KANGAROO MOTHER CARE
An Interview with Dr. Nils Bergman by Marit Olanders
"Hold me, Feed me, Love me"
"The very best environment for a baby to grow and thrive, is the mother's body," says Dr Nils Bergman, a doctor specializing in Kangaroo Mother Care (KMC) in South Africa. "When placed skin-to-skin on the mother's chest, the baby receives warmth, protection and food, and its brain can develop optimally. Not feeding the baby often enough and leaving it to sleep alone after a feed can result in the baby getting colic", he adds. "The mother's skin is the baby's natural environment, and both physically and emotionally the healthiest place for the baby to be".
The mother's body is the only natural, healthy environment for a new baby
Nils Bergman says he would like to place the breastfeeding of small babies in its wider context, and his point of departure is the biological perspective. He says that the behavior of the baby is determined by its environment, and the environment in which it is placed can have a positive or negative outcome. The correct environment for a baby is the mother's body, and he emphasises that the baby is totally dependent on being kept in this optimal environment all the time.
Protest despair response
Failure to be kept in conact with the mothers skin, maintains Bergman, is not only a negative behaviour but also creates a state of pathophysiological stress. This is true for healthy full-term babies, as well as those born prematurely. As with other mammals that are moved from their natural environment, human babies react with protest and despair. In the protest phase, the baby tries intensely to re-establish contact with its correct environment, the mother, usually by crying.
If that fails, the baby becomes too tired to cry anymore. Instead it lapses into a state of despair in which the individual withdraws in order to conserve energy and concentrate on survival. The result of this is a lower body temperature and heartbeat, while at the same time there are greatly increased levels of stress hormones, because a baby separated from its mother, is in fact stressed. When the baby is returned to its correct environment, which is skin-to-skin on the mother's chest, the temperature and heart rate quickly return to normal levels.
Human babies are biologically extremely immature when they are born. Nils Bergman points out that the newborn's brain size is only 25% of its final size, which he compares with 45% in chimpanzees and 80% in antelopes. Not until around one year of age does the human baby's brain reach 80% of its final size. Compared with other mammals, we should have a 21-month pregnancy. The reason human babies are born so early and so immature is the fact that the width of the birth canal through the mother's pelvis was reduced when our ancestors started walking upright. At the same time the brain volume increased. The evolutionary solution was that babies began to be born earlier and therefore more immature, and in need of constant parental care.
Despite their immaturity, human babies in their proper environment, which is skin-to-skin on the mother's chest, can take care of themselves, says Nils Bergman. He refers inter alia to the research of Ann-Marie Widström, et. al, as well as the findings of other researchers, showing that healthy newborn babies without any prompting and without assistance, can, if placed on the mother, crawl up to her breast, find the nipple, latch on and start to breastfeed.
The right environment also means free breastfeeding
Dr Bergman says that babies sleep in cycles of 1 to 1 ½ hours. But even if the baby is asleep, the brain registers whether or not it is in its right environment (skin-to-skin with its mother or separated from her). Of course babies can be made to sleep alone and for longer periods, but that is a learned behavior, not a natural or healthy one.
Colic, according to Nils Bergman, can be caused by too much food being given at any one time, or by the fact that the normal digestive process in the newborn baby stops when it is separated from the mother. According to him, the natural situation would be one where babies feed approximately every 90 minutes, and consume 30 mls of milk, which in turn corresponds to the volume of one excretion reflex. Among breastfeeding counselors, one often hears talk about several excretion reflexes taking place during one feed. But according to Bergman, this is a reflex that occurs because the baby is not fed often enough, and then is given too much at one single feeding.
On the first day following birth, the baby's stomach can contain only 5 ml of fluid. By the time the baby is a week old, its stomach can hold 30 mls. If the stomach is filled with more than 30 ml of milk per feeding, the excess content leaves the body either by way of excretion or by the baby positing up some of the milk. If neither of these occurs, the excess milk is trapped in the stomach and the stomach muscles become stretched as a result. That alone can cause colic, explains Nils Bergman, as he demonstrates the size of the tiny stomach with his hands.
Furthermore, if the baby is separated from its mother after it has fed, its level of stress hormones increases due to the trauma of being separated from her, and as a result the digestion stops, which can also cause colic. The correct digestive processes in a baby are totally dependent on the fact that it should not be separated from its mother.
The development of the brain is benefited and normalised by skin contact
The greatest advantage of the baby being kept skin-to-skin with the mother for 24 hours a day, and being breastfed freely, is the development of the brain, Nils Bergman points out. A baby is born with a maximum number of synapses (that is, potential connections) between the nerve cells. Neurological pathways become established between the synapses that are used, and unused synapses die off. By 6 months of age, all the baby's brain cells are fully developed. After that, it is the neural pathways that have been formed which become the important determining factor in the quality of life that the individual will experience. These neural pathways can be stress-related or pleasure-related paths, depending on the environment in which the baby is placed - closeness to the mother, or separation from her.
If the baby has to use the stress-related paths in infancy, the pleasure-related paths are pruned away. The stress-driven neurological pathways then become dominant for the rest of the life of the individual. We talk about the plasticity of the brain, and the fact that the brain can compensate for various losses, but this does not apply to these very early and fundamental nerve pathways, which become permanently set in the brain.
The brain is a bio-social organ. In this context its function is to create and maintain relationships. If it is not allowed to do so right from the beginning, dissociation occurs. This leaves a legacy of defective mental health which affects the ability of the individual to act flexibly in different situations, Nils Bergman explains.
In the first 8 weeks of life, skin-to-skin contact is the most important stimulant for the development of the brain. He says this continuous physical contact is an essential requirement if the fundamental structures of the brain are to be developed in a healthy way. After this requirement, the most important stimuli that the brain needs for normal development are eye contact, and the physical need to be carried by the parents. Sometimes babies have to go through painful procedures or stressful situations, and at such times it is even more important for the baby to have skin contact with the mother.
"When my own children were small, and had middle-ear infections, they slept best if they were allowed to lie on my chest. I'm sure that was good for them in several ways", Nils Bergman says. "What we experience during birth and the following weeks, affects us for the rest of our lives. Nowadays we are bringing up children in a manner which is essentially pathological."
In Western societies one often hears the advice given that babies be put down to lie on the floor in order to develop their back muscles. Nils Bergman emphasises, "What is commonly done is not necessarily normal, or what should be done". A baby who is carried, develops in a very different way from a baby who is left lying down. The physical differences relating to where the baby is placed, are not in or of themselves of primary importance, he says, it is the final outcome, optimal brain development resulting from being carried by the parents, that matters.
Nils Bergman bases his reasoning on a review of Allan Schore's research in the Infant Mental Health Journal, 2001, and he compares this with the manner in which we care for our newborns in the field of Western neonatology today. He states that practically all of us who have been born and have grown up in the Western World in the last decades, have been prevented from reaching our full potential.
"Only in the last century we have abandoned our three million year-old pattern of caring for children. We have replaced continuous carrying of the child, co-sleeping with the parents, and breastfeeding on immediate demand with leaving the child to lie alone, ignoring its crying, and feeding it every four hours with formula", he adds.
Mothers need support
Mothers today have lost their mothering instincts because they have inherited inappropriate behaviors from their mothers. They need support in order to rediscover these instincts. After that, further support is needed to help empower mothers to act according to these instincts, in a society that does not understand, nor has the cultural memory that is needed. Support is also needed to help parents maintain uninterrupted and continuous skin-to skin contact with the baby during the early weeks, even if it means that the father or someone else takes over for a while in giving this contact.
Nils Bergman concludes that mothers also need for this support during pregnancy, and he emphasises the importance of the support of a doula or mother figure during birth, as well as having an active birth experience, for optimal outcomes for the mother and baby.
The above is condensed from an article by Marit Olanders, published in Amningsnytt (Breastfeeding News) in Sweden, Dec. 2004.
Translation and editing - Åke and Pat Törngren