Never a dull moment

13 september 2010

Borstvoedingprijs 2010

2 jaar geleden was ik winnaar van de Borstvoedingprijs 2008 en nu voorzitter van de jury voor de Borstvoedingprijs 2010. Mijn collega juryleden zijn Chantal van de Bossche van WECF en Justine Pardoen van Ouders Online.
Vanaf nu kan worden gestemd door ''het publiek'' uit de drie door de jury uit de nominaties gekozen kandidaten Ellen van Kooij, Chella Verhoeven en Marianne Vanderveen.

Stem nu!

3 september 2010

Kangaroo Mother Care: Nils Bergman over de kracht van huidcontact

"Miracle premature baby"

A news report of an infant declared dead, and surviving after being given to mother to hold in skin-to-skin contact, has made major media attention. Prompted by inquiries, I have made this commentary.

This is an emotive story, but hardly original! Unusual, but occurs ... actually right here in Cape Town just two weeks ago! Susan Ludington-Hoe opens one of her books on Kangaroo Care with a similar anecdote.

My own research and "hypothesis" on this is based on the fact that to almost all newborn mammals, separation from mother is life-threatening. This activates a very powerful defence response, which is to shut down and immobilise ( freeze and dissociation by vagal nerve activation). Reptiles use this exact same vagal defence mechanism to slow their hearts to levels that would kill mammals, who need more oxygen! As adults, we think that stress increases heart rate because of our sympathetic nervous system, but what is not properly understood is that even full term newborns have very immature sympathetic nervous systems, and premature infants extremely immature. Prems can only dissociate, and if they are stressed before they are born, they may just remain in dissociation ... with dangerously low oxygen levels.

Our resuscitation technology can force some regulatory oxygen and breathing and blood pressure and temperature ... but it is working against the "autonomic nervous system tide". There is great variability in sensitivity and resilience in all human beings, and some are sensitive and succumb despite our technology.

What "kangaroo care" does is restore the basic biology for survival. It is "skin-to-skin contact" which is the key, because the deep sensory fibres from the skin go to the "emotional processing unit" of the brain (amygdala), and tells the brain "you are safe". This de-activates the dissociation (un-safe mode), and restores the regulation (safe mode) - which is the real function of the vagal nerve.

But there may be a paradox in this very case. Circumstances led to this infant being allowed to stay in skin-to-skin contact for a long time, which may in fact have been its saving grace !! Perhaps its tolerance of separation may have been non-existant. But the paradox may work even deeper ... perhaps it was so profoundly powerful in its vagal response to dissociate in order to survive, that it could last long enough in the shutdown state to be allowed to come back to mother! He may therefore be highly resilient, which is why he survived !!!! The World Health Organisation calls this Kangaroo Mother Care, and Mother was the key to this baby's survival.

But it is good that this is receiving so much attention ...
all babies should be in skin-to-skin contact with Mother from birth onwards,
no babies should be separated from their mothers (or fathers!).
This applies particularly to premature babies.

Dr Nils Bergman
Cape Town, South Africa