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Wednesday, September 23, 2020

From the womb to the world: A baby’s transitional journey

While the baby's arrival into the world is a momentous event, nature has orchestrated a complex mechanism. To support the optimal unfolding of this we should be mindful of the baby's transition.

August 27, 2020 12:18:58 pm
newborn baby, parentingBirth cannot be seen as a point in time but as the starting point of the baby's life. (Source: getty images)

By Divya Deswal

With so much focus on labour and delivery, we begin to think that the birth of the baby is the end of the journey. It may be the end of pregnancy, but it is most certainly the beginning of life for that little human and their relationship to this world and people. For the most part everyone heaves a sigh of relief as the baby emerges and makes a birth cry. The mother, father, doctor, and family in the waiting room then begin to move between cooing over the baby and picture taking to sending out the good news and recounting the labour.

What about the baby?

Do we really think that the baby was a passive participant to whom birth happened? Nothing could be further from the truth. While the baby’s arrival into the world is a momentous event, nature has orchestrated a complex mechanism. To support the optimal unfolding of this we should be mindful of the baby’s transition.

The baby may need to adapt instantly for some mechanisms, while other adaptations may happen over time. Therefore, birth cannot be seen as a point in time but as the start point of the baby’s life

Here are some broad categories of changes.

1 Pulmonary – lungs become fully functional for gas exchange.

2. Circulatory – the heart functioning adapts by including the pulmonary circuit and gradually shutting off the circuit that facilitated umbilical circulation.

3. Sensory perceptions – a dramatic change in the environment of the baby.

4. Nervous system regulation – the nervous system of the baby is far more sophisticated than we give it credit for and has a keen sense of safety and threat.

5. Metabolic adaptation – the fuel requirement of the body vis a vis feeding and thermoregulation and stress.

Just this short list may seem like a lot that needs to be done. Mechanisms of most of these processes are preset in the baby’s biology. The parent’s role will then be of the protector, provider and keeper of these systems.

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The preparation for life on earth begins in utero with the lungs beginning to mature to be able to breathe air and exchange gases. This is probably one of the last organs to mature. There is a dual task to be accomplished while getting the lungs ready. On the one hand, the lungs should be capable of exchanging oxygen and carbon dioxide after birth and on the other hand this should not happen until the baby is out of the womb. Nature ensures this by filling the lungs with a fluid called surfactant. Long story short, this fluid keeps the pressure in the lungs higher than the cord pressure and which then stays the “breathing mechanism” of the baby. As the lungs mature the baby produces biochemicals that signal to the mother their readiness for birth. The mother’s body responds with making changes of its own. This internal communication ensures the start of labour is optimal for both mother and baby.

We now know that the baby is not passive through the birthing process. The baby navigates the pelvis and is keenly participating in labour by signaling and supporting the actions of the mother’s body. Birth itself culminates with the mother bearing down and bringing the baby out. This is facilitated by the action hormone adrenaline. For the baby too, this hormone has a very specific role. Adrenaline protects the baby’s internal organs from lack of oxygen while the baby moves through the birth canal; this lack of oxygen in turn signals part of the brain to secrete chemicals for initiate breathing. Adrenaline is popularly known as one of the stress hormones and while is beneficial in the short term, long term exposure is not good for the baby. So, the sequence after birth, which is encoded in the baby, ensures that the baby’s nervous system regulates.

To completely understand what that sequence does and how it works it may be good to list out the various stressors at the time of birth Two major and life-defining changes are changing the gas exchange from placenta to lungs and correspondingly opening the pulmonary circulation and shutting the bypasses for the umbilical circuit. There opening to and through the heart begin to shut down as the pulmonary circuit boots up. We have already spoken of the changes to the lungs.

This is an absolute must of any human at birth to survive and we have seen that the mother’s body mechanisms that birth the baby also facilitate the baby’s breathing mechanism. The connection to the mother via the umbilical cord ensures that the baby can make this immediate transition without a sense of panic. The umbilical cord is bringing oxygen-rich blood to the baby while the lungs begin to function. Then at the appropriate time, the cord stops pulsating and transferring blood and the pulmonary system takes over.

This new setting also needs the baby to regulate the metabolic activity for the needs of maintaining their body temperature and meeting the fuel needs of the vital organs. Baby’s warm up much faster in skin-to-skin contact and the mother’s body serves as a thermoregulator. Her presence supports nervous system regulation and stabilizes blood sugar. Research for premature babies show all parameters of wellness like a heartbeat, blood sugar, temperature all regulates faster in proximity of the mother versus in a radiant warmer. This has led to the protocols of skin to skin for premature babies called Kangaroo Mother Care.

As the baby emerges, let’s hold awareness of the stark changes he/she encounters in the environment. For a watery world to air and gravity-oriented world. They would suddenly feel their weight and temperature change for the very first time. Sensory organs will meet light, sound, and smell. How the baby is handled will have a distinct tactile sensation, temperature, texture, and pressure. Add this to the stress hormone already coursing through the baby’s body, it becomes imperative to ensure that their stress levels fall, and they integrate this new world at a pace and in a way that does not overwhelm them.

Nature in its infinite wisdom has created a mechanism for just this. The mother is the habitat for the baby and that simply creates a point of reference for the newborn. In proximity to the mother, the baby begins to sense into the warmth of her tissues, her smell which is unique for this baby as it is a reminder of the amniotic fluid. The sound of her voice and beat of her heart are all sensory inputs that tell the baby that they have arrived home. As a social engagement system response, the baby lifts the head to look at the mother upon hearing the familiar voice. This response is involuntary and is the same for adults. As the baby engages in eye-to-eye contact, this instills a sense of safety and begins the attachment process.

Babies settle on mothers’ bellies and then in a sequence of distinct steps of activity and rest crawl to the breast and initiate breastfeeding. This lays the foundation of immunity, gut health, and nutrition.

While the mother’s body adds to the baby’s skin microbiome, we find that many simultaneous mechanisms occur in proximity. These all point in one direction. Mother and baby staying together after birth is a biological imperative. This is acceptable for good practice for premature babies.

Separation from the mother can be very traumatic for babies. Research shows us that separation can have a cascade effect on many biological functions and long-term effects on development. While skin to skin with a settled mother soothes the baby’s nervous system, reduces the nervous system activation, it also serves as a therapeutic field for any birth intensity and trauma to be resolved. This sets the template for safety, trust, relationship and foundation for health for life.

It should be our aim to keep mothers and babies together after birth and provide the baby loving human contact if separation is medically needed.

(The author is co-founder, My Child First.)

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