Breathing

‡ Right after birth the most important thing for the infant is to - start breathing, and then - establish an optimal respiration. ‡ This happens more easily when a baby is placed STS, instead of experiencing the physiological stress of separation.
(Christensson K et al. Acta Paediatrica 1992;81:488-93.)

Prematures kept STS: More stable heart-lung function heartAlso premature infants have higher oxygen levels and greater heart-lung stability when they are STS than when they are kept in incubators
Bergman NJ et al. Acta Paediatr. 2004

Mammalian ´protest-despair´ ´protestNo will to live?
‡ 34 infants 1.2-2.2 kg RCT by computer before birth to STS or control. ‡ After 6 hrs: all STS-infants (8/18) as opposed to 6/13 incubator infants were hearth-lung stable. ‡ Cardio-respiratory instability in separated infants is consistent with ´protestdespair´/´dissociation´.
‡ Bergman NJ et al, Acta Paediatr. 2004

Bergman et al. baby gets cold ‡ Also term newborns are often put in incubators or wrapped in warm blankets to help them maintain an optimal temperature.1992. into cool.Born wet. ‡ A number of studies have demonstrated that skin-to-skin contact with mother is better for regulating the baby¶s temperature. 2004) . (Christensson K et al.

352:1115 Cumulative proportion of rewarmed infants % reaching 36.5°C 100 80 60 40 20 0 0 60 120 180 240 300 360 420 480 540 600 Time (minutes) (By compliments of A.Rewarming hypothermic newborns Christensson K et al. Lancet 1998.Cattaneo) C h skin-to-skin incubator .

2000 .It¶s warmest up front ‡ A mother¶s chest gets warmer during STS ‡ Lactating breasts are warmer than nonlactating ones. ‡ An infant in a ³maternal nest´. will have a higher temperature than one placed in a warmed cot. Uvnäs-Moberg K. made up of her chest and arms.

put in cot next to mother 90 minutes after birth those placed STS had significantly higher blood-glucose and maintained their bloodglucose better even without feeding. is common in newborns after an hour or more.Blood sugar and metabolism Low bloodsugar. term babies randomized to be: . Acta Paediatr 1992) . 50 healthy.³separated´. et al. Christensson K.placed STS with mother. hypoglucemia. or .

Uvnäs-Moberg K.Cold hands and feet need energy Separation: Colder babies have lower bloodsugar This may have to do e. Acta Paediatr 1989.g. . with less optimal bloodcirculation. requiring more energy. resulting particularly in colder hands and feet for hours. as the small vessels contract in babies kept in their cots.

randomized to ‡ A) STS with mother ‡ B) Cot ‡ C) Cot. stop at reunion. then STS Infants recognize separation. for 90 min. cry in pulses. Christensson K et al.Crying: a separation distress call? Newborns obs. Acta Paediatr 1995 . Genetically encoded reaction.

‡ Most mothers will react to baby¶s call by talking to the infant. some for the first time.Baby¶s calling affects mother ‡ Most newborns will after a while emitt calling sound like ´eh!. . eh!´ ‡ AM Widstrøm was a pioneer in making us all concious of this every-day event. ‡ Most mothers recognize the voice of their own babies in the maternity ward.

. ‡ New York State Psychiatric Institute.Mother's voice organize brain function in the newborn ‡ Mother¶s well known voice has a strong influence on the newborn with both acute and enduring effects on the developing brain. Moon CM. 1994 Jun. Fifer WP.397:86-93 . as well as for later social and emotional development. ‡ This has ramifications for the development of the auditory system.Acta Paediatr Suppl.

‡ can see well ‡ have visual preferences: they want to see a face! Faroni T et al.Love at first sight? Right after birth most babies ‡ are wide awake. Proc Natl Acad Sci 2005 .

rooting. ‡ Widstrøm AM at al Acta Paedr Scand 1987 . calling. sucking. touching. tongue.and lipmovements.Organized pre-feeding behaviour pre‡ Most unsedated newborns placed STS will undergo the now well known behaviour with ´crawling´. ‡ Breastfeeding initiated after such an uninterupted sequence of events is very often successfull also long term.

1990 . Early Hum Dev.Baby¶s touch does things to mom? ‡ Baby¶s post partum contact with the breast influences later maternal behaviour: ‡ Mothers whose infants had touched or licked the areola and nipple within 30 min. ‡ left babies less in the nursery (p<.002) and ‡ talked more to them during breastfeeding on day four (31/31 vs 18/25) ‡ Widstom AM et al.

Birth 2001 . resulting in surges of oxytocin in mother. but restarted during pauses in suckling. ‡ Mattiesen AS et al. ‡ Blood tests from mother every 15 min. During suckling baby¶s hands were still. ‡ Infants used their hands to explore and stimulate the breast before feeding.Hands on: Touch releases oxytocin ‡ 10 newborns were placed STS and videofilmed with assessment every 30 sek.

on day 1-3 Schaal B Dev Psychobiol 2006 . maternal perception of latch on and sucking. onset of lactation. .Areolar scent attracts baby The more areolar skin glands the better neonatal weight gain.

full-term neonates randomly assigned to STS postpartum or control ‡ 1 and 4 d after birth STS infants responded differently to own mother¶s milk compared to another mother¶s milk. Mizuno k et al.9 months longer. orange juice.Infants recognize odour of own mother¶s milk after early STS 60 healthy. Acta Paediatrica 2004.93:1640-45 . ‡ STS infants: larger difference at 4 days ‡ STS infants were breastfed an average of 1. distilled water. formula.

Makhoul IR. Pediatrics 2004.. or B) Standard care in nursery ‡ After 4 hrs: one hour-long observation: infants who had been STS slept longer. were mostly in a quiet sleep state.STS and neurobehavioral responses of the term newborn ‡ 15 min after birth 47 healthy infants RCT: A) STS lasting another hour. had more flexor movements and postures showed less extensor movements ‡ STS seems to influence neurobehaviour and system modulation of the newborn ‡ Goldstein Ferber S.113 858-65 .

Early STS . Hofer MA Acta Paediatr Suppl 1994 . ‡ future hormone regulation. In humans there is some evidence that early separation may disturb subtle processes influencing both body and mind and future social relationships.Lasting psycologic effect on newborn humans? Newborn rats: Separation from mother results in disturbance not only of e. but of ‡ future behaviour as well.g.

Dev Psykobiol 2005 . including humans Newborn neural circuitry including amygdala: different from adult. ´The brain of a newborn is uniquely designed to optimize attachment.Neonatal brain: sensitive periods Mammalian imprinting models are of critical importance in mammals.´ Moriceau S & Sullivan RM.

Can we make up for lost time? ‡ Luckily there seems to be compensatory mechanisms particularly in young who depends for a long time on parental care. ‡ Humans have their large brains. inventivenes. 2002 But what about vulnerable families? .and can use reason. patience etc to make up: ´Environmental enrichment during the peripubertal period´ Francis DDJ Neurosci. emotional reassurance.

STS and maternal stress. Pediatrics 2005.116:1105±13 . mood. heart rate and cortisol Premature infants 25-33 w STS mothers compared to ctrl: salivary cortisol down (32%) lower heart rates (7%) less stress (89%) improved mood (6%) STS Infants: lower heart rates lower pain scores cortisol up or down (some need stress?) Morelius E et al.

Taechan Kanho Hakhoe Chi 2005 .Maternal psycological well-being wellIncreased quantity of neo-maternal exposure in NICU has a beneficial effect on maternal self-esteem and attatchment Ahn YM & Kim MR.

Franceschini R et al. ‡ In humans. Br J Obstet Gynaecol 1989. ´When I feed you I feel great myself!´ .Endorphins promote happiness ‡ Why do mothers go to all the trouble? ‡ What¶s in it for her ± right now? ‡ In non-human primates beta-endorpin are central as regulators of mother-infant interaction. as well as for groupsocializing. levels of endorpins double during breastfeeding ±peaking after 20 m.

improves sleep-quality ‡ Increases during massage. much more sensitive . intercourse ´HORMONE OF LOVE´ ‡ Affects men. but w.Oxytocin . ‡ It has a number of effects in humans: ‡ Overflows brain to make mom drowsy and relaxed.mediator of STS effects ‡ Oxytocin .not only usefull for uterine contractions and milk let-down reflex.

Frightful faces trigges activity in amygdala. Frightful faces triggered a dramatic reduction in amygdala activity in subjects who had sniffed oxytocin. 2005. . suggesting that oxytocin mediates social fear and trust via the amygdala and related circuitry. Kirsch P et al. suggesting that oxytocin mediates trust. who had sniffed oxytocin there was a dramtic reduction. 25(49):11489-93. Functional magnetic resonance imaging data (red) superimposed on structural MRI scans. In subj.. J Neurosci.

Departments involved ‡ ‡ ‡ ‡ ‡ ‡ Obstetrics Maternity Operating theatre Anesthesiology Postopertive (PO/Recovery) Pediatrics (Neonatal) .

116:1105±13 Extra important in C-section mothers? .Lower maternal stresshormones skin-toskin-to-skin Mothers with baby STS: ‡ ‡ ‡ ‡ salivary cortisol down lower heart rates less stress improved mood Morelius E et al. Pediatrics 2005.

suggesting that oxytocin mediates trust. suggesting that oxytocin mediates social fear and trust via the amygdala and related circuitry. . 25(49):11489-93. In subj. J Neurosci. Functional magnetic resonance imaging data (red) superimposed on structural MRI scans.. who had sniffed oxytocin there was a dramtic reduction. Kirsch P et al.Frightful faces trigges activity in amygdala. Frightful faces triggered a dramatic reduction in amygdala activity in subjects who had sniffed oxytocin. 2005.

but restarted during pauses in suckling. Birth 2001 . ‡ Blood tests from mother every 15 min. During suckling baby¶s hands were still. ‡ Infants used their hands to explore and stimulate the breast before feeding.Hands on: Touch releases oxytocin ‡ 10 newborns were placed STS and videofilmed with assessment every 30 sek. resulting in surges of oxytocin in mother. ‡ Mattiesen AS et al.

Nissen E et al.Elevated p. 1995 ‡ Oxytocin makes the uterus contract and reduces bleeding. ‡ Oxy needed in maternal bonding in animals. ‡ After 1 hr oxy returns to pre partum levels.p. Acta Obstet Gynecol Scand. . oxytocin peaks with baby STS Oxytocin is elevated particularly the first hour after delivery ± peaks with baby STS.

. ‡ Oxy needed in maternal bonding in animals. Nissen E et al. Acta Obstet Gynecol Scand. ‡ . p.Elevated Oxytocin 1. ‡ Mothers delivered by c.p. ‡ Oxytocin is elevated . hour. ‡ After 1 hr oxy returns to pre partum levels. hour p. particularly prone to hemorrage.s.p.particularly the first hour after delivery ± peaks with baby STS. usually do not get their babies the 1. 1995 ‡ Oxytocin makes the uterus contract and reduces bleeding.

p: ‡ STS.and incubator-babies warmer than those kept in a cot ‡ After 24 hrs: STS-babies warmer than babies who started out in cot OR incubator Christenson K.Maternal nest is warmest. Acta Paediatr 1996 . BUT Dad¶s skin also provides heat ‡ 44 infants randomized after c-section to: a) incubator b) cot c) STS with father ‡ Results 2 hrs p.

2003. Issue 2. .Early STS with healthy newborns Cochrane conclusions: conclusions: ‡ Seventeen studies involving 806 infants ‡ Early STS contact associated with: ± better maintenance of temperature ± better maintenance of blood glucose ± less infant crying ± more breastfeeding at 1-3 months ± longer breastfeeding ± higher scores of maternal affectionate love/touch during breastfeeding Anderson GC et al. The Cochrane Library.

s. 2003 C. 2005 Norway . express great satisfaction. Unpublished data.C-section moms and neos miss out Two groups obs for 24 hrs of rooming-in.´ Rocha SM et al. after ‡ A) Natural birth ‡ B) Cesarean section Conclusion: ´Mothers who have c-sections need more attention to begin breastfeeding.moms who get to keep their babies STS very early.Rev Bras Enferm.

. The Cochrane Library.Early STS with healthy newborns Cochrane conclusions: conclusions: ‡ Seventeen studies involving 806 infants ‡ Early STS contact associated with: ± better maintenance of temperature ± better maintenance of blood glucose ± less infant crying ± more breastfeeding at 1-3 months ± longer breastfeeding ± higher scores of maternal affectionate love/touch during breastfeeding Anderson GC et al. 2003. Issue 2.

Yes. ‡ Today exactly such knowledge may be used to support evolutionary developed. well-tested ³natural´ ways of handling newborns and their mothers. support from both modern medicine and ³nature´ ‡ Measurable ³hard´ facts have typically dominated modern medicine. please. ‡ The main conclusion: try not to separate the newborn baby from it¶s mother! .

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