MATERNAL PERINATAL
NEUROBEHAVIOR.
Dr Nils Bergman
”M.D., D.C.H., M.P.H., Ph.D.”
M.B.Ch.B., M.P.H., M.D.
Cape Town, South Africa
Hominines were prey
at Sterkfontein,
“Cradle of Mankind”
Immediate feeding
response to crying
Father frequently
and closely involved ...
EXTREME EGALITARIANISM
EQUALITY (gender, age, capacity)
INTENSE SOCIAL COHESION
 NO AGGRESSION !!!!!
UNIQUE
hominin feature:
carry food home
to share …
BERGMAN
‘sharing phenotype’
From James McKenna
“Scientific foundation” … a synthesis
THE HUNTER GATHERER (cont)
Infant care patterns in such societies
(which are closest to our origins):
1
2
3
4
5
Infant carried most of time
Mother sleeps with infant same bed
Immediate feeding response to crying
Breastfeeding 24 months or more
Father frequently and closely involved ...
Platform for better understanding of PUBLIC HEALTH.
… policy and practice that impacts the care of mothers and babies.
EVOLUTIONARY
BIOLOGY
Everything else
The Place FITNESS
ENVIRONMENT
EXPECTED
NEUROSCIENCE
EPIGENETICS
The Brain
The DNA
EXPERIENCE
ADAPTATION
UNEXPECTED
HEALTH
DISEASE
SPECTRUM of expression in POPULATION
Platform for better understanding of PUBLIC HEALTH.
… policy and practice that impacts the care of mothers and babies.
1
The Neuroscience of Birth & Breastfeeding
EVOLUTIONARY BIOLOGY
The reproductive programme
The DNA
The Brain
Behaviour
EPIGENETICS NEURODEVELOPMENT EVOLUTIONARY BIOLOGY
ENVIRONMENT ADAPTATION
is in the mother and the baby
EXPERIENCE REPRODUCTIVE FITNESS
BABY
BONDING
BIRTH
DEFENSE
NUTRITION REPRODUCTION
BREASTFEEDING
BEYOND
Feed  Sleep Cycling
Secure
attachment
WHAT IS NORMAL MOTHER BEHAVIOUR?
Doula:
MOTHER
An ancient Greek word
meaning “handmaid.”
DOULA
This term has come to represent
a compassionate, experienced woman
who provides physical, emotional,
educational and practical support to
another woman and her family during
all the events surrounding childbirth.
Shorter labor
Decreased distress
“Happier baby”
Neocortex
Limbic brain
Klaus & Kennell fetal distress 24%  10%
birthdoulasofpittsburgh.com
MOTHER
PARTNER
FETUS
MOTHER
PARTNER
DOULA
FETUS
Neocortex
Limbic brain
DOULA
FETUS
Shorter labor
Decreased distress
“Happier baby”
Neocortex
Limbic brain
Shorter labor
Decreased distress
“Happier baby”
2
DOPAMINE MOTHER
DOPAMINE MOTHER
DOULA
DOULA
OXYTOCIN
OXYTOCIN
FETUS
FETUS
Shorter labor
Decreased distress
“Happier baby”
Neocortex
Limbic brain
Limbic brain
MOTHER
MOTHER
Shorter labor
Decreased distress
“Happier baby”
Neocortex
AM I SAFE ??
DOULA
DOULA
OXYTOCIN
FETUS
Neocortex
Limbic brain
Shorter labor
Decreased distress
“Happier baby”
NUTRITION REPRODUCTION
DEFENCE
OXYTOCIN
HORMONES
NERVES
MUSCLES
With permission from Kerstin Uvnäs Moberg
Oxytocin release
mechanisms
• Via the parvocellular neurons
of the PVN and SON into
the brain (as a
neurotransmittor)
• Via the neurohypophysis into
the blood stream (hormonal
action)
• Directly via cell bodies and
dendritic parts of the
neuron by volume
transmission
EYE CONTACT
Centrally released oxytocin coordinates the onset of
maternal nurturing behavior at parturition
and plays a role in mother-infant bonding.
Ross 2009
3
Can this be influenced ??
Reduced catecholamine surge after C-section
Can this be influenced ??
OXYTOCIN
FERGUSON
REFLEX
OXYTOCIN
Vaginal delivery
Elective C-section
OXYTOCIN
OXYTOCIN comes from
Head stretches
loweruterine
segment 
Positive feedback
loop of oxytocin
What about PITOCIN ?
(Synthetic OXYTOCIN)
Cervical dilatation
Breastfeeding
Skin-to-skin contact
Eye-to-eye contact
What about PITOCIN ?
(Synthetic OXYTOCIN)
Olza 2012 Acta Paed 101 (7): 749-754
… intrapartum exogenous oxytocin
seems to disturb sucking and
breastfeeding duration
Doula care
In 127 out of 128 societies
(reported in a major anthropological
study of non-industrialised
geographically isolated societies)
“a woman is in attendance
throughout labour”
not the father ….
not a midwife !!
4
Effects of doula care
No doula
USA (Kennell et al 1991)
Epidural
55%
Caesarean section 18%
Forceps delivery 26%
Fetal distress
24%
Effects of doula care
Doula
8%
8%
8%
10%
Birth Findings – review
•
•
•
•
50% less Caesar Rate
30%less Medication
60% reduction in Epidurals
40% reduction in Forceps
No doula
Doula
USA (Kennell et al 1991)
Caesarean section 18%
8%
Cost of C/S = R3600
Cost of NVD = R1800
Halved C/S rate saving
One doula every delivery
= R2.2 m
= R1.6 m
“If a Doula was a drug,
it would be unethical
not to use it”
Dr. John Kennell
OXYTOCIN
IS A DRUG !!
1922 -2013
NOVEL SERVICE:
KANGAROULA
KANGAROO Mother Care
plus DOULA care
First 1000 minutes
Strictly: 16.6 hours = basically: First day!
Pregnancy
Labour
Birth
Transition Parenting
DOULA
MOTHER
SUPPORT
Prematurity
Counselling
NEWBORN
SUPPORT
Attachment Parenting
Counselling
KANGAROULA
Impact depends on previous 1000 minutes!
5
Highly conserved
DOULA and KANGAROULA
BIRTH
‘previous 1000 minutes’
‘the first 1000 minutes’
DEFENSE
DOULA
protects
OXYTOCIN
during
labour.
KANGAROULA
protects
OXYTOCIN
after
birth.
OXYTOCIN comes from
VAGINAL BIRTH
BREASTFEEDING
SKIN-TO-SKIN
OXYTOCIN
CONTACT
Porges proposes term :
“neuroception”
 neural process that
evaluates risk
HORMONES
NUTRITION REPRODUCTION
NERVES
MUSCLES
Neuro-endocrine behavior
SEPARATION
CORTISOL
OPPOSITES
SKIN-TO-SKIN
OXYTOCIN
CONTACT
Porges 
same neural circuitry,
adapted to circumstance
safe
dangerous
life threatening
Oxytocin | Vasopressin  Cortisol
6
With permission from Kerstin Uvnäs Moberg
With permission from Kerstin Uvnäs Moberg
Oxytocin release
mechanisms
HPA axis
Hypothalamus
CRF
Anterior
pituitary
• Via the parvocellular neurons
of the PVN and SON into
the brain (as a
neurotransmittor)
• Via the neurohypophysis into
the blood stream (hormonal
action)
• Directly via cell bodies and
dendritic parts of the
neuron by volume
transmission
OXYTOCIN
ACTH
Adrenal
cortex
CORTISOL
DANGER (axis 1)
PAIN (axis 2).
Amygdala (CRF)
Locus Ceruleus (NA)
PVN
(CRF)
NTS (NA)
Long-term effects of
PVA (CRF)
OXYTOCIN
CORTISOL
INHIBITION
• Sensory inputs signalling
• Soft innocuous
PEACE comfort & SAFETY
sensory stimulation
• Release of oxytocin
• Increase of alfa 2
adrenoceptors
– Amygdala
OXYTOCIN • NTS
– PVN
• Decreased NA activity
• Inhibition of HPA axis
• Decreased HPA activity
• Inhibition of NA
Fight or flight
With permission from Kerstin Uvnäs Moberg
versus
TEND AND BEFRIEND
… tendency is to AFFILIATE, to come together in
groups in threatening times.
… there is an AFFILIATIVE NEUROCIRCUITRY
that prompts affiliation in response to stress.
… basis for this regulation … OXYTOCIN.
•
•
•
•
•
•
•
•
•
Anxiolytic-like effect
Increased pain threshold
Decreased inflammation
Lowered bloodpressure
Lowered cortisol levels
Increased vagal nerve tone (GI hormones)
Facilitated learning (conditioned avoidance)
Increased weight gain (females)
Increased rate of wound healing
FERGUSON
REFLEX
Head
stretches
lower
uterine
segment 
positive
feedback loop
of oxytocin
7
Clinics in Perinatology,
June 2004, Vol 31(2) page 210
Stanley Graven
Early neurosensory visual
development of fetus and newborn.
The reproductive programme
is in the mother and the baby
DEFENSE
NUTRITION REPRODUCTION
HORMONES
NERVES
MUSCLES
“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.
Highly conserved
The Neuroscience of Birth & Breastfeeding
The DNA
The Brain
Behaviour
EPIGENETICS NEURODEVELOPMENT EVOLUTIONARY BIOLOGY
ENVIRONMENT ADAPTATION
BABY
BIRTH
BEYOND
BONDING
EXPERIENCE REPRODUCTIVE FITNESS
MOTHER
Sensitization
BIRTH
BREASTFEEDING
MOTHER
BONDING
Sensitization
BREASTFEEDING
Feed  Sleep Cycling
Secure
attachment
REPRODUCTION
BABY
Feed  Sleep Cycling
Attuned
parenting
Secure
attachment
Attuned
parenting
Neuro-endocrine behavior
Highly conserved
DEFENSE
HORMONES
NUTRITION REPRODUCTION
NERVES
MUSCLES
Neuro-endocrine behavior
8
Estrogen peaks
Progesterone falls
New circuits =
enhanced learning
Increased spines
(dendrification)
Pup stimulation
Rich environment
New circuits =
enhanced learning
Amygdala
Less fear / anxiety
Hippocampus
Better learning / memory
Hypothalamus
Better stress tolerance
Maternal neurobehaviour
Maternal neurobehaviour
Enhanced foraging
Enhanced foraging
Time to find a
baited food well:
Non-mother 130 sec
Stress responsiveness
Enhanced problem solving
Mother mouse 40 sec
More emotional resilience
Enhanced problem solving
A maze with food
At end:
Mother mouse
learns her
way through
ONE DAY
Non-mother
ONE WEEK
MEMORY
permanently
improved
Same MAZE,
TWO YEARS
LATER:
Mother mouse
REMEMBERS
TWICE AS FAST
9
Stress responsiveness
“Open Arm” – exposed
and scary for mouse.
“Closed arm” – secluded
and safer, less anxiety.
PROLACTIN rises
OXYTOCIN rises
Mother mouse
30 -40 %
OXYTOCIN
MEMORY permanently improved
Non-mother
5 – 10%
More emotional
resilience
LESS ANXIETY
LACTATION
Opioids
Glucocorticoids
Norepinephrine
Vasopressin
BDNF (=Brain Derived
Neurotropic Factor)
etcetera .....
(fathers specially)
BDNF (=Brain Derived
Neurotropic Factor)
“The combination of these ... converge to
produce the most dramatic results ...
“ the totality and natural ramifications of
reproductive experience ....
enhancements .... neuroplasticity ...
(p522)
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.
“The picture that begins to emerge is one
of a healthy, “protected” brain that may
provide benefits to its owner well into
senescence.” (p517)
The Neuroscience of Birth & Breastfeeding
The DNA
The Brain
Behaviour
EPIGENETICS NEURODEVELOPMENT EVOLUTIONARY BIOLOGY
ENVIRONMENT ADAPTATION
BABY
BIRTH
BONDING
EXPERIENCE REPRODUCTIVE FITNESS
MOTHER
Sensitization
“needed neural
processes”
10
SUE CARTER
Mock job
interview:
Breastfeeding
mothers have
HIGHEST
VAGAL TONE
 Stress
Resistance
LOWER systolic
blood pressure
 Stress
tolerance
SUE CARTER
In lactating women,
these phenomena could theoretically
# conserve energy required for lactation
# protect against stress associated
inhibition of lactation,
# relieve psychological stress, and
# enhance immune function
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 may
appear helpless, but
skin-to-skin contact
The reproductive programme
is in the mother and the baby
DEFENSE
NUTRITION REPRODUCTION
“Needed
neural
processes”
apply to
HORMONES
NERVES
MUSCLES
parents’ brains also.
stimulates prolactin
Hypothalamus
Pitutiary 
PROLACTIN
stimulates oxytocin
MILK
stimulates cholecystokinin
 NUTRITION
PROLACTIN
Oligodendrite
cells
 MYELIN
 SURFACTANT
11
FEAR
CONTROL
CENTRE
Brain stem and
limbic system structures
related to threat and safety
CORTISOL
PREDATOR
Smell
cingulate
FEAR
FREEZE
OXYTOCIN
+ OXYTOCIN
cingulate
suppressed
Less fear
FORAGE
When oxytocin is released within the brain,
its effects are to diminish fearfulness;
this not only encourages social investigation of
newcomers, but also may enhance a tendency to
express aggression toward an intruder. Leng 2008
Measure of a
“good mammal mother” :
FEROCITY OF
DEFENCE
OF YOUNG.
Personal testimony
of a mother at
international KMC meeting
“The instinct of a
mother to hold and
care for her baby
is primordial and
primitive, and an
overwhelmingly
powerful feeling.”
Jane Davis, Bogota, Dec 1998
http://www.time.com/time/magazine/article/0,9171,1625193,00.html
Margaret Mikol
“I changed into a beast
to protect my child”
In the FIRST HOUR …….
….. the newborn
ELICITS CARE GIVING
INSTINCTUAL
BEHAVIOUR FROM
THE MOTHER !!
12
OXYTOCIN 
Cingulate
suppressed
CHOLECYSTOKININ
Amygdala:
Emotion / satiety
 REGULATION
PROTECTION
CHOLECYSTOKININ
Amygdala:
SELF-REGULATION
Nucleus Ambiguus:
(Vagus)  DIGESTION
OXYTOCIN  PFOC
Gaze increase:
BONDING
approach
Cingulate
Hypothalamus
Pituitary:
OXYTOCIN
Maternal
Cingulate
Suppressed ferocity

PROTECTION
Hypothalamus
Amygdala
Pituitary:
Milk making
PROLACTIN NUTRITION

Amygdala:
CHOLECYSTOKININ
 Emotion / satiety
REGULATION
OXYTOCIN
 Gaze increase:
 BONDING
“Scientific foundation” … a synthesis
EVOLUTIONARY
BIOLOGY
Everything else
The Place FITNESS
ENVIRONMENT
NEUROSCIENCE
EPIGENETICS
The Brain
The DNA
EXPERIENCE
ADAPTATION
“needed neural
processes”
“The newborn may
appear helpless, but
skin-to-skin contact
stimulates prolactin
ensures nutrition
stimulates oxytocin
ensures protection
stimulates cholecystokinin
ensures wellbeing bonding
The first hours after birth are a
CRITICAL PERIOD
mutual
psycho-neuro-physiological
caregivers
13
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
SENSITIZATION
Dose of SCC first 24 hours correlates
Maternal behaviour Q Sort
Predicts attachment security
25
Hours of SSC in Infants' First 24 Hours
Hours of SSC in Infants' First 24 Hours
25
20
15
10
5
0
-0.2
The Relation of Early Mother-Infant
Skin-to-Skin Contact
to Later Maternal Sensitivity
in South African Mothers
of Low Birth Weight Infants
20
15
Ann E. Bigelow, et al ()
10
5
0
0
0.2
0.4
0.6
Maternal Behavior Q-Sort
0.8
1
25
27
29
31
33
35
37
39
41
43
45
Maternal Behavior Subscale of the NCATS
Dose of SCC first 24 hours correlates
NCATS ( Nursing Child Assessment Teaching Scale )
Predicts cognitive outcome
SENSITIZATION
Skin-to-skin contact accelerated infants’ social
expectations for their mothers’ behavior and
enhanced infants’ awareness of themselves as
active agents in social interactions.
From Bergman et al 2004 RCT
SSC time first 24 hr correlated
with SSC time first month.
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.
14
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.
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.15526909.2012.01350.x
BONDING
Control
SSC
EPDS (depression) score DECREASED
significantly for first two visits.
JOGNN, 41, 369-382; 2012. DOI: 10.1111/j.1552-6909.2012.01350.x
SENSORY STIMULATION
SKIN-TO-SKIN CONTACT
EMOTIONAL EXCHANGES
Mutual OXYTOCIN
BONDING
CRITICAL
PERIOD
PATHWAY
FIRING
EMOTIONAL
INTELLIGENCE
ATTACHMENT
SOCIAL
INTELLIGENCE
(Bergman mini-model)
Birth experience:
Sensations  hormonal changes
 neural circuits
LIMBIC PLATFORM
MATERNAL
SENSITIVITY
Early life experience:
Neural circuits 
emotional & social intelligence
CORTICO-LIMBIC CIRCUITRY
ATTACHMENT
PRATHIBA REEBYE
BIDIRECTIONAL !!
Affect regulation
BONDING
Sensitization
“Human brains are RELATIONAL”
Secure
attachment
Attuned
parenting
… co-creating touch
… signature unique to caregiver
15
The Neuroscience of Birth & Breastfeeding
The DNA
The Brain
Behaviour
EPIGENETICS NEURODEVELOPMENT EVOLUTIONARY BIOLOGY
ENVIRONMENT ADAPTATION
BABY
BONDING
BIRTH
BEYOND
EXPERIENCE REPRODUCTIVE FITNESS
MOTHER
Sensitization
BREASTFEEDING
Feed  Sleep Cycling
Secure
attachment
Attuned
parenting
EMOTIONAL
INTELLIGENCE
SOCIAL
INTELLIGENCE
SENSORY STIMULATION
SKIN-TO-SKIN CONTACT
EMOTIONAL EXCHANGES
Mutual OXYTOCIN
BONDING
CRITICAL
PERIOD
PATHWAY
FIRING
EMOTIONAL
INTELLIGENCE
ATTACHMENT
SOCIAL
INTELLIGENCE
BONDING
(Bergman mini-model)
Birth experience:
Sensations  hormonal changes
 neural circuits
LIMBIC PLATFORM
MATERNAL
SENSITIVITY
Early life experience:
Neural circuits 
emotional & social intelligence
CORTICO-LIMBIC CIRCUITRY
ATTACHMENT
BRAIN WIRING
PATHWAYS
BABY
MOTHER
BONDING
Sensitization
BREASTFEEDING
Feed  Sleep Cycling
Secure
attachment
Attuned
parenting
 CIRCUITS  NETWORKS
The Neuroscience of Birth & Breastfeeding
The DNA
The Brain
Behaviour
EPIGENETICS NEURODEVELOPMENT EVOLUTIONARY BIOLOGY
ENVIRONMENT ADAPTATION
BABY
BIRTH
BEYOND
BONDING
EXPERIENCE REPRODUCTIVE FITNESS
MOTHER
SEPARATION
Sensitization
BREASTFEEDING
Feed  Sleep Cycling
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.
Underactivity
Slide by: Jack P. Shonkoff, M.D.
Overactivity
EUSTRESS
16
“absence of the
buffering protection
of adult support”
The Neuroscience of Birth & Breastfeeding
The DNA
The Brain
Behaviour
EPIGENETICS NEURODEVELOPMENT EVOLUTIONARY BIOLOGY
ENVIRONMENT ADAPTATION
BABY
BONDING
BIRTH
BEYOND
Toxic Stress
• Disrupts brain architecture …
… increasing the risk of
stress-related physical and mental illness.
EXPERIENCE REPRODUCTIVE FITNESS
MOTHER
SEPARATION
Sensitization
Toxic stress
BREASTFEEDING
Insensitive
parenting
Feed  Sleep Cycling
Secure
attachment
Attuned
parenting
CORTISOL
SEPARATION
Toxic stress
Insensitive
parenting
… anxious parenting …
mediated by stress-related mechanisms
and greater neural disorganization.
Can this be influenced ??
Reduced catecholamine surge after C-section
OXYTOCIN
Well-adapted parenting
… reward-related motivational mechanisms,
temporal organization, and affiliation hormones
Can this be influenced ??
OXYTOCIN
FERGUSON
REFLEX
OXYTOCIN
Vaginal delivery
Elective C-section
Head stretches
loweruterine
segment 
Positive feedback
loop of oxytocin
17
Can this be influenced ??
Can this be influenced ??
Oxytocin surge absent in Caesarean
Vaginal birth  unique pattern
 sensory processing, empathy, arousal,
motivation, reward and habit-regulation
circuits … MORE SENSITIVE
OXYTOCIN
CORTISOL
Brain differences
between VD
& CSD mothers …
may contribute to mental health risks &
RESILIENCY in the mother–infant dyad.
OXYTOCIN
OXYTOCIN comes from
Cervical dilatation
Breastfeeding
Skin-to-skin contact
Eye-to-eye contact
OXYTOCIN comes from
OXYTOCIN
Oxytocin surge absent in Caesarean
Solution: continuous skin-to-skin contact,
and hourly breastfeeding
Breastfeeding
Skin-to-skin contact
Eye-to-eye contact
18
J Psychosom Obstet Gynaecol. 1998 Mar ;19 (1):49-58
With permission from Kerstin Uvnäs Moberg
Oxytocin, prolactin, milk production and their
relationship with personality traits in women
after vaginal delivery or Cesarean section.
Long term effects of
skin to skin contact
• The concept of an early
sensitive period (Klauss and
Kennel)
• Increased bonding
• Decrease of anxiety stress
levels
Social desirability and oxytocin pulsativity
were also correlated with the amount of milk
transferred from the mother to the baby.
The correlations indicate that central oxytocin
… may be involved in behavioral adaptations
to the maternal role.
With permission from Kerstin Uvnäs Moberg
ANGELA UNDERDOWN
Link to attachment theory
Affective communication
• Is oxytocin involved in the
development of secure attachment
in the child?
• Does oxytocin released during skin
to skin contact facilitate the
development of secure attachment?
OXYTOCIN DURING LABOUR
CHANGES MOTHER’S
BRAIN !!
This brain responds to
baby’s cry differently :
REWARD
CONTROL
CENTRE
CONTROL
CENTRE
DOPAMINE
CORTISOL
EMOTION
CONTROL
CENTRE
Mirroring
Attunement
Reciprocity
Rupture / repair
Containment
Reflective
function
Mind-mindedness
Mentalisation
OXYTOCIN DURING LABOUR
SOCIAL
OXYTOCIN
•
•
•
•
•
FEAR
CONTROL
CENTRE
Amygdala –
The emotional brain - to love her baby –
relationship - to focus on care for baby
Orbitofrontal cortex –
activates approach
Nucleus accumbens –
Reward and pleasure
motivation- (dopamine)
Fusiform gyrus –
(face coding unit of brain)
seeks her baby’s face
19
OXYTOCIN DURING LABOUR
OXYTOCIN DURING LABOUR
Cingulate - (inhibition)
switched off - makes
ferocity for defence
CHANGES MOTHER’S
BRAIN !!
Thalamus activity coordinating
centre of brain - to focus on care for baby
NOTICE:
Same brain circuits …
as RESILIENCE,
“highly conserved
neuro-endocrine behavior”
Hypothalamus –
activates arousal response to respond
OXYTOCIN-RICH MUM “CORTISOL” MUM
SYNCHRONOUS
or “in-tune” mum
SENSITIVE
to approach crying baby
REWARD
related motivation
COMPASSION
and empathy for baby
INSTINCTIVE care
INTRUSIVE
not in tune with baby
ABLE TO IGNORE
her crying baby, is distant
STRESS DRIVEN
response to Baby’s cry
ANXIETY AND WORRY
as to how to care for baby
INTELLECTUAL care
CARE IS EASY
and natural
CARE IS HARD WORK
though can be very good
HEALTH
DISEASE
Attachment
Attunement
Synchronous
Sensitive
The psychology of human parent-infant relationships
Parenting is regulated by key hormones and neurotransmitters
Neuroanatomical circuits of parenting
Integrative physiology of normal parenting behaviours
Brain imaging of human parent-infant relationships
The neurobiology of empathy and parenting
Conclusions and critical summary
(Swain et al, 2007)
20
“Scientific” features of love
autonomic responsivity
longing for reciprocity
separation distress
direct physical contact
emotionally charged caring
reciprocal patters of interaction
HYPERAROUSAL -
(Schore 2001)
Moro reflex –
often called a
STARTLE REFLEX
(neurologically) compelled to approach
distress
crying ... then
because it occurs when a baby is
startled by a loud sound or movement
maintains proximity and elicits care
Moro reflex Thumb flex
finger claw
STARTLE
Perry:
VIGILANCE
FREEZE
FLIGHT
FIGHT
CORTISOL
Hyperarousal
Continuum
REST
(Male Child)
VIGILANCE
(Crying)
RESISTANCE
Freeze
DEFIANCE
‘Posturing’
AGGRESSION
Dissociative
Continuum
REST
(Female
Child)
AVOIDANCE
(Crying)
COMPLIANCE
Freeze
DISSOCIATION
‘Numbing’
FAINTING
‘Minipsychosis’
NEOCORTEX
Subcortex
SUBCORTEX
Limbic
LIMBIC
Midbrain
MIDBRAIN
Brainstem
BRAINSTEM
Autonomic
ABSTRACT
CONCRETE
‘EMOTIONAL’
REACTIVE
REFLEXIVE
CALM
AROUSAL
FEAR
TERROR
PRIMARY
secondary
Brain Areas
SSHHH!!
Responses to threat - FAR
REST
(Adult Male)
Adaptative
Response
FREEZE
Cognition
Mental State
VIGILANCE
21
Perry:
Adaptative
Response
Responses to threat
REST
(Adult Male)
VIGILANCE
FREEZE
FLIGHT
FIGHT
Hyperarousal
Continuum
REST
(Male Child)
VIGILANCE
(Crying)
RESISTANCE
Freeze
DEFIANCE
‘Posturing’
AGGRESSION
Dissociative
Continuum
REST
(Female
Child)
AVOIDANCE
(Crying)
COMPLIANCE
Freeze
DISSOCIATION
‘Numbing’
FAINTING
‘Minipsychosis’
NEOCORTEX
Subcortex
SUBCORTEX
Limbic
LIMBIC
Midbrain
MIDBRAIN
Brainstem
BRAINSTEM
Autonomic
ABSTRACT
CONCRETE
‘EMOTIONAL’
REACTIVE
REFLEXIVE
CALM
AROUSAL
FEAR
TERROR
PRIMARY
secondary
Brain Areas
Cognition
Mental State
State of “fear terror”
ALWAYS
RESPOND
ALWAYS
COMFORT
“Crying, the highest behavioural state,
is DETRIMENTAL.
It impairs lung functioning,
jeopardizes the closure of the foramen ovale,
increases intra-cranial pressure, and
initiates a cascade of stress reactions”.
(Anderson 1996)
Children Need Touching and Attention,
Harvard Researchers Say
April 09, 1998
America's "let them cry" attitude toward children
may lead to more fears and tears among adults,
according to two Harvard researchers.
Instead of letting infants cry, American parents
should keep their babies close,
console them when they cry,
and bring them to bed with them,
where they'll feel safe,
according to Michael Commons and Patrice Miller
http://www.hno.harvard.edu/gazette/1998/04.09/ChildrenNeedTou.html
22
optimal development or outcome
April 09, 1998
ALLOSTATIC
LOAD
Quality loss
Health impact
Life span loss
Social
consequences
Reproductive
failure
Children Need Touching and
Attention, Harvard Researchers Say
ideal benign
malevolent
unsuitable
The result, Commons and Miller said,
is a nation that doesn't like caring
for its own children,
a violent nation marked by loose,
nonphysical relationships.
http://www.hno.harvard.edu/gazette/1998/04.09/ChildrenNeedTou.html
"There's no harm in a child crying:
the harm is done only
if his cries aren't answered.
If you ignore a baby's signal for help,
you don't teach him independence...
What you teach him is that
no other human being will
take care of his needs.“
(Dr Lee Salk)
NOTA BENE
The circuitry we have problems with
In substance abusing mothers, MAY BE
PRIMARY PARENTING CIRCUITS
“highly conserved
neuro-endocrine behavior”
HEALTH
DISEASE
NOTA BENE
Can this be influenced ??
The circuitry we have problems with
In substance abusing mothers, MAY BE
PRIMARY PARENTING CIRCUITS
“highly conserved
neuro-endocrine behavior”
Reduced catecholamine surge after C-section
The NEWBORN is the real object of
this behaviour / neural network
1 It is PLASTIC …
OXYTOCIN
Vaginal delivery
Elective C-section
23
OXYTOCIN comes from
OXYTOCIN
Oxytocin surge absent in Caesarean
CORTISOL
Cervical dilatation
Brain differences
between VD
& CSD mothers …
Breastfeeding
Skin-to-skin contact
Eye-to-eye contact
may contribute to mental health risks &
RESILIENCY in the mother–infant dyad.
NOTA BENE
The circuitry we have problems with
In substance abusing mothers, MAY BE
PRIMARY PARENTING CIRCUITS
“highly conserved
neuro-endocrine behavior”
The NEWBORN is the real object of
this behaviour / neural network
1 It is PLASTIC
2 It could be harnessed 
DOPAMINE
SEPARATION
Toxic stress
Insensitive
parenting
… anxious parenting …
mediated by stress-related mechanisms
and greater neural disorganization.
NOTA BENE
The circuitry we have problems with
In substance abusing mothers, MAY BE
PRIMARY PARENTING CIRCUITS
“highly conserved
neuro-endocrine behavior”
OXYTOCIN
Well-adapted parenting
… reward-related motivational mechanisms,
temporal organization, and affiliation hormones
The NEWBORN is the real object of
this behaviour / neural network
1 It is PLASTIC
2 It could be harnessed 
24
“Breastfeeding does not treat or
cure NAS but allows skin-to-skin
contact that could lessen …
(Courty & Nacache 2012)
“Interventions that support
breastfeeding in the treatment of
NAS include skin-to-skin contact …
(Pritham 2013)
Numerous studies indicate breastfeeding
decreases NAS severity. (Logan 2014)
ENVIRONMENT
ADAPTATION
BABY
BIRTH
BONDING
EXPERIENCE
REPRODUCTIVE FITNESS
Numerous studies indicate breastfeeding
decreases NAS severity. (Logan 2014)
Nonpharmacologic interventions,
particularly breastfeeding, may
decrease NAS severity.
Douglas KENRICK (2010)
“We revisit the idea of a motivational hierarchy in light
of theoretical developments at the interface of
evolutionary biology, anthropology, and psychology.”
MOTHER
Sensitization
 substance abusing mothers must have
ZERO
SEPARATION
http://www.psychologicalscience.org/journals/pps/5_3_inpress/Kenrick.pdf
Fathers ??
DOPAMINE
OXYTOCIN
CORTISOL
Currently available
data are broadly
consistent with a
working hypothesis
that the expression of
parental behavior will
involve homologous
neuroendocrine
circuits in male and
females.
Wynne-Edwards 2001
25
8 % of mammals paternal caregiving
EVOLUTIONARY BIOLOGY
The reproductive programme
is in the mother and the baby
DEFENSE
NUTRITION REPRODUCTION
WHAT IS NORMAL MOTHER BEHAVIOUR?
WHAT IS NORMAL FATHER BEHAVIOUR ??
24 videtapes
THE HUNTER GATHERER (cont)
Infant care patterns in such societies
(which are closest to our origins):
1
2
3
4
5
Infant carried most of time
Mother sleeps with infant same bed
Immediate feeding response to crying
Breastfeeding 24 months or more
Father frequently and closely involved ...
WHAT IS NORMAL FATHER BEHAVIOUR ??
Twelve parents (6 mothers and 6
fathers)
Taken by surprise: For mothers,
the premature birth created a
feeling of powerlessness and
they experienced the
immediate postnatal period as
surreal and strange.
Using a modified
frequency method,
behaviors were
identified in four main
categories:
proximity, gaze, touch, and movement.
The analysis showed that proximity and gaze
were high-frequency behaviors and
touch and movement were low-frequency behaviors.
Tomlinson 1991
Taken by surprise:
For mothers, the premature birth created a feeling of
powerlessness and they experienced the
immediate postnatal period as surreal and
strange. The fathers experienced the birth as a
shock, but were ready to be involved
immediately.
The fathers experienced
the birth as a shock,
but were ready to be
involved immediately.
Fegran 2008
26
Mothers engaged in more caregiving, talking, and holding
during initial contacts, but the disparity in maternal and
paternal interactions decreased with time.
Except for caregiving,
in which mothers still surpassed fathers,
fathers equaled mothers in all other
activities at the time of the
infants' discharge from the hospital.
Fathers consistently surpassed mothers
in playing and stimulating.
After C/S
29 father-infant pairs
participated either skinto-skin with their father
or next to the father
in a cot.
SSC infants became drowsy
within 60 min after birth,
infants cared for in a cot
reached the same stage
after 110 minutes.
Levy-Schiff 1989
Infants in the
skin-to-skin group
cried less than the
infants in the
cot group (p < 0.001).
Results demonstrated that
both mothers and fathers
rated their experiences
of love significantly higher
when
holding their infants skin to skin
than when holding their infants
wrapped in blankets
(differences two types of holding:
mothers p= 0.0002
fathers p= 0.0001
The crying of infants in
skin-to-skin group
decreased within
15 minutes of being
placed skin-to-skin
with the father.
Gloppestad 1998
We found that
We found that
(1) fathers hearing the cry stimuli felt more sympathetic
and more alert …;
(1) fathers hearing the cry stimuli felt more sympathetic
and more alert …;
(2) fathers and non-fathers with lower testosterone
levels had higher sympathy and/or need to respond … ;
(3) fathers with higher prolactin levels were also more
alert and more positive in response to the cries;
(4) fathers hearing the cry stimuli showed greater
percentage increase in testosterone …;
(5) experienced fathers hearing the cries showed a
greater percentage increase in prolactin levels …
(6) … both experience and testosterone contributed to
the variance in fathers' affective responses to infant
cries.
Fleming 2002
27
Taken together, these results indicate
that, as with a number of other biparental
species, human fathers are more
responsive to infant cues than are nonfathers and fathers' responses to infant
cues are related to both hormones and to
caregiving experience
Fleming 2002
Maternal OT was related to
the amount of affectionate
parenting behaviors …
… whereas paternal OT
correlated with the degree
of stimulatory parenting behaviors …
DOPAMINE
Given the central importance of rewards for
survival, reproduction, and competitive gains, it
may not be surprising that several specialized
and only partly overlapping brain mechanisms
have developed during evolution.
OXYTOCIN
Well-adapted parenting
… reward-related motivational mechanisms,
temporal organization, and affiliation hormones
PROLACTIN and testosterone levels in first
time fathers during skin-to-skin contact with
their babies soon after birth.
Rebecka Bradshaw
Ngah Veranyuy Dzeaye
Nils Bergman
(University of Cape Town, South Africa.)
Rebecka initiated the project as a medical student
project, Nils completed the vaginal birth cases, and
supervised Vera. Vera did all the caesarean cases, as a
thesis towards a Masters in Nursing.
Yes I am still feeling the Awe of being a new
father.
I was going to send you pictures from the
theater as I feel privileged to have been part
of the trial. I obviously can't compare the
difference between having had her in the
skin-to-skin position vs not, but I really feel
connected to my beautiful little girl. She
seems to find comfort in sleeping on my
chest when she is unsettled and am
convinced that this is due to her early
connection with me.
28
FATHER
AT BIRTH
Should also do
skin-to-skin
contact – and
STAY !!
Best  midwife + doula + father
cortisol
… continue until
goes home, then
until baby says
“enough, thanks”
oxytocin
ZERO
SEPARATION
Best  midwife + doula + father
dopamine
cortisol
oxytocin
dopamine
The Neuroscience of Birth & Breastfeeding
The DNA
The Brain
Behaviour
EPIGENETICS NEURODEVELOPMENT EVOLUTIONARY BIOLOGY
FATHER
AT BIRTH
ENVIRONMENT ADAPTATION
BABY
ZERO
SEPARATION
BIRTH
COMPANION
BIRTH
oxytocin
Sensitization
BREASTFEEDING
BEYOND
Feed  Sleep Cycling
Secure
attachment
Best  midwife + doula + father
cortisol
BONDING
EXPERIENCE REPRODUCTIVE FITNESS
MOTHER
SEPARATION
Toxic stress
Insensitive
parenting
Attuned
parenting
dopamine
The Neuroscience of Birth & Breastfeeding
The DNA
EPIGENETICS
ENVIRONMENT
The Brain
NEURODEVELOPMENT
ADAPTATION
BABY
BIRTH
BEYOND
BONDING
DISEASE
Sensitization
BREASTFEEDING
Feed  Sleep Cycling
Secure
attachment
HEALTH
EXPERIENCE
MOTHER
Attuned
parenting
Behaviour
EVOLUTIONARY BIOLOGY
REPRODUCTIVE FITNESS
SEPARATION
Toxic stress
Insensitive
parenting
Disordered
attachment
Resilience
Vulnerability
HEALTH
DISEASE
29
Psalm 22 v 9
“I learnt trust on my mother’s breasts”
Neural circuitry of bonding
Eyes
say “contact”
Visual
cortex
says “open eyes”
PFOC
says “approach”
Amygdala says “safe”
SSC
Psalm 22 v 9
“I learnt trust on my mother’s breasts”
“trust” (bâṭach)
to hie for refuge; figuratively to trust,
be bold (confident, secure, sure),
(make to hope, make to trust. )
“breast” (shôd)
the breast of a woman
or animal (as bulging):
- breast, pap, teat.
says “mother”
‘MOTHERING’
we can aim to bring our society,
that we can change,
into better harmony with
our biological “givens”
that we cannot change ...
“It is necessary to work with Nature and
not against her if we are to promote health
and wellbeing in young children,
their mothers, and society.”
Infancy cannot be re-run later.
EMPOWER PARENTS BY
SKIN-TO-SKIN CONTACT
SKIN-TO-SKIN
EMPOWERS
PARENTS
Infancy cannot be re-run later.
“Put the patient in
the best position for
Nature to act upon him.”
Florence Nightingale
30