Showing posts with label attachment. Show all posts
Showing posts with label attachment. Show all posts

Tuesday 3 June 2014

A midwife's personal journey into supporting birth honestly


Elly Copp is a guest blogger today.



 Photo: Elly Copp

Elly is a hospital midwife working in a birth centre in the south-west of the UK.  She is also an integrative therapist in private practice in Bristol and where she lives, in Somerset.  I first 'met' Elly on twitter over a year ago and liked her approach to midwifery, women and birth. I was interested in Elly's many 'hats' and how she managed to work within the system with her approach to women and their families. I invited Elly to write a piece for this blog to share her rich understanding and experience and here it is.

Enjoy!

Elly writes:

"I recently attended a conference on “Attachment, Loss and Significant Change” which taught me such rich and relevant information that I have been able to synchronise all my learning for the first time. This experience feels like a culmination of years of process which has made a direct and immediate improvement to my work as a midwife and mentor.

The two presenters, experts in their fields, shared their knowledge with us:

Sir Richard Bowlby, spoke about his father, Sir John Bowlby and his work on attachment theory. He identified the key needs we all have in order to survive our life, which begins as early as birth. By the third trimester, a baby is equipped with senses, feelings, reflexes and a personality. We are born ready to make contact with our parents. Attachment is a core need and initiates in us a sense of belonging and feeling ok in the world.
Conversely, the effects of not having our needs met in the early days and not being ‘seen’ just as we are, is likely to have long lasting effects on health and relationships. Considering the impact on a baby when she loses her mother temporarily or permanently will have us all unsettled as we don't like the idea of it or how it felt when that was our experience. As midwives we are in a prime position to assist at these moments of a person’s life: mother, father and new baby, the evidence is there and now our challenge is to bring it into our daily work. The rewards for us as individuals will fuel more courage, compassion and love we have for ourselves and the women we meet.

The second speaker, Dr Una Mccluskey, talked about the roles of care seeking and care giving and the dynamic between the two. In our world these are the roles of ‘mothers’ and ‘midwives’. Midwives with good attunement antenna will pick up the ‘state’ a mother is in and will consider the next appropriate step. Dr Mccluskey says it's what the care giver does with that knowledge which is important. In order that she does that effectively, a midwife has to be aware of her own state, her own ability to regulate her internal system. This ability to self-regulate takes attention, commitment and support.

When fear diminishes, the ability to explore and be curious expands. That is true for midwives and the women they care for.  When we model our own state we see it mirrored and replicated. In her book “Why Love Matters" Sue Gerhardt looked at effects of being and feeling loved. When young people experienced no or poor attachment the consequence on their internal regulatory system was an inability to find equilibrium and resulted in negative, anti-social behaviours. What is known is that we do not manage so well in life if we have not felt the feeling of being loved and cared for, cherished, touched and cuddled by our mother or a mother like figure, a person who will stay with us long enough to understand us and regulate our internal state, and will keep coming back to us, again and again.

Watching film clips of mothers and their babies interacting and learning the theories behind this brings to life vividly the need for a secure attachment from the start, as well as feeling empathy for the newborn, the impact of a secure attachment for the baby on lifelong health is absolutely clear.
I consider myself very lucky , because I have been involved in some very profound births .I am often moved to tears and have the sense that I have been appreciated at a very deep level of the mothers'  being. These spiritual births where I feel a connection with the mother often come after she has experienced a traumatic time in a previous labour and birth .My understanding is that these women had been holding their trauma in mind and body and are very relieved to be able to let it go and feel pleasure, happiness and wonder in a birthing environment. It is my quest to remain open, available, curious and exploratory and I offer these mothers the same, and work very hard not to move myself or be manoeuvred or coerced by others into a fear state. The ability to translate that knowledge into practice is transformational and meaningful for the mother, the father the baby, the midwife and the student midwife.

As a midwife of 20 years, I am familiar with the realm of labour and birth and work in a birth centre where the environment is spacious. I learn here, and carry that knowledge to other places I go to, such as the delivery suite or ante /post natal ward for example. Even in a different environment I bring with me the assumption that this doesn't have to change a woman’s ability to birth and bond, and the baby to attach. When the environment is out of our control, we can still make it work, as everyone needs a supportive and companionable attachment system wherever they are.

A recent birth demonstrated to me how it is possible for a mother to change her physiology and emotional state when the people she has supporting her are present, being in the now, mindful and observant. I wish to share this with the intention that midwives reading this will be motivated to make their own deliberate but subtle and invisible switch in their own understanding and response. All the names have been changed to maintain confidentiality.

As a hypnotherapist, I am familiar with the mind and how it works, the limbic system, the cognitive brain and how the two are affected by each other and the environment. Dr Stephen Porges describes the neurophysiological foundations of attachment, emotions, communication and self-regulation so well in his book “The Polyvagal Theory ". It is quite manageable to digest and process the theory, the difficulty is making theory useful practically in such a busy environment where risk is calculated and expectations and therefore stress is high.

"Help for the Helper" by Babette Rothschild discusses how roles can get confused when boundaries are not maintained, the mirror neurones in our brain mean that before we realise it, care seekers are mirroring and mimicking the care givers own state.

It is significant that working in a fear state a lot of the time is not helpful or healthy for us, and has a part to play in burnout. We have a real vested interest to self-care and ensure we regulate our systems frequently to maintain our health. This is extra difficult when we are working a shift pattern which is pre-arranged for us. Add to that the variety of work needing to be attended to, which can be acute and immediate for a short or prolonged time, plus no breaks and the situation for the midwife can become untenable.

When a midwife is in fright / flight mode herself she needs to become aware and notice it quickly so she can shift it. Her brain will prevent any connectivity or attunement as long as it it is focused on anxiety. In such a situation the midwife cannot create a safe birthing environment; instead she becomes distracted and loses focus. No one is grounded, no one is self-regulating. 

Dr Mccluskey stated that in supportive relationships, a genuine response must match the depth of the other person’s situation; Women will know it if we show mixed messages. The words need to match our actions for us to be seen and trusted by the women in our care to have faith in us She states: " we are all hard wired to care for other people, to seek care for ourselves and to pursue interests " As midwives in a work environment where the care we give is increasingly scrutinised and critiqued retrospectively, seeking care for ourselves and pursuing interests can be the aspects where we are not so successful, and therefore less able to self-care. In addition our workload becomes greater and visibility around each other is reduced.
For a mother, when the fright /flight brain is in ascendance, dissociation from the self, the body and the baby will result (as a survival technique), it will not be easy for her to experience an empowered birth. I believe that when doctors, midwives, anaesthetists and health care assistants operate collectively from this place of flight/fright, disconnect is a constant presence.

When women can be in a calm and regulated state there is sufficient capacity for them to utilise internal resources, to stay exploratory and look for ways to cope. Ultimately they give birth in an engaged and connected way.

When a midwife successfully regulates her own internal state, the woman she is with can be in touch with her own skills necessary to deal with any upset. We are facilitating an environment within which a woman can build her own competence in the world, which is what she will simultaneously be passing on to her baby. Having worked in a birth centre since 2008, I have found my own ability to problem solve and find solutions has expanded and that is apparent in the confidence I have and pass to the parents I meet.

I am also a Bowen technique practitioner (Bowen is a way of working with the fascia and muscle spindles which rebalances the body via the vestibular system). During a Bowen session, a body can restore health and vitality to the best of its ability. There are clear parallels between Bowen and birth, because the same environmental conditions are required for best outcome. Michel Odent commented " an ideal situation for a mother to birth in is where there is as little interference to the mother’s natural process as possible: speaking, feeling cold, feeling unsafe and bright lights are stimulation which is not conducive to giving birth."

What seems to be happening during a Bowen session is that the body is allowed to re-orient to a memory of a previously healthy state or an original blue print of health. Many of the moves are made on areas significant during embryological development (John Wilks, The Bowen Technique). Like the mind and its ability to move from a fear state into a calm state, the body can do too, physiological changes occur when liquid crystals in the cells which hold memory and have the capacity to register a new experience which are highly receptive to change are touched.
Sheila Kitzinger writes about birth crises and the effects on bonding with the baby as well as any future births. Where a woman has experienced a shocking birth experience and felt helpless and out of control, that memory of helplessness stays with her. If she does some work to recover from her trauma, restore her self-esteem and confidence, she can experience healing in advance of her next birth. If she's doesn't, her bonding and attachment with her next baby will be negatively affected
Sir Richard says:
“If she doesn't recognise that state and therefore remains static she cannot release the dynamic energy needed to give birth to her next baby. She becomes stuck in her thoughts and in her muscles. This is visible in the way a mother uses her body in labour, during and in-between contractions, her posture, her eye contact and how she expresses herself and receives support”.

Putting all this into practice is sometimes straight forward and sometimes very complex. The woman I met called Suzy* and her husband John* seemed initially to be quite a simple care in labour, part of my daily work, but moved into a more complicated area as she moved through her labour and some details emerged.

Two years ago. Suzy had been in labour with her first baby in the pool, and out of the blue, the midwife became worried about the baby's heart rate. Suzy was rushed and hurried along a long corridor to the obstetric theatre where her daughter Imogen was born by forceps. It happened fast. Suzy and John were handed Imogen after a while when she was dressed. There were no other concerns about her health; the perceived concerns about her wellbeing during labour had not affected her wellbeing at birth. This aspect was never discussed though, and the couple were not given any more information about what had happened.

Suzy and John decided to have another baby a year later, but Suzy was very worried about how the birth would go during the second pregnancy. She only told John about this, he was as supportive and kind as he could be. He couldn't see they had any choices.  Suzy started her labour in the early hours and they drove to the birth centre, she wanted to use the pool again but was plagued by lack of confidence, worry and fear about it. She questioned herself so much that she couldn't actually think any more. It was a busy night and the couple met 4 different midwives over 4 hours. Suzy began to panic that her contraction pattern was spacing out. She started to think that this was an impossible situation for her. She was kneeling and closing her eyes a lot of the time.

I entered the room and saw a lovely and supportive man talking gently to his wife and introduced myself and my student who is gentle and kind and softly spoken.

My colleague who was leaving thought that the birth was imminent so we waited for some signs; it was 07:30 am.

We watched and attuned to Suzy and through John we learned about their experience with Imogen. Suzy said it was awful, she had been worrying about it, she didn't want that to happen again but she was frightened it was heading the same way.

I am very careful about discussing previous births with couples because my experience is that it can detract from this baby, but on this occasion, the nature of Imogen's birth needed to be spoken about out loud because the residual fear seemed to be stopping Suzy from giving birth. It felt like an elephant in the room.

My thinking is always how do I give the woman my full and complete attention, my whole person support without judgement or a set of conditions - as well as give her free reign to find her own path to birth her baby. I wonder and worry that I may be perceived as unsupportive, disinterested or lazy. In "Birthing Normally” Gayle Petersen details birth stories where she has attuned herself to women’s fears and needs and in doing this, has enabled the mother to birth her baby herself without any interventions. Whilst Gayle knows the women she describes, I am unfamiliar with the women I meet and not knowing them I cannot know their preoccupations and concerns.

Nine o'clock now and I observe Suzy in a pickle, she is wanting it to be over, saying she can't do it and becoming increasingly negative, defeatist and a little self-centred; rejecting Johns loving support. In my calm state I am wondering how to move Suzy out of her fear state and back into exploratory without being dictatorial or overbearing.

Where is that internal space for her to connect with herself, find her resilience and prepare to meet her baby? Dr Mcclusky says we are moving inside ourselves with other people all the time, and that self-regulation goes on as background music. "We are born with the expectation of being met as a person” resonates within me, and I want that for Suzy so that her baby receives that meeting.

Meanwhile Suzy is becoming more despondent and closer to giving birth (9cm dilated). Is analgesia the right thing to offer? Is that kind and appropriate I ask myself? Maybe, but I think not is my internal answer.
After another of Suzy's desperate outbursts that "she cannot do it", I realise she is overwhelmed and I ask her 3 questions very carefully.

What does she need right now - she answers “not to feel any of this”

What does her baby need right now - “to be born quickly”

How can the two align?  A pause and then - “I had better get a grip", said with a sense of authority and humour.

John smiles at me, as if we have made a breakthrough, it feels like she has moved from her fear state to her maternal and problem solving state.

That is the moment the labour changes, because 30 minutes later and without any pushing at all her baby's head is born in the pool, the membranes are intact and still over his face when Suzy brings Harry to the surface.

We were all in tears, moved by her capacity to change and in how by releasing something negative from her past she became free to move energetically and give birth so smoothly.

A few hours later, we chatted it over and she said last time her birth had been taken away from her, she felt she had lost a part of herself which she hadn't realised until this birth. I told her what had been going through my mind about analgesia, and she agreed she had been thinking that too - I reflected how we had synchronised. She loved having so much skin to skin with her baby because that had not been included last time, and she valued us as helpers and enablers whilst we saluted her for her courage and commitment to her baby.

To conclude, I do not say that having this understanding will mean all births are going to be smooth or straightforward, but I do believe that seeing a woman for who she is gives her choices and with those choices she can make the best decisions for herself and her baby.
 
The approaches I use incorporate my knowledge of hypnosis and Bowen technique, directly and indirectly. Sometimes I use touch, and sometimes calm and reassuring suggestions. The midwifery training itself did not give me a good enough education to understand the minutiae and nuance of what birth entails. I was shocked when I was in labour with my first baby that my training had not prepared me for the realities of birth and what resources I needed. It has taken years of work and application, critique and evaluation to reflect on what holistic means and how to see women holistically. It is a journey not encouraged within the hospital system and finding my own identity has been a hard slog but one I could not avoid. My passion has stemmed from a mixture of sources and is maintained by the appreciation I receive from women and their families as well as colleagues and students. When a mentee says "all we are told about is litigation and self-protection" I worry a little bit more about the lack of self-awareness and acknowledgement these fledging midwives are being trained in.

The other motivation is personal: as a daughter, wife and mother of four, I have to keep working at all my relationships - and in trying, my efforts will be seen, and I will be met as a person. 

You can contact Elly via her email eleanorcopp@me.com and she tweets as @EleanorCopp

REFERENCES

Bowlby,EJM. (1997) Attachment: Volume 1 of the attachment and loss trilogy. (1st ed) UK:Vintage publishing. 

Gerhardt,S.(2004). Why love matters: how affection shapes a baby's brain.(1st ed.)UK:Brunner-Routledge.

Kitzinger,S.(2006). Birth Crises. (1st ed.).UK: Routledge.

McCluskey,U.(2005).To be met as a person: The dynamics of attachment in professional encounters.(1st ed) UK:Karnac. 

Peterson, G. (1984). Birthing Normally: a personal growth approach to childbirth (2nd ed.). USA: Shadow and Light.

Porges, S (2011) The Polyvagal Theory: Neurophysical foundations of emotions attachment communication self-regulation. (1st ed) USA: W.W.Norton and company.

Rothschild,B.(2006) Help for the Helper: self care strategies for managing burnout and stress.(1st ed ) USA:W.W Norton and company.


Wilks,J (2007)The Bowen Technique: The inside story (1st ed) UK:CYMA LTD.

Sunday 29 July 2012

The voice of reason: Researchers reject statement that co-sleeping in dangerous




So good to see this media release from researchers at The Queensland Centre for Mothers & Babies! At last, the voice of reason and evidence informed practice on this very important aspect of parenting.

Researchers reject statement that co-sleeping in dangerous

Researchers from UQ’s Queensland Centre for Mothers & Babies are concerned about recent messages that parents should never sleep in the same bed as their babies. 

QCMB Director Professor Sue Kruske said a recent comment by the Victorian Coroner, who labelled it “inherently dangerous” for a parent to sleep in the same bed as an infant younger than a year old, was not representing current evidence.

“It is not the act of bed sharing that is solely responsible for these deaths,” Professor Kruske said.

“Rather it is other environmental factors that occur in combination with bed sharing.”

She said the vast majority of these 'co-sleeping deaths' were in the context of other circumstances including smoking, alcohol and drug use and unsafe adult sleep environments.

“Prohibiting bed-sharing will actually lead to more harmful practices such as falling asleep with the baby on a couch, which is known to be dangerous, as well as increased cases of babies falling,” she said.

She said research showed many benefits for babies who bed-share safely with their parents, including improved breastfeeding duration rates, improved settling with reduced crying, more infant arousals which are protective for baby, and improved maternal sleep.

Dr Jeanine Young, Chair of SIDS and Kids National Scientific Advisory Group and safe infant sleep expert, said inconsistent messages were making it hard for parents to make informed decisions.

“To make sweeping statements about this practice would require reliable prevalence data,” Dr Young said.

“We know from the studies we have done that shared sleeping is understandably very common for families in Australia especially for breastfeeding parents. If deaths could be ascribed to co-sleeping without other risk factors present, we would expect a lot more.

No environment for babies is risk free. Babies have died alone in cots and babies have died in adult beds. We give clear advice for reducing risks in cot environments but we have not yet addressed shared sleep environments in the same way.

“Many people die in car accidents but we don’t tell people not to drive. We tell them not to drink and drive, to wear seat belts and not speed.

“Similarly, the message for parents is that if you choose, or have no option but to co-sleep, the risks can be reduced by not overheating the baby, not wrapping the baby while bed-sharing, not having either parents as smokers, or under the influence of drugs or alcohol.

“We also know that premature or unwell babies are at higher risk of sudden infant death.”

Media: Professor Sue Kruske 0418 882 337, Dr Jeanine Young 0415 174 003, or Andrew Dunne, QCMB Communications Manager, 0433 364 181.

About the QCMB
The Queensland Centre for Mothers & Babies is an independent research centre based at The University of Queensland and funded by the Queensland Government. The role of the Centre is to work towards consumer-focused maternity care that is integrated, evidence-based and provides optimal choices for women in Queensland.

Monday 31 January 2011

The Umbilical Cord: When do we clamp it?

Clamping the umbilical cord immediately at birth was something that I was taught to do as a routine part of 'delivery' management. The reason for clamping the cord so quickly, I was told, was to stop the baby getting unnecessary blood because the extra blood would be all the more for the baby to process and they would be at risk of becoming jaundiced, caused by the breakdown of all the fetal blood cells.  A nuchal cord (cord around the neck of the baby) was felt for and cut before the shoulders and rest of the baby was born.

Added to the problem of extra blood with an uncut cord, was the fact that the woman was routinely injected with a synthetic form of oxytocin to hasten third stage. The injection of the synthetic oxytocic in third stage made the uterus contract. Authorities believed that if the cord wasn't cut swiftly, the uterine contractions caused by the injection would cause an even greater surge of blood into the new baby, causing the baby to be overloaded with blood and at even more risk of jaundice. 

Once I started working with childbearing women in a one to one way in private practice, the need to clamp and cut the umbilical cord immediately at birth was challenged by the women I worked with. They wanted the cord to be left alone until it stopped pulsating. Some even wanted the placenta to be born before the cord was cut. A few wanted the placenta and cord to be left attached to the baby and allowed to drop off itself, a process called Lotus birth.

The literature was mixed in regards to the advisability of leaving the cord to pulsate or clamping immediately. The opposed camps had reasons such as jaundice, blood volume, postpartum haemorrhage rates to explain their particular views and reasons for their recommendations. The reasons for cutting the cord have been proven to be spurious.  There is however a lot of evidence for leaving the cord alone.  Women and midwives have been talking about and promoting leaving the cord alone as a best practice strategy for several decades now and the evidence for doing so is only getting stronger.  Have a look at the way the cord changes in the minutes after birth.  The evidence for leaving the cord intact is also clear in the case of nuchal cords. Leaving them alone, gently 'somersaulting' the baby to untangle the cord as the baby is born works perfectly and there is no risk of having the baby's oxygen supply prematurely interrupted.  As beautifully explained on the Midwife Thinking blog, the oxygen carrying capacity of an intact cord is the baby's first line of resuscitation after birth. Our medical colleagues have been slower to take up the idea of leaving the cord alone. However a 2011 report has confirmed that iron stores are improved when the cord is left to stop pulsating. A more recent review found that "newborns with later clamping [were heavier and] had higher hemoglobin levels 24 to 48 hours postpartum and were less likely to be iron-deficient three to six months after birth, compared with term babies who had early cord clamping".


A wonderful demonstration of why the umbilical cord should be left alone is provided by Penny Simkin in this video.

Hope for a more balanced approach to the topic of cord clamping or leaving it alone is on the horizon as an obstetric doctor in the US has written about what he calls 'delayed cord clamping' and has produced the following videos for The Grand Rounds on this topic.

Delayed cord clamping Grand Rounds 1

Delayed cord clamping Grand Rounds 2

Delayed cord clamping Grand Rounds 3

Delayed cord clamping Grand Rounds 4 

For more information on the umbilical cord and placenta, go to Rachel Reed's Midwife Thinking blog.  There is a post on the placenta in birth films on this blog here.

Another aspect that hasn't really been explored in great detail as yet, is the perfusion of the newborn's brain at birth. My thinking is that leaving the cord alone allows the newborn's brain to be optimally perfused and ensures that the neuronal connections that proliferate in response to birth to wire in the best possible way, especially when the baby is skin to skin with her/his mother and exposed to the multisensory stimulation that occurs in a physiologically mediated birthing experience. The question to be asked is "do babies suffer subtle brain damage through premature clamping of the cord and less than optimal sensory experiences at birth?" I suspect they do.


Some women want the cord clamped and pulled to get the placenta out as quickly as possible, others see the placenta as the spiritual twin of the baby and want to keep the baby and placenta together.  There are many reasons for leaving the transition to extrauterine life and resuscitation system alone, what's your view?

I can see the day dawning when we look back and say "remember when we used to think that cutting the umbilical cord prematurely was a good thing to do" with incredulous amazement.

Postscript: There is an article (8th October 2014) in the Journal of Midwifery and Women's Health on clamping the umbilical cord at birth. Called "Is it time to Rethink Cord Management when Resuscitation is needed" the article provides compelling evidence for leaving the cord intact and resuscitating a compromised infant by the mother's side.

Post Postscript: A landmark paper published 26th May 2015 has added evidence to my theory of brain & gut damage associated with early cord clamping:

The authors concluded:

Delayed cord clamping (CC) compared with early CC improved scores in the fine-motor and social domains at 4 years of age, especially in boys, indicating that optimising the time to CC may affect neurodevelopment in a low-risk population of children born in a high-income country.

PPS A non peer reviewed article discusses the issues of hypovolaemia in newborns caused by premature cord clamping says this:
Modern human childbirth is “managed” obstetrics, designed to avoid complications and to preserve physiology – a normal, healthy outcome. However, management often intrudes on physiology, producing unintended consequences.
and raises concerns around the potential for multiple organ damage, including brain damage with premature cord clamping.

Now for anyone not yet convinced of the value in leaving the cord to do its magic, this post from AWHONN on a Placental Transfusion for Neonatal Resuscitation after a complete Abruption may help you to change your mind!

Time for practice change everyone!

Tuesday 17 August 2010

OB Gyn perspective on "OB Patient"

YouTube - OB patient

There is a rash of these mini movies. Clever, 'funny' (?) and short. Humour is a great way of getting a message across.



Ask yourself, what is the message that is being sent with this movie?

Here's another mini movie doing the rounds.



What is the message being promoted in this mini movie about women? What message is being sent about pregnant women?

and then, there is the anaesthetist's perspective on midwifery



I asked someone 'in the know' is that really how 'they' see us? "I'm afraid it is" was the answer.

all in good fun the film maker said. Really?

Words are powerful creators and transmitters of cultural beliefs and habits. What we see and what we hear shape and create patterns of thinking that become our perspective and our reality. These patterns and ideas take a life of their own, becoming a cultural meme and influencing every aspect of our minds, our behaviour and our culture. Emotions make those patterns deeper and stronger. Humour is a great release and can often bring the truth of a situation into a clear light. However, humour can seem benign, but is in reality, a particularly powerful pattern 'fixer' and giving more life to a meme.

I feel deep concern that childbearing women are being profiled in the way that these videos do. Yes, there are women who take advantage of systems and other people. In the main, most women want the best for their babies. Ignorance, abuse, violence and poverty are common themes in the lives of those who take drugs, avoid maternity care and lack education. Objectifying women as these videos do is unkind and leads to the adoption of a negative stereotypical view of anyone who is different and then flows on to include all those who seek choice, control and autonomy.

Maternity care is generally constructed to suit the health care institution and the doctors. For some women, their experience of maternity care is horrendous and deeply traumatising. These women can feel raped, violated and brutalized by their experience.

As Amity Reed writes "we should be striving to make all birthing environments, whether at home or in hospital, both safer and more peaceful and empowering".

Safe, peaceful, empowering birth environments for all women is a meme that is essential for our culture to adopt and create. Pregnancy and birth set the foundations for the future health and wellbeing of the baby.

We all know that anyone can change, grow and develop. Respectful, kind, supportive care that engages the heart of the woman does more to promote growth than unkind objectification and superior attitudes.

Videos like those above create a perspective that is harmful and ultimately degrading what's possible.

Sunday 4 July 2010

The Look of Love: birth, mothers, babies and attachment

We humans are gifted with a prefrontal cortex, the site of our executive functioning. Our prefrontal cortex allows us to make choices, decide on different courses of action, rather than reflex, reactive behaviour.  Our prefrontal cortex enables us to evaluate different options and make a decision on what suits us best.

Sociologists contend that rather than being self determining agents with free will, we are culturally constructed, and our decision making is culturally driven and that we do not make decisions based on true free will, but based on what society has taught us is 'expected' and 'accepted' behaviour. Certainly, marketing psychology takes advantage of our tendency to buy on emotions and rationalise our purchases. We make our decisions based on emotionally based programming, we over ride our instincts and go with what is culturally predetermined as 'right'.  In the eyes of the law and culturally accepted social codes, such as avoiding fighting, stealing and self aggrandizement, that form of socially constructed behaviour is useful and makes for a safer and perhaps kinder society. However, there is a down side to over-riding innate instincts. 

Nowhere is the negative side of culturally driven behaviour more apparent than childbirth. Childbirth has been corrupted in our modern world.  In 1972, Doris Haire wrote a wonderful piece about the Cultural Warping of Childbirth, drawing attention to the way that the medicalisation of women's bodily processes at birth were causing harm. A more recent article by Estelle Cohen has drawn attention to "alarming continuing decline in the scores of high school students on the Scholastic Aptitude Tests or, "SAT's," a decline which had started with the 18-year-olds born in 1945 and thereafter. From 1963 to 1977, the score average on the verbal part of the SAT's fell 49 points. The mathematical scores declined 31 points. (1)" Estelle questions whether this decline in academic performance is linked to the way that obstetrics "manages" childbirth.

There are myriad intersecting and interconnecting influences on the personality, health, breastfeeding success, intelligence etc of any human being. However, the links between the way someone is born and their future health and wellbeing is becoming more understood. Epigenetics is one of the scientific arenas that are explaining the links. Many of the practices around the birth of a baby are pivotal and set the scene for the long term relationship of mother and baby. More and more attention is being paid to the mother baby interaction at birth, the role of being skin to skin for mother and baby on both the mother and the baby's future health.

Hospital practices have meant that entire generations of mothers and babies have been separated at birth. The consequences of that separation are only now starting to really be understood.

When my daughter was born, she was whizzed off to the resus trolley, cleaned up and wrapped, then shoved under my nose for about five seconds, then whisked off to the nursery.  I didn't see her until the next morning. About three hours after she was born, I found myself pacing the corridor of the hospital ward. I was surprised by my behaviour, but I recognise now that my body was looking for my baby, even though my conscious mind knew she was in the nursery. I did not think to question, to ask to see her; I fully accepted that she was in the nursery.


Lynne Reed, a Birth Keeper said in a recent interview that “We are the only animals on this planet where the mother will willingly give up her baby to someone else,” she says. “To me, that’s a huge indicator of how separated we are from our natural instincts, which would be so fierce to protect the baby.”

I certainly was separated from my natural instincts and days passed before I saw my daughter naked and we never had the skin to skin experience. I wonder if that is why I was so keen to go back to work and why putting her on the bottle was totally acceptable?  Research shows clearly that women who have skin to skin time at birth with their babies have all kinds of benefits and sequelae such as happier babies, self soothing babies, better breastfeeding experiences, less likely to leave their babies with others, babies smile earlier and more frequently. The list goes on and on.


A significant part of the experience seems to be the first eye to eye connection between mother and baby. Carla Hartley from Trust Birth has spoken about the smile a newborn gives her mother when she looks up at her as they connect skin to skin at birth. Carla describes that moment as 'precious' and 'sacred'. That eye to eye connection can be seen as a connection of spirits, a recognition of souls on this life journey.

For those who haven't had this connection, the gap can feel profound and deep. For example, in a Facebook conversation about this topic, Katherine Suszczewicz said " I was adopted. I hadn't realized until just now how my birth affected me today. It just occurred to me reading this that I have lived 45 years with a smothered urge to look my (birth) mother in the eye, something she didn't do when I was born. That feeling has been simmering and is quickly reaching a rolling boil. Just to look into each other's eyes, there's something there". When I asked Katharine if I could share her words she gave permission and said "whatever choices a momma makes, I think that first gaze is crucial....to begin life with the first air breath, a stare into your mother's eyes, and a feeling of love, security, to feel that someone is fiercely protecting you.....will carry you all your days on earth".

Leah Ann Sandretzky commented on Katharine's post and gave me permission to share her story. Leah said
"Katherine Suszczewicz: my heart goes out to you. ♥ my mother was and still is a recovering drug addict and alcoholic; she's looked me in the eyes many times and I have never seen that love. She says she loves me; and I know she does deep down . . . but her heart is gone from her selfishness. I was cared for by my grandparents most of my life; ...and to this day my soul longs for a Mother's love in my heart. I've taken that pain, that want, and turned it around to love my children 10x more than I think I can every day....in honor of the mother I never had. I don't know your story, your heart; but I hope that whether or not you have or will find that Mother's love in someone's eyes for you; you can go on loving like a Mother should. ♥ "

Another woman said "... the "look" I never received, I was adopted as well. My mother wasn't allowed to look, touch or hear me at birth due to the trauma of adoption on her. I was wisked away and the nurses kept me in the closet behind the nurses station so my mother or her family wasn't tempted to see me. The nurses spoiled me, I was told... and held me all the time but it just isn't the same. I hear the pain of the other women saying almost the same things. Way before reading this article I came to a conclusion during self reflection that I had a very hard time allowing anyone to get too close to me. I have attachment issues with everyone on this planet except for my children. Who I wouldn't let out of me sight when they were born. Thanks for posting this. I never put the two together about the "look" and bonding, I always assumed it was not being with my birth mom in general".
 
That look of love at birth is crucial for brain patterning and wiring a sense of self for the baby. Newborn babies are wired to look at faces and to prefer their mother's face to any other. That look of love triggers cascades of oxytocin in both mothers and babies, welding them together, spiritually, emotionally and physically. 
 
The implications for midwifery practice are clear. We are the guardians of the birth territory. We must facilitate the space so that mothers and babies can connect in this deep and profound way. The future of society and every individual's health and wellbeing depend upon us getting the beginning 'right' and providing an optimal environment, enabling a woman to respond to that innate voice and do what comes 'naturally' or rather, instinctively. 
 
 
 

Monday 14 June 2010

Distracted parenting: Hang up and see your baby - The Boston Globe

Claudia Gold, a paediatrician in Great Barrington, wrote in the Boston Globe today:
"RECENTLY I was on vacation sitting by a pool. I noticed a father with his infant daughter who looked to be about 3 months old. Perched on a table in her car seat, she sat kicking and smiling. Her father faced her, but was talking on his cellphone. He distractedly shook the rattle hanging in front of her as he spoke in an animated way with the person on the other end of the line"
Her article continues to talk about how the baby develops her/his sense of self by the way the mother looks at her/him and interacts on a moment to moment basis. Dr Gold cautions that parents are perhaps not aware of the critical importance of the first few months and the vital importance of attending to and engaging with the baby to optimise the way the brain develops and the infant forms her/his sense of self. Fathers are taking more and more of the primary caretaking role of newborns and infants. A recent article in the New York Times outlined the way that social norms are changing as fathers become more engaged in parenting. Gold discusses the role of oxytocin in the way that mothers are preoccupied with their babies. Perhaps males are disadvantaged in this biological aspect? As feminists in the 70's, one of our catch cries was that 'biology is not destiny' but perhaps we were and are wrong not to pay attention to biological factors and instead of seeing these physiological realities as 'biological determinism' we could reframe the way that hormones and other communication molecules behave as 'biological intelligence'.

Mothers behaviour and orientation to their babies displays what D.W. Winnicott called 'primary maternal preoccupation'. Mothers are meant to be fixated on their babies, attending to their facial expressions; responding and reacting to them. In the past, women were told that babies are such 'time wasters'; that sitting staring at a baby was of no value, however, neuroscience has proven the value of primary maternal preoccupation and those hours of staring, awestruck at the wonder of one's own baby. From the beginning, a baby's brain wires itself, connecting and associating neurons to other neurons in response to environmental cues and emotional experiences. These neuronal associations form patterns of connection that from the earliest days form a mental map for security, enabling an infant to feel safe (or not) in the presence of her/his primary care giver. This primary relationship sets the stage for the child's future relationships and how the child perceives the world. As an infant feels more and more secure in her/his attachment to her/his primary care giver, she/he is able to then turn outward to the world and start engaging with the people and events in his/her wider environment. In those early days, the mother's face provides a mirror which allows the infant to see him/herself and form a sense of self that reflects that image. When mothers are fully engaged, smiling, encouraging, reflecting joy in being, the infant emerges emotionally resilient. Research has shown that mothers with flat affect produce withdrawn, less communicative infants.

Walking through any postnatal unit or going to any home where a new mother and baby reside, you see the ubiquitous cell phone in residence, either next to the woman's ear or being pounded by her flashing finger tips as she dashes off messages to cyberspace. Is it possible that primary maternal preoccupation has, in many instances, been diverted to the cell phone. What message and brain patterning do you think the little ones are getting? What do you think Mary Ainsworth and John Bowlby would make of this phenomenon?

Wednesday 5 May 2010

Talking about the importance of baby's birth experiences at the Mother of all rallies, PH Canberra 2009

I happened upon this video when I was searching for some information on Google! What a rally that was. I was interviewed at the rally for the upcoming film 'Face of Birth' and this is the result of that interview:



There are other snippets of the film in the making on the site.

Carolyn Hastie - Mother of all rallies, PH Canberra 2009

Thursday 18 February 2010

Medical News: Developmental Delay Linked to 'Flat Head' Syndrome - in Pediatrics, General Pediatrics from MedPage Today

from MedPage

"Babies with misshapen heads from lying on their backs too long may be at heightened risk for developmental delays, researchers said, although they stressed that infants should still sleep in the supine position"
The worry about SIDS (Sudden Infant Death) is understandable. Parents have been terrified about the possiblity of SIDs and it is heartbreaking when SIDS occurs. The Back to Sleep campaign has reduced the number of SIDs cases, but parents have become terrified to put their children in any other position than on their backs.
SIDS has been linked to low levels of a hormone called Serotonin and the enzyme that makes it in the baby's brainstem.  Brainstem circuits control breathing, blood pressure, and heart rate during sleep, Hannah C. Kinney, MD, of Children's Hospital Boston, and colleagues reported in the Feb. 3 issue of the Journal of the American Medical Association. A baby with an abnormality in control of these systems might not be able to respond to a life-threatening challenge like asphyxia by rousing from sleep or turning its head the researchers explained.
 These researchers suggest that the back to sleep campaign has saved those babies who would not have been able to move their heads or bodies in response to changing physiology. 

Now researchers are saying that flat heads from back lying are associated with neurodevelopmental delay. A fascinating and troubling finding. The authors are at pains to say that these babies may have developed plagiocephaly because they already had a problem and caution that parents should still ensure babies lie on their backs to sleep.

I wonder if we are not having a problem that is self perpetuating here.  Neurophysiologists like James Prescott (a hero of mine) tell us that the brainstem gets 'set' at birth by the environment the baby meets. If the baby gets skin to skin with his/her mother, the brain stem gets set for love, happiness and contentment - states associated with serotonin.  If babies are whizzed off to the resuscitaire, their brain stems are set for fear and distress. That state is associated with a lack of serotonin.

These days, with the back to sleep campaign, many children are not having any tummy time, they are not being carried and they are certainly not sleeping with their mother, all of which adds up to mean they are not having the stimulation from movement and touch that they get from being held, carried and laid in different positions. I suspect the brainstem issue could relate to how they are treated at birth and the neurodevelopmental delay that is associated with plagiocephaly could be due to lack of stimulation.

Babies need to be carried, they need to sleep with their mothers to get the stimulation necessary for optimal brain growth . One of my many heroes, Dr James McKenna at Notra Dame University has done many mother-infant sleep studies.

Go to  Dr McKenna's home page to find the latest research and information about the sleep studies.

Dr McKenna's sensible and baby/mother friendly suggestions for babies sleeping safely can be found at this link:    Babies Sleeping Safe



CO-SLEEPING RESEARCH

The psychophysiological effects of sleep-sharing are studied in sleep laboratories that mimic, as much as possible, the home bedroom. Over the past few years, over a million dollars of research money has been devoted to sleep-sharing research. These studies have all been done on mothers and infants ranging from two to five months in age. Here are findings based on mother-infant pairs studied in the sleep-sharing arrangement versus the solitary-sleeping arrangement (Elias 1986, McKenna 1993, Fleming 1994; Mosko 1994):

1. Mothers and babies who sleep together are more 'in sync' than those who do not: when either the mother or the baby moved, stirred, coughed or changed stages of sleep, the other would change in synchrony, without waking.

2. Both mother and baby generally spent more time in the same stage of sleep and for longer periods when they slept together.

3. Mothers sleep better even though their babies sleep deeply for shorter periods when they sleep together: thought to be a protective mechanism. Mothers tend to stir and babies follow if baby sleep is deep for any length of time.

4. Sleep-sharing infants arouse more and breastfeed more than babies who sleep separately; mothers to not report waking more frequently than those who slept separately.

5. Sleep-sharing infants tended to sleep more often on their backs or sides and less often on their tummies, a factor that could itself lower the SIDS risk.

6. Mothers and babies who sleep together, touch and interact a lot, even when sleeping: each affects the night time behaviour of the other.

Insightful mothers have always felt better sleeping with their babies. Babies suffer separation distress when they are apart from their mothers.

In my view, plagiocephally (flat back of head) is an iatrogenic problem. The neurodevelopmental delay associated with plagiocephaly results from the lack of stimulation caused by the 'lie your baby on its back dictum' is, also, in my view, iatrogenic.

Our culture is really weird. Anything that is good and wholesome, like birth at home with those you love, sleeping with your baby and attachment parenting is branded medically suspect. I guess the beneficiaries of the regular doctor visits, helmet makers and surgeons who correct misshapen heads have to make a living.

Monday 11 January 2010

The most natural thing in the world!

The street were I live is on a little peninsula, boarded by a river on one side and a lake on the other. At the end of the street is a walking track through the bush to the end of the peninsula where the river meets the lake. The track is about a kilometre long.

looking out along the track


I have been writing a chapter on the birth environment in a new book by Lorna Davis called "Sustainability, Midwifery and Birth", the focus of which is reducing the carbon footprint of maternity care and the midwife's role in that. I took time out from the final edits and rejigging of the content yesterday evening to go for a walk. As I was walking back from the end of the track, musing about the chapter,  a young couple holding hands were walking towards me.

The father was 'wearing' a baby in a carrier produced by the Australian Breastfeeding Association. I stopped and said hello, congratulating them and commenting on the lovely baby to be told the baby was born the night before last. As we chatted, they told me they had their baby at home - 'in the water', said the proud grinning father as he gently stroked his daughter's hair. The mother was smiling with that look that new mothers who feel fabulous and proud of themselves do. Their conversation about their birth experience was calm, relaxed and full of a sense of joy. The young woman told me her sister is a midwife (who I know) and that the experience had been wonderful. Her confidence was palpable. Being in their presence was such a gift.

I left that couple and their new baby and walked back home, thinking about their experience. That woman's labour and birth was a perfect example of how birth, when women feel good and in control and surrounded by people who love and support her and her process, is a sustainable, eco-friendly human activity.

If ever anyone needs a reason to protect, promote and support normal natural birth, that woman and her experience provides a shining example of how birth is meant to be.

The most natural thing in the world...