Fall 1998
Articles
Reviews
1998 Award Recipients
1997 Award Recipients
Special Presentation
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Perinatal Care in the 21st Century:
Evidence Supports Changing the Management for both Mother and Infant
by Marshall Klaus, M.D. FAAP
Editor's Note: Dr. Klaus, author of several landmark books on attachment and
bonding, childbirth and the doula, and the capabilities of the newborn, will be giving a
special talk at the American Academy of Pediatrics Fall Meeting for the Section on
Developmental and Behavioral Pediatrics. Here is an abstract of his intended talk.
A renewed interest in the first minutes, hours, and days of life has been stimulated
by several recent provocative behavioral and physiologic observations in both mothers and
infants. Most visual of the findings is the observation at 20 - 60 minutes of life of the
ability of newborn infants (when their mothers do not have large amounts of premedication)
who are not bathed nor receive vitamin K or eye ointment, to crawl when they are placed
near the tip of the sternum to their mother’s breast, open their mouths widely, and
latch on all on their own.
When the newborn is placed on the chest between the breasts, the infant is able to
reach the breast but with a different pattern of behavior. A mother’s chest appears
adapted for the infant since the newborn, when dried and placed there, will maintain their
temperature or be warmed if they are cold as well as high-tech heating devices. In
addition, infants placed on their mother’s chest cry hardly at all compared to a
control group wrapped in a blanket and placed in a bassinet. One of the most significant
findings in this early period is that if the mother wants to breast-feed and is permitted
early contact,
suckling in the first hour of life, and
rooms-in with her infant
she is far more successful than mothers who do not have these experiences.
These interventions are part of the 10-point
Baby Friendly Initiative of UNICEF to increase breast-feeding world-wide. A recent
unexpected finding was a drop in infant abandonment in maternity hospitals in Thailand,
Philippines, Costa Rica, and St. Petersburg, Russia when these practices were instituted.
A possible key to understanding what is happening is the observation that if the lips of
the infant touch the mother’s nipple in the first hour of life, a mother will decide
to keep her baby 100 minutes longer in her room every day during her hospital stay than
another mother who did not have contact until later.
It seems likely that each of these features--the crawling ability of the infant, the
sensitivity of the mother’s nipple, the decreased crying when close to their mother,
and the warming capabilities of the mother’s chest -- are adaptive and were built
into human beings several hundred thousand years ago, during much more stressful times, to
help preserve the infant’s and mother’s lives.
In addition, when the infant suckles from the breast, there is a large outpouring of
19 different gastrointestinal hormones in both the mother and the infant, - including
cholecystokinin, which stimulate growth of the baby’s and mother’s intestinal
villi and increase the absorption of calories with each feeding. The stimuli for this
release are the mother’s nipple and the inside of the infant’s mouth. These
responses were essential for survival thousands of years ago when periods of famine were
more common before the development of modern agriculture. These findings will be discussed
in relation to new information on blood oxytocin levels, breast-feeding, and brain
oxytocin.
These findings and a metanalysis of the 11 randomized trials of emotional and physical
support in labor, which reveals significantly lowers cesarean section rates, length of
labor, etc., as well as altered maternal behavior in relation to anxiety, depression,
self-esteem, and infant caretaking 6-8 weeks postpartum, are all increasing evidence that
the time around labor, birth, and the next 7 days are a sensitive period for the human
mother.
These observations suggest that major changes in perinatal care should be considered,
including
continuous labor support by experienced women for all laboring mothers,
early contact, suckling, and rooming-in should become routine, and normal newborn
nurseries should be closed.
It is hoped that as we become better acquainted with the biology of both the mother
and infant that their perinatal care will become more appropriate to their physiology.
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