"Value Disorganization!": Good Advice for New Parents!

It is a bitterly cold January day in Boston. I'm musing over the question of why Bostonians face this weather hatless, as I jump on a local bus heading to The Children's Hospital and Touchpoints training. I am here to study with the renowned pediatrician, Dr. T. Berry Brazelton, and his able staff for a full five days. My excitement over this opportunity creates nearly enough heat to thaw my feet!

Dr. Brazelton is the creator of the NBAS (Newborn Behavioral Assessment Scale), a marvelous tool used around the world to look closely at babies in order to understand an individual infant's amazing capabilities and important challenges. (Brazelton, T. B. [1995]. Neonatal behavioral assessment scale. Suffolk, United Kingdom: The Lavenham Press Ltd.) His book, Touchpoints, gives parents important insight and practical tips for successful parenting.(http://www.touchpoints.org/)

Over the years I have sat in huge audiences captivated by the way Dr. Brazelton shares just how much a baby can communicate! The audience cackles as he screws up his face to imitate an infant trying to wake himself up, a baby attempting to put herself to sleep, or a newborn tuning out the energy of an exuberant parent. Dr. Brazelton has the gift of helping new parents (and those who care for them) appreciate the potential of each interaction with a baby.

This week in Boston I am presented with a new parenting slogan, "Value Disorganization." During these five days we discuss the challenges of early parenthood. Instead of hoping parents will not feel overwhelmed by this experience, Dr. Brazelton suggests that this sense of disorganization may actually fuel the passion and offer the energy needed for early parenthood. "Value the chaos, give parents the support they need, and teach them how to 'read' their baby" are phrases repeatedly echoed during this week in training. These concepts are gifts to me that cold week in January.

As a nurse practitioner I find great joy in sharing with new parents the temporary disorganization of early parenthood. Once new moms and dads settle into the idea that feelings of confusion and fatigue are normal, and perhaps even helpful, life may suddenly seem more manageable.

I recently spoke with Dr. Brazelton about The HUG, the DVD I developed to help parents understand the behavior of their newborns (see www.hugyourbaby.com). I was delighted to conclude the DVD with this credit:

"Jan Tedder gratefully acknowledges the research, teaching, and clinical approach of Dr. T. Berry Brazelton. His NBAS and Touchpoints training are the single greatest influence on her work and the development of The HUG.

Dr. Brazelton: “The HUG captures important elements of the NBAS and offers parents another way to understand their baby.”

"Value disorganization" - the phrase encourages new parents, and me (their nurse), to take hold of the insights we gain during challenging moments as well as during peaceful times. Surely life has much to teach us from both!

"ME do it!" the Two-Year-Old Shouts!

Two-year-old Sabrina is exploring the exam room with gusto. Doors are opening and closing, magazines stacked and unstacked. The exam room's rolling stool spins around as Sabrina explores the boundaries of time, space, and relationships. Just as she is about to dump the basket of toys, she glances up to make sure her mom hasn't missed a thing. Mom's scowl is just the fuel the child needs to launch a full-scale delivery of all items to the floor. When Mom ask Sabrina to help pick up the toys, the child throws herself to the floor with shrieks of "No, me do it!"

"I don't get it," Mom sighs heavily. "Sabrina wants to be in charge of everything these days. On the other hand, she ask me to carry her down the stairs like a baby and to hold her cup of milk as she drinks. Does she want to be a baby or not?"

Sabrina's behavior says it all. She is moving from the dependent days of the first two years of life toward the independence of the toddler years. Many professionals believe the conflict a child feels as she balances the security of those early months with this internal drive for independence creates the tension some call the "terrible twos." How marvelous (and necessary) is this stretching of personality! While she wants to demonstrate the newfound power of "me," Sabrina also feels insecure about independence, and that insecurity causes her to regress to younger behavior. If Mom pushes her to "be a big girl" all at once, Sabrina will probably feel less secure and her tantrums may increase.

Mom delights in making a connection between these two sets of behavior. I suggest that Mom play "baby time" with Sabrina. In a playful way Mom puts the child on her lap and cuddles and kisses her while giggling, "You are my little baby girl." For a week or so Sabrina revels in this attention. Then, she suddenly seems bored with the game. Sabrina jumps down from Mom's lap, and is off to conquer the world again. She walks herself down the stairs and shouts "ME do it!" when Mom hands Sabrina her cup of juice. Mom feels a tug in her heart as she realizes that her daughter is not a "little baby girl" anymore!

The Baby Looks "Out of It"

The young woman felt on the verge of tears. She had just watched the new video from the Guatemalan orphanage where her soon-to-be-adopted eight-month-old was now living. Though the government papers were promised to be complete in "just" three more months, Tonya worried that by then it would be "too late" for her to bond with her baby.

On Tonya's trip to Guatemala, she had met Sofia, a beautiful, robust six-month-old. The baby had watched attentively as Tonya reached out to take her from the caretaker's arms. Sofia had playfully pulled Tonya's hair and had giggled when the new mother had shaken the purple and green rattle she'd brought from Kansas. Sofia seemed ready to take on a new mom, and Tonya was sure ready for her baby.

But the new video had troubled Tonya. Sofia had looked slightly frightened as the camera lens captured the caregiver lifting her from the crib. The bulky camera equipment and the hustle and bustle of several camera people seemed to cause Sofia to look "out of it," Tonya had told her friend and mentor at the local school of nursing.

The nursing professor was reassuring as she explained how newborns and even older children can protect themselves from overstimulation with a temporary "shutting down" maneuver. The professor had just taught a class about the normal coping strategies children have and how these actions can signal a baby's competencies rather than deficiencies. She sent the new mom a DVD which depicted these very behaviors in hopes that Tonya would be reassured. (See: www.hugyourbaby.com)

Tonya called several days later to report that she had looked at the DVD and then at the Guatemalan video again. She had noticed that as the filming progressed Sofia snuggled close to her caregiver and smiled up affectionately at her. Of course, Tonya knew that there would still be questions to ask about the bonding process of an adopting family, but today she felt more confident. Sofia would use her body language to show her new mom how to make those new and important connections, and Tonya was ready to learn!

Birthing a Breastfeeding Mother

Alyse looked embarrassed. "I just needed someone to talk to about this," Alyse whispered tentatively to me in the exam room one day. In my line of work I've learned to expect anything! Imagine my surprise when she asked, "My friends and family think I'm nuts 'cause I want to have natural childbirth and breastfeed my baby. Do you think that's a really silly idea?"

I confess to being shocked that our childbirthing culture had come this far backwards--that a pregnant woman might feel ashamed of her desire for a natural childbirth. With only a little encouragement from me Alyse was well on her way to discovering just how much the process of birth and early newborn care contribute to breastfeeding success (or failure).

During early pregnancy Alyse had already noticed that her breasts were getting larger and the areolae were darkening. "Makes an easy target for your baby's mouth," I explained. By the fourth month her breasts occasionally leaked a little of that amazingly rich, potent, and concentrated colostrum getting ready to nourish a baby, even if born early.

Alyse's determination to have the birth she wanted for her baby and herself really paid off.

When labor began, surging levels of oxytocin created strong and effective contractions. This high level of oxytocin caused a release of Alyse's endorphins, a natural pain killer, which helped her cope with childbirth. As her baby passed through the birth canal, catecholamines were released, giving Alyse just the boost of energy she needed right then! (Catecholamines later caused her baby to alert at birth, while a hit of mom's endorphines relaxed the newborn, making the baby both eager and ready to meet her mom!)

When the baby was delivered and placed on Alyse's chest, her baby instinctively crawled toward mom's darkened nipple. In this skin-to-skin position, the baby pulled her head back, opened her mouth wide, and began to nurse. Her suckling caused the release of prolactin, sometimes called the "love hormone," which helped Alyse melt at the sight and feel of her precious newborn. This hormone told Alyse's breasts to start making milk. Surging oxytocin told Alyse's breast ducts to eject the milk into her baby's mouth. The same hormone also told Alyse's placenta to separate from her womb and her womb to contract in order to prevent further bleeding.

Birth interventions have become so "routine" in "developed" countries that medical providers and patients can forget (if they ever knew) that pitocin does not elevate endorphins like oxytocin does, that epidurals reduce oxytocin levels, and that without high levels of these two hormones the energizing catecholamines do not increase. Taking babies immediately off the mother's chest (for bathing and testing) reduce levels of these milk-making hormones. And C-sections can wreak havoc on all these natural hormone interactions. Modern medical interventions are important to sometimes save lives, but used routinely they threaten breastfeeding success and may produce a less responsive mother and baby.

An article by Judith Lothian puts it well: "In a very real sense, the birth of a baby is also the birth of a mother - the birth of a breastfeeding baby and mother."**

Alyse couldn't have agreed more as she stroked the fuzzy head of her newborn, delighted that she chose to give herself, and her baby, the gift of a natural birth!

**[Lothian, J.(2005). The birth of a Breastfeeding Baby and Mother. Jo of Perinatal Education 14(1) p 43.]

"Am I Awake or Asleep?" My Baby Wondered.

He was a big baby. Jerry was born by emergency c-section two weeks early when his mom started to bleed during early labor. Although he was a full 9 lbs 3 ounces at birth, his entrance into the world a few weeks early presented him with a few extra challenges.

Jerry seemed to "never know what he is doing," his mom explained. He would fuss and appear ready to eat. He'd get to the breast, take a few sucks, then fall back asleep. Mom's breasts were full, so she would pump while Jerry slept. Jerry would wake up in forty-five minutes, cry inconsolably, and Mom would have to give the pumped milk since her breasts had not filled up again. In one hour the process started again. Mom's milk supply was down, the baby seemed hungry, and Mom's nipples were sore. It was time to stop this downward cycle before Mom gave up on breastfeeding.

Mom's story suggested a baby who had not yet developed clear "Resting" and "Ready" Zones (see http://www.hugyourbaby.com/skills.html). It is common for a baby born early to need his mom's help to figure out whether he is really awake or asleep. In addition to needing this help, Jerry was also a baby with VERY active, "Active Sleep," which was being misunderstood by his mom as waking up to eat.

I had hoped to see this behavior in action, and I wasn't disappointed. As Mom and I spoke, Jerry started to stir on the exam table. He cried suddenly and began to jerk his arms about but never opened his eyes. Since he had just eaten one hour before, I swaddled him and spoke quietly to him instead of putting him immediately to Mom's breast. He squirmed and fussed for a full five minutes. Then Jerry relaxed and fell back into a deep, peaceful sleep for another hour and a half. Now he stirred again and repeated his performance. However, this time Mom swaddled him and spoke quietly to him; he calmed down, opened his eyes, and started to root around. He was now in the "Ready Zone," ready to eat. Mom put him to her breast, where he nursed a full twenty minutes and became calm and content as he gazed up at his mother.

It's normal for new parents to feel confused as they attempt to read an infant's early body language. Howver, learning to help a baby in "Active Sleep" calm back down and sleep a bit longer can be crucial for breastfeeding success. As Jerry's mom practiced what we had discovered together, her supply of breast milk increased, her baby thrived, and she settled into a new comfort zone herself. Mom's timely action to help her child organize his sleep and wake cycles will really pay off in the months ahead.

" My Baby Doesn't Like my Milk!"

"Diane doesn't like my milk!" the young mother declared. "It must not be strong enough for her. I guess it's time for formula."

Her words were a surprise to me. Three-week-old Diane had regained her birth weight in just ten days and was growing at a great, 1/2-ounce-a-day clip. I could see her cheeks beginning to fill out, and she was "filling" her diapers with gusto. Why did this mother think that her breastfeeding was going poorly?

"She just doesn't seem satisfied," Diane's mother said. "Diane doesn't act like she's happy."

As a lactation specialist, I am trained to note weight gain, to identify the sound of milk being swallowed, and to document the number of wet and stooled diapers. Hearing this mother, my suspicion was that Diane's mom was responding to non-feeding infant behavior and projecting those concerns onto her breastfeeding experience.

In addition to noticing the physical signs of breastfeeding success listed above, I also am aware that research shows that a mother will see her baby as "satisfied" when she observes particular newborn behaviors. She wants to see her baby become alert and gaze deeply into her eyes. She wants to calm her baby effectively and doesn't want her baby to appear irritable or difficult to console. Mom wants to enjoy cuddling with her baby and to know that her baby likes to cuddle right back.

Understanding this, I picked up the baby to play some newborn "games." First I swaddled Diane to bring out the best in her ability to play. Next, I swayed Diane gently until her eyes became bright and alert. Then I shook a rattle and watched as Diane followed the toy intently with her eyes. She watched closely as I moved the rattle without a sound. Diane's mom giggled and glowed with the words, "She's really smart, I guess!" With my encouragement the young mother called her baby's name. Diane turned slowly in her mom's direction. With a big grin the mother lifted the baby from my hands and snuggled her face into the crease of the baby's soft neck. One of mom's hands went to her breast to suppress the unexpected let down of milk.

Now Diane's mom is a breastfeeding star and an advocate for other new moms. She comes to our breastfeeding class to discuss the challenges and joys of breastfeeding. "Babies are little people who have special ways of communicating," she says. "Don't just count their pees. Learn to speak their language, and you'll soon know how much they love your milk!"