The Importance of Skin to Skin Contact

There are now a multitude of studies that show that mothers and babies should be together, skin to skin (baby naked, not wrapped in a blanket) immediately after birth, as well as later. The baby is happier, the baby’s temperature is more stable and more normal, the baby’s heart and breathing rates are more stable and more normal, and the baby’s blood sugar is more elevated. Not only that, skin to skin contact immediately after birth allows the baby to be colonized by the same bacteria as the mother. This, plus breastfeeding, are thought to be important in the prevention of allergic diseases. When a baby is put into an incubator, his skin and gut are often colonized by bacteria different from his mother’s.

We now know that this is true not only for the baby born at term and in good health, but also even for the premature baby. Skin to skin contact and Kangaroo Mother Care can contribute much to the care of the premature baby. Even babies on oxygen can be cared for skin to skin, and this helps reduce their needs for oxygen, and keeps them more stable in other ways as well.

From the point of view of breastfeeding, babies who are kept skin to skin with the mother immediately after birth for at least an hour, are more likely to latch on without any help and they are more likely to latch on well, especially if the mother did not receive medication during the labour or birth. As mentioned in “Breastfeeding – Starting out Right”, a baby who latches on well gets milk more easily than a baby who latches on less well. When a baby latches on well, the mother is less likely to be sore. When a mother’s milk is abundant, the baby can take the breast poorly and still get lots of milk, though the feedings may then be long or frequent or both, and the mother is more prone to develop problems such as blocked ducts and mastitis. In the first few days, however, the mother does not have a lot of milk (but she has enough!), and a good latch is important to help the baby get the milk that is available (yes, the milk is there even if someone has “proved” to you with the big pump that there isn’t any). If the baby does not latch on well, the mother may be sore, and if the baby does not get milk well, the baby will want to be on the breast for long periods of time worsening the soreness.

To recap, skin to skin contact immediately after birth, which lasts for at least an hour has the following positive effects on the baby:

  • Are more likely to latch on
  • Are more likely to latch on well
  • Have more stable and normal skin temperatures
  • Have more stable and normal heart rates and blood pressures
  • Have higher blood sugars
  • Are less likely to cry
  • Are more likely to breastfeed exclusively longer

There is no reason that the vast majority of babies cannot be skin to skin with the mother immediately after birth for at least an hour. Hospital routines, such as weighing the baby, should not take precedence.

The baby should be dried off and put on the mother. Nobody should be pushing the baby to do anything; nobody should be trying to help the baby latch on during this time. The mother, of course, may make some attempts to help the baby, and this should not be discouraged. The mother and baby should just be left in peace to enjoy each other’s company. (The mother and baby should not be left alone, however, especially if the mother has received medication, and it is important that not only the mother’s partner, but also a nurse, midwife, doula or physician stay with them—occasionally, some babies do need medical help and someone qualified should be there “just in case”). The eyedrops and the injection of vitamin K can wait a couple of hours. By the way, immediate skin to skin contact can also be done after cæsarean section, even while the mother is getting stitched up, unless there are medical reasons which prevent it.

Studies have shown that even premature babies, as small as 1200 g (2 lb 10 oz) are more stable metabolically (including the level of their blood sugars) and breathe better if they are skin to skin immediately after birth. The need for an intravenous infusion, oxygen therapy or a nasogastric tube, for example, or all the preceding, does not preclude skin to skin contact. Skin to skin contact is quite compatible with other measures taken to keep the baby healthy. Of course, if the baby is quite sick, the baby’s health must not be compromised, but any premature baby who is not suffering from respiratory distress syndrome can be skin to skin with the mother immediately after birth. Indeed, in the premature baby, as in the full term baby, skin to skin contact may decrease rapid breathing into the normal range.

Even if the baby does not latch on during the first hour or two, skin to skin contact is still good and important for the baby and the mother for all the other reasons mentioned.

If the baby does not take the breast right away, do not panic. There is almost never any rush, especially in the full term healthy baby. One of the most harmful approaches to feeding the newborn has been the bizarre notion that babies must feed every three hours. Babies should feed when they show signs of being ready, and keeping a baby next to his mother will make it obvious to her when the baby is ready. There is actually not a stitch of proof that babies must feed every three hours or by any schedule, but based on such a notion, many babies are being pushed into the breast because three hours have passed. The baby not interested yet in feeding may object strenuously, and thus is pushed even more, resulting, in many cases, in babies refusing the breast because we want to make sure they take the breast. And it gets worse. If the baby keeps objecting to being pushed into the breast and gets more and more upset, then the “obvious next step” is to give a supplement. And it is obvious where we are headed (see “When a Baby Refuses to Latch On”).


Is All That Baby Gear Really Necessary?

Parents-to-be are confronted with many items of baby gear that are presented by the industry and our culture as “must-have” items: cribs, baby swings and bouncers, playpens, strollers, bottles and bottle-warmers, pacifiers, mobiles, and more. It can be a daunting task to decide whether each of these items is truly necessary and useful, especially for a new or expectant parent with little experience in the care of an infant. Yet most of the baby items sold today are not only unnecessary and expensive, but harmful. They are all substitutes for the more natural and beneficial things that only parents can give. Such items as swings and bouncers take the place of parent-and-baby play. Formula, bottles, and bottle warmers substitute for breastfeeding. Pacifiers take the place of nursing for comfort. Cribs take the place of co-sleeping, playpens take the place of holding, and strollers substitute for carrying.
Many of these items came about during the 1940’s and 1950’s, when our culture, focusing on post-war “modernization”, saw mothering as yet another occupation that could benefit from modern inventions. While new household gadgets, such as dishwashers, vacuum cleaners, and washing machines have made housework easier, parenting-related items have only made life more difficult for both parents and children. It’s far more likely that a child will look forward to sleeping next to a parent than sleeping alone in a crib, making bedtime a pleasure for everyone, instead of the most dreaded time of day.
Because our Stone Age babies with instinctual knowledge of their true needs expect natural, age-old approaches, substitute approaches will inevitably be resisted, leading to repeated conflicts. Such conflicts endanger the parent-baby relationship, and to what purpose? I feel deep sadness when I read about well-meaning but misinformed parents letting their baby “cry it out” in a crib. Not only is this process painful for all concerned, it accomplishes nothing worthwhile, and gives many harmful messages to the baby: that no one can be counted on in times of need, that they are not worth caring about, and – worst of all – that it’s OK to disregard another person’s needs and feelings as long as one holds the power in that relationship. These harmful messages can remain within the child as a general life philosophy long after the specific experiences have been forgotten.Which items are truly useful and beneficial for new parents? Not very many: a king-size bed (or futons covering the bedroom floor) for cosleeping, a comfortable sling for carrying your baby, a breastfeeding pillow and footstool to make nursing easier, a nursing necklace (if needed), and, especially, heartfelt books, magazines, and articles on attachment parenting. As Marilyn Hogan wrote, “Baby equipment should only be used to enhance the bond between parents and baby.” Unfortunately, many items on the market today can only damage that relationship.

Babies who are simply trying hard to have their legitimate needs met deserve much more. Fortunately, those needs – loving attention, breastfeeding, co-sleeping, and carrying, cost nothing at all to give, yet are the most important gifts of all.


“If You Hold That Baby All The Time…”

“The single most important child rearing practice to be adopted for the development of emotional and social healthy infants and children is to carry the newborn/infant on the body of the mother/caretaker all day long…

– James Prescott, Ph.D.

Every mother who has ever had a baby shower has probably heard someone say, “I wish they had made something like that when I had my babies.” For some reason, it always annoyed me to hear that and I vowed I would never say that to any expectant mother about any new baby gadget. I kept my vow until my first grandchild was born. By then I had done so much research on the importance of carrying babies and the benefits of keeping them in close physical contact, I knew we had to have a sling to carry this baby. I wanted my grandchild to have the holding my own children didn’t get enough of, because I was taught to believe it would spoil them.

I ordered “The New Native” baby carrier from an ad in Mothering. Since we all lived together, I had lots of opportunities to see my daughter “wearing” my granddaughter, and I had lots of opportunity to wear her myself. I was able to learn first-hand what I had read about “babywearing”. She nursed in her sling, and she napped in her sling. She was totally content and I still had both hands free to do whatever I needed to do.

What a win-win: happy baby, happy caregiver. Unless she was hungry and only nursing could meet her need, carrying her in the sling would always make her happy, whether it was Mom or Dad or Grandma doing the carrying. Wearing your baby in a sling completely transforms the experience of parenting an infant.

Now slings could hardly be called “new baby gadgets,” since they have been used in many other cultures around the world for millions for years. However, in North America, they are something new. Whenever one of us was wearing my granddaughter in a public place, people would always stop to ask us about the sling and marvel at this great “new” way of carrying babies. Babies want and need to be “in arms” and they let us know that. A baby crying in a stroller usually becomes content as soon as he or she is picked up and held. I often see parents carrying a baby in one arm and struggling to push an empty stroller with the other!

Contrary to what we have been taught to believe, research shows that babies who are held and carried all the time and get their need for touch well-met in their first year do not become clingy and overly dependent. They cry much less and they grow to become happier, more intelligent, more independent, more loving and more social than babies who spend much of their infancy in infant seats, swings, cribs, and all the other plastic baby-holding gadgets that don’t provide babies with human contact. We had all those baby-holders for my granddaughter and she spent a little time in all of them, but she spent most of her infancy in her sling because she was happiest there, and we loved carrying her and being close to her.

Many new parents buy a sling or receive one as a gift and end up not using it because they can’t figure out how to get themselves and the baby comfortable. I’ve heard parents say they tried a sling once, but the baby didn’t like it so they just never used it again. In other cultures, parents naturally know how to use slings, because as children they grew up seeing slings used, and wearing their siblings in slings. Since slings are new to our culture, anyone just being introduced to using a sling will usually need someone to show them how to get themselves and the baby comfortable. Since I am passionate about the use of baby slings – based on both my research and my personal experience – I often demonstrate the use of slings in my parenting classes. Parents are thrilled when they learn how comfortable and convenient it can be to meet their baby’s needs and still do all the other things they need to do.

Slings are different than front carriers. A sling is like a hammock. From newborn to the sitting-up stage, babies’ spines are best supported in slings because their weight is distributed along the length of the spine. Front carriers that hold the infant upright with their legs hanging down, can stress the spine because they put all the baby’s weight at the base of the spine.

There are many styles and brands of slings. While “The New Native Baby Carrier” is my personal favorite, the best sling is the one you are most comfortable wearing. It is helpful to try several and have someone who is comfortable using each one show you how to use it. If you aren¹t comfortable, your baby won’t be either. The two most important things I tell parents about using a sling are: 1) if the baby’s bottom is below your belly button, the sling is too low and your back will hurt; 2) each time you put the baby in the sling, you will need to walk around until the baby settles in. Babies like and need movement.

When we wear/carry a baby, we are providing more than the comfort of the sound of our heartbeat and voice and the touch and warmth of our body. According to research by James Prescott, a developmental neuropsychologist and cross cultural psychologist, “vestibular-cerebellar stimulation (which happens when we carry our babies) is the most important sensory system for the development of “basic trust” in the affectional bonding between mother and infant. It establishes the biological and psychological foundations for all other human relationships.” We have learned that carrying infants is a vital part of nature’s biological plan for mother-infant bonding, and that it is critical to the development of trust, empathy, compassion and conscience. Carrying or wearing an infant in a sling, keeping the infant in constant human contact, and breast feeding on demand are the biological design for optimal physical, intellectual and emotional human development. Research confirms that carrying human infants develops their intelligence and their capacity for trust, affection, intimacy, and love and happiness. Anthropologist Ashley Montagu refers to this carrying stage, or “in arms” period, as the “external gestation period” the infant needs to complete his/her development. There is even a brand of sling called “Womb with A View.”

Recently when I was demonstrating the use of a sling in a parenting workshop, one of the fathers shared the following story. On one of his trips to the island of Haiti, a very distraught father came to the hospital carrying a newborn whose mother had died in childbirth. The father’s biggest concern was “who will carry this baby”. It is unlikely that this baby’s father had read the scientific research on the importance of carrying babies. Yet he knew it was what his baby needed most. The father in my workshop told of his amazement at seeing many children there who had barely enough to eat, few clothes, no shoes, no toys, and yet were some of the happiest children he had ever seen. As babies these children were carried all day long as part of the natural and loving parenting practiced in their culture.

For decades, we have been taught to believe that holding babies too much “spoils” them, even though in much of the rest of the world, babies are and always have been carried or worn in a sling all day until they could walk. In cross-cultural studies of child rearing practices, James Prescott found that the countries that are the least violent are the countries where babies are constantly carried or worn on the body of the mother/caregiver. The United States has the highest rate of crime and violence in the world and it has the lowest number of constantly carried babies in the world. Is there a connection here?

Meeting our infant’s biological need for human contact is not about following a particular parenting philosophy. It is about honoring and adhering to nature’s biological plan for optimum human development. Keeping our infants in almost constant human contact for nine to twelve months may sound like an impossible goal in modern society. Sleeping with our infants provides that contact at night. Holding them or wearing them in a sling will give them more of the human contact they need. Now that research has shown that holding babies does not “spoil” them, but is, in fact, what they need most, we would be wise to listen to our hearts and “hold that baby all the time.”


The Human Baby

Tenderness appeared in man’s mammalian ancestors eons before he learned to preserve fire or shape a stone.

– Lewis Mumford, The Conduct of Life

The human infant is a helpless creature at birth. He is virtually immobile, he cannot creep, walk, or speak, and is greatly limited in his ability to act with purpose. Unlike other primates, he cannot even hold on to or cling to his mother. He must be carried if he is to go from one place to another. Seventy-five per cent of his brain develops after birth. He cannot continue to live without the efforts of another human. He requires years of development before he can care for himself. A baby’s helplessness and immature development requires a source of care. Nature has provided a source to match this need – the human mother.

Mothers are biologically and genetically designed to nurture their babies. A newborn’s mother has everything a baby needs – arms to hold him, breasts with human milk to feed and comfort him, a human body to share with him, a person to protect and be there for him. She is someone who has evolved with the power and specific resources that will allow her baby to continue to live and to develop normally after he is born. Mother and infant did not evolve separately, but together. The mother is the other half of the human nurturing process, a process which begins at conception and which continues for many years after birth. Although a mother and her baby are from the moment of conception structurally separate, they evolved to function together as a unit. Donald Winnicott, the English psychologist, has said that, “There is no such thing as a baby, there is a baby and someone.” This statement captures the reality of the human baby – a reality which is often overlooked in our society because babies are inaccurately perceived from the moment of birth as separate individuals.

It is not possible to fully understand the human baby or his development if we study him in separateness from the “someone” who keeps him alive. There has never been a baby who lived without the help and support of another human – with the possible exception of a few isolated and unproven reports of feral children raised by animals. And since those few individuals were abnormal in their development when they were found, it seems safe to conclude that a baby who develops without the care of another human being will be abnormal. So, when we talk about babies, or about their needs, we must also talk about mothers – or the “someone” or “someones” who take her place. Babies’ needs and who babies become, have to do, not only with their genes, but with their caretakers and the society in which they develop.

Babies enter the world with only one power – the power to elicit the emotion of tenderness and a caring response to them from other humans, especially and specifically from their mothers. Everything about an infant is designed to bring about such a response. She is small, soft, vulnerable, harmless and engaging. Her need for care and protection is obvious. Her cry evolved to make her mother (and other humans) anxious and concerned. It is a signal of distress to which emotionally appropriate human beings respond to with efforts to be of help. Mother and baby are at first strangers to each other, but the mother, by affirming her baby’s life with herself, establishes a joined entity in which each becomes a part of the other. The mother becomes the “someone” who makes it possible for the baby to continue to live and develop after birth.

A baby will, shortly after birth, begin to smile, to make pleasant and sweet happy sounds, to recognize and to explore his mother, and then to laugh, reach out, touch and hug, all of which increases his mother’s tender attachment to him. He indicates that he likes being with his mother, that he wants to be with her, that he is not a stranger, that he is a friendly, social being, that he has all the human emotions that she does. Mother and baby are structurally separate and without a placental attachment after birth, but they are not physically or emotionally separate. They evolved to be a nursing couple in close, physical contact day and night – a couple who are reactive to each other’s moods and feelings. A mother smiles when her baby smiles, laughs when her baby laughs, is anxious when her baby is anxious, content when he is content, peaceful when he is peaceful, and sad when he is unhappy. A baby smiles when his mother smiles, laughs at her sounds of delight, becomes upset when his mother is upset, anxious, distant, angry, or not available when he wants to be with her.

The mother-infant relationship, because of its physical intimacy, minimal separateness, strong mutual dependency, and the necessity for unity in functioning, collaboration, empathy, and identification may well be the most social of all human relationships. No other relationship, including that of the adult couple, tests the power of the human capacity to imagine, wonder, and become “another”, since it is at first nonverbal, and then minimally verbal for many years. A baby cannot tell you with language who he is, what he feels, or what he wants or needs. The mother must come in touch with the “forgotten language”, those non-verbal ways of communicating with another of our kind, that once was for humans (before we developed language) the only way to express our caring feelings to another.

For a baby, innately social, the relationship with his mother is his introduction to humanity, his first human relationship, and the one that sets the tone for all of his future relationships. For the mother, it is an opportunity to nurture and cherish the life of another, to directly share and participate in the development and creation of a human being, and by so doing, grow in her human connection.

A baby isn’t at first aware that he can have an effect on his mother, that he has the power to make her feel tenderness toward him. Neither can he do anything special to make her take care of him. He is, without knowing it, relying on millions of years of mammalian evolution, on the fact that he is a baby and that she is a mother, in order to receive the tenderness and nurturing that his mother evolved to provide to her children.

We are a species whose existence is genetically rooted in our ability to feel tenderness toward the life we create and the capacity to nurture this life, both before and after birth. Prior to birth, the nurturing process follows its own natural genetic and biological course, and, in its tenacity, can only be terminated by miscarriage or abortion. The mother’s body spontaneously accommodates as well as conditions permit to the growing embryo and fetus. Even unwanted conceptions that are carried to full term can deliver healthy infants. For many individuals, the process prior to birth, because it is independent of culture, may be the only time in their lives when they are nurtured in a normal human way.

As with all mammals, human gestation does not end with birth. The nurturing process after birth, although it is genetically and biologically continuous with the process before birth, is unfortunately not automatic. In humans, the mother can choose, and be influenced by others within her culture, to discontinue being a part of this process. It is likely that in our human beginnings mothers were governed much more by hormonal, instinctive, and reflexive processes in their response to their newborns than they later came to be. But as we developed our modern brain, the care of infants and young children became a conscious activity, and as consciousness became more and more determined by culture, the care of infants and children became a cultural process, greatly influenced by the socioeconomic organization of a society.

Babies are no longer cared for in ways that fit them, but in ways that make them fit their society. We are a species that is genetically designed to nurture our offspring and also one which can, because of our capacity for consciousness and awareness, understand, value, and give priority to the newborn’s need for nurturing. We can – as individuals and as a society – encourage mothers to nurture their babies. However, consciousness is a two-edged sword. From cultural conditioning, we can believe, for example, that biological mothering is unimportant, unnecessary, and an unfair and burdensome intrusion on women’s lives, or that too much nurturing “spoils” babies and is harmful to their development, or even that some babies, depending on their gender, “imperfection” at birth, parentage, or “illegitimacy,” should not live.

We can be certain that for the bulk of human existence, mothers, mothering, and a baby’s need for a mother were highly valued and given great priority by the human group. If such had not been the case, we would not have survived as, or continued to be, a species that required mothering. Mother and baby could not have lived very long on their own, separate from the group. Neither could they have survived without the support of the group.

Ninety-nine percent of all humans who have ever lived were hunter-gatherers (Nanda). Studies of hunter-gatherer societies readily confirm the respect given, and the support provided, by the group to a mother nurturing a baby. Since ancient times, however, continuing until the present, there has been a concerted effort in Western civilization to eliminate the necessity for the natural mother to nurture her newborn. Mothers in many cultures and at various times have been encouraged to suppress their tender feelings toward their babies, discouraged from nurturing them in the biological human way, and to give over their baby’s care to others. The wet nurse and baby bottle attest to these historical facts. Both of these cultural methods of providing infants with sustenance have – to our misfortune – succeeded in achieving their goal of eliminating the necessity for the natural mother to have to care for her baby. They have dramatically changed the biological conditions for human reproduction, the way new human life develops and, perhaps, the human species itself.

The history of childhood in the civilized world reveals that babies have not always been perceived as lovable or needing tenderness. At various times and for varied reasons, they have been seen as evil, harmful, burdensome, worthless, unwanted, and expendable. They have, of course, been treated in accordance with these beliefs about them (deMause, Beekman). Lloyd de Mause, in his book on the history of child care, has stated, “The history of childhood is a nightmare from which we have only recently begun to awaken. The further back in history one goes, the lower the level of child care, and the more likely children are to be killed, abandoned, beaten, terrorized, and sexually abused”.

DeMause is referring to the societies of civilization, not to societies of people living outside civilization. The story of people who live as hunter-gatherers is quite different as regards children than the one described by him. Studies by anthropologists of hunter-gatherer groups do not describe infant and child care in these groups as a “nightmare.” They usually describe the care of the young as “indulgent”. One does find, however, that as these groups are exposed to “civilized ways”, the care of babies and young children becomes less nurturing and more harsh, cruel, and punitive.

Humans evolved in the natural world and evolved to adapt to that world. Crucial to our success as a species when we lived in that world was our capacity to collaborate as a unified group. The human individual, as compared to other animals, is poorly endowed to survive in nature. We have no claws or fangs that can serve as weapons, we are slow-moving, and we have no protective armor. Even our superior brain, coupled with the manual dexterity that allows us to create what we can imagine, would have little survival value if we were not able to act collectively. Indeed, the human brain, with its capacity for language, empathy, and the ability to imagine and to play at being another, evolved as it did to enhance our capacity for collaborative and collective behavior. Those traits that allow us to survive in the modern world, such as self-sufficiency, independence, competitiveness, selfishness, and indifference to the plight or misfortune of others would have had little adaptive value when we lived in small groups as hunter-gatherers. Our adaptive strength then was in our ability for combined and unified functioning, not in our individual and separate skills, powers, possessions, or wealth.

The nurturing mother-infant interaction, rooted in the mother’s capacity to care about the life she creates, was for most of our existence the model for all human relationships and the foundation for human society. It allowed the newborn to be born in an immature state and to slowly develop his brain and mind in relation to loving others. The nurturing process, predicated on the unity of mother and baby, developed individuals who would find it natural to function in unison with others. We would be a very different kind of species – a very unsocial one – if we were born fully developed and did not require mothering.

A human baby born today, to any parents anywhere in the world, would have no trouble fitting into a hunter-gatherer society. He evolved to do so. On the other hand, any baby born today in modern society does not fit our world, nor would any baby born in the past fit it either. Babies (and mothers) have not changed in their reproductive biological or genetic structure; it is society and mothers who have changed in their response to, and in their attitude toward, babies. We no longer value and support mothering or the babies’ critical need to develop in relation to a tender, nurturing mother. We have deviated from the nurturing aspect of reproductive biology by changing the baby’s “someone”.

In a society where a baby lives and develops without his mother’s presence and without human tenderness, some babies, if not most, become a different kind of human than they were meant to be. They must adapt to and fit the substitutes that have replaced natural mothering: formula, pacifiers, cribs, playpens, security objects, and substitute caregivers. In doing so, they are, as adults, different from adults who develop in relation to a nurturing mother. Inappropriately and poorly nurtured children grow up without the internalization of tenderness. We evolved to pass on to the newborn our tender feelings for them.

Babies need tenderness. They do not grow well without it. It is the stuff that makes us human.



Having a Baby? Ten Questions to Ask

Have you decided how to have your baby? The choice is yours!

First, you should learn as much as you can about all your choices. There are many different ways of caring for a mother and her baby during labor and birth.

Birthing care that is better and healthier for mothers and babies is called “mother- friendly. “Some birth places or settings are more mother-friendly than others.

A group of experts in birthing care came up with this list of 10 things to look for and ask about. Medical research supports all of these things. These are also the best ways to be mother-friendly.

When you are deciding where to have your baby, you’ll probably be choosing from different places such as:

  • birth center,
  • hospital, or
  • home birth service.

Here’s what you should expect, and ask for, in your birth experience. Be sure to find out how the people you talk with handle these 10 issues about caring for you and your baby. You may want to ask the questions below to help you learn more.

1. Ask, “Who can be with me during labor and birth?”

Mother-friendly birth centers, hospitals, and home birth services will let a birthing mother decide whom she wants to have with her during the birth. This includes fathers, partners, children, other family members, or friends.

They will also let a birthing mother have with her a person who has special training in helping women cope with labor and birth. This person is called a doula or labor support person. She never leaves the birthing mother alone. She encourages her, comforts her, and helps her understand what’s happening to her.

They will have midwives as part of their staff so that a birthing mother can have a midwife with her if she wants to.

2. Ask, “What happens during a normal labor and birth in your setting?”

If they give mother-friendly care, they will tell you how they handle every part of the birthing process. For example, how often do they give the mother a drug to speed up the birth? Or do they let labor and birth usually happen on its own timing?

They will also tell you how often they do certain procedures. For example, they will have a record of the percentage of C-sections (Cesarean births) they do every year. If the number is too high, you’ll want to consider having your baby in another place or with another doctor or midwife.

Here are some numbers we recommend you ask about.

  • They should not use oxytocin (a drug) to start labor for more than 1 in 10 women (10%).
  • They should not do an episiotomy (ee-pee-zee-AH-tummy) on more than 1 in 5 women (20%). They should be trying to bring that number down. (An episiotomy is a cut in the opening to the vagina to make it larger for birth. It is not necessary most of the time.)
  • They should not do C-sections on more than 1 in 10 women (10%) if it’s a community hospital. The rate should be 15% or less in hospitals which care for many high-risk mothers and babies.
  • A C-section is a major operation in which a doctor cuts through the mother’s stomach into her womb and removes the baby through the opening. Mothers who have had a C-section can often have future babies normally. Look for a birth place in which 6 out of 10 women (60%) or more of the mothers who have had C-sections go on to have their other babies through the birth canal.

3. Ask, “How do you allow for differences in culture and beliefs?”

Mother-friendly birth centers, hospitals, and home birth services are sensitive to the mother’s culture. They know that mothers and families have differing beliefs, values, and customs.

For example, you may have a custom that only women may be with you during labor and birth. Or perhaps your beliefs include a religious ritual to be done after birth. There are many other examples that may be very important to you. If the place and the people are mother-friendly, they will support you in doing what you want to do. Before labor starts tell your doctor or midwife special things you want.

4. Ask, “Can I walk and move around during labor? What position do you suggest for birth?”

In mother-friendly settings, you can walk around and move about as you choose during labor. You can choose the positions that are most comfortable and work best for you during labor and birth. (There may be a medical reason for you to be in a certain position.) Mother-friendly settings almost never put a woman flat on her back with her legs up in stirrups for the birth.

5. Ask, “How do you make sure everything goes smoothly when my nurse, doctor, midwife, or agency need to work with each other?”

Ask, “Can my doctor or midwife come with me if I have to be moved to another place during labor? Can you help me find people or agencies in my community who can help me before and after the baby is born?”

Mother-friendly places and people will have a specific plan for keeping in touch with the other people who are caring for you. They will talk to others who give you birth care. They will help you find people or agencies in your community to help you. For example, they may put you in touch with someone who can help you with breastfeeding.

6. Ask, “What things do you normally do to a woman in labor?”

Experts say some methods of care during labor and birth are better and healthier for mothers and babies. Medical research shows us which methods of care are better and healthier. Mother-friendly settings only use methods that have been proven to be best by scientific evidence.

Sometimes birth centers, hospitals, and home birth services use methods that are not proven to be best for the mother or the baby. For example, research has shown it’s usually not helpful to break the bag of waters.

Here is a list of things we recommend you ask about. They do not help and may hurt healthy mothers and babies. They are not proven to be best for the mother or baby and are not mother-friendly.

  • They should not keep track of the baby’s heart rate all the time with a machine (called an electronic fetal monitor). Instead it is best to have your nurse or midwife listen to the baby’s heart from time to time.
  • They should not break your bag of waters early in labor.
  • They should not use an IV (a needle put into your vein to give you fluids).
  • They should not tell you that you can’t eat or drink during labor.
  • They should not shave you.
  • They should not give you an enema.

A birth center, hospital, or home birth service that does these things for most of the mothers is not mother-friendly. Remember, these should not be used without a special medical reason.

7. Ask, “How do you help mothers stay as comfortable as they can be? Besides drugs, how do you help mothers relieve the pain of labor?”

The people who care for you should know how to help you cope with labor. They should know about ways of dealing with your pain that don’t use drugs. They should suggest such things as changing your position, relaxing in a warm bath, having a massage and using music. These are called comfort measures.

Comfort measures help you handle your labor more easily and help you feel more in control. The people who care for you will not try to persuade you to use a drug for pain unless you need it to take care of a special medical problem. All drugs affect the baby.

8. Ask, “What if my baby is born early or has special problems?”

Mother-friendly places and people will encourage mothers and families to touch, hold, breastfeed, and care for their babies as much as they can. They will encourage this even if your baby is born early or has a medical problem at birth. (However, there may be a special medical reason you shouldn’t hold and care for your baby.)

9. Ask, “Do you circumcise baby boys?”

Medical research does not show a need to circumcise baby boys. It is painful and risky. Mother-friendly birth places discourage circumcision unless it is for religious reasons.

10. Ask, “How do you help mothers who want to breastfeed?”

The World Health Organization made this list of ways birth services support breastfeeding.

  • They tell all pregnant mothers why and how to breastfeed.
  • They help you start breastfeeding within 1 hour after your baby is born.
  • They show you how to breastfeed. And they show you how to keep your milk coming in even if you have to be away from your baby for work or other reasons.
  • Newborns should have only breast milk. (However, there may be a medical reason they cannot have it right away.)
  • They encourage you and the baby to stay together all day and all night. This is called “rooming-in.”
  • They encourage you to feed your baby whenever he or she wants to nurse, rather than at certain times.
  • They should not give pacifiers (“dummies” or “soothers”) to breastfed babies.
  • They encourage you to join a group of mothers who breastfeed. They tell you how to contact a group near you.
  • They have a written policy on breastfeeding. All the employees know about and use the ideas in the policy.
  • They teach employees the skills they need to carry out these steps.

How to Hold Your Baby

I was recently asked how to hold a baby. This is an interesting question, because it’s a reminder of how far we’ve come from intuitive parenting. If we could travel back in time to the Stone Age, and were to ask mothers and fathers this question, I’m sure they would be quite perplexed. Judging from historical trends and from modern-day observation of newly-discovered Stone Age tribes, these parents would be spending so much skin-to-skin time with their babies, they would have a first-hand knowledge of their baby’s needs moment-to-moment. They would have even known (as many parents in so-called primitive societies still know) when their baby needed to pee! When asked how they know this, they are baffled, and ask in return, how do we know when we have to pee? Some modern-day parents are rediscovering this kind of beautiful awareness of their baby’s needs, through elimination communication training.1Parents who have this kind of connection will also know instinctively how to hold their baby, by staying alert to their baby’s movements, breathing, and facial expressions, and by listening closely and respectfully, with a focus on determining their baby’s unmet needs. Such parents would never waste time and energy wondering if they should respond to their baby’s protests and tears; they would naturally and consistently give them the same loving respect they would want themselves when they had an urgent need.
Sadly, many parents have lost this kind of awareness and connection. They are too overwhelmed by their busy life to stop and hear what their babies are telling them. Many parents even ignore loud crying because they’ve been told that crying is an attempt to manipulate the parents, not an attempt to communicate an important need. This has been an unfortunate and harmful development in parenting; it has created mistrust and fear where there should only be a joyful and loving connection.
So how should we hold our babies? Like many other questions new parents face, we should watch and listen to what our baby is trying so desperately to tell us. If she isn’t comfortable, she will let us know, even in the earliest weeks and months. Ignoring this communication is as unhelpful as ignoring our partner’s or friend’s communication. It creates problems that shouldn’t exist, and which can be avoided so easily by connecting and hearing what our baby is trying to tell us. Yes, it’s easier to know what our baby needs once they learn our language, but their gestures, facial expressions, body language and verbalizations can give us a wealth of information if we only pay attention. Teaching a baby sign language (which can start as early as the third month, with the baby signing back by about the sixth month)2 can also make it easier to know their needs more specifically, but long before that, parents can connect so closely on an emotional and physical level that words are not needed.Communication comes in many forms. While it’s not possible to predict what kind of holding a baby will need at a specific time beforehand, in general, they like to be held with their head on our left side so they can hear our heart beat, as they did in the womb. Research suggests this facilitates the baby’s emotional development.3 It also reassures them of our continued presence, and is emotionally and physically calming.
Babies like to be picked up in a gentle, natural, intuitive way, and to be held lovingly, calmly and gently, with no sudden changes or movements. They like skin-to-skin contact, which provides many physiological benefits.4 Whether using a baby carrier or your arms, have the baby facing in, which helps the parent attend to the baby’s cues and avoid overstimulation. It also helps the baby’s spine to develop normally.5 Be sure her head is held gently but securely at all times.

After picking her up, give her your full attention. If she squirms, stiffens, or looks uncomfortable, try a different position. Keep making adjustments until she looks and feels comfortable. She will let you know in many ways that babies want to be held as much as possible throughout the day. A baby who insists on being held all day is simply a baby who knows that holding meets her needs in the most beautiful and effective way. She is not “spoiled” – she is smart! And research suggests that babies who are held the most cry the least and have the most secure emotional attachment.6,7

Hold her at night as well as during the day, so she has reassurance of your continued presence, and so you can monitor her breathing (which will be more regular than if she were sleeping away from you). All other mammals sleep with their parents, and for very good reasons. Babies who cosleep have improved heart rates, breathing rates, blood pressure, blood sugar levels and body temperature. And they are learning what love should look like.

Of course, these are just general guidelines. Only your baby knows what she needs at any given moment, just as she will know at every age. Trust what your heart tells you. Connect, watch, and listen. Your child is the best parenting counselor you can have!


The Critical Importance of a Child’s First Years: a Baby Speaks

Statistics tell us that something has gone wrong in our world. A steadily rising rate of social ills, and the proliferation of self-help books and therapy techniques for “reparenting the inner child” attest to the sad fact that we have lost our way in raising our children.

It is up to us as parents – despite our personal limitations – to give our children the right start in life: to help them become fulfilled, emotionally healthy adults, capable of loving and trusting others. Philosopher Blaise Pascal wrote that “the entire ocean is affected by a pebble.” Our children should be like pebbles bringing forth waves of joy, not more sorrow and suffering.

Current thinking about our failure to fulfill our children’s needs points to the importance of the earliest years of childhood, making it clear that the first three years are especially critical. What should we be doing during those years to ensure that our children have the best chance of becoming healthy and happy – as they deserve to be? Consider what a member of that age group might recommend to us – if only they could speak:

I am eleven months old. I can’t talk yet, so when I am hungry, tired, wet, lonely, ill, or in pain, I cry. It is the only means I have to let my parents know that something is wrong.

If my crying is ignored, all that happens is that my needs become greater – I get even more miserable. On top of that, I have to face the fact that apparently no one cares about me. I’m sure Mommy would feel the same way if she were crying and Daddy ignored her. Believing that no one cares about you is a very devastating thought.

When my tears are ignored, I begin to believe that no matter how hard I cry, and no matter what is wrong, no one will ever come. If no one ever comes, I worry that I will die, because I cannot meet my own needs yet. You see, I have no concept of time, and two minutes is forever to me.

Sometimes I stop crying – but I am not learning patience – I am learning despair. When I stop crying, it means that I have lost all hope of ever being loved again, and all I feel is helplessness and despondency. I worry that I will never learn to communicate with words if I am not allowed to communicate with cries. And I worry that if I feel this frustration too many times, I will withdraw and stop feeling anything.

It sure can be frightening to think that no one cares enough about me to meet my needs. In fact, when my cries are ignored, I begin to think the world is a really bad place, and I worry that this will give me a negative and selfish outlook on life. But when my needs are met, I feel loved and secure enough to return that love to others, and eventually to my own children. I do so want to become a loving, caring person, but how will I learn to be like that if I don’t see examples of it?

I get very lonely if I am separated from my parents. For nine months, my mother and I were inseparable, and I felt so much love inside her. She was all I knew when I arrived on this strange planet. It will require a certain amount of time – perhaps three years or longer – before my sense of trust is established and I am ready to spend extensive time with other caregivers. The more secure I can feel now, the sooner that time will come. if I am forced to face this separation before I am ready, it will take a lot longer; in fact, I may never reach the level of maturity that I hope to reach by the time I am an adult.

At night, I like to sleep next to my parents. Being able to touch them and hear them during the dark hours of the night are my only means of knowing that they have not disappeared. There are other reasons for wanting them near: their presence helps to regulate my heart rate, blood pressure, body temperature and sleeping cycles, and their breathing regulates my own breathing.

I love to breastfeed. Breast milk is the best food for me; it contains important substances, not found in formula, which will help to keep me healthy for many years. When Mommy breastfeeds, she produces a hormone which keeps her happy too. Best of all, breastfeeding keeps Mommy and me close.

I have no desire to take unfair advantage of my parents. I love them very deeply. I am simply asking for the same care that was given to babies for thousands of years until recent history. If my needs are met, I will be free to demonstrate all the love and trust I was born with. All I want is a chance to express that love fully.


why babies smile

It’s hard not to feel overjoyed when your baby gazes adoringly into your eyes and flashes a brief, but unmistakable smile. But is she really trying to communicate her joy at seeing you, or does she simply have gas?

Open-mouth baby smiles indicate joyBabies usually don’t start social smiling until about eight months, but their smiles can still say a lot before then. “In fact, babies smile when they’re asleep from birth,” says Dr. Daniel Messinger.

Baby smiles at 0-1 months

Neonatal smiling occurs from birth to one month of age and shows no emotional content. Smiles are spontaneous and often occur while the baby is drowsy or during REM stages of sleep. Baby smiles are subcortical in origin and will actually decrease with maturity (so premature babies smile more than full-term babies). And, contrary to popular belief, baby smiles have nothing to do with gas.

Baby smiles at 1-2 months

At around one or two months, babies will gradually start to respond to environmental stimulation. Your baby’s first smile when she’s fully awake will likely appear between six and 10 weeks.
At this age, your baby’s brain is developing, her vision is improving and she can recognize your face. Your baby will likely respond to auditory stimuli first, such as music or mom or dad’s voice. Next comes a response to visual and auditory stimulation combined. The last thing to make baby smile is visual stimulation alone.

Baby smiles at 2-6 months

“Earlier is not better,” says Dr. Messinger. But you should see a doctor if your baby is not smiling by three months. Don’t push your little one to smile, but once she does, have fun with it. At two to three months, you’ll notice your baby starts to look right at you when she smiles. During this time period babies will increasingly respond to face-to-face interaction. Make funny faces to get your baby to laugh.

By four to six months, your baby will start to smile, then look away. “Babies are learning to regulate emotions and the joy may be too intense,” says Dr. Messinger. Let her look away, then reengage once she returns her smile to you.

Baby Smiles at 6-12 months

During this period you will start to see lots of different smiles. As a general rule, open mouth smiles demonstrate more joy than closed. Your baby will also start to play with laughter. By eight or nine months, smiles are used often in social situations and as a method of communication so make sure to respond to your baby when she gives you a big smile.


Children are Born Innocent

What do you see when you look into the eyes of a newborn?

When I first looked into the eyes of my son, I saw trustfulness, curiosity and joyfulness. I saw no deviousness, meanness or selfishness. In that instant it became clear to me that if he ever acted in a devious, mean, or selfish way, his behavior would have been created by circumstances, not by him. In that instant, I knew what a great responsibility I had to honor and protect his innocence and joy in life.

Children are born innocent. They want only to be loved, to learn, and to contribute. Those parents who are not able to appreciate this truth miss what should be the most precious moment of their life. They cannot trust their child – they instead suspect him of being somehow flawed and requiring constant correction. The emphasis is on fixing something, not on enjoying and learning about this new person. The focus, from that point on, is on the child’s behavior, not on the parent-child connection.

A parent’s attitude is absolutely critical in determining the kind of relationship they will have with their child. I find nothing sadder than seeing a parent who has somehow missed seeing their child’s basic sweetness and good intentions, and thus believes that punishment is necessary to set him on the right path. This parent is always watchful, looking for ways to correct the child, which stifles his natural exuberance. This kind of suspiciousness is self-fulfilling – the child who is punished responds emotionally – as does any other person – with anger and fantasies of revenge, and physiologically with a burst of the stress hormone cortisol. The parent then feels justified in continuing and even escalating the punishments. The child is from then on seen as potential trouble – as the enemy.

The parent who is fortunate enough to see in his newborn’s eyes only love, curiosity, and joy, will continue to trust and enjoy their child. Instead of looking for “misbehavior”, this parent looks for ways to connect and to bring joy into their child’s life. This attitude is also self-fulfilling, because love begets love. The child responds to being loved and trusted as we all do – by loving and trusting in return.

What takes place at the moment a parent first looks into their child’s eyes sets the stage for a lifetime of joyful connection, or a lifetime of struggle. It sets the stage for a rewarding relationship of trust and connection, or a battle between adversaries. This first meeting carries the seeds of years of happiness or misery. For those who can see their newborn’s innocence and pure intentions, parenting may be challenging at times, but it is never a burden.

Look closely at this new being. Learn from him how delightful and simple life is meant to be. It’s just an instant of time, but once this truth is fully grasped, it lasts forever.


A Baby Cries: How Should Parents Respond?

Imagine for a moment that you have been abducted by space ship to a distant planet, and you are surrounded by giant strangers whose language you do not speak. Two of those strangers take you under their care. You are entirely dependent on them for the satisfaction of all your needs – hunger, thirst, comfort, and – especially – reassurance that you are safe in this strange place. Then imagine that something is very wrong – you are in pain, or terribly thirsty, or in need of emotional support. But your two attendants ignore your cries of distress, and you are unable to get them to help you or to understand your needs. Now you have another problem, more serious than the first: you feel completely helpless and alone in an alien world.

In all innocence, a baby assumes that we, as his parents, are correct – that whatever we do is what we ought to be doing. If we do nothing, the baby can only conclude that he is unloved because he is unlovable. It is not within his capabilities to conclude that we are only busy, distracted, worried, misled by “experts”, or simply inexperienced as parents. No matter how deeply we love our baby, it is mostly the outward manifestations of that love that the baby can understand.

No one likes to have his communication ignored. and if it is, this brings on feelings of helplessness and anger that inevitably damage the relationship. Such a response seems to be one that is universally experienced by adults, and there is no reason to conclude that it is any different for babies and children. Few people would ignore an adult while he repeatedly said, “Can you help me? I’m not feeling right.” Ignoring such a request would be considered most unkind. But a baby cannot make such a statement; he can only cry and cry until someone responds – or until he gives up in despair.

Immediate response to a baby’s cry went unquestioned for thousands of years until recent times. In our culture, we assume that crying is normal and unavoidable for babies. Yet in natural societies where babies are carried close to the care-giver much of the day and night for the first several months, such crying is rare. In contrast to what many in our society would expect, babies cared for in this way show self-sufficiency sooner than do babies not receiving such care.

In fact, research on early childhood experiences consistently shows that children who have enjoyed the most loving care in infancy become the most secure and loving adults, while those babies who have been forced into submissive behavior build up feelings of resentment and anger that may well be expressed later in harmful ways.

In spite of this research, most arguments for ignoring crying are based on fears of “spoiling” the baby. A typical baby-care brochure advises the parent to “let the baby handle it for a while”. Though infancy can be a challenging time for the parents, a baby is simply too young and inexperienced to “handle” the cause of the crying, whatever it may be. He cannot feed himself, change himself, or comfort himself in the way that nature intended. Clearly, it is the parents’ responsibility to meet their baby’s needs for nurturing, security, and love, not the baby’s responsibility to meet his parents’ need for peace and solitude.

The pamphlet implies that if the parents give their baby an opportunity to become self-reliant, they are helping him to mature. But an infant is simply not capable of such maturity. True maturity reflects a strong foundation of emotional security that can only come about from the love and support of those closest to him during the earliest years.

An immature person can only respond to stress in an immature way. A baby denied his birthright of comforting from his parents may respond by turning to ineffective self-stimulation (head-banging, rhythmic rocking, thumb-sucking, etc.) and emotional withdrawal from others. If his needs are routinely ignored, he may decide that loneliness and despair are preferable to risking further disappointment and rejection. Unfortunately, this decision, once made, can become a permanent outlook on life, leading to an emotionally impoverished life.

Many child-care professionals feel that parental encouragement of self-satisfiers and over-substitution of material objects – teddy bears substituting for parents, strollers for arms, cribs for shared sleep, pacifiers for nursing, toys for parents’ attention, music boxes for voices, formula for breast-milk, wind-up swings for laps – have led to an age of materialistic acquisition, personal loneliness and lack of emotional fulfillment.

Ignoring a baby’s crying is like using earplugs to stop the distressing noise of a smoke detector. The sound of a smoke detector is meant to alert us to a serious matter that requires a response – and so is the cry of a baby. As Jean Liedloff wrote in The Continuum Concept, “a baby’s cry is precisely as serious as it sounds.”

Stressful though it may be, infant crying should be seen not as a power struggle between parent and child, but as a gift of nature to ensure that all babies can grow to adulthood with a generous capacity for love and trust.