphasize communication between parent and unborn child as a powerful way to strengthen the bond.

I’d like to offer my take on this phenomenon and urge everyone who works with expectant parents to tell them about some unique and heart-warming benefits of singing or reciting rhymes to their unborn babies.

I think my interest in parents singing to their babies prenatally began in the 1980s when I first read Michel Odent’s book, “Birth Reborn”(3). Odent is a French physician who has always been ahead of his time. He had a unique and original maternity care program at his hospital in Pithiviers, France. His book had a great influence on my understanding of normal birth, and the book is still worth reading today, along with all his subsequent ones. One lovely aspect of his program is particularly relevant to the topic of this blog post. The program included a weekly singing group at the hospital, attended by pregnant women, their partners, families with young babies, the midwives, and Odent himself. The group was led by an opera singer who believed singing to be important for fetuses, babies and those who care for them. Odent’s account inspired me to invite Jamie Shilling, a folk singer who had recently taken my birth class, to bring her guitar and her baby to my classes a half hour early each week and sing with the expectant parents. That went on very successfully for several class series, then the groups decided to combine and carry on in a monthly sing- along for expectant parents and new families, in a private home –Although the groups  eventually disbanded, they provided many parents with opportunities to sing together and connect with their babies and each other in relaxing and peaceful surroundings. A high point during that time was when Michel Odent came to Seattle to give a conference and he agreed to come to one of our sing-alongs. See the photo of Jamie leading the group of expectant and new parents, with Michel Odent and myself participating. He taught us the song, “Little Black Cat” in French.

© Penny Simkin

I couldn’t help but think during those times, how the unborn and new babies must love hearing their parents singing. Seeing the parents caressing the mother’s belly as they sang was heartwarming. That happened  in the mid- 1980s, when much research on the capabilities of the unborn and newborn baby was beginning to be published. Recalling those special gatherings, I have always suggested to my students in childbirth class that they sing to their unborn babies, or play their favorite recorded music, with the thought that the baby will remember it and be soothed by it after birth.

But it was one couple, whom I served as a birth doula, who took my suggestion to another level, and showed me much more about the value of singing to the unborn baby. They were having their second child, hoping for a VBAC. When they discovered that they were having a boy, they decided to give their baby the song, “Here Comes the Sun” and sang it to him often during pregnancy. The VBAC was not possible, and as the cesarean was underway, and the baby boy, crying lustily, was raised for the parents to see, the father began belting out the baby’s song. Though the mother didn’t have a strong voice under the circumstances, she also sang. The baby turned his head, turned his face right toward his father and calmed down while his father sang. Time stopped. As I looked around the operating room, I saw tears appear on the surgical masks.

It’s a moment I’ll never forget, and it was that event that taught me the value, not only of singing prenatally, but also, singing the same song every day. Not only does the baby hear his or her parents’ voices, not only does he or she hear music, but the baby also gets to know one song very well. Familiarity adds another feature to this concept, because we know that fetuses have memory and prefer the familiar. Think for a moment about what this might have meant to our cesarean-born baby –suddenly being removed from the warmth, wetness, and dimness of the womb with its mother’s reassuring heartbeat, into the cold bright noisy operating room. The baby’s transition to extrauterine life is hectic and full of new sensations. He cries reflexively, but perhaps also out of shock and discomfort. Then he hears something familiar – voices and music and the sounds of words that he has heard many times before – something he likes. He calms down, and seeks the source of this familiar song. Everyone present is moved by this gift to the baby from his parents.

I’ve become passionate about this idea as a way to enhance bonding between parents and babies, but also as a unique and very practical measure for soothing a fussing baby or a sick baby who can’t be held or breastfed. Please join me on Thursday, for Part Two on this topic when I will continue the discussion including research evidence that supports this concept: practical suggetions for childbirth professionals to share with expectant parents; and some very endearing film clips of families singing to their babies.

References:

1. Brazelton B. Cramer B. (1991)The Earliest Relationship: Parents, Infants, and The Drama Of Early Attachment . Da Capo Press Cambridge, MA.

2. De Casper A. 1974, as described in Klaus M, Klaus P, Kennell J. 2000. Your Amazing Newborn. Da Capo Press, Cambridge, MA.

3. Odent M. 1984, Birth Reborn. Pantheon Books: New York 

Penny Simkin Cesarean Birth, Childbirth Education, Doula Care, Guest Posts, Infant Attachment, Newborns, Parenting an Infant, Vaginal Birth After Cesarean (VBAC) Childbirth Education, Infant Attachment, Michel Odent, newborns, Penny Simkin, perinatal bonding, Singing to baby