Skin-to-Skin Contact, Breastfeeding, and Perinatal Neuroscience Hollister HollisterBreastfeeding...

Skin-to-Skin Contact,Skin-to-Skin Contact,Breastfeeding, and Breastfeeding, and

Perinatal Perinatal Neuroscience Neuroscience

Hollister Hollister

BreastfeedingBreastfeeding

ProgramProgram 2006 2006

Boston, MABoston, MA Denver, CODenver, CO Redlands, CARedlands, CA Mission Viejo, CAMission Viejo, CA

Perinatal Perinatal Neuroscience Neuroscience

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

Cape Town, South Africa Cape Town, South Africa

www.kangaroomothercare.comwww.kangaroomothercare.com

Perinatal Perinatal Neuroscience:Neuroscience:

Implementing Best Implementing Best Practice in U.S. Practice in U.S.

Hospitals Hospitals

OverviewOverview

Perinatal neurosciencePerinatal neurosciencebrain developmentbrain developmentnormal newborn normal newborn

behaviourbehaviouradverse factorsadverse factors

Defining the original paradigm Defining the original paradigm Kangaroo Mother CareKangaroo Mother CareRandomised trialRandomised trialImplicationsImplications

NEUROSCIENCENEUROSCIENCE

90% of what we know90% of what we know

about the brain has about the brain has been discovered inbeen discovered in

the last 15 yearsthe last 15 years

Society of Neuroscience estimateSociety of Neuroscience estimateDr Sandra Witelson, McMasterDr Sandra Witelson, McMaster

FETAL BRAIN DEVELOPMENTFETAL BRAIN DEVELOPMENT

The first 10 – 14 weeks,The first 10 – 14 weeks,fetal brain growth isfetal brain growth is

determined by genes (the DNA)determined by genes (the DNA)

Thereafter, Thereafter, brain growth is an active process.brain growth is an active process.

The neurons migrate,The neurons migrate, extend their axons and branches, extend their axons and branches, and make synapses (thousands)and make synapses (thousands) connecting to sensory organsconnecting to sensory organsMore sensations More sensations more synapses more synapses

Brain growth Brain growth depends on experiences !!depends on experiences !!

0 10 20 30 40w 6m 2y 10y 60y

Neurulation

NEUROGENESIS

Myelination

Arborisation

SYNAPTOGENESIS

NEURODEVELOPMENTNEURODEVELOPMENT

EARLY DEVELOPMENTEARLY DEVELOPMENT

Gestational ageGestational age20w20w all structures completedall structures completed

parallel development parallel development of structure & functionof structure & function

(Hugo Lagercrantz 2004)(Hugo Lagercrantz 2004)

23w23w fetus is aware / conscious fetus is aware / conscious parallel development of structure & functionparallel development of structure & function

Neurobehaviour and neurodevelopmentNeurobehaviour and neurodevelopmentare inseparableare inseparablea single integrated whole.a single integrated whole.

EARLY DEVELOPMENTEARLY DEVELOPMENT

25w25w layering, layering, dendrification, dendrification,

synapse formationsynapse formation

““The brain is not a computer,The brain is not a computer,it is a jungle.”it is a jungle.”

““The perinatal sensorium The perinatal sensorium is never in chaos ….is never in chaos ….

… … the infant’s world is structured,the infant’s world is structured,competent and organized,competent and organized,developing in an ever ordered,developing in an ever ordered,yet ever more complex and yet ever more complex and more flexible field of perception”more flexible field of perception”

(Schore)(Schore)

Porges SW Polyvagal theory.

evolution of autonomic nervous system

1st primitive unmyelinated vagusimmobilisation behaviours

2nd sympathetic nervous system, Behaviours for “fight or flight”

3rd myelinated vagus – rapid regulation cardiac outputengagement / disengagement

Gestational ageGestational age

23w23w fetus is aware / conscious fetus is aware / conscious

25w25w layering, layering, dendrification, dendrification,

synapse formationsynapse formation

28w full complement of neural cells28w full complement of neural cells

(Hugo Lagercrantz 2004)(Hugo Lagercrantz 2004)

30 wfetus can recognise mother’s voice from other women, from single words played back to it by a tape-recorder,

It can distinguish mother’s language from another language, again from a single word or phoneme.

The fetus has a GREATER SENSORIUMthan the adult …

FETAL BRAIN DEVELOPMENT

Cells that fire together,

wire together

Use it,or lose it.

Neuronal Plasticity

• programmed cell death or apoptosis

• pruning and elimination of redundancy= neuronal plasticity

0 10 20 30 40w 6m 2y 10y 60y

Neurulation

NEUROGENESIS

Myelination

Arborisation

SYNAPTOGENESIS

Programmed cell deathCOMPETITIVEELIMINATION

NEURODEVELOPMENTNEURODEVELOPMENT

At birth, the At birth, the human being has human being has more synapses more synapses in its brain than in its brain than at any other at any other stage of life.stage of life.

Development is a processDevelopment is a processof “pruning” some,of “pruning” some,and developing other synapses and developing other synapses – – creating “neural pathways”.creating “neural pathways”.

These can be good or bad – These can be good or bad – depending on type of sensations depending on type of sensations and experience of the newbornand experience of the newborn

SENSORY STIMULUS SENSORY STIMULUS

synapse store chemical signalsynapse store chemical signal

chemical signal strongerchemical signal stronger

THRESHOLD THRESHOLD EXEMPT from eliminationEXEMPT from elimination

(synapse stabilised)(synapse stabilised)PATHWAYPATHWAY

(Rima Shore 1997)(Rima Shore 1997)

R ShoreR Shore

Critical period concept Critical period concept ::

““Windows of opportunity in early Windows of opportunity in early life when a child’s brain is life when a child’s brain is exquisitely primed to receive exquisitely primed to receive sensory input in order to develop sensory input in order to develop more advanced neural systems.”more advanced neural systems.”

SchoreSchore

Critical period concept :Critical period concept :

““brain is brain is exquisitely susceptibleexquisitely susceptible to adverse factors”to adverse factors”at particular times or stagesat particular times or stages

SchoreSchore

Critical period :Critical period :

““Early interpersonal events Early interpersonal events positively positively and negativelyand negativelyimpact the impact the

structural organisationstructural organisationof the brain.”of the brain.”

NEWBORN DEVELOPMENTNEWBORN DEVELOPMENT

Tactile stimulations Tactile stimulations ““facilitate the flow of affective informationfacilitate the flow of affective information

from the infant … to the mother”from the infant … to the mother”““the language of mother and infant consiststhe language of mother and infant consists

of signals produced by the autonomicof signals produced by the autonomicnervous system of both parties”.nervous system of both parties”.

This is the basis of healthy development!This is the basis of healthy development!

SchoreSchore

In early postnatal life, maintenanceIn early postnatal life, maintenanceof critical levels of tactile input … is of critical levels of tactile input … is important for normal brain maturation. important for normal brain maturation.

Areas of the amygdala …. Areas of the amygdala …. are in a critical period of maturation,are in a critical period of maturation, … … in the first two months of lifein the first two months of life

The fetus has well developedThe fetus has well developed sensations for touch and position sensations for touch and position

(tactile and kinesthestic sensations).(tactile and kinesthestic sensations).

““The infant actively seeks to adhereThe infant actively seeks to adhere to as much skin surface on theto as much skin surface on the mother’s body as possible”mother’s body as possible”

(Harlow 1958, from Schore 2001)(Harlow 1958, from Schore 2001)

NEWBORN DEVELOPMENT

skin-to-skin contactskin-to-skin contact Tactile stimulations build the amygdala - preorbital cortical tract during the first 8 weeks

The next pathway requires eye-to-eye contacteye-to-eye contact

This is the basis of healthyright brain development!

Brain-to brain interactionFace-to-face communicationEye-to-eye orientations voice, hands, movements

Interpersonal awarenessEmotions

Myron Hofer Myron Hofer

… … the private realm ofthe private realm ofsensory stimulation constructed sensory stimulation constructed by the mother and infant from by the mother and infant from numberless exchanges of numberless exchanges of subtle clues.subtle clues.

(Gallagher 1992)(Gallagher 1992)

Through such “hidden maternalThrough such “hidden maternal regulators” he discovered that regulators” he discovered that

a mother precisely controls everya mother precisely controls every element of her infants physiologyelement of her infants physiology,,

from its heart rate to its from its heart rate to its release of hormonesrelease of hormones

from its appetite to the from its appetite to the intensity of its activityintensity of its activity

The mere presence of the mother not only ensures the infants well-being, but also creates a kind of invisible hothouse in which the infant’s development can unfold.

““For a baby the For a baby the environment is the environment is the mother”mother”

(Hofer in Gallagher 1992)

Hofer discovered that what Hofer discovered that what seems to be a single physical seems to be a single physical function, such as grooming or function, such as grooming or nursing, is actually a kind of nursing, is actually a kind of umbrella that covers stimuli umbrella that covers stimuli of touch, balance, smell, of touch, balance, smell, hearing and vision, each withhearing and vision, each with a specific effect on the infant.a specific effect on the infant.

a kind of invisible hothouse

“the wiring of the brain’s pathways is best supported when it can integrate quality sensory input through several pathways at once, particularly during critical periods of development.” (McCain 1999)

Neuronal Plasticity“the first three years are decisive”

The cortex retains some plasticity throughout life …

But the limbic systemand the midbrain is fixed after the age of three years …

AttachmentRegulation EmotionControl

Arousal Appetite Sleep

Neuronal Plasticity“the first three years are decisive”

platform forsubsequent development of higher cognitive functions.

AttachmentRegulation EmotionControl

Arousal Appetite Sleep

Infant brain development

Early brain development is

INTERACTIVE RAPID

DRAMATIC

CRITICAL PERIODS require specific stimulations at specific times

Quality SENSORY STIMULATIONmakes brain able to think and regulate

Negative experiences (both absence of good … and presence of bad)

have long lasting effects

= FALSE ASSUMPTION !!= FALSE ASSUMPTION !!

Current paradigm:Infant brain development

1. Genetically determined2. Develops in linear time3. Activity increases w age4. Mother = good context5. Deficits correctable later

Current paradigm versus NEW:Infant brain development

1. Genetically determined EXPERIENCE2. Develops in linear time CRITICAL

PERIOD3. Activity increases w age GREATEST 3

yrs4. Mother = good context = WIRES

BRAIN5. Deficits correctable later Limbic FIXED at

(Rima (Rima Shore 1997)Shore 1997)

“The mammalian brain is designed to be sculpted into its final configuration by

the effects of early experience”

These experiences are embeddedin the attachment relationship.

Our cortex distinguishes us from other animals …

BUTThe “primitive”hindbrain is vital We can learn

about ourselves from animals, and mammals!

THE “OLD” BRAIN HAS THE “OLD” BRAIN HAS

3 PROGRAMMES3 PROGRAMMES

DEFENCE NUTRITION REPRODUCTION

The neurobehavioural programmes The neurobehavioural programmes originate in the originate in the LIMBIC SYSTEMLIMBIC SYSTEM Expressed through Expressed through

hypothalamushypothalamus(autonomic nervous system)(autonomic nervous system)

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

cerebellar connectionscerebellar connections(somatic system)(somatic system)

HORMONESHORMONES NERVES NERVES MUSCLESMUSCLES

endocrineendocrine autonomic NS autonomic NS somaticsomatic

REPRODUCTIONNUTRITIONDEFENCE

BEHAVIOURBEHAVIOUR

WHOLE BODY

All mammals have set All mammals have set sequence of behaviours at sequence of behaviours at birth ………….birth ………….

REPRODUCTION

… … MUSCLESMUSCLES

…………. . All with a All with a single single purpose : topurpose : to

BREASTFEEDBREASTFEED

After birth, events are determined … … by the neonate stimulating the mother!

(Rosenblatt 1994)

Breast-feeding is “establishedthrough a set of mutual,complex sensory stimulations in mother and child.”

(Kjellmer & Winberg 1994)

In all mammals …….

….. the newborn is responsible for initiating breastfeeding,

not the mother !!

EXCEPT IN HUMAN ???

Sequence human newborn breast-feedingSequence human newborn breast-feedingPre-requisite = habitatPre-requisite = habitat

hand to mouthhand to mouthtongue movestongue movesmouth movesmouth moveseye focuses nippleeye focuses nipplecrawls to nipplecrawls to nipplelatches to nipplelatches to nipplesuckles suckles

(Widstrom et al 1994)(Widstrom et al 1994)

“The newborn may appear helpless, but displays an impressive and purposeful motor activity which, without maternal assistance, brings the baby to the nipple.

(Michelson et al 1996)

R ShoreR Shore

Critical period concept Critical period concept ::

““Windows of opportunity in early Windows of opportunity in early life when a child’s brain is life when a child’s brain is exquisitely primed to receive exquisitely primed to receive sensory input in order to develop sensory input in order to develop more advanced neural systems.”more advanced neural systems.”

SchoreSchore

The first hours after birth are a The first hours after birth are a

CRITICAL PERIODCRITICAL PERIOD

Mother and infantMother and infant are mutual are mutual

psycho-physiological psycho-physiological caregivers caregivers

Warming, feeding andprotection behaviours areintricately, inseparablylinked to the right place.

(Alberts 1994)

= NUTRITION PROGRAMME

The “habitat - niche” concept

HABITAT

DETERMINES

BEHAVIOUR

Self-attachment:Self-attachment:Is this feeding ??Is this feeding ??

Success ? Success ? everything depends on a good start !!!everything depends on a good start !!!

CRITICAL PERIOD BEHAVIOURCRITICAL PERIOD BEHAVIOUR

Warming, feeding andprotection behaviours areintricately, inseparablylinked to the right place.

(Alberts 1994)

= NUTRITION PROGRAMME

Hofer discovered that what Hofer discovered that what seems to be a single physical seems to be a single physical function, such as grooming or function, such as grooming or nursing, is actually a kind of nursing, is actually a kind of umbrella that covers stimuli umbrella that covers stimuli of touch, balance, smell, of touch, balance, smell, hearing and vision, each withhearing and vision, each with a specific effect on the infant.a specific effect on the infant.

1000 million years1000 million years

LIFE ?LIFE ?

DINOSAURSDINOSAURS

MAMMALSMAMMALS

PRIMATESPRIMATES

Brief history of our origins !!Brief history of our origins !!

4,6 billion years – earth forms4,6 billion years – earth forms

230 million years DINOSAURS230 million years DINOSAURS

200 million years – MAMMALS200 million years – MAMMALS

50 million years – PRIMATES50 million years – PRIMATES

6 million years - HOMINIDS6 million years - HOMINIDS

UNIQUELY HUMAN ….

BIPEDALISM &BIPEDALISM &NARROWER NARROWER

PELVISPELVIS

““LUCY” walked uprightLUCY” walked upright= bipedalism= bipedalism

The pelvis flattened The pelvis flattened and narrowed as a and narrowed as a resultresult

TOOL USETOOL USE &&LANGUAGELANGUAGE

PELVISPELVIS

““LUCY’s” descendants,LUCY’s” descendants, having free hands,having free hands, started using toolsstarted using tools

INCREASED INCREASED BRAIN SIZEBRAIN SIZE

PELVISPELVIS

About one millionAbout one million years ago, years ago, the brain sizethe brain sizestarted increasingstarted increasing = = encephalisationencephalisation

PROBLEM ! ! !PROBLEM ! ! !

PELVISPELVIS … … PROBLEM ?PROBLEM ?

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

PELVISPELVIS

EXCEEDINGLY EXCEEDINGLY IMMATURE IMMATURE BIRTHBIRTH

SOLUTION …SOLUTION …

PELVISPELVIS

EXCEEDINGLY EXCEEDINGLY IMMATURE IMMATURE BIRTHBIRTH““THE EVOLUTIONARY COMPROMISE”THE EVOLUTIONARY COMPROMISE”

Bipedalism and encephalisation (McKenna et al 1993)Bipedalism and encephalisation (McKenna et al 1993)

PELVISPELVIS

EXCEEDINGLY EXCEEDINGLY IMMATURE IMMATURE BIRTHBIRTH

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

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

(McKenna 1993)(McKenna 1993)

100%100%

25%25%

0%0%ADULTADULTBIRTHBIRTH

CONCEPTIONCONCEPTION

FETUSFETUS NEWBORNNEWBORN

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

80%80%

100%100%

25%25%

Homo sapiens Homo sapiens = HUMAN= HUMAN

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

EXPECTEDEXPECTEDBIRTHBIRTH

21/1221/12

100%100%

25%25%

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

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

EXCEEDINGLY EXCEEDINGLY IMMATUREIMMATURE

21/1221/12

ACTUALACTUALBIRTHBIRTH

9/129/12

100%100%

25%25%

HumansHumansessentiallyessentially completecomplete gestation gestation OUTSIDE OUTSIDE THE WOMBTHE WOMB..

21/1221/12

9/129/12

100%100%

25%25%

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

21/1221/12

9/129/12

OxygenationOxygenationWarmthWarmthNutritionNutritionProtectionProtection

UTERUSUTERUS UMBILICAL CORDUMBILICAL CORD++++++--++++++++++

In the UTERINE HABITAT, the umbilical cord In the UTERINE HABITAT, the umbilical cord delivers all the basic biological needs to the fetus.delivers all the basic biological needs to the fetus.

The placenta via the umbilical cordThe placenta via the umbilical cordis the means whereby the fetus is the means whereby the fetus

CONTINUES ITS GESTATIONCONTINUES ITS GESTATION..

Human milk is the means Human milk is the means whereby the immature infant whereby the immature infant CONTINUES ITS GESTATIONCONTINUES ITS GESTATION..

CHESTCHEST MOTHER’S MILKMOTHER’S MILK(BREAST)(BREAST)

(+)(+)++++++++++++

In the NEWBORNS HABITAT, the In the NEWBORNS HABITAT, the mother’s breastmother’s breast delivers all the basic biological needs to the fetus.delivers all the basic biological needs to the fetus.

UTERUSUTERUS UMBILICAL CORDUMBILICAL CORD++++++--++++++++++

CHESTCHEST MOTHER’S MILKMOTHER’S MILK(BREAST)(BREAST)

(+)(+)++++++++++++

Human milk is the means Human milk is the means whereby the immature infant whereby the immature infant CONTINUES ITS GESTATIONCONTINUES ITS GESTATION..

100%100%

25%25%

Full termFull termcompletes completes 12 months12 months

gestation bygestation byskin-to-skinskin-to-skin

contact.contact.

21/1221/12

9/129/12

100%100%

25%25%

What if theWhat if thegestationgestationrequired isrequired is14 months14 monthsrather than rather than 12 months?12 months?

21/1221/12

77/12/12

9/129/12

If skin-to-skin contactIf skin-to-skin contactis essential for theis essential for the

the immature newbornthe immature newborn,,

IS IT MORE ??IS IT MORE ?? OR LESS ??OR LESS ??essential foressential for

the premature the premature newbornnewborn ?? ??

100%100%

25%25%

21/1221/12

77/12/12

9/129/12

Skin-to-skinSkin-to-skin contact iscontact isESSENTIALESSENTIALif prematureif premature

THE CORRECT

HABITATHABITAT IS EVEN MORE ESSENTIAL IN

PREMATURITYPREMATURITY

THE CORRECT

HABITATHABITAT IS

MATERNAL-INFANTSKIN-TO-SKIN

CONTACT

KANGAROO MOTHER CAREKANGAROO MOTHER CARE

Skin-to-skin contactSkin-to-skin contact**********************

BreastfeedingBreastfeeding**********************

Support to the dyadSupport to the dyad

WHY KANGAROO ?WHY KANGAROO ?

Marsupials have aMarsupials have apouchpouch

……which has which has four nipplesfour nipples

… … and can close tightand can close tightfor protectionfor protection

HUMAN HUMAN KANGAROO KANGAROO MOTHER CARE!MOTHER CARE!

does the same fordoes the same for the premature !the premature !

- Skin-to-skin- Skin-to-skin- Breastfeeding- Breastfeeding- Protection- Protection

-Skin-to-skinSkin-to-skin CALORCALOR warmthwarmth

-BreastfeedingBreastfeeding LECHELECHE milkmilk

-ProtectionProtection AMORAMOR lovelove

KMC started by KMC started by Drs Rey and Drs Rey and MartinezMartinez,, (1979) Bogota, Colombia.(1979) Bogota, Colombia.UNICEF report 1983UNICEF report 1983

““remarkable claims”remarkable claims”

Further informationFurther information

Video: Rediscover the Natural WayVideo: Rediscover the Natural Way

Research andResearch andPhysiology of Physiology of

temperaturetemperatureoxygenation, oxygenation, nutrition,nutrition,protectionprotection

HUMANITY FIRST

TECHNOLOGY SECOND

-Skin-to-skinSkin-to-skin PLACE or HABITATPLACE or HABITAT

-BreastfeedingBreastfeeding BEHAVIOURBEHAVIOUR or NICHEor NICHE

-ProtectionProtection SUPPORT to DYADSUPPORT to DYAD

A mother and A mother and baby baby DYADDYAD

are a single are a single psychobiological psychobiological

organismorganism

DEFENSE NUTRITION REPRODUCTION

= BREASTFEEDING= BREASTFEEDING

REPRODUCTIONNUTRITION

The DEFENCE program shutsThe DEFENCE program shuts

off the others immediately off the others immediately

= PROTEST - DESPAIR= PROTEST - DESPAIR

DEFENSE

Universal response toUniversal response toseparation (wrong habitat):separation (wrong habitat):

protest - …..protest - ….. … … intense intense activity,activity, trying to trying to find thefind the habitat …habitat …

Universal response to Universal response to separation (wrong habitat):separation (wrong habitat):

- - despair responsedespair response …. ….……when separationwhen separationis prolonged …is prolonged …

……system shuts down for system shuts down for prolonged survivalprolonged survival

DEFENCE program prepares DEFENCE program prepares the separated newborn for the separated newborn for

SURVIVAL - SURVIVAL - protestprotest DEFENSE

HORMONESHORMONES

Massive amountsMassive amounts

of stress of stress hormoneshormones

(increase HR, RR)(increase HR, RR)

SURVIVALSURVIVAL - - protestprotestDEFENSE

NERVESNERVES Switches on theSwitches on the

adrenergic system adrenergic system

(stress response (stress response

of protest) of protest)

SURVIVALSURVIVAL- - protestprotestDEFENSE

MUSCLESMUSCLES

““Fight or Fight or flight”flight”

Extensor and Extensor and frantic movementsfrantic movements

(Wastes energy)(Wastes energy)

SURVIVALSURVIVAL - - despairdespairDEFENSE

HORMONESHORMONES

(Vagal associates)(Vagal associates)

Massive amountsMassive amountsof vagal of vagal

hormones hormones

Low temperature, Low temperature, Slow heart rate, Slow heart rate, (conserve energy) (conserve energy)

SURVIVALSURVIVAL - - despairdespairDEFENSE

NERVESNERVES Switches on theSwitches on the

vagal system vagal system

(on top of the (on top of the adrenergic !! ) adrenergic !! )

SURVIVALSURVIVAL- - despairdespairDEFENSE

MUSCLESMUSCLES

SuperimposedSuperimposed

PSNS (vagal)PSNS (vagal)

stimulation.stimulation.

Dissociation Dissociation (playing dead)(playing dead)

“ … “ … immobility immobility and inhibition of and inhibition of cries for help … “cries for help … “

Protest – despairProtest – despair

is also calledis also called

HYPERAROUSAL - HYPERAROUSAL - DISSOCIATION DISSOCIATION

DEFENSE

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

“… “… sympathetic system sympathetic system activated, activated, increasing HR, BPincreasing HR, BP, , tone, vigilance, tone, vigilance,

distress is expressed as in distress is expressed as in crying then screaming, a state crying then screaming, a state of “frantic distress” or of “frantic distress” or “fear-“fear-terror”terror”

hypermetabolic state in the hypermetabolic state in the brain”brain”

DISSOCIATION DISSOCIATION (Schore 2001)(Schore 2001)

“… “… later forming, later forming, parasympathetic, state of parasympathetic, state of “conservation-withdrawal”“conservation-withdrawal”

a hypometabolic process, in a hypometabolic process, in which the individual passively which the individual passively disengages ”to conserve disengages ”to conserve energies” …energies” … “to “to foster survival by the risky foster survival by the risky posture of feigning death”.posture of feigning death”.

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

““in this state both sympathetic in this state both sympathetic and parasympathetic and parasympathetic components are hyperactivated components are hyperactivated … Creating… Creating

… … chaotic biochemical chaotic biochemical alterationsalterations

… … a toxic neurochemistry in a toxic neurochemistry in thethe developing braindeveloping brain

““in the developing brain, in the developing brain,

states organize neural states organize neural systems,systems,

resulting in enduring traits.”resulting in enduring traits.”

Cells that fire together,

wire together

SchoreSchore

Critical period concept :Critical period concept :

““brain is brain is exquisitely susceptibleexquisitely susceptible to adverse factors”to adverse factors”at particular times or stagesat particular times or stages

SchoreSchore

““early adverse experiences result in early adverse experiences result in an increased sensitivity to the an increased sensitivity to the effects of stress later in life, and effects of stress later in life, and render an individual vulnerable to render an individual vulnerable to stress related psychiatric stress related psychiatric disorders.”disorders.”

SEPARATION IS HARMFULSEPARATION IS HARMFUL

““Origins of many behaviouralOrigins of many behavioural deviations are unknown -deviations are unknown -

child neglect, abuse, child neglect, abuse, abnormal shyness, abnormal shyness,

attention deficiencies, attention deficiencies, hyperactivity, colic, hyperactivity, colic,

sleep disorders etc,sleep disorders etc,

““Origins of many behaviouralOrigins of many behavioural deviations are unknown …deviations are unknown …

… … can some be traced back to can some be traced back to

violations of an innate agendaviolations of an innate agenda?"?"

(Kjellmer and Winberg 1994).(Kjellmer and Winberg 1994).

Advent of hospital nurseriesAdvent of hospital nurseriesand early separations correlates withand early separations correlates with

attachment disorders,attachment disorders,maternal abandonment of babymaternal abandonment of babyincreased addictive behavioursincreased addictive behaviours

(unmet oral needs)(unmet oral needs)

(Zimberoff & Hartman 2002)(Zimberoff & Hartman 2002)

Birth complications … affect personality, Birth complications … affect personality, relationships, self-esteem … andrelationships, self-esteem … andbehaviour patterns later on in life”behaviour patterns later on in life”

(Emerson 1998)(Emerson 1998)

Maternal rejection and lack of bonding added:Maternal rejection and lack of bonding added:strong correlation to strong correlation to violent criminal behaviour”.violent criminal behaviour”.

"Early separation can produce major"Early separation can produce major shifts in susceptibility to shifts in susceptibility to stress-induced pathology" stress-induced pathology" (Hofer 1994)(Hofer 1994)

(Maladaptive pathways have formed… )(Maladaptive pathways have formed… )

"Early separation can produce major"Early separation can produce major shifts in susceptibility to shifts in susceptibility to stress-induced pathology" stress-induced pathology" (Hofer 1994)(Hofer 1994)

Syndrome XSyndrome XObesityObesityDiabetesDiabetesHypertensionHypertension

Contemporary neuroscienceContemporary neuroscience

currently exploring early beginnings currently exploring early beginnings of adult brain pathology …of adult brain pathology …

… … alterations in the functional alterations in the functional organisation of the human brain …organisation of the human brain …

… … correlated with the absence correlated with the absence of early learning experiences.of early learning experiences.

““social stressors are social stressors are far more detrimentalfar more detrimentalthan nonsocial aversive stimuli”than nonsocial aversive stimuli”

““infant’s immature brain infant’s immature brain exquisitely vulnerable to early exquisitely vulnerable to early

adverse experiences, including adverse experiences, including adverse social experiences.”adverse social experiences.”

SchoreSchore

““developmental psychoneurobiological modeldevelopmental psychoneurobiological model””good attachment good attachment efficient right brain regulation efficient right brain regulation

infant mental health infant mental health adult mental health .adult mental health .

Schore / Schore / Bergman Bergman

““developmental psychoneurobiological modeldevelopmental psychoneurobiological model””good attachment good attachment efficient right brain regulation efficient right brain regulation

infant mental health infant mental health adult mental health .adult mental health .

Poor adult mental health Poor adult mental health caused by caused byPoor infant mental healthPoor infant mental health caused by caused by

Poor right brain regulationPoor right brain regulation caused by caused byPOOR ATTACHMENTPOOR ATTACHMENT caused by caused by

lack of skin-to-skin contactlack of skin-to-skin contact caused by caused bySEPARATIONSEPARATION

BUT = OURCURRENT

PRACTICE !!

THE CURRENTPARADIGM

SEPARATESMOTHERS & BABIES

currently exploring early beginnings currently exploring early beginnings of adult brain pathology …of adult brain pathology …… … alterations in the functional alterations in the functional

organisation of the human brain …organisation of the human brain …… … correlated with the absence correlated with the absence

of early learning experiences.of early learning experiences.Dr Bergman translation:Dr Bergman translation:““hospital labour ward routines …”hospital labour ward routines …”

INCUBATOR CAREseparates - causes

“protest - despair response”

STRESS & FETAL BRAIN DEVELOPMENTSTRESS & FETAL BRAIN DEVELOPMENT

At birth, the human being hasAt birth, the human being has

sensory perceptionssensory perceptionswith no “filters” –with no “filters” –

it experiences all its it experiences all its sensations maximally.sensations maximally.

As it develops,As it develops,

it learns to “dampen down” it learns to “dampen down” sensory inputs.sensory inputs.

SEPARATION EFFECT ON NEWBORN

Prematures and newborns have a nervous system which lacks the ability to dampen down sensory signals.

Over-stimulation of any of the senses will be experienced as PAINbe experienced as PAIN..

Stress hormones Stress hormones increase the perception of pain. increase the perception of pain.

Newborn separation

switches on both

cholinergic and adrenergic

systems

Only one other medical condition has a similar

pathophysiology

In medical literature –two conditions uniquely show hyperstimulation of both arms of the ANS

NEWBORN SEPARATION

BUTHID SCORPIONISM

NEONATENEONATE

At birth, the human being hasAt birth, the human being has

sensory perceptionssensory perceptionswith no “filters” –with no “filters” –

it experiences all its it experiences all its sensations maximally.sensations maximally.

As it develops,As it develops,

it learns to “dampen down” it learns to “dampen down” sensory inputs.sensory inputs.

Buthid scorpionismButhid scorpionism

Buthid toxins act on Buthid toxins act on Na and K channels Na and K channels of all excitable of all excitable tissues, resulting in tissues, resulting in hyperstimulation of hyperstimulation of the nerve or tissue, the nerve or tissue, every sensory nerve every sensory nerve hyperstimulated.hyperstimulated.

““no filters”no filters”

BUTHID SCORPIONISMBUTHID SCORPIONISM

Buthid scorpionism …Buthid scorpionism …… … is a potentially is a potentially deadly condition,deadly condition,… … causes the most severe paincauses the most severe pain

possible and imaginable …possible and imaginable …

Biblical writers use “scorpion sting” as a metaphor to convey the worst kind of pain !!

BUTHID SCORPIONISM

The clinical effect is a hyperstimulation of allthe nerves of the bodyincluding the autonomic nervous system.

““Autonomic storm”Autonomic storm” used to be the explanation for the fatal illness seen.

BUTHID SCORPIONISMUnique – P. transvaalicus cholinergic without

adrenergic - thought impossible!! P. granulatus P. transvaalicussympathetic parasympathetic (= adrenergic) (= cholinergic)

Pulmonary oedema Fatal syncope

sympathetic parasympathetic (= adrenergic) (= cholinergic)PROTEST DESPAIR

HYPERAROUSAL DISSOCIATION

Mother and offspring live in a Mother and offspring live in a biological state that has much in biological state that has much in common with addiction. When common with addiction. When they are parted the infant does not they are parted the infant does not just miss its mother; it experiences just miss its mother; it experiences a physical and psychological with-a physical and psychological with-drawal from a host of her sensory drawal from a host of her sensory stimuli, not unlike the plight of a stimuli, not unlike the plight of a heroin addict who goes cold heroin addict who goes cold turkey.turkey.

THE SEPARATED BABY THATTHE SEPARATED BABY THATHAS “HAS “SETTLEDSETTLED” IS RESTING, ” IS RESTING,

IT IS IN IT IS IN DESPAIRDESPAIR , ,

DISSOCIATIONDISSOCIATION

IT IS IT IS

HARDWIRING PRIMITIVE HARDWIRING PRIMITIVE DEFENCE PATHWAYS !!!DEFENCE PATHWAYS !!!

THE “PRIMARY VIOLATION”… the veryworst thing …

to any newborn according to biologists is SEPARATION.

SEPARATION !!! SEPARATION !!!

SEPARATING MOTHERS FROM BABIES IS BAD NEWS

BABIES SHOULDNEVERBESEPARATED

SEPARATION SEPARATION

VIOLATESVIOLATES

THE INNATE AGENDATHE INNATE AGENDA

OF MOTHER OF MOTHER

AND NEWBORNAND NEWBORN

MATERNAL-INFANTMATERNAL-INFANT

SEPARATIONSEPARATION

= ABUSE= ABUSE

WHY DO WE SEPARATEBABIES FROM MOTHERS ???

Ignaz SEMMELWEISS Ignaz SEMMELWEISS 1818 - 651818 - 65

Hungarian obstetricianHungarian obstetrician1840’s – Vienna 30% died1840’s – Vienna 30% died of puerperal fever – of puerperal fever – Pushed handwashing, Pushed handwashing, cleanliness & standards:cleanliness & standards:Maternal death rateMaternal death ratefrom 12% to 1% in 2 yearsfrom 12% to 1% in 2 years

Ostracised by peers,Ostracised by peers,Died insaneDied insane

Stephane TARNIER Stephane TARNIER 1828 -971828 -97

French obstetricianFrench obstetrician

Saw a warmed box forSaw a warmed box forhatching chickens, hadhatching chickens, hadone designed for one designed for ““weaklings” …weaklings” … … … invented incubatorinvented incubator

Pierre BUDIN Pierre BUDIN 1846 - 19071846 - 1907

Friend of Tarniers …took Friend of Tarniers …took Incubators, made centresIncubators, made centresfor the care of weaklings,for the care of weaklings,wrote book on subject.wrote book on subject.

Political support …Political support …France versus GermanyFrance versus Germany

BUDIN was very particular to includeBUDIN was very particular to includemother, reason for the glass window ….mother, reason for the glass window ….

Martin COUNEY Martin COUNEY 1860 - 19501860 - 1950

German born, learnt German born, learnt of incubator from of incubator from Budin, took Budin, took “hatchery” to “hatchery” to Exhibitions, famous Exhibitions, famous for for ““preemie road show”.preemie road show”.MONEY MAKING SHOWMONEY MAKING SHOW

Berlin 1896, Buffalo Berlin 1896, Buffalo Omaha Omaha 1902-4, 1902-4, Chicago Fair 1932 2Chicago Fair 1932 2ndnd highest highest receipts,receipts,Last show New York 1940.Last show New York 1940.

Equal parts P.T. Barnum-style circus sideshows and

World's Fair wonders, Dreamland delivered

novel and fantastic diversions of the odd and unusual. It was the home to scientific,

ethnological and cultural exhibits, including Dr. Couney's Baby Incubator pavilion, which had been shown at the 1901 Buffalo Exhibition and the St. Louis Pike (seen here).

Catering to the public's endless fascination with oddities and freaks, Dreamland had, as one of its main attractions, "Lilliputia,"

Couney succesfullyCouney succesfullyraised 5000 prems!raised 5000 prems!

BUT – BUT – used wet-nurses, used wet-nurses, excluded mothersexcluded mothers

(mother got free pass to the shows !)(mother got free pass to the shows !)

Mothers were excluded – “germs” …Mothers were excluded – “germs” …

Sarah Morris Hospital, Chicago Sarah Morris Hospital, Chicago 1923, others followed – all with a 1923, others followed – all with a

““policy of strict separation”.policy of strict separation”.

With the advent of artificial infant With the advent of artificial infant formula, mother not needed at all !!formula, mother not needed at all !!

Habitat AND niche now synthetic !!Habitat AND niche now synthetic !!

EVIDENCE BASED MEDICINE.EVIDENCE BASED MEDICINE.

The INCUBATOR The INCUBATOR was invented was invented

19001900The INCUBATOR wasThe INCUBATOR was standard Care for prems by standard Care for prems by

19401940

HOW MUCH HOW MUCH

SCIENCE ??SCIENCE ??

HOW MUCH HOW MUCH

SCIENCE ??SCIENCE ??

RESEARCH ??RESEARCH ??

German born, learnt German born, learnt of incubator from of incubator from Budin, took Budin, took “hatchery” to “hatchery” to Exhibitions, famous Exhibitions, famous forfor ““preemie road show”.preemie road show”.MONEY MAKING SHOWMONEY MAKING SHOW

Berlin 1896, Buffalo Berlin 1896, Buffalo Omaha Omaha 1902-4,1902-4, Chicago Fair 1932 2Chicago Fair 1932 2ndnd highest highest receipts,receipts,Last show New York 1940.Last show New York 1940.

WHY DO WE SEPARATEBABIES FROM MOTHERS ?

The INCUBATOR is anACCIDENT OF HISTORY

Is there an alternative Is there an alternative for premature infants ??for premature infants ??

-Skin-to-skinSkin-to-skin CALORCALOR warmthwarmth

-BreastfeedingBreastfeeding LECHELECHE milkmilk

-ProtectionProtection AMORAMOR lovelove

KMC started by KMC started by Drs Rey and Drs Rey and MartinezMartinez,, (1979) Bogota, Colombia.(1979) Bogota, Colombia.UNICEF report 1983UNICEF report 1983

““remarkable claims”remarkable claims”

Origin of BIRTH K M C Origin of BIRTH K M C

Drs Rey & MartinezDrs Rey & Martinez1979 Bogota, Colombia1979 Bogota, Colombia

LATE K M CLATE K M C

19851985 Andrew Whitelaw Andrew Whitelaw 19871987Agneta JurisooAgneta Jurisoo

BIRTH K M CBIRTH K M C

DEFINITION of KMC (1990)DEFINITION of KMC (1990)MANAMA, ZIMBABWEMANAMA, ZIMBABWE

## Skin-to-skin contactSkin-to-skin contact from birth, continuousfrom birth, continuous

## Breastmilk from birth Breastmilk from birth & exclusive breastfeeding& exclusive breastfeeding

## Psychological supportPsychological support to motherto mother

KMC as above used regardless KMC as above used regardless of weight and gestation.of weight and gestation.

KMC provides the baby KMC provides the baby with very intensive care.with very intensive care.

KC (in the USA) - In-hospital skin-to-skin KC (in the USA) - In-hospital skin-to-skin contact, any duration, primarily adjunct to contact, any duration, primarily adjunct to CMC (Conventional Method of Care).CMC (Conventional Method of Care).

Results – ManamaResults – Manama

(Infants 1000g to 1500g)(Infants 1000g to 1500g)

Survival pre KMC Survival pre KMC 10%10%Survival with KMCSurvival with KMC 50%50%

Weight gain / dayWeight gain / day 24g/d24g/dBreastfeeding rateBreastfeeding rate 100%100%

The impact of The impact of Kangaroo Mother CareKangaroo Mother Care,,

in neonatology, has been in neonatology, has been equivalent to that of the equivalent to that of the advent to the worldadvent to the world

of of Penicillin .Penicillin .Prof Bob Pattinson, Prof Bob Pattinson,

Kalofong Hospital, South AfricaKalofong Hospital, South Africa..

SKIN-TO-SKIN& BREASTFEEDING :

THEN ADD

TECHNOLOGY

Is there an alternative Is there an alternative for premature infants ??for premature infants ??

IMPLICATIONS Third WorldIMPLICATIONS Third World

The solution:The solution:

BIRTH K M CBIRTH K M C

Is KMC safe forIs KMC safe forUnstable newborns?Unstable newborns?

Archie COCHRANE Archie COCHRANE 1909 1988 1909 1988

Any intervention Any intervention should be subject toshould be subject toRANDOMISEDRANDOMISEDCONTROLLED TRIALCONTROLLED TRIALand meta-analysis and meta-analysis … …

EVIDENCE BASEDEVIDENCE BASEDMEDICINE.MEDICINE.

The INCUBATOR The INCUBATOR was invented was invented

19001900The INCUBATOR wasThe INCUBATOR was standard Care for prems by standard Care for prems by

19401940The Randomised ControlledThe Randomised Controlled

TRIAL was “invented” by TRIAL was “invented” by

19601960Kangaroo Mother CareKangaroo Mother Care

was “discovered” in was “discovered” in

19801980

The INCUBATOR wasThe INCUBATOR was standard Care for prems by standard Care for prems by

19401940The Randomised ControlledThe Randomised Controlled

TRIAL was “invented” by TRIAL was “invented” by

19601960Birth Kangaroo Mother CareBirth Kangaroo Mother Care

was “discovered” in was “discovered” in

19901990First RCT comparing birth KMC First RCT comparing birth KMC

to incubator started into incubator started in

20002000

For the human newborn, it is the habitat which determines which brain programme is operating, which then determines the behaviour (niche).

HABITAT

MOTHER

There are only these two habitat choices available

BREAST- VAGALMOTHER FEEDING (PSNS) GROWTH

OTHER PROTEST- STRESS SURVIVAL orDESPAIR (SNS)

SKIN-TO-SKIN CONTACT

SEPARATION

HABITAT NICHE MEANS RESULT

Habitat – niche hypothesis Habitat – niche hypothesis

HABITAT NICHE MEANS RESULT

““Habitat – niche hypothesis”Habitat – niche hypothesis”How would YOU design an RCT ?How would YOU design an RCT ?

Research funded byTHRASHER RESEARCH FUND, U.S.A.

Admin and stats byMEDICAL RESEARCH COUNCIL, R.S.A.

KANGAROO MOTHER CAREFROM BIRTH

COMPARED TO CONVENTIONAL INCUBATOR CARE

KANGAROO MOTHER CAREFROM BIRTH

COMPARED TO CONVENTIONAL INCUBATOR CARE

Nils Bergman Lucy Linley, Sue Fawcus

Mowbray MaternityCape Town, RSA.

Primary hypothesisPrimary hypothesis

SSC (skin-to-skin contact) from birth is superior to incubator care for low birthweight infants

ONLY HABITAT DIFFERS

BAILOUT points ….

“physiological parameters exceeding normal limits, requiring medical assessment and or intervention”

1 Skin temp consistently <35.5oC

2 Heart rate <100; or > 180 bpm

3 Apnoea longer than 20 seconds

4 O2 sats below 89% (x2), (CPAP/60% O2)

5 Blood glucose < 2,6mmol/l, (laboratory)

SCRIPSCORE

Heart rate Regular Deceleration to 80-100

Rate <80 or >200 bpm

Respiratory rate

Regular Apnoea <10s, or periodic

breathing

Apnoea >10s

Tachypnoea >80 pm

Oxygen saturation

Regular >87%

Any fall to 80 – 87%

Any fall below 80%

“Stability of Cardio-Respiratory system In Preterm Infants”(Fischer et al, 1988)

Score allocated for a five minute period ofcontinuous observation, maximum six for period

Research hypotheses

Stabilising

DURING 6h

Stabilised

AT 6 hours

BAILOUT H1a H1b

SCRIP H2a H2b

Results Minimisation technique ensured groups balanced for confounders.

( n = 34) KMC CMCMean weight 1813g 1866gMean GA 34.2w 35.3wApprop’ GA 65% 64%Male 60% 50%

(p 783)

RESULTSH1a At six hours, SSC will have

fewer NICU admissions than CMC

KMC(n = 20)

CMC(n = 14)

Chi-square

Transferred to NICU

2 1 0.773

(10%) (7%) NS

HAWTHORNE EFFECTHAWTHORNE EFFECT

H1b In the first six hours, SSC will have fewer bailout points than CMC

KMC CMC Chi-Square

(n = 18) (n = 13) Met bailout crit’ 3 12 <0.001

Temp <35.5 C 1 8 0.006

HR <100, >180 0 0 NS

Apnoea >20 sec 0 1 NS

Ox sats <89% 1 0 NS

Blood sugar <2.6 1 3 0.02

The results strongly support the hypothesis

SSCSSC 17% 17% CMCCMC 92%92%

STABLE:STABLE:SSCSSC 83%83%CMCCMC 8%8%

Research hypotheses H2b During the sixth hour,

“SCRIP” better with KMC (24pts)

KMC CMC t-test

(n = 18) (n = 13)

SCRIP 6th hour (mean)

24.0 23.0 0.012

(Std deviation) 0 1.22

Perfect score24 18 (100%)

6(46%)

H2b During the sixth hour,“SCRIP” better with KMC (24pts)

The hypothesis is strongly supported.100% of KMCinfants were stabilised at6 hours, whileless than 50%of CMC …..

STABILITY better with KMC ….

KMC babies STABLE by 6 hours,INCUBATOR remained unstable,

with no trend towards stabilisationwith no trend towards stabilisation..

H2a Through the six hours,“SCRIP” better with KMC (78pts)

Subanalysis <1800g

SCRIP KMC(n = 9)

CMC(n = 4)

t-test

SCRIP first six hours (mean)

76.67 71.75 0.049

(standard deviation)

1.5 6.65

Number perfect score (78)

4 (44%)

0 (0%)

H2b During the sixth hour,“SCRIP” better with KMC (24pts)

Subanalysis <1800g

SCRIP KMC(n = 9)

CMC(n = 4)

t-test

SCRIP in 6th hour (mean)

24.0 22.25 0.008

(standard deviation)

0 1.71

Number perfect score (24)

9 (100%)

1 (25%)

If skin-to-skin contactIf skin-to-skin contactis essential for theis essential for the

the immature newbornthe immature newborn,,

IS IT MORE ??IS IT MORE ?? OR LESS ??OR LESS ??essential foressential for

the premature the premature newbornnewborn ?? ??

100%100%

25%25%

21/1221/12

77/12/12

9/129/12

Skin-to-skinSkin-to-skin contact iscontact isESSENTIALESSENTIALif prematureif premature

Skin-to-skin Skin-to-skin contact contact

IS MORE IS MORE essential foressential for

premature premature newborns!newborns!

CONCLUSION

SSC started from birth,is superior to incubator for infants 1200 - 2199g , with respect to stabilisation as defined by basic physiological parameters, (HR, RR, Ox sats, Dx, apnoea).

INCUBATORS INCUBATORS DE-STABILISEDE-STABILISENEWBORNSNEWBORNS

SEPARATION

THIS IS THE “PHYSIOLOGY”IN OUR TEXT BOOKS …

SEPARATION

THIS IS THE “PHYSIOLOGY”IN OUR TEXT BOOKS …actually PATHOPHYSIOLOGY

A mother and A mother and baby baby DYADDYAD

are a single are a single psychobiological psychobiological

organismorganism

Julian Huxley,Julian Huxley,… … to his students,to his students,… … circa 1900.circa 1900.

““During the next century, During the next century, half of what we know now half of what we know now will be proven wrong.will be proven wrong.

Unfortunately, we don’t know which half.”Unfortunately, we don’t know which half.”

EVIDENCE FOR

SAFETY OF INCUBATORS …

The evidence is assumed, taken for granted!

It is part of our paradigm.

EVIDENCE FOR

SAFETY OF INCUBATORS …

We know their use to achieve thermal control and appropriate

humidity …

… but we’ve neglected the brain !

Paradigm shift ….Paradigm shift ….

For unstable newbornsFor unstable newborns::

Is “Birth KMC” safe ?Is “Birth KMC” safe ?

Is “Birth KMC” safer … ?Is “Birth KMC” safer … ?

Is “incubator” safe ?Is “incubator” safe ?

Is “incubator” unsafe ?Is “incubator” unsafe ?

INTERVENTION DOES :

LITTLE

HARM PRIMUM NON NOCEREPRIMUM NON NOCERE

SSCSSCSSCSSC

Incubator

INTERVENTION DOES :

LITTLE

HARM PRIMUM NON NOCEREPRIMUM NON NOCERE

Incubator

INCUBATORS INCUBATORS DE-STABILISEDE-STABILISENEWBORNSNEWBORNS

INCUBATORS INCUBATORS DE-STABILISEDE-STABILISE

PREEMIESPREEMIES

Video: Restoring the Original ParadigmVideo: Restoring the Original Paradigm(intended for professionals)(intended for professionals) … … on which KMC is grounded:on which KMC is grounded:

Covers additional topics not covered in this talk:Covers additional topics not covered in this talk:AnthropologyAnthropologyEvolutionary theoryEvolutionary theoryHabitat niche argumentHabitat niche argumentPhysiology and research resultsPhysiology and research results

(Protest-despair behaviour)(Protest-despair behaviour)Breastfeeding and breastmilkBreastfeeding and breastmilk

Video: Rediscover the Natural WayVideo: Rediscover the Natural Way(intended for mothers and all)(intended for mothers and all) … … including practical applicationincluding practical application

(Immaturity of birth, biology)(Immaturity of birth, biology)Physiology of temperaturePhysiology of temperature

oxygenation, nutrition,oxygenation, nutrition,(Separation behaviours)(Separation behaviours)(Self-attachment)(Self-attachment)

Milk effects, protectionMilk effects, protectionUse of KangaCarrierUse of KangaCarrierInterviews mothers and staff …Interviews mothers and staff …

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

treated. Efforts to reduce exposure to stress and abuse

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

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

generations.”Martin H Teicher

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

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

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

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

Perinatal Perinatal Neuroscience:Neuroscience:

Implementing Best Implementing Best Practice in U.S. Practice in U.S.

Hospitals Hospitals

Skin-to-Skin Contact, Breastfeeding, and Perinatal Neuroscience Hollister HollisterBreastfeeding...

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