Presentation is loading. Please wait.

Presentation is loading. Please wait.

Anthropological and sociological aspects of skin-to-skin contact.

Similar presentations


Presentation on theme: "Anthropological and sociological aspects of skin-to-skin contact."— Presentation transcript:

1 Anthropological and sociological aspects of skin-to-skin contact.
Dr Nils Bergman M.B.Ch.B., M.P.H., M.D. Cape Town, South Africa Intro

2 Nothing an infant can or except in light of mother’s body
Babies Celebrated, Beatrice Fontanel and Claire D’Harcourt, © 1998 Harry N. Abrams, Inc. “For species such as primates, the mother IS the environment.” Sarah Blaffer Hrdy, Mother Nature (1999) Nothing an infant can or cannot do makes sense, except in light of mother’s body

3 CENTRAL DOGMA – all biological processes
EVOLUTIONARY BIOLOGY NEUROSCIENCE EPIGENETICS Everything else The Brain The DNA The Place ENVIRONMENT FITNESS EXPERIENCE ADAPTATION Skin-to-skin = key that unlocks the neuroscience !

4 Sequence human newborn breast-feeding
Pre-requisite = habitat hand to mouth tongue moves mouth moves eye focuses nipple crawls to nipple latches to nipple suckles (Widstrom et al 1994)

5 FIRE TOGETHER, WIRE TOGETHER,
Cells which FIRE TOGETHER, WIRE TOGETHER, and those which don’t, won’t.” Carla Shatz There are “needed neural processes” !

6 ... spontaneous synchronous firing particularly important
fetal REM sleep (or active sleep) seems to be particularly important to the developing organism ... spontaneous synchronous firing Marks et al 1995

7 BRAIN WIRING Peirano 2003

8 connect direct to the amygdala
AT BIRTH, the brain has TWO CRITICAL SENSORY NEEDS: SMELL & CONTACT connect direct to the amygdala

9 THE NEWBORN BRAIN SKIN-TO-SKIN CONTACT fires and wires
the amygdala-prefronto-orbital cortical pathway (PFOC)

10 INTELLIGENCE SOCIAL and EMOTIONAL AMYGDALA: Emotional Processing
Unit CPU Prefrontal cortex Executive function SOCIAL and EMOTIONAL INTELLIGENCE

11

12 SENSATIONS THAT WIRE BRAIN
SEES Mum’s eyes Ear HEARS Mum’s voice SMELLS Mum’s milk MOVES with Mum TASTES Mum’s milk Back FEELS Mum’s arm holding Hand TOUCH Mum’s skin WARMED on Mum’s front Skin-to-skin CONTACT Slide from JILL BERGMAN

13 a kind of invisible hothouse
Through “hidden maternal regulators” ... “ physiological set points “ “ internal working models’ “ scripts – templates”

14 SENSORY ORGAN = SOCIAL ORGAN
The brain is a SENSORY ORGAN BREAST - FEEDING = BRAIN – WIRING SOCIAL ORGAN

15 “Scientific foundation” … a synthesis
EVOLUTIONARY BIOLOGY NEUROSCIENCE EPIGENETICS Everything else The Brain The DNA The Place ENVIRONMENT FITNESS EXPERIENCE ADAPTATION ENVIRONMENT GENETIC FACTORS

16 BREASTMILK MOTHER BREASTFEEDING NATURE NICHE NURTURE ENVIRONMENT
GENETIC FACTORS STIMULATION BEHAVIOUR EXPERIENCE NURTURE BREASTFEEDING

17 MOTHER is the KEY for NEURODEVELOPMENT

18

19 SEPARATION DYSREGULATES

20 PROTEST – DESPAIR causes DYSREGULATION
Social deprivation alters neurobiological systems. This pathology ... cannot be cured ...

21 3-day separation: induces physiological
changes (immune,system, heart rate, sleep, cortisol, loss of body temperature.. anaclitic depression: hyperactivity conservation- withdrawal; death or recovery Slide & photo from James McKenna

22 Primate separation studies
Maternal Separation Paradigm 0w 1w 2w 3w 4w 5w 6w   12w n 4 Mat MNS group reared no mother n 4 Mat    MNS  group as above n 4 Mat       (control)

23 Increased self soothing Anxiety Decreased sociality  Depression
Gene specific for the AMYGDALA ( GUYC1A3) Separated at 1 week: LOW gene expression Increased self soothing Anxiety Decreased sociality  Depression

24 Primate separation studies
Maternal Separation Paradigm Early Deprivation (ED) vs control (CON) 0d 2d  28d   48w ED n 11 Mat min daily  CON n 4 Mat       48w

25 Repeated short separations:
LOW gene expression Correlate to human adult depression

26 Sabatini Arabadzisz

27 Positive Stress Moderate, short-lived stress responses, such as brief increases in heart rate or mild changes in stress hormone levels. An important and necessary aspect of healthy development that occurs in the context of stable and supportive relationships. Slide by: Jack P. Shonkoff, M.D.

28 = Eustress Positive Stress EUSTRESS Under- activity Over- activity
An important and necessary aspect of healthy development that occurs in the context of stable and supportive relationships. EUSTRESS Over- activity

29 Tolerable Stress Stress responses that could disrupt brain architecture, but are buffered by supportive relationships that facilitate adaptive coping. Generally occurs within a time-limited period, which gives the brain an opportunity to recover from potentially damaging effects. Slide by: Jack P. Shonkoff, M.D.

30 Toxic Stress Strong and prolonged activation of the body’s stress management systems in the absence of the buffering protection of adult support. Disrupts brain architecture and leads to stress management systems that respond at relatively lower thresholds, thereby increasing the risk of stress-related physical and mental illness. Slide by: Jack P. Shonkoff, M.D.

31 Unsafe environment activates HPA axis (autonomic nervous system, ANS).
MICHAEL MEANEY “In response to stress, CRF … and vasopressin are released … anterior pituitary … synthesis release ACTH …glucocorticoids  ” Unsafe environment activates HPA axis (autonomic nervous system, ANS). Early stress alters gene expression, with health impact across lifespan.

32 BRUCE McEWEN allostasis

33 Vocabulary Homeostasis the coordinated operation of
physiological processes that maintain the steady state required to sustain life Allostasis the mechanism by which homeostatic systems are maintained in balance as life cycle and environment changes Allostatic state elevated activity of mediators, with return to baseline and no impact on health.

34 REGULATION (similar to earlier … ) the objective is to achieve the
ability to establish: ‘STABILITY THROUGH CHANGE’ The foundation for INFANT MENTAL HEALTH

35 Allostatic load elevated activity –
Vocabulary Allostatic load elevated activity – sustained over time, or severe, or mediators dysregulated  changes target cells of mediators, and so changes the “set points” for homeostasis (e.g. increasing blood pressure, change in cholesterol level) Allostatic overload the point at which chronic load results in actual disease or abnormal conditions.

36 “wear and tear that results from
KNOCK TOXIC STRESS Sensitivity HIGH ALLOSTATIC LOAD: “wear and tear that results from chronic overactivity (or underactivity) of allostatic systems.” (McEwen 1998, 1999)

37 TEICHER’S Developing Brain (1) Early Stress (2) EARLY STRESS
Neurogenesis Neural morphology Synaptogenesis Myelination Early Stress (2) Neuronal death, smaller brain Fewer dendritic spines Poorer connections Fewer glial cells, less myelin TEICHER’S EARLY STRESS CASCADE MODEL Sensitivity (3) Genetic Gender Timing Developmental rate GCR density Enduring (4) consequences Attenuated L brain devlopment Poor R / L integration Irritability limbic system Poorer function vermis Stimulation Resilience MENTAL HEALTH Neuropsychiatric vulnerabilities (5) Dissociative identity disorder Depression Personality disorder Substance abuse Post Traumatic Stress Disorder

38 Schore: “Infant trauma will interfere with critical period limbic organisation ... future capacity to adapt ... correlated with maladaptive adult mental health”

39 Schore: “long term alterations brain function “risk for developing severe psycho- pathologies at later stages of life.”

40 ALLOSTASIS STRESS RESPONSE ALLOSTATIC STATE ALLOSTATIC LOAD
PERCEPTIONS “NEUROCEPTION” Psychological Neurological Endocrine Immune STRESS RESPONSE  RESILIENCE / SENSITIVITY  ALLOSTATIC STATE ALLOSTATIC LOAD ALLOSTATIC OVERLOAD HEALTH DISEASE WELL-BEING  SUSCEPTIBILITY  MORBIDITY  MORTALITY

41 SPECTRUM of expression in POPULATION
ALLOSTATIC LOAD: “wear and tear that results …. HEALTH DISEASE SPECTRUM of expression in POPULATION

42 “Scientific foundation” … a synthesis
EVOLUTIONARY BIOLOGY NEUROSCIENCE EPIGENETICS Everything else The Brain The DNA The Place ENVIRONMENT FITNESS EXPERIENCE ADAPTATION EXPECTED UNEXPECTED HEALTH DISEASE SPECTRUM of expression in POPULATION Platform for better understanding of PUBLIC HEALTH. … policy and practice that impacts the care of mothers and babies.

43 “EEA” Environment of Evolutionary Adaptedness

44 “Environment” is the usual place and context for which the genes have adjusted

45 … because she is the RIGHT PLACE !!
MOTHER is the key to neurodevelopment … … because she is the RIGHT PLACE !!

46 Anthropological and sociological aspects of skin-to-skin contact.
Anthropology Evolutionary Biology DNA & Epigenetics Neuroscience of stress Mal-Adaptation Sociological consequence Intro

47 Anthropological and sociological aspects of skin-to-skin contact.
SCIENTIFIC AND EVIDENCE BASIS FOR INCUBATOR ?? Intro

48 Stephane TARNIER 1828 -97 French obstetrician Saw a warmed box for
hatching chickens, had one designed for “weaklings” … … invented incubator

49 Pierre BUDIN 1846 - 1907 Friend of Tarniers …took
Incubators, made centres for the care of weaklings, wrote book on subject. Political support … France versus Germany BUDIN was very particular to include mother, reason for the glass window ….

50 Martin COUNEY 1860 - 1950 Born in Germany claims he learned
the techniques for Budin .... Berlin Exhibition 1896, success ! Photograph: Pan-American Exhibition in Buffalo, New York, 1901.

51 Martin COUNEY 1860 - 1950 Berlin 1896, success to USA: Buffalo 
Omaha , Chicago Fair nd highest receipts, Last show New York 1940. Baby Incubator, 1904 St.Louis Fair

52 Martin COUNEY 1860 - 1950 ... famous for “preemie road show”.
MONEY MAKING SHOW PERMANENT pavilion in Dreamland New York Worlds Fair, 1939

53 Martin COUNEY 1860 - 1950 Born in Germany claims he learned
the techniques for Budin .... Berlin Exhibition 1896, success ! London World fair 1898, fiasco! ALL THE BABIES DIED .... “MOTHERS TO BLAME”

54 Martin COUNEY 1860 - 1950 Couney succesfully raised 5000 prems! BUT –
used wet-nurses, excluded mothers (mother got free pass to the shows !) Mothers were excluded – “germs” …

55 Sarah Morris Hospital, Chicago 1923, others followed – accepting the “policy of strict separation”.

56 WHY do we separate mothers from babies ??
INCUBATOR & SEPARATION = ACCIDENT of HISTORY

57 PERINATAL NEUROSCIENCE & SKIN-TO-SKIN CONTACT
THE INCUBATOR HAS NO SCIENTIFIC FOUNDATION !!

58 … because she is the RIGHT PLACE !!
MOTHER is the key to neurodevelopment … … because she is the RIGHT PLACE !!

59 MOTHER is the key to Environment of Evolutionary Adaptedness
neurodevelopment … Environment of Evolutionary Adaptedness

60 KEY TO MONITORING WELL BEING  AUTONOMIC NERVOUS SYSTEM MONITOR !  if HARM can be monitored, HARMING CARE MUST CHANGE

61 Separation from mother
is stressful for humans. Salivary cortisol is a good measure of stress.

62 Separation DOUBLES CORTISOL
RCT (Anderson et al 1998) Two groups of newborns, both given best care, only one separated from mother at one hour age Cortisol levels measured every hour. Cortisol separate = 9 Cortisol with mom = 4 SEPARATION = STRESS

63 Skin-to-skin 66% lower 74% lower
Preterm infants experience prolonged severe stress, with tenfold increases in stress hormones. Stress hormones at such levels are neurotoxic. (Modi & Glover 1998, Mooncey et al 1997) RCT on methods to reduce of stress (at one hour): Cortisol Endorphin Massage slightly lower no change Soft music no change no change Skin-to-skin 66% lower 74% lower

64 evolutionary survival machine
EEG ANS autonomic downstream HRV

65

66 PLACE convention Breastfeeding Holding MIS (Cot) 1 SSC (Skin-to-skin)

67 ANDERSON BEHAVIOURAL STATE SCALE
12 11 Crying 10 Fussing 9 Active 8 Breastfeeding 7 Alert Awake 6 Quiet Awake 5 Drowsy 4 3 Active Sleep 2 Irregular Sleep 1 Regular / Quiet Sleep

68 social vagus (validated) sympathetic (accepted)
HRV produces IBI (Inter Beat Interval) FFT / AR / wavelet social vagus (validated) sympathetic (accepted) “old vagus” (our hypothesis) D V C S N S V V C

69 GREEN = OLD RED = SNS BLUE = NEW AUTONOMIC STATE COMPONENTS:
VEGETATIVE VAGUS RED = SNS SYMPATHETIC BLUE = NEW SOCIAL VAGUS

70 7 x more QS is SSC 3 x more ANS in MIS
SEPARATE 176% Increase Autonomic activity 7 x more QS is SSC 3 x more ANS in MIS Skin-to-skin contact = *NORMAL* PLACE SEPARATE 86% Decrease Quiet Sleep

71 Normal sleep cycling Higher state arousal
BREAST- VAGAL MOTHER FEEDING (PSNS) GROWTH OTHER PROTEST- STRESS SURVIVAL or DESPAIR (SNS) SKIN-TO-SKIN CONTACT SEPARATION Normal sleep cycling Higher state arousal Separated neonates experience disturbances of sleep cycling.

72 Maternal separation may be
NEURO PHYSIOLOGY of SEPARATION Maternal separation may be a stressor the human neonate is not well-evolved to cope with, and may not be benign.

73 ? MOTHER IS OUR “NORMAL” “BETTER” CARE CULTURE OUR “NORMAL” THIS IS
ideal benign malevolent unsuitable HEALTH DISEASE ? MOTHER IS OUR “NORMAL” “BETTER” CARE CULTURE OUR “NORMAL” THIS IS BIOLOGY “WORSE”

74 Skin-to-skin contact – our developmental environment.
“Maternal separation may be a stressor the human neonate is not well-evolved to cope with, and may not be benign.” Intro

75 Skin-to-skin contact – our developmental environment.
It matters how we are born! It influences our emotional and social development, our future EQ. Intro

76 Skin-to-skin contact – our developmental environment.
Separation is perceived as stress, which increases cortisol, disrupts development of new neural pathways Intro

77 Skin-to-skin contact – our developmental environment.
Contrary to old beliefs: the human newborn is profoundly sentient and perceptive, at birth and thereafter. Intro


Download ppt "Anthropological and sociological aspects of skin-to-skin contact."

Similar presentations


Ads by Google