PREGNANCY

A baby's need for touch is as fundamental as her need for nourishment and warmth.

Scientists will tell you that, from an evolutionary point of view, the needs of babies haven't changed much in the last million or so years. Babies and their parents are designed to be inseparable for the first weeks and months of life. Held close, babies get to eat whenever they want, stay warm, and are protected from wild animals. So a baby's need for touch is as fundamental as her need for nourishment and warmth.

When parents and babies stay in touch, both benefit. We know, for instance, that babies who are placed on their mother's bodies following birth are better able to regulate their body temperature than babies put under a warmer. When close physical contact is maintained, babies tend to sleep better and cry less. Lots of contact improves breastfeeding and lessens engorgement during the early postpartum period. And getting in touch with a baby helps parents tune in and respond to her cues.

Lessons from Kangaroo Care

First pioneered out of necessity in a Columbian hospital where incubators were scarce, kangaroo care is the practice of placing premature babies skin-to-skin against their parents. The doctors and nurses first put premature babies on their mothers chests in a last-ditch effort to keep them warm, but to their surprise the babies seemed to thrive on the extra contact. Study after study has shown that when premature babies are cared for in this way, breastfeeding, sleep and weight gain show remarkable improvement. The babies get well faster, grow more quickly and are able to go home sooner. Kangaroo care is now a standard of care for premature infants in many Canadian hosptials.

Carrie Oliphant's daughter, Sierra, was born at 25 weeks gestation, weighing only one pound, 4 1/2 ounces. Both mother and daughter were very sick at the time of the birth, and the doctors told Carrie that her baby might not survive. But survive she did; Sierra is now a busy toddler of 19 months.

"I wasn't able to hold her until she was three weeks old, when we started kangaroo care," recalls Oliphant. "It sounded wonderful to me because it was so hard not to be able to hold her. It's a natural thing. When your child is born, you hold your child. It's funny, when I held her, it was as if she knew she was where she should be. She clung there, and laid her little head on my heartbeat. It gave me that sense of, 'Oh, everything is going to be okay.' That's when I started to see her improve. She became more responsive and aware, she slept better and started to gain weight."

For many babies like Sierra, skin-to-skin contact seems to give them the edge they need to survive the challenges of premature birth. But what about the full-term, healthy newborn infant?

Peterborough, Ontario mother Carolyn Kay remembers the first weeks with her son, how staying close was good for both of them. "The most powerful sense of connection I felt with Sebastian was when I began rocking him to sleep at night. When I think about touch, I guess what I think about is how we communicate, or how we get along through touch. I love to hold him and hug him, and he loves to be held."

Roseanne Hickey is a clinical nurse specialist in perinatal care at Women's College Hospital in Toronto, who also leads infant care workshops for parents experiencing high-risk pregnancies.She's seen first-hand how important touch is to babies. "We've seen the value of kangaroo care, and you can make the extrapolation to the healthy newborn. Just watching a baby sleeping on mom's chest, or receiving a massage, or when a baby is upset, I've seen the nurses in an ICU put a hand on each side of the baby, one on the tummy and one on the back, just firmly but gently hold that baby... It's amazing how they come back into themselves."

Hickey encourages parents to think about the first four to six weeks as a sort of second gestation, a time when the baby gradually makes the transition from womb to world. Parents have the task of easing that transition, of helping the baby feel as secure and comfortable as possible. And the best way to do that is to try and replicate, as much as possible, those womb-like conditions.

"They've really been getting a big hug in there, for all those months," says Hickey. "Just think what a shock it must be, to come in to the world and then to be wrapped up in a blanket away from Mom. Do we think they're going to be happy then? To me it's just so silly that for years we thought that was what should happen. But now we are encouraging lots of free access to the breast, lots of skin-to-skin contact in the first hours especially."

Sometimes though, staying in touch with your baby means side-stepping some pretty entrenched cultural biases. Etobicoke, Ontario mother Kelley Nadal recalls the first few days with her daughter Bronwyn, when she was warned more than once about the dangers of picking up the baby too much. "It was almost this taboo, that if I picked her up too much, or nursed too much, she might become clingy. I made a definite decision to spend more time alone with her, and not have so many visitors. I gave myself permission to pick her up whenever she cried and to breastfeed as much as she wanted, because I felt I needed to hold her more, and learn how I was able to soothe her."

Bronwyn's father, Jono Pye, remembers the simple pleasure of holding his babies skin-to-skin. "We did that a lot. Lying in bed, it's just sort of a natural thing to do. You draw them in close, and that generally calms them. Having a baby lying on your chest is a really great thing."

Jono recalls other ways in which touch helped him develop a close, hands-on relationship with his children. "Just lots of hugging when you're carrying them, and talking to them. I always rubbed their foreheads for some reason. Somehow it soothed both of us." Jono remembers too, how important it was to have lots of contact when his babies were content, and then to develop strategies for those times when they weren't so happy that would help both of them.

"I found that Bronwyn was very sensitive to how I was feeling as well. I had to stay calm myself. Because if a baby's crying a lot, no matter how saintly you are, you get tense after awhile. But that just sort of exacerbates the whole thing. So you know, you go through the initial checklist ÿ is she hungry, or wet, or too cold or too hot. After that, it becomes a matter of finding a way to soothe her that would also help me stay calm. For us, it was often some gentle music or a quiet walk outside."

What About Crying?

It's a fact that when babies cry, the most effective way to stop the crying is to pick them up. We all do it instinctively, because it works. But in the 1980s, a Monteal study that looked at the effect of increased carrying on infant crying found that carrying your baby now, may actually help reduce the amount of crying later.

Ronald Barr and Urs Hunziker, both physicians and researchers at the McGill University Children's Hospital Research Institute in Montreal, recruited 99 full-term, first-born breastfeeding infants and divided them into two groups. In the first part of the study, both groups of infants were carried for about one hour a day, to determine the average amount of crying in a day. Barr and Hunziker then asked the first group of mothers to increase the amount of time they spent carrying their babies, either in their arms or in a baby carrier, an additional three hours each day.

The results were dramatic. After only one week, the babies in the increased carrying group were crying less, while the control group actually were crying more than they had initially. There were other benefits as well. Babies in the increased carrying group breastfed more frequently and gained weight faster, suggesting that the added body contact helped the moms tune in and respond more quickly to their baby's cues.

But perhaps the most surprising finding was the effect that the increased carrying had on the overall pattern of infant crying. "The crying pattern of normal infants in industrialized societies is characterized by an overall increase until six weeks of age, followed by a decline until four months of age, with a preponderance of evening crying," says Barr. But the infants in the study who were carried more did not experience the six-week "crying peak," and cried and fussed 43 percent less during the evening hours. The researchers concluded that the relatively low levels of carrying in our culture may predispose our babies to increased amounts of crying and colic.

For some babies however, it seems that the womb-to-world transition is simply more difficult. Jono remembers Bronwyn as a baby who was always soothed by being carried. But then came a feisty boy called Liam, who challenged all his parent's resources. "He would cry every night for hours," remembers Jono. "The only time he stopped was once when we were at a cottage and we would walk along the beach with Liam in the snuggle sack. That seemed to work."

Kelley was sure that holding Liam was just as important as it had been for Bronwyn. "I remember not knowing what to do, but nevertheless wanting him to know that we were there. We didn't know what he wanted or how to soothe him, but I think maybe that's when it's most important to hold your baby. I couldn't imagine putting him in a crib and letting him scream for an hour. I know it can be very difficult, but I figure even if I can't get them to stop crying, I can let them know I'm here. And the only way to do that is by touching them."

Of course parents do need the occasional break, and we may not choose to carry our babies 24 hours a day as our evolutionary forebears did. But lots of touch helps both us and our babies, and honouring that instinct to stay close is good for everyone.

There's a mountain of research that shows how touch can influence brain development, enhance self-esteem and attachment, and promote physical growth and well-being. But the simple truth is that touch is the first language we speak with our babies.Through touch we let them know the world is a safe and secure place. And very soon the day comes when the baby reaches out to touch us ÿ just to let us know we've got it right.

The Benefits Of Massage

Cindy McNeely is a registered massage therapist in Toronto who teaches and supervises massage students working in five different perinatal care units. She explains that the benefits of massage to an infant are essentially the same as those experienced by an adult. "It helps increase the circulation, relaxation and food absorption, and sometimes eases gas or colic. A bedtime massage can help a baby sleep better."

McNeely finds that many of the parents who attend her infant massage classes are massaging their babies already, but want to know how to "do it right."

"I teach a very specific technique for each area of the body. It's not necessary that parents follow it to the letter, but it does create a format and a framework so that parents feel like they know what they're doing, whether that's the direction of the strokes, the moulding of the hands, or the depth of pressure they use." McNeely also encourages parents to begin with a little relaxation exercise themselves, so that they're able to slow down and focus on the massage.

The most important element for McNeely though, is what she calls "asking the baby's permission," which essentially means tuning in to how the baby is responding to the massage. "You're watching the baby, watching the face, the arms and the legs, looking for startle reflexes... Because if a parent isn't listening to the baby's cues then it's not going to be a positive experience," observes McNeely. "I have seen babies literally kick their parents' hands away. They let you know very clearly whether they're enjoying it or not."

McNeely works not only with well babies and their families, but also with babies facing medical or developmental challenges. "When there have been a lot of medical interventions and parents haven't had all the cuddling and holding you normally get with a healthy newborn, seeing how their babies respond in a positive way to touch really helps build parents' confidence."

McNeely suggests that parents who are interested in learning infant massage attend a class, or find a registered massage therapist who can offer private instruction. If those resources aren't available in your community, McNeely recommends the book "Nurturing Touch", by Kallena Bapeshosf and Juliana Dellinger-Bavolek (Family Development Resources Inc.) which is also appropriate for families where English is not the first language, since it illustrates the strokes very clearly. (Available through Parentbooks, at 1-800-209-9182, for about $9 plus shipping and handling.)

Winter 1998/99