SCIENTIFIC & EVIDENCE BASE for SKIN-TO-SKIN CONTACT · SCIENTIFIC & EVIDENCE BASE for SKIN-TO-SKIN...

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)


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


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


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.

http://news-service.stanford.edu/news/2006/july12/gifs/2297.html

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


warmth activity levelmilk heart rate

“ physiological set points “internal working modelsscripts – templates




(Gallagher 1992)


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)




(Gallagher 1992)



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




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

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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




EPIGENETICS

BIRTH

BABY

BONDING

“needed neural processes”

MOTHER

Sensitization


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 !!

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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.

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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


Secure attachment

Attuned parenting

22

NEURODEVELOPMENT

The DNA Behaviour




EPIGENETICS

BIRTH


MOTHERBABY


Secure attachment

Attuned parenting

EMOTIONAL INTELLIGENCE

SOCIAL INTELLIGENCE

NEURODEVELOPMENT

The DNA Behaviour




EPIGENETICS

BIRTH


SEPARATIONMOTHERBABY


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




EPIGENETICS

BIRTH




Secure attachment

Attuned parenting

Toxic stress

Insensitiveparenting

23

… anxious parenting … mediated by stress-related mechanisms

and greater neural disorganization.

SEPARATION

Toxic stress


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


Oxytocin surge absent in Caesarean


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




EPIGENETICS

BIRTH




Secure attachment

Attuned parenting

Disordered attachment

Toxic stress


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


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





These findings translate previous results from rats / monkeys to humans

2ND

KNOCK

CORTISOL

Arabadzisz

Luby CORTISOL

28

NEURODEVELOPMENT

The DNA Behaviour




EPIGENETICS

BIRTH




Secure attachment

Attuned parenting

Resilience Vulnerability


Toxic stress


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


RESPONSESTRESS

ALLOSTATIC STATE


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)



RESPONSESTRESS

ALLOSTATIC STATE


EndocrineImmune

ALLOSTATIC LOAD

ALLOSTATIC OVERLOAD

HEALTH

the point at which chronic load results in actual

disease or abnormal conditions.

2ND

KNOCK



RESPONSESTRESS

ALLOSTATIC STATE


EndocrineImmune

ALLOSTATIC LOAD

ALLOSTATIC OVERLOAD

DISEASEHEALTH

WELL-BEING SUSCEPTIBILITY MORBIDITY MORTALITY


Spectrum of health:

29



RESPONSESTRESS

ALLOSTATIC STATE


EndocrineImmune

ALLOSTATIC LOAD

ALLOSTATIC OVERLOAD


DISEASEHEALTH

RESILIENCE VULNERABILITY

RESILIENCE:“capacity to maintain

healthy emotional functioning in the after-

math of stressful experiences”

PR - Peer Reared


Plasma CORTISOL response to STRESS (2y)




DISEASEHEALTH MR PR



RESPONSESTRESS

ALLOSTATIC STATE


EndocrineImmune

ALLOSTATIC LOAD

ALLOSTATIC OVERLOAD


DISEASEHEALTH







RESPONSESTRESS

ALLOSTATIC STATE


EndocrineImmune

ALLOSTATIC LOAD

ALLOSTATIC OVERLOAD


DISEASEHEALTH



DISEASEHEALTH


NEURODEVELOPMENT

The DNA Behaviour




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




EPIGENETICS

BIRTH




Secure attachment

Attuned parenting

Resilience Vulnerability

DISEASEHEALTH


Toxic stress


30

“buffering

protection of

adult support”

NEURODEVELOPMENT

The DNA Behaviour




EPIGENETICS

BIRTH



Vulnerability

DISEASE


Toxic stress



BIRTH


MOTHERBABY


Secure attachment

Attuned parenting

Resilience

HEALTH

A mother and baby

DYADare asingle

psychoneurobiologicalorganism


SEPARATION

Vulnerability

DISEASE


Toxic stress


SEPARATION

VIOLATESthe innate agendaof mother and baby

NEURODEVELOPMENT

The DNA Behaviour




EPIGENETICS

BIRTH


BONDING Sensitization Toxic stress

IT MATTERS

HOW WE ARE BORN

“needed neural

processes”

NEURODEVELOPMENT

The DNA Behaviour



EPIGENETICS

“except in the light

of mother’s body.”

NEURODEVELOPMENT

The DNA Behaviour




EPIGENETICS

EXPECTED UNEXPECTED

31

“buffering

protection of

adult support”

NEURODEVELOPMENT

The DNA Behaviour




EPIGENETICS

BIRTH



Vulnerability

DISEASE


Toxic stress


ZERO

SEPARATION

NEURODEVELOPMENT

The DNA Behaviour




EPIGENETICS

BIRTH




Toxic stress


SCIENTIFIC & EVIDENCE BASE for SKIN-TO-SKIN CONTACT · SCIENTIFIC & EVIDENCE BASE for SKIN-TO-SKIN...

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