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Staying Connected After Birth: A Peaceful Beginning

Brian O'Neil

by Marcy Axness, Ph.D
Dr. Marcy Axness is an early development specialist, popular international speaker, and author of Parenting for Peace: Raising the Next Generation of Peacemakers. She is a top blogger at Mothering.com and is featured in several documentary films as an expert in adoption, prenatal development and Waldorf education. Dr. Axness has a private practice coaching parents-in-progress, and considers as one of her most important credentials that she raised two peacemakers to share with the world — Ian and Eve, both in their twenties.
marcyaxness.com

My life explorations as an adopted person and my studies of the foundations of human wellbeing have consistently turned up a key element of health: the experience of and capacity for connection. Birth presents us a momentous opportunity to foster connection. It is also important to understand the costs of not staying connected after birth — whether it is due to adoption, NICU confinement, health issues in the mother, or other circumstances preventing mother-newborn connectedness. This is not about guilt or blame, but the empowerment that comes with understanding what happens with neonatal separation.       

During and immediately after birth, a complex hormonal cocktail orchestrates biochemical exchanges between a mother and her newborn, offering never-to-be-repeated opportunities to set the stage for optimally healthy psychosocial development. Levels of oxytocin — our hormone of love, connection, peace and healing — peak during this time. This paves the way for important brain circuitry to wire up in the baby’s social and emotional centers. It also nurtures the mother’s urge toward maternal behavior.

Oxytocin is a primary peacemaker hormone in the body: it elicits a relaxation and growth response, which in turn reduces activity in the stress (fight, flight or freeze) system. We’re all familiar with the idea that love conquers fear, and thanks primarily to oxytocin, it’s not just a worthy ideal, it’s a basic feature of our physiological design! Along with its ability to moderate a person’s tendency to switch into stress-response mode, oxytocin is involved in such basic peacemaker capacities as empathy, adaptation, tolerance, cognition, and interdependence. Impairment of the oxytocin system has been implicated in autism, as well as schizophrenia, drug addiction and even cardiovascular disease.[i]

Understanding the Trauma of Separation

Throughout generations of routine obstetrical, hospital, and adoption practice in this country, the attitude has been, “Why would the separation from its mother affect a newborn baby?” But with the advent in the last thirty years of prenatal and perinatal research, we have astounding findings about what a fetus experiences in the womb. We now know what a strong connection a baby has with its mother long before birth, and how intelligent, aware and remembering a newborn is.  Researchers currently feel the more appropriate question to be, “Why wouldn’t separation from the mother to whom he or she was connected for nine months affect an infant in fundamental ways?”

As Nancy Verrier wrote in her landmark 1993 book, The Primal WoundUnderstanding the Adopted Child,

“Many doctors and psychologists now understand that bonding doesn’t begin at birth, but is a continuum of physiological, psychological, and spiritual events which begin in utero and continue throughout the postnatal bonding period.  When this natural evolution is interrupted by a postnatal separation from the biological mother, the resultant experience of abandonment and loss is indelibly imprinted upon the unconscious minds of these children, causing that which I call the ‘primal wound.’”

Verrier’s book is well-known in the adoption world, but her insights are critically important for any circumstance in which there is prolonged or chronic neonatal separation. So as I go on to describe the implications of not staying connected after birth in terms of adoption, they can apply to other separation circumstances as well, including NICU stays. Over my years of counseling and coaching, I have seen so-called “classic adoption issues” (e.g., trust, intimacy, persecution complex) show up in those who were separated by NICU confinement. This can be a difficult line of exploration, because none of this is ever done maliciously or with anything but the best intentions. How painful it can be to discover that even our best intentions don’t trump biology! The good news is, there is always healing possible — but only once we recognize the truth of what our child experienced.

Rather than deeply question whether the experience of separation in adoption is traumatic, we as a society tend to believe that enough love and care can make everything right.  But psychologists have taught us that the first stage of psychological growth includes the development of trust, as a foundation for secure relationships with others, and ourselves.  Babies who are separated from the only connection they’ve ever known — their primordial biological and psychological matrix — have had their nascent sense of trust deeply violated.

Adoptees may unconsciously feel that it’s too dangerous to love and be loved authentically and deeply; all of the love and care parents give them sometimes has a hard time “getting in” past the child’s defenses against the hurt and abandonment that they are internally “hardwired” to expect.  As Verrier says of her own relationship to her adopted daughter, “I discovered that it was easier for us to give her love than it was for her to accept it.”

Again, varying degrees of deep distress can occur for newborns under circumstances other than adoption, such as NICU stays for premature or ill babies — in which case the trauma of separation may be compounded by painful medical procedures, isolation, and harsh, invasive surroundings.

My Own Problems Staying Connected After Birth

Separation wounds can also happen in the most “normal” of birth and postpartum circumstances. Like so many modern American moms giving birth to healthy, full-term babies in hospitals... and despite my best intentions (and the admonition of my very progressive pediatrician, to “not let them take your baby away from you!”)... I found myself overpowered by the momentum of standard hospital protocols, which involve separating mother and baby for a variety of reasons, for various lengths of time.  Not only did this have its effect on our son’s developing trust, it also interrupted the unfolding of my own maternal instincts and identity, which was a dangerous thing given my risk profile for postpartum depression.

The Trauma & The Healing

The trauma of newborn separation is registered largely on the physical level, leaving the nervous system predisposed to getting stuck in survival mode: fight or flight, or freeze. In babies, these powerful feelings are thus expressed physically, through:

inconsolable crying (or the other extreme, virtually no at all)
extreme startle responses
arching or stiffening at being held
“spacing out” or sleeping all the time
severe colic
other illness (e.g., I contracted pneumonia at 6 months of age)

The primal sense of loss, abandonment and rage that results from the trauma of separation is overwhelming to a newborn, who hasn’t yet developed an ego, much less ego defense mechanisms. Left unacknowledged and unaddressed, these unresolved nervous system patterns permeate the psychological and personality realms. They can manifest in such ways as hyper-controlling behavior (“the little tyrant”) and intense emotional volatility (adoptees often pick up the diagnosis of borderline personality disorder or bipolar, which are indeed marked by such volatility).  Or these patterns can show themselves in the opposite way — a superficially cheerful adaptiveness (“the pleaser”).

Children often split themselves off from the injured parts of their psyche, and develop a functional, acceptable, “false self.” This concept of the false self is often the explanation behind what seems like “wonderful adjustment” on the part of an adoptee, or traumatized child who has responded to the deep fear of further abandonment or trauma by becoming compliant and adaptive to the needs and expectations of the parents or caregivers. But their grief and anger is simply buried in the unconsious, curdling their social and emotional lives.

However, all is not lost. Parents needn’t feel hopeless in the face of these revelations. (Indeed, when faced with an inexplicably unsoothable baby... or, one who kind of “tunes out” and won’t engage... a parent without these insights could understandably feel hopeless and helpless!) When parents are provided this understanding about the impact of these early experiences upon their child, it can be very liberating (after the initial shock and grief passes). It frees them to reach beyond themselves and not take the child’s behavior personally (“He doesn’t like me!”). This can empower a parent to make herself truly available as a loving, healing presence for her baby. How?

Staying Connected After Birth with Healing Words

One of the most powerful healing forces is available to every parent, free of charge: empathy. Empathy allows a person, even a tiny baby, to feel her feelings, rather than repress them, so they can be released. Babies who have lost their original mothers, permanently or even temporarily... and babies who have suffered other painful or traumatic experiences... need to express their feelings of grief and loss.

 They need our help to do this, and this help needs to take the form of active empathy... saying the words, out loud, that let the baby know that what he or she is feeling makes sense and is allowed.

So instead of the very common dismissive mantra chanted to upset babies, “It’s okay, you’re okay, you don’t need to cry...” the thoughtful and knowledgeable adoptive parent can gently croon to her baby in distress:

“You miss your mother. You miss your connection. You’ve lost something very important, and I understand. I’m not the mom you expected, I don’t smell like her, I don’t sound like her. I’m a different mom and I am here for you... always... when you feel sad, and when you feel joyful...”

 

Infant Reflux on the Rise?

Brian O'Neil

by Richard Pass, RN
Director, Save A Little Life, Inc.

Richard Pass, RN, BS, founded “Save a Little Life” in 1999. He has been a Registered Nurse & Health Educator for over 30 years. He is on staff at Cedars-Sinai Medical Center in Los Angeles and is currently a part-time clinical instructor of nursing at California State University, Northridge. The goal for Save a Little Life is to provide a simpler, more “user friendly” CPR course. Savealittlelife.com

When doing my pediatric CPR and family emergency workshop I often hear parents concern over episodes where the infant seems to stop breathing, causing tremendous fear for that family. In some instances a 9-1-1 call is made, particularly when the baby “turns blue” (a cardinal sign of low oxygen). These episodes are frequently associated with feeding which increases the perception that a choking event is underway.

Because of these very real fears many parents visit their pediatrician’s office and want answers. According to a recently published article in the Journal Pediatrics, there has been an alarming increase in the diagnosis of “infant reflux.” Among other things, this has been the cause of a huge increase in treatment, principally with the prescribing of acid suppressing medications (Pepcid, Zantac, etc.) for these infants.

What Is Reflux?

Taber’s medical dictionary defines reflux as “a return or backward flow.” Consequently, the terms (reflux and regurgitation) are often used interchangeably. Various studies reveal that a major percentage of the infant population in the U.S. (40-70%) has some form of reflux event. In many cases these events are noted when a baby “spits up” during feeding. There are, however, numerous occasions when I have heard parents tell me that some form of regurgitation can happen during non feeding times.

The rapidly growing infant usually ingests volumes of food (breast milk/formula, etc.) that on a per kilogram basis are much greater than larger children or adults. Because of this relative high volume and a relatively shorter esophagus (stomach tube) a “spillover effect” can occur. Many pediatricians believe this to be “physiologic reflux” as opposed to “reflux disease.”

Episodes of this spillover can occur infrequently or multiple times a day. This puts many parents and care providers on constant alert, often causing significant anxiety, including fear of feeding the infant. Several medical studies suggest that the situation is self-resolving in approximately 95% of infants by 12-15 months of age.

Reflux and the Incidence of Apnea

Without question, the issue of effective breathing during these episodes is of primary concern to the parents I speak with. So, what is the relationship here? In depth studies looking at the relationship of regurgitation and apnea (cessation of breathing) consider the physiologic factors. Basically, “apnea is linked to a reflex in the larynx (near or around the air passages) cause respiratory pauses, airway closure, and swallowing immediately after regurgitation to the upper airway.” The consequences of these episodes are usually minimal to non-existent. Yet, as mentioned earlier, some infants have prolonged apnea, turn blue and on some occasions begin to lose consciousness. These are clearly the most unusual but cause the most panic in the parent or care provider.

Getting the Right Diagnosis

It is far too simple to assume that if an infant has episodes of reflux/regurgitation, that they in fact have GERD. There are specific diagnostic markers that your physician will look for before making this diagnosis. In the meantime, there has been a skyrocketing in the use of the aforementioned medications to treat the symptoms of reflux. One belief is that parents are so affected by the promotion of medications (usually seen on T.V. for the adult population) for this disorder that they demand a prescription and, in fact, often feel that the baby is under-treated if they leave the office without one. It turns out that the F.D.A. has not approved the use of these medications, specifically for the infant population.

In the meantime, what can parents do to assure that their baby is safe? The most common recommendations tend to include:

•       Propping the infant at a somewhat higher angle while feeding

•       Increase the time between feeding and going down for nap/sleep

•       Place some risers at the head of the infant’s crib (several inches at least)

•       Keep a “spitting up” or reflux log that you can refer to when speaking with your pediatrician

In those very rare instances when breathing stops and the infant turns bluish in color (either face, lips, etc.) you should be prepared to stimulate the infant by using a modified “airway obstruction” position, and use some patting to their back when they are turned in a head down position. This stimulation is most likely what will get a response, even though this is not a true airway obstruction event.

Finally, be prepared for the most unusual of events —where a baby has prolonged loss of breathing. This may require the initiation of CPR in rare cases. Haven’t taken a pediatric CPR course recently? Call Save a Little Life and sign up for one today.

Save a Little Life, inc.
818.344.1442
Savealittlelife.com