by Donna Walls, RN, BSN, IBCLC ANLC
Newborns are often seen as helpless, but when we take a closer look this isn’t altogether true. They actually have many ways in which to adapt to life outside the uterus; systems that have been in place for millennia and are often misunderstood by medical science.
Jaundice
A prime example is the bilirubin molecule. The molecule can cause jaundice, or at worst can cause encephalopathy or kernicterus. Modern medicine has determined that jaundice needs to be aggressively treated and kept at as low a level as possible. Interestingly though, about 70 percent of newborns are clinically jaundiced. Doesn’t it seem strange that something which occurs in the majority of newborns is deemed pathological? When scientists began investigating the bilirubin molecule, it was found to have antimicrobial and anti-inflammatory effects. (Hansen, 2018) So can bilirubin be a first line of defense against infections or sepsis in newborns? This ancient system in newborns might be misunderstood, resulting in overtreatment and potentially jeopardizing an effective way to reduce the risk of infections. Of course, ongoing monitoring of bilirubin levels is important to prevent kernicterus, but this phenomenon deserves further investigation to test whether jaundice should be treated as aggressively as current practice suggests.
Vernix
Vernix–that cheesy substance found on newborns’ skin– is another example of how infants’ innate protective mechanisms are not well understood or utilized in modern medicine. In the drive for cleanliness in hospitals, the practice of bathing newborns as quickly as possible after birth became a routine practice. Medical asepsis became a priority (and often still is), over mother-baby attachment and bonding. In fact, there are many benefits to leaving the baby “unwashed” and the vernix intact. Studies show that vernix has an antimicrobial effect, (Singh, 2008), a moisturizing effect, and is thermoregulating. If undisturbed, vernix will be absorbed into the newborn skin in about five days.
Stress response
Maternal hormones, present in all mammals, elicit a strong protective response toward our offspring. (Saltzman, 2011) Newborns, too, demonstrate a stress response when separated from their mothers. Infants begin frantic crying, show hyperarousal with increased stress hormone levels, heart rate, blood pressure and glucose utilization. (Bergman, 2013) Still, modern practice often separates the dyad. Parents are often told “they need their rest” or that their baby needs to be taken to the nursery for exams and/or vital signs, when these goals are easily achieved with baby in close proximity to the mother. Parent baby separation can send a subtle message that health care providers (HCPs) can do a better job of caring for the newborn than the parent can. For instance, removing the baby from the mother immediately after birth to be warmed in an artificial warmer, ignores the mother’s ability to warm her baby on her chest (Kolsoom, 2018). When we provide care that does not build parents’ confidence to care for their babies, we have not delivered the best care possible. HCP’s job is to honor and facilitate the ancient system of mother baby attachment and bonding through policies, practices and our words to ensure the best health outcomes.
Colostrum and milk
Human milk is tailored specifically to the needs of our offspring. Studies by Lozoff (2013) clearly demonstrate the constituents of human milk not only support infant nutritional needs, but also provide necessary immunities and other protective factors. The amount of lactose and the concentration of human milk affects feeding patterns and parenting styles. Biologically, our newborns require frequent feedings (roughly 10 to 12 each 24 hours) demonstrated by the high water content (dilute) of human milk, and constant close contact between mother and newborn facilitate this frequent feeding pattern. Again, common medical practice requires, or at least encourages, newborns to spend time in the newborn nursery away from their mother.
Breast-seeking behavior
Additionally, where technology and arbitrary procedures has largely interrupted newborn instinct, newborns aren’t given the opportunity to recognize their mother’s smell, another way of facilitating mother-infant bonding and initiating breastfeeding. Irrefutable evidence shows that immediate, uninterrupted skin-to-skin contact after birth allows baby to successfully complete its first feeding. Instinctive breast-seeking behaviors ensure the newborn will receive the colostrum needed to maintain blood sugar and body temperature. In the 1970s a Swedish midwife, Ann-Marie Widstom, observed a specific pattern of movements as the newborn accomplishes the first feeding. These movements, the nine stages, are universal in healthy newborns and provide the most stable environment for their immediate adaptation. (Brymdir, 2017) It has been documented that very few maternity care facilities allow the time for newborns to complete the 9 stages and self-attachment to the breast which can affect an entire breastfeeding relationship. Care protocols too often place the emphasis on the “tasks” of initial vital signs, drying, weighing and assessments often leading to transfer from the labor area. But when newborn instinct is left to proceed uninterrupted, mothers glean benefits too; as the newborn crawls to the breast, it kneads the fundus of the uterus to prevent maternal hemorrhage. All of these phenomena considered, several questions arise: How did a system that routinely separates mothers and babies become the norm? Why do we place the needs of the system– staffing, policies, artificial time constraints– ahead of time-tested newborn and maternal abilities? How did mothers become socialized into allowing their newborns to be taken away when our biology strongly encourages mothers to keep them protectively close? Why is it that we do not change “the system” to prioritize what is most certainly the biological norm, the safest and most stable place for the newborn?
References
Agosti M1, Tandoi F, Morlacchi L, Bossi A. (2017) Nutritional and metabolic programming during the first thousand days of life. Pediatr Med hir. Jun 28;39(2):157. doi: 10.4081/pmc.2017.157. Baker-Rush, M. (2015) International Journal of Childbirth Education . Jul, Vol. 31 Issue 3, p44-47. 4p. Bergman, J., Bergman, N. (2013) Whose Choice? Advocating Birthing Practices According to Baby’s Biological Needs. J Perinat Educ. Winter; 22(1): 8–13. doi: 10.1891/1058-1243.22.1.8 Brimdyr, K, Cadwell, K, et al, (2017). An implementation algorithm to improve skin‐to‐skin practice in the first hour after birth. Maternal & Child Nutrition, doi.org/10.1111/mcn.12571 Charpak, N (2016), Twenty-year Follow-up of Kangaroo Mother Care Versus Traditional Care. Pediatrics 139(1):e20162063 Condo, H. et al. (2019) Initiative to Improve Exclusive Breastfeeding by Delaying the Newborn Bath. Journal of Obstetric, Gynecologic & Neonatal Nursing, DOI: 10.1016/j.jogn.2018.12.008 Dunfield, K. (2014). A construct divided: Prosocial behavior as helping, sharing, and comforting subtypes. Frontiers in Psychology, 5, 1-13. Hansen, R. et al. (2019) Adaptive response of neonatal sepsis-derived Group B Streptococcus to bilirubin. Scientific Reports volume 8, Article number: 6470 Kolsoom, S., et al. (2018) The effect of mother and newborn early skin-to-skin contact on initiation of breastfeeding, newborn temperature and duration of third stage of labor. Int Breastfeed J. 2018; 13: 32. Published online Jul 16. doi: 10.1186/s13006-018-0174-9 Li J, Li Y. (2018) Birth with dignity from the Confucian perspective. Theor Med Bioeth.Oct;39(5):375-388. doi: 10.1007/s11017-018-9460-1. Lozoff, M. (2013) Childrearing and Infant Care Issues A Cross Cultural Perspective. Nova Science Publishers, Inc. NewYork, NY. McNabb, M., Oudshoorn, C. (2011) Moves to transform maternity AIMS Journal Volume 23, Issue 3, Pages 19-21 Mobbs, E. (2016) Imprinting, latchment and displacement: a mini review of early instinctual behaviour in newborn infants influencing breastfeeding success Acta Paediatrica. 28 April 2015 https://doi.org/10.1111/apa.13034 Odent, M. (2009) “The instincts of motherhood: Bringing joy back into newborn care” Early Human Development. Volume 85, Issue 11, November, Pages 697-700 https://doi.org/10.1016/j.earlhumdev.2009.08.053 Saltzman,W.., Maestripieri, D.,The Neuroendocrinology of Primate Maternal Behavior. Prog Neuropsychopharmacol Biol Psychiatry. Jul 1; 35(5): 1192–1204. Published online 2010 Oct 1. doi: 10.1016/j.pnpbp.2010.09.017
