maternal perinatal behaviour. dr nils bergman ”m.d., d.c.h., m.p.h., ph.d.” m.b.ch.b., m.p.h.,...

MATERNAL PERINATAL BEHAVIOUR.

Dr Nils BergmanDr Nils Bergman ””M.D., D.C.H., M.P.H., Ph.D.” M.D., D.C.H., M.P.H., Ph.D.”

M.B.Ch.B., M.P.H., M.D.M.B.Ch.B., M.P.H., M.D. Cape Town, South AfricaCape Town, South Africa

www.kangaroomothercare.cowww.kangaroomothercare.comm

Speaker Disclosure

Under ACCME guidelines:Under ACCME guidelines:a)a) I have a financial affiliation withI have a financial affiliation with

AMEDA : Speakers BureauAMEDA : Speakers Bureau

b)b) My wife markets educational materialsMy wife markets educational materials and shirts related to and shirts related to the talk content the talk content

Kangaroo Mother Care PromotionsKangaroo Mother Care Promotions

PERINATOLOGY !!!

Neonatal care = postpartum OBGYN

Neonatal outcomes may be Neonatal outcomes may be predetermined at birth ...predetermined at birth ...

neonatal care should start neonatal care should start at conception !!!!at conception !!!!

Doula care

“doula” -- Greek word for a “birth companion”

In 127 out of 128 societies(reported in a major anthropological study of non-industrialised geographically isolated societies)

“a woman is in attendance throughout labour”

not the father ….not a midwife !!

Effects of doula care

No doula DoulaUSA (Kennell et al 1991)

Epidural 55% 8%Caesarean section 18% 8%Forceps delivery 26% 8%Fetal distress 24% 10%

Effects of doula care

No doula DoulaUSA (Kennell et al 1991)

Caesarean section 18% 8%

Cost of C/S = R3600 at MMH.Cost of NVD = R1800 at MMH

Halved C/S rate would save = R2.2 mA doula for every delivery = R1.6 mAdd epidural saving, less fetal distress …

Active Birth.

Active birth is NOT - providing a place - with amenities

- alternative or complementary care - abdicating clinical responsibility

Active Birth …… enables a labouring woman to respond

naturally and instinctively to her birthing process,and to make appropriate choices. Women are encouraged to remain mobile and uprightand to adopt the position of their choice duringlabour and birth, and unnecessary restrictions and procedures are minimized. Fundamentally it is an attitude of respectand support for the labouring woman and her family.

(Adopted by ABU Board, 28 August 2002)

Active Birth.

Active Birth is about allowing the mother to be in tune with herself and her pregnancy, to empower her and give her control of her own labour. Active Birth provides time and space for the family to bond and grow.

ANNAANNA

““I lost it” ...I lost it” ...

Unpleasant ....Unpleasant ....

Surrender to Surrender to

processprocess

These experiences are embeddedThese experiences are embedded

in the attachment relationship.in the attachment relationship.

Active Birth.

Fundamentally, it returnsrespect anddignity to the mother.

Birthing position

1000 year old Mexican statue of woman in labour, was exhibited in Denmark for 20 years, lying down.

Same Mexican statue, placed vertically

-toes curl appropriately,-leaves do not fall off her shoulders- headpiece undisturbed

Birthing position

In 80% of societies, mothers deliver in upright position,which increases thepelvic outlet diameter by 28%

Duration of labour is reduced by 25 -36%

Birthing position

Mothers in Active Birth will “instinctively” choose birth positions appropriate to the lie and presentation of the fetus.Squatting, kneeling, lying, crouching …There is only one bad position =lithotomy

INCREASED INCREASED BRAIN SIZEBRAIN SIZE

TOOL USETOOL USE &&LANGUAGELANGUAGE

BIPEDALISM &BIPEDALISM &NARROWER NARROWER

PELVISPELVIS … … PROBLEM ?PROBLEM ?

How is the biggerHow is the bigger head going to be head going to be born out of the born out of the smaller pelvis ??smaller pelvis ??

INCREASED INCREASED BRAIN SIZEBRAIN SIZE

BIPEDALISM &BIPEDALISM &NARROWER NARROWER

PELVISPELVIS

EXCEEDINGLY EXCEEDINGLY IMMATURE IMMATURE BIRTHBIRTH

The growing brainThe growing brain must come out must come out before it is toobefore it is too big to pass big to pass throughthrough the birth canal ...the birth canal ...

SOLUTION: “the birth of SOLUTION: “the birth of exceedingly neurologically exceedingly neurologically immature infants for whom immature infants for whom the majority of brain growth the majority of brain growth will occur postnatally and will occur postnatally and not in the womb.”not in the womb.”

(McKenna 1993)(McKenna 1993)

100%100%

25%25%

0%0%

CONCEPTIONCONCEPTION

FETUSFETUS

80%80%

100%100%

25%25%

0%0%ADULTADULTBIRTHBIRTH

CONCEPTIONCONCEPTION

FETUSFETUS NEWBORNNEWBORN

In all mammals, In all mammals, brain grows inbrain grows in utero until it utero until it reaches 80% ofreaches 80% of full adult size ….full adult size …. … … then BIRTHthen BIRTH… … then the brain then the brain grows the last grows the last 20% to final20% to final full adult size. full adult size.

80%80%

100%100%

25%25%

0%0%

Homo sapiens Homo sapiens = HUMAN= HUMAN

also has a brain also has a brain that grows along that grows along this pattern … this pattern … … … the brainthe brain reaches 80% reaches 80% of final size of final size at the age ofat the age of 21 months21 months

EXPECTEDEXPECTEDBIRTHBIRTH

21/1221/12

100%100%

25%25%

0%0%

Actual birth Actual birth takes place at takes place at 9 months …9 months …

… … which makeswhich makes the human birththe human birth one year too soon:one year too soon:

EXCEEDINGLY EXCEEDINGLY IMMATUREIMMATURE


21/1221/12

ACTUALACTUALBIRTHBIRTH

9/129/12

100%100%

25%25%

0%0%

HumansHumansessentiallyessentially completecomplete gestation gestation OUTSIDE OUTSIDE THE WOMBTHE WOMB..


21/1221/12


9/129/12

100%100%

25%25%

0%0%

A fulltermA fulltermnewborn hasnewborn has12 months12 monthsof gestationof gestationto complete !to complete !


21/1221/12


9/129/12

Maternal Maternal behavior among behavior among primates primates extends extends throughout an throughout an extremely long extremely long infant and infant and juvenile period, juvenile period, with prolonged with prolonged periods of periods of physical physical contact.contact.

(Orangutan) (Orangutan)

At birth the At birth the human infant is human infant is the the leastleast neurologically neurologically mature primate mature primate of all, and the of all, and the most reliant on most reliant on physiological physiological regulation b the regulation b the caregiver for the caregiver for the longest period longest period of time. of time. (McKenna)(McKenna)

QUESTION ?

HOW SAFE IS THIS?

DOULA, ACTIVE BIRTH

““SOLUTION: “the birth of exceedingly SOLUTION: “the birth of exceedingly neurologically immature infants for whom the neurologically immature infants for whom the majority of brain growth will occur postnatally majority of brain growth will occur postnatally and not in the womb.”and not in the womb.”

(McKenna 1993)(McKenna 1993)

THIS WAS A COMPROMISE …THIS WAS A COMPROMISE …

THE PRICE FOR MOTHERS: THE PRICE FOR MOTHERS: Cephalopelvic disproportion.Cephalopelvic disproportion.Maternal mortality risk.Maternal mortality risk.

THE PRICE FOR NEWBORNS:THE PRICE FOR NEWBORNS: Biological immaturity comes at the Biological immaturity comes at the

increased risk forincreased risk for PREMATURITY,PREMATURITY,

Hyaline membrane diseaseHyaline membrane disease

CONSEQUENCECONSEQUENCE

““Back to nature” is NOT recommended !Back to nature” is NOT recommended !Understanding nature is essential ….Understanding nature is essential ….

Care should be based on this understanding:Care should be based on this understanding:Antenatal care,Antenatal care,Emotional support Emotional support clinical effects clinical effectsNO SEPARATION of dyad.NO SEPARATION of dyad.

THE GAINSTHE GAINSIntelligence drive –Intelligence drive –

positive feedback loop:positive feedback loop:Greater mother’s intelligence Greater mother’s intelligence required to care for baby ….required to care for baby ….

Mother chooses man accordinglyMother chooses man accordinglyimmature baby drives IQ increaseimmature baby drives IQ increase

Doula careDoula care, , Active BirthActive Birth, and the , and the Birth positionsBirth positions described have described have

evolutionary and neurobehavioural origins, evolutionary and neurobehavioural origins, evidenced in anthropological studies, evidenced in anthropological studies, which minimise the very high risk of which minimise the very high risk of adverse outcome from CPD.adverse outcome from CPD.

( ( Equates to better care at lower costEquates to better care at lower cost ) )

PERINATOLOGY !!! –

OBGYN care = antepartum neonatology

““practice strategies to practice strategies to promote dyad care”promote dyad care”R.D. White 2004 (p 384)

PERINATOLOGY !!!

Neonatal care = postpartum OBGYN

““The parents body can be seen as The parents body can be seen as the most optimal, appropriate and the most optimal, appropriate and physiologically stabilising physiologically stabilising environment for these infantsenvironment for these infants””

J.V. Browne 2004 (p294)

IN ALL MAMMALS :

The brain eventsThe brain events

originate in theoriginate in the

old mammalianold mammalian

brain - “innatebrain - “innate

programmed behaviour”programmed behaviour”

THE HINDBRAIN HAS THE HINDBRAIN HAS

3 PROGRAMMES3 PROGRAMMES

DEFENSE NUTRITION REPRODUCTION

The neurobehavioural programme The neurobehavioural programme is situated in the hind brain,is situated in the hind brain,

limbic systemlimbic system hypothalamushypothalamus

(autonomic nervous system)(autonomic nervous system)hypophysishypophysis

(endocrine system, hormones)(endocrine system, hormones)


HORMONESHORMONES NERVES NERVES MUSCLESMUSCLES

ONLY ONE PROGRAM is ever ONLY ONE PROGRAM is ever operating at any one time – operating at any one time –

usually it is NUTRITION usually it is NUTRITION



REPRODUCTIONNUTRITION

The DEFENCE program shutsThe DEFENCE program shuts

off the others immediately off the others immediately


DEFENSE

All 3 programs work on same All 3 programs work on same systems, only purpose differssystems, only purpose differs



The The hormones, nerves, hormones, nerves, muscles muscles drive entire system or drive entire system or bodybody


BODY

The The result of all this is result of all this is

BEHAVIOURBEHAVIOUR


BODY

The reproductive programmeThe reproductive programme

is in the mother and the babyis in the mother and the baby



Estrogen peaksEstrogen peaksProgesterone falls Progesterone falls

Increased spinesIncreased spines(dendrification) (dendrification)

New circuits =New circuits =enhanced learningenhanced learning

Pup stimulationPup stimulationRich environmentRich environment

New circuits =New circuits =enhanced learningenhanced learning

Less fear / anxietyLess fear / anxietyAmygdalaAmygdala

Better learning / memory Better learning / memory HippocampusHippocampus

Better stress toleranceBetter stress toleranceHypothalamusHypothalamus

Maternal neurobehaviourMaternal neurobehaviour

Maternal neurobehaviourMaternal neurobehaviour

Enhanced foragingEnhanced foraging

More emotional resilienceMore emotional resilience

Stress responsivenessStress responsiveness

Enhanced problem solvingEnhanced problem solving

Enhanced foragingEnhanced foraging

Enhanced problem solvingEnhanced problem solving

More More emotional emotional resilienceresilience

Stress responsivenessStress responsiveness

PROLACTION risesPROLACTION risesOXYTOCIN rises OXYTOCIN rises

MEMORY permanently improvedMEMORY permanently improved

BDNF (=Brain Derived BDNF (=Brain Derived Neurotropic Factor)Neurotropic Factor)

OpioidsOpioidsGlucocorticoids etcetera .....Glucocorticoids etcetera .....NorepinephrineNorepinephrineVasopressinVasopressin (fathers specially)(fathers specially)

LACTATIONLACTATION

MEMORY permanentlyMEMORY permanentlyimprovedimproved

BDNF (=Brain Derived BDNF (=Brain Derived Neurotropic Factor)Neurotropic Factor)

““The picture that begins to emerge is oneThe picture that begins to emerge is oneof a healthy, of a healthy, ““protectedprotected”” brain that may brain that mayprovide benefits to its owner well intoprovide benefits to its owner well intosenescence.senescence.”” (p517)(p517)

““ the totality and natural ramifications ofthe totality and natural ramifications ofreproductive experience ....reproductive experience ....

enhancements .... neuroplasticity ...enhancements .... neuroplasticity ... (p522)(p522)

““The combination of these ... converge toThe combination of these ... converge toproduce the most dramatic results ...produce the most dramatic results ...

The reproductive programmeThe reproductive programme

is in the mother and the babyis in the mother and the baby

WHAT IS NORMAL MOTHER BEHAVIOUR?WHAT IS NORMAL MOTHER BEHAVIOUR?


How many mothers How many mothers in this room have in this room have breastfed their babies?breastfed their babies?

How many mothers How many mothers in this room had in this room had babies that breastfed?babies that breastfed?

BREASTFEEDING IS A

BRAIN BASEDBEHAVIOUR

THE NEWBORN INITITIATES

BREASTFEEDING

THE NEWBORN MAINTAINS

BREASTFEEDING

BREASTFEEDING IS A BEHAVIOUR OF THE NEWBORN

Not the mother !!

IN ALL MAMMALS :

The brain eventsThe brain events

originate in theoriginate in the

hindbrainhindbrain

THE HINDBRAIN HAS THE HINDBRAIN HAS

3 PROGRAMMES3 PROGRAMMES


All 3 programs work on same All 3 programs work on same systems, only purpose differssystems, only purpose differs



The The result of all this is result of all this is

BEHAVIOURBEHAVIOUR


BODY

WHAT IS APPROPRIATE BEHAVIOUR

OF THE MOTHER ?

“ …. mother

to hold and care

for her baby”

Mother’s have an innate, Mother’s have an innate, inborn inborn

BEHAVIOURBEHAVIOUR


HOLD & CARE

50 million years –50 million years – PRIMATESPRIMATES

Primates carry Primates carry their young, due their young, due to their relative to their relative immaturity.immaturity.

40 million years40 million years –– PRIMATESPRIMATES

Newborn apes Newborn apes havehavea powerful grasp a powerful grasp reflex, due to reflex, due to quadrupedal gait.quadrupedal gait.

They are They are ““carry feeders”carry feeders”And they feedAnd they feed““continuously”continuously”

4 million years –4 million years – HOMINIDSHOMINIDS

Newborn HomoNewborn Homoweak grasp weak grasp reflex, due to reflex, due to bipedal, hairlessbipedal, hairlessmothermother

They have to They have to bebe““HOLD feeders”HOLD feeders”

40 million years 40 million years –– primatesprimates

Newborn apesNewborn apespowerful grasp powerful grasp reflex, due to reflex, due to quadrupedalquadrupedal

They are They are ““carry feeders”carry feeders”




Hold and carryHold and carryThis holding is the best for This holding is the best for

a baby, a baby,

but it is also deeply but it is also deeply fulfilling for a mother .fulfilling for a mother .

(Jill Bergman, (Jill Bergman, 2007)2007)

100%100%

25%25%

0%0%

Actual birth Actual birth takes place at takes place at 9 months …9 months …

… … which makeswhich makes the human birththe human birth one year too soon:one year too soon:

EXCEEDINGLY EXCEEDINGLY IMMATUREIMMATURE


21/1221/12


9/129/12

The human baby is born with only The human baby is born with only 25% of its final brain size; if it 25% of its final brain size; if it followed the pattern of other followed the pattern of other mammals, humans should be mammals, humans should be born at 21 months!born at 21 months!

They need to be held and carried They need to be held and carried for the first two years of life for for the first two years of life for optimal brain developmentoptimal brain development

MOTHERMOTHER

is the KEY foris the KEY forNEURODEVELOPMENNEURODEVELOPMEN

TT

Mother is Mother is PRIMARY PRIMARY CAREGIVERCAREGIVER

Nurse isNurse isPRIMARY PRIMARY SUPPORTERSUPPORTER

Empowerment & ownershipEmpowerment & ownership

• EmpowerEmpower the parents to care for their the parents to care for their own baby.own baby.

• Nurse is to Nurse is to encourageencourage and and reassurereassure• For the nurse it is 6 -12 weeks, for For the nurse it is 6 -12 weeks, for

Mum and baby it is the start of their Mum and baby it is the start of their whole lives!whole lives!

• ExplainExplain what is happening what is happening

BREAST- VAGALMOTHER FEEDING (PSNS) GROWTH

OTHER PROTEST- STRESS SURVIVAL orDESPAIR (SNS)

SKIN-TO-SKIN CONTACT

SEPARATION

THE PLACE MODEL PLACE MODEL




SEPARATION

HYPERAROUSAL - HYPERAROUSAL - (Schore (Schore 2001)2001)

distress distress crying ... then crying ... then screaming, then screaming, then

“fear-terror”“fear-terror”

FETAL FETAL CIRCULATIONCIRCULATION (from J Lind et al )(from J Lind et al )

Oxygen rich bloodOxygen rich bloodfrom placenta,from placenta,

First through liver,First through liver,to inf vena cava,to inf vena cava,

Divides in heart, throughDivides in heart, throughFORAMEN OVALEFORAMEN OVALE

Right flow to brainRight flow to brainLeft flow to body, ANDLeft flow to body, AND

back to placentaback to placenta

PLACENTA

BRAIN

LUNG

LIVER

RVLV

LARA

NEONATAL CIRCULATIONNEONATAL CIRCULATION (from J Lind et al )(from J Lind et al )

Expansion of lungs Expansion of lungs (takes one third second,)(takes one third second,)

Pushes volume of fluid to Pushes volume of fluid to left ventricle, pressureleft ventricle, pressureCLOSES foramen ovaleCLOSES foramen ovale

Left ventricle pushes blood Left ventricle pushes blood to brain and bodyto brain and body

Blood returns via both vena cava,Blood returns via both vena cava,Right heart pumps to LUNGS,Right heart pumps to LUNGS,Oxygenated blood to left heartOxygenated blood to left heartLeft atrial pressure keepsLeft atrial pressure keeps

foramen ovale closedforamen ovale closed..PLACENTA

BRAIN

LUNG

LIVER

NEONATAL NEONATAL CIRCULATIONCIRCULATION (from J Lind et al )(from J Lind et al )

There is a small amount ofThere is a small amount of contrast shunted to LA.contrast shunted to LA.

Note also that contrast refluxesNote also that contrast refluxes easily up into the easily up into the superior vena cavasuperior vena cava

CRYING CRYING CIRCULATIONCIRCULATION (from J Lind et al )(from J Lind et al )

CRYING INCREASESCRYING INCREASESright atrial pressureright atrial pressure

closed glottisThoracic contractionAbdominal muscles

BRAIN

LUNG

LIVER

CRYING CIRCULATIONCRYING CIRCULATION (from J Lind et al )(from J Lind et al )

CRYING INCREASES right atrial pressureCRYING INCREASES right atrial pressureThe foramen ovale OPENS, Venous blood mixes with The foramen ovale OPENS, Venous blood mixes with

oxygenated blood, oxygenated blood, Cyanosis resultsCyanosis results

CRYING CIRCULATIONCRYING CIRCULATION (from J Lind et al )(from J Lind et al )

CRYING INCREASESCRYING INCREASESright atrial pressureright atrial pressure

Foramen ovale OPENSForamen ovale OPENSVenous blood mixes with Venous blood mixes with

oxygenated blood,oxygenated blood,Cyanosis resultsCyanosis resultsALSO: increased pressureALSO: increased pressure

in carotid arteriesin carotid arteriesincreased pressureincreased pressurein superior vena cavain superior vena cava

Choroid plexus unsupportedChoroid plexus unsupportedIntraventricular Intraventricular haemorrhagehaemorrhage

BRAIN

LUNG

LIVER

“Crying, the highest behavioural state, is DETRIMENTAL.

It impairs lung functioning, jeopardizes the closure of the foramen ovale, increases intra-cranial pressure, and initiates a cascade of stress reactions”.

(Anderson 1996)

“Crying, the highest behavioural state, is DETRIMENTAL.

Separated infants cry much more SSC babies Cot babies

Number of cries 4 41Seconds cried 70 2839

(Christenson 1992)

CRYING IS BAD FOR BABY !!CRYING IS BAD FOR BABY !!

““Crying Crying ……depletes energy reserves and oxygen, depletes energy reserves and oxygen, increases intracranial pressure, increases intracranial pressure, increases increases white blood count and white blood count and increases increases base excess,base excess,re-establishes fetal circulation, re-establishes fetal circulation, interferes with the infantinterferes with the infant’’s ability tos ability to

interact with caregivers.interact with caregivers.””Gene Cranston Anderson (1984)Gene Cranston Anderson (1984)


““These effects place fulltermThese effects place fullterm and and preterm infants at greaterpreterm infants at greater risk for risk for

respiratory distress, respiratory distress, pneumothorax, pneumothorax, acute oracute or subclinical intra-ventricular subclinical intra-ventricular haemorrhage, haemorrhage, unnecessary treatment unnecessary treatment for pseudosepsis, delayed circulatory for pseudosepsis, delayed circulatory andand psychosocial adaptation to psychosocial adaptation to extrauterine life.extrauterine life.””

Gene Cranston Anderson (1984)Gene Cranston Anderson (1984)


These effects place fullterm and preterm These effects place fullterm and preterm infants at greater risk for infants at greater risk for

delayed physiological anddelayed physiological andpsychosocial adaptation psychosocial adaptation to extrauterine life.to extrauterine life.””

Gene Cranston Anderson (1984)Gene Cranston Anderson (1984)

HYPERAROUSAL - HYPERAROUSAL - (Schore (Schore 2001)2001)

distress distress crying ... then crying ... then

(neurologically) compelled to approach

maintains proximity and elicits care

Children Need Touching and Attention, Children Need Touching and Attention, Harvard Researchers SayHarvard Researchers SayApril 09, 1998April 09, 1998

America's "let them cry" attitude toward childrenAmerica's "let them cry" attitude toward childrenmay lead to more fears and tears among adults, may lead to more fears and tears among adults, according to two Harvard researchers.according to two Harvard researchers.

Instead of letting infants cry, American parentsInstead of letting infants cry, American parentsshould keep their babies close, should keep their babies close, console them when they cry, console them when they cry, and bring them to bed with them, and bring them to bed with them, where they'll feel safe, where they'll feel safe, according to Michael Commons and Patrice Miller according to Michael Commons and Patrice Miller http://www.hno.harvard.edu/gazette/1998/04.09/ChildrenNeedTou.html

BABIES SHOULD

NEVERCRY

efficiently efficiently regulated and regulated and organisedorganisedright brainright brain

AMYGDALA:AMYGDALA: fear and emotionfear and emotion

Prefrontal cortexPrefrontal cortex approach / avoidapproach / avoid

Behavioural Behavioural activation systemactivation systemreward-basedreward-based (dopamine)(dopamine)

Amodio 2008

MATERNAL-INFANTMATERNAL-INFANT

SEPARATIONSEPARATION

= ABUSE= ABUSE

“Society reaps what it sows in the way that infants and children are

treated. Efforts to reduce exposure to stress and abuse

in early life may have far-reaching impacts on medical and

psychiatric health and may reduce aggression, suspicion and untoward stress in future

generations.”Martin H Teicher

“Society reaps what it sows in the way that infants and children are

treated. Efforts to reduce exposure to stress and abuse (specifically

MATERNAL INFANT SEPARATION Bergman)in early life may have far-reaching impacts on medical and psychiatric health and may reduce aggression,

suspicion and untoward stress in future generations.”Martin H Teicher

In the FIRST HOUR ……. In the FIRST HOUR ……. ….. the ….. the newborn newborn

ELICITS CARE GIVINGELICITS CARE GIVING

INSTINCTUALINSTINCTUALBEHAVIOUR FROMBEHAVIOUR FROM

THE MOTHER !!THE MOTHER !!

Measure of a “good mammal mother” :Measure of a “good mammal mother” :

FEROCITY OF DEFENCE OF YOUNG.FEROCITY OF DEFENCE OF YOUNG.

Oxytocin effect !!!!Oxytocin effect !!!!

Margaret MikolMargaret Mikol TIME Magazine, June 4, 2007 TIME Magazine, June 4, 2007

http://www.time.com/time/magazine/article/0,9171,1625193,00.html

Margaret MikolMargaret Mikol

““I changed into a beastI changed into a beastto protect my child”to protect my child”



Oxytocin effect !!!!Oxytocin effect !!!!



Sodersjukhuset, StockholmSodersjukhuset, StockholmRandomisation to new and old unitRandomisation to new and old unit

Maternal ferocity ???Maternal ferocity ???

Replaced by Replaced by subservient inheritance !subservient inheritance !thankfulness, staff “own the baby”thankfulness, staff “own the baby”

bonding & attachmentbonding & attachmentbreastfeeding success ?breastfeeding success ?

Separation causes changes in the fundamental efficiency of systems …

(McKenna 1993)

THE “PRIMARY VIOLATION”… the veryworst thing …

to any newborn according to biologists is SEPARATION.

SEPARATION !!! SEPARATION !!!

to any newborn according to biologists is SEPARATION.

TO ANY MOTHERDISEMPOWERMENT !!!

SEPARATION !!! SEPARATION !!!

Maternal effects of separation –

Lack of bondingPostnatal depression Breast problems –

Birth/NICU Birth/NICU KMC ward KMC ward Discharge Discharge

PPDPPD 37.3%37.3% 16.9%16.9%

PPD = Post Partum Depression PPD = Post Partum Depression

Dombrowski et al 2001.Dombrowski et al 2001.

ABSTRACTABSTRACTThe mother in this case study had The mother in this case study had numerous known risk factors for PPD.numerous known risk factors for PPD.expressing feelings of sadness expressing feelings of sadness baby unwrapped for first KC. baby unwrapped for first KC. Thereafter her self-reported Thereafter her self-reported depression scores decreased rapidly anddepression scores decreased rapidly and had disappeared by 32 hours postbirth. had disappeared by 32 hours postbirth.

Kangaroo (Skin-to-Skin) Care With a Postpartum Woman Who Felt Depressed

There is new knowledge ... There is new knowledge ... the maternal HPA axis dampened during the maternal HPA axis dampened during last trimester ...last trimester ... ““Perhaps appropriate reactivation of Perhaps appropriate reactivation of the maternal HPA axis can be triggered the maternal HPA axis can be triggered following birth by the stimulation following birth by the stimulation inherent in KC, thereby minimizing inherent in KC, thereby minimizing risk for postpartum depression.risk for postpartum depression.

http://www.imhaanz.org.nz/peter-cooks-mothering-denied-available-internet

MOTHERING DENIED

How our culture harmswomen, infants and

society

Dr Peter Cook

‘‘MOTHERING’ =MOTHERING’ =politicallypolitically incorrect terminology ... incorrect terminology ...

(parenting, care-giving)(parenting, care-giving)culturallyculturally not valued .... not valued ....

BUTBUTneuroscienceneuroscience provides new provides new

understanding and definitions ..understanding and definitions ..biologicallybiologically based survival requirement based survival requirement

‘‘MOTHERING’ = biological definitionMOTHERING’ = biological definitionbreastfeedingbreastfeedingcarryingcarryingsecure attachmentsecure attachmentmutual reward mutual reward

enjoyment and empathyenjoyment and empathymutual playfulness and joy mutual playfulness and joy

ALL have evidence based science ALL have evidence based science

‘‘MOTHERING’ = biological definitionMOTHERING’ = biological definition

basic needs of infants basic needs of infants arise from their biologyarise from their biology

Mothering is biologyMothering is biology

‘‘MOTHERING’MOTHERING’... we can aim to bring our society,... we can aim to bring our society,

that we can change,that we can change,into better harmony with into better harmony with our biological “givens” our biological “givens”

that we cannot change ...that we cannot change ...

THE HUNTER GATHERERTHE HUNTER GATHERER

Homo sapiens evolved as a Homo sapiens evolved as a ““tropical hunter gatherer”.tropical hunter gatherer”.

Anthropological studies of current Anthropological studies of current tropical societies:tropical societies:

20% of diet from hunting mammals, 20% of diet from hunting mammals, 40-60% from gathering foods40-60% from gathering foods

Both hunting and gathering require mobility.Both hunting and gathering require mobility.

THE HUNTER GATHERER (cont)THE HUNTER GATHERER (cont)

Infant care patterns in such societies Infant care patterns in such societies (which are closest to our origins):(which are closest to our origins):

11 Infant carried most of timeInfant carried most of time22 Mother sleeps with infant same bedMother sleeps with infant same bed33 Immediate feeding response to cryingImmediate feeding response to crying44 Breastfeeding 24 months or moreBreastfeeding 24 months or more55 Father frequently and closely involved ...Father frequently and closely involved ...

Infant care patterns Infant care patterns in 186 non-western cultures:in 186 non-western cultures:

newborn is carried constantly,newborn is carried constantly,always sleeps with motheralways sleeps with mother

immediate feeding if cryingimmediate feeding if cryingfeeding on demand, feeding on demand, every hour or twoevery hour or twobreastfeeding for 24 monthsbreastfeeding for 24 months

((Lozoff and Brittenham, J Pediatrics 1979; 95:478Lozoff and Brittenham, J Pediatrics 1979; 95:478))

ANTHROPOLOGY, HABITAT AND NICHEANTHROPOLOGY, HABITAT AND NICHE

In a major anthropological study of non-industrialisedIn a major anthropological study of non-industrialised,, geographically isolated societies, geographically isolated societies, ::

the newborn infant is carried constantlythe newborn infant is carried constantly the infant always sleeps with the motherthe infant always sleeps with the mother

((Lozoff and Brittenham 1979Lozoff and Brittenham 1979))

““For species such as For species such as primates, the mother primates, the mother ISIS the environment.” the environment.”Sarah Blaffer Hrdy, Sarah Blaffer Hrdy, Mother NatureMother Nature (1999) (1999)

Babies Celebrated, Beatrice Fontanel and Claire D’Harcourt, © 1998 Harry N. Abrams, Inc.

Nothing an infant can or Nothing an infant can or

cannot do makes sense, cannot do makes sense,

except in light of mother’s except in light of mother’s bodybody




SEPARATION

THE PLACE MODEL PLACE MODEL

THE HUNTER GATHERERTHE HUNTER GATHERER

In a major anthropological study of non-industrialisedIn a major anthropological study of non-industrialised,, geographically isolated societies, geographically isolated societies, ::

the newborn infant is carried constantlythe newborn infant is carried constantly the infant always sleeps with the motherthe infant always sleeps with the mother PLACEPLACE

immediate nurturant response to cryingimmediate nurturant response to cryingfeeding on demand, every hour or twofeeding on demand, every hour or two BEHAVIOURBEHAVIOURbreastfeeding for 24 monthsbreastfeeding for 24 months

((Lozoff and Brittenham 1979Lozoff and Brittenham 1979))

Maternal behaviour Maternal behaviour & modern & modern

neuroscience neuroscience mirrors Greek mirrors Greek

myth ... myth ...

ARTEMISARTEMIS

goddess of the goddess of the hunthunt

and fertility...and fertility...

ARTEMISARTEMIS

Greek Greek goddess ofgoddess of

- the hunt- the hunt- fertility- fertility- virginity- virginity

contradicticontradictionsons

MOTHERINGMOTHERINGis a high calling ... is a high calling ...

and also neuroscience and also neuroscience !!

maternal perinatal behaviour. dr nils bergman ”m.d., d.c.h., m.p.h., ph.d.” m.b.ch.b., m.p.h.,...

Documents

active birth

human birth

lithotomy slide

birth canal

birth companion

actual birth

fetal distress slide

clinical responsibility