Science & Sensibility

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. 

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.

Five positive ways for parents to interact with their babies:  Consistently interact with a baby using prolonged eye contact, gentle skin to skin touching and smiling Actively watching appropriate media with a baby is a way for parents to get a needed sitting rest and also enhances learning and mitigates negative effects Baby massage is a wonderful tool for parents. Studies show it reduces anxiety and depression in both parents and babies (Field, Hernandez-Reif, M. and Diego,  2006) Teach her to regulate her emotional states by appropriately soothing her when necessary. She is learning how to accept and tolerate her own emotional states from parents, so remain calm and consistent. Remind parents that they don’t need to be perfect, they just need to be good enough!

 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

In this series about EMDR (Eye Movement Desensitization and Reprocessing), Part One looked at qualitative research evaluating EMDR as treatment for post-traumatic stress disorder (childbirth onset). In Part Two, EMDR clinicians weighed in on their feelings about the safety of EMDR during pregnancy. When those EMDR posts were published, I received a lot of behind the scenes feedback from women who either loved or hated their experiences with EMDR; there didn’t seem to be a middle ground!

I felt these women’s voices need to be heard (many thanks to Sharon Muza, S&S Community Manager, for her gracious agreement!) The results are here: four interviews conducted with four real women who suffered from trauma in the perinatal period and tried EMDR.

It’s unfortunate these lovely women suffered extreme emotional turmoil at such an important time in their life; when they were working and hoping to build their emergent family and when they were primarily responsible for the safety and care of their infants.

Through sharing their stories, all women indicated to me that they hope that their voices will contribute to the collective movement to incorporate mental health care into the overall care of women and their families in the childbearing year.

Characteristics of Their Trauma

All of the women interviewed experienced trauma in the early postpartum period. Three suffered specifically from birth trauma; all experienced a severe perinatal mood disorder. Three of the women additionally were coping with complex, long-term, multi-layered emotional trauma, stemming back to abuse in childhood.

All of the women interviewed were seeing licensed therapists who incorporated EMDR into their overall treatment plan for trauma. Some asked to have their identities masked, so identifying details and names are obscured, but the overall personal statements and feelings are preserved.

They are empowering to all of us in that ALL of them valued their mental health and were brave enough to seek professional help!

Personal Healing Processes

The women interviewed are all emotionally mature adults. They’re aware of their life situations and the impact of trauma on their well-being. They’ve worked hard to explore and develop life-long skills and methods of managing their emotions. Thus, these are all women who are proactive, sophisticated and intelligent about their emotional healing processes. Before they used EMDR, all of the women had already incorporated many forms of healing into their personal self-care plans.

Their self-care plans included: long-term psychotherapy, journaling, expressive therapies such as art, music and movement, yoga, exercising, gardening, cognitive behavioral therapy, goal setting and medication. One woman indicated she was in so much pain from long-term, severe, past abuse she had seriously discussed electroconsulsive therapy with her psychiatrist. So, when their trusted therapists suggested trying EMDR, specifically designed to treat trauma, all the women agreed.

Personal Perinatal Traumatic Events:

In their own words, the women share their individualized, personal perinatal trauma experiences below.

Birth Trauma:

Kim (not her real name) shares her traumatic birth story:

“My son was born after an easy pregnancy but a complicated birth. I’d very nearly had a vaginal birth; the nurses could see the top of his head, but it was turning to the side each time I pushed. After nearly 2 hours of this, I underwent a c-section because I had spiked a fever and things were not progressing. During my c-section, I was overcome by anxiety and completely paralyzed by fear.

I literally thought I was dying as my son was being born, yet due to the panic, I was unable to verbalize this fear to anyone.

I spent that time shaking and having what I thought were my last panicked thoughts and breaths. It was the the most afraid I’ve ever been in my entire life, and also the most alone I’d felt, despite being surrounded by others.

After the surgery, I wasn’t able to hold my son for 3 hours. I spent the time in recovery, scared that something were wrong and nobody was telling me. I am still not sure of the reason for the delay.

My maternity leave felt long, due to postpartum anxiety and depression and a baby who barely slept and I cried nonstop some days. I felt like a terrible mother who was unable to console her child or enjoy him. I felt tremendous guilt. In addition to the emotional aspects, my c-section scar was not healing properly, so I felt as if I were constantly making a 30-mile trek (newborn in tow) to my ob-gyn’s office for checkups. “

Birth Trauma Layered on Childhood Trauma:

Karen (not her real name) said:

“My very traumatic birth triggered already active memories of severe childhood abuse, parental suicidal attempts in front of me, active alcoholism & substance abuse in the family and severe childhood neglect.”

Helen (not her real name) said:

“I was working on birth trauma at the start of the EMDR, but later on, abuse, illnesses, and marital distress. I was mainly focused on the birth trauma I had experienced when I used EMDR.”

Postpartum Traumatic Event Layered on Childhood Trauma:

Jessica Banas explained her perinatal trauma as such:

“I was traumatized by my childhood with my father. He was very emotionally abusive. Seeing him overdose (on a drug called GHB) the first night my parents were to supposed to have been watching my infant son for me, so I could rest, felt like the ultimate betrayal. Once again, not only were they NOT there for ME, but I had to SAVE them (again) instead!!!”

Women’s Experiences Show Us Moms with PTSD Suffer Co-morbid Perinatal Depression & Anxiety

It is fascinating and sad that all three women with pre-existing trauma stated their prior trauma was re-triggered by a perinatal traumatic event (traumatic birth or other traumatic event postpartum). And all four suffered from severe postpartum depression and anxiety after their traumatic perinatal event. A woman’s mental health is an important aspect of the childbearing year.

As discussed in a previous blog post, one in four women suffers depression at some point in her life, and women are more likely to suffer depression during and shortly after pregnancy than at any other time (Nonacs, 2006). Ruta Nonacs, MD (2011), editor-in-chief of Massachusetts General Hospital’s Center of Women’s Mental Health’s website estimates annually in the US, there are about 4 million births, and about 950,000 to 1,000,000 mothers suffer from depression either during or after childbirth every year. 

Having a personal history of a mental illness in her lifetime, such as depression, anxiety, PTS/PTSD, OCD or bipolar disorder (remember, this is whether it was diagnosed & treated or undiagnosed & untreated) increases a woman’s risk of postpartum depression. A previous history of previous postpartum depression increases a woman’s risk of a recurrence to 50 – 80 % risk of recurrent PPD, as compared to a 10- 20% risk factor without having had a prior episode.

It’s important to note that the women’s constellation of PTSD symptoms intensified and they developed severe postpartum depression and anxiety.

Jessica eloquently states how important women’s mental health is to the postpartum period:

” One important symptom of my PTSD that complicated and worsened my PPD was when my infant son would cry and interrupt my ruminations of my father Od-ing. I’d get angry….that would trigger thoughts of wanting to harm my son and cause me great anxiety and incredible guilt…..there were many times I was too afraid if I went to tend to him, I’d treat him harshly, or hurt him This created such a sense of worthlessness and shame, I thought of suicide one night. Instead, I told my husband and we reached out and got help.

It is a very important aspect of PTSD in that I am personally aware how detrimental it is on PPD. My PPD rapidly escalated after getting PTSD. And one seemed to feed on the other. Getting treated for BOTH issues was very important.”

Women’s Experiences Show Us the EMDR Outcomes

Two very positive experiences

Kim’s Experience with Traumatic Birth & Postpartum Anxiety & EMDR

Kim, who suffered from birth trauma and postpartum anxiety, had a positive experience with EMDR. Here is her story of healing.

Kim said that her therapist incorporated EMDR into her current psychotherapy sessions. She said she hadn’t realized that she’d been suffering with PTSD until almost a year after the incident. She says she discovered her anxiety was stemming from a traumatic birth experience at a therapy session:

Kim says:

“…of course I’d had PTSD from thinking I was dying while my son was being born! My anxiety, which had a lot to do with waiting for something terrible to happen to me or my son, started to make sense in light of this new revelation.”

Kim experienced the EMDR itself as calming. She held tappers in her hands while her therapist led her through visualizations. Her therapist warned her that EMDR could be emotionally triggering and if she needed to call her, she was welcome to do so. And it was triggering for Kim. After her first session, she suffered from an anxiety attack and had to call her therapist, and received the help she needed.

Ultimately, Kim’s overall experience with EMDR was emotionally freeing and healing.

She goes on to say:

“Up until the EMDR, I was unable to speak about my c-section at all. I couldn’t see anything related to the birth experience (with or without c-sections involved) on television, either. If I caught a glimpse of a birth on TV, I cried. I had a lot of anxiety on the few occasions I tried to watch A Baby Story on TLC, as a test to see how I felt watching another woman’s experience.

After EMDR a few times, I became more comfortable thinking about and processing my experience, and even eventually talking about it with others. I no longer viewed my scar as something horrible and ugly. Having EMDR gave me back my confidence because it helped me stop seeing myself as a failure (because I needed a c-section instead of birthing vaginally). “

Kim would recommend EMDR to another person trying to recover from trauma, but with some warnings about the emotional response.

Jessica’s Experience of Postpartum Traumatic Event, PPD, Suicidal Ideation & EMDR

Jessica, who experienced the trauma of her father’s overdose while her parents were supposed to be watching her baby, had a positive experience with EMDR. Here is her story of healing:

Jessica said that her therapist incorporated EMDR into her current psychotherapy sessions. Her therapist suggested she try something “new” that would remove the sting of the trauma from her mind. Jessica was skeptical but thought she’d give it a try.

Jessica says:

“The EMDR was pretty much wrapped around by talk therapy in that we’d start out by talking and end up by talking… EMDR took the emotional ties from the traumatic memories away. I no longer find myself reliving any of those memories that were treated with EMDR. I no longer feel any emotional pain from the OD event. I have no loss of sleep, anger, depression, or any anxiety over that event.”

Jessica says she did not find the EMDR emotionally triggering at all, but many childhood memories came flooding back. .

“Not at all…frankly, I thought it was lame at first (wiggling a finger in my face? REALLY?) and had no hope it would have ANY effect at all. Once we (quickly) healed the OD trauma, memories from my childhood did come flooding back! I found that to be very interesting! Fortunately, my childhood was not as terrible as many, so I could handle this phenomenon.”

Jessica recommends EMDR:

“…as long as the person is seeing a well trained, compassionate therapist! EMDR helped me and I have gone on to suggest it to other people who were in pain as I was….those people have been healed by EMDR as well….I find it a useful treatment and extremely non-invasive compared to other treatments!!”

Two very negative experiences

Karen’s Experience with Birth Trauma, Past Trauma, PPD, PPA & EMDR

“My experience was physical and emotional and in both cases negative. I felt physically ill, vertigo, nausea. Disorientation, short-term memory loss, headache. Emotionally, it was detrimental as it brought up my most difficult trauma and I felt completely triggered. I tried to hang in there with the process, but only did a few sessions. The EMDR sessions were not processed with in-between traditional talk therapy sessions. The EMDR made my symptoms worse, my anxiety worse, and the neurological side-effects were horrible. While my therapist did a wonderful job at regrouping,  after we decided to stop doing it, I actually went up on my medications and saw her 2x a week for a while. It was just too much. What I think had happened to me was more resurfacing of old memories that I had compartmentalized in years of talk therapy and medication. I actually think I needed a medication adjustment when I was so desperate for relief. “

Karen would not personally recommend EMDR to another.

Helen’s Experience with Birth Trauma, Past Trauma, Postpartum Mental Health Complications & EMDR

“My therapist suggested the EMDR may be helpful for both traumas (birth and childhood). I had 6 sessions that were each an hour long. Some of this process was also traditional talk therapy in between the EMDR. I found EMDR not helpful in treating my traumas.”

“It was extremely triggering and the therapist pushed me into a lot of it. She would try to help me regroup by taking deep breaths and little breaks in between. But I always felt drained after each session and even more triggered with PTSD.”

Helen would not recommend EMDR for another person:

“I do not think I would personally recommend EMDR to another person for a trauma. I believe the therapist shoved me into it too soon and left me for days swirling in the emotions of that. I have heard it can be wonderful and healing for others. For me, it triggered too much to soon and my experienced left me more traumatized. I can’t think of those (EMDR) coping skills and techniques without feeling overwhelmed with memories.” 

Conclusions

As we can see from real women’s experiences, EMDR was extremely triggering to two of the women, but resolved emotional distress well for the two other women. Again we are reminded that one size does not fit all when it comes to treating mental health.

The women’s experiences indicated that when working with EMDR for trauma, even experienced and trusted therapists encountered strong triggering responses in their clients. In these instances, these therapists needed to know how to appropriately re-group and therapeutically support their clients either in the session and/or be appropriately available outside of scheduled sessions.

It was not appropriate for a therapist to urge a client to try or keep using EMDR if the client did not really want to, or if the client was having an overall non-therapeutic effect.

As we can see from these real women’s experiences, the treatment of post-traumatic stress has the potential to be devastating to the client as far as awakening or re-triggering compartmentalized past emotional distress.

In this small article and small example, it is interesting to me that the four women who volunteered to share their stories in this small had extreme reactions to EMDR, none neutral. These results reinforce my usual conservative approach to managing emotional distress, that is, if one is suffering from debilitating mental and emotional distress, it is best to consult with a licensed professional.

What I find empowering about these interviews is that ALL of these women VALUED their mental health and were brave enough to seek help. Fight the stigma! Don’t be afraid to get help!

Author’s Note: None of these women were or are my clients. I sought out non-clients for the purpose of these interviews.

References

Nonacs, R. (2006). A deeper shade of blue. New York: Simon and Schuster.

Kathy Morelli Birth Trauma, Cesarean Birth, Childbirth Education, Depression, Do No Harm, EMDR, Evidence Based Medicine, Maternal Mental Health, Perinatal Mood Disorders, Postpartum Depression, Pregnancy Complications, PTSD, Research, Trauma work EMDR, guest posts, Kathy Morelli, maternal mental health, Post Traumatic Stress Disorder after childbirth, postpartum depression, PTSD, trauma, traumatic birth

Today, Kathy Morelli shares the second part of her series on EMDR, and exams clinical opinions  on the safety of EMDR as a treatment modality.  You can find part one of Kathy’s post on EMDR here. –  SM

There is a lack of specific empirical research to support the safety or lack of safety about incorporating EMDR into a trauma treatment plan for a pregnant woman.

However, there are many experienced trauma clinicians who work weekly in their practices with pregnant women. I gathered clinical information about this issue from several experienced and distinguished trauma clinicians who work with women, pregnancy and trauma and use EMDR.

Background Research about Maternal Stress and the Uborn

The mom and unborn baby (I will henceforth use the term, uborn, borrowed from Michelle LeClaire O’Neill) are connected via stress hormones, which reach the uborn via the placenta.

There are many studies about the effects of stress hormones on the uborn. In general, the research draws a distinct difference between the impact of moderate amounts of stress and the impact of long-term chronic stress. (For a more detailed discussion of this, see How Much Stress is Too Much Stress in Pregnancy?)

Chronic and extreme stress is characterized as famine, poverty, major natural disasters, domestic violence and other extreme life stressors. Studies show the release of excessive amounts of maternal stress hormones may impact the uborn’s brain development (Johnson, 2012; Mulder et al, 2002). In addition, there may be changes in the blood flow to the uborn and this may impact the development of other organs. The research also indicates there are individualized, mitigating factors on the effects of extreme stress, such as social supports and individual resilience (Johnson, 2012; Mulder et al, 2002).

While there isn’t much specific research about the effects of using Eye Movement Desensitization and reprocessing (EMDR) to treat PSTD (childbirth onset) in the pregnant population, there is a lot of research about using EMDR to treat PTSD in the general population.

What are clinicians’ experiences regarding the safety of using EMDR during a subsequent pregnancy to treat PTSD (onset childbirth)?

In my interviews of clinicians regarding the processing of traumatic material with pregnant women, several guidelines emerged:

•  Little or no empirical research on this issue exists
• Clinician must be experienced in trauma work
• Clinician must use good clinical judgment, as it is not always appropriate to go forward
• Treatment must be tailored to the individual woman and her needs
• Recommend consultation with her physician if there are existing physical issues or if she is in her third trimester
• Processing traumatic material during pregnancy generally does more good than harm

Benefits cited:

• processing attachment trauma (abuse) promotes healthy attachment & bonding behaviors
• enhances enjoyment of pregnancy,
• enhances confidence in healthy birth
• can be used to reinforce positivity about the birth, including what was learned in childbirth classes, such as the Lamaze methods

Julia Wood, M.D., a psychiatrist specializing in women’s issues, has a special focus on trauma and borderline personality disorder. She is Medical Director of Brookhaven Recovery Retreat for Women. Her past position was at the Massachusetts General Hospital Center of Women’s Health. She began by saying, when working with traumatic material with pregnant women, in the absence of empirical research indicative of either benefit or harm to the developing fetus, one must use good clinical judgment.

While at Massachusetts General Hospital’s Center for Women’s Health, she worked with a disenfranchised population: pregnant women under chronic stress due to domestic violence and poverty. Although she believes caution should be used when treating traumatic material with a pregnant woman, she said her overall clinical experiences indicated it was beneficial for her patients to be treated for their psychological trauma during pregnancy.

Dr. Wood stated the mental health support helped her patients process their personal traumatic experiences, be more confident about pregnancy and birth, form a more positive attachment with their babies and learn positive coping skills.

Dr. Wood said she does not favor any particular trauma treatment modality, but stressed that the value of clinical experience when treating trauma is key and good clinical judgment is a necessary component of compassionate and successful treatment.

Heidi Koss, LCSW, Executive Director of Postpartum Support International of Washington State, and an expert clinician in childbirth trauma, says she uses an integrative approach with pregnant clients. She creates an individualized treatment plan, incorporating EMDR and other modalities such as interpersonal therapy, mindfulness and somatic experiencing to help her clients process traumatic material. When using EMDR, she says “….I don’t have them recall all the details of their previous traumatic birth, just enough to access the neural pathways we are targeting in order to calm, to lessen any spikes in cortisol that might impact the fetus.”

Kathleen Reay, Ph.D., who has been teaching EMDR for 12 years, has worked extensively with traumatic material with pregnancy clients. Dr. Reay stresses that good clinical judgment must always be used.

Dr. Reay says she’s never come across any safety issues in her work with pregnant clients and she believes there are extensive benefits to working through traumatic material while pregnant. However, Dr. Reay says that when the mother has a pre-existing medical or physical issue, or if she is in her third trimester, she discusses her work with her client’s physician, before beginning any treatment with EMDR, in order to ensure safety. She also says it’s important to discuss the treatment with the mom, too, assuring her she may stop the session(s) at any time.

Dr. Reay believes the benefits to processing traumatic material during pregnancy are twofold. One, it helps the mom work out her own traumatic attachment issues (perhaps related to abuse) and addresses pervasive emotional dysregulation, thus promoting self-regulation, appropriate regulation of her baby and a secure attachment with her uborn and newborn.

Two, EMDR can be used to strengthen the mom’s own resources and positive attitudes about her upcoming birth, such as positive beliefs that she will be able to get the support shes needs, and EMDR can be used to reinforce whatever birth practice the mom chooses to use, including Lamaze’s Healthy Birth Practices.

Julie Greene is an EMDR trainer with extensive experience with pregnancy and trauma. She has been practicing EMDR since 1998 and teaching since 2005. Ms. Greene says as a trainer as well as a clinician, she stresses caution and safety first. She has extensive experience with using EMDR during pregnancy, and has an integrative approach, using mindfulness in her practice as well.

Like Dr. Reay, Ms. Greene uses EMDR to do resource development with any pregnant client, in order to strengthen inner feelings of self-efficacy and emotional flexibility.

Also like Dr. Reay, her cautionary clinical signals are if the mom was either in her third trimester or experiencing physical difficulties, she first speaks to her client’s physician, in order to assess whether or not to proceed with the trauma treatment.

Generally, her thoughts are the benefits to the baby are usually higher than the risk. Ms. Greene says the best reasons to do EMDR trauma work during pregnancy are when there are issues stuck in the mom’s bodymind related to pregnancy and birth. For example, she says, if the mom is terrified and stressed the entire pregnancy, there is a benefit to the current pregnancy to clear this out of the mother’s system using EMDR.

Or, if the client has traumatic history, such as sexual abuse, locked in her body, this can cause a lot of mental and emotional difficulty during pregnancy. There may be a lot of shame and negative thoughts and feelings about her body, the pregnancy, and fears of becoming a parent. Ms. Greene says EMDR is a good way to release this.

Like Dr. Reay, Ms. Greene uses EMDR to help her clients access and strengthen their internal resources, so they feel and believe they made good decisions that are right for them for their personal birth and parenting experience.

To sum up, when processing traumatic material with EMDR with pregnant women, these clinicians used caution and followed good clinical guidelines, tailoring the treatment to the individual woman, and generally believed the benefits regarding birthing and parenting confidence outweighed the harm.

References

EMDR Institute, Inc. (2012). Research Overview. Retrieved July 29, 2012 from http://www.emdr.com/general-information/research-overview.html

Johnson, K. (2012). The effects of maternal stress and anxiety during pregnancy. Retrieved September 25, 2012 from http://bit.ly/QhNyIq 

LeClaire, Michell O’Neill (2000). HypnoBirthing- the original method. Chicago: Papyrus Press.

Mulder, E.J.H., Robles de Medina, P.G., Huiznik, A.C., Van den Burgh, B.R.H. & Buitelaar, J.K., &Visser, G.H.A., (2002). Prenatal maternal stress: effects on pregnancy and the (unborn) child. Early Human Development, 70, 3-14.

Parnell, L. (2007). A therapist’s guide to EMDR: Tools and techniques for successful treatment. New York: W.W. Norton & Co.

SAMHSA National Registry of Evidence-Based Programs & Practices (NREPP) (2012). Eye movement desensitization and reprocessing. Retrieved July 29, 2012 from http://nrepp.samhsa.gov/ViewIntervention.aspx?id=199

Wood, J. PTSD and Childbirth. Retrieved July 29, 2012 from http://www.womensmentalhealth.org/posts/ptsd-and-pregnancy/

 

Kathy Morelli Birth Trauma, Cesarean Birth, Depression, EMDR, Guest Posts, Infant Attachment, Kathy Morelli, Maternal Mental Health, Parenting an Infant, Postpartum Depression, PTSD, Trauma work birth trauma, childbirth PTSD, EMDR, guest post, Kathy Morelli, Lamaze Healthy Birth Practices, postpartum depression, PTSD

Today’s post, the first of two, is written by regular contributor, Kathy Morelli, and provides some insight into a mode of therapy, EMDR, that can help women deal with birth trauma .  Are you a provider who is trained in EMDR?  Or have experienced it yourself?  Share your thought sin our comments section.- SM

Research by doctoral candidate Claire Stramrood and her colleagues of the Netherlands was published in the March, 2012 edition of Birth, The Patient Observer: Eye-Movement Desensitization and Reprocessing for the Treatment of Posttraumatic Stress following Childbirth.  The researchers were evaluating the possibility of using Eye Movement Desensitization and Reprocessing (EMDR) as a treatment modality for post-traumatic stress disorder (PTSD) (childbirth onset) during a subsequent pregnancy. The researchers worked with three women who experienced traumatic births, were diagnosed with post-traumatic stress disorder (childbirth onset) and were now subsequently pregnant again.

 The researchers hypothesized EMDR could be used to reduce the womens’ symptoms and improve confidence about the current pregnancy and impending birth.

Post-traumatic stress disorder (childbirth onset) is a debilitating condition affecting between 1 – 6% of women in developed countries (Ayers, 2008; as cited in Stramrood et al, 2012). It is important for women of childbearing years to receive treatment in a timely manner to reduce current suffering and to avoid a cycle of pain that might carry over into the next generation.

A traumatic experience during a previous birth can set up a woman’s subsequent pregnancy as a trigger for recurring symptoms. During the subsequent pregnancy, women may experience intrusive flashbacks, high anxiety about the upcoming birth, have an over-riding desire to schedule a cesarean section, have an increased risk for developing a perinatal mood disorder, and experience ambivalence about her unborn baby thus interfering with bonding and attachment before and after the birth (Stramrood et al, 2012).

 

 

What is EMDR?

EMDR is a mindbody therapy designed to help people heal from disturbing events or trauma. Francine Shapiro, Ph.D., developed EMDR in the late 1980s. More than twenty randomized studies have found EMDR to be effective in the treatment of post-traumatic stress disorder (PSTD) and hundreds of case studies report effective relief. The Substance Abuse and Mental Health Services Aministration (SAMHSA) of the U.S. Department of Health and Human Services cites EMDR as an evidence-based treatment for trauma. Because of the highly reactive nature of traumatic client material, EMDR is taught only to licensed mental health professionals.

How is EMDR Integrated into Psychotherapy and How Does it Work?

Psychotherapists integrate EMDR into their client care by designing a structured, goal-oriented treatment plan including history taking, establishment of client safety measures, supportive ego strengthening techniques, identification of traumatic memories, and the reprocessing of the traumatic memories. It is believed that EMDR allows the traumatic memories to be reprocessed so as to actually be stored and retrieved in a different way (Parnell, 2007).

Traumatic memories are stored in the brain’s neuronal pathways differently than non-traumatic memories. They are fragmented, thus recollection of a traumatic event is fragmented and can be intrusive. It is difficult for a person to achieve perspective on an event that is horrific in nature but also cannot be recalled as a whole, inclusive of emotion, image and narrative (Rothschild, 2000).

In addition, the EMDR clinician utilizes the techniques of positive resourcing, positive templates and coping skills, all created directly by and with the client.

The study: Three women’s histories, childbirth trauma experiences, EMDR treatment protocols & results

The three women in the study were all in their twenties and giving birth for the first time.

Patient A

Patient A had complications with hypertension during pregnancy. After a 17 hour labor and an unsuccessful vacuum extraction, she underwent an emergency cesarean section. She said she felt like the whole experience was like a “bruise” and felt like she was unable to “stand up for herself.” She felt disempowered by the experience. She blamed the staff for the birth events. She experienced anxiety, intrusive thoughts and flashbacks when passing the hospital.

After four EMDR sessions, Patient A no longer experienced flashbacks or intrusive thoughts. She reframed her feelings about herself during the birth and felt she did a good job. She was proud of herself for completing the EMDR treatment. She said she did not prefer either a natural or surgical birth, just an experience where she did not feel “psychologically damaged.” Her second child was born by cesarean section and she looks back on the birth of her second child as a positive event.

Patient B

Patient B had life-long hypothyroidism, but then developed painful unilateral hydronephrosis, a painful kidney condition, in week 31 – 39 of the pregnancy. During the delivery, she experienced a tear up to her anus. She could not stand up after the birth for three weeks. She reported still experiencing pain at the suture site two years later and an inability to insert tampons and experience pain-free intercourse. She says the birth was “one big trauma” and could not look at her vulva or vagina since.

After six EMDR sessions, Patient B felt calmer, less alone, and was more confident about her next birth. She had scheduled a cesarean section, but now decided she wanted a vaginal birth. She prepared a birth plan where she stated her desires for the birth. She delivered her second child vaginally, had some tearing and sutures, but did not experience subsequent painful intercourse. She looks back on the birth of her second child as a positive event.

Patient C

Patient C had a traumatic past in that she had personally witnessed the death of two of her brothers due to an inherited cardiac event. She was monitored for cardiac symptoms for the duration of the pregnancy but was healthy. She developed symptomatic pre-eclampsia after the birth and was hospitalized for headache, shakiness and elevated liver enzymes. She says her experience of illness and the medical interventions, while necessary, were traumatic to her because of the negative cardiac family history. She experienced flashbacks, intrusive thoughts and debilitating anxiety.

Patient C underwent five EMDR sessions, dealing with her postpartum experience, the deaths of her brothers, her father’s hospitalization and her medical interventions. After these sessions, she reported no post-traumatic stress symptoms, much less anxiety and generally felt better. She gave birth vaginally. She experienced postpartum hemorrhage and hypertension. She looks back on the birth of her second child as a positive event.

Implications of the study’s findings

All three women experienced post-traumatic stress symptoms for several years before becoming pregnant a second time. After the treatment with EMDR, all three women’s symptoms abated and their emotional suffering was much reduced. Before completion of the EMDR sessions, all three women were asking to schedule cesarean surgery. Afterward all three were less fearful of the upcoming birth experience and were open to attempting to give birth vaginally.

Thus, it appears that EMDR can be used to help some women move through her emotional distress, experience more joy in pregnancy, shift towards confidence towards her unborn baby and the upcoming birth.

In the study, the clinician’s approach was flexible in how s/he integrated EMDR into an overall personalized, clinical treatment plan; the treatment plans were informed by the women’s individualized needs.

Thus, it appears it is important for clinicians to have enough experience with working with trauma to help clients develop feelings of safety, a good working therapeutic relationship and to know how to incorporate EMDR effectively into an overall treatment plan, in order to be effective.

Part Two of this series, scheduled for Thursday will examine some clinical opinions about whether or not it is safe to process traumatic material using EMDR during pregnancy.

References

EMDR Institute, Inc. (2012). Research Overview. Retrieved July 29, 2012 from http://www.emdr.com/general-information/research-overview.html

Parnell, L. (2007). A therapist’s guide to EMDR: Tools and techniques for successful treatment. New York: W.W. Norton & Co.

Rothschild, B. (2000). The body remembers: The psychophysiology of trauma and trauma treatment. New York: W.W. Norton & Company.

SAMHSA National Registry of Evidence-Based Programs & Practices (NREPP) (2012). Eye movement desensitization and reprocessing. Retrieved July 29, 2012 from http://nrepp.samhsa.gov/ViewIntervention.aspx?id=199

Stramrood, C.A.I., van der Velde, J., Doombos, B., Paarlberg, K.M., Willibrod, C.M., Schultz, W. & van Pampus, M.G. (2012). The patient observer: Eye movement desensitization and reprocessing for the treatment of post-traumatic stress following childbirth. Birth, 39(1), 70-76.

Kathy Morelli Birth Trauma, Cesarean Birth, Childbirth Education, Depression, EMDR, Guest Posts, Kathy Morelli, Parenting an Infant, Perinatal Mood Disorders, Postpartum Depression, PTSD, Survivors of Sexual Abuse, Trauma work birth trauma, chidbirth and PTSD, childbirth related PTSD, EMDR, guest post, Kathy Morelli, postpartum depression, PTSD, Trauma work

Today’s Science & Sensibility post is written by regular contributor, Kathy Morelli.  To learn more about Kathy, please check out our contributor page or visit her at her website.

Lamaze Childbirth Educators work hard to be innovative and creative when designing their childbirth classes.  Today’s post highlights a LCCE who thinks out of the box by offering couples the opportunity to enjoy a couples’ retreat weekend while taking their childbirth classes.   Teaming with her husband, Rosemarie DiMare, this couple meets families at a comfortable, romantic resort, and includes sessions for mothers led by Rosemarie and sessions for partners led by her husband, John. Read more of Kathy’s interview with Rosemarie below.- SM

I had the honor of interviewing Rosemarie DiMare, a long-term doula and childbirth educator. She and her husband,  John, recognized the importance of including the male perspective duing the childbearing years and developed a unique way of helping families open to their pregnancies and new lives as parents. Their story follows.

Rosemarie DiMare has been in the childbirth business since 1997.  She is married and has two sons, ages 19 & 16 years old.  Rosemarie became a DONA certified doula after the birth of her second son and began teaching childbirth education classes as well. In 2007, she became a Lamaze certified childbirth educator. Her inspiration was her own doula.  S&S asked Rosemarie some questions:

S&S: What was your inspiration for becoming a birth worker? 

My doula was amazing, and in 1996, I was hearing more and more about doulas; it was a new profession at the time. I really loved the idea of supporting women in their births. I wanted to give back to the community and help women in my work, and I wanted to be a full-time mom. So, in the beginning, I didn’t take many births. The first year, I only took 4 births. Within the first year of becoming a doula, I started teaching childbirth education classes.  At that point, my husband began working at home, so I could really start to do the work of birth.

S&S: Tell us about your childbirth education journey and why you chose to become a Lamaze-trained educator? 

I’ve been a childbirth educator for almost 15 years.  I have developed my in-depth childbirth curriculum over those years. I take a lot of training and I incorporate information from different sources. I noticed that prenatal couples were taking hospital-based childbirth education classes. These classes were not informing them about their choices, instead they were being told what was going to happen to them. I felt a need to educate people about their options and choices. I am not bashing hospital based classes, I just don’t see how they tell prenatal couples the whole story.  I believe that if you don’t know your options, you don’t have any, so it is important to get some education about your options.  I always tell women, plan to afford a doula,  don’t expect Dad/partner to do everything. Get some help

I certified with Lamaze in 2007.  I really felt the Lamaze philosophy connected with my philosophy. I am blessed to be associated with Lamaze.  Lamaze is about developing confidence in your body’s ability to give birth.  It is not about the breathing. Lamaze has a moderate approach. We’re not against interventions if necessary, but not everyone needs it. I believe that Lamaze reinforces my own belief that if a woman has a really good support system: a good doctor or midwife, a doula, a good partner, a good hospital or good home setting with a midwife, she has the chance to have a good birth experience. I love the Lamaze Six Healthy Birth Practices. More and more women want to have a say in their birth and are willing to go the extra mile to find and see a provider that will respect them and work with them.

S&S: How did you come to create your unique “Before Baby Arrives Weekend Getaway classes?

To me, it’s all about creating good, positive memories.   We all remember the details of the birth(s) of our children.  I wanted to help families create positive memories to empower women of future generations.

I’ve been married for 23 years. John, my husband, and I work together through our church, mentoring couples preparing for marriage. We work with couples teaching them practical skills such as how to fight fair and how to work together as a couple. We talk about finances and also cover the spiritual aspects of marriage.  It’s something we’ve been doing for a long time and it’s a lot of fun for us. And when I teach my childbirth classes at my home, of course John meets the couples and gets to talking to the Dads, who like to pick his brain about what it’s like to be a father.

One day we realized it was a very useful, needed service to incorporate both the male and female viewpoints in prenatal education. We felt we could help the Dads a lot too, during the prenatal time.

S&S: How do the breakway prenatal classes help couples open to their new family? 

We thought that it would be nice to set something up where the pregnant couple could break away from everyday life to be with their partner  and learn about the wonder of childbirth.  We wanted to deepen the experience of pregnancy for the couples and also help them focus on the pregnancy and open up emotionally and psychologically to the experience of their baby.

I started thinking about the importance of the dads and how having a baby really changes your life for the better.  We combine Lamaze-based birth philosophy with mentoring couples for marriage and parenting.   We wanted to help dads (and moms) realize being married and being a parent is, in reality,  not a 50/50 proposition, but is actually requires you to give of yourself 100%. When mom is pregnant, birthing, breastfeeding, there are lots of times partners will need to pick up the slack.   We emphasize communication and what you can do to strengthen your relationship during the transition to parenting.

We have structured, safe couples groups and also groups just for the men and just for the women,  so men and women can share their fears with their partner and also share their fears privately.

We teach the normal childbirth education curriculum and include a lot of the Lamaze research-based information about birth. And we also emphasize decision-making skills, such as how a budget needs to be totally re-arranged, how fathers need to help by protecting the circle of family life. With the men, John discusses the realities of sex after a baby arrives, educating them about how six weeks afer birth may not be enough time for healing for some women, how overwhelming breastfeeding can feel to both partners, and how a woman’s sex drive can differ from a man’s.   John says that he teaches that men need to respect, honor and love their spouses.

There’s a lot of teaching time and sharing time but the weekend also has some downtime built-in, to let the couples take the time they need for themselves. It is truly a retreat, to replenish, to open to the beauty of childbrith and to gain new skills for parenting.

 S&S: Do you have any final thoughts you’d like to share?

I’d like to say if there are any other CBE couples out there who want to plan such an inclusive class experience, do it, you’ ll know if it’s a total fit for the two of you.  You can put together your curriculm and your props, and help couples to cope with pregnancy, birth and the transition to parenting in a holistic way.

Have you thought of a childbirth education retreat weekend?  Are you thinking outside the box when and where you offer your childbirth classes?  Do you teach in an unusual location? An uncommon format?  Combine your curriculum with something else to meet the needs of pregnant families?  I would love to highlight your unusual classes in a future blog post if you would drop me an email to let me know a bit about you. – SM

About Rosemarie & John DiMare  

Rosemarie & John DiMare have been married for 23 years and have two sons. They live in central New Jersey,  where they mentor couples through pregnancy, birth & the transition to parenting. Visit them at their website Mother to Mother Services.

Kathy Morelli Childbirth Education, Guest Posts, Healthy Birth Practices, Healthy Care Practices, informed Consent, Uncategorized childbirth classes, Childbirth Education, childbirth educators, Kathy Morelli, lamaze, Lamaze International, rosemarie dimare