Neuroendocrinology of the mother-child interaction

Oxytocin in growth, reproduction, restoration and health

This article summarizes my scientific work and describes some personal experiences during this period. After my basal medical training (MD) (1971), I obtained a PhD in pharmacology (1976) and ended up as a professor of Physiology. My initial studies were within the field of gastroenterology. I showed that the gastrointestinal hormone gastrin, which stimulates HCL secretion in the stomach, was released in response to stimulation of the vagal nerve. Later I showed that the entire endocrine system of the gastrointestinal (GI) tract that promotes digestion and anabolic metabolism and growth was under vagal nerve control. I also showed that activation of the vagal nerve inhibits the function of the inhibitory substance somatostatin. 10 years later, after some big changes in my personal life, my research focus changed. I became interested in female physiology, particularly the role of oxytocin. In addition, I became aware of the situation of female scientists and started to work with questions regarding equality between women and men. I gathered a group of interested female medical students and midwives around me. We demonstrated that breastfeeding and touch (e.g., between mother and baby), via stimulation of sensory nerves in the skin, activated the endocrine system of the GI tract and, thereby, anabolic processes and growth. The effects were exerted via a vagal mechanism and involved activation of parvocellular oxytocinergic neurons from the paraventricular nucleus (PVN). We also showed that the gastrointestinal hormone cholecystokinin stimulated the release of oxytocin in a calorie-dependent way via an afferent vagal mechanism. In summary, there is a bidirectional, vagally mediated connection between the endocrine system of the GI tract and the oxytocin producing neurons in the supraoptic (SON) and paraventricular (PVN) nuclei of the hypothalamus.1. Oxytocinergic neurons from the PVN enhances the activity of the endocrine system of the GI tract and thereby growth and regeneration. The effect is exerted via efferent vagal fibers which inhibit the release of somatostatin. 2. Food in the duodenum triggers a release of cholecystokinin (CCK), which via a vagal afferent mechanism stimulates the release and function of oxytocin. This mechanism is not activated in the absence of food intake. Administration of oxytocin induces a multitude of actions, i.e., anxiolytic and sedative effects, increased pain threshold, lowering of cortisol and blood pressure and an increased activity of the endocrine system of the GI tract. Repeated administration of oxytocin may induce long-term effects and "secondary" mechanisms such as an increased activity of alpha-2- adrenoceptors are involved. Oxytocin released by suckling during breastfeeding or by touch during social interaction will induce a similar effect spectrum. Activation of the parvocellular neurons will stimulate some aspects of social behavior, induce calm and well-being, and decrease levels of fear, stress, and pain. In addition, vagal functions and the activity of the endocrine system of the GI tract will be stimulated. Together, these effects are consistent with the oxytocin-mediated calm and connection response and, in a long-term perspective, with the promotion of well-being and health. A second period of professional difficulties occurred in the late 1990s. I moved to the Swedish University of Agriculture, where I started to investigate the role of oxytocin in interactions between humans and pets, as this type of interaction had been shown to promote health. I continued to study the role of oxytocin in female reproduction, in particular, the role of oxytocin during labor and birth and in the peripartum period. In addition, I started to write books about different aspects of oxytocin. I also wanted to establish a role for oxytocin in the treatment of vaginal atrophy. Several clinical studies show that local intravaginal application of oxytocin in women with vaginal atrophy increases the regeneration of vaginal mucosal cells and function.

New policies on skin-to-skin contact warrant an oxytocin-based perspective on perinatal health care

Background

In 2023, the World Health Organization (WHO) published a Global Position Paper on Kangaroo Mother Care (KMC), which is applicable to all countries worldwide: from the moment of birth, every "small and sick" newborn should remain with mother in immediate and continuous skin-to-skin contact (SSC), receiving all required clinical care in that place. This was prompted by the startling results of a randomized controlled trial published in 2021: in which 1,609 infants receiving immediate SSC were compared with 1,602 controls that were separated from their mothers but otherwise received identical conventional state-of-the-art care. The intervention infants showed a 25% reduction in mortality after 28 days.

New perspectives

The new WHO guidelines are a significant change from earlier guidance and common clinical practice. The author presents that separating mothers and babies is assumed to be "normal" (a paradigm) but actually puts newborns at increased risk for morbidity and mortality. The author presents arguments and ethical perspectives for a new perspective on what is "normal," keeping newborns with their mothers is the infant's physiological expectation and critical requirement for healthy development. The author reviews the scientific rationale for changing the paradigm, based on synchronous interactions of oxytocin on both mother and infant. This follows a critique of the new policies that highlights the role of immediate SSC.

Actionable recommendations

This critique strengthens the case for implementing the WHO guidelines on KMC for small and sick babies. System changes will be necessary in both obstetric and neonatal settings to ensure seamless perinatal care. Based on the role of oxytocin, the author identifies that many current routine care practices may actually contribute to stress and increased vulnerability to the newborn. WHO has actionable recommendations about family involvement and presence in newborn intensive care units.

Discussion

The concepts of resilience and vulnerability have specific definitions well known in perinatal care: the key outcome of care should be resilience rather than merely the absence of vulnerability. Newborns in all settings and contexts need us to re-evaluate our paradigms and adopt and implement the new WHO guidelines on KMC in perinatal care.

Impact of doula's continuous support on serotonin release in parturients: a pilot randomized clinical trial

Objective

To evaluate whether the continuous support provided by doulas influences the endogenous release of serotonin in parturients.

Methods

This pilot study included 24 primigravidae at term. Of these, 12 women received continuous doula support (Experimental Group), whereas the other 12 received the usual assistance without doula support (Control Group). Blood samples were collected from all the women at the active and expulsion stages of labor and at the fourth period of labor (Greenberg period) for evaluation of their serotonin levels using high-performance liquid chromatography.

Results

The average serotonin concentrations in the control and experimental groups were respectively 159.33 and 150.02 ng/mL at the active stage, 179.13 and 162.65 ng/mL at the expulsion stage, and 198.94 and 221.21 ng/mL at the Greenberg period. There were no statistically significant differences in serotonin concentrations between the two groups at the active and expulsion stages of labor. By contrast, within the experimental group, a significant increase in serotonin concentration was observed in the Greenberg period compared with the levels in the active and expulsion stages (p < 0.05).

Conclusion

The novelty of this study relies on the ability to correlate the influence of the continuous support offered by doulas with the release of serotonin in parturients, with the results suggesting that the assistance received during labor can modulate the levels of hormone release in the Greenberg period.

Brazilian Registry of Clinical Trials

RBR-4zjjm4h.

Impact of intrapartum oxytocin administration on neonatal sucking behavior and breastfeeding

This study aimed to examine the effect of intrapartum oxytocin administration on neonatal sucking behavior and breastfeeding. A total of 64 pairs (29 in the group treated with intrapartum oxytocin and 35 in the control group) of normal infants within 24-48 h of birth and their mothers were recruited. Sucking ability was evaluated by measuring Non-Nutritive Sucking (NNS) for 5 min. Data on the rate of exclusive breastfeeding at 1 month postpartum were collected. In the adjusted multiple regression models, intrapartum oxytocin exposure was significantly associated with fewer total NNS bursts (95% confidence interval (CI), -7.02 to -0.22), longer pause times (95% CI, 1.33 to 10.21), and greater pause-time variability (95% CI, 3.63 to 63.92). Effects estimated using structural equation modeling revealed that intrapartum oxytocin exposure had a significant negative and direct effect on the practice of exclusive breastfeeding 1 month postpartum (β = -0.238, p = 0.047). However, no NNS-mediated indirect effects were observed. This report demonstrates that infants born to mothers who receive intrapartum oxytocin may have impaired sucking ability for at least the first 48 h after birth, and breastfeeding support should be provided.

Association of infants' feeding pattern up to 2 years postpartum with mothers' mental and physical health: the Japan Environment and Children's Study

BACKGROUND

Exclusive breastfeeding, a longer breastfeeding duration, and interaction with the baby during lactation improve mothers' mental health. However, few studies have targeted women around 2.5 years after childbirth, when women are still considered to have been in a period of mental and physical health vulnerability. This study examined this aspect in a large cohort of mother-child pairs.

METHODS

Data were obtained from 85,735 mothers in an ongoing nationwide birth cohort study in Japan. Exposures were exclusive breastfeeding (yes/no), continued breastfeeding up to 2 years (yes/no), and interaction with the baby during feeding (yes/no). Outcomes were mothers' mental and physical health 2.5 years after childbirth measured using Mental and Physical Component Summary scores (MCS and PCS scores, respectively) from the 8-item Short-Form Health Survey. Generalized additive mixed model analysis was used to derive each estimate for the three exposures and their interactions, with each "no" answer as reference.

RESULTS

Exclusive breastfeeding and interaction with the baby during feeding were associated with MCS score increases of 0.28 (95%CI: 0.10-0.47) and 0.41 (95%CI: 0.29-0.54), respectively. However, no associations were found for continued breastfeeding up to 2 years and no interactions were identified. No significant differences were observed for PCS scores.

LIMITATIONS

All variables were measured using a self-administered questionnaire.

CONCLUSIONS

Continued exclusive breastfeeding until 6 months and interaction with the baby during feeding may help to promote mother's mental health 2.5 years after childbirth. These findings further strengthen the rationale for the World Health Organization's recommended lactation practices.

Association between newborn separation, maternal consent and health outcomes: findings from a longitudinal survey in Kenya

OBJECTIVES

Disrespectful and poor treatment of newborns such as unnecessary separation from parents or failure to obtain parental consent for medical procedures occurs at health facilities across contexts, but little research has investigated the prevalence, risk factors or associated outcomes. This study examined these experiences and associations with healthcare satisfaction, use and breast feeding.

DESIGN

Prospective cohort study.

SETTING

3 public hospitals, 2 private hospitals, and 1 health centre/dispensary in Nairobi and Kiambu counties in Kenya.

PARTICIPANTS

Data were collected from women who delivered in health facilities between September 2019 and January 2020. The sample included 1014 women surveyed at baseline and at least one follow-up at 2-4 or 10 weeks post partum. PRIMARY AND SECONDARY OUTCOME MEASURES: (1) Outcomes related to satisfaction with care and care utilisation; (2) continuation of post-discharge newborn care practices such as breast feeding.

RESULTS

17.6% of women reported newborn separation at the facility, of whom 71.9% were separated over 10 min. 44.9% felt separation was unnecessary and 8.4% reported not knowing the reason for separation. 59.9% reported consent was not obtained for procedures on their newborn. Women separated from their newborn (>10 min) were 44% less likely to be exclusively breast feeding at 2-4 weeks (adjusted OR (aOR)=0.56, 95% CI: 0.40 to 0.76). Obtaining consent for newborn procedures corresponded with 2.7 times greater likelihood of satisfaction with care (aOR=2.71, 95% CI: 1.67 to 4.41), 27% greater likelihood of postpartum visit attendance for self or newborn (aOR=1.27, 95% CI: 1.05 to 1.55), and 33% greater likelihood of exclusive breast feeding at 10 weeks (aOR=1.33, 95% CI: 1.10 to 1.62).

CONCLUSIONS

Newborns, mothers and families have a right to high-quality, respectful care, including the ability to stay together, be informed and properly consent for care. The implications of these experiences on health outcomes a month or more after discharge illustrate the importance of a positive experience of postnatal care.

Is There an Association Between Oxytocin Levels in Plasma and Pregnant Women's Mental Health?

BACKGROUND: Mood and anxiety disorders are prevalent in women during peripartum. AIMS: Purpose of the present article was to study the relationship between oxytocin (OT) plasma levels and affective symptoms in women during the third trimester of pregnancy. METHODS: Thirty-four pregnant women (13 with an affective disorder, 9 with preeclampsia, and 12 controls) were evaluated through the Edinburgh Postnatal Depression Scale (EPDS), the State/Trait Anxiety Inventory Form Y (STAI-Y), and the Prenatal Attachment Inventory (PAI). A blood sample was collected from all participants, and OT plasma levels have been compared between diagnostic groups. The total sample has been divided into two groups, according to OT median plasma levels, and compared using (a) χ² tests for qualitative variables and (b) a multivariate analysis of covariance for quantitative ones. RESULTS: No statistically significant difference was found among the diagnostic groups in terms of OT plasma levels (F = 0.49, p = .62). Women with lower OT plasma levels, independent from the presence of preeclampsia or an affective disorder, showed worse EPDS and STAI-S total scores than individuals with higher hormone levels (F = 5.93, p = .02 and F = 7.57, p = .01, respectively). CONCLUSIONS: OT may play a role in the etiology of anxious/depressive symptoms during perinatal period independent from a medical or psychiatric diagnosis. This result has a clear effect on the quality of the relationship of patients with mental health professionals, including nurses, and higher levels of this hormone, in the light of its anxiolytic and antidepressive effect, may make easier medical and nursing procedures.

Influence of infants' feeding patterns and duration on mothers' postpartum depression: A nationwide birth cohort -The Japan Environment and Children's Study (JECS)

BACKGROUND

Breastfeeding is increasingly being promoted worldwide. Although several studies have examined breastfeeding and postpartum depression, contradictory results concerning their relationship have been found. This study investigated the influence of the feeding patterns of 1- to 6-month-old infants on maternal postpartum depression, as well as the influence of activities performed by mothers during feeding on postpartum depression.

METHODS

We used data from parents and children who participated in the Japan Environment and Children's Study (JECS). The data were from 71,448 mothers who did not show depressive symptoms at 1 month postpartum.

RESULTS

The group that continued exclusive breastfeeding for 6 months postpartum had a lower risk of postpartum depression compared with those who adopted other feeding patterns. Regardless of the pattern or duration of feeding, the group that maintained eye contact or talked to their baby during feeding had a lower risk of postpartum depression compared with the group that performed other activities. Furthermore, the group that continued both exclusive breastfeeding for 6 months and maintained eye contact or talked to their babies during feeding had an odds ratio of 0.69 for postpartum depression (95% confidence interval: 0.61-0.79), the lowest of any group.

LIMITATIONS

All variables were measured using a self-administered questionnaire.

CONCLUSIONS

It may be possible to control the onset of postpartum depression by recommending breastfeeding to new mothers, providing them with appropriate information on how to interact with their babies, and offering them support.

TRIAL REGISTRATION

UMIN000030786.

Changes in the cortisol and oxytocin levels of first-time pregnant women during interaction with an infant: a randomized controlled trial

Background

During pregnancy, physiological, psychological, and social changes affect pregnant women’s childcare anxiety and childrearing behavior. However, there are scarce reports on hormonal evaluation related to such anxiety and behavior. Herein, we evaluated changes in salivary cortisol (primary outcome) and oxytocin (secondary outcome) levels of first-time pregnant women when interacting with an infant and discussed the relation of these changes to the women’s stress level.

Methods

This was a two-arm randomized controlled trial. Participants were randomly assigned using a web-based randomization system. The experimental group involved interaction with an infant for 30 min. The control group involved watching a DVD movie of an infant for 30 min. Saliva samples were collected at preintervention and postintervention. Saliva samples were assayed, and all data were compared between and within the groups using independent t-test and paired t-test with a two-sided 5% significance level. This study was approved by the Research Ethics Committee of St. Luke’s International University.

Results

A total of 102 women were randomly assigned to the experimental (n = 51) and control (n = 51) groups. Finally, 38 women in the experimental group and 42 women in the control group were analyzed. The salivary cortisol level significantly decreased after the interventions in both groups (t = 4.57, p = 0.00; t = 5.01, p = 0.00). However, there were no significant differences in the salivary cortisol (t = 0.349, p = 0.73) and oxytocin (t = − 1.945, p = 0.58) levels between the two groups.

Conclusions

The salivary cortisol level of first-time pregnant women significantly decreased in the experimental and control groups postintervention, although no significant difference was found between the two groups. Such decrease indicates stress reduction and release among these women. The absence of a significant increase in salivary oxytocin level in both groups may be related to the limitations of an insufficient number of samples that could be analyzed owing to the small saliva volume in some samples and the lack of adequate tactile stimulation of the intervention protocol. These results and procedural limitations provide useful insights into approaching subsequent studies aiming at continuously optimizing detection procedures.

Trial registration

UMIN000028471 (Clinical Trials Registry of University Hospital Information Network. July 31, 2017- Retrospectively registered.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12884-021-03609-8.

Social support is linked to mental health, quality of life, and motor function in multiple sclerosis

OBJECTIVE

To investigate associations of social support to psychological well-being, cognition, and motor functioning in patients with multiple sclerosis (MS). Secondarily, we were interested in exploring sex differences in these relationships, based on a bioevolutionary theoretical justification.

METHODS

Social support was assessed in 185 recently diagnosed patients (RADIEMS cohort), and in an independent validation sample (MEMCONNECT cohort, n = 62). Patients also completed a comprehensive neurobehavioral evaluation including measures of mental health, fatigue, quality of life, cognition, and motor function. Correlations tested links between social support and these variables, along with potential gender differences.

RESULTS

In both samples, higher social support was associated with better mental health, quality of life, subjective cognitive function, and less fatigue. In the RADIEMS cohort, higher social support was associated with better motor functions, particularly grip strength and gait endurance in women.

CONCLUSIONS

These findings highlight associations of social support to overall psychological health and motor functioning in persons with MS, underlining the potential opportunity of evaluating and promoting social engagement in novel treatment strategies.

The risk of low risk: First time motherhood, prematurity and dyadic well-being

Premature birth has a well-documented impact on infants, mothers and their dyadic interactions. First time motherhood in the context of low risk premature birth-relatively unexplored in the literature-is a specific experience that sits at the nexus of premature infancy, motherhood and the processes that underpin dyadic connection. This qualitative study analyzed semistructured interviews with first time mothers of low risk premature babies. Findings were generated in response to research questions concerning mothers' meaning-making, bonding and identity. Findings demonstrated that maternal meaning-making emerged from a dyadic framework. When mothers or their infants were considered outside of a dyadic context, surplus suffering inadvertently occurred. Findings have important implications for infant mental health practice in medical settings, for postnatal support in the aftermath of premature birth, and for understanding the meaning of risk.

Does touch matter? The impact of stroking versus non-stroking maternal touch on cardio-respiratory processes in mothers and infants

The beneficial effects of touch in development were already observed in different types of skin-to-skin care. In the current study, we aimed at studying potential underlying mechanisms of these effects in terms of parasympatho-inhibitory regulation. We examined the specific impact of affective maternal stroking versus non-stroking touch on the cardio-respiration of both mothers and infants in terms of respiratory sinus arrhythmia (RSA). We compared a 3-min TOUCH PERIOD (stroking or non-stroking touch) with a baseline before (PRE-TOUCH) and after (POST-TOUCH) in 45 dyads (24 stroking/21 non-stroking touch) with infants aged 4-16 weeks. We registered mother-infant ECG, respiration and made video-recordings. We calculated RR-interval (RRI), respiration rate (fR) and (respiratory corrected) RSA and analyzed stroking mean velocity rate (MVR) of the mothers. ANOVA-tests showed a significant different impact on infants' respiratory corrected RSA of stroking touch (increase) versus non-stroking touch (decrease). Further, during and after stroking touch, RRI significantly increased whereas fR significantly decreased. Non-stroking touch had no significant impact on infants' RRI and fR. In the mothers, RRI significantly decreased and fR significantly increased during the TOUCH PERIOD. The mothers' MVR occurred within the range of 1-10 cm/s matching with the optimal afferent stimulation range of a particular class of cutaneous unmyelinated, low-threshold mechano-sensitive nerves, named c-tactile (CT) afferents. We suggest CT afferents to be the a potential missing link between the processing of affective touch and the development of physiological and emotional self-regulation. The results are discussed with regard to the potential role of CT afferents within the building of early self-regulation as part of a multisensory intuitive parenting system and the importance to respect this ecological context of an infant in research and clinical applications.

Physiology of Stress and Use of Skin-to-Skin Care as a Stress-Reducing Intervention in the NICU

Advances in neonatal care have allowed for the increasing survival of critically ill infants. These infants experience significant stress related to painful procedures and physical separation from their parents. The purpose of this article is to describe the physiologic stress mechanisms that contribute to mortality and morbidity in infants in the NICU and the physiologic mechanisms by which skin-to-skin care (SSC) acts on the stress response system. Findings from current literature supporting the use of SSC and barriers and facilitators to implementation are reviewed. SSC is a safe and effective intervention to reduce stress for infants and their parents. Nurses play a key role in facilitating SSC to optimize outcomes of care in the NICU.

Social context modulates digestive efficiency in greylag geese (Anser anser)

In group-living animals, social context is known to modulate physiology, behaviour and reproductive output as well as foraging and nutritional strategies. Here we investigate the digestive efficiency of 38 individuals belonging to different social categories of a semi-feral and individually marked flock of greylag geese (Anser anser). During 9 consecutive days in winter 2017, when the ground was fully covered with snow (i.e. no grass or other natural forage available) and the accessible food was standardized, 184 individual droppings were collected and analysed to estimate the apparent digestibility of organic matter (ADOM). Lignin was used as an indigestible internal marker in the food and droppings. The digestive efficiency was higher in pairs with offspring as compared to pairs without offspring or unpaired birds. Furthermore, individuals with high ADOM were more likely to breed successfully in the following season than those with low ADOM. Our findings demonstrate that social status modulates digestive efficiency, probably via a chain of physiological mechanisms including a dampened stress response in individuals enjoying stable social relationships with and social support by their family members (i.e. their own pair-partner and offspring). Our findings underline the importance of the social network in modulating physiology, such as digestive efficiency, and ultimately reproductive success.

Oxytocin and Cortisol Levels in Dog Owners and Their Dogs Are Associated with Behavioral Patterns: An Exploratory Study

We have previously shown that dog-owner interaction results in increasing oxytocin levels in owners and dogs, decreasing cortisol levels in owners but increasing cortisol levels in dogs. The present study aimed to further investigate whether oxytocin and cortisol levels in the previously tested owners and dogs were associated with their behaviors during the interaction experiment. Ten female volunteer dog-owners and their male Labrador dogs participated in a 60 min interaction experiment with interaction taking place during 0-3 min and blood samples for analysis of oxytocin and cortisol were collected at 0, 1, 3, 5, 15, 30, and 60 min. The entire experiment was videotaped and the following variables were noted; the different types (stroking, scratching, patting and activating touch, i.e., scratching and patting combined) as well as the frequency of touch applied by the owner, the number of times the owner touched her dog, the dog's positions and time spent in each position. Correlations were analyzed between the behavioral variables and basal oxytocin levels, maximum oxytocin levels, delta oxytocin levels, basal cortisol levels and cortisol levels at 15 min. Owners with low oxytocin levels before and during the interaction touched their dogs more frequently (0 min: R_s = -0.683, p = 0.042; oxytocin maximum: R_s = -0.783, p = 0.013). The lower the dogs' oxytocin levels during the interaction, the more stroking they received (R_s = -0.717, p = 0.041). The more frequently activating touch was applied by the owner, the higher the dogs' cortisol levels became (15 min: R_s = 0.661, p = 0.038). The higher the owners' maximum oxytocin level the fewer position changes the dogs made (R_s = -0.817, p = 0.007) and the shorter time they spent sitting (R_s = -0.786, p = 0.036), whereas the higher the owners' basal cortisol levels, the longer time the dogs spent standing (0 min: R_s = 0.683, p = 0.041). In conclusion, oxytocin and cortisol levels, both in dogs and in their owners, are associated with the way the owners interact with their dogs and also with behaviors caused by the interaction.

Endocrinology of human female sexuality, mating, and reproductive behavior

Hormones orchestrate and coordinate human female sexual development, sexuality, and reproduction in relation to three types of phenotypic changes: life history transitions such as puberty and childbirth, responses to contextual factors such as caloric intake and stress, and cyclical patterns such as the ovulatory cycle. Here, we review the endocrinology underlying women's reproductive phenotypes, including sexual orientation and gender identity, mate preferences, competition for mates, sex drive, and maternal behavior. We highlight distinctive aspects of women's sexuality such as the possession of sexual ornaments, relatively cryptic fertile windows, extended sexual behavior across the ovulatory cycle, and a period of midlife reproductive senescence-and we focus on how hormonal mechanisms were shaped by selection to produce adaptive outcomes. We conclude with suggestions for future research to elucidate how hormonal mechanisms subserve women's reproductive phenotypes.

Effects of Father-Neonate Skin-to-Skin Contact on Attachment: A Randomized Controlled Trial

This study examines how skin-to-skin contact between father and newborn affects the attachment relationship. A randomized controlled trial was conducted at a regional teaching hospital and a maternity clinic in northern Taiwan. The study recruited 83 first-time fathers aged 20 years or older. By block randomization, participants were allocated to an experimental (n = 41) or a control (n = 42) group. With the exception of skin-to-skin contact (SSC), participants from each group received the same standard care. Both groups also received an Early Childcare for Fathers nursing pamphlet. During the first three days postpartum, the intervention group members were provided a daily SSC intervention with their respective infants. Each intervention session lasted at least 15 minutes in length. The outcome measure was the Father-Child Attachment Scale (FCAS). After adjusting for demographic data, the changes to the mean FCAS were found to be significantly higher in the intervention group than in the control group. We recommend that nurses and midwives use instructional leaflets and demonstrations during postpartum hospitalization, encouraging new fathers to take an active role in caring for their newborn in order to enhance father-neonate interactions and establish parental confidence. This trial is registered with clinical trial registration number NCT02886767.

A Meta-Analysis of the Efficacy and Safety of Using Oil Massage to Promote Infant Growth

The synthesizing evidence on the effectiveness of using oil massage to promote the growth of infants is still lacking. This paper aims to determine whether oil massage can promote the physical and neurobehavioral growth of infants according to variables and to evaluate whether oil massage is safe for infant skin.

ELIGIBILITY CRITERIA

The randomized controlled trials, clinical controlled trials and quasi-experimentally designed trials published prior to or in 2014 were searched according to predetermined inclusion criteria and exclusion criteria in Medline, PubMed, Ovid, the Cochran Library, and Chinese databases, including the China National Knowledge Infrastructure, Wan Fang database and VIP journal integration platform. Besides, the grey lectures were searched as well through Open Grey, GrayLIT Network and Clinical Trials.gov.

SAMPLE

Eight studies out of 625 retrieved articles were eligible for inclusion.

RESULTS

Oil massage increased the infant weights, lengths and head circumferences. However, it did not promote a significant advantage in neurobehavioral scores or cause a significant risk of adverse skin reactions.

IMPLICATIONS

The core mechanisms and standard procedures of oil massage as well as the preferred oil type should be the focus of future nursing practice and research.

CONCLUSIONS

Oil massage may effectively improve the physical growth of infants, and it presents a limited risk of adverse skin reactions. However, the relationship between neurodevelopment and oil massage requires further study.

Hypothesis on supine sleep, sudden infant death syndrome reduction and association with increasing autism incidence

AIM: To identify a hypothesis on: Supine sleep, sudden infant death syndrome (SIDS) reduction and association with increasing autism incidence.

METHODS: Literature was searched for autism spectrum disorder incidence time trends, with correlation of change-points matching supine sleep campaigns. A mechanistic model expanding the hypothesis was constructed based on further review of epidemiological and other literature on autism.

RESULTS: In five countries (Denmark, United Kingdom, Australia, Israel, United States) with published time trends of autism, change-points coinciding with supine sleep campaigns were identified. The model proposes that supine sleep does not directly cause autism, but increases the likelihood of expression of a subset of autistic criteria in individuals with genetic susceptibility, thereby specifically increasing the incidence of autism without intellectual disability.

CONCLUSION: Supine sleep is likely a physiological stressor, that does reduce SIDS, but at the cost of impact on emotional and social development in the population, a portion of which will be susceptible to, and consequently express autism. A re-evaluation of all benefits and harms of supine sleep is warranted. If the SIDS mechanism proposed and autism model presented can be verified, the research agenda may be better directed, in order to further decrease SIDS, and reduce autism incidence.

Oxytocin is associated with infant-care behavior and motivation in cooperatively breeding marmoset monkeys

The neurohormone oxytocin (OT) is positively involved in the regulation of parenting and social bonding in mammals, and may thus also be important for the mediation of alloparental care. In cooperatively breeding marmosets, infants are raised in teamwork by parents and adult and sub-adult non-reproductive helpers (usually older siblings). Despite high intrinsic motivation, which may be mediated by hormonal priming, not all individuals are always equally able to contribute to infant-care due to competition among care-takers. Among the various care-taking behaviors, proactive food sharing may reflect motivational levels best, since it can be performed ad libitum by several individuals even if competition among surplus care-takers constrains access to infants. Our aim was to study the link between urinary OT levels and care-taking behaviors in group-living marmosets, while taking affiliation with other adults and infant age into account. Over eight reproductive cycles, 26 individuals were monitored for urinary baseline OT, care-taking behaviors (baby-licking, -grooming, -carrying, and proactive food sharing), and adult-directed affiliation. Mean OT levels were generally highest in female breeders and OT increased significantly in all individuals after birth. During early infancy, high urinary OT levels were associated with increased infant-licking but low levels of adult-affiliation, and during late infancy, with increased proactive food sharing. Our results show that, in marmoset parents and alloparents, OT is positively involved in the regulation of care-taking, thereby reflecting the changing needs during infant development. This particularly included behaviors that are more likely to reflect intrinsic care motivation, suggesting a positive link between OT and motivational regulation of infant-care.

Hormonal Physiology of Childbearing, an Essential Framework for Maternal-Newborn Nursing

Knowledge of the hormonal physiology of childbearing is foundational for all who care for childbearing women and newborns. When promoted, supported, and protected, innate, hormonally driven processes optimize labor and birth, maternal and newborn transitions, breastfeeding, and mother-infant attachment. Many common perinatal interventions can interfere with or limit hormonal processes and have other unintended effects. Such interventions should only be used when clearly indicated. High-quality care incorporates salutogenic nursing practices that support physiologic processes and maternal-newborn health.

A theory of social thermoregulation in human primates

Beyond breathing, the regulation of body temperature-thermoregulation-is one of the most pressing concerns for many animals. A dysregulated body temperature has dire consequences for survival and development. Despite the high frequency of social thermoregulation occurring across many species, little is known about the role of social thermoregulation in human (social) psychological functioning. We outline a theory of social thermoregulation and reconsider earlier research on people's expectations of their social world (i.e., attachment) and their prediction of the social world. We provide support and outline a research agenda that includes consequences for individual variation in self-regulatory strategies and capabilities. In our paper, we discuss physiological, neural, and social processes surrounding thermoregulation. Emphasizing social thermoregulation in particular, we appeal to the economy of action principle and the hierarchical organization of human thermoregulatory systems. We close with future directions of a crucial aspect of human functioning: the social regulation of body temperature.

Self-soothing behaviors with particular reference to oxytocin release induced by non-noxious sensory stimulation

Oxytocin, a hypothalamic nonapeptide, is linked to increased levels of social interaction, well-being and anti-stress effects. The effects of oxytocin that is released by sensory stimulation during different kinds of interactive behaviors are often underestimated or even forgotten. In fact, many of the positive effects caused during interaction, such a wellbeing, stress reduction and even health promotion, are indeed linked to oxytocin released in response to activation of various types of sensory nerves. Oxytocin is released in response to activation of sensory nerves during labor, breastfeeding and sexual activity. In addition oxytocin is released in response to low intensity stimulation of the skin, e.g., in response to touch, stroking, warm temperature, etc. Consequently oxytocin is not only released during interaction between mothers and infants, but also during positive interaction between adults or between humans and animals. Finally oxytocin is also released in response to suckling and food intake. Oxytocin released in the brain in response to sensory stimulation as a consequence of these types of interactive behaviors, contributes to every day wellbeing and ability to handle stress. Food intake or sex may be used or even abused to achieve oxytocin-linked wellbeing and stress relief to compensate for lack of good relationships or when the levels of anxiety are high. The present review article will summarize the role played by oxytocin released by sensory (in particular somatosensory) stimulation, during various kinds of interactive behaviors. Also the fact that the anti-stress effects of oxytocin are particularly strong when oxytocin is released in response to “low intensity” stimulation of the skin will be highlighted.

Evidence for a role of the oxytocin system, indexed by genetic variation in CD38, in the social bonding effects of expressed gratitude

Oxytocin is thought to play a central role in promoting close social bonds via influence on social interactions. The current investigation targeted interactions involving expressed gratitude between members of romantic relationships because recent evidence suggests gratitude and its expression provides behavioral and psychological 'glue' to bind individuals closer together. Specifically, we took a genetic approach to test the hypothesis that social interactions involving expressed gratitude would be associated with variation in a gene, CD38, which has been shown to affect oxytocin secretion. A polymorphism (rs6449182) that affects CD38 expression was significantly associated with global relationship satisfaction, perceived partner responsiveness and positive emotions (particularly love) after lab-based interactions, observed behavioral expression of gratitude toward a romantic partner in the lab, and frequency of expressed gratitude in daily life. A separate polymorphism in CD38 (rs3796863) previously associated with plasma oxytocin levels and social engagement was also associated with perceived responsiveness in the benefactor after an expression of gratitude. The combined influence of the two polymorphisms was associated with a broad range of gratitude-related behaviors and feelings. The consistent pattern of findings suggests that the oxytocin system is associated with solidifying the glue that binds adults into meaningful and important relationships.

Neuroendocrinology of childbirth and mother-child attachment: the basis of an etiopathogenic model of perinatal neurobiological disorders

This review focuses on the neuroendocrine mechanisms in the mother and the newborn that are involved in the generation and consolidation of mother-child attachment. The role that different hormones and neurotransmitters play on the regulation of these mechanisms during parturition, the immediate postpartum period and lactation is discussed. Interferences in the initiation of mother-child attachment may have potential long-term effects for the behavior and affection of the newborn. Therefore, the possible consequences of alterations in the physiological neuroendocrine mechanisms of attachment, caused by elective Cesarean section, intrapartum hormonal manipulations, preterm delivery, mother-infant postpartum separation and bottle-feeding instead of breastfeeding are also discussed.

The Mother-Newborn Skin-to-Skin Contact Questionnaire (MSSCQ): development and psychometric evaluation among Iranian midwives

Background

Despite the benefits of mother-newborn skin-to-skin contact immediately after birth, it has not been universally implemented as routine care for healthy term neonates. Midwifes are the first person to contact the neonate after birth. However, there is evidence that many midwives do not perform mother-newborn skin-to-skin contact. The aim of this study was to develop and psychometrically evaluate an instrument for measuring factors associated with mother-newborn skin-to-skin contact (MSSCQ) based on the PRECEDE-PROCEED model.

Methods

This was a two-phase qualitative and quantitative study. It was conducted during 2010 to 2012 in Tehran, Iran. In the qualitative part, 150 midwives working in labor room participated in 19 focus group discussions in order to generate a preliminary item pool. Then, content and face validity were performed to provide a pre-final version of the questionnaire. In the quantitative phase, reliability (internal consistency and test-retest analysis), validity and factor analysis (both exploratory and confirmatory) were performed to assess psychometric properties of the instrument.

Results

A 120-item questionnaire was developed through the qualitative phase. It was reduced to an 83-item after content validity. The exploratory factor analysis loaded fifteen-factors and three constructs (predisposing, enabling and reinforcing) containing 82 items (38, 18, and 26 statements, respectively) that jointly accounted for 60.61% of observed variance. The Confirmatory factors analysis determined a model with appropriate fitness for the data. The Cronbach’s alpha coefficient showed excellent internal consistency (alpha = 0.92), and test-retest of the scale with 2-week intervals indicated an appropriate stability for the MSSCQ (ICC = 0.94).

Conclusion

The Mother-Newborn Skin-to-Skin Contact Questionnaire (MSSCQ) is a reliable and valid theory-based measurement and now can be used in clinical practice, midwifery and nursing studies.

Short communication: use of a mechanical brush by Holstein dairy cattle around parturition

Grooming is a normal behavior that may contribute to relief of stress. The purpose of this study was to investigate the effect of access to a mechanical brush on auto-grooming behavior in parturient cows. The hypothesis was that cows would increase the total time spent scratching using the brush if they had access to a brush around the time of calving, whereas auto-grooming would be lower for the brush group compared with the no-brush group. The use of a mechanical brush was analyzed both in a group-housed pen (72 to 48 h before calving) and in an individual maternity pen (6h before to 6h after calving) in 16 multiparous Holstein cows. In the maternity pen, cows were randomly assigned to have access to the brush or not. The provision of a mechanical brush in the individual maternity pen did not change the amount of time spent auto-grooming but cows did use the brush before calving and after the calf was removed. Despite being housed in pens containing a brush, cows failed to use it when the calf was present. However, cows with access to a brush spent more time licking their calves in the first hour postcalving (β=8.7 min; 95% confidence interval: 1.5, 15.8) than cows that did not have access to a brush. Regardless of treatment, cows increased the time spent auto-grooming and scratching following separation of their newborn calf (β=1.4 min; 95% confidence interval: 0.46, 2.3 and β=0.07 min; 95% confidence interval: 0.02, 0.12, respectively). Further research is warranted to investigate possible benefits of mechanical brush devices at the time of calving, particularly for cows that experience difficult calving and require manual or mechanical assistance.

Effect and mechanism of acupuncture on gastrointestinal diseases

Acupuncture modulates various biomechanical responses, such as prokinetic, antiemetic, and antinociceptive effects. Acupuncture treatment involves the insertion of thin needles into the skin and underlying muscle and the needles are stimulated manually or electrically. Thus, acupuncture stimulates the somatic afferent nerves of the skin and muscles. The somatic sensory information from the body is carried to the cortex area of the brain. Somatic sensory fibers also project to the various nuclei, including the brain stem, periaqueductal gray (PAG), and paraventricular nucleus (PVN) of the hypothalamus. Somatosensory pathways stimulated by acupuncture activate these nuclei. Activation of the brain stem modulates the imbalance between sympathetic activity and parasympathetic activity. Opioid released from the PAG is involved in mediating antiemetic and antinociceptive effects of acupuncture. Oxytocin release from the PVN mediates antistress and antinociceptive effects of acupuncture. Acupuncture may be effective in patients with functional gastrointestinal (GI) disorders because of its effects on GI motility and visceral pain. It is expected that acupuncture is used in the treatment of patients with functional GI disorders.

The relationship of appetitive, reproductive and posterior pituitary hormones to alcoholism and craving in humans

A significant challenge for understanding alcoholism lies in discovering why some, but not other individuals, become dependent on alcohol. Genetic, environmental, cultural, developmental, and neurobiological influences are recognized as essential factors underlying a person's risk for becoming alcohol dependent (AD); however, the neurobiological processes that trigger this vulnerability are still poorly understood. Hormones are important in the regulation of many functions and several hormones are strongly associated with alcohol use. While medical consequences are important, the primary focus of this review is on the underlying confluence of appetitive/feeding, reproductive and posterior pituitary hormones associated with distinct phases of alcoholism or assessed by alcohol craving in humans. While these hormones are of diverse origin, the involvement with alcoholism by these hormone systems is unmistakable, and demonstrates the complexity of interactions with alcohol and the difficulty of successfully pursuing effective treatments. Whether alcohol associated changes in the activity of certain hormones are the result of alcohol use or are the result of an underlying predisposition for alcoholism, or a combination of both, is currently of great scientific interest. The evidence we present in this review suggests that appetitive hormones may be markers as they appear involved in alcohol dependence and craving, that reproductive hormones provide an example of the consequences of drinking and are affected by alcohol, and that posterior pituitary hormones have potential for being targets for treatment. A better understanding of the nature of these associations may contribute to diagnosing and more comprehensively treating alcoholism. Pharmacotherapies that take advantage of our new understanding of hormones, their receptors, or their potential relationship to craving may shed light on the treatment of this disorder.

Being a resource for both mother and child: fathers' experiences following a complicated birth

The aim of this study was to describe fathers' experiences of being present on a postnatal ward and during the first days at home following a complicated birth. Fifteen fathers were interviewed, and content analysis was used for the analysis. The theme illustrated that fathers were a resource for both mother and child through practical and emotional engagement. The categories describe how the father empowers the mother and illustrates adapting to new family roles. Following complicated birth, fathers should be invited to stay around-the-clock on postnatal wards because it gives them the opportunity to place their resources at the disposal of mother and child. In antenatal courses, fathers should be prepared for their empowering role after a complicated birth.

Sex differences in newborn interaction with mother or father during skin-to-skin contact after Caesarean section

AIM

To investigate differences between the breast-seeking and crying behaviour of girls and boys in skin-to-skin contact (SSC) with their mother or their father after Caesarean section as well as the point-in-time for the first breastfeeding and to compare mothers' and fathers' interactive behaviour with their newborn girl or boy.

METHODS

Twenty girls and 17 boys were randomized to 25 min of SSC with one or the other parent immediately after birth. The interaction was videotaped.

RESULTS

Girls started rooting movements earlier than boys in SSC with either parent (p = 0.027). Infants started to breastfeed significantly earlier if having been in SSC with mothers compared with SSC with fathers during the first 5-30 min (p = 0.018). Girls cried more than boys in SSC with either parent (p = 0.02). Mothers used more touching behaviour towards their newborn infant than fathers (p = 0.001). Mothers touched girls less than boys (p = 0.038). Fathers directed less speech towards girls compared with boys (p = 0.042).

CONCLUSION

Early mother-infant SSC immediately after Caesarean section should be promoted until the occurrence of the first breastfeed. If the mother is unable to provide SSC immediately after birth, the father-infant SSC is a valuable alternative because it enhances paternal interaction.

Understanding behavioral effects of early life stress using the reactive scope and allostatic load models

The mechanisms through which early life stress leads to psychopathology are thought to involve allostatic load, the "wear and tear" an organism is subjected to as a consequence of sustained elevated levels of glucocorticoids caused by repeated/prolonged stress activations. The allostatic load model described this phenomenon, but has been criticized as inadequate to explain alterations associated with early adverse experience in some systems, including behavior, which cannot be entirely explained from an energy balance perspective. The reactive scope model has been more recently proposed and focuses less on energy balance and more on dynamic ranges of physiological and behavioral mediators. In this review we examine the mechanisms underlying the behavioral consequences of early life stress in the context of both these models. We focus on adverse experiences that involve mother-infant relationship disruption, and dissect those mechanisms involving maternal care as a regulator of development of neural circuits that control emotional and social behaviors in the offspring. We also discuss the evolutionary purpose of the plasticity in behavioral development, which has a clear adaptive value in a changing environment.

Instant messages vs. speech: hormones and why we still need to hear each other

Human speech evidently conveys an adaptive advantage, given its apparently rapid dissemination through the ancient world and global use today. As such, speech must be capable of altering human biology in a positive way, possibly through those neuroendocrine mechanisms responsible for strengthening the social bonds between individuals. Indeed, speech between trusted individuals is capable of reducing levels of salivary cortisol, often considered a biomarker of stress, and increasing levels of urinary oxytocin, a hormone involved in the formation and maintenance of positive relationships. It is not clear, however, whether it is the uniquely human grammar, syntax, content and/or choice of words that causes these physiological changes, or whether the prosodic elements of speech, which are present in the vocal cues of many other species, are responsible. In order to tease apart these elements of human communication, we examined the hormonal responses of female children who instant messaged their mothers after undergoing a stressor. We discovered that unlike children interacting with their mothers in person or over the phone, girls who instant messaged did not release oxytocin; instead, these participants showed levels of salivary cortisol as high as control subjects who did not interact with their parents at all. We conclude that the comforting sound of a familiar voice is responsible for the hormonal differences observed and, hence, that similar differences may be seen in other species using vocal cues to communicate.

Mothers' experiences of skin-to-skin care of healthy full-term newborns--a phenomenology study

OBJECTIVES

Previous reports have shown that skin-to-skin contact immediately after birth is the optimal form of care for a full-term, healthy infant and its mother. As this is rarely researched the aim of this study was to explore experiences of skin-to-skin care in healthy mothers of healthy, full-term infants in the first days after birth.

STUDY DESIGN

Using a lifeworld phenomenological approach, 20 women who had childbirth in hospital and were practising skin-to-skin care were interviewed 1-2 weeks after birth. Analysis of all interview texts was directed towards discovering qualitative meanings through a process of identifying meaning units. These were then clustered and analysed with the aim of describing themes of meaning and the essence of the phenomenon.

FINDINGS

The mothers wanted to give their newborn child the best possible care and the skin-to-skin care started a positive spiral. A mutual interaction developed which acted as a generator releasing energy to the mother who wanted to continue the practice which in terms increased mother-infant affinity. Happiness, peace and satisfaction were expressed by the newborns; also a child who was crying or troublesome exhibited a positive response to skin-to-skin care.

CONCLUSION

The study provides insight and knowledge which should guide attitudes and promote practices of this simple healthcare intervention; skin-to-skin contact care to healthy infants born at term. Healthcare professionals should support affinity between a mother and her newborn through facilitation and the provision of information about its benefits.

Beneficial effects of social attachment to overcome daily stress

Accumulation of daily life stress (chronic stress) often causes functional gastrointestinal diseases. Central oxytocin plays an important role in attenuating stress responses and regulating positive social interactions. Adult male rats were either paired or singly housed 1 week prior to the stress loading. Solid gastric emptying was measured after 7 consecutive days of chronic heterotypic stress. To study whether endogenous oxytocin is involved in restoring the delayed gastric emptying after paired housing, an oxytocin antagonist was injected intracerebroventricularly (icv) before the gastric emptying study. CRF and oxytocin mRNA expression in the paraventricular nucleus (PVN) and supraoptic nucleus (SON) was evaluated by real time RT-PCR. In singly housed rats, chronic heterotypic stress significantly delayed gastric emptying (35.1+/-2.8%, n=6, P<or=0.01), compared to that of non-stressed rats (53.2+/-1.3%, n=6). Delayed gastric emptying observed in singly housed rats induced by chronic heterotypic stress was significantly improved by paired housing (54.8+/-3.5%, n=8, P<0.05). Central-administration of oxytocin antagonist attenuated the restored gastric emptying in paired housed rats (33.2+/-4.1%, n=6) following chronic heterotypic stress. Increased CRF mRNA expression at the PVN and SON observed in singly housed rats was significantly reduced in paired housed rats following chronic heterotypic stress. In contrast, oxytocin mRNA expression at the PVN and SON was significantly increased in paired housed rats. Social attachment restores delayed gastric emptying following chronic heterotypic stress, via down-regulating CRF expression and up-regulating oxytocin mRNA expression. Our study may provide the scientific benefit of social attachment in our daily life.

Combined administration of secretin and oxytocin inhibits chronic colitis and associated activation of forebrain neurons

BACKGROUND

The pathogenesis of inflammatory bowel disease is unknown; however, the disorder is aggravated by psychological stress and is itself psychologically stressful. Chronic intestinal inflammation, moreover, has been reported to activate forebrain neurons. We tested the hypotheses that the chronically inflamed bowel signals to the brain through the vagi and that administration of a combination of secretin (S) and oxytocin (OT) inhibits this signaling.

METHODS

Three daily enemas containing 2,4,6-trinitrobenzene sulfonic acid (TNBS), which were given to rats produced chronic colitis and ongoing activation of Fos in brain neurons.

KEY RESULTS

Fos was induced in neurons in the paraventricular nucleus of the hypothalamus, basolateral amygdala, central amygdala, and piriform cortex. Subdiaphragmatic vagotomy failed to inhibit this activation of Fos, suggesting that colitis activates forebrain neurons independently of the vagi. When administered intravenously, but not when given intracerebroventricularly, in doses that were individually ineffective, combined S/OT prevented colitis-associated activation of central neurons. Strikingly, S/OT decreased inflammatory infiltrates into the colon and colonic expression of tumor necrosis factor-alpha and interferon-gamma.

CONCLUSIONS & INFERENCES

These observations suggest that chronic colonic inflammation is ameliorated by the systemic administration of S/OT, which probably explains the parallel ability of systemic S/OT to inhibit the colitis-associated activation of forebrain neurons. It is possible that S and OT, which are endogenous to the colon, might normally combine to restrict the severity of colonic inflammatory responses and that advantage might be taken of this system to develop novel means of treating inflammation-associated intestinal disorders.

Social vocalizations can release oxytocin in humans

Vocalizations are important components of social behaviour in many vertebrate species, including our own. Less well-understood are the hormonal mechanisms involved in response to vocal cues, and how these systems may influence the course of behavioural evolution. The neurohormone oxytocin (OT) partly governs a number of biological and social processes critical to fitness, such as attachment between mothers and their young, and suppression of the stress response after contact with trusted conspecfics. Rodent studies suggest that OT's release is contingent upon direct tactile contact with such individuals, but we hypothesized that vocalizations might be capable of producing the same effect. To test our hypothesis, we chose human mother-daughter dyads and applied a social stressor to the children, following which we randomly assigned participants into complete contact, speech-only or no-contact conditions. Children receiving a full complement of comfort including physical, vocal and non-verbal contact showed the highest levels of OT and the swiftest return to baseline of a biological marker of stress (salivary cortisol), but a strikingly similar hormonal profile emerged in children comforted solely by their mother's voice. Our results suggest that vocalizations may be as important as touch to the neuroendocrine regulation of social bonding in our species.

Early contact versus separation: effects on mother-infant interaction one year later

BACKGROUND

A tradition of separation of the mother and baby after birth still persists in many parts of the world, including some parts of Russia, and often is combined with swaddling of the baby. The aim of this study was to evaluate and compare possible long-term effects on mother-infant interaction of practices used in the delivery and maternity wards, including practices relating to mother-infant closeness versus separation.

METHODS

A total of 176 mother-infant pairs were randomized into four experimental groups: Group I infants were placed skin-to-skin with their mothers after birth, and had rooming-in while in the maternity ward. Group II infants were dressed and placed in their mothers' arms after birth, and roomed-in with their mothers in the maternity ward. Group III infants were kept in the nursery both after birth and while their mothers were in the maternity ward. Group IV infants were kept in the nursery after birth, but roomed-in with their mothers in the maternity ward. Equal numbers of infants were either swaddled or dressed in baby clothes. Episodes of early suckling in the delivery ward were noted. The mother-infant interaction was videotaped according to the Parent-Child Early Relational Assessment (PCERA) 1 year after birth.

RESULTS

The practice of skin-to-skin contact, early suckling, or both during the first 2 hours after birth when compared with separation between the mothers and their infants positively affected the PCERA variables maternal sensitivity, infant's self-regulation, and dyadic mutuality and reciprocity at 1 year after birth. The negative effect of a 2-hour separation after birth was not compensated for by the practice of rooming-in. These findings support the presence of a period after birth (the early "sensitive period") during which close contact between mother and infant may induce long-term positive effect on mother-infant interaction. In addition, swaddling of the infant was found to decrease the mother's responsiveness to the infant, her ability for positive affective involvement with the infant, and the mutuality and reciprocity in the dyad.

CONCLUSIONS

Skin-to-skin contact, for 25 to 120 minutes after birth, early suckling, or both positively influenced mother-infant interaction 1 year later when compared with routines involving separation of mother and infant.

Optimising psychophysiology in third stage of labour: theory applied to practice

BACKGROUND

Active management of the third stage of labour is routine in delivery suites. New South Wales (NSW) Health has a policy which prescribes active management because medically designed randomised controlled trials have claimed a reduced blood loss in third stage with active, compared with 'physiological', management. In home and birth centre settings however, physiological third stage is common as women who access these settings prefer to labour without medical intervention and midwives who work in these settings adopt a holistic approach to working with women. The holistic approach is psychophysiological as the midwife engages with and supports integration of the woman's spirit, mind and body in her childbearing process.

PURPOSE

To present midwifery theory that describes, explains and predicts how women and midwives work together to enable selected women to safely experience an optimal psychophysiological third stage of labour.

METHOD

Key terms are defined. The literature relevant to psychophysiology and management of the third stage of labour is reviewed. An expanded understanding of risk factors for postpartum haemorrhage is presented and justified. A theoretical framework of Midwifery Guardianship is presented and discussed and applied to third stage care.

CONCLUSIONS

A psychophysiological third stage is quite different from what has been defined as 'physiological management' in the medically designed randomised trials comparing active versus physiological care. The conditions for deciding if a particular woman, in a particular context with a particular midwife is a good candidate for a psychophysiological third stage are presented and discussed. Only if all these conditions are met it is safe to proceed with a psychophysiological third stage. Research about the effectiveness of midwifery care in a psychophysiological third stage of labour urgently needs to be conducted.