Concerned About Unconventional Mental Health Interventions?

Concerned About Unconventional Mental Health Interventions?
Alternative Psychotherapies: Evaluating Unconventional Mental Health Treatments

Monday, February 14, 2011

Is It Kin, or Is It Skin? Conclusions About Skin-to-Skin Contact for Low-Birth-Weight Babies

The Huffington Post blogger Jennifer Lauck has done a piece arguing that separation of very young babies from their mothers is traumatic for the babies, and that, therefore, adoption policies need to be changed dramatically (see http://www.huffingtonpost.com/jennifer-lauck/adoption-myth-buster-what_b_822175.html). (And thank you to J.P. for giving me a noodge about this post.) Lauck refers to her own children as evidence for her position, but she also cites a study by the South African physician Nils Bergman (http://www.ncbi.nlm.nih.gov/pubmed/1524427).

The Bergman study took 34 low-birth-weight babies and randomized them to two groups shortly after birth. Half of the babies were randomly assigned to incubator care, the standard method of caring for them. The other babies were placed skin-to-skin with their mothers. The incubator babies did less well in terms of breathing and heart rate and were more likely to experience low body temperatures (which, incidentally, can trigger a cascade of harmful events in LBW or even average babies).

So far, so good. Bergman’s study agrees with much older work that the ordinary isolette is not best-suited for premature or LBW infants. Other researchers, like Tiffany Field, have shown the advantages of devices like water beds or sheepskin pads for these small infants. Human skin-to- skin contact has a whole list of advantageous characteristics—skin is not only warm, but movement of the adult and the baby can make sure that as much of the baby’s skin is kept warm as possible; a human caregiver will shift position from time to time, keeping persistent pressure from being uncomfortable to the baby as it might be if the baby were lying on a firm surface; human voices provide a background of mild stimulation that works better for the baby than quiet; human breathing and heartbeat help entrain the baby’s breathing into appropriate rhythms. It’s all good. But is it about the mother?

Lauck and Bergman both seem convinced that the birthmother is the important factor here. Lauck uses the study to draw conclusions about adoption reform. Bergman says “The cardio-respiratory instability seen in separated infants… is consistent with mammalian ‘protest-despair’ biology, and with ‘hyper-arousal and dissociation’ response patterns described in human infants: newborns should not be separated from their mothers.” In both cases, the conclusion seems to be that the birthmother plays a role that cannot be performed in any other way.

I’m sure most readers will see where I’m going with this. Both Lauck and Bergman are having trouble interpreting confounded variables. They are confusing the effect of skin-to-skin contact with the effect of separation from the birthmother specifically. This confusion is present because Bergman did not design the study to discriminate between experiences of warmth, movement, and good breath and heart patterns, and experiences of being with the mother (what Lauck calls “bonding”). Even more confusingly, Bergman uses terms like “protest-despair” and “dissociation” that imply subjective experiences rather than the objective measures of body temperature, breathing, and heart rate that were actually measured. These terms are especially questionable when applied to low-birth-weight babies who may have had many other developmental problems, as such babies often do. The Bergman study does not support either Lauck’s conclusions, or the implications that the researcher suggests. It’s neither good science nor good policy to jump to conclusions that have little to do with what was studied.

Let me hasten to point out that I am all for whatever makes life more pleasing for both babies and mothers. I spent some time many years ago studying the painful procedures used with pre-term babies and collecting evidence that even babies born at less than 30 weeks’ gestational age showed reactions to pain. In the course of those studies, I reported that procedures were often much longer and more painful than they sounded. (In one case, I observed a heel-stick for a blood sample that took 17 minutes and more than half a dozen sticks to get a few drops of blood.) I noticed that some NICUs were very cautious about keeping things quiet and dimly lighted, and staff spoke in low voices to each other and to the babies. In others, bright lights, loud voices, and constant alarm bells provided exactly the wrong situation for babies trying to live and parents trying to understand and help with medical care. I will always remember seeing a nurse vigorously clean and diaper a pre-term baby with a horrible diaper rash, then perch the agitated baby on her knee and thrust a bottle into her mouth while talking to another adult.

I remain very concerned that babies, full term or pre-term, be treated with as much care as we can manage in all cases, and left primarily to their parents’ care whenever that is possible. There are many reasons why this is beneficial, and some of the reasons gave rise to the British “care-by-parent” pediatric unit several decades ago. But it is not to anyone’s benefit that we exaggerate the role of the birthmother in necessary care or that we draw less-than-warranted conclusions about family relationships, including adoption.

6 comments:

  1. So many great points! A friend of my son had a very premature baby, less than 2 lbs at birth, and both Mom and Dad went everyday to hold the baby when he was in the NICU, plus they had volunteers to hold the babies whose parents were not available all the time. Human touch is important at all ages, but it does not have to be the biological mother doing the touching. That baby is a bright, healthy kid today, 10 years old, does karate and other sports.

    I commented on the Huff Po about the statement in the article that "babies go into shock after 45 minutes of being separated from their mother". I asked the author to clarify, she did not.

    ReplyDelete
  2. I think she meant that the incubator babies were more likely to have low body temperatures and problematic heart and breathing patterns. Those are certainly things to be concerned about.

    Your point about volunteer baby holders is a good one. Obviously we don't really think that Mom is the only option-- and how about Dad, anyway?

    These people seem to be convinced that not only does it not take a village to raise a child, the village will just cause trouble if it gets into the picture.

    ReplyDelete
  3. The comment did not qualify that it meant incubator babies, and implied all newborns, including healthy full term babies, went into shock being separated.

    It was from Verrier quoting Joseph Pierce:
    "Verrier's work in Coming Home to Self, published in 2003, points to a study by Joseph Chilton Pearce, author of Magical Child and Evolutions End, who states that it takes less than forty-five minutes for an infant separated from his mother to go into shock and this reaction has immediate impact on the brain and functions like sight."

    So this piece was not from the study of preemies and skin contact, but from a whole other book of fringe belief. The whole article was so confused and confusing, I find it hard to believe Ms. Lauck is an acclaimed writer. She seems to confuse fiction with non-fiction, belief with science.

    ReplyDelete
  4. Thanks for the great detective work, and I'm embarrassed that I didn't go back to Verrier to check that out.

    It's interesting that the cited study refers to an impact on vision. Robert Zaslow, the daddy of attachment therapy,claimed he had restored someone's vision by holding therapy. I suppose this is a claim that gets every parent's attention.

    As someone says in "The Color Purple", "it all just too triflin and confuse"!

    ReplyDelete
  5. There is a lot out there on vision impairment in premature babies, and it is not about lack of contact with mom. It is a developmental issue of the extremely premature. Here is a newspaper article, but there is plenty of more technical stuff if you google "premature infant vision impairment"
    http://www.tampabay.com/news/health/premature-babies-suffer-vision-impairment/1067230

    For those now adults who were preemies, in the past too much oxygen in incubators caused eye damage including blindness.

    ReplyDelete
  6. Lots of possible reasons for visual and other impairments,including whatever it was that caused the premature birth to begin with.

    ReplyDelete