Childbirth: A Love Story (sometimes derailed)

She gazes into his eyes and speaks to him in soft murmuring tones. He follows her every move with rapt attention. For both, the other is a person full of light and color, while the rest of the world has faded to a kind of uniform pale background. She is obsessed by thoughts of him and worries that something terrible may befall him. He is constantly attuned to her whereabouts.

In this week of Valentine's Day, you might think I am describing romantic love. But I am, in fact, describing a mother and her newborn son. Physicians, nurses and other professionals who work with pregnant women and newborns have the frequent privilege of bearing witness to people falling in love. When all goes well, the period of time when a newborn, who is wired for successful communication from the start, meets his or her caregivers, is a time of joy and bliss.

It is particularly devastating, therefore, when this first communication, this early developing relationship, is less than successful. When this happens, it is often because of postpartum depression and/or anxiety, a very fussy baby, or both. In fact, these problems often go together, as stress in pregnancy, as well as psychiatric medication use in pregnancy, may be associated with irritability, poor sleep, and feeding problems in the newborn.

Traditionally, help for postpartum depression and anxiety has been aimed at treating the caregiver (usually the mother) with psychotherapy, psychiatric medication and support groups. Problems seen as residing in the baby are treated separately, usually by the pediatrician.

But if one thinks of these problems as disruptions in a love relationship, it makes sense to work with parent and child together (to continue the analogy- it's kind of like couples therapy.) Recent research suggests that working with mother and baby together, with the specific aim of supporting successful communication, may be effective in preventing long-term negative effects on child development. Among the most well studied of these interventions is the Newborn Behavioral Observations (NBO) system.

This tool was developed by J. Kevin Nugent and colleagues as a practical, clinical application of T. Berry Brazelton’s Neonatal Behavioral Assessment Scale (NBAS) Brazelton was among the first, in the early 1970's to recognize the range of capabilities of the newborn, and their contribution to the parent-child relationship.

I am in the process of introducing this intervention at Newton-Wellesley Hospital as part of the new Social Emotional Health Program. It is ideally done in the hospital when often both caregivers are present, and there is less time pressure and external stress than in an office visit. It can also be done in the home setting by home visitors. In addition, it can be done in the office setting up to about 3 months of age.

When I am consulted to do the NBO with a mother-baby pair, it never fails to be an exhilarating experience. I have been thinking about the reason for my intense reaction. When I am with a mother, particularly one who has been worried about her connection with her baby, as she experiences the way her baby responds to her voice, or learns about his ability to calm himself, or any other of a number of abilities revealed by the NBO, I am in the presence of a profound and deepening love relationship. No wonder it is a kind of a high that eclipses all other events of the day!