Neurons to Networks–An Excellent Video

Twelve years ago it was the book “From Neurons to Neighborhoods” and a wonderful conference in Los Angeles that brought together people who understood the importance of the links between healthy brain development and safe, supportive neighborhoods for families.

Now even more research supports the concept that safe, loving early relationships have phenomenal power over the trajectory of childhood brain development. Such research also serves to underline some of the reasons for the high aggression and poor learning ability (among other symptoms) shown by many of the young children I see in therapy–the powerful effects of early childhood trauma: abuse and neglect (sometimes even before birth–such as exposure to street drugs or alcohol).

There are regrettably few individuals around the world who know how to restructure brain development gone awry, and they can only do so much and only up to a certain point. We need to be able to get it right the first time, and to help people understand why this is so important, and what it will take to make it possible for more babies and their parents.

Anyway, this was meant to be a brief introduction to the video: which the makers are willing to tailor to the needs of individual organizations that wish to use it. Please enjoy it (it lasts under 11 minutes) and feel free to share it wherever it might be useful.

My personal hope is that it will help us to provide what is necessary to give infants and young children a better start in life–with safer, more loving families, more time with the folks who care for them, paid parental leave, and simpler births more supportive of mothers’ and babies’ mutual dance of love.

The Relationship between Artificial Oxytocin (Pitocin) Use at Birth for Labor Induction or Augmentation and the Psychosocial Functioning of Three-year-olds

SUMMARY OF FINDINGS OF THE STUDY

Claire L. Winstone, Ph.D. 

 

The focus of my dissertation research study was, as you can see by the above title, an exploration of whether there is any relationship between the use of Pitocin (artificial oxytocin) to start or speed up labor, and the way children born with its use function individually and in their relationships when they are three years old. I was interested in Pitocin use because what I read suggested that around two-thirds of inductions are now for non-medical reasons, but there wasn’t a lot of research to tell us whether there were any specific consequences to the child of this use.

 

Before starting this research I first interviewed six therapists who work with babies, children, and adults to resolve issues arising fromchallenging prenatal or birth experiences. All the therapists had worked with clients who had been born with the use of Pitocin. The therapists told me what they had observed and learned about their clients and the role they thought Pitocin played in their functioning. I performed a content analysis on the interview transcripts, and about two years later, had a long list of “items” that eventually became the raw material for a survey to be conducted with mothers of three-year-old children. I sent this list to the six therapists with a voting form, and they helped me select which items best represented the various areas of functioning about which I planned to ask the mothers.

 

Eventually, this list became the survey that participants were invited to complete. Ultimately, I had 498 completed surveys that could be analyzed to see if Pitocin use appeared to be related to a difference in how three-year-olds functioned.  The following is a summary of the findings that were statistically significant.

  

1.      Receiving Pitocin resulted in more negative recollections of labor and delivery, suggesting that mothers who received it had a more challenging experience than those who didn’t. However, there was a similar finding for the use of epidural anesthesia and for pain medication, both of which tend either to precede or follow the use of Pitocin.

 

2.      Mothers who received Pitocin spent less time with their babies in the first hour after delivery, and were less likely to feed their babies exclusively at the breast in the first six months. In other words, babies who were born without Pitocin were more likely to be fed exclusively at the breast in the first six months than those born with Pitocin

  

3.      Two factors distinguished children born with Pitocin from those born without Pitocin.

 

The first was called “Assertiveness”, which describes a socially appropriate way that babies and children communicate their need for help and comfort when they are feeling uncomfortable or unsafe. Typically, crying, using facial expressions and physical gestures, and later, verbalizing their thoughts and feelings, elicits helpful responses from parents, who try to identify and meet the need the baby or child is expressing. However, babies born with Pitocin, whose mothers reported having had a more challenging time during labor and delivery, appear to have a higher need to be assertive because they seem to experience more discomfort, but are apparently less effective in asserting their needs and getting them met when they feel unsafe or uncomfortable.

  

The second factor was called “Need to Control Environment” and this summarizes what seems to be a higher level of discomfort or insecurity, particularly in response to “outside-in” influences (e.g., reacting to food with digestive problems or being picky eaters; problems coping with other people’s timing and structure, refusing help from others) and increased or exaggerated efforts to control their environment, resulting in behaviors that may be more challenging to their mothers/family. There appears to be some continuity of effects between infancy and age three: for example, children who were described as picky eaters, or as having digestive problems at three, were likely to have been colicky, fussy babies. Interestingly, the hormone oxytocin is very involved in the digestive process: it plays a role in the production of digestive enzymes and as we enjoy our meal, in a positive feedback loop, we produce more oxytocin.

  

It may be that a process described as “hormonal imprinting”, identified in a considerable number of animal studies since the 1970s, is the mechanism that accounts for these differences between children exposed to Pitocin and those who were not. Using Pitocin to initiate labor may “flood” the available oxytocin receptors in mother and baby, apparently affecting children’s internal comfort levels and how they interact with others, although how this takes place in the babies has not yet been studied. Since both mother and baby receive Pitocin during labor and delivery, it is as yet unclear to what degree each contributes to challenges in their mutual relationship.  

Santa Barbara Graduate Institute

July 2008 

 Use these links to download a .pdf of the Powerpoint presentation of this material:

Microsoft PowerPoint – APPPAH 2010 Handout Format

 Microsoft PowerPoint – 6 slides per page

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Musing About Prenates

Imagine that you are fast asleep.  Suddenly you are awoken by a strange and frightening sensation. It seems to be inside your body and you might equate it to suddenly having 12 cups of espresso in your system, only worse—it’s more jittery, more jagged. You can’t escape the sensation, it doesn’t seem to go away, and you can’t possibly go back to sleep. But what’s really scary about it is that you don’t know or understand what it is, or if it might get worse. Your heart is racing and you seem to be having trouble getting enough oxygen. You don’t know if you are going to survive this onslaught that seems to be coming from inside you and racing through your body and you don’t know how long it will last. There is no escape. After your first or maybe second experience like this, you become too anxious to be able to relax and sleep, never knowing when this experience will be repeated and whether you will survive the next time.

 Imagine then that this same experience happens unpredictably for a number of months: perhaps only occasionally, perhaps daily or even more often. This may be what it is like to be a fetus exposed to maternal substance abuse: particularly a substance like methamphetamine. The fetus is also exposed to its mother’s stress hormones–adrenaline, cortisol, norepinephrine—depending on her circumstances: there may be domestic violence, she may be homeless, prostituting, and not eating well. She is unlikely to get regular prenatal care and her baby may come early, and spend time in the N.I.C.U., where its already hypersensitized nervous system is further assaulted by the standard care that infants receive in most neonatal intensive care units: no warnings before a diaper change, a bath, or a needle being poked into a vein: if they are lucky, a nurse will speak softly to them, if not, sounds, lights, sensations and medical procedures can be exhausting and overwhelming. In addition, many of these children are detained from their mothers at birth and find themselves in the care of others: perhaps family members, or strangers. Some of the babies not detained at birth show up in the child welfare system months or years later: victims of neglect and possibly abuse.  

 By age three many of these children are being “suspended” or “expelled” from their preschool or day care for their aggressive behaviors, their resistance to following directions, their disruptiveness and their inability to relax and sit quietly through an activity or story. Many also have problems with falling or staying asleep, which may add to their irritability. By five, many of them will have been diagnosed with Disruptive Behavior Disorder, AD/HD, Oppositional Defiant Disorder and other similar childhood diagnoses. Some will begin on medication early, sometimes for a lack of alternative treatments (such as occupational therapy for sensory processing and/or regulatory disorders that often co-occur with AD/HD), or to keep their teachers happy and keep them in school, perhaps making it possible for them to avoid being placed in Special Education classes or classes for “emotionally disturbed children.”

 I have a theory. I wonder if the sensations of angry feelings inside a preschooler are experienced as similar to the sensation of drugs in their bloodstream prenatally. I wonder if these children therefore believe that they cannot control angry feelings (the very big angry feelings common in 3-5-year-olds) because they couldn’t control the sensations of the drugs entering their fetal bodies carried by blood from their mother through the umbilical cord (although apparently many try—they instinctively contract the muscles around the umbilicus in a vain attempt to squeeze off the offending substance, but of course, can’t do this with complete effectiveness because they’d also be reducing their oxygen levels. These children tend to have constipation as infants and gait problems when they begin to walk from this chronic pattern of muscle contraction.  I wonder if each time they experience feeling angry and frustrated they also feel the terror of possibly being annihilated by those sensations, just as they formerly feared the very real possibility of dying as a result of a huge overdose of a drug for the size of the fetal body. I wonder if their hyperactivity and inability to settle and focus results from the hardwired need to be hypervigilant, to watch out at all times for the next possible threat to their survival. I wonder if their aggressive behaviors are the result of the fight/flight system having become the dominant operating system at such a young age. Not necessarily that they are just plain aggressive, but that they perceive every stick to be a snake, every movement around them to be a potential source of danger.

 I wonder what these souls seek in such a life experience. What makes them survive circumstances that might result in miscarriage for another fetus in a similar situation? They used to say that our fears for “crack babies” were overstated and that many turned out just fine. A psychiatrist I know said that prenatal drug exposure is such a random process it affects the brain like scattershot, so the damage is like Swiss cheese: little pockets of damage concealed among normal brain tissue.  You may see the effects right away or not until later on. And no two children so affected are affected in quite the same way, though there are commonalities in many (see above).  Is it treatable?  Yes, I think so, in most cases. But whether the appropriate treatments are available and affordable varies by location and family circumstances. And then there are the families. Some are in denial that there is any problem. Others simply don’t notice anything out of the ordinary until later on. Some have limited resources. Some are misled by practitioners who are unaware of the possibilities for helping such children into thinking there is little or nothing they can do. Many children ultimately get medication, which treats symptoms, but not the source.

 I would so love to find out what’s being done for these little ones around the country, and around the world. I’ll bet there are pioneers all over the place, some of whom are doing marvelous, brilliant things. I only wish they were right here where I live and work!

Here is a link to a report of a recent study on prenatal methamphetamine exposure: http://tinyurl.com/lgf5do

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