Diego was born at 38 weeks of gestation by elective cesarean, the mother is a precesarizzata. Until that time Diego had done his duty, putting in cephalic position, but without haste, because he had not noticed any sign that indicated that having to commit. No warning biochemical or hormonal, no mechanical signal, no communication between him and the placenta, no real dialogue between his brain and that of the mother. He could not know that this small circle on the calendar in the kitchen was to indicate that on Wednesday morning at 8, in a modern operating room, his world would be permanently changed. When the gloved hand extracts it carefully, but without asking permission, his face is a single huge grin, as if by a siphon dragging out all his cash (and his own, he produced it). As rightly they say: Diego comes to light, the light of life? No, the light from the operating light (or rather two, made in Germany).
With flicks and safe is immediately separated from its placenta, 'the placenta is the only organ in the body that is thrown away'.
The Apgar score is given after the first minute, but Diego will start to breathe in the third second, and eight seconds already shows all the ten points. He continues to cry, but, 'crying baby, anesthesiologist who ride'. In fact all laugh and compliment each other; Diego also receives many compliments, but he does not like, and continues to cry. The midwife who has taken to bring him on the couch trying to calm him down and drying it by wrapping it with a warm towel. Feel good already and is not drawn, even the light off of the couch is not disturb it unnecessarily, but he continues to cry. It 's so angry in opisthotonus from buckling, the limbs are too stiff. Fortunately, this attitude does not last long, or even breathing would start to get difficult.
is wrapped more closely in the drape to give him a boundary and a side plate, but he continues to cry. The anesthesiologist now no more laughs and is surprised by this despair 'because it so? What's less traumatic birth by cesarean section without even the effort of labor? '. These words strike me, though from the perspective of the doctor, or simply an adult, are logical. E 'from the point of view instead of Diego are meaningless.
try to understand why.
Technically Diego was born with a birth hasty; is not possible to devise a way to rise faster than this. Without labor, he was not any preparation, nor can any involvement. Just waiting for the start of spontaneous labor, we could tell when Diego was ready to be born. It 'also why those born at term by cesarean section without labor, have a risk of respiratory disease by about seven times more difficult adjustment of offspring of spontaneous delivery.
Failure to attend to the physical and emotional labor and delivery, preventing the activation of those fine fetal movements of locomotion and propulsion Milani Comparetti identified as a repertoire innate fetus can begin to automatic primary (ie, genetically programmed to activate those skills from the experience and give rise to important adaptive functions).
Diego tried to imagine how he lived until a few seconds after birth.
Enveloped by the liquid in the absence of gravity, constantly massaged by the soft walls, smooth buttons and the uterus, accompanied by continuous sounds (inside and outside the mother's body), in constant and rhythmic rocking. Diego as all fetuses for nine months a child is 'flawed', in utero In fact the need is met even before being received, the state is absent in the perception of lack. Hunger and thirst are canceled by a lavish placenta, similar to the manna of biblical narrative, a food emergency and non-conservative, in a dose defined as required.
If we deepen our efforts to imagine the life of fetal Diego, we can guess that for him (still without conscious individuality) meets the inner world and outer world, he is also her placenta, but also her uterus, and also his mother. For some months after the birth Diego will not have a mother because her mother will continue for a while ' to be perceived as a part of himself. In utero has lived much of his time in a sort of half-sleep, in active sleep (and this has helped his development of the brain). In reality Diego is unable to distinguish between waking and sleeping, between reality and dream, and since when does not know to dream dreams, live the dream with the same intensity of active wakefulness.
Diego until the time of birth has lived only time uterus, which is a non-time, with characteristics of constancy and predictability, where the beat frequency is given by the biology of maternal and fetal. E 'is this consistency of the existence uterine fetal to characterize the world, where the emotional consciousness is represented by a global sensory perception, in which the cognitive and affective dimension coincide.
Diego Like every fetus is a synesthetic subject, unable to separate and catalog with rational thought and symbolic nature of their perceptions and emotions. He is his body, but the body also includes the environment in which it is inserted, and its environment comes from where his perceptive ability is capable of achieving.
Diego When a child is born is so 'flawed' can not do unless the experience gained in utero, an experience that could be defined as 'report-no report' (where exactly does exactly 1 +1 1), when born must begin to experience a new form of existence (and this point in the logic of birth will be 1-1 2). Now we need to build a genuine relationship between two or more individuals, but Diego will take months to understand or difficult to perceive this truth.
return once more to Milani Comparetti that more than twenty years ago, with prophetic clarity, described the birth of 'an event that acts as an organizer of new and diverse biological factors and relational', and stressed the 'ontogenetic continuity of the evolutionary process' in which every birth is entered.
Dialogue biological and psychological, that characterizes the mother-child relationship began in utero, with the birth does not stop, but convert back and reorganized, mother and child begin a relationship in which each of them is both subject and object.
The mother's voice is the first strong link with prenatal life, we know that for most of fetal life, hearing is well developed and active, allowing what is called intrinsic or evocative memory. The timbre, tone and musicality of the maternal voice can be considered the first form of link between the endo el'esogestazione. Every other sound is new, strange, disturbing, unable to summon anything.
neurophysiology studies showed different brain activation produced in the infant from the mother's voice - the motherese - compared to the common voice of the adult, demonstrating that the infant, from the seventh month of gestation, is capable of process the sound quality by discriminating against the linguistic components.
As the baby relaxes, finds a new balance and a new sensory dimension kinesthetic coming to open our eyes. Initially 'will not look' can not see anything known (not even the mother's face), it will take some 'time, linking the mother's face with her voice, her smell, her touch, her breasts, her milk, ....
contact with the breast the baby back to the predictability and consistency to the uterus. For him, the reality is even synesthetic: When sucking the breast, mouth and drinking milk with his eyes drinking her mother's face, meanwhile, smells, touches and is touched. While feeding his senses are especially active and synergistic, so when the feeding are so many needs that are simultaneously satisfied: hunger, thirst, heat containment, touch, vision, and for a while ... 'is reassuring to realize a new homeostasis.
While sucking at the breast the baby can fall asleep directly into REM sleep, dreaming of starting immediately, but to dream of what? likely or nurse dreams of being back in the belly 'where every need is met before it can be perceived'.
The transition from fetus to newborn is a biological and psychological processes that involves mainly the CNS (the other organs and equipment are involved only secondarily). In the last weeks of pregnancy the brain stem has finished its maturation and the bark has started to integrate with the subcortical structures allowing the processing of sensory experiences. Through brain plasticity, stimulation and interaction with the environment constraints and produce structural changes on brain maturation, is the last period in the early months of fetal life.
The journey from fetus to newborn could be considered a form of 'search for meaning', initially for consistency and balance, and immediately after major organization.
We also compare the infant to a teenager, in fact they both live a busy and challenging experience of transition from a world permanently lost and another completely new to build.
But how to help this 'adolescent' unconscious and symbolic thought, crazy in love with his own mother? How to help this individual incapable of recognizing reality, but which in reality is to live fully exposed, with no filters and defenses?
Our species lives in the first half of fetal life maintaining functions of nature, and for this reason we speak of esogestazione. For Winnicott the infant at birth is not yet ready to be born and Selma Fraiberg noted that 'the events of his life is no connection'.
If we want to make it easier for the baby his desperate search for balance, we must bring order and consistency in the 'confusion' of his perceptions, remembering, as noted J. Korzack, he thinks to 'emotions and feelings'.
Diego showed a striking all his need to adapt, but also his mother and his father are not without needs special and emotionally important.
Their first need arises from the need to see, hear and touch the child, to feel alive (to us instead of medical care to its vitality, ... is not the same thing). But after you see the need to be seen by him, and then be touched, until you get to be 'eaten' by him (even if initially only a small taste).
In a moment you see the real child, the real one, which replaces the imaginary, but the baby picture is also a bit 'feared, and so you need a trustworthy person explicitly states: it is healthy and well (although it was already self-evident).
keep the arm is the end of the fatigue of pregnancy and purpose of the pain of childbirth, but also the beginning of a real life project that can be looked at and touched. In this moment is filled, in an almost automatic and unconscious, that empty feeling of a belly uninhabited, where sudden movements and actions no longer occur.
This process can be rapid or may take longer if the baby is taken away, if the child's invisible stomach does not remain in continuity with the baby held in her arms, the child returned washed and dressed, may be perceived as another child.
Wrote a mother: the awakening from anesthesia of cesarean section was weird, the belly was gone and there was my daughter (...) It was all so painful, a real nightmare It was as if I had not given birth, I acted as if my son had never been born, as if I had never been pregnant, otherwise I would not right this unnatural separation (...)
It 's very difficult for hospital staff help a disoriented baby, it demonstrates the ease with which you accepted his tears. The cry is not simply a form of expression (otherwise babies sing!) Nor a respiratory gymnastics (sic), the crying need to experience the consolation. When we stay without reacting to screams and cries as journalists we are insistent that war correspondents at the front, in a short time, detached and cynical take on attitudes and our behavior is a normal defense, but the risk is to create an environment anaffective where the parents for air conditioning and imitation can be seen drying or freeze their sensitivity and unconscious emotions.
As health professionals we can instead help parents to be emotionally available, encouraging their susceptibility all'accudimento, encouraging the making, providing reassurance and responding to questions and if necessary to prevent the unspoken prejudices, 'Lord, perhaps the child wants to be taken into and cuddled, try to take him now that he's still young no risk of spoiling '.
We must also avoid confusion with the mothering Childcare: Childcare in practices and procedures for the conduct of operators, while mothering includes all the actions and attitudes allowing the mother to care for the child. Childcare can be standardized and standards to protocols, and the mothering is always and only personal, unique, dynamic and creative.
The two areas can become contaminated positively operators can customize their actions and improve their sensitivity, the parents may be able to acquire an easier and more confident. It should, however, avoid inconsistency and confusion of roles: the mother who becomes a good and precise nurse the child, the operator which replaces the mother in expressing an important relational value tasks such as feeding or take in arm (he wrote with a little 'perfidy of Winnicott: do not let someone take your child in his arms, if you know that this has no meaning for her).
As professionals we must aim to improve sensitivity and attention to grasp the nuances of the relationship between parent-child, 'cleaning up' our language, encouraging intimacy and reassurance, we grow in our understanding that any procedure or action can never be neutral and, if necessary, will immediately become an obstacle to the process of adaptation and bonding.
Using a moment at the prospect of the baby, let's ask ourselves: the infant at birth is expected to be placed in a cradle or be picked up? Incubate for a few hours after birth a baby that does not need it, is to replace the uterine dialogue that has suddenly stopped, with a neutral environment and anaffective, the infant is not able to understand and manage; 's incubator is an object with which you can not interact and that prevents a baby responsive to organize a primary relationship, thereby undermining its search for balance with the new environment.
are now numerous evidence showing the superiority of skin to skin contact from the incubator to stabilize the temperature control in the immediate postpartum. As already noted for breastfeeding, even the mother-infant contact immediately after birth takes many meanings, involving all the mental and physical components of the newborn and producing effects far superior to the practice outright.
We all know that the first period after birth is a special moment for the construction of the processes of attachment between parent and child. Bowlby's theory was a theory called 'space' in the sense that requires constant contact and closeness, I think it is also a theory 'time' that requires time and privileged modes, the reference is the pace and frequency uterus. In this phase is thus particularly useful snooze immediately or is not strictly necessary.
should rediscover and refine a know-how that promotes normal (Milani Comparetti spoke of positive symptomatology) may remain so for the physiology of birth and culture is not contaminated by activities and procedures that do not belong .
Safeguarding the 'normality' of a newborn means not suck if coughing and spitting, it means interrupting the tub if he does cry, it means take steps to quickly bring to a state of tranquility (Apgar 12?), postponing the prophylaxis and ophthalmology at least a couple of hours after birth.
Even the baby can do action of empowerment, in order to channel and target resources and energy with which nature has provided.
We were able to lead the 'perinatal mortality' a very low percentage, but now what percentage think we succeed in bringing the 'perinatal happiness'?
As players we can ask ourselves to educate us from birth and babies meet every day, but an educational process requires a constant readiness to change, both individual and group.
Parents however the task to activate strong emotions and empathy, as Winnicott writes, 'the child present to the world in a way that makes sense for him'. Initially, only the mother (recently abandoned the uterine environment) can make a filter with the 'outside world' experience and minimizing stimuli to the baby and just incomprehensible tolerable, but by facilitating the necessary adjustments to regain the lost balance.
In a sense, an infant separated from its mother is a baby 'malformed', because it lacks something essential, he can be considered a homeostatic system open, regulated by the processes of attachment and interaction with the mother. The regulation that the mother has on him is final and can also reactivate in adult life every time you realize the conditions and basic needs.
through breast-feeding mother is capable of turning to organic food to emotional nourishment, becoming all-encompassing experience. As the placenta for nine months have passed nutrients to live and grow after birth the breast is to provide vital substances, such as cord blood, stem directly from the mother's body.
Already Ludovico Dolce in 1547 defined the woman's milk 'white blood' and he explained: 'Provide the nature of children nudritura to convert with beautiful artificial blood into milk, similar to the one aspect does not scare' . Indeed, the mother's milk makes the baby in close dependence on biological, allowing him to continue to feed her. The separation the mother's body is made slow and progressive, thus limiting the 'trauma' of a birth inevitably always too fast.
In 1794 in his Discourse on lactation de 'children Antonio Fantini stated that' holding out her breast to the child's mother feels a portion of his life go in to him, 'and this sense of intimate statement of existence is so strong and so exciting 'it all is forgotten in a moment, and all the dearest ties come off and she closes her house, and knows not to live for his son, who holds the place of all '; after more than two centuries our modern science came to help us discover bonding and maternal reverie.
Even the current discussions on the rooming-in and attachment early breast have been the subject of reflection already many decades ago (at least since the '40s) and a little-known pediatrician in Milan, Ferdinand Cislaghi in 1956 had the courage to write: the nursery is convenient for many, unless the baby. When is a serious and honest discussion on the futility and iatrogenic damage produced for decades from the nests of our motherhood?
To end the story of how Diego, with which we started this reflection, we have to tell that his persistent and inconsolable crying has stopped for a few minutes only when it was brought close to her mother (still on the operating table) and was able to hear his voice.
As for us traders on Wednesday morning when Diego was born is a common working day for him that was the most important day of his life yet to experience an existential change as challenging and significant must wait until the last seconds of his life.
Alessandro Volta, a pediatrician
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