A Mother’s Journey: Ghosts in the Nursery
by Mary Ann Zettelmaier, MSN
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In the previous discussion, I described elements of effective parenting and suggested that those elements play out across a broad range of parental personality and infant temperament. In other words, parenting is a learned process, marked by some level of trial, error, and readjustment around a core of relationship and emotional and physical ties. It’s that “tolerance for mistakes” thing.
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I also suggested that there are times and circumstances in which, despite our best intentions, learning to be a particular parent to a particular child presents challenges that can’t be ignored or avoided.
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Enter “ghosts in the nursery.” This isn’t my phrase; it belongs to the late Selma Fraiberg, who was instrumental in developing the field of infant mental health. Basically, what she said was this:
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1. All parents experience “ghosts in the nursery,” or some memories of their own experiences of being parented that were painful or confusing, and so challenge their sense of competence as parents. Since no parent is perfect, we all have them. These memories are elicited when we parent our own children.
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2. Under most circumstances, the ghosts are only minor discomforts that parents can recognize for what they are—only ghosts—and set them aside so that they don’t adversely affect their own journey into and through parenting.
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3. But under some circumstances, the ghosts become so overwhelming and so painful that they dominate the nursery and create barriers to effective parenting. Try as we might, we can’t get them out of the way, at least not by ourselves.
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There seem to be some circumstances that make it easier, or more likely, for the ghosts to dominate the nursery. Clearly, a parent’s own experience of abuse, neglect, or problematic attachment makes it likely that, without help, s/he is likely to replicate that experience with her/his children. A new parent whose own parent was depressed or mentally ill easily fears that the same thing will happen to them.
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But other experiences can also challenge a parent’s sense of competence and effectiveness, such that even small ghosts take on big proportions and turn a normal sense of initial vulnerability and uncertainty into what feels like an insurmountable barrier.
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Typical small-ghosts-that-grow include having a sick, atypical, and/or pre-term baby, one who requires more than baseline parenting and/or stands in the way of self-regulating parent and infant contact. The parent who was ready for all the challenges of parenting a typical baby questions their competence at a very basic level and may even have trouble accepting help, perceiving that to be only a reinforcement of a sense of inadequacy. Another potential ghost rears its head when there is a bigger-than-anticipated gap between the idealized baby and the real baby. A quiet, undemanding parent who wants a quiet, undemanding baby and instead gets a high-reactivity, active baby who isn’t easily satisfied or consoled might have trouble finding a level of interaction that is satisfying to both parent and child. Conversely, an active parent who has a quiet child, who doesn’t provide a lot of feedback, may be confused and discouraged in their efforts at parenting. Sometimes an adoptive parent, despite their basic competence as an adult and potential competence as a parent, initially experiences the actual baby as final and permanent evidence of inability to create a biological child. And these are but a few examples. Basically anything that stands as a barrier to a parent’s sense of, or actual, effectiveness is a ghost that won’t leave the nursery, at least not without help.
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In an earlier post, I talked about some basic strategies that every parent benefits from employing in the early days and weeks after childbirth. These are types of help that any new parent needs, actually deserves, as they embark on the most significant journey of their life. Not only are there ways to get healthy parenting off to a good start, but there are also ways to make the ghosts in the nursery manageable, when and if they appear. The goal is not for us to be perfect parents but rather to be real, genuine, good enough parents, ones who give our children their elemental experience in being good enough, genuine human beings themselves, capable of healthy relationships in their own lifetimes. Dr. Fraiberg suggested that the infant’s biggest need in the first year of life is to learn to “Love love,” which is only learned, actually concretely experienced, in relationship with a loving, attentive parent.
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The bigger the challenges that parents perceive and experience, the bigger the need for lots of support, not only from others in the parents’ social network but also from professional caregivers. The next few articles will be devoted to discussions about family-centered care, what parents need, and how to get it.
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Read other articles in Mary Ann Zettelmaier’s A Mother’s Journey series.
The First Hour after Birth
Adjustment Strategies
How Babies Sleep
Asleep, Awake, and In-Between
Infant Temperament
Getting to Know You
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Mary Ann Zettelmaier, MSN specializes in maternal-infant communication, with a comprehensive clinical focus on developing programs of family-centered care.
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A Mother’s Journey: Getting to Know You
by Mary Ann Zettelmaier, MSN
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In the previous entry, I described variations in infant temperament and what those variations tell us about how individual babies express their needs. But no baby can live in isolation, and the primary persons with whom babies interact and depend on are their parents. It is not an exaggeration to say that the quality of parent-infant relationship is the first and most influential experience that an infant has with the world, and it will shape future interactions in her/his life. What makes this relationship unique is that both infant and parent come to it with different capacities for interaction and potentially dissimilar behavioral styles. While an infant can’t talk, they can still express needs as well as respond to others; while a parent can’t regulate the infant’s behavior, they can still learn to respond in helpful and appropriate ways. In other words, the development of this most important relationship in the lives of both is a kind of dance, largely nonverbal, that involves a great deal of improvisation, novelty, and trial and error.
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Rest assured: there is no more a single prescription for parenting style than there is a single style of infant behavior.
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One expert in newborn/infant behavior, J. Kevin Nugent, PhD, has described some common threads in effective parenting, no matter what the unique characteristics of a parent’s personality. Briefly, these are:
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Contingent responsiveness, or the parent’s attentiveness to the infant’s expression of need;
Respect for, and acceptance of, the infant’s unique behavioral style of expression, as well as acceptance of the developmental limitations of the infant’s contribution to the relationship;
Empathy, or the ability to understand, appreciate, and identify with the commonality of human experience and need, despite developmental and stylistic differences;
Time, insofar as any relationship requires the willingness on the part of the partners (primarily here the parents) to invest in the time it takes to develop a relationship. The challenge here is that the parent needs to be willing to suspend an adult approach to time management to meet the infant on their own terms, or availability and capacity for interaction;
Tolerance for mistakes. Because no infant is ideal and no parent is perfect, both need the lived experience that love means flexibility and healthy relationships “offer avenues for repair.”
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Having said all this, it bears repeating that parents need to take the initiative in engaging an infant in the first interactive experience of their life … not that our infants don’t have the capacity to engage, enthrall, and hold us to them. For varieties of reasons, though, this process sometimes presents us with overwhelming, but usually not irreparable, challenges (it’s that “tolerance for mistakes” thing).
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Next time I’ll discuss such challenges, or “ghosts in the nursery,” and the idea of the “good enough” parent. Stay tuned.
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Read other articles in Mary Ann Zettelmaier’s A Mother’s Journey series.
The First Hour after Birth
Adjustment Strategies
How Babies Sleep
Asleep, Awake, and In-Between
Infant Temperament
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Mary Ann Zettelmaier, MSN specializes in maternal-infant communication, with a comprehensive clinical focus on developing programs of family-centered care.
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A Mother’s Journey: Infant Temperament
by Mary Ann Zettelmaier, MSN
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It doesn’t take long for parents to realize that individual babies have unique, identifiable characteristics: they are not, never have been, and never will be blank slates upon whom we, as parents, write the entire script for their lives. It’s best to consider each baby his/her own special blend of nature and nurture … our job as parents is to find a balance between establishing limits and promoting autonomy, such that a baby’s inborn capabilities grow and develop in safety and security. In other words, even before they can speak, babies can tell us a lot about their needs.
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Enter the idea of infant “temperament.” Basically, this is a way to describe a baby’s “style” of interacting with and learning from her/his world. Surely there are a number of methods to evaluate infant temperament, and at some point your pediatrician or nurse practitioner may use some of the fine-tuned methods to help you understand your baby. For practical purposes, I’ve found the basic framework developed by Dr. T. Berry Brazelton, the renowned pediatrician, to be particularly helpful. It’s simple and it captures a range of normal infant behavior, suggesting there’s no one standard to which all infants can or should comply. What he suggests is that most babies’ temperaments can be described as active, average, or quiet.
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Building on the previous discussion about infant sleep and wake patterns, here are some major characteristics of each “type” of infant behavioral style.
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“Active” babies tend to spend more awake time in an active alert state. They’re also the babies whose sleep time is on the lower end of the spectrum of normal. They’re easily aroused and react intensely to sensory input. They tend to cling tightly when they’re held; they smile and laugh easily and usually early. If they’re breastfeeding, they actively search for the nipple and suck vigorously. While this level of responsiveness is usually a great source of satisfaction for parents, these are the babies who sometimes have trouble moving from one state of sleep or wakefulness to another, fussing when falling asleep, crying loudly and easily, and having a hard time turning off stimulation when they’ve had enough. These are the babies who need a quiet environment for sleeping, who need gentle, soothing voices and sequential, rather than multiple, inputs when awake. They need to be held a lot and usually have clear preferences for how they’re held. They benefit from being stroked and/or swaddled if they seem to be thrashing arms and legs when they’re upset.
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At the other end of the spectrum are the “quiet” babies. They can sleep through thunderstorms and other loud sounds; they react slowly to stimulation and spend more awake time in a quiet alert state, looking around without much vocalization or activity. Multiple sensory inputs don’t seem to bother them, and they tend to self-soothe pretty easily. These are the babies who cuddle more than cling when they’re being held. When they nurse, they sometimes need help grasping the nipple. They’re sometimes described as “gourmet” nursers who suck gently and take longer to feed, in contrast to the active baby, the “barracuda” nurser, who tends to feed vigorously and fast. Where an active baby will “announce” developmental milestones (like growth spurts and teething) with maximum upset, the quiet baby seems to glide along with hardly a glitch. But sometimes quiet babies make it harder for parents to “read” their signals and needs, because they’re not as demonstrative and demanding. Thus they need more parental sensitivity to small cues, like the little sucking motions that indicate readiness to feed, the beginnings of drowsiness that indicate time for a nap, the quiet alertness that indicates readiness for interaction. The rule of thumb for meeting these babies’ needs is respect for their lower level of reactivity but enough stimulation to provide opportunities for interaction and engagement.
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In between are the “average” babies, the ones who fit the middle range of sleep and awake states and developmental milestones, who develop feeding routines fairly easily. These are the babies who self-soothe with some, but not a lot, of help, and who negotiate movement between sleep and awake states in a fairly predictable manner. They’re usually fairly easy to console and require less trial-and-error experimentation to figure out their needs and how to meet them.
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When all is said and done, and with all babies of whatever temperament, trial and error are the most operative words for parents in learning how to identify and meet their babies’ needs. In the next entry, I’ll discuss some of the “basics” in building relationships with our children and how we as parents are the other half of the equation in the dance of connectedness.
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Read other articles in Mary Ann Zettelmaier’s A Mother’s Journey series.
The First Hour after Birth
Adjustment Strategies
How Babies Sleep
Asleep, Awake, and In-Between
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Mary Ann Zettelmaier, MSN specializes in maternal-infant communication, with a comprehensive clinical focus on developing programs of family-centered care.
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A Mother’s Journey: Asleep, Awake, and In-Between
by Mary Ann Zettelmaier, MSN
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The first year of a baby’s life is a time of rapid development and maturation, only slightly, and gradually, slower than the growth that occurs prior to birth. Some have suggested that, for about the first nine months, an infant experiences a pace of brain growth similar to that before birth, and perhaps we would do well to consider our infants still fetal during the first months of extrauterine life.
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We know from ultrasound (as well as from maternal experience) that babies go through fairly predictable cycles of waking and sleeping prior to birth. Ditto for the first months afterward. The following six “states,” three of sleeping and three of waking, have been identified. On a continuum, they are:
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Deep sleep
Light, or random eye movement (REM) sleep
Drowsy, semi-alert or transitional sleep
Quiet alert wake state
Active alert wake state
Crying
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Newborn infants spend about 16–18 hours of a 24-hour period sleeping. Most of that is light, or REM, sleep. Although there’s variation from infant to infant, it’s typical that any single sleep cycle lasts only about 4–6 hours. So in a 24-hour period an infant will usually go through about 3 to 4 sleep cycles. A great deal of maturation, especially of the neuromuscular and digestive systems, occurs during REM sleep, which likely explains why this state occupies the better part of the sleep cycle.
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What do these states of sleeping and waking look like?
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In deep sleep (about 35% to 45% of sleep time), an infant’s breathing is regular and shallow, and movement is minimal. There may be a few startle movements, but they are brief and don’t seem to disturb the infant. There is little to no eye movement.
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In active/REM sleep (about 45% to 50% of sleep time), breathing is more irregular (shallow and deep breaths), and movement is irregular. The baby sometimes makes sucking movements, and though her/his eyelids are still closed, you can see movement of the eyes under the lids.
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In transitional sleep (5% to 20% of sleep time), the baby’s eyes may be partially opened, activity levels are variable, and sucking movements may be more pronounced. Some babies go into and through this state easily; some fuss until they either wake or get into a deeper sleep. Either way, a complete sleep cycle is usually characterized by movement back and forth between sleep states.
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Then there’s the remaining 6–8 hours of a newborn’s day spent in some state of wakefulness, but which won’t occur in a single stretch and won’t completely occur during the day. As a baby rouses from sleep, she/he may or may not cry (the high end of awake) and will spend some amounts of time in states of quiet and active alertness.
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In the quiet alert state, babies are bright-eyed but not overly active. It’s in this state that babies are most receptive to interaction. They will follow a parent’s voice, make direct eye contact, and within a very few weeks will start to smile and imitate a parent’s facial expression. This is the beginning of socialization, of learning about feedback from the world around him/her, of learning whether or not that world is safe, secure and predictable.
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In an active alert state, babies are wide-eyed and more physically active. They may be fussy, and for sure they are more sensitive to their surroundings, thus requiring less stimulation. Some babies will signal that they’ve “had enough” input or stimulation by shutting their eyes or turning their heads to break eye contact.
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Crying is, well … the state that most disturbs our babies and ourselves. It’s more than fussing and varies from a few minutes of mild distress to ear-splitting, interminable screeching, what someone has described as “table-pounding.” Either way, it’s a signal that requires our attention, and as parents we’re left to figure out how much and what kind of response best addresses our baby’s signal that he/she needs help managing her/his internal or external world.
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In forthcoming entries, I’ll address variations in the style of response that infants can demonstrate, sometimes described as infant temperament or personality, and what a particular style tells us, as parents, about meeting our own infant’s needs. Stay tuned.
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Read other articles in Mary Ann Zettelmaier’s A Mother’s Journey series.
The First Hour after Birth
Adjustment Strategies
How Babies Sleep
Infant Temperament
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Mary Ann Zettelmaier, MSN specializes in maternal-infant communication, with a comprehensive clinical focus on developing programs of family-centered care.
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A Mother’s Journey: How Babies Sleep
by Mary Ann Zettelmaier, MSN
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In the last twenty years, there has been considerable attention paid to how babies are positioned for sleep. To make sense of all this, it’s worth taking a look at babies’ inborn competencies and why sleeping position is probably important.
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First of all, babies come into the world with some, but not a lot, of the head and shoulder strength they need to turn, and hold up, their heads. Additionally, they are “obligate” nose breathers, which means they have to have their noses free in order to breathe. They don’t breathe through their mouths, which is why they can suck and breathe at the same time. If babies are sleeping on their stomachs, it may be hard for them to turn their heads and keep their noses free. And it will be some months before they can hold up their heads independently and turn over to get off their stomachs.
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In the meantime, they are at risk for Sudden Infant Death Syndrome (SIDS). Under the best of circumstances, and for reasons not totally understood, a very small percentage of babies between one month and one year of age stop breathing, and die, in their sleep. This, by definition, is SIDS. Sleeping position seems to make a difference: babies sleeping prone (on their stomachs) and on a soft surface, as well those exposed to parental smoking and drug use and/or of low birth weight, seem to be at greater risk for SIDS.
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In 1992, the American Academy of Pediatrics issued recommendations that young babies sleep on their backs, on a firm surface, and in a bed separate from their parents or other siblings. Since then, the rate of SIDS has decreased by half in the United States, from 1.2 per thousand live births to 0.6 per thousand in 2000. The rate has remained essentially stable since then. Still, the United States lags behind all developed countries studied (13 total), except New Zealand, in SIDS deaths.
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The common threads in all the evidence, including that from traditional cultures where SIDS rates are even lower than in developed countries, seem to be that babies are best off sleeping on their backs, on a firm surface, with nothing to cover their faces. Breastfeeding also seems to be protective against SIDS. Where they sleep is not nearly as clear an issue and certainly does vary by culture. Very recently, the American Academy of Pediatrics made the additional recommendation that crib “bumpers” never be used, since there is a risk of babies getting their faces entrapped against a bumper and/or of being strangled by the bumper ties.
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Now that most babies are sleeping on their backs, many of them have started to look like the backs of their heads are flat. Actually, babies’ skull bones are still pretty flexible, and as long as they have time off their backs their heads will round out. By the time they’re upwards of a year old, they’re rolling around in bed anyway, and SIDS is not a risk after a year. Prior to a year of age and/or prior to the baby’s ability to roll over, this can mean “tummy time” during play, as long as a responsible adult is paying attention. Or, it can mean what human babies need the most anyway: being held and carried, in contact with what and who means the most to them: another human being.
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Read other articles in Mary Ann Zettelmaier’s A Mother’s Journey series.
The First Hour after Birth
Adjustment Strategies
Asleep, Awake, and In-Between
Infant Temperament
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Mary Ann Zettelmaier, MSN specializes in maternal-infant communication, with a comprehensive clinical focus on developing programs of family-centered care.
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A Mother’s Journey: Adjustment Strategies
by Mary Ann Zettelmaier, MSN
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You are a competent, responsible, successful, high-functioning adult. You thought long and hard about taking on the joy and challenge of starting a family. Or, even if your pregnancy was a surprise, you’re happy about your baby. You have a good relationship with your partner and have a host of friends and acquaintances. Then why do you feel like a bumbling, awkward, tongue-tied, can’t-even-think-straight, irrational jerk?
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Welcome to parenthood.
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I wish I knew an easy, shortcut way around the most profound adjustment you’ll ever make in your life, but I’ve yet to find one. And I’d venture to say that for those of us who are parents in the good old U.S. of A. at this point in time, the adjustment is a particularly challenging one. Here’s my take, based on some beginning research, of why this is so.
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We are a culture that greatly values individualism, self-sufficiency, independence, equality, self-determination, and doing our own thing. We have few models for valuing, to the same degree, interdependence, complementarity, connectedness, and difference. We want things to be clear and not fuzzy, communication to have one clear, easy-to-figure-out meaning.
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Then all of a sudden our lives, as new parents, are totally dominated by a little creature who doesn’t talk, signals with behavior that we’re left to figure out by trial and error, remains as connected to us as if the umbilical cord were never cut, is totally dependent, has absolutely no concern for our feelings, our schedules, our desire for private time with our partners, and doesn’t care if we’ve had time to eat or sleep, much less shower and get dressed. None of this means we don’t love our babies. In fact, we’re frequently so overwhelmed by a new kind of love that we can’t easily grasp the breadth and depth of it.
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We know that our babies are new, but until it happens, it’s hard for us to appreciate how new we are, too.
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While I will address many aspects of new parenting in forthcoming posts, for now I simply want to suggest some adjustment strategies that might help along the way.
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1. Give yourself a break. Keep your expectations of yourself and your partner pretty minimal. Given the gap I’ve described between your public world, with its prevailing values, and your new lived reality, you need time to put the two together. Parental work leave is an opportunity to at least begin that process. The findings of my own small study, plus those of others, suggest that it takes the better part of the first year of your baby’s life for you to completely emerge into a new personal reality. Your baby isn’t the only one celebrating that first birthday.
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2. Get help. As a new mom you need to be mothered, too, at least through the initial adjustment of the first couple of weeks. Confine yourself to feeding and caring for your baby. Let somebody else—frequently your own mom—take care of you, your house, and the rest of your family. Many cultures have clear rituals to help a new mom with initial adjustments, but ours doesn’t. So make your own arrangements. If your mom isn’t available, many areas now have doulas, or mother’s helpers, who can fill the bill. Sometimes they’re available through home health agencies. Check to see what’s available to you, and whether or not your health insurance covers such services. If friends offer to prepare meals, accept and thank them.
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3. Make a list of caregivers who can help. That could mean your midwife, your obstetrician, your pediatrician or pediatric/family nurse practitioner, your childbirth educator or a lactation consultant. Perhaps even before you deliver, list your potential helpers and their phone numbers. Post the list in a place that you can access without having to think twice. And don’t hesitate to use it.
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4. Sometime in the weeks and months after your baby’s birth, you may find yourself making new friends of others with young families. Frequently these are people you’ve met in childbirth classes. You might also forge new relationships with siblings or other relatives who have young families. That doesn’t necessarily mean giving up old friends who are either single or don’t have children, but don’t be surprised if you find yourself with new and different interests. You need these new friends to share your journey.
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Future discussions will address other issues that affect new parents, such as “reading” your baby’s behavior, variations in baby personalities, sleeping issues, and situations in which adjustment to parenthood is especially troublesome. Stay tuned.
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Read other articles in Mary Ann Zettelmaier’s A Mother’s Journey series.
The First Hour after Birth
How Babies Sleep
Asleep, Awake, and In-Between
Infant Temperament
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Mary Ann Zettelmaier, MSN specializes in maternal-infant communication, with a comprehensive clinical focus on developing programs of family-centered care.
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A Mother’s Journey: The First Hour after Birth
by Mary Ann Zettelmaier, MSN
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After the intensity and inward focus of the latter part of labor, a mother’s psychological awareness literally opens up on a new existence, for herself and her baby, in the first hours and minutes after birth. It’s not unusual for a mother to feel a new kind of alertness, although it’s limited in scope. Some moms will describe a kind of “halo” of awareness that surrounds herself and her baby, but beyond which her surroundings are literally blurred and insignificant. Within that halo, fascinating and important things are happening.
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First, and under most circumstances, both she and her baby are especially alert and sensitive to each other. At that time, most babies are quiet and looking around. While some moms quietly cry (in wonder and relief), most are like their babies … quiet and simply pondering what has happened. This is a time of re-acquaintance and of adding a new dimension to a bond that has grown with pregnancy and gestation.
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To the extent that it’s possible, this is a time for moms to hold their babies so that the two of them can gaze at each other. Babies are usually wide-eyed at this time, and while their vision is not perfect, it is functional and effective at about eight to twelve inches from what the baby is trying to focus on. The very best thing to focus on is his/her mom’s face. Her voice (and that of her partner’s) will be familiar, and the baby will usually respond by turning to the source of quiet, soothing words within that little “cocoon” of focus and awareness.
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Typically, there’s a lot of baby care going on right after birth, but most of it can occur with a mom holding her baby, or at least within her sight. Additionally, most babies (unless heavily medicated during labor) are ready to suckle and can be put to breast. Note, too, that the distance from a mom’s face to her breast is about eight to twelve inches, or within the baby’s best visual range. If she can and does breast feed, the baby will benefit from early suckling and ingestion of colostrum, a precursor to human milk and a good source of calories and protective antibodies. Early nursing will also release maternal oxytocin, a hormone that will help the mother’s physical recovery from birth.
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If it’s possible and if a mom desires, there are also benefits to skin-to-skin contact between mom and baby. A baby’s skin surface—relative to body weight a newborn’s largest sensory organ—will usually respond to mom’s touch by calming and quieting. Additionally, a mom is a better source of temperature regulation for a baby than any warming machine. In some hospitals a warming light can be placed over the mom as she holds her baby skin-to-skin, but under any circumstances she herself does more to keep her baby appropriately warm than anything or anybody else. If a blanket is used, it can be placed over both of them, together.
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One aspect of care that occurs during that “magic” first hour is installation of antibiotic ointment to protect the baby’s eyes from infection. Use of antibiotic ointment is frequently regulated by law, but in order to make optimal use of the baby’s capacity for vision early on, parents can request that the ointment be instilled toward the end of the hour.
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At about one to one and a half hours after birth, most babies will begin to get drowsy and will go into a fairly prolonged, deep sleep. At the same time, most moms are ready to sleep also, and they need and deserve that quiet time to begin to recoup the energy expended in delivering their babies. While mutual regulation is a “dance” that will occupy many months (if not years) of a baby’s new life and a mom’s new life, this first step is an important one that gets both of them off to a good start.
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Read other articles in Mary Ann Zettelmaier’s A Mother’s Journey series.
Adjustment Strategies
How Babies Sleep
Asleep, Awake, and In-Between
Infant Temperament
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Mary Ann Zettelmaier, MSN specializes in maternal-infant communication, with a comprehensive clinical focus on developing programs of family-centered care.
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