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NEWBORN BONDING
- • Bond:
- – Unique relationship between two people that
- endures time
- • Bonding:
- – tie between parent & infant
- • Attachment:
- – tie between infant to parent
- – feelings that bind one person to another in
- either direction
-
Newborn-parental attachment & bonding
- Study by Spitz shows that
- absence of loving care-taking/affection
- →
- ↓↓ infant growth
- ↑ infant death
-
NEWBORN BONDING
- Early 1970s: Family-centered care in
- early 1970s in delivery room and in
- NICU (Neonatal Intensive Care Unit)
- 1980s: rooming in of infant with mom
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BENEFITS OF VAGINAL DELIVERY FOR INFANT
- Vaginal delivery stimulates infant to
- prepare her/him to adjust to aerobic
- environment
- Squeezes fluid out of infants lungs
-
Benefits of vaginal Birth for Infants
-
Fetus produces high levels of norepinephrine
- & epinephrine
- → stimulates the cardiovascular system
- → facilitates immediate adjustment to the
- aerobic environment
- Fetus produces high levels of beta-endorphins
- → facilitates attachment of infant parents
-
Cesarian-section Results in:
- More fluid in babies’ lungs
- Lower levels of norepinephrine,
- epinephrine, and beta-endorphins in
- baby’s blood
-
Physiology of mom & infant at birth & post-partum
- Beta-endorphins
- Both mom & infant have peak levels of betaendorphins
- Beta-endorphins facilitate bonding and
- attachment between infant & parents
-
PHYSIOLOGY OF MOM AND INFANT AT BIRTH AND POST-PARTUM
- Epidural anesthesia
- → ↓ endogenous beta-endorphin levels in mother
- → ↓ ability of mother to bond to infant
- → ↓ endogenous beta-endorphin levels in mother
- → ↑ incidence of post-partum depression
- Epidural anesthesia
- → ↑ incidence of depression in mothers at six months
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Physiology of mom & infant at birth
- Oxytocin facilitates bonding and attachment
- between infant & parents
- Mothers’ levels of oxytocin are 10 mcg/dl
- minutes after birth
-
Physiology of mom and infant at birth
- Oxytocin:
- when infant touches & massages mom’s nipple with
- her/his hand → ↑ mothers oxytocin
- When infant suckles nipple:
- → ↑↑ mothers oxytocin level
- → facilitates bonding/attachment between infant and
- mother
- also → ↑ milk ejection from nipple
- also → ↓ post-partum bleeding in the mother
-
Oxytocin labor during labor
- If mother’s nipple is massaged
- → ↑ endogenous production of oxytocin
- → ↑ progression of labor
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First Hour after Birth
Quiet Alert State:
- Forty minutes out of first hour of life, babies are in a
- quiet alert state
- During this time, babies rarely move and their eyes are
- wide open and (if given the opportunity) they look
- directly at the mother or father and their tiny hands
- may touch the parents skin.
- In this state, motor activity is minimal and baby’s
- energy is focused on seeing, hearing, responding, and
- deepening its level of bonding and attachment to its
- parents.
- During first week of life about 10 % of each 24 hour day,
- the baby is in receptive quiet alert state.
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Location of baby immediately after delivery
- Standard hospital practices have been to separate
- baby from mother very soon after delivery to
- examine, weigh, bath, give Vitamin K injection,
- apply eye ointment, and draw blood glucose from
- the baby. The baby and the mom would often not
- be reunited until hours after the delivery.
- Unfortunately, this prevents the baby from being
- with the mother during this important period
- shortly after birth.
-
Location of baby immediately after delivery
- Immediately after delivery baby should be dried off with
- a soft warm towel and immediately placed on the
- mothers abdomen & chest for skin to skin contact.
- When the baby is dried it is best to not use soap and
- water, as studies have shown that the smell of amniotic
- fluid sooths the newborn.
- The mothers soft warm skin and her caressing hands are
- soothing & comforting for baby.
- The mothers body provides heat for the baby as well and
- warms up the baby faster than an incubator.
-
Location of baby immediately after delivery
- If given the opportunity, the baby will
- typically spontaneously touch, smell, lick,
- and latch onto breast by her/his own
- efforts & start breast feeding in early
- minutes of life
- Early breastfeeding behavior can be
- disturbed by labor analgesia and/ c-section
-
Location of baby immediately after delivery
- Women who are able to nipple newborn
- in the first hour of life have
- • have easier time breast feeding
- • breast feed more frequently
- • breast feed more months of babies life
-
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Infant room sharing with parents at home in
- early months of life
- → ↓ risk of sudden death infant syndrome
- (SIDS)
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Animal studies on maternal attention versus deprivation
- Neglected animals (absence of mother)
- → neurons died at twice the rate as animals kept with
- mother
- Presence of mother also reduces the levels of stress
- hormones
- Simple act of mother animals licking infants triggers a
- dramatic reduction in the levels of stress hormones
- As mother physically comforts her
- newborn
- → ↑ production of biochemicals that
- → ↓ production of CRH (corticotropinreleasing
- hormone)
-
Animal studies on maternal
attention versus deprivation
- As mother physically comforts her newborn
- → ↑ production of biochemicals that
- → ↓ production of CRH (corticotropinreleasing hormone)
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Male fetuses are more vulnerable to
stress than females
- • Generally, more maternal stress leads
- to a lower ratio of male to female births
- • When pregnant mother is stressed, she
- is more likely to have a spontaneous
- abortion or a miscarriage if the fetus is
- male versus female
-
Male infants are more vulnerable to stress than females
- • International studies on malnutrition and
- infant survival have shown that male
- infants have a lower survival rate than
- female infants
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Human breast milk
- • Fresh & readily available at optimal
- temperature
- • Has not been pasteurized and thus the
- peptides and immunoglobulins have not been
- broken down
- • No time needed for preparation
- • Free of contaminating bacteria that cause
- diarrhea (especially important in developing
- countries where un-boiled water may be used
- to prepare cows formula)
-
Breast feeding & ovulation
- • Nippling stimulates prolactin which suppresses
- ovulation
- • Lactating mothers who breast feed their infants
- at least 10 times a day have are likely to
- suppress ovulation
- • Lactating mothers who breast feed their infants
- less than 6 times a day are unlikely to suppress
- ovulation
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Human breast milk components
- • Protein
- • carbohydrates
- • fats
- • vitamins
- • minerals
- • hormones
- • growth factors
- • neuropeptides
- • immunoglubulins/antibodies
-
Nutrition Hormones:
- substances formed in one organ or part of the
- body and carried in the blood to another
- organ or part of the body
- Growth factors:
- substances that increase endothelial cell,
- collagen, and smooth muscle development
- Neuropeptides:
- peptides found in brain tissue e.g., endorphins,
- enkephalins
-
Human breast milk components Hormones:
- Placenta provides a rich source of hormones &
- growth factors that regulates the growth &
- differentiation of the embryo & fetus
- The breast is the post-birth counterpart of the
- placenta that picks up where the placenta
- leaves off and provides continuity in the supply
- of the human growth factors and hormones that
- are essential for optimal growth & development
- Beneficial hormones from the mothers blood are
- concentrated in breast milk
- Human breast tissue also produces
- neuropeptides & hormones
-
Human breast milk components
- Colostrum:yellowish fluid that breast secretes for 2 – 4 days after delivery that is rich in
- – hormones/growth factors
- – protein
- –minerals (e.g., calcium)
- – immunoglobulins
- by day 2 – 4, a transitional form of breast milk is produced that gradually develops into “mature” breast milk by week 3 - 4
-
Human breast milk components
- Melatonin: helps body establish circadian rhythms
- Thyroid hormones: may help alleviate congenital hypothyroidism
- Oxytocin: helps facilitate loving bond between mother & infant
- Endorphins: neuropeptides that help facilitate loving bond between mother & infant
-
Human breast milk components
- Mamotrope differentiating hormone
- – appears to foster maturation of cells of pituitary gland which supplies hormones to the body
- Insulin-like growth factors; Growth factors/neuropeptides
- – both enhance development of brain, liver, intestines, pancreas & other organs
- Surface area of intestine is increased in both
- – breast feeding infants &
- – lactating mothers
-
Human breast milk components
- Leptin
- • Hormone thought to control obesity in humans
- • Present in human breast milk
- • May help set the stage for weight regulation in childhood and later in life
- • Cow’s formula fed babies have higher rates of obesity as children & adults
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Human breast milk components
- Gonadotropin Releasing Hormone (GnRH)
- – exists in human milk far above the levels in mothers’ blood
- – nursing mothers’ breast tissue generates this hormone
- – GnRH influences the development of newborns’ sex organs
- – GnRH may influence brain regions that effect sexual behavior
- Fatty acids in breast milk
- Omega 3 fatty acids
- –DHA (docosahexaenic acid)
- –AA (arachidonic acid)
- Rich source in breast milk
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Omega 3 fatty acids
- Adults store omega 3 fatty acids and nursing mothers transfer these from stores into breast milk
- Good dietary sources are walnuts, nuts, grains, flax seed oil, hemp oil, vegetables, salmon, mackerel, sardines, tuna, trout
- Unfortunately, omega 3 fatty acids are low in the typical USA diet
- Omega 3 fatty acids levels in breast milk in women in the USA are among the lowest in the world
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Omega 3 fatty acids & infant brain development
- Brain development occurs rapidly in early months
- Full term infants who are fed on cow’s formula do not have enough omega 3 fatty acids to foster optimal brain & visual development
- Omega 3 fatty acids enhance neurological and visual development in infants (especially premature infants)
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Cow’ milk vs. human breast milk
- Compared to breast fed babies, babies fed with Cow’s milk formula are at increased risk for:
- • Allergies
- • Atopic dermatitis/Eczema
- • Increased risk for intestinal disturbances & feeding difficulties
- – diarrhea
- – intestinal bleeding
- – colic
- – spitting up milk
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Breast milk benefits
- Breast milk consumption in infants reduces the risk of following diseases:
- – sudden infant death syndrome
- – allergic diseases e.g., eczema (atopic dermatitis)
- – insulin-dependent diabetes mellitus
- – inflammatory bowel disease (Crohn’s disease & ulcerative colitis)
- – chronic digestive diseases
- – lymphoma
- Increased proportion of breast fed infants:
- Breast feeding
- → ↓ ↓ infant illness at the community level
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• Breast milk consumption in infants reduces the risk of following diseases:
- – diarrhea
- – lower respiratory infection e.g., pneumonia
- – otitis media
- – bacteremia (bacterial infection of blood)
- – bacterial meningitis
- – botulism
- – urinary tract infection
- – necrotizing enterocolitis
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• Substances in human breast milk inhibit growth of viruses:
- – rotavirus
- – polio
- – influenza
- –mumps
- – influenza
- – vaccinia
- – Japanese B encephalitis
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Benefits of breast milk
- • Glycoprotein lactoadherin in human breast milk:
- →binds to rotavirus and inhibits its replication
- →↓ rotavirus infection in humans (rotavirus is the most common cause of diarrhea in infants)
- • Stool pH lower in breast milk fed babies
- →inhibits bacterial growth
- • Intestinal flora in breast milk fed babies
- →inhibits growth of some strains of Escherichia coli
- • Xanthine oxidase in breast milk
- → nitric oxide production
- → inhibits growth of Escherichia coli & Salmonella enteritides
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Immunological benefits of breast milk:
- • Secretory IgA is predominant immunoglobulin in breast milk
- – prevents bacterial adherence to epithelial cell surfaces
- – specific IgA antibodies against
- Escherichia coli
- – breast fed babies are less prone to bacterial & viral intestinal infections
- • Interleukin-6 present in colostrum
- → stimulates increase in mononuclear macrophage cells in breast milk
- • Macrophages in colostrum & mature breast milk synthesize
- – complement
- – lysozyme
- – lactoferrin (iron binding whey protein)
- (lactoferrin inhibits growth of Escherichia coli in intestine)
- • T lymphocytes & B lymphocytes
- • Breast milk transfers T lymphocyte immunity → protection against tuberculosis
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Main causes of infant mortality in tropical countries
- • Diarrhea & dehydration
- • Lung infections (pneumonia, bronchiolitis)
- • Malaria
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Infant survival rates in USA
- - Largest single contributor to increased
- infants survival rates in USA in the 1st half
- of the 20th century was the implementation
- of enhanced hygiene with microbiologically
- clean water made available throughout the
- population
- • Enhanced maternal-child nutrition also
- contributed
- • Development of penicillin, other antibacterials,
- and immunizations also
- contributed, but to a much less degree than
- simple clean water
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Emerging problems with maternal child health in USA
- • Obesity in mothers increased risk of
- pregnancy
- • Obesity in children has increased
- dramatically over the past 20 years
- • Associated with obesity are higher rates
- of Type 2 diabetes mellitus,
- hypertension, and cardiovascular
- disease
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Global infant/child health
- • Good maternal nutrition
- • Maintain normal maternal weight before,
- during, and after delivery (underweight moms
- and overweight moms increase risks for fetus
- and infant)
- • Breast feed at least 2 years
- • Loving caretakers
- • Access to clean water
- • Access to clean air
- • Diet rich in vegetables and fruits
- • Diet rich in beta-carotene rich food
- • Family access to land to grow kitchen garden
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