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1
Dr Nils Bergman
MB ChB, DCH, MPH, MD
(USA equiv: MD, MPH ,PhD)
Cape Town, RSA
www.skintoskincontact.com
SCIENTIFIC & EVIDENCE BASE for SKIN-TO-SKIN CONTACT
Speaker DisclosureUnder ACCME guidelines:
a) I am the South African distributor of
MIRIS : Human Milk Analyzer
b) My wife and I are owners and directors of
NINO Academy (Tendotouch Pty Ltd)
produce educational & promotional goods and materials
related to the talk content.
SCIENTIFIC & EVIDENCE BASE for SKIN-TO-SKIN CONTACT
“Cells which
FIRE TOGETHER, WIRE TOGETHER,
and those which don’t, won’t.”
Carla Shatz
Prof Hugo Lagercrantz
0 10 20 30 40w 6m 2y 10y 60y
Birth
NEUROGENESIS
Myelination
Arborisation
SYNAPTOGENESIS
Programmed cell deathCOMPETITIVEELIMINATION
NEURONAL PLASTICITYMIGRATION
0 10 20 30 40w 1y 3y 13y 50y 80y
28 Birth Puberty
MAXIM
AL O
CCURRENCE
Synapses
Dendrification:
peak 2m & 6m
0 10 20 30 40w 1y 3y 13y 50y 80y
28 Birth Puberty
MAXIM
AL O
CCURRENCE
RELATIVE BRAIN ACTIVITY
METABOLIC ACTIVITY
peaks3 years
NEW SYNAPSE FORMATION
2
Convolutions of the cortex
•
Robinson RJ & Tizard JPM Br Med Bull 1966 22:49-55
The HARD DISK
Computer has 500 GB=500 000 000 000 b
Brain connections = 500 000 000 000 000 000 000
50 billion neurons, 50000 synapses, 2000 neuron networks
SECOND COMMANDMENT OF NEUROSCIENCE
USE IT, OR
LOSE IT
SYNAPSE DEVELOPMENT
At birth, the human being has more synapses in its brain than at any other stage of life.
Impulse
Presynaptic neuron
Vesicle
Transmitters
Synaptic cleft
ReceptorsPostsynaptic
neuronPostsynaptic activity
SENSORY STIMULUS
synapse store chemical signal
chemical signal stronger
THRESHOLD EXEMPT from elimination
(synapse stabilised)PATHWAY
(Rima Shore 1997)
3
fetal REM sleep(or active sleep) seems to be
particularly importantto the developing organism
... spontaneous synchronous firing
Marks et al 1995
REMNR1NR2NR3SWS
ACQUISITION CONSOLIDATION MEMORYFORMATION
poly-sensory input transfer information P wavesshort-term memory “SNR” strong signals returns infostored cortex amygdala / to neocortex:
hippocampus organizedAwake and REM NREM stage 4 REM
BRAIN WIRING
Stanley Graven 2006
Primary function of sleep pertains to consolidation of memory
EARLY DEVELOPMENT
Gestational age20w all structures completed
parallel development of structure & function
(Hugo Lagercrantz 2004)
Brain growth depends on experiences !!
NEURO DEVELOPMENT
NEURO PHYSIOLOGY
NEURO BEHAVIOUR
NEURO DEVELOPMENT
NEURO BEHAVIOUR
PATHWAYS CIRCUITS NETWORKS
4
When does the infant
become conscious?
Scientific American 1986
Scientific American Mind 2009
You can never reach the same highlevels of catecholamine levels
during your whole life as at birth
Reduced catecholamine surge after C-section
Vaginal delivery Elective C-section
The infant brain is not
blank!Resting activity
-“stream of
consciousness”
The newborn brain consumes 50 %
of all the blood glucose-
In the adult 20 %
Scientific American 2010
The infant brain is not
blank!Resting activity
-“stream of
consciousness”
Noradrenergic neurons from
LOCUS COERULEUS
Awake at birth
AWAKE / ALERT CENTRE
5
FEARCONTROL
CENTRE
REWARDCONTROL
CENTRE
SOCIALCONTROL CENTRE
OXYTOCINDOPAMINE
CORTISOL
AT BIRTH,
the brain has TWO CRITICAL SENSORY NEEDS:
SMELL & CONTACTconnect direct to the amygdala
THE NEWBORN
BRAIN
SKIN-TO-SKINCONTACT
fires and wires
the amygdala-prefronto-orbital cortical pathway (PFOC)
AMYGDALA:EmotionalProcessingUnit CPU
Prefrontal cortexExecutive
function
SOCIAL and EMOTIONAL
INTELLIGENCE
6
In humans, oxytocin increases gaze to the
eye region of human faces and enhances
interpersonal trust and the ability to infer
the emotions of others from facial cues.
Interpersonal awareness
Emotions
Kerstin
Uvnas-Moberg
Ross 2009
Simulation theory:EMPATHY is generated by inner imitationof actions of others
Morphing emotion AMYGDALA FUSIFORMGYRUS
Smell
Skin contact
FACE RECOGNITIONCENTRE
OXYTOCIN
EMOTIONCONTROL CENTRE
FEARCONTROL
CENTRE
REWARDCONTROL
CENTRE
SOCIALCONTROL CENTRE
OXYTOCINDOPAMINE
CORTISOL
EMOTIONCONTROL CENTRE
7
The BOND is made up of the
sensory inputs from the parent to the infant
REGULATION
Bowlby 1969, 1973, 1980
Through “hidden maternal regulators” ...
warmth activity levelmilk heart rate
“ physiological set points “internal working modelsscripts – templates
a mother precisely controls everyelement of her infant’s physiology,
from its heart rate to its release of hormones
from its appetite to the intensity of its activity
(Gallagher 1992)
Through “hidden maternal regulators” ...
Clinics in Perinatology,
June 2004, Vol 31(2) page 210
Stanley Graven
Early neurosensory visual
development of fetus and newborn.
“It is a serious mistake to assume that the
principles derived from careful animal studies
do not apply to human infants.
The risk of suppression or disruption of
needed neural processes ... is very significant and potentially lasts a life time.
BONDING components
ANS
Upstream
Downstream
EmotionalANS
Social
Physical
8
SENSORY STIMULATION
AUTONOMICBODY CONTROL
EMOTIONAL EXCHANGES
WELL-BEING
HEALTH
The First Idea: How Symbols, Language,
and Intelligence Evolved from our
Primate Ancestors to Modern Humans
Stanley I. Greenspan & Stuart G. Shanker
The First Idea
“It is necessary for a child to be engaged in a series of affective (emotional) interactions that give rise to the developmentof motor sensory and social capacities,which, when combined with symbol formation, lead to language.
Greenspan & Shanker 2006, p39
The First Idea (p39)
“The symbolic use of language, in turn, creates the foundationfor more advanced social and intellectual capacities, including higher and higher levelsof reflective thinking.
Greenspan & Shanker 2006, p39
SENSORY STIMULATION
BODYLANGUAGE
AUTONOMICBODY CONTROL
EMOTIONAL EXCHANGES
COMMUNICATIONWELL-BEING
SPEECHHEALTH
ATTACHMENT - REGULATION
the objective is to achieve theability to establish an efficiently regulated right brain:
‘STABILITY THROUGH CHANGE
The foundation for INFANT MENTAL HEALTH
Schore 2001a
RESILIENCE(= STRESS RESISTANCE)
“capacity to maintain healthy emotional functioning in the after-math of stressful experiences”
DUAL CODING REGULATION - ATTACHMENT
9
SENSORY STIMULATION
BODYLANGUAGE
AUTONOMICBODY CONTROL
EMOTIONAL EXCHANGES
COMMUNICATIONWELL-BEING
SPEECHHEALTH
Neuronal Plasticity“the first three years are decisive”
The cortex retains some plasticitythroughout life …
But limbic systemand the midbrain are fixed after theage of three years
Neuronal Plasticity“the first three years are decisive”
platform forsubsequent development of higher cognitive functions.
MOTHERBOARD
Motherboard is thehardware platform tobuild the computer.
The limbic brain is the“platform for higher cognitive functions
Stanford Report, July 12, 2006
Forget the latest toys: All kids really need is loveAuthors say public policy should focus on helping
children have good experiences in their earliest years
Knudsen et al, 2006
“The brain
is designed to be
sculpted into its final
configuration by the
effects of early
experiences”
These experiences are embedded
in the attachment relationship.
10
MOTHER
is the KEY forNEURODEVELOPMENT
All mammals have set sequence of behaviours at birth ………….
……. All with a single purpose : to
BREASTFEED
After birth, events are
determined …
… by the neonate
stimulating the mother!
(Rosenblatt 1994)
Breast-feeding is “established
through a set of mutual,
complex sensory stimulations
in mother and child.”
(Kjellmer & Winberg 1994)
HABITAT
DETERMINES
BEHAVIOUR
BEHAVIOUR ENSURES
BIOLOGICALNEEDS
Warming, feeding andprotection behaviours areintricately, inseparablylinked to the right place.
(Alberts 1994)
= NUTRITION PROGRAMME
11
Through “hidden maternal regulators” ...
warmth activity levelmilk heart rate
“ physiological set points “internal working modelsscripts – templates
a mother precisely controls everyelement of her infant’s physiology,
from its heart rate to its release of hormones
from its appetite to the intensity of its activity
(Gallagher 1992)
Through “hidden maternal regulators” ...
In all mammals …….
….. the newborn is responsible for initiating breastfeeding,
not the mother !!
EXCEPT IN HUMAN ???
Sequence human newborn breast-feeding
Pre-requisite = habitat
hand to mouth
tongue moves
mouth moves
eye focuses nipple
crawls to nipple
latches to nipple
suckles
(Widstrom et al 1994)
There are “needed neural processes” !
12
Activation of Olfactory Cortex in Newborn
Infants After Odor Stimulation:
A Functional Near-Infrared
Spectroscopy Study
SMELL vanilla / colostrum / water (control)
read NIRS activity FRONTAL LOBE
In the 14 babies
older than 24 h
there was no
significant
difference
between the
changes in [Hb
O2] during control
and colostrum
exposure
Those babies
showing the
greatest
increase in
[Hb O2] were
between 6 and
24 h old at
testing
• This was confirmed by
demonstration of a statistically
significant negative correlation
between changes in [Hb O2] and
postnatal age (r 520.64, p 5 0.001
with 95% confidence interval) (Fig.
4). Those babies showing the
greatest increase in [Hb O2] were
between 6 and 24 h old at testing
• In the 14 babies older than 24 h
there was no significant difference
between the changes in [Hb O2]
during control and colostrum
exposure
“The newborn may appear
helpless, but displays an
impressive and purposeful
motor activity which, without
maternal assistance, brings the
baby to the nipple.
(Michelson et al 1996)
“The newborn may appear
helpless, but
raises its own temperature,has a higher blood glucose,metabolic adaptation faster.
(Widstrom 1987)
METABOLIC ADAPTATION
SSC started in the first 20 minutes after birth
SSC CotBlood glucose (1 hr) 3.17 2.56Base excess drop 3.4 1.8
(Christenson 1992)
13
Warming, feeding and
protection behaviours areintricately, inseparablylinked to the right place.
(Alberts 1994)
a mother precisely controls everyelement of her infant’s physiology,
from its heart rate to its release of hormones
from its appetite to the intensity of its activity
(Gallagher 1992)
Through “hidden maternal regulators” ...
Clinics in Perinatology,
June 2004, Vol 31(2) p293
Joy Browne
“Early relationship environments:
physiology of skin-to-skin contact
for parents and their preterm infants”
The mother and infant at birth are
ready to develop optimal attachment
relationships and to work together
toward organised cognitive, social
and emotional development.Joy Browne 2004
... the newborn child is a small human being, with all its senses developed,
open and receptive.(John Lind, 1979)
Visualcortex
PFOC
Amygdala
SSC
says “open eyes”
says “mother”
says “safe”
says “approach”
Eyes say “contact”
Psalm 22 v 9
“I learnt trust on my mother’s breasts”
Neural circuitry of bonding
EPIGENETICS,NEUROSCIENCE,EVOLUTIONARY
BIOLOGY,
THE NEUROSCIENCE OF BIRTH AND BREASTFEEDING
14
Scientific
American,December 2011
INK “Genome” – genes of species
“Genotype” - genes in specimen
… highly conserved neuro-endocrine behaviors
INK
PENCIL
“Genome” – genes of species
“Genotype” - genes in specimen
“Phenotype” – specimen resulting from
gene – environment interaction
… highly conserved neuro-endocrine behaviors
INK
Pencil
“Phenotype” – specimen resulting from
gene – environment interactionPencil
EPIGENES …controls on the DNA/gene
“switches in the mind”
G x E
“For species such as primates, the mother IS the environment.”
Sarah Blaffer Hrdy, Mother Nature (1999)
Babies Celebrated, Beatrice Fontanel and Claire D’Harcourt, © 1998 Harry N. Abrams, Inc.
Nothing an infant can or
cannot do makes sense,
except in light of mother’s body
15
“except in the light
of mother’s body.”
NEURODEVELOPMENT
The DNA Behaviour
EVOLUTIONARY BIOLOGY
ENVIRONMENT EXPERIENCE REPRODUCTIVE FITNESSADAPTATION
The Neuroscience of Birth & BreastfeedingThe Brain
EPIGENETICS
EXPECTED UNEXPECTED
NEURODEVELOPMENT
The DNA Behaviour
EVOLUTIONARY BIOLOGY
ENVIRONMENT EXPERIENCE REPRODUCTIVE FITNESSADAPTATION
The Neuroscience of Birth & BreastfeedingThe Brain
EPIGENETICS
BIRTH
BEYOND BREASTFEEDINGFeed Sleep Cycling
MOTHERBABY
BONDING Sensitization
Secure attachment
Attuned parenting
BIRTH
BABY
BONDING
BREASTFEEDINGFeed Sleep Cycling
Secure attachment
MOTHER
Sensitization
Attuned parenting
REPRODUCTION
Highly conserved
Neuro-endocrine behavior
DEFENSE NUTRITION REPRODUCTION
HORMONES NERVES MUSCLES
Highly conserved
Neuro-endocrine behavior
Estrogen peaksProgesterone falls
Increased spines(dendrification)
New circuits =enhanced learning
Pup stimulationRich environment
New circuits =enhanced learning
Less fear / anxietyAmygdala
Better learning / memory Hippocampus
Better stress toleranceHypothalamus
Maternal neurobehaviour
16
Maternal neurobehaviour
Enhanced foraging
More emotional resilience
Stress responsiveness
Enhanced problem solving
Enhanced foraging Time to find abaited food well:
Non-mother 130 sec
Mother mouse 40 sec
Enhanced problem solving
A maze with foodAt end: Mother mouse
learns herway through
ONE DAYNon-mother
ONE WEEK
MEMORY permanently
improved
Same MAZE,TWO YEARS
LATER:
Mother mouse REMEMBERSTWICE AS FAST
More emotional resilience
LESS ANXIETY
Stress responsiveness“Open Arm” – exposed and scary for mouse.“Closed arm” – secludedand safer, less anxiety.
Mother mouse 30 -40 %
Non-mother 5 – 10%
PROLACTIN risesOXYTOCIN rises
MEMORY permanently improved
BDNF (=Brain Derived Neurotropic Factor)
OpioidsGlucocorticoids etcetera .....NorepinephrineVasopressin (fathers specially)
LACTATION
OXYTOCIN
17
SUE CARTER Breastfeedingmothers have
HIGHESTVAGAL TONE Stress
Resistance
LOWER systolicblood pressure Stress
tolerance
Mock jobinterview: NEURODEVELOPMENT
The DNA Behaviour
EVOLUTIONARY BIOLOGY
ENVIRONMENT EXPERIENCE REPRODUCTIVE FITNESSADAPTATION
The Neuroscience of Birth & BreastfeedingThe Brain
EPIGENETICS
BIRTH
BABY
BONDING
“needed neural processes”
MOTHER
Sensitization
Clinics in Perinatology,
June 2004, Vol 31(2) p293
Joy Browne
“Early relationship environments:
physiology of skin-to-skin contact
for parents and their preterm infants”
The mother and infant at birth are
ready to develop optimal attachment
relationships and to work together
toward organised cognitive, social
and emotional development.Joy Browne 2004
Milk production
NUTRITION
HypothalamusPituitary:PROLACTIN
HypothalamusPituitary:
PROLACTINOligodendrite cells MYELIN
SURFACTANT
Maternal ferocity
PROTECTION
OXYTOCIN Gaze increase: BONDING
OXYTOCINCingulateSuppressedCingulate
PFOC
approach
EYE CONTACT
Centrally released oxytocin coordinates the onset of maternal nurturing behavior at parturition and plays a role in mother-infant bonding.
Ross 2009
18
In the FIRST HOUR ……. ….. the newborn
ELICITS CARE GIVING
INSTINCTUALBEHAVIOUR FROM
THE MOTHER !!
With permission from Kerstin Uvnäs Moberg
Brain stem and limbic system structures
related to threat and safety
PREDATOR
Smell cingulate
FEARFREEZE
+ OXYTOCIN
cingulatesuppressed
Less fearFORAGE
OXYTOCIN Measure of a “good mammal mother” :
FEROCITY OF DEFENCEOF YOUNG.
Sodersjukhuset, StockholmRandomisation to new and old unit
Personal testimonyof a mother at
international KMC meeting
“The instinct of a mother to hold andcare for her baby is primordial andprimitive, and an
overwhelmingly powerful feeling.”
Jane Davis, Bogota, Dec 1998
In the FIRST HOUR ……. ….. the newborn
ELICITS CARE GIVING
INSTINCTUALBEHAVIOUR FROM
THE MOTHER !!
19
REGULATION
Amygdala:CHOLECYSTOKININ Emotion / satiety
Amygdala
Milk production
NUTRITION
HypothalamusPituitary:PROLACTIN
Maternal ferocity
PROTECTION
OXYTOCIN Gaze increase: BONDING
OXYTOCINCingulate Suppressed
REGULATION
Amygdala:CHOLECYSTOKININ Emotion / satiety
HypothalamusPituitary:
Cingulate
Amygdala
NEUROSCIENCE
The DNAEverything else
EVOLUTIONARYBIOLOGY
The Brain
EPIGENETICS
The PlaceENVIRONMENT
EXPERIENCEFITNESS ADAPTATION
“Scientific foundation” … a synthesis
“needed neural processes”
“The newborn may
appear helpless, but
skin-to-skin contactstimulates prolactin
ensures nutritionstimulates oxytocin
ensures protectionstimulates cholecystokinin
ensures wellbeing bonding
The first hours after birth are a
CRITICAL PERIOD
mutual psycho-neuro-physiological
caregivers
Critical period concept :
“Windows of opportunity in early life when a child’s brain is exquisitely primed to receive sensory input in order to develop more advanced neural systems.”
a mother’s brain …
SENSITIZATION
20
SENSITIZATION
0
5
10
15
20
25
-0.2 0 0.2 0.4 0.6 0.8 1
Maternal Behavior Q-Sort
Ho
urs
of
SS
C i
n In
fan
ts' F
irst
24 H
ou
rs
Dose of SCC first 24 hours correlatesMaternal behaviour Q SortPredicts attachment security
SENSITIZATION
0
5
10
15
20
25
25 27 29 31 33 35 37 39 41 43 45
Maternal Behavior Subscale of the NCATS
Ho
urs
of
SS
C i
n In
fan
ts' F
irst
24 H
ou
rs
Dose of SCC first 24 hours correlatesNCATS ( Nursing Child Assessment Teaching Scale )
Predicts cognitive outcome
The Relation of Early Mother-Infant Skin-to-Skin Contact to Later Maternal Sensitivity in South African Mothers of Low Birth Weight Infants
Ann E. Bigelow, et al ()
From Bergman et al 2004 RCTSSC time first 24 hr correlatedwith SSC time first month.
Skin-to-skin contact accelerated infants’ social expectations for their mothers’ behavior and enhanced infants’ awareness of themselves as active agents in social interactions.
Infants with skin-to-skin contact began responding to changes in their mothers’ behavior with their affect at 1 month; infants without skin-to-skin contact did so at 2 months.
At 3 months, infants with skin-to-skin contact increased their non-distress vocalizations during the still face phase, suggesting social bidding to their mothers.
21
Conclusion: Mother/infant SSC benefits mothers by reducing their depressive symptoms and physiological stress in the postpartum period.
JOGNN, 41, 369-382; 2012. DOI: 10.1111/j.1552-6909.2012.01350.x
EPDS (depression) score DECREASED significantly for first two visits.
JOGNN, 41, 369-382; 2012. DOI: 10.1111/j.1552-6909.2012.01350.x
Control
SSC
BONDING (Bergman mini-model)
Birth experience:Sensations hormonal changes
neural circuitsLIMBIC PLATFORM
MATERNAL SENSITIVITY
Early life experience:Neural circuits emotional & social intelligenceCORTICO-LIMBIC CIRCUITRY
ATTACHMENT
SENSORY STIMULATIONSKIN-TO-SKIN CONTACT
EMOTIONAL EXCHANGESMutual OXYTOCIN
CRITICALPERIODPATHWAYFIRING
EMOTIONAL INTELLIGENCE
SOCIAL INTELLIGENCE
BONDING
ATTACHMENT
BIDIRECTIONAL !!
Affect regulation
“Human brains are RELATIONAL”
… co-creating touch… signature unique to caregiver
PRATHIBA REEBYE
BONDING Sensitization
Secure attachment
Attuned parenting
22
NEURODEVELOPMENT
The DNA Behaviour
EVOLUTIONARY BIOLOGY
ENVIRONMENT EXPERIENCE REPRODUCTIVE FITNESSADAPTATION
The Neuroscience of Birth & BreastfeedingThe Brain
EPIGENETICS
BIRTH
BEYOND BREASTFEEDINGFeed Sleep Cycling
MOTHERBABY
BONDING Sensitization
Secure attachment
Attuned parenting
EMOTIONAL INTELLIGENCE
SOCIAL INTELLIGENCE
NEURODEVELOPMENT
The DNA Behaviour
EVOLUTIONARY BIOLOGY
ENVIRONMENT EXPERIENCE REPRODUCTIVE FITNESSADAPTATION
The Neuroscience of Birth & BreastfeedingThe Brain
EPIGENETICS
BIRTH
BEYOND BREASTFEEDINGFeed Sleep Cycling
SEPARATIONMOTHERBABY
BONDING Sensitization
Secure attachment
Attuned parenting
Toxic stress
Positive Stress
• Moderate, short-lived.
• An important and necessary
aspect of healthy development
occurs in the context of stable
and supportive relationships.
Slide by: Jack P. Shonkoff, M.D.
Under-activity
EUSTRESS
Over-activity
Tolerable Stress• Stress responses that could disrupt brain
architecture, but are buffered by supportive
relationships that facilitate adaptive coping.
Slide by: Jack P. Shonkoff, M.D.
• Strong and prolonged activation of the body’s
stress management systems in the absence of
the buffering protection of adult support.
Toxic Stress
“absence of the
buffering protection
of adult support”
Toxic Stress• Disrupts brain architecture …
… increasing the risk of
stress-related physical and mental illness.
CORTISOL
NEURODEVELOPMENT
The DNA Behaviour
EVOLUTIONARY BIOLOGY
ENVIRONMENT EXPERIENCE REPRODUCTIVE FITNESSADAPTATION
The Neuroscience of Birth & BreastfeedingThe Brain
EPIGENETICS
BIRTH
BEYOND BREASTFEEDINGFeed Sleep Cycling
SEPARATIONMOTHERBABY
BONDING Sensitization
Secure attachment
Attuned parenting
Toxic stress
Insensitiveparenting
23
… anxious parenting … mediated by stress-related mechanisms
and greater neural disorganization.
SEPARATION
Toxic stress
Insensitiveparenting
Well-adapted parenting … reward-related motivational mechanisms, temporal organization, and affiliation hormones
OXYTOCIN
Reduced catecholamine surge after C-section
Vaginal delivery Elective C-section
Can this be influenced ??
OXYTOCIN
Can this be influenced ??
Oxytocin surge absent in Caesarean
Can this be influenced ??
Vaginal birth unique pattern sensory processing, empathy, arousal,
motivation, reward and habit-regulation circuits … MORE SENSITIVE
may contribute to mental health risks & RESILIENCY in the mother–infant dyad.
Brain differences between VD & CSD mothers …
24
Affective communication
• Mirroring• Attunement• Reciprocity• Rupture / repair• Containment
Reflective function
Mind-mindednessMentalisation
ANGELA UNDERDOWN
Attunement
Attachment
Synchronous Sensitive
Contingent infant directed
Non-contingent
Intrusive InsensitiveMultiple environmental factors
NEURODEVELOPMENT
The DNA Behaviour
EVOLUTIONARY BIOLOGY
ENVIRONMENT EXPERIENCE REPRODUCTIVE FITNESSADAPTATION
The Neuroscience of Birth & BreastfeedingThe Brain
EPIGENETICS
BIRTH
BEYOND BREASTFEEDINGFeed Sleep Cycling
SEPARATIONMOTHERBABY
BONDING Sensitization
Secure attachment
Attuned parenting
Disordered attachment
Toxic stress
Insensitiveparenting
25
Mary Ainsworth (1913 – 1999)
… provide scientific evidence forBowlby’s theories.
Strange Situation Test:- secure attachment- insecure ambivalent (anxious )- insecure avoidant
CORTISOL
MICHAEL MEANEY
Unsafe environment activates HPAaxis (autonomic nervous system, ANS).
“In response to stress, CRF
… and vasopressin are
released … anterior pituitary
… synthesis release ACTH
…glucocorticoids ”CORTISOL
MICHAEL MEANEY epigenetics
Early stress alters gene expression,with health impact across lifespan.
HG BABY HG BABYLOW Grooming care
HG - High Grooming Low Grooming LG
HG BABY LG BABY
MOTHER MOTHER
Healthy UNHEALTHYadult adult
HG – High Grooming Low Grooming - LG
Makes MOTHER Makes MOTHER
UNHEALTHYadult
LOW Grooming LG
Makes MOTHER
CORTISOL
HG – High Grooming Low Grooming - LG
Makes MOTHER Makes MOTHER
HEALTHYadult
HIGH Grooming HG
Makes MOTHER
Earliest care at birth matters
Same gene switched
LG BABY LG BABYHIGH grooming care
OXYTOCIN
26
BONDING components
EmotionalANS
Social
Physical
BONDING consequence
EmotionalANS
Social
Physical
Child: Insecureattachment
Adult: AttachmentANXIETY to partner
Adult: Higher CORTISOL andlower immunity
(CD4 cells) Jaremka 2013
CORTISOL
MR – Mother Reared
Locomotion passive active
Stereotypicity neurotic relaxed
Sitting togetherreclusive social
Peer Reared - PR
Peer Reared - PR
MR – Mother Reared
Plasma CORTISOL response to STRESS (2y)
CORTISOL
Primate separation studies
Maternal Separation ParadigmEarly Deprivation (ED) vs control (CON)
0d 2d 28d 48wED n 11 Mat 30 -120 min daily
CON n 4 Mat 48w
CORTISOL
Repeated shortseparations:LOW gene expression
smalller hippocampal volume
Adults with depression, suicides:LOW gene expression
smalller hippocampal volumereduced expression frontal lobe
27
Adults with depression, suicides:LOW gene expression
smalller hippocampal volumereduced expression frontal lobe
Adults with depression, suicides:LOW gene expression
smalller hippocampal volumereduced expression frontal lobe
These findings translate previous results from rats / monkeys to humans
2ND
KNOCK
CORTISOL
Arabadzisz
Luby CORTISOL
28
NEURODEVELOPMENT
The DNA Behaviour
EVOLUTIONARY BIOLOGY
ENVIRONMENT EXPERIENCE REPRODUCTIVE FITNESSADAPTATION
The Neuroscience of Birth & BreastfeedingThe Brain
EPIGENETICS
BIRTH
BEYOND BREASTFEEDINGFeed Sleep Cycling
SEPARATIONMOTHERBABY
BONDING Sensitization
Secure attachment
Attuned parenting
Resilience Vulnerability
Disordered attachment
Toxic stress
Insensitiveparenting
RESILIENCE(= STRESS RESISTANCE)
“capacity to maintain healthy emotional functioning in the after-math of stressful experiences”
BRUCE McEWEN allostasis
PERCEPTIONS“NEUROCEPTION”
RESPONSESTRESS
ALLOSTATIC STATE
ALLOSTASIS ANY STRESS:PsychologicalNeurological
EndocrineImmune
HEALTH
elevated activity of mediators,
with return to baseline and no impact on
health.
RESISTANCE / SENSITIVITY
PERCEPTIONS“NEUROCEPTION”
RESPONSESTRESS
ALLOSTATIC STATE
ALLOSTASIS ANY STRESS:PsychologicalNeurological
EndocrineImmune
ALLOSTATIC LOAD
HEALTH
elevated activity –sustained over time,
or severe … changes the “set
points” for homeostasis(e.g. increasing blood pressure,
change in cholesterol level)
RESISTANCE / SENSITIVITY
PERCEPTIONS“NEUROCEPTION”
RESPONSESTRESS
ALLOSTATIC STATE
ALLOSTASIS ANY STRESS:PsychologicalNeurological
EndocrineImmune
ALLOSTATIC LOAD
ALLOSTATIC OVERLOAD
HEALTH
the point at which chronic load results in actual
disease or abnormal conditions.
2ND
KNOCK
RESISTANCE / SENSITIVITY
PERCEPTIONS“NEUROCEPTION”
RESPONSESTRESS
ALLOSTATIC STATE
ALLOSTASIS ANY STRESS:PsychologicalNeurological
EndocrineImmune
ALLOSTATIC LOAD
ALLOSTATIC OVERLOAD
DISEASEHEALTH
WELL-BEING SUSCEPTIBILITY MORBIDITY MORTALITY
WELL-BEING SUSCEPTIBILITY MORBIDITY MORTALITY
Spectrum of health:
29
RESISTANCE / SENSITIVITY
PERCEPTIONS“NEUROCEPTION”
RESPONSESTRESS
ALLOSTATIC STATE
ALLOSTASIS ANY STRESS:PsychologicalNeurological
EndocrineImmune
ALLOSTATIC LOAD
ALLOSTATIC OVERLOAD
WELL-BEING SUSCEPTIBILITY MORBIDITY MORTALITY
DISEASEHEALTH
RESILIENCE VULNERABILITY
RESILIENCE:“capacity to maintain
healthy emotional functioning in the after-
math of stressful experiences”
PR - Peer Reared
MR – Mother Reared
Plasma CORTISOL response to STRESS (2y)
RESILIENCE:“capacity to maintain
healthy emotional functioning in the after-
math of stressful experiences”
DISEASEHEALTH MR PR
RESISTANCE / SENSITIVITY
PERCEPTIONS“NEUROCEPTION”
RESPONSESTRESS
ALLOSTATIC STATE
ALLOSTASIS ANY STRESS:PsychologicalNeurological
EndocrineImmune
ALLOSTATIC LOAD
ALLOSTATIC OVERLOAD
WELL-BEING SUSCEPTIBILITY MORBIDITY MORTALITY
DISEASEHEALTH
RESILIENCE VULNERABILITY
RESILIENCE:“capacity to maintain
healthy emotional functioning in the after-
math of stressful experiences”
RESISTANCE / SENSITIVITY
PERCEPTIONS“NEUROCEPTION”
RESPONSESTRESS
ALLOSTATIC STATE
ALLOSTASIS ANY STRESS:PsychologicalNeurological
EndocrineImmune
ALLOSTATIC LOAD
ALLOSTATIC OVERLOAD
WELL-BEING SUSCEPTIBILITY MORBIDITY MORTALITY
DISEASEHEALTH
RESILIENCE VULNERABILITY
WELL-BEING SUSCEPTIBILITY MORBIDITY MORTALITY
DISEASEHEALTH
RESILIENCE VULNERABILITY
NEURODEVELOPMENT
The DNA Behaviour
EVOLUTIONARY BIOLOGY
ENVIRONMENT EXPERIENCE REPRODUCTIVE FITNESSADAPTATION
The Neuroscience of Birth & BreastfeedingThe Brain
EPIGENETICS
EXPECTED UNEXPECTED
EXPECTED UNEXPECTED
SPECTRUM of expression in POPULATION
Platform for better understanding of PUBLIC HEALTH.… policy and practice that impacts the care of mothers and babies.
NEURODEVELOPMENT
The DNA Behaviour
EVOLUTIONARY BIOLOGY
ENVIRONMENT EXPERIENCE REPRODUCTIVE FITNESSADAPTATION
The Neuroscience of Birth & BreastfeedingThe Brain
EPIGENETICS
BIRTH
BEYOND BREASTFEEDINGFeed Sleep Cycling
SEPARATIONMOTHERBABY
BONDING Sensitization
Secure attachment
Attuned parenting
Resilience Vulnerability
DISEASEHEALTH
Disordered attachment
Toxic stress
Insensitiveparenting
30
“buffering
protection of
adult support”
NEURODEVELOPMENT
The DNA Behaviour
EVOLUTIONARY BIOLOGY
ENVIRONMENT EXPERIENCE REPRODUCTIVE FITNESSADAPTATION
The Neuroscience of Birth & BreastfeedingThe Brain
EPIGENETICS
BIRTH
SEPARATIONMOTHERBABY
BONDING Sensitization
Vulnerability
DISEASE
Disordered attachment
Toxic stress
Insensitiveparenting
ENVIRONMENT EXPERIENCE REPRODUCTIVE FITNESSADAPTATION
BIRTH
BEYOND BREASTFEEDINGFeed Sleep Cycling
MOTHERBABY
BONDING Sensitization
Secure attachment
Attuned parenting
Resilience
HEALTH
A mother and baby
DYADare asingle
psychoneurobiologicalorganism
ENVIRONMENT EXPERIENCE REPRODUCTIVE FITNESSADAPTATION
SEPARATION
Vulnerability
DISEASE
Disordered attachment
Toxic stress
Insensitiveparenting
SEPARATION
VIOLATESthe innate agendaof mother and baby
NEURODEVELOPMENT
The DNA Behaviour
EVOLUTIONARY BIOLOGY
ENVIRONMENT EXPERIENCE REPRODUCTIVE FITNESSADAPTATION
The Neuroscience of Birth & BreastfeedingThe Brain
EPIGENETICS
BIRTH
SEPARATIONMOTHERBABY
BONDING Sensitization Toxic stress
IT MATTERS
HOW WE ARE BORN
“needed neural
processes”
NEURODEVELOPMENT
The DNA Behaviour
EVOLUTIONARY BIOLOGY
The Neuroscience of Birth & BreastfeedingThe Brain
EPIGENETICS
“except in the light
of mother’s body.”
NEURODEVELOPMENT
The DNA Behaviour
EVOLUTIONARY BIOLOGY
ENVIRONMENT EXPERIENCE REPRODUCTIVE FITNESSADAPTATION
The Neuroscience of Birth & BreastfeedingThe Brain
EPIGENETICS
EXPECTED UNEXPECTED
31
“buffering
protection of
adult support”
NEURODEVELOPMENT
The DNA Behaviour
EVOLUTIONARY BIOLOGY
ENVIRONMENT EXPERIENCE REPRODUCTIVE FITNESSADAPTATION
The Neuroscience of Birth & BreastfeedingThe Brain
EPIGENETICS
BIRTH
SEPARATIONMOTHERBABY
BONDING Sensitization
Vulnerability
DISEASE
Disordered attachment
Toxic stress
Insensitiveparenting
ZERO
SEPARATION
NEURODEVELOPMENT
The DNA Behaviour
EVOLUTIONARY BIOLOGY
ENVIRONMENT EXPERIENCE REPRODUCTIVE FITNESSADAPTATION
The Neuroscience of Birth & BreastfeedingThe Brain
EPIGENETICS
BIRTH
SEPARATIONMOTHERBABY
BONDING Sensitization
Disordered attachment
Toxic stress
Insensitiveparenting