Try the Middle Ground between Natural and Hospital Birth

Many things about a hospital birth have the potential to rupture or impede the first bonding between mother and child. For example, epidurals and anesthetic do seem to get into the baby's blood stream, so that both mother and baby are groggy and sickish following the birth. Babies delivered without anesthetic are alert and soon naturally begin to look for the breast, stimulating the release of oxytocin in mom and, likely, in baby.

Some think that the steady drip of pitocin, an artificial form of oxytocin, given to the laboring woman can create a sort of allergic reaction, or oversensitivity, in the baby. Later, according to this theory, that child may reject experiences that cause the oxytocin release. Some people think this may be part of the explanation for autism.

In any case, this article from Mother Earth News lays out a middle ground. Sharon Maehl suggests having the baby in the hospital, but staying there for as short a time as possible. She takes you through all the decision points and wraps up with the account of the birth of her second child.

The key to this way of giving birth, along with finding the right doctor and hospital, is making your mind up ahead of time that you won't stay, according to Maehl. She says,

Somewhere along the line you should tell the staff that you'll have to be running along soon (you left a cake in the oven?) Whatever you do, though, don't mention this to anyone in the hospital until the baby is born. If you tell the doctor during your pregnancy, he may even refuse to accept you for pre-natal care. Doctors are not known for their flexibility. Best wait until the baby is born and safely in your arms before you tell anyone your plans.

Her idea minimizes the time in hospital and the pressure from doctors and nurses for medical interventions, while making sure that if anything does go wrong, help is right there.


Cuddles Now or Hookups Later

A terrific article in Time magazine talks about how we develop the ability to love -- as well as the style in which we love.

Writer Tiffany Sharples mentions unpublished research showing that kids who grow up in cold or hostile families are more likely to engage in sexual behavior at an early age.

Psychologists have long warned that children who grow up in a hostile home or one in which warmth is withheld are likelier to start having sex earlier and engage in it more frequently. In a study that will be published in March, Trish Williams, a neuropsychology fellow at Alberta Children's Hospital, studied a group of 1,959 kids ages 11 to 13 and did find a striking correlation between a volatile home and earlier sexual behavior. A few of the children had had intercourse at as young an age as 12, and while the number of sexually active kids wasn't high--just 2% of the total--the cause was clear. "Hostile parenting is highly associated with problem behavior," says Williams.

This is another thing that can seem like a big duh. When you don't get enough love at home, you'll try to get it wherever you can -- and for preteens and teens, love is pretty hard to separate from sex. (And that craving for love can be seen as a need for more oxytocin release to counteract the stress of daily life.)

But it's important to have this kind of statistical backing for what some people understand intuitively, because other people don't. Everyone thinks  -- or at least unconsciously feels -- that the way they grew up is normal. If you had cold withdrawn parents, you're very likely to parent your kids the same way, rationalizing it by saying, "They need to be independent and able to stand up to the hardships of life." Or something.

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Clingy Babies Make Confident Adults

To develop a healthy oxytocin response, a person needs to have a warm, secure and loving environment as a baby. Now, some people worry that coddling a young child will make him or her shy, clingy or needy.

Well, a child is needy; she needs everything from her parents. She has no way of getting anything she needs without them.

Children who grow up with a lot of love have a less reactive fear response and they're more open to connecting with other people. It's a recipe for healthy adulthood.

A study from the University of Haifa confirms this. Irit Yanir found that young adults who regularly spent time with their parents and felt comfortable sharing feelings with them were actually better able to cope with the responsibilities of adulthood:

While a close relationship is often viewed as a sign of dependence, the research results show that those with close relationships with their parents were more financially self-sufficient, more independent in their day-to-day lives, professionally stable, felt more mature and were more likely to be involved in a stable intimate relationship.


Neglected Kids More Likely to Be Obese

A study at Temple University found that kids who are neglected are more likely to be obese. Abuse or maltreatment, on the other hand, didn't seem to affect their weight.

Temple's Robert Whitaker looked at data from the Fragile Families and Child Wellbeing Study of nearly 5,000 children. At age three, children'sheight and weight were measured, while mothers answered a questionnaire about three types of child maltreatment in the prior year: neglect (such as not providing proper supervision for the child), corporal punishment (such as spanking the child on the bottom with a bare hand) and psychological aggression (such as threatening to spank the child but not actually doing it).

According to the article,

Eighteen percent of the children were obese, and the prevalence of any episode of neglect, corporal punishment or psychological aggression was 11 percent, 84 percent and 93 percent, respectively.

The odds of obesity were 50 percent greater in children who had experienced neglect, after controlling for the income and number of children in the household, the mothers' race/ethnicity, education, marital status, body mass index, prenatal smoking and age, and the children's sex and birth weight.

On the other hand, there was no correlation between corporal punishment or psychological aggression and overweight.

This makes sense if you look at overeating as a way to compensate for oxytocin deprivation. We tend to see overeating as a reaction to stress, which it is. But the stress of isolation is the lack of the ability to connect in an oxytocin-producing interaction with another person. (Although in prairie voles, isolated animals actually produce more oxytocin;  researchers at University of Illinois who did these experiments think this oxytocin production drives the animal to try harder to connect.  See The Amazing Vagus Nerve and The Sex/Food/Love Connection.

Eating -- or rather digesting food, especially fatty food -- sends signals from the gut to the brain via the vagus nerve. Those signals cause the hypothalamus to release oxytocin, which travels to the gut and creates the sensation of satiety.

It seems very likely that this oxytocin release also tweaks the neurons in the brain that create the pleasure in social interactions. So, it makes perfect sense that kids who are lonely for their mothers -- or for anyone to pay attention to them -- could use eating to take the place of social relationship.


Will Bad Mothering Become the Newest Disorder?

On the Women's Bioethics Blog, Sabrina W wonders whether the growing interest in oxytocin-based drugs could place mothers under medical scrutiny.

The way humans are wired is, labor and natural childbirth releases waves of oxytocin that not only produce contractions that expel the baby and dull pain, but also begin the bonding process between mother and child. Later, mothering helps shape the oxytocin response in the baby's brain.

She writes,

It is often the case that the presence of a "cure" will pathologize any condition that could be treated by it. How long until a mother, or even a woman without children, who "lacks a nurturing personality" will experience social pressure to "correct her deficiency"?

This is reminiscent of early thinking on autism, that it was the mother's fault. So-called "refrigerator mothers," who weren't warm to their children, could damage their kids and create autistic symptoms.

While that theory is out the window, many researchers wonder if the heavy-duty dose of artificial oxytocin routinely given to laboring women could be at fault.


Generation Alienation Is a World-Wide Problem

It's easy for those of us living in the dysfunctional United States to blame our indigenous culture on the growing crisis in attachment. But this story from the Bay of Plenty Times in New Zealand shows that country is experiencing a similar attachment crisis.

Writer Elaine Fisher quotes psychotherapist Augustina Driessen, who predicts that child abuse will worsen in New Zealand as kids who have been neglected, abused or ignored grow up to become parents themselves. Driessen says,

  "To break the cycle we must teach many parents how to parent, to stop them bringing up their children as they were brought up.

  "It is a privilege to have children. In extreme cases, some parents should never be allowed to have children again."

I agree. In modern society, having children shouldn't be considered a human right. It should be a privilege reserved for those who can prove they can provide for a child's emotional needs, as well as the most basic physical needs, that is, enough to eat and secure shelter.

For more on this, see "A Generation in Pain."


Honor the Breast During World Breastfeeding Week

Annie of SA Parent Life has a wonderful compendium of information from multiple sources about the benefits of breastfeeding for both mother and child. World Breastfeeding Week runs from August 1 through August 7.

Initiating the oxytocin bond between mother and child, and beginning the process of brain development whereby the baby will come to associate the warmly connected feeling of oxytocin with safe intimacy.

In addition, according to Annie's blog, allowing the baby to drink colostrum, the first milk, provides crucial nutrition and immunity. She also includes a link to video of the "breast crawl," the instinctive movement of a newborn toward the breast.

See also "The Mother/Baby Attachment Gap"


Book Review: The Connected Child

Karyn Purvis, David Cross and Wendy Lyons Sunshine have written a handbook for parents of at-risk kids that's vitally needed. With the rise in international adoptions and adoptions of kids in foster care has come a mostly unacknowledged crisis. Unprepared and unsupported families are finding themselves unprepared for the task of parenting children with severe emotional problems.

The Connected Child
helps parents put some of their therapeutic techniques into practice; more important, it helps them understand their kids in a new way.

Dr. Purvis is the director of Texas Christian University's Institute of Child Development; Dr. Cross is associate director of the institute and a TCU psychology professor. They treat kids with attachment and other behavioral disorders, and they run a summer camp for kids.

The book explains to parents how their assumptions of normal and acceptable behavior may be completely foreign to their children. Not being touched, not having enough to eat, not having toys or stimulation can create a worldview that's totally out of synch with the parents.

That's why setting rules for behavior or other cognitive approaches may not work with these kids. When parents understand that so-called bad behavior comes from fear or self-protection, they can find strategies that address the underlying fear and thereby change behavior.

For example, stealing or hoarding food is common among children from orphanages. They had no choices about when or what they could eat, and often didn't get enough to eat. Instead of demanding that the behavior stop, or that kids hew to mealtimes, the authors offer techniques to maintain a healthy, regular diet while increasing feelings of security about food.

For example, if a child asks for an energy bar a few minutes before mealtime, instead of saying, "No, we'll be eating in ten minutes," they advise giving her the bar and letting her choose whether to keep it in her pocket or by her plate to eat after dinner. Another option is letting the child keep a basket with healthy snacks in her room that she can eat whenever she wants.

Even sending a kid to her room for a time-out can hurt more than it helps, they write. If a child already feels cut off from the family, this isolation seems to reinforce that belief. Instead of dealing out consequences for misbehavior that may seem arbitrary and unrelated to the misdeed, Purvis, Cross and Sunshine illustrate how to help a child understand the real consequences of his behavior. For example, if a kid mistreats a dog, parents are advised to sit down with him and brainstorm the negative consequences of the behavior, such as, "If I hit the dog, it will run away from me." Next, they should make a list of positive consequences that might occur if the dog is treated kindly, such as, "It will like me."

They write,

"Adopted and foster children deserve deep compassion and respect for what they may have endured before they were welcomed into your home. Some of these little ones have survived ordeals that defy the imagination. … the difficult history of these children means that you, as a caretaker, have to work harder to understand and address their unique deficits and make a conscious effort to help them learn the skills they need at home with a caring family."

Parents need to respond to acting out, tantrums and other dysfunctional behavior with love and understanding. Over and over, the book helps parents understand the roots of misbehavior, so that they can respond with love instead of anger.

At-risk kids need to be told directly and simply what's expected of them, according to Purvis and Cross. Parents should identify specific behaviors or values they want to enable, and name them, for example, "asking with respect." If a child asks for something demandingly, the parent says, "Is that asking with respect? Can you ask me with respect?" Throughout, the book provides clear strategies and scripts for handling a wide variety of problems and behaviors.

Finally, The Connected Child includes a chapter called "Healing Yourself to Heal Your Child." Without judgment and with much compassion, the authors point out how much any child, and especially a traumatized child, needs to feel secure and loved by her parents. If a parent hasn't dealt with his or her own grief, anger or emotional dissociation, it will be difficult for that child to heal. If the child does begin to open up, it may actually make her parents uncomfortable.

They offer some advice for such parents, which tends to be on the cognitive side, such as reflecting on their own attachment styles and practicing identifying and articulating their own feelings. Of course, this isn't always so easy, and parents with attachment issues may benefit more from the same kinds of experiential therapy that kids get.

In fact, guiding a child with an attachment disorder toward healing could be exactly the kind of experience that could help a parent heal -- as long as it's done consciously and carefully. The Connected Child is a wonderful guide.

For background on the work of Dr. Purvis and Dr. Cross, see this article from the Texas Christian University magazine.


A Rising Tide of Pain

Our children are getting sicker. In 2001 a group of experts on child development and health surveyed the state of America's children. The results were frightening: One of every four adolescents in the U.S. is at serious risk of not achieving productive adulthood. According to the study, 21 percent of children aged nine to 17 had a diagnosable mental or addictive disorder; 20 percent of students reported having seriously considered suicide in the past year. The report concluded that this generation of young people is more likely to be depressed and anxious than its parents' generation was.

The report by the Commission on Children at Risk, 2003, called Hardwired to Connect, was cosponsored by the YMCA, Dartmouth Medical School, and the Institute for American values. The Commission for Children at Risk is a panel of 33 doctors, neuroscientists, researchers and youth services professionals.

The report found rising rates of depression, anxiety, attention deficit and conduct disorders, suicide and other serious mental, emotional or behavioral problems among children and adolescents. Since the 1950s, death rates from disease or injury have fallen by about 50 percent among youth -- while the homicide rates rose by more than 130 percent. Suicide rates rose by nearly 140 percent. Suicide is now the third leading cause of death among young people in the United States.

While medicine -- antidepressants, anti-anxiety meds, and other such -- is improving, the report found that we have a bias against recognizing that parts of the problems are caused by society and parenting itself.

The report looked at the latest findings from neuroscience and accepts the idea that we are biologically primed to connect with other people. But how we connect with them makes all the difference. Our brains are designed to develop in response to communication with another brain in a process called limbic resonance. This relationship, this limbic resonance, can facilitate growth development and health. But it can thwart it, too, twisting development and pushing the child down a path of lifelong pain, psychiatric disorder, and isolation.

Although oxytocin researchers are leery of applying their findings to humans, the commission had no such fear. The report makes the case for the role of oxytocin and vasopressin in bonding. It describes the way neurochemicals including dopamine, prolactin, endogenous opioid peptides, as well as estrogen, testosterone and progesterone, help trigger parental care, which in turn helps to trigger the release of more attachment hormones, in a virtuous circle that creates the bond we know as love.

The report says, "The human child is talked into talking and loved into loving." It points out that the drive for connection with other people can help guide a child's willingness to behave in response to the parents' wishes.
Steve Suomi of the National Institutes of Health did studies of rhesus monkeys showing that the inherited risks of anxiety, aggression, impulsivity, and alcohol usage could be mitigated by a family environment. On the other hand, a negative family environment can trigger a kid's potential for depression, violence or substance abuse into active behavior.

At adolescence there's another period of brain growth maturation and remodeling which will extend into the third decade of life. At this time of change and transition, there's increased risk-taking and novelty seeking, while friends become more important than the family. There are alterations in levels of activity of the neurotransmitter dopamine in parts of the adolescent brain, which can lead to what the report calls a reward deficiency. While traditional culture cultures mobilize to define and help adolescents accept social standards of sexuality and strength, shaping them to grow in ways that will be pro-social, our culture has lost that. We have no rites of passage or rituals to guide and fortify children as they pass into adolescence and adulthood.

It's up to parents to clean up their own issues and take responsibility for helping shape their kids' brains and their lives, helping them succeed not only at sports and academics, but at loving.


The Time is Right for "Holding Time"

It's time for another look at an 18-year-old book on repairing the attachment between mother and child.

When Martha G. Welch wrote Holding Time in 1989, the idea of attachment -- the bond between mother and baby -- was something intuitively understood, but not scientifically proven. Since then, studies of rodents, mammals and humans using functional MRI have begun to show how early nurturing shapes the brain, and how the lack of it harms brain development.

Welch treats attachment disorder using holding therapy at her treatment centers in New York City, Chautauqua and Greenwich, Conn. She's a psychiatrist at Columbia University's Department of Neuroscience, and she's studying both the role of oxytocin and secretin in autism and possible therapeutics using these two peptides. (Secretin is a gastric hormone that prompts the pancreas, stomach and liver to release digestive enzymes.)

Welch's method aims to repair the bond between mother and child. A baby's nervous system and brain aren't fully formed at birth, and development takes place in response to interactions with her mother.

Holding, nursing and nurturing develop the oxytocin response and they seem to determine the amount and sensitivity of oxytocin receptors in the brain, especially the parts of the brain that deal with social interaction. Oxytocin also is critical in moderating the fight-or-flight response.

If a baby experiences fear or abuse, she develops a strong and oversensitive stress response. If she is neglected, or doesn't get enough holding and attention, her brain won't learn to release oxytocin when she does have physical contact -- and contact, even soft nurturing, may seem intense and scary to her deprived body.

The diagnosis of reactive attachment disorder is a catchall similar to autism spectrum disorder. But, no matter the symptoms, its roots are trauma, neglect and the lack of a secure bond with a mother. (I'm using mother here to describe a role; anyone who is the primary caregiver and nurturer of a baby is acting as her mother.)

In Welch's method, the mother takes the child into her lap and attempts to make and keep eye contact. Welch's holding therapy typically goes through three stages: confrontation, rejection and reconciliation. In the first stage, holding often means restraining the child on her lap. In the second stage, the child may reject not only being held but also his mother, telling her he hates her, she smells, she's bad. The mother may express her own feelings, saying, "It makes me feel bad that you won't look at me," for example.

Finally, all the negative feelings having been expressed, the child and mother feel peaceful and can connect lovingly. According to Welch, this process is a more expressive version of the gentle cycling between arousal and calm that ideally happens when a mother interacts with her newborn. Being restrained on Mommy's lap gets the child's adrenaline going; that leads to the expression of rage, fear and sorrow, leading to release of those feelings and a new kind of arousal, that of pleasure in being close to Mommy.

Welch writes, "As the struggle continues, the child usually experiences a whole range of emotions but in the safety of his mother's arms. This time the state of arousal is associated with being held lovingly, resolutely, and closely."

It's important for the mother to also be able to release some of her frustration and anger, Welch believes. She writes, "Holding time allows both of you to discharge your pent-up aggression in a safe way."

Welch's method has much in common with Theraplay: The child being controlled and kept in therapist's or mother's lap; the therapist or mother taking charge of the interaction (designed to let the child know there is an adult in control); the goal of mutual gazing and intimacy; and the theory of consciously recreating the experiences that lead to healthy brain development in the infant.

While Theraplay uses activities to distract the child from her distress and engage her less directly with therapist or parent, the holding time method asks mother and child to stay with their feelings and work through them.

The book and Welch's treatment have come in for criticism because of the enforced holding, especially in light of the horrible cases where RAD kids have died during different types of holding therapy, when they were covered in blankets of grownups laid on top of them.

But her work makes sense in light of attachment theory. Children who aren't well attached to their mothers may be either anxious -- desperately craving attention -- or avoidant. Avoidant kids have learned that being close to Mommy means being hurt -- either being rejected or being yelled at. So, they've decided the safest course is to cut themselves off from anyone else.

I grew up avoidant. I still remember the moment when I consciously decided, "I'm not going to let them hurt me anymore." I still craved love and connection, but when it was offered to me, I froze. I desperately needed someone to break through the ice, take hold of me and love me. I kept waiting for someone to do that, but of course, since I couldn't reach out or ask for it, no one ever did.

From my own experience, I think holding therapy may be just what an avoidant kid needs.
Holding Time explains how to use this method; however, I'm not so sure parents should try it without training. The key to holding therapy is that the mother accept the child's rage, letting him know she loves him no matter what. This is easier said than done.

In the examples in the book, the mothers always respond by expressing their needs or feelings in non-judgmental ways. "I know you are angry at me, but I still love you." "I feel upset when you scream and fight. I am going to hold you until we both feel better."

This kind of response is tough for any of us to do; and, to be brutally honest, if this kind of interaction comes naturally to a mom, her kid is not likely to be in need of holding time. (In the book, Welch doesn't discuss the special needs of adopted children, who may have been traumatized or deprived before being adopted; this was before adoption became as widespread as it is today.)

A parent who hasn't been trained in how to respond could end up damaging the child more. As one Amazon.com reviewer, a self-described survivor of forced hugging, put it, "I found it punitive and abhorred it. Who wants to be yelled at and told to look at somebody while being subdued by force?! Who wants to be the recipient of false accusations with no recourse or defense?!"

If the mother hasn't learned how to give love, if she uses holding time to express herself in ways that frighten or hurt her kid, it will damage the bond even worse, by denying the child the one defense he has: withdrawal.

But if mother and child learn to do this with the support and guidance of a therapist, it could be that revelation that Welch promises: "a closer, more satisfying and truly wonderful relationship with your child."

Theraplay to Shape a Child's Brain

Interview: Dafna Lender, Theraplay Institute