How can we convince and influence doctors and nurses about the importance of being attentive at birth?

Question 2 on the Newborn from 

The International Montessori Congress in Prague

from Panagiota Panagopoulou (Athens, Greece)

Every day that I go to the hospital to observe newborns I am in contact with nurses, nurse midwives, pediatricians and obstetricians. They are often curious to know what could be so interesting about watching a newborn in the incubator in his first hours of life.

From my observation journal, Feb. 8, 2018

"Yesterday I heard a pediatrician say to a nurse, shortly after a baby was put in the tiny heated plexiglass room, “look how his mouth is searching for his mother” and commented on how strong his instincts are. I should have followed her interest and invited her to say more, but I wanted to share an observation of my own that I have made over and over again.

Active listening would have been much more productive. I would have drawn more from the well of her knowledge about how these instincts serve the mother and child to come back together immediately after their epic separation, how nature provides humans with the capacity to “reconnect” after the cord is cut, how one of the 79 primitive reflexes present at birth, suckling, allows the child's mouth to attach to the breast of the mother, drawing out the golden liquid that protects him from the bacterial world he has entered, preparing his digestive system for milk in the days that follow, putting him in a position close to her face where eye to eye contact is possible.

My observation that I tried to share with this doctor and nurse was about the ability of the newborn to look deep into a person's eyes, ideally his mother's, but often mine, since they return him to his mother long after this alert state is over and he is deeply asleep. When I approach an incubator and find the eyes of the baby, this person holds my gaze... for great lengths of time... and if I move to the other side, he or she will often track me to maintain eye contact. If I pick up a crying newborn to hold him close he often arches his back and wants to look into my face. This has happened many times and I am convinced that he is actively seeking to look at me.

I experimented one day with a tiny person who I had dressed after his incubator time. I put him in his tiny rolling bed and we looked into each other's eyes. To do this I have to bend over, as standing up I am too far away. I moved to the other side of his bed and called to him with my voice, and he followed me there. And again to the other side and back again. I repeated this 15 times and I was convinced that he was voluntarily tracking me visually using auditory cues and his instinct to “connect” with his world outside his womb.

This was what I had wanted to share with this pediatrician. But all I managed to say was “when I bend over to put myself in the visual range of the baby...” the doctor stopped me in my tracks and to tell me that newborns can't see anything. And I tried again, “I've noticed that they see me...” and she stopped me again to explain in great detail how their eyes can't focus yet, and they can't see specific points, drawing two points on a piece of paper to illustrate the fact that the eyes don't do this yet, and the eyes don't do that yet. Yet we know that the dark color of the areola, the large circle around the nipple, is like a target that the newborn uses to center his open mouth before bringing himself towards the breast."





If you would like to read about the neuroscience of visual development, I recommend the book, “What's Going on in there: How the brain and mind develop in the first five years of life" by Lise Elliot..”

Here is an interesting Huffington Post article about research on newborn baby's gaze and later behavior:

http://www.huffingtonpost.co.uk/2015/07/01/babys-gaze-predict-behavioural-problems_n_7703236.html

This experience helped me see how different our perspectives are, how different our languages are. I am explaining my direct experience and the doctor is explaining a scientific fact. We are both right and yet neither one of us is able to communicate our perspective to the other. We do not share a common paradigm.

This question is not an easy one to answer. How can we convince doctors to be attentive, psychologically, at birth? How can we influence practices in hospitals that consititute the first experiences of life, the passage into the world of civilization? How can we help doctors and nurses see the psychological sensitivity of a new human life, of the spiritual embryo? 

“We can't even imagine, we can even conceive of what it means to have a humanity wounded at birth and in the first years of life, prevented from following natural instincts... 

What must this create, what must this create? 

So our responsibility is great. 

When Maria Montessori talked about “education from birth as a help to life” she imagined a path towards peace for the human species, in the sense that by respecting each individual, this respect produces a person who is socialized to know how to be amongst others. 

This respect produces a person who knows how to concentrate, who is independent, who is not violent towards others because he doesn't need to affirm himself in that way, he is satisfied inside... 

So we Montessorians have a great work to do, we have a great responsibility. No one else is talking about it in this way.” 

Grazia Honegger Fresco, from the conclusion of the Cosmic Task of 0-3, Montessori Congress, Prague 2017.

Feelings

In my past, I spent two years working on some personal issues with a therapist. She would often ask me what I was feeling about the topic we were exploring. I would close my eyes to go inside and search for a feeling, and usually I found nothing to report. I realized that I was disassociated from my feelings. I knew how to think about I how felt, but had lost the ability to simply feel how I felt. I was living in my head, using thoughts, reasoning, and mental experiences. This is fairly common in adults as we have often been conditioned after childhood to leave the realm of feelings behind. 

But when you look at children (and the younger they are the more it is with emotions that they express themselves) the expression of sensations and emotions is their language. Life for a baby is only sensations and emotions. If you look at photos of babies you see every kind of emotional state expressed on their faces: joy, fear, anger, rage, curiosity, humor and on and on. But many of us lose this capacity as we 'grow up' and become socialized. Society expects us to control our emotions, or even hide them, and at some point we even forget how to experience them. Males, more so than females, are socialized not to feel.

So if we are going to empathize with babies and understand life from their perspective we must learn to identify feelings and we must learn to feel them. To help doctors and nurses who work with tiny people and their mothers (the mamas are also in an emotional state of mind due to the hormones of pregnancy, labor and delivery) we can help them regain their emotional intelligence. We can help them transform themselves through experiences where they are delivered out of the rational brain and into the emotional brain. 

This can be done through music, a very strong emotional trigger, or though poetry, which is not so much a story as a vision or a dream expressed in words. Art activity or creative expression can be a bridge into feelings.

When I begin a lesson with the nurses and nurse midwives with whom I am working this year in Italy, I begin by singing them a song, and then I follow it with a piece of poetry, and I weave in a silent experiences where we use only eye contact or physical contact. I ask them to discuss in small groups how they feel when they think about a difficult separation they have lived in their lives. I offer them the practice of feeling. More than giving them information, I think they need this. And with this tool, the ability to feel, they can move closer towards developing empathy for a newborn child.

To help doctors and nurses be more sensitive to moms and newborns we have to help them recognize how the patient feels, interpreting the feelings of their patients from direct experience, and  how to respond holistically rather than only to pulses, heart rates, oxygen saturation levels, and test results...

Normalization

What my work in Montessori offers me is to “normalize” - to heal from past experience, to find my cosmic task, to express myself authentically, to be whole, to feel again like I could when I was a child. As an adult, feelings and the rational brain can integrate and work together, as a child under three this is not yet possible. 

I think this is what Montessori has the potential to offer everyone: normalization.

So the question is how do we help doctors and nurses normalize? 

As we know for children, it is an active process from being in an environment that provides for the whole person, through active learning experiences, feeling the nurturing capacity of a community, and allowing oneself to be vulnerable, to make mistakes, to be humbled without shame. Does this sound like something that can happen inside a hospital where the rule of law is protocols based on statistical analysis and evidence based medicine and the prevention of malpractice cases?

A few years ago I visited the doctor weekly for several months to address some chronic issues. Each visit I was measured: weight, blood pressure, pulse, temperature, last menstrual cycle, and all of this data was entered into the database. I wasn't greeted by a person who wanted to look into my eyes and seek to empathize with me, asking me questions to tease out the story behind my problems. I could barely establish eye contact with the physician's assistant who was so busy entering data on the computer. Modern medicine has eliminated the human as the measuring device in the quest for objectivity, and from this act we have lost the humanitarian essentials in doctor/patient care practices.

Maria Montessori abandoned medicine and never went back, maybe she recognized the futility of introducing the idea of psycho-somatic unity into medical practice. But newborns are not able to attend Montessori schools and doctors will continue to be their "prepared adults." As long as psychological health is not within the normal scope of medical practice newborns will continue to be treated and measured with instruments of technology rather than emotional intelligence.

What I am trying to teach the group of health care workers I am with this year is how to enter into direct communication with the newborn and understand the emotional sensorial being – who is so different from the adult – in order to hear what he or she is telling us.