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Healthy Birth Practice #6, Keeping Mother and Baby Together – It’s Best for Mother, Baby, and Breastfeeding

June 28th, 2011 by avatar

Mother and Child Reunion

The goal of Lamaze “Healthy Birth Practice #6, Keeping Mother and Baby Together – It’s Best for Mother, Baby, and Breastfeeding” is to encourage and support mothers so they may confidently insist that they not be separated from their newborns, and be allowed to have ample opportunity for skin-to-skin contact without delay or interruption, as recommended by a multitude of sources concerned with infant and maternal health.

Dr. Lennart Righard’s seminal study1, published in the Lancet in 1990, gave rise to his famous video, “Delivery Self Attachment”2, which illustrated parts of that research.  It shows babies who, when left undisturbed on their mothers’ bodies immediately after birth, find the breast by themselves, crawl to it and suckle with competence. It observes also those babies whose abilities are either impaired or negated because of exposure to intrapartum meds, separation from their mothers after birth, or both.

“Newborns have a great need for love which makes a separation between mother and child most unfortunate”3, Lennart is quoted as saying, poignantly, in a blurb on the packaging of his video. A banner below that quote, set in 16-point type and caps, proclaims “THIS SIX MINUTE VIDEO WILL CHANGE PROTOCOLS!”

It is ”unfortunate” indeed that  many mothers still experience resistance to this best-evidence protocol; hospital staff and caregivers still whisk newborns away for routine procedures, processing and observation after just a few minutes of time with their mothers.   As with so many maternity-care practices, the protocols that Righard thought with certainty would change, are still in place, even as the evidence for keeping mother and baby together mounts.  Some state Departments of Health, as that in Ohio, have got it right, and officially recommend skin-to-skin. That state prints and distributes cards for its WIC program that read, in part:  “Hold me, Mom. Babies who are held skin-to-skin on their mother‘s chest right after birth are happier and less likely to cry, are more likely to latch on and [sic] breastfeeding well, have better heart rates, have better temperatures than under a warmer, have better blood sugars, burn less [sic]  calories than under a warmer. So, be sure to tell your doctor and the hospital nurses that you want to hold your baby for at least the first hour after the birth, skin-to-skin (baby naked, not wrapped in a blanket). That‘s the best way to introduce your baby to the world”4. (Emphasis mine.) How can we account for the fact that a mother is advised by a government agency to “be sure” to tell her doc and staff to give her best-evidence care? Even for this well-documented and uncomplicated course of action, we cannot count on our caregivers to act reliably in the interests of mother and baby.  Again, a Healthy Birth Practice can be read as a subtle warning: Do not let them take your baby from you for the first hour!

Mothers have always needed to keep their babies with them, and supporting evidence for that urgent desire has been around for quite a while.  In 1979, Michel Odent proposed, in a theory and review article on human ecology, and under the aegis of his Primal Research Center, that the natural ecology  for an infant is to be skin-to-skin (S2S) with the mother. The Human Ecolog deals with “primal” health, a branch of epidemiology that brings together studies exploring correlations between what happens during the primal period (fetal life, perinatal period and the year following birth) and what occurs later in life in terms of health and personality traits. The treatment of mother and newborn as an inseparable dyad is the basis for those studies and can be found compiled in the Primal Health Research Data base 5.

With the understanding of what is best for the “primal” health of the newborn, and in light of the wisdom of Healthy Birth Practice #6, the Baby Friendly Hospital Initiative of the WHO and UNICEF very specifically and unequivocally advises that mothers and infants remain together 24 hours a day.  As of May 2011, out of 3,000 or so hospital maternity centers and free standing birth centers in this country, only 110 have achieved the status of Baby Friendly.  No wonder women must be advised and exhorted to ask or demand treatment that should be just pro forma in every LDR. Why must women spend precious energy and focus during labor to advocate for best-evidence care for themselves when that kind of care should just be expectations met?  Period.

Kangaroo Care, “a universally and biologically sound method of care for all newborns,” 6 incorporating S2S, breastfeeding and support of mother and baby, has become a standard of care in many NICUs.  While there is no citation to back up that statistic, Wikipedia represents that fully 82% of NICUs in the US practice KC.  That is not surprising, given the wealth of studies going all the way back to 1979 that show how effectively KC helps at-risk babies i.e., improving and normalizing vital signs, stabilizing breathing and heart rate and normalizing glucose and stress levels. Many studies can be accessed at the kangaroo care website: http://www.kangaroomothercare.com.   Kangaroo Care babies have been shown to have significantly higher scores in visual and auditory  orientation, alertness, cuddliness, self-quieting, attention and state regulation, and higher scores at 6 months on the Infant Temperament Questionnaire than standard-care infants.  Kangaroo care has been shown to promote neonatal behavioral organization and enhanced developmental outcomes through the first year of life. 7Is it such a stretch to extrapolate that practice to all term healthy newborns whose need for their mothers is just as acute as that of those in NICUs?

There are some fascinating studies about interactions between mother and baby immediately after birth that investigate “the  ‘smellscape’ of mother’s breast: the effects of odor on neonatal arousal, oral and visual responses”.8 Here are just a couple of  observations from a multitude of studies available: “volatile compounds originating in areolar secretions or milk, release mouthing, stimulate eye-opening and delay and reduce crying in newborns”.9 “The odor of human milk is more attractive to human newborns than formula milk…independent of postnatal feeding experience.”10

The skin-to-skin interactions between mother and babe are maturational for newborn; the contact stimulates the vagal nerve, causing increased growth in size of the villi in the newborn gut, which provides a larger surface area for the absorption of nutrition. Nancy Mohrbacher, author and breastfeeding expert, in her article “Rethinking Swaddling” 11 has pointed out the differences between the infant held skin-to-skin and those who were wrapped and held by their mothers.  She cites studies showing that swaddling delays the first breastfeed and leads to less effective suckling, greater weight loss, and more jaundice. Routine swaddling has negative effects on the infant whether in the hospital or at home.

In the main, Healthy Birth Practice #6 addresses a mother’s time in the hospital, to promote behavior that is really just a prelude to how mother and baby should proceed together when they go home. But along with that vital and valuable information, another aspect of a new mother’s experience needs to be examined and promoted… we must begin to examine with mothers something that is rarely mentioned, rarely talked about by OBs, and rarely discussed as part of the normal and natural part of a new life coming into the world…the remarkable abilities and competence of the newborn.  Birthing of the placenta gets more coverage in birth literature than do the stellar capacities of a new baby.

The Righard video of newborn behavior amazes because we see the antithesis of what first-time mothers imagine that their infants will be like.  Popular images show a greasy-eyed newborn, wrapped up and be-blanketed as tight as a little taco, handed over to mom to hold. The Righard video, familiar to many of us, causes gasps at the first images of that lively newborn pushing its little legs against its mother’s abdomen, bobbing its little head with power and purpose, and performing the initial latch with brio.  Mothers need to be told that, even if they have had intrapartum medications, they must continually give their newborns the opportunity to perform as they are hard-wired to do, and we must emphasize that newborns are capable and competent. Dr. Christina Smillie’s approach to breastfeeding…and her video “Baby-Led Breastfeeding12 rely on the baby’s instinctive responses to seek and find the breast when they are allowed to stay on their mother’s bodies.  It demonstrates without equivocation how well babies can navigate about to find the breast. Every mother-to-be should be told about the amazing capabilities of her newborn, and encouraged to spend time every day with her newborn skin-to-skin.  That information should be part of every childbirth education syllabus.

A couple of videos that came out this year also address that important hour or so after birth, and illustrate the nine stages through which the newborn progresses.  Sponsored by the Healthy Children Project, the video called The Magical Hour13 and based on the research of Anne-Marie Widstrom and colleagues, is aimed at parents-to-be, and shows newborns in all the stages of adaptation to life outside from Stage One, the Birth Cry, to Stage Nine, Sleep. The other video, Skin to Skin in the First Hour after Birth: Practical Advice for Staff after Vaginal and Cesarean Birth 14, also from the Healthy Children Project, is aimed at hospital staff, delineating the same nine stages as The Magical Hour. It lays out guidelines for the treatment of mother and baby immediately after birth, whether vaginal or cesarean, with the view that the implementation of direct and uninterrupted contact between mother and newborn is the perfect beginning for a new family.

http://youtu.be/xzQWv5ZWtIM

 

 

References

1-      Lancet, Vol. 336,1105-07

2-      Delivery Self Attachment, 1995 Lennart Righard & Kittie Franz, Geddes Productions, Los Angeles, CA

3-      Ibid

4-       Ohio Department of Health. (2008). Hold me, Mom. Columbus, Oh: Ohio Dept.  of Health Printing, Warehouse # 3977.23.

5- www.primalhealthresearch.com Odent, M. (2006).  Homo Super-predator to Homo Ecologicus. http://www.wombecology.com/homo.html#top.

6-www.kangaroomothercare.com/whatis01/htm

7-Fukida M, Moriuchi, Akiyama T, Nugent JK, Brazelton, TB, Arisawa K, Takahashi T, & Saito H (2002) The effects of kangaroo care on neonatal neurobehavioral organization, infant development and temperament in healthy infants through one year. J Perinatology, 22(5).384-379

8-Doucet S, Soussignan R, Sagot P, Schaal B, Dev Psychobiol 49(2); 129-38, 2007 Equipe d’Ethologie et de Psycholbiologie Sensorielle Centre des Sciences du Gout Umr 5170 CNRS Dijon, France. doucet@cesg.cnrs.fr

9-Ibid

10-Mizuno K, Mizuno N, Shinohara T, et al; Mother-infant Skin-to-skin contact after delivery results in early recognition of own mother’s milk odour. Acta Paediatrica 93(12):1640-1645, 2004 katsuorobi@aol.com

11-Rethinking Swaddling, International Journal of Childbirth Education, 2010

12-Baby-Led Breastfeeding, Geddes Productions, Los Angeles, CA, 2007, Christina M Smillie, Ivy Makelin, Kittie    Franz

13-The Magical Hour; Holding Your Baby for the First Hour After Birth. DVD Produced by Kajsa Brimdyr, Kristin Svensson and Ann-Marie Widstrom, www.healthychildren.cc

14-Skin to skin in the First Hour After Birth: Practical Advice for Staff after Vaginal         and Cesarean Birth,  DVD Produced by  Kajsa Brimdyr, Kristin Svensson and Ann-Marie Widstrom, www.healthychildren.cc


Posted by:  Jackie Levine, LCCE, FACCE, CD(DONA), CLC

Baby Friendly Initiative, Breastfeeding, Evidence Based Medicine, Films about Pregnancy, Healthy Birth Practices, Healthy Care Practices, Patient Advocacy, Practice Guidelines, Uncategorized , , , , , , , , , , , , , ,

Breastfeeding: What More Beyond a Breast and a Baby?

January 10th, 2011 by avatar

Where We’re At

Country       Initiation %     Exclusivity % at 6 months      
Canada        90[1]     14[2]      
Australia        92     14[3]      
New Zealand       88[4]     26[5]      
United States       75     13[6]      
Austria       96     46      
Germany, Switzerland:       94     11      
United Kingdom overall       69     21[7]      
Lithuania       98     14      
Norway       99[8]     17*[9]      
Ireland       47[10]     10*[11]      
                    *denotes any breastfeeding

There is much to celebrate in the breastfeeding world in regard to the world-wide increase in initiation rates (let’s ignore Ireland’s abysmal 47%).  Alas, such numbers plummet as we speak about duration rates.  Canada’s disappointing record of 17% of babies exclusive breastfeeding at 6 months[12] is matched in many European countries, and USA and others are lower still.  This is both strange and concerning in light of the World Health Organization’s call for exclusivity to around 6 months.  Do we not have enough marketing out there to demonstrate the importance of breastfeeding and the risks of not breastfeeding?  Is it that mothers are not trying hard enough to make it work?

In fact, we have done a great job with our marketing—the initiation rates prove that.  And many countries around the world have made great advances in ensuring babies have the right to breastfeed anywhere.  Like childbirth, the reclaiming of breastfeeding as a woman’s right has been a slow one but it has made concrete and substantial progress.  There is still a significantly long road ahead, to be sure, and we will get there—of that I am confident. 

The Issue of Support
This brings us to my second point, so let’s get the record straight: mothers are trying hard enough—some (like patients in the clinic where I work) are visiting up to 9 practitioners just to get the breastfeeding help they need.  The challenge is, though we encourage mothers to breastfeed, we don’t always make it easy for them to do so:  Birthing has become medicated all too frequently and studies are starting to reveal the adverse effects of this highly medicalized birthing model on the process of breastfeeding.[13],[14]  Despite improving federal policies, on a micro level we still tend to make our public environments non-breastfeeding friendly by admonishing mothers when they breastfeed in places like airplanes, museums, swimming pools and restaurants, and we provide them with very little support on the how-to part of this natural-process-but-learned behaviour. 

It is on this last point that I will focus these next few blog posts:  the support, or lack of good support we give mothers who choose to breastfeed.  This “support” comes in many forms, too many to delve into in this article and many that will eventually work themselves out as the marketing of breastfeeding continues to snowball and win over the nay-sayers and the practitioners who claim: “hey, I wasn’t breastfed and look at me, I’m just fine” (see James Akre’s The Problem with Breastfeeding[15]—it’s an easy read which elegantly addresses this point).  The kind of support I am most concerned about is that which is given in the guise of expert advice or care and yet is anything but.  This support usually comes from nurses and lactation consultants and often from midwives and doctors.  It comes from a lack of solid education in breastfeeding and lactation medicine.   That so many practitioners put so little importance on breastfeeding is a significant part of the issue, to be sure (though obviously this cannot be said of all midwives, doctors, and lactation consultants).  And even more, though they might believe in the importance of breastfeeding, many practitioners don’t have faith in breastfeeding as a way to sustain life and help perpetuate the species. The fact that we are almost 7 billion strong demonstrates breastfeeding must be somewhat responsible in perpetuating our species–remember, commercially–prepared artificial baby milks have only been around for a relatively short while.  In fact, up until very recently, few babies ever received any breastmilk substitutes, therefore it is safe to say that statistically speaking, almost every human being that has ever walked this earth was breastfed. 

So back to the issue of support.  Let me extend kudos to the practitioners who do make it their responsibility to stay updated with their skills and who are never afraid to say, “I don’t know how to fix this, let’s refer you to someone who may.”  The problem, however, lies in the numerous practitioners lacking proper training and education—or those underutilizing the training they do have—and instead rely upon tools and gadgets to augment their breastfeeding support. Unfortunately, nothing can replace good hands-off/hands-on training and mothers far and wide are suffering from practitioners’ ill-equipped attempts to mimic this type of support.   Over the next few months I will share with you my thoughts around how and where we fail when it comes to getting mothers and babies off to the best start.

Support Pitfall #1 ~ Lack of Skin to Skin Contact:  Early Separation/ Rooming in/Swaddling:
Rooming-in has become the norm in Canada for the most part, (thanks largely to The Baby Friendly Hospital Initiative—BFI[16], [17]) though all too often babies are removed from their mothers at night “to give their mothers some rest.” In fact, an alarming but well-intentioned, non-evidenced based new programme is now in place in Toronto, Canada that separates mothers and babies for 5 nights where there is a concern or suspected risk of postpartum depression. All this in the face of tremendous research with overwhelming and compelling evidence that goes against such practices[18],[19],[20],[21],[22],[23]

In fact, immediately after birth, babies do best when placed skin-to-skin (SSC—skin-to-skin care/contact[24]) with their mothers for many hours throughout the day not just during feedings but in between feedings as well[25].   Yet in most hospitals in the US, babies are kept either separated from their mothers or are kept swaddled in blankets.  In Canada, though most hospitals have made great strides toward SSC, many nurses still teach mothers how to wrap and swaddle babies in 2 or even 3 blankets to ensure baby stays warm instead of spending time teaching about the benefits of SSC (even though the evidence on SSC clearly shows that babies stay warmer when SSC with their mothers[26]).  With breastfeeding, we want to ensure baby and mother achieve the best latch possible (more on that in the next blog).  Imagine how challenging it is to latch a crying bundle with all those blankets in the way! When babies are kept SSC their SCRIP scores (stability of the cardiorespiratory system in premature infants36)are stabilized.  Likewise, most mothers do better when their babies are with them; they witness less crying in their babies and breastfeeding gets off to the best start[27],[28],[29],[30] , [31],[32],[33].  As importantly, when baby is SSC with mother, the baby will behave in a way which is neurologically appropriate for a newborn—waking when appropriate and cueing when hungry[34].  The baby who is wrapped or swaddled tends not to cue early, and, it is suggested, is more likely to sleep through his/her hunger, “content to starve,” as the old paediatric adage goes.  Or, they sleep so long and then when woken, are so desperately hungry they cry inconsolably and often refuse to eat.  Conversely, SSC ensures timely waking and feeding. There are many recommendations for baby-led feeding and certainly SSC makes it increasingly possible. 

Paediatrician and public health specialist, Dr. Nils Bergman speaks about placing baby in the correct habitat[35] so that s/he can behave in a way which is neurologically appropriate[36].  Dr. Bergman suggests that when babies are wrapped or swaddled their behaviour changes and becomes conservationist (of their energy—they shut down, and seem to sleep but really are doing nothing of the sort) or becomes desperate (they utter distress cries)[37].  Furthermore, when a baby is placed skin to skin with his mother he will find the way to the breast on his own and begin the “breastfeeding process” (exchange of necessary sensory information[38]) well before actual sucking begins.  This journey and subsequent sucking at the breast is critically important for baby’s neurological organization and survival.

A baby will behave like a baby when in the habitat of her parent’s body, especially her mother’s.  Wrapping or swaddling babies is an unfounded practice that needs to go and this applies to babies whose mothers do intend to breastfeed and even more so for those who don’t.  If we want babies and babies’ brains[39] to have a healthy start it is crucial we help them get to the starting line.  And as for establishing breastfeeding?  Skin to skin!  Provide the vehicle, and they will know the way.  



[1]Breastfeeding Initiation in Canada: Key statistics and graphics 2007-2008 www.hc-sc.gc.ca

[2]Chalmers B et al. Breastfeeding rates and hospital breastfeeding practices in Canada: A national survey of women. Birth 2009, June;36(2)122-132

[3] Australian National Breastfeeding Strategy. 2009, Commonwealth of Australia on behalf of the Australian Health Ministers Conference (2009)

[4] Breastfeeding and Weaning Practices in New Zealand: Breastfeeding and Prenatal Nutrition Issues.  Nutrition Research Newsletter. Aug 2002

[5] New Zealand Ministry of Health (2007) www.moh.govt.nx/moh.nst/index.mh/heha-nations-breastfeeding-campaign

[6]Centres for Disease Control and Prevention. www.cdc.gov/breastfeeding/data/NIS_data/index.htm

[7]Yngve & Sjostrom. Breastfeeding in countries of the EU and EFTA: Current and proposed recommendations, rationale, prevalence, duration and trends. Public Health Nutrition 4(2B)631-645

[8]Cattaneo et al. Protection, promotion and support of breastfeeding in Europe: Current situation. Public Health Nutrition 2005 8:39-46

[9] www.breastfeeding.ie/policy-strategy (2008)

[10]Tarrant & Kearney. Session 1:Public health nutrition. Breast-feeding practices in Ireland. Proc Nutr Soc 2008 Nov;67(4) 371-80

[11] www.breastfeeding.ie/policy-strategy (2008)

[12] It is important to note that many countries are still suggesting solid foods be introduced at 4 or 4-6 months and so this column might be somewhat skewed.  Often the number will refer to any breastfeeding.  Stats on true exclusivity are difficult to obtain.  The stats do show, however, that even at 3 months, there is not much difference between 3 and 6 months when referring to exclusivity.  

[13]Kroeger M & Smith LJ Impact of Birthing Practices on Breastfeeding: Restoring the Mother-Baby Continuum Boston, MA: Jones & Bartlett Publishers, 2004

[14]Ransjo-Arvidson, AB Matthiesen AS, Lilja G, Nissen E, Widstrom AM, Uvnas-Moberg K. Maternal analgesia during labour disturbs newborn behaviour: effects on breastfeeding, temperature, and crying.  Birth.  2001; 28 (1): 5-12

[15]Akre, James, The Problem With Breastfeeding:  a Personal Reflection,  Hale Publishing, 2006

[16] The Baby Friendly Initiative’s Ten Steps help to ensure rooming in is secure.  However, so few North American hospitals have earned this accreditation.

[17] Pincombe J, Baghurst P, Antoniou G, Peat B, Henderson A, Reddin E. Baby Friendly Hospital Initiative practices and breast feeding duration in a cohort of first-time mothers in Adelaide, Australia Midwifery. 2006

[18]Buranasin B. The effects of rooming-in on the success of breastfeeding and the decline in abandonment of children. Asia Pac J Public Health. 1991;5(3): 217-20.

[19]Song JE. A comparative study on the level of postpartum women’s fatigue between rooming-in and non rooming-in groups. Korean J Women Health Nurs. 2001;7:241–255.

[20]Kim ES, Park YS. The effect of rooming-in on maternal attitude and self confidence for infant care among primiparas. Korean J Women Health Nurs. 2001;7:256–270.

[21]Song JE, Lee MK, Chang SB. Differences of maternal fetal attachment between the rooming-in and non-rooming in groups of postpartum women. J Korean Acad Nurs. 2002;32:529–538.

[22]Kjellmer I, Windberg J. The neurobiology of infant-parent interaction in the newborn: an introduction. Acta Paediatr Suppl 1994; 397:1-2.

[23]Hofer MA. Early relationships as regulators of infant physiology and behaviour.  Acta Paediatr 1994; Suppl 397: 9-18.

[24]This kind of care is based on KMC (Kangaroo Mother Care) started in Bogotá, Columbia by Dr. Rey and Dr. Martinez, 1979

[25]Bystrova K, Matthiesen AS, Widstrom AM, Ransjo-Arvidson AB, Welles-Nystrom B, Vorontsov I, Uvnas-Moberg K.  The effect of Russian Maternity Home routines on breastfeeding and neonatal weight loss with special reference to swaddling.  Early Human Develop. 2007; 83:29-39

[26]Anderson GC, Moore E, Hepworth J, Bergman N. Early skin-to-skin contact for mothers and their healthy newborn infants. Cochrane Database Syst Rev. 2003;(2):CD003519

[27] Nissen E, Lilja G, Widstrom AM, Uvnas-Moberg K. Elevation of oxytocin levels early post partum in women.  Acta Obstet Gynecol Scand. 1995; 74(7): 530-3.

[28] Boutet C, Vercueil L, Schelstraete C, Buffin A, Legros JJ. Oxytocin and maternal stress during the post-partum period.  Ann Endocrinal (Paris). 2006; 67(3): 214-23

[29]Christensson K, Siles C, Moreno L, Belaustequi A, De La Fuente P, Lagercrantz H, Puyol P, Winberg J. Temperature, metabolic adaptation and crying in healthy full-term newborns cared for skin-to-skin or in a cot.  Acta Paediatr. 1992; 81: 488-493.

[30]Michelsson K, Christensson K, Rothganger H, Winberg J. Crying in separated and non-separated newborns: sound spectrographic analysis.  Acta Pediatr 1996; 85(4): 471-5

[31] Rapley G. Keeping mothers and babies together–breastfeeding and bonding.  RCM  Midwives. 2002 Oct; 5(10): 332-4

[32] Vaidya K, Sharma A, Dhungel S. Effect of early mother-baby close contact over the duration of exclusive breastfeeding.  Nepal Med Coll J. 2005;7(2):138-40

[33] Rapley G. Keeping mothers and babies together–breastfeeding and bonding.  RCM  Midwives. 2002 Oct; 5(10): 332-4

[34]Hofer MA. Early relationships as regulators of infant physiology and behaviour.  Acta Paediatr 1994; Suppl 397: 9-18.

[35]Bergman NJ, Linley LL, Fawcus SR. Randomized controlled trial of skin-to-skin contact from birth versus conventional incubator for physiological stabilization in 1200- to 2199-gram   newborns.  Acta Pediatr 2004; 93 (6): 779-85.

[36]Ferber SG, Makhoul IR. The effect of Skin-to-Skin Contact (Kangaroo Care) Shortly After Birth on the Neurobehavioural Responses of the Term Newborn: A Randomized, Controlled      Trial.  Pediatrics 2007; 113: 858-865

[37]Bergman NJ, Jurisoo LA. The ‘kangaroo-method’ for treating low birth weight babies in a developing country.  Trop Doct 1994; 24(2): 57-60.

[38]McKenna JJ, Thoman EB, Anders TF, Sadeh A, Schechtman VL, Glotzbach SF.  Infant-parent co-sleeping in an evolutionary perspective: implications for understanding infant sleep development and the sudden infant death syndrome.  Sleep 1993; 16(3): 263-82.

[39]Schore AN. Effects of a secure attachment relationship on right brain development affect regulation, and infant mental health.  Infant Mental Health Journal 2001; 22(1-2): 7-66

Posted by:  Edith Kernerman, IBCLC, NBCI

Baby Friendly Initiative, Breastfeeding, Science & Sensibility , , , , , , , , , , , , , , , , ,

In Response: Why Do We Recommend Kangaroo Care to New Mothers?

November 24th, 2010 by avatar

In Monday’s post from the blog site, Expecting Words, came this suggestion, following the description of a friend of hers who had recently been encouraged to have her baby room in and conduct skin-to-skin newborn care rather than have the baby cared for in the hospital nursery:

…I am shocked at this likely cost-cutting scenario billed as natural mothering.  This was her second birth at this major NYC hospital.  The first time, they had a nursery and she could have some rest.  I can only imagine what a first-time mother feels as she endures her two days in the hospital believing that the nurses must be right and that any time her baby is crying it’s because she hasn’t done enough skin-to-skin contact.  What a set-up for baby blues and postpartum depression.

Wow.  I am sad to think of the women who might read this and believe that their local hospital, in an effort to do something right for moms and babies would be motivated only by budgetary cost-cutting.

Skin-to-skin care, otherwise known as kangaroo care, fosters so much more than relief of work on the hospital nursing staff.  Babies kept skin-to-skin remain more stable in terms of body temperature, heart rate and stress hormone levels.

Studies also repeatedly show that newborns attended to via kangaroo care cry less and breastfeed with greater success.  Not only do infants held skin-to-skin frequently benefit, but mothers do too.   Women utilizing kangaroo care are generally calmer and more relaxed during their interactions with their babies, and report less depressive symptoms than women who do not employ kangaroo care.

My guess is, the hospital mentioned in Expecting Words’ post may have either been working on, or recently achieved Baby Friendly Designation from the  Baby Friendly Hospital Initiative, USA (a program sponsored by both the World Health Organization and UNICEF)  and possibly the Mother-Friendly Childbirth Initiative endorsement from the Coalition for Improving Maternity  Services.  These initiatives are ALL ABOUT improving care and the overall childbearing and early parenting experiences of not only the baby, but the mother as well.  Common sense tells us that a well cared for, well educated woman, in terms of immediate postpartum self care and newborn care, will more likely translate into a calmer, happier, more successful mother.  And a happier baby, to boot.  That’s what kangaroo care is about.  That’s what the initiatives described above are about.  And, I’m guessing, that’s what the woman’s experience described in this post was all about.

I, for one, am thankful for the hospitals which are beginning to look seriously at these issues, and move forward to implement practices and policies that are both mother and baby friendly.

And on that note…Happy Thanksgiving to all!

Practice Guidelines, Science & Sensibility , , , , , , ,

Keeping Baby Close: The Importance of High-Touch Parenting

August 3rd, 2010 by avatar

A couple of weeks ago, at the Hyatt Regency in Vancouver, British Columbia, Canada, some intriguing (but not really startling) data were presented at the annual Brain Development and Learning Conference: mothers who touch their babies more often can alter their offspring’s genetic expression and foster calmer babies who will grow up to be increasingly nurturing parents.  For those of us in the childbirth education arena, this is not surprising in the least.

For years, folks who promote safe, gentle birthing practices also tend to favor gentle parenting practices.  High-touch infant care falls under this category.  Famed pediatrician/author Dr. Sears calls it Attachment Parenting.  Others call it Kangaroo Mother Care (a philosophy which is often only thought of as being used with premies or newborns but can, in fact, be carried on throughout infancy).  Others, still:  Baby wearing.

The basic idea?  Keep your baby close by, offer skin-to-skin contact as a means of warming and/or comforting, bonding, teaching your child that you are there for her for the most basic of needs and that you are a tender, loving resource.

When our three kids were infants, we did the same thing I see thousands of other new parents doing:  we hauled our kids around in their detachable infant cars as if we were carrying around a utilitarian bucket of potatoes.  Because, let’s face it:  it’s easier, right?  No buckling and unbuckling the five-point harness every time we got in and out of the car.  No disturbing baby when he’s asleep in his bucket.

My friend who is an awesome mama, prenatal yoga instructor and doula, practiced baby wearing reverently with her two boys in their infancy.  As I observed her–always showing up with her little one snuggled into a wrap on her chest (or hip, as the baby grew) I pondered the realities:  doesn’t her back ever get sore?  Doesn’t she sometimes want her own space?

I imagine, the answer might have sometimes been ‘yes.’  But I also know that Gloria has a bond with her children like none other and was able to put aside the short term gains of her own comfort for the long term gains of what baby wearing likely fostered in the bond between mother and child.  And, I imagine, many “baby wearers” will tell you that they are comfortable wearing their babies–especially if fit with an appropriate sling/baby carrier.

Heres the thing:  with physical closeness comes psychological closeness, and you can bet those two boys of Gloria’s learned to trust their mama for their every need, early on.  Do kids who weren’t kept close as infants not trust their parents?  No, not necessarily.  But there are degrees of trust and psychological closeness and, where on that scale do you think a kiddo falls, who was kept close to his/her parents as an infant?  Just think of the inherent message baby wearing…attachment parenting…kangaroo care…sends:

I am here for you. Always. Your well-being is so important to me that I will make sure I am close by to recognize when you need something. You are not alone.

I also ponder the messages being sent to a baby who spends a ton of her time in her infant car seat:

My convenience is more important than your being comforted. I hold you (literally) at arm’s length because it is easier for me. I will take you with me according to my schedule (as opposed to being home for baby’s nap time–thus avoiding the concern about removing a sleeping baby from her car seat) rather than one that is more advantageous for you.

I know I am simplifying things here.  But really, when you consider implied messages contained in our daily actions, the messages we send can be deafening, and are sometimes different from that which we’d really like to be relaying.

I recently learned about a new product hitting the markets…designed for a similar rural population as the one I wrote about, here.  In an earnest attempt to create a life-saving product for premature babies born in developing countries  a product has been developed called the Embrace–a sleeping bag-looking “portable incubator” with a pocket in the back for an inserted heat pack.

I applaud the Stanford researchers who’ve come up with this, and their aggressive goal of saving hundreds of thousands of teeny tiny lives at $25 a pop (this is an entrepreneurial effort).  But I also have to wonder, what about good-old skin-to-skin contact?  Studies have repeatedly shown that babies’ body temperatures (and heart rate, breathing rate and blood sugar levels) remain more stable when held skin-to-skin vs. when placed in an incubator.  Would the money otherwise spent in R&D, developing new and newer baby warming technology be better spent on community health education campaigns, instead?  What do you think?

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The 6th Healthy Birth Blog Carnival: MotherBaby Edition…

June 19th, 2010 by avatar

…is up! Go check it out at Giving Birth with Confidence. What a PHENOMENAL collection of contributions about the moments, hours, and days after birth. Each of our Blog Carnivals has vastly surpassed my own expectations. I hope you’ll agree.

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