ArticlePDF Available

The neuroscience of birth – and the case for Zero Separation

Authors:

Abstract

Currently, Western maternal and neonatal care are to a large extent based on routine separation of mother and infant. It is argued that there is no scientific rationale for this practice and a body of new knowledge now exists that makes a case for Zero Separation of mother and newborn. For the infant, the promotion of Zero Separation is based on the need for maternal sensory inputs that regulate the physiology of the newborn. There are harmful effects of dysregulation and subsequent epigenetic changes caused by separation. Skin-to-skin contact is the antithesis to such separation; the mother's body is the biologically 'normal' place of care, supporting better outcomes both for normal healthy babies and for the smallest preterm infants. In the mother, there are needed neural processes that ensure enhanced reproductive fitness, including behavioural changes (e.g. bonding and protection) and improved lactation, which are supported by the practice of Zero Separation. Zero Separation of mother and newborn should thus be maintained at all costs within health services.
Original Research
doi:10.4102/curaonis.v37i2.1440
hp://www.curaonis.org.za
The neuroscience of birth – and the case for Zero
Separaon
Author:
Nils J. Bergman1
Aliaon:
1Department of Human
Biology, University of
Cape Town, South Africa
Correspondence to:
Nils Bergman
Email:
nils@ninobirth.org
Postal address:
8 Francis Road, Pinelands
7405, South Africa
Dates:
Received: 25 July 2014
Accepted: 12 Sept. 2014
Published: 28 Nov. 2014
How to cite this arcle:
Bergman, N.J., 2014, ‘The
neuroscience of birth – and
the case for Zero Separaon’,
Curaonis 37(2), Art. #1440,
4 page. hp://dx.doi.
org/10.4102/curaonis.
v37i2.1440
Copyright:
© 2014. The Authors.
Licensee: AOSIS
OpenJournals. This work
is licensed under the
Creave Commons
Aribuon License.
Currently, Western maternal and neonatal care are to a large extent based on routine
separation of mother and infant. It is argued that there is no scientic rationale for this practice
and a body of new knowledge now exists that makes a case for Zero Separation of mother and
newborn. For the infant, the promotion of Zero Separation is based on the need for maternal
sensory inputs that regulate the physiology of the newborn. There are harmful effects of
dysregulation and subsequent epigenetic changes caused by separation. Skin-to-skin contact
is the antithesis to such separation; the mother’s body is the biologically ‘normal’ place of
care, supporting better outcomes both for normal healthy babies and for the smallest preterm
infants. In the mother, there are needed neural processes that ensure enhanced reproductive
tness, including behavioural changes (e.g. bonding and protection) and improved lactation,
which are supported by the practice of Zero Separation. Zero Separation of mother and
newborn should thus be maintained at all costs within health services.
Introducon
Problem statement
Until recently, the standard belief about the newborn brain was that it was extremely immature
at birth. It was believed that maturation was primarily a genetically guided process and therefore
relatively impervious to inuence by early care at birth and inevitable adverse experiences. It
was believed that mothers had negligible inuence on their newborns’ brains or bodies and
that the important thing was to ensure newborn survival. There was a legacy of high maternal
mortality, so childbirth was regarded as extremely dangerous and required management by
specialists that ensured survival. In the process, success became measured largely by survival
itself, not by quality of survival or any other behavioural or social outcomes. Over the last 100
years, this world view has shaped the way in which health services are designed and operated.
New ideas that might possibly undermine the good results that modern care has achieved are
often met with resistance.
Aims
The above beliefs and ideas about childbirth are not supported by 21st century neuroscience or
by evidence-based medicine. This brief scientic report provides a critical examination of the
current gap between latest evidence and current practice in newborn care.
Trends
Early childhood development and policy makers refer to the ’rst 1000 days’ as the rst two
years of life, as well as the 270 days preceding birth (Panter-Brick & Leckman 2013). The human
newborn is born with a relatively small brain, but science has shown that it is perfectly wired
and competent for early extra-uterine life (Schore 2001a; Winberg 2005). A human will never
be as alert as after a vaginal birth: noradrenalin wakes up the brain and is 10 times higher at
birth than ever again (Lagercrantz & Bistoletti 1977). High levels of noradrenalin activate the
lungs and, more importantly, ensure early bonding with the mother (Ross & Young 2009). The
mother’s smell (Porter 1998), contact and warmth ‘re’ a pathway from the baby’s amygdala to
its frontal lobe (Bartocci et al. 2000), which connects the newborn’s emotional and social brain
circuits (Nelson & Panksepp 1998). Whilst genes have made this possible (Lagercrantz 1996),
the experience of a mother’s constant and uninterrupted physical presence make it happen
(Hofer 1994). It used to be asked whether ‘nature or nurture drove development; more recently
it was believed that it was nature and nurture AND niche’ – with niche being the environment
– that did so. The current view is to regard both nurture and niche as environment; nature’s
gene effects are multiplied in their interaction with this environment (commonly written GxE)
(Caspi et al. 2010).
Page 1 of 4
Scan this QR
code with your
smart phone or
mobile device
to read online.
Read online:
Original Research
doi:10.4102/curaonis.v37i2.1440
hp://www.curaonis.org.za
The case for Zero Separaon
Is the safest place for a newborn the observation nursery,
separated from its mother? The Cochrane review on early
skin-to-skin contact (SSC) for healthy newborns and their
mothers (Moore et al. 2012) nds strong evidence that SSC
produces improved physiological regulation and increases
breastfeeding rates. Another Cochrane Review on the
Kangaroo Mother Care (KMC) strategy which includes
SSC, breastfeeding and early discharge (World Health
Organization [WHO] 2003), concludes that KMC lowers
mortality (Conde-Agudelo, Belizán & Diaz-Rossello 2011).
Premature babies are, in many hospitals, believed to be
unstable, thus holding and touch is discouraged. Findings
from a randomised controlled trial published 10 years ago
indicate, however, that low-birth-weight newborns stabilised
because they were not separated from their mothers. In
contrast, preterm babies became increasingly unstable
during their rst six hours of life in optimal incubator care
(Bergman, Linley & Fawcus 2004). Why then do private and
public hospital staff still believe that the mother’s body is a
dangerous place for newborns, when research demonstrates
that premature babies become unstable because their
mothers are not holding them, that is to say, because of
maternal-infant separation (Bergman et al. 2004)?
A common view of a newborn is that it lies in its bed, where
it either cries or sleeps; and swaddling is helpful for stopping
its crying. Crying is said to be good, helping to ll the lungs
with air. Modern neuroscience, however, does not support
this view. The science behind reproductive biology is that all
of a mother’s body sensations help control all of the different
parts of the physiology of the baby (Hofer 2005); this is
called regulation. Prolonged maternal regulation results
in healthy physiological set-points (Hofer 2005), mediated
by epigenetic settings that wire midbrain neural circuits
(Meaney & Szyf 2005). Babies cry because of the absence
of the maternal sensory regulators: they are experiencing
dysregulation (Christensson et al. 1995; Hofer 2005). This
shuts off the baby’s growth hormone and switches on
cortisol (Hofer 2005). Cortisol diverts all the calories and
other neurological resources to ensuring survival, so that
homeostasis is re-established, but at the cost of growth. Such
infants do have ‘stable vital signs’, but the energy consumed
to achieve this homeostasis is not measured (McEwen
& Seeman 1999). When the mother provides regulation
through her own body, all of the baby’s energy is available
for development.
In a study of two-day-old healthy babies sleeping
alternatively in cots and in SSC (their own controls), cot
sleeping showed three times higher autonomic nervous
system (ANS) activation compared with SSC (Morgan, Horn
& Bergman 2011). It is now known that more calories are
required with higher ANS activity; this is accompanied by
high cortisol levels. When cortisol is doing the regulating,
less efcient homeostatic set-points are being programmed
in the physiology of the baby. These set-points remain for
life (Hochberg et al. 2011). The most well established effect
of this re-programming is obesity (Stettler et al. 2005), but
hypertension, high cholesterol and diabetes may become
likely health outcomes because of such changes (Coe
& Lubach 2008). Furthermore, the infant connection of
amygdala to frontal lobe is weakened (Schore 2001b) and
the capacity for trust is compromised when the infant’s basic
needs are not met (Ross & Young 2009).
The swaddled and separated baby lies still with its eyes
closed, and is believed to be sleeping. A study on autonomic
activation (Morgan et al. 2011), showed that quiet sleep was
reduced by 86% in separated babies and their sleep cycling
was almost abolished. There were also specic autonomic
patterns in separated babies, which match perfectly those
described as ‘threat responses’ found in abused children
(Perry et al. 1995). The rst sign of perceived threat results
in vigilance, where crying has survival value since the
perceived threat is further away than the mother. When
the perceived threat is closer than the mother, or if the
mother is not responding, a cry response would, however,
increase danger, thus a state of freeze follows (Misslin
2003). This ‘freeze state’ is produced by intense and total
autonomic activation, with profound avoidance activation
on electroencephalogram (Jones, McFall & Diego 2004). Such
babies lie absolutely still, absolutely quiet, with eyes rmly
closed. This is believed to be sleep! It is however a state of
high arousal, also called ‘fear-terror’ (Perry et al. 1995). When
this state is prolonged, cortisol may initiate harmful changes
that can affect the individual across its lifespan.
Whilst survival rates are important, it is the quality of
survival that actually matters. This is specically true for
preterm infants that spend weeks in separation. It has been
shown that there is a poor quality of survival with respect
to their immunity (Baron et al. 2011; Bird et al. 2010), IQ and
scholastic achievement (Jain 2008; Morse et al. 2009). SSC
with Zero Separation is the biological normal (default) and
is the one intervention above any other that can improve
quality of survival.
The impact of Zero Separaon on the mother
Nursing practices also ensure the mother’s safety, but many
procedures and restrictions have no evidence base. Over
recent years, procedures have been tested methodically in
randomised controlled trials and have been shown to be
unhelpful or even harmful. Examples of such procedures
include shaving, episiotomy, giving birth in lithotomy,
continuous cardiotocograph use and starving during
labour (WHO 2014). Whilst there have been changes,
health professionals still maintain control of the whole
birth experience; the mother is not allowed this basic right
(WHO 2014).
A new mother is often still coerced or encouraged into
thinking that she needs ‘to rest and be alone’ after birth, that
this is good for her and that it is safest and best for her baby
to be in the hospital nursery. Reproductive biology afrms
that there are critical periods that operate in the newborn
(Lee 2003), but equally so in the mother. The stimulations
Page 2 of 4
Original Research
doi:10.4102/curaonis.v37i2.1440
hp://www.curaonis.org.za
Page 3 of 4
the newborn provides to the mother, including eye contact,
nipple stimulations and sounds, all work together to trigger
new neural circuits in the mother. One of these is an oxytocin
effect in the anterior cingulate gyrus (Uvnäs-Moberg 2003),
which produces ‘ferocity of defence of young’ (Hahn-
Holbrook et al. 2011; Leng, Meddle & Douglas 2008). The
window for this effect is only a few hours (Uvnäs- Moberg
2003). Early suckling produces prolactin which ensures that
mammogenesis is optimal (Uvnäs-Moberg et al. 1990); the
window for this is two days. Thus, successful breastfeeding
requires Zero Separation. Many other effects are taking
place, but sufce it to say, it is a huge disservice to mothers
when their newborns are removed.
Whilst mothers themselves need observation and care in order
to prevent complications during and after childbirth, this
author believes that current care must accommodate the new
understanding of reproductive biology and developmental
neuroscience. Maternal and fetal outcomes are profoundly
improved when doula care is provided (American College
of Obstetricians and Gynecologists 2014) along with ‘natural
birth’ (Mercer et al. 2007; Smith, Plaat & Fisk 2008), as well as
when the ecologically-valid environment that produces the
‘GxE’ described earlier is ensured. Although the technology
and skills available for newborn and preterm care are
wonderful, they do not require separation; they should instead
be applied to the right place, the mother’s chest (Phillips 2013;
White 2004). In this way, maternal, physiological regulation
will be working in synergy with the baby’s ANS, the need for
technology will be lessened and the intensity thereof can be
reduced, with better outcomes.
The essential requirement is maternal-infant ‘togetherness’,
the rst part of which is SSC, starting from the moment of
birth and Zero Separation (Bergman & Bergman 2013).
Achieving ‘togetherness’ also requires that the father does
SSC (Erlandsson et al. 2007; Gloppestad 1998). Space thus
needs to be provided for both mother and father to care for
their baby. Broader social support is needed, not the ‘one
size ts all’ and ‘no space for father’ that institutional and
impersonal service often codify so rigidly.
Conclusion
The one intervention above any other that would improve
neonatal and maternal outcomes is Zero Separation for the
rst day of every newborn’s life.
Acknowledgements
Compeng interests
The author declares that he has no nancial or personal
relationship(s) that may have inappropriately inuenced
him in writing this article.
References
American College of Obstetricians and Gynecologists, 2014, ‘Obstetric care
consensus no. 1: Safe prevenon of the primary cesarean delivery’,
Obstetrics and Gynecology 123(3), 693–711. hp://dx.doi.org/10.1097/01.
AOG.0000444441.04111.1d
Baron, I.S., Erickson, K., Ahronovich, M.D., Baker, R. & Litman, F.R., 2011, ‘Cognive
decit in preschoolers born late-preterm’, Early Human Development 87(2),
115–119. hp://dx.doi.org/10.1016/j.earlhumdev.2010.11.010
Bartocci, M., Winberg, J., Ruggiero, C., Bergqvist, L.L., Serra, G. & Lagercrantz, H.,
2000, Acvaon of olfactory cortex in newborn infants aer odor smulaon:
A funconal near-infrared spectroscopy study’, Pediatric Research 48(1), 18–23.
hp://dx.doi.org/10.1203/00006450-200007000-00006
Bergman, J. & Bergman, N., 2013, ‘Whose choice? Advocang birthing pracces
according to baby's biological needs’, The Journal of Perinatal Educaon 22(1),
8–13. hp://dx.doi.org/10.1891/1058-1243.22.1.8
Bergman, N.J., Linley, L.L. & Fawcus, S.R., 2004, ‘Randomized controlled trial of
skin-to-skin contact from birth versus convenonal incubator for physiological
stabilizaon in 1200- to 2199-gram newborns’, Acta Paediatrica 93(6), 779–785.
hp://dx.doi.org/10.1111/j.1651-2227.2004.tb03018.x
Bird, T.M., Bronstein, J.M., Hall, R.W., Lowery, C.L., Nugent, R. & Mays, G.P., 2010,
‘Late preterm infants: Birth outcomes and health care ulizaon in the rst year’,
Pediatrics 126(2), e311–e319. hp://dx.doi.org/10.1542/peds.2009-2869
Caspi, A., Hariri, A.R., Holmes, A., Uher, R. & Mo, T.E., 2010, ‘Genec sensivity to
the environment: The case of the serotonin transporter gene and its implicaons
for studying complex diseases and traits’, The American Journal of Psychiatry
167(5), 509–527. hp://dx.doi.org/10.1176/appi.ajp.2010.09101452
Christensson, K., Cabrera, T., Christensson, E., Uvnäs-Moberg, K. & Winberg,
J., 1995, ‘Separaon distress call in the human neonate in the absence of
maternal body contact’, Acta Paediatrica 84(5), 468–473. hp://dx.doi.
org/10.1111/j.1651-2227.1995.tb13676.x
Coe, C.L. & Lubach, G.R., 2008, ‘Fetal programming: Prenatal origins of health and
illness’, Current Direcons in Psychological Science 17(1), 36–41. hp://dx.doi.
org/10.1111/j.1467-8721.2008.00544.x
Conde-Agudelo, A., Belizán, J.M. & Diaz-Rossello, J., 2011, ‘Kangaroo mother care
to reduce morbidity and mortality in low birthweight infants’, The Cochrane
Database of Systemac Reviews 3, CD002771.
Erlandsson, K., Dsilna, A., Fagerberg, I. & Christensson, K., 2007, ‘Skin-to-skin
care with the father aer cesarean birth and its eect on newborn crying and
prefeeding behavior’, Birth 34(2), 105–114. hp://dx.doi.org/10.1111/j.1523-
536X.2007.00162.x
Gloppestad, K., 1998, ‘Experiences of maternal love and paternal love when preterm
infants were held skin to skin and wrapped in blankets: Dierences between two
types of holding [Norwegian]’, Vård i Norden 47(1), 23–30.
Hahn-Holbrook, J., Holt-Lunstad, J., Holbrook, C., Coyne, S.M. & Lawson,
E.T., 2011, ’Maternal defense: Breast feeding increases ag gression by
reducing stress‘, Psychological Science 22(10), 1288–1295. hp://dx.doi.
org/10.1177/0956797611420729
Hochberg, Z., Feil, R., Constancia, M., Fraga, M., Junien, C., Carel, J.C. et al., 2011,
‘Child health, developmental plascity, and epigenec programming’, Endocrine
Reviews 32(2), 159–224. hp://dx.doi.org/10.1210/er.2009-0039
Hofer, M.A., 1994, ‘Early relaonships as regulators of infant physiology and behavior’,
Acta Paediatrica 397, 9–18. hp://dx.doi.org/10.1111/j.1651-2227.1994.
tb13260.x
Hofer, M.A., 2005, ‘The psychobiology of early aachment’, Clinical Neuroscience
Research 4(5–6), 291–300. hp://dx.doi.org/10.1016/j.cnr.2005.03.007
Jain, L., 2008, ‘School outcome in late preterm infants: A cause for concern’, The
Journal of Pediatrics 153(1), 5–6. hp://dx.doi.org/10.1016/j.jpeds.2008.03.001
Jones, N.A., McFall, B.A. & Diego, M.A., 2004, ‘Paerns of brain electrical acvity in
infants of depressed mothers who breaseed and bole feed: The mediang role
of infant temperament’, Biological Psychology 67(1–2), 103–124. hp://dx.doi.
org/10.1016/j.biopsycho.2004.03.010
Lagercrantz, H., 1996, ‘Stress, arousal, and gene acvaon at birth’, Physiology 11(5),
214–218.
Lagercrantz, H. & Bistole, H., 1977, ‘Catecholamine release in the newborn infant at
birth’, Pediatric Research 11(8), 889-893. hp://dx.doi.org/10.1203/00006450-
197708000-00007
Lee, C., 2003, ‘Bonding’, Pediatrics in Review 24(8), 289–290. hp://dx.doi.
org/10.1542/pir.24-8-289
Leng, G., Meddle, S.L. & Douglas, A.J., 2008, ‘Oxytocin and the maternal brain’,
Current Opinion in Pharmacology 8(6), 731–734. hp://dx.doi.org/10.1016/j.
coph.2008.07.001
McEwen, B.S. & Seeman, T., 1999, ‘Protecve and damaging eects of mediators
of stress. Elaborang and tesng the concepts of allostasis and allostac
load’, Annals of the New York Academy of Sciences 896, 30–47. hp://dx.doi.
org/10.1111/j.1749-6632.1999.tb08103.x
Meaney, M.J. & Szyf, M., 2005, ‘Maternal care as a model for experience-dependent
chroman plascity?’, Trends in Neurosciences 28(9), 456–463. hp://dx.doi.
org/10.1016/j.ns.2005.07.006
Mercer, J.S., Erickson-Owens, D.A., Graves, B. & Haley, M.M., 2007, ‘Evidence-based
pracces for the fetal to newborn transion’, Journal of Midwifery & Women’s
Health 52(3), 262–272. hp://dx.doi.org/10.1016/j.jmwh.2007.01.005
Misslin, R., 2003, ‘ The defense system of fear: behavior and neurocircuitry’,
Neurophysiologie Clinique 33(2), 55–66. hp://dx.doi.org/10.1016/S0987-
7053(03)00009-1
Moore, E.R., Anderson, G.C., Bergman, N. & Dowswell, T., 2012, ‘Early skin-to-skin
contact for mothers and their healthy newborn infants’, The Cochrane Database
of Systemac Reviews 5, CD003519.
Morgan, B.E., Horn, A.R. & Bergman, N.J., 2011, ‘Should neonates sleep
alone?’, Biological Psychiatry 70(9), 817–825. hp://dx.doi.org/10.1016/j.
biopsych.2011.06.018
Original Research
doi:10.4102/curaonis.v37i2.1440
hp://www.curaonis.org.za
Page 4 of 4
Morse, S.B., Zheng, H., Tang, Y. & Roth, J., 2009, ‘Early school-age outcomes of late
preterm infants’, Pediatrics 123(4), e622–e629. hp://dx.doi.org/10.1542/
peds.2008-1405
Nelson, E.E. & Panksepp, J., 1998, ‘Brain substrates of infant-mother aachment:
contribuons of opioids, oxytocin, and norepinephrine’, Neuroscience and
Biobehavioral Reviews 22(3), 437–452. hp://dx.doi.org/10.1016/S0149-
7634(97)00052-3
Panter-Brick, C. & Leckman, J.F., 2013, ‘Editorial commentary: resilience in child
development – interconnected pathways to wellbeing’, The Journal of Child
Psychology and Psychiatry 54(4), 333–336. hp://dx.doi.org/10.1111/jcpp.12057
Perry, B.D., Pollard, R.A., Blakley, T.L., Baker, W.L. & Vigilante, D., 1995, ‘Childhood
trauma, the neurobiology of adaptaon, and "use-dependent" development
of the brain. How "states" become "traits"’, Infant Mental Health Journal
16(4), 271–291. hp://dx.doi.org/10.1002/1097-0355(199524)16:4<271::AID-
IMHJ2280160404>3.0.CO;2-B
Phillips, R., 2013, ‘The sacred hour: Uninterrupted skin-to-skin contact immediately
aer birth’, Newborn & Infant Nursing Reviews 13(2), 67–72. hp://dx.doi.
org/10.1053/j.nainr.2013.04.001
Porter, R.H., 1998, ‘Olfacon and human kin recognion’, Geneca 104(3), 259–263.
hp://dx.doi.org/10.1023/A:1026404319384
Ross, H.E. & Young, L.J., 2009, ‘Oxytocin and the neural mechanisms regulang
social cognion and aliave behavior’, Froners in Neuroendocrinology 30(4),
534–547. hp://dx.doi.org/10.1016/j.yfrne.2009.05.004
Schore, A.N., 2001a, ‘Eects of a secure aachment relaonship on right
brain development, aect regulaon, and infant mental health’, Infant
Mental Health Journal 22(1–2), 7–66. hp://dx.doi.org/10.1002/1097-
0355(200101/04)22:1<7::AID-IMHJ2>3.0.CO;2-N
Schore, A.N., 2001b, ‘ The eects of early relaonal trauma on right brain
development, aect regulaon, and infant mental health’, Infant Mental
Health Journal 22(1–2), 201–269. hp://dx.doi.org/10.1002/1097-
0355(200101/04)22:1<201::AID-IMHJ8>3.0.CO;2-9
Smith, J., Plaat, F. & Fisk, N.M., 2008, ‘The natural caesarean: A woman-centred
technique’, Brish Journal of Obstetrics and Gynaecology 115(8), 1037–1042.
hp://dx.doi.org/10.1111/j.1471-0528.2008.01777.x
Steler, N., Stallings, V.A., Troxel, A.B., Zhao, J., Schinnar, R., Nelson, S.E. et al., 2005,
‘Weight gain in the rst week of life and overweight in adulthood: A cohort
study of European American subjects fed infant formula’, Circulaon 111(15),
1897–1903. hp://dx.doi.org/10.1161/01.CIR.0000161797.67671.A7
Uvnäs-Moberg, K., 2003, The oxytocin factor: Tapping the hormone of calm, love, and
healing, 2nd edn., Da Capo Press, Cambridge, MA.
Uvnäs-Moberg, K., Widström, A-M., Nissen, E. & Björvell, H., 1990, ‘Personality traits
in women 4 days postpartum and their correlaon with plasma levels of oxytocin
and prolacn’, Journal of Psychosomac Obstetrics & Gynaecology 11(4), 261–
273. hp://dx.doi.org/10.3109/01674829009084422
White, R.D., 2004, ‘Mothers' arms – the past and future locus of neonatal care?’,
Clinics in Perinatology 31(2), 383–387, ix. hp://dx.doi.org/10.1016/j.
clp.2004.04.009
Winberg, J., 2005, ‘Mother and newborn baby: Mutual regulaon of physiology and
behavior – a selecve review’, Developmental Psychobiology 47(3), 217–229.
hp://dx.doi.org/10.1002/dev.20094
World Health Organizaon, 2003, Kangaroo mother care: a praccal guide, WHO,
Geneva.
World Health Organizaon, 2014, The WHO Reproducve Health Library, viewed
30 July 2014, from hp://apps.who.int/rhl/en/
... The newborns are moved to an artificial, and often times harsh, NICU environment for both the child and the family, which culminates in negative health consequences, like hypothermia, hypoglycaemia and infection (mmediatetudy G, 2020). Kangaroo care (KC) or skin-to-skin contact (SSC) is ideal to promote zero separation of mothers and babies (mmediatetudy G, 2020;Bergman, 2014;Bergman, 2015), minimize these negative consequences and provide positive physical contact, while in the NICU (Stadd et al., 2019), with improvement of life quality of the newborn (Bergman, 2014). KC or SSC involves holding only a diaper-clad infant on the parent's bare chest. ...
... The newborns are moved to an artificial, and often times harsh, NICU environment for both the child and the family, which culminates in negative health consequences, like hypothermia, hypoglycaemia and infection (mmediatetudy G, 2020). Kangaroo care (KC) or skin-to-skin contact (SSC) is ideal to promote zero separation of mothers and babies (mmediatetudy G, 2020;Bergman, 2014;Bergman, 2015), minimize these negative consequences and provide positive physical contact, while in the NICU (Stadd et al., 2019), with improvement of life quality of the newborn (Bergman, 2014). KC or SSC involves holding only a diaper-clad infant on the parent's bare chest. ...
Article
Full-text available
Background Kangaroo Care allows newborns to share skin-to-skin contact, also called Kangaroo care, with parents, warmed by conductive and radiant heat transfer, enhances the mother's birth experience. KC has demonstrated long-term health benefits for both infant and parent during hospitalization. Aim Identify parents’ opinions about the Kangaroo Care, its benefits to the infant and themselves and the reasons to change KC to skin-to-skin contact holding during the hospitalization. Design Observational, exploratory, and descriptive study with a qualitative approach. The textual content of interviews conducted with 21 parents was subjected to lexicographical textual (descending hierarchical classification and similarity analysis) with IRaMuTeQ. Results 809 segments were analysed in the descending hierarchical classification, retaining 82.5% of the total for the creation of four classes. The similarity analysis of the words representing the parental opinion about KC led to three central cores, represented by the words: nurse, holding, benefit. Conclusion A maioria dos pais revelou ter algum conhecimento sobre o KC, que foi reforçada pela informação transmitida oralmente e através de exposição de posters durante o internamento. Contudo, verificou-se que esta não foi suficiente para a manutenção do KC. Parents cite the presence of positive support and reassurance received by the nurses as important for them to continue KC, although there were some differences identified between mothers and fathers.
... At the moment of birth and during the hours and days that follow, mothers and newborns have a physiological need to be together. Keeping mothers and newborns together is a safe and healthy birth practice (Bergman, 2014;Crenshaw, 2014;Moore et al., 2016). Skin-to-skin contact refers to the contact between a newborn and a parent's bare chest when the newborn is placed in a prone position, naked and with towels covering its back (Anderson et al., 2007;Crenshaw, 2014). ...
... Zero separation is a concept introduced by Bergman where zero separation is defined as skinto-skin contact with one parent or one of the parents being present with the newborn all the time (Bergman, 2014). The Swedish National Board of Health and Welfare defines zero separation as couplet care between the mother and the newborn, where zero separation is an important part of family-centred care. ...
Article
Full-text available
Purpose Zero separation is a family-centred approach where newborns should be accompanied by their parents, regardless of the type of birth or health status. To our knowledge, few studies have described the way this approach is realized in clinical practice. This study describes situations of separation between mother/partner and newborn after birth on the labour ward, maternity ward and at the neonatal unit. Method An observation study was conducted during four months at a Swedish hospital. All caregivers at the three units were given the task of collecting the data. A semantic thematic analysis was performed with an inductive approach. Results Six themes emerged from the analysis. Two themes were common to all three units, one theme was common to two units and three themes emerged at only one unit. The themes describe various causes of separation, such as organizational and economic barriers, clinical routines, parents’ own decisions, shortage of collaboration within and between units, as well as a shortage of interprofessional communication. Conclusion Our study shows that there is still a gap between the latest evidence-based knowledge of the importance of zero separation and current practice in newborn care. There is a need for continuous collaboration between all units responsible for the care of mother and newborn.
... Separation induces heightened autonomic nervous system (ANS) activity and cortisol levels-which utilizes excess calories and may compromise newborn growth and brain development during a critical period. 47 Additionally, early heightened activation alters homeostasis setpoints for life, with the most studied outcome being obesity, and likely hypertension, hypercholesterolemia, and diabetes, America's leading causes of mortality. 9,10,26 Furthermore, physical separation compromises trust and adaptability to the newborn's cues between birth parent and newborn. ...
Article
Full-text available
An review of the racially disparate composition of child welfare, especially in California, and policies and practices that contribute. We focus on the removal of newborns and infants due to parental substance use as a key opportunity to explore and develop practices which support and strengthen families and move prevention upstream of a mandated report.
... This phenomenon is also reported by other studies [25]. Within the BFHs, decision makers and health professionals were urged to keep together what could not be separated, if not at the cost of mental and physical health outcomes affecting both parenting and early child development [26][27][28]. WHO and UNICEF affirmed the BFH standard as being, still, the most appropriate and effective way to ensure maternal and newborn health, as the benefits of breastfeeding, bonding and closeness outweighed what was subsequently demonstrated to be a low risks of virus transmission [10,23]. Despite the provision of evidence, respondents in our study reported that COVID-19+ mothers were often left alone during labor and childbirth, were not allowed to bond with their babies and could not be supported by a partner during their hospital stay. ...
Article
Full-text available
Background: At the beginning of the COVID-19 pandemic, healthcare workers were faced with difficult decisions about maternity care practices. The evidence-based practices recommended by the WHO/UNICEF Baby Friendly Hospital Initiative (BFHI) were confirmed by Italian national guidance. Aim: To describe, in a number of facilities that are part of a national Baby-Friendly network, the adherence to some steps of BFHI standards during the COVID-19 emergency. Methods: We conducted a cross-sectional online survey, inviting all hospitals interested in the Initiative, to fill out a semi-structured questionnaire. Results: Out of the 68 participating hospitals, 30.9% were hubs and 69.1% spokes. During May 2020, 61.8% of hospitals had COVID-19 and non-COVID-19 clinical pathways, while 38.8% were only non-COVID-19. None was dedicated exclusively to COVID-19 pathways. The BFHI was effective in guaranteeing ≥80% exclusive breastfeeding, the presence of companion of mother's choice, skin-to-skin and rooming-in. The type of accreditation was associated with the presence of a companion of the mother's choice during labour (p=0.022) and with skin-to-skin (p<0.001). According to the narratives, increased interpersonal distance made interactions with mothers difficult and the absence of a birth companion was reported as a major issue. Discussion and conclusions: The BFHI is a highly-structured, evidence-based care model. Investing in strong collaborative care approaches contributes to hospitals' preparedness.
... Kangaroo mother care (KMC), 1 skin-to-skin contact (SSC) 2 and zero separation practised early after birth are the biological "normal" that can improve quality of survival for newborn infants. 3 However, depending on the infant's condition after birth, care at a neonatal unit can be necessary, which increases the risk of separation and delayed KMC and thereby SSC. If a zero separation paradigm stated by Bergman 3 could be regarded as one acceptable goal for neonatal care, based on the knowledge that separation of the mother and the infant is of harm for both, arrangements are needed to achieve this goal. ...
Article
Full-text available
Background Kangaroo mother care including skin-to-skin care aims to overcome the negative effects of separating parents and infants and to increase the quality of care for infants and parents in need of neonatal care. In most cases where inter-hospital transport is needed, the infant is placed in a transport incubator, which increases the risk of separation due to ambulance service restrictions that imply that parents are not allowed to accompany these transport trips. Aim To illuminate parents' experiences of holding their infant in a kangaroo position during neonatal ground ambulance transport. Study design A qualitative design with an inductive approach. Methods A total of 11 open interviews with Swedish parents were conducted two to seven days after their infant had been transferred in a kangaroo position between hospitals. The transcribed interviews were analysed using qualitative content analysis. Results The emerged overarching category was “an uninterrupted closeness chain.” The parents experienced that holding their infant during the transport extended the time they were close to their infant. Using the kangaroo position during ground ambulance transport also created a feeling of being important as a parent, as their participation during transport was appreciated. Parents' experiences were allocated into three categories: “Strengthen the feeling of being important as a parent,” “promote security and create a positive environment for the baby” and “the professionals' attitude promotes security.” Conclusion and relevance for clinical practice This knowledge about parents' experiences is important in the continued work to develop interventions that focus on promoting zero separation in neonatal care. Using kangaroo position in a safety harness during ambulance transport enhances zero separation and closeness. To encourage the implementation of kangaroo position during ambulance transport, further research is needed to address parents' experiences of zero separation during transport of infants to a higher level of care.
... The high maternal satisfaction following skin to skin contact underlines the importance of increasing this practice, in addition to all others the health benefits [43,44]. This approach is included in the framework of "Zero Separation" according to which keeping mother-baby together from birth, protects physiological and neurophysiological processes for both, and guarantees successful breastfeeding [45]. ...
Article
Full-text available
Background: Breastfeeding success is determined by early skin to skin contact, early initiation of breastfeeding, rooming-in, baby-led breastfeeding, creation of a favorable environment, specific training of health professionals, and continuity of care. Objective: To investigate the women's satisfaction regarding the care and support received in the first days after childbirth. Material and methods: A questionnaire of 24 items was administered to mothers before discharge, from May to September 2019 at the University Hospital of Modena. Results: The predictive variables of exclusive breastfeeding were the delivery mode, age at birth and parity. The multivariate analysis showed that a high satisfaction score was associated with vaginal birth (OR=2.63, p=0.005), rooming-in during the hospitalization (OR=8.64, p<0.001), the skin to skin contact (OR=6.61, p=0.001) and the first latch-on within 1 hour after birth (OR=3.00, p=0.02). Conclusions: Mothers' satisfaction is one of the important factors of positive experience during hospital stay and of better health outcomes.
Article
Full-text available
Background: Children with down syndrome (DS) are breastfed to a lesser extent than infants in general, despite research showing that it is possible for these children to breastfeed successfully. Aim: The aim was to describe how mothers of children with DS experienced breastfeeding and breastfeeding support from healthcare professionals. Method: A qualitative study with an inductive approach. Individual interviews were performed with seven mothers from southern Sweden. The interviews were analysed using qualitative content analysis. Result: The mothers felt that the support varied, as some healthcare professionals were supportive, while others had preconceptions regarding breastfeeding and DS. They also experienced that the guidelines could be an obstacle in the encounter with healthcare professionals thereby affecting the possibility to establish breastfeeding. Information and support were important to the mothers, and when insufficient, they turned to the internet for help. Conclusions: Mothers felt that healthcare professionals were bound to ward routines and guidelines, which could be contrary to their own and the family's wishes. They were also sensitive to the attitudes of healthcare professionals, which can affect their own state of mind. Healthcare professionals' preconceptions regarding breastfeeding and DS have not changed, despite research showing that infants with DS can breastfeed successfully. Increased awareness of the possibility to breastfeed an infant with DS is needed to provide better support to mothers.
Article
Resumen Objetivos Evaluar la costó-efectividad del contacto piel a piel (CPP) inmediato comparado con el CPP temprano en la morbilidad neonatal prevalente del recién nacido de bajo riesgo al nacer en Colombia. Métodos se realizó un análisis de costó-efectividad. Se utilizó la perspectiva del tercer pagador (sistema de salud) y el horizonte de tiempo fue el primer mes de vida. Se incluyeron recién nacidos a término de bajo riesgo al nacer. La estimación de los costós se obtuvo de un consenso de expertos y de una cohorte retrospectiva de neonatos hospitalizados en una unidad neonatal. La efectividad de las intervenciones se obtuvo de un ensayo clínico controlado y se definió como caso evitado de hospitalización. Se construyó un árbol de decisión y se cálculo la Razón de Costó-Efectividad Incremental. Se realizaron análisis de sensibilidad determinísticos y probabilísticos de los efectos y costós. Resultados El CPP temprano fue una intervención dominada. En los análisis de sensibilidad probabilísticos el CPP temprano no fue una opción a escoger en ningún escenario y se mostró dominado en el 68% de las simulaciones. Conclusiones Los hallazgos sugieren que el CPP temprano es una intervención dominada. Desde la perspectiva económica el CPP inmediato es una intervención deseada para la prevención de las enfermedades prevalentes del recién nacido de bajo riesgo al nacer.
Article
Full-text available
Though studies showing a causal relationship between adoption and trauma are scarce, there is enough cross-disciplinary research to suggest such a connection. Likewise, there are many adult adopted persons, like myself, who see their adoption narratives as traumatic in one way or another. Mental health outcomes for adopted people also indicate adoption might be a source of and not just a preventative measure against trauma. In this paper, I utilize an autoethnographic approach to highlight the relationship between infant adoption and what I refer to as “latent traumatic memories.” Recounting several major life events that led to traumatic upheavals in my understanding of my own identity as an adopted person, I then relate my story to current research on trauma experienced very early in life and how it is remembered implicitly in the body. My account, I argue, highlights the need to further research adopted people's evolving views about their adoption and how and to what extent certain events in adulthood precipitate the rediscovery of latent trauma.
Article
Objective: The study aimed to investigate the effects of kangaroo mother care (KMC) on repeated procedural pain and cerebral oxygenation in preterm infants. Study design: Preterm infants of 31 to 33 weeks of gestational age were randomly divided into an intervention group (n = 36) and a control group (n = 37). Premature infant pain profile (PIPP) scores, heart rate, oxygen saturation, regional cerebral tissue oxygenation saturation (rcSO2), and cerebral fractional tissue oxygen extraction (cFTOE) were evaluated during repeated heel stick procedures. Each heel stick procedure included three phases: baseline, blood collection, and recovery. KMC was given to the intervention group 30 minutes before baseline until the end of the recovery phase. Results: Compared with the control group, the intervention group showed lower PIPP scores and heart rates, higher oxygen saturation, and rcSO2 from the blood collection to recovery phases during repeated heel sticks. Moreover, there were significant changes in cFTOE for the control group, but not the intervention group associated with repeated heel stick procedures. Conclusion: The analgesic effect of KMC is sustained over repeated painful procedures in preterm infants, and it is conducive to stabilizing cerebral oxygenation, which may protect the development of brain function. Key points: · KMC stabilizes cerebral oxygenation during repeated heel sticks in preterm infants.. · The analgesic effect of KMC is sustained over repeated painful procedures in preterm infants.. · KMC may protect the development of brain function..
Article
Full-text available
Modern western society and media often present the mother's choices for her birth as paramount. Various gurus provide the mother with often conflicting advice. But the reality is that childbirth often becomes a medicalized event with many interventions and less than ideal outcomes. In many instances, the choices are made to suit health professionals and hospital routines rather than the mother. All the aforementioned are based on ideas and assumptions which predate evidence-based medicine and recent neuroscience. In reproductive biology, the newborn is an active participant and agent in birthing (Alberts, 1994). Based on this, the perspective which has been lacking is what is best for the baby; our choices should be primarily based on the basic biological needs of the infant.
Article
Full-text available
The manner in which a new baby is welcomed into the world during the first hours after birth may have short- and long-term consequences. There is good evidence that normal, term newborns who are placed skin to skin with their mothers immediately after birth make the transition from fetal to newborn life with greater respiratory, temperature, and glucose stability and significantly less crying indicating decreased stress. Mothers who hold their newborns skin to skin after birth have increased maternal behaviors, show more confidence in caring for their babies and breastfeed for longer durations. Being skin to skin with mother protects the newborn from the well-documented negative effects of separation, supports optimal brain development and facilitates attachment, which promotes the infant’s self-regulation over time. Normal babies are born with the instinctive skill and motivation to breastfeed and are able to find the breast and self-attach without assistance when skin-to-skin. When the newborn is placed skin to skin with the mother, nine observable behaviors can be seen that lead to the first breastfeeding, usually within the first hour after birth. Hospital protocols can be modified to support uninterrupted skin-to-skin contact immediately after birth for both vaginal and cesarean births. The first hour of life outside the womb is a special time when a baby meets his or her parents for the first time and a family is formed. This is a once-in-a-lifetime experience and should not be interrupted unless the baby or mother is unstable and requires medical resuscitation. It is a “sacred” time that should be honored, cherished and protected whenever possible.
Article
The fetus is adapted to a low O2 level with a number of functions inhibited. During delivery, the catecholamines and other stress hormones surge. In the brain of the newborn rat, increased norepinephrine turnover and expression of c-fos have been demonstrated. These findings might explain the arousal and alertness of the newborn infant.
Article
Aims: At The National Hospital in Oslo, Norway, a comparison was made between parents' rated experiences of maternal/paternal love when holding their preterm infants skin to skin (kangaroo), as compared to holding their infants wrapped in blankets.
Article
Newborn Care Paper Presentation Objective To assess the effects of early skin‐to‐skin contact (SSC) on breastfeeding, physiological adaptation, and behavior in healthy mother–newborn dyads. Design Systematic review and meta‐analysis. Setting N/A. Sample Thirty‐four randomized controlled trials involving 2,177 participants (mother–infant dyads). The search strategy included the Cochrane Pregnancy and Childbirth Group's Trials Register (September 2011), the Cochrane Neonatal Group's Trials Register (June 2011), and Medline (1976‐2011). Selection criteria included randomized controlled trials comparing early SSC with usual hospital care. Methods We independently assessed trial quality and extracted data. Study authors were contacted for additional information. Results Data from more than two trials were available for only 10 outcome measures. We found statistically significant and positive effects of early SSC on breastfeeding at 1 to 4 months post birth (13 trials, 702 participants) (risk ratio 1.27, 95% confidence interval [CI] 1.06 to 1.53, and a trend toward significance (p = .06) in breastfeeding duration (seven trials, 324 participants) (mean difference [MD] 42.55 days, 95% CI –1.69 to 86.79). SSC infants were more likely to have a successful first breastfeeding (two trials, 54 participants) (MD in IBFAT scores 1.79, 95% CI 0.24‐3.35). Late preterm infants had better cardio‐respiratory stability with early SSC (one trial, 31 participants) (MD 2.88, 95% CI 0.53‐5.23). SSC infants cried for a shorter length of time (one trial, 44 participants) (MD –8.01, 95% CI –8.98 to –7.04). The overall methodological quality of trials was mixed, and there was high heterogeneity for some outcomes. Limitations included methodological quality, variations in intervention implementation, and outcomes. Conclusion/Implications for Nursing Practice Mother–infant separation post birth is common in Western culture. Early SSC begins ideally at birth and involves placing the naked baby, head covered with a dry cap and a warm blanket across the back, prone on the mother's bare chest. This time may represent a psychophysiologically sensitive period for programing future physiology and behavior. The intervention appears to benefit breastfeeding outcomes, cardio‐respiratory stability, and infant crying, and has no apparent short‐ or long‐term negative effects. Further investigation is recommended. To facilitate meta‐analysis, future research should be done using outcome measures consistent with those in the studies included here. Published reports should clearly indicate if the intervention was SSC with time of initiation and duration and include means, standard deviations, and exact probability values.
Article
Research on young animals and humans has demonstrated the critical importance of the fetal stage as a formative period in normal development. However, the significance of these findings has not always been incorporated into our thinking when trying to elucidate the origins of health and disease. It is not only that babies react to the state of the mother and to salient environmental events while still in the uterus. This stimulation and priming seems to be essential for guiding the optimal maturation of the nervous, endocrine, and immune systems. Experiences during prenatal life also program the regulatory set points that will govern physiology in adulthood. During this malleable maturational phase, these biological processes should be viewed as flexible “learning systems” that guide the developmental trajectory toward health or derail it toward pathology. Our studies on infant primates have shown that the competence of their immune responses and the structure and activity of certain brain regions, as well as many aspects of behavior and emotional reactivity, are strongly affected by the pregnancy conditions of their mothers.
Article
Childhood trauma has profound impact on the emotional, behavioral, cognitive, social, and physical functioning of children. Developmental experiences determine the organizational and functional status of the mature brain. The impact of rruumufic experiences on the development and function of the brain are discussed in context of basic principles of neurodevelopment. There are various adaptive mental and physical responses to trauma, including physiological hyperarousal and dissociation. Because the developing brain organizes and internalizes new information in a use-dependent fashion, the more a child is in a state of hyperarousal or dissociation, the more likely they are to have neuropsychiatric symptoms following trauma. The acute adaptive states, when they persist, can become maladaptive traits. The clinical implications of this new neurodevelopmental conceptualization of childhood trauma are discussed. Le trauma de l'enfance a un impact profond sur le fonctionnement émotionnel, comportemental, cognitif, social et physique des enfants. Les expériences en matière de développement déterminent l'organisa-tion et le fonctionnement du cerveau arrivé à maturité. L'impact d'expériences traumatiques sur le développement et le fonctionnement du cerveau sont discutés dans le contexte de principes de bases de neurodéveloppe-ment. Il existe plusieurs résponses mentales et physiques d'adaptation au trauma, parmi lesquelles l'excitation physique intense et de la dissociation. Parce que le cerveau qui se développe organise et internalise les nouvelles “informations” d'une manière liée B l'utilisation et en dépendant, plus un enfant se trouve dans un état d'excitation ou de dissociation et plus il risque d'y avoir des symptǒmes neuropsychiatriques aprés le trauma. L'“état” adaptatif aigu peut devenir persistent et conduire à des “traits” d'inadaptation. Les implications cliniques de cette nouvelle conceptualisation de neurodéveloppement du trauma de l'enfance sont discutées.
Article
The aim of the present investigation was to explore whether the personality characteristics of women who have recently given birth differ from those of a control group of similar aged women and if so, whether such deviations are related to the pregnancy- and lactation-associated hormones oxytocin and prolactin which in animal experiments have been shown to play a role in maternal behavior. Thereforethe Karolinska Scales of Personality (KSP) were used in 50 women 4 days postpartum and in addition 18 blood samples were drawn in connection with breastfeeding. Oxytocin and prolactin levels were measured by radioimmunoassay. The women investigated scored lower in Muscular Tension (p < 0.05), in Monotony Avoidance (p < 0.001) and Psychasthenia (p < 0.01) and higher in Social Desirability (p < 0.001) than a reference material. Plasma levels of oxytocin and prolactin rose as expected in response to breastfeeding. When the average prolactin and oxytocin levels obtained at the 18 different timepoints of each woman were correlated with the scores obtained in the various KSP items, some significant relationships were found. Significant positive correlations were found between prolactin and the KSP dimensions Social Desirability and Inhibited Aggression and negative correlations with Psychasthenia. Significant inverse relationships between oxytocin and several Anxiety and Aggression variables, Guilt in particular, were also found. Correlations with oxytocin and prolactin levels were as a rule particularly clear in samples collected during breastfeeding. The data obtained are discussed from a biological point of view in relation to the specific 'maternal behavior' described in other mammals. It is suggested that subtle psychological and behavioral changes occur in women during motherhood and that these changes may in part be related to prolactin and oxytocin.