The Needs of the Newborn in the First Few Hours of Life

During the past decades the emphasis in the field of childbirth has been largely upon those factors which influence the physical health of mother and child. We therefore welcome the emerging “home birth” movement, the “family centered childbirth” movement “kangaroo mother care” and “baby friendly” hospitals, which, while maintaining the emphasis on safety and high medical standards, regards as equally important an emphasis on the factors influencing the emotional health and well-being of the mother and baby.

The importance of the relationship between a mother and her newborn child can never be overemphasized. It is from this relationship that all human relation¬ships grow. Research over the last 25 years has shown that the contact between mother and the newborn baby during the first few hours after birth may set down life-long patterns which are extremely difficult to change later. This is raising serious questions about the routine policies of many mater¬nity hospitals where separation of the mother and neonate directly after birth is still often the standard practice. The aim of this article is to consider the effects of routine hospital procedures on the mother/child relation¬ship in particular.

During the past decades it has been the standard procedure in most hospitals to remove the newborn directly after birth, while the mother is taken to the recovery room to rest. In some more progressive hospitals the mother may be allowed to nurse briefly on the delivery table. All too soon however, the baby is taken away to the central nursery where it is placed alone in a crib. There it has to wait in isolation till the official hospital schedule allows it to be taken to the mother to be fed. (This may involve waiting periods of up to three hours at a time, depending on the hospital policy.) In addition, during the first day, while the baby is under observation, it is sometimes kept from the mother for an extended period of many hours. In some hospitals, mothers who were sedated for the birth may not see their babies at all till they are up to12 hours old.

Klaus and Kennell have done extensive research into the phenomenon of maternal-infant bonding, (Klaus & Kennell, 1976). The results suggest that a mother's interaction with her baby during the first few hours of life, critically affects her atti¬tude towards the child for at least the next five years. It is not yet known exactly how long the 'sensitive' period lasts, but it is believed to lose effectiveness between three and four hours after the birth, (Spezzano & Waterman, 1977). If there has been no contact between the mother and neonate during this period, adequate bonding does not occur. If a mother and infant have almost uninter¬rupted contact during this period, a strong maternal-infant bond is created and the re¬sulting maternal feelings in the mother con¬tinue after the 'sensitive' period has elapsed.

After a drug-free delivery, both mother and baby are in a state of wakefulness and receptivity for the first few hours. During this time touch and eye contact are vitally important. The mother spends much time holding the baby in the 'en face' position, and talks to him in a special tone of voice. The baby looks up at the mother, following the movement of her eyes. This elicits a return-response from her. Sound and smell are also important bonding elements. After hearing her baby's cry only once, a mother who has bonded with her baby can often recognize it from a group of babies by the baby’s voice alone. The baby, when first offered the breast, will also lick and smell the nipple before sucking. Later it will recognize the mother by her smell.

If early bonding has occurred the baby will cry when handed to a stranger, quietening down as soon as it is returned to its own mother. For the mother, having the baby in her arms means that the climax of birth is followed by a time of quiet close¬ness when she can get to know her baby. This is described by those who have experienced it, as deeply fulfilling. It leaves the mother with strong feelings of attachment to the baby and positive feelings about herself as a mother. She also has strong feelings that the child is really hers.

The Effects of Separation on the New Mother

Klaus and Kennell (1976) were among the first to suggest a connection between separation of the mother and baby directly after birth, and later child abuse. It was found for example that there was a high incidence of child battering among children who had been premature infants and had spent the first hours of life in an incubator, away from the mother. Mothers who had been separated from their new¬born babies were also more likely to put them up for adoption during the first year of life, even if the pregnancy had been planned and the mother was looking forward to the birth.

The following statement is typical of what they said when interviewed , “S/he’s’s a beautiful baby, but somehow I don't feel right about him/her. This baby could belong to anyone. I never really felt this was my own child." These feelings did not occur if the baby had been placed in the mother's arms on the delivery table and had spent the first three or four hours of life in skin-to-skin contact with her.

Bricklin (1975) has suggested that if bonding has not occurred and the mother is aware of her lack of maternal feelings, she can attempt to remedy the situation by getting breast-feeding established as soon as possible and concentrating on the feelings of closeness, which this interaction brings. She feels that the strong bond created by the breastfeeding situation may to some extent make up for the deficiency already created and help to bridge the emotional gap between mother and infant. The problem here is that many 'low-con¬tact' mothers choose not to breastfeed.

'High-contact' mothers on the other hand are usually eager to breastfeed their babies. Follow-up of a group of such mothers showed that their babies were less likely to be

abused, abandoned, neglected or to receive inadequate care, (Spezzano & Waterman, 1977). These mothers were more nurturing and maintained more eye contact with their babies at one month old than mothers in the control group who had received standard hospital treatment. The babies in the experimental group also gained weight better than those in the control group, cried less and smiled more. By one year of age 'high-contact' mothers were more likely to be breastfeeding their babies than 'low-contact' mothers. They also spent more time soothing them in a pediatric examination.

At five years of age the differences between the two groups of children were still apparent. The 'ex¬tended-contact' children were better adjusted and had higher lQ's than the con¬trol group. They also obtained more ad¬vanced scores on language tests than the 'low-contact' children. As far as can be ascertained, differences shown in the two groups of children seem to be largely dependent on the fact that 'ex¬tended-contact' mothers relate more posi¬tively to their children as a result of ade¬quate early bonding.

It is well known that if the newborn of most animals are removed from the mother directly after birth and then returned later, the mother is likely to reject the young, and may even kill them. The same is true if young animals are born while the mother is under general anesthesia and presented to the mother after she has regained consciousness. We cannot generalize these findings to humans without further research, but it does seem possible that a similar mechanism is at work here.

There is one important distinction however. Human beings are able to reflect and ration¬alize. Thus a human mother may not overtly reject or abandon her baby. In¬stead, a mother who has expected to feel a rush of love and maternal pride, may feel let down and disappointed when she sees her day-old baby for the first time and feels nothing. She may experience bewilderment and guilt because she does not come up to her own ideals of what a mother should be. She is often powerless to know what to do because she does not understand the source of her feelings. She may even react to the baby with hostility because it is seen as the cause of her disappointment and self-condemnation. This is a vicious circle as her hostility towards her child creates more guilt-feelings. The final out¬come is often exhaustion and depression.

It is highly significant that proponents of the home birth movement which is gaining such momentum worldwide, report that post-partum depression is almost unknown among mothers who give birth at home. There the newborn is seldom separated from the mother for lengthy periods during the first week of life. One of the problems , which occurs most frequently in the hospital situation where the mother and baby have been separated and bonding has hot been achieved, is that the mother seems to lack much of the instinctual knowledge of how to relate to her baby. This is most likely to reach a crisis when the mother has to return home and take care of her baby alone. She is more likely to be unable to cope and feel exhausted and depressed, and may also reproach herself for being a bad mother.

The Effects of Separation on the Neonate

Until the 1970s there was very little subjec¬tive information as to how the baby felt during birth and shortly thereafter, but with the advent of primal therapy, a large number of patients started reliving early expe¬riences, including the first day of life. They became able to describe in great detail those experiences which were painful and traumatic to them, showing how these factors often created life-long maladaptive behaviour patterns.

One of the most painful traumas relived by many primal patients, is being sepa¬rated from the mother directly after birth. The baby 'knows' instinctively it cannot stay alive without its mother. It is completely helpless and totally dependent on her for survival. The baby feels instinctively that to be separated from her is to die. It cannot be made to understand that it has not been abandoned, but is simply waiting in a central nursery, and will be taken to its mother eventually. The baby has no way of interpreting what is happening to it, or of knowing that the separation and abandonment it is experiencing are ever going to end. The only way the baby can shut off the pain of the long hours without its mother, is by using sleep as a defense.

Primal patients who have relived this particular trauma have often gained insights into the fact that this became a prototypic defense for them and that they continued to use sleep as an escape whenever reality became too painful. Often the trauma of being left lying alone in the crib was experienced physically when it was relived. For example, one primal patient said, "I felt the pain all over my body, because that was where I hurt. I needed to feel someone holding me - to let me know I wasn't going to be left to die all alone. I've tried to get that from lovers in the present and it's no wonder I couldn't keep a relationship going. I would cling to people, afraid that they were going to abandon me. I wasn't acting like an adult at all. I was still that hurt, abandoned baby”.

Another patient reported how early in her therapy, she relived how she had lain in the crib, waiting in a state of desperation for the sound of the footsteps that would take her to her mother to be held and fed. The footsteps approached, but in¬stead of stopping, they went past. And she was left with the terrible loneliness again. All she could do was scream and hope that she could make someone see her. Afterwards she realized that she had spent much of her life doing spectacular things, trying to get people to see her and notice her needs, afraid that they might overlook her or forget about her. The feeling underneath was, "I've got to make them see me or I'll die."

In my own therapy I connected to how insecure I had always felt in close relationships. No matter how well relationships were going for me in the present, I always felt they could never last. Finally I was able to connect this to my early experience in the hospital where I was born. I was kept in the central nursery and only taken to my mother briefly for feeds. Each time I was handed to her I would feel that the pain and loneliness were over at last. Just as I was starting to feel safe and secure in my mother's arms, I was taken away from her and back to the nursery again. This experience, repeated many times, left me with the feeling, "It's no use getting close to anyone, because as soon as I do, they will be snatched away from me again."

Birth is a great upheaval for the newborn. More than at any other time, in the hours following its birth, the baby needs the warmth and comfort of being physically close to its mother. The familiar sounds of her heartbeat and breathing are something the baby knows. They create a sense of continuity between the baby’s previous experience in the womb and the new condi¬tions to which it must adjust. Continuous early contact with its mother will leave the baby secure in the knowledge that the mother will not abandon it.

The baby also needs to know that the mother will meet all of its needs as they arise. This means that that she should respond whenever the baby expresses its needs by crying, and feed the baby whenever it is hungry. The mother and the mother’s breast are a source of food and warmth and comfort to a tiny baby – the baby should know that its mother will be there for it whenever it needs her. This necessitates 'rooming-in' facilities if the baby is born in a hospital. It is also important that the mother have had a drug-free delivery if possible so that she is awake and able to begin caring for her baby immediately.

Conclusion

While separation of the mother and newborn, and other hospital procedures out¬lined above, cannot be held solely respons¬ible for the creation of later neurosis, they do often lay down prototypic maladaptive patterns upon which later problems are compounded. While the creation of some of these early traumas may take a few hours or at most a few days, the resulting problems often take years of intense and costly therapy to resolve. In primal therapy it has been found that it can take years to integrate 'first line' pain, i.e. pain laid down in the system during birth and the first days of life, so prevention though education is definitely better than having to try to cure the problem later.

During the past decades the emphasis in the field of childbirth has been largely upon those factors which influence the physical health of mother and child. We therefore welcome the emerging “home birth” movement, the “family centered childbirth” movement, “kangaroo mother care*” and “baby friendly” hospitals, which, while maintaining the emphasis on safety and high medical standards, regards as equally important an emphasis on the factors influencing the emotional health and well-being of both the mother and her child.

*For more information on “kangaroo mother care”, there is an article on KMC
on the internet at: http://www.primal-page.com/bergman.htm

This article is dedicated to my primal friend and buddy, Helmut Viehmann, who brought the research of Klaus and Kennell to my attention when we were both in therapy at the Primal Institute in L.A. in 1977. It resulted in a change of career for me in my mid 30s, and led me to qualify as a Childbirth Educator with the American Institute of Family Relations. As a result, I was able to spend many years of my life working with expectant parents, educating them about how they could meet the very real, and greatly misunderstood, primal needs of their babies.

Pat Törngren is a veteran primaller from the Cape Town area of South Africa, an avid primal community builder, and the list owner and moderator of the online Primal Support Group.