Anthropological and
sociological aspects of
skin-to-skin contact.
Dr Nils Bergman
M.B.Ch.B., M.P.H., M.D.
Cape Town, South Africa
Babies Celebrated, Beatrice Fontanel and Claire D’Harcourt, © 1998 Harry N. Abrams, Inc.
“For species such as
primates, the mother
IS the environment.”
Sarah Blaffer Hrdy, Mother Nature (1999)
Nothing an infant can or
cannot do makes sense,
except in light of mother’s body
CENTRAL DOGMA – all biological processes
EVOLUTIONARY
BIOLOGY
NEUROSCIENCE
Everything else
The Brain
The DNA
EXPERIENCE
ADAPTATION
The Place FITNESS
ENVIRONMENT
EPIGENETICS
Skin-to-skin = key that
unlocks the neuroscience !
Sequence human newborn breast-feeding
Pre-requisite = habitat
hand to mouth
tongue moves
mouth moves
eye focuses nipple
crawls to nipple
latches to nipple
suckles
(Widstrom et al 1994)
Cells which
FIRE TOGETHER,
WIRE TOGETHER,
and those which
don’t, won’t.”
Carla Shatz
There are “needed neural processes” !
fetal REM sleep
(or active sleep) seems to be
particularly important
to the developing organism
... spontaneous
synchronous firing
Marks et al 1995
BRAIN WIRING
Peirano 2003
AT BIRTH,
the brain has
TWO
CRITICAL
SENSORY
NEEDS:
SMELL & CONTACT
connect direct to the amygdala
THE
NEWBORN
BRAIN
SKIN-TO-SKIN
CONTACT
fires and wires
the amygdala-prefronto-orbital
cortical pathway (PFOC)
Prefrontal cortex
Executive
function
SOCIAL
and
AMYGDALA:
Emotional
Processing
Unit
CPU
EMOTIONAL
INTELLIGENCE
SENSATIONS THAT WIRE BRAIN
SEES
Mum’s eyes
Ear HEARS
Mum’s voice
SMELLS
Mum’s milk
MOVES
with Mum
TASTES
Mum’s milk
Hand TOUCH
Mum’s skin
Back FEELS
Mum’s arm
holding
Skin-to-skin
CONTACT
WARMED on
Mum’s front
Slide from JILL BERGMAN
a kind of invisible hothouse
Through
“hidden maternal regulators” ...
“ physiological set points “
“ internal working models’
“ scripts – templates”
The brain is a
SENSORY ORGAN
BREAST - FEEDING
=
BRAIN – WIRING
SOCIAL ORGAN
“Scientific foundation” … a synthesis
EVOLUTIONARY
BIOLOGY
NEUROSCIENCE
Everything else
The Brain
The DNA
EXPERIENCE
ADAPTATION
The Place FITNESS
ENVIRONMENT
GENETIC
FACTORS
EPIGENETICS
ENVIRONMENT
BREASTMILK
NATURE
MOTHER
NICHE
ENVIRONMENT
GENETIC
FACTORS
STIMULATION
BEHAVIOUR
EXPERIENCE
NURTURE
BREASTFEEDING
MOTHER
is the KEY for
NEURODEVELOPMENT
SEPARATION DYSREGULATES
PROTEST – DESPAIR
causes DYSREGULATION
Social deprivation
alters neurobiological systems.
This pathology ... cannot be cured ...
3-day separation:
induces physiological
changes (immune,system,
heart rate, sleep, cortisol,
loss of body temperature..
anaclitic depression:
•hyperactivity
•conservation- withdrawal;
•death or recovery
Slide & photo from
James McKenna
Primate separation studies
Maternal Separation Paradigm
0w 1w 2w 3w 4w 5w 6w   12w
n 4 Mat MNS group reared no mother
n 4 Mat 


MNS  group as above
n 4 Mat 





(control)
Gene specific for the AMYGDALA
( GUYC1A3)
Separated at 1 week:
LOW gene expression
Increased self soothing
 Anxiety
Decreased sociality
 Depression
Primate separation studies
Maternal Separation Paradigm
Early Deprivation (ED) vs control (CON)
0d 2d 
28d

ED n 11 Mat 30 -120 min daily

CON n 4 Mat 




 48w
 48w
Repeated short
separations:
LOW gene expression
Correlate to human adult depression
Sabatini
Arabadzisz
Positive Stress
• Moderate, short-lived stress responses, such
as brief increases in heart rate or mild changes
in stress hormone levels.
• An important and necessary aspect of healthy
development that occurs in the context of
stable and supportive relationships.
Slide by: Jack P. Shonkoff, M.D.
Positive Stress
= Eustress
Underactivity
• An important and necessary
EUSTRESS
aspect of healthy development
Overthat occurs in the context of
stable and supportive relationships.
activity
Tolerable Stress
• Stress responses that could disrupt brain
architecture, but are buffered by supportive
relationships that facilitate adaptive coping.
• Generally occurs within a time-limited period,
which gives the brain an opportunity to recover
from potentially damaging effects.
Slide by: Jack P. Shonkoff, M.D.
Toxic Stress
• Strong and prolonged activation of the body’s
stress management systems in the absence of
the buffering protection of adult support.
• Disrupts brain architecture and leads to stress
management systems that respond at relatively
lower thresholds, thereby increasing the risk of
stress-related physical and mental illness.
Slide by: Jack P. Shonkoff, M.D.
MICHAEL MEANEY
“In response to stress, CRF … and vasopressin are released …
anterior pituitary … synthesis release ACTH …glucocorticoids  ”
Unsafe environment activates HPA
axis (autonomic nervous system, ANS).
Early stress alters gene expression,
with health impact across lifespan.
BRUCE McEWEN
allostasis
Vocabulary
Homeostasis the coordinated operation of
physiological processes that maintain
the steady state required to sustain life
Allostasis
the mechanism by which
homeostatic systems are maintained in balance
as life cycle and environment changes
Allostatic state
elevated activity of
mediators, with return
to baseline and no impact on health.
(similar to earlier … )
REGULATION
the objective is to achieve the
ability to establish:
‘STABILITY THROUGH CHANGE’
The foundation for
INFANT MENTAL HEALTH
Vocabulary
Allostatic load
elevated activity –
sustained over time, or severe, or mediators
dysregulated  changes target cells of mediators,
and so changes the “set points” for homeostasis
(e.g. increasing blood pressure,
change in cholesterol level)
Allostatic overload
the point at which
chronic load results in actual disease
or abnormal conditions.
TOXIC
STRESS
2ND
KNOCK
Sensitivity
HIGH
ALLOSTATIC LOAD:
“wear and tear that results from
chronic overactivity
(or underactivity)
of allostatic systems.”
(McEwen 1998, 1999)
Developing
Brain (1)
Neurogenesis
Neural morphology
Synaptogenesis
Myelination
Early
Stress (2)
Neuronal death, smaller brain
Fewer dendritic spines
Poorer connections
Fewer glial cells, less myelin
Sensitivity (3)
Genetic
Gender
Timing
Developmental rate
GCR density
Stimulation
Resilience
MENTAL HEALTH
TEICHER’S
EARLY STRESS
CASCADE MODEL
Enduring (4)
consequences
Attenuated L brain devlopment
Poor R / L integration
Irritability limbic system
Poorer function vermis
Neuropsychiatric
vulnerabilities (5)
Dissociative identity disorder
Depression
Personality disorder
Substance abuse
Post Traumatic Stress Disorder
Schore:
“Infant trauma will interfere with
critical period limbic organisation ...
future capacity to adapt ...
correlated with maladaptive
adult mental health”
Schore:
“long term alterations brain function
“risk for developing severe psychopathologies at later stages of life.”
ALLOSTASIS
PERCEPTIONS
“NEUROCEPTION”
STRESS
Psychological
Neurological
Endocrine
Immune
RESPONSE
 RESILIENCE
/ SENSITIVITY 
ALLOSTATIC STATE
ALLOSTATIC LOAD
ALLOSTATIC OVERLOAD
HEALTH
DISEASE
WELL-BEING  SUSCEPTIBILITY  MORBIDITY  MORTALITY
ALLOSTATIC LOAD:
“wear and tear that results ….
HEALTH
DISEASE
SPECTRUM of expression in POPULATION
“Scientific foundation” … a synthesis
EVOLUTIONARY
BIOLOGY
NEUROSCIENCE
Everything else
The Brain
The DNA
EXPERIENCE
ADAPTATION
The Place FITNESS
ENVIRONMENT
EXPECTED
HEALTH
EPIGENETICS
UNEXPECTED
DISEASE
SPECTRUM of expression in POPULATION
Platform for better understanding of PUBLIC HEALTH.
… policy and practice that impacts the care of mothers and babies.
“EEA”
Environment of
Evolutionary
Adaptedness
“Environment”
is the usual place and
context for which the
genes have adjusted
MOTHER
is the key to
neurodevelopment …
… because she is the
RIGHT PLACE !!
Anthropological and
sociological aspects of
skin-to-skin contact.
Anthropology
Evolutionary Biology
DNA & Epigenetics
Neuroscience of stress
Mal-Adaptation
Sociological consequence
Anthropological and
sociological aspects of
skin-to-skin contact.
SCIENTIFIC
AND EVIDENCE
BASIS FOR
INCUBATOR ??
Stephane TARNIER
1828 -97
French obstetrician
Saw a warmed box for
hatching chickens, had
one designed for
“weaklings” …
… invented incubator
Pierre BUDIN
1846 - 1907
Friend of Tarniers …took
Incubators, made centres
for the care of weaklings,
wrote book on subject.
Political support …
France versus Germany
BUDIN was very particular to include
mother, reason for the glass window ….
Martin COUNEY
1860
- 1950
Born in Germany
claims he learned
the techniques for
Budin ....
Berlin Exhibition 1896, success !
Photograph: Pan-American Exhibition in Buffalo, New York, 1901.
Martin COUNEY
1860
- 1950
Berlin 1896, success
to USA: Buffalo 
Omaha 1902-4,
Baby Incubator,
1904 St.Louis Fair
Chicago Fair 1932 2nd highest receipts,
Last show New York 1940.
Martin COUNEY
1860
- 1950
... famous for
“preemie road show”.
MONEY MAKING SHOW
PERMANENT
pavilion in
Dreamland
New York Worlds Fair, 1939
Martin COUNEY
1860
- 1950
Born in Germany
claims he learned
the techniques for
Budin ....
Berlin Exhibition 1896, success !
London World fair 1898, fiasco!
ALL THE BABIES DIED ....
“MOTHERS TO BLAME”
Martin COUNEY
1860
- 1950
Couney succesfully
raised 5000 prems!
BUT –
used wet-nurses,
excluded mothers
(mother got free pass to the shows !)
Mothers were excluded – “germs” …
Sarah Morris Hospital,
Chicago 1923,
others followed –
accepting the
“policy of strict separation”.
WHY
do we
separate
mothers from
babies ??
INCUBATOR & SEPARATION
= ACCIDENT of HISTORY
PERINATAL NEUROSCIENCE
& SKIN-TO-SKIN CONTACT
THE
INCUBATOR
HAS NO SCIENTIFIC
FOUNDATION !!
MOTHER
is the key to
neurodevelopment …
… because she is the
RIGHT PLACE !!
MOTHER
is the key to
neurodevelopment …
Environment of
Evolutionary
Adaptedness
KEY TO MONITORING
WELL BEING 
AUTONOMIC NERVOUS
SYSTEM MONITOR !
 if HARM can be monitored,
HARMING CARE MUST CHANGE
Separation from mother
is stressful for humans.
Salivary cortisol is a
good measure of stress.
Separation DOUBLES CORTISOL
RCT (Anderson et al 1998)
Two groups of newborns,
both given best care, only
one separated from mother
at one hour age
Cortisol levels measured
every hour.
Cortisol separate = 9
Cortisol with mom = 4
SEPARATION = STRESS
Preterm infants experience
prolonged severe stress, with
tenfold increases in stress hormones.
Stress hormones at such levels
are neurotoxic.
(Modi & Glover 1998, Mooncey et al 1997)
RCT on methods to reduce of stress (at one hour):
Cortisol
Massage
Soft music
Endorphin
slightly lower
no change
no change no change
Skin-to-skin 66% lower 74% lower
evolutionary survival machine
ANS
HRV
EEG
autonomic
downstream
PLACE convention
4
3
2
1
Breastfeeding
Holding
MIS (Cot)
SSC (Skin-to-skin)
ANDERSON BEHAVIOURAL STATE SCALE
12
11
10
9
8
7
6
5
4
3
2
1
Crying
Fussing
Active
Breastfeeding
Alert Awake
Quiet Awake
Drowsy
Active Sleep
Irregular Sleep
Regular / Quiet Sleep
HRV produces IBI
(Inter Beat Interval)
D
V
C
S
N
S
V
V
C
FFT / AR / wavelet
• social vagus (validated)
• sympathetic
(accepted)
• “old vagus”
(our hypothesis)
AUTONOMIC STATE
COMPONENTS:
GREEN = OLD
VEGETATIVE VAGUS
RED = SNS
SYMPATHETIC
BLUE = NEW
SOCIAL VAGUS
7 x more
QS is SSC
SEPARATE
176%
Increase
Autonomic
activity
Skin-to-skin contact
= *NORMAL* PLACE
3 x more ANS
in MIS
SEPARATE
86%
Decrease
Quiet Sleep
SKIN-TO-SKIN CONTACT
BREASTVAGAL
MOTHER
FEEDING
(PSNS) GROWTH
Normal sleep cycling
OTHERPROTESTSTRESS
SURVIVAL or
DESPAIR
(SNS)
Higher state arousal
SEPARATION
Separated neonates experience
disturbances of sleep cycling.
NEURO PHYSIOLOGY
of SEPARATION
Maternal separation may be
a stressor the human neonate
is not well-evolved to cope with,
and may not be benign.
ideal
benign malevolent
unsuitable
HEALTH
DISEASE
?
MOTHER IS
“BETTER”
OUR “NORMAL”
CARE CULTURE
OUR “NORMAL”
BIOLOGY
THIS IS
“WORSE”
Skin-to-skin contact –
our developmental
environment.
“Maternal separation may be
a stressor the human neonate
is not well-evolved to cope with,
and may not be benign.”
Skin-to-skin contact –
our developmental
environment.
It matters how we are born!
It influences our emotional
and social development,
our future EQ.
Skin-to-skin contact –
our developmental
environment.
Separation is perceived as stress,
which increases cortisol,
disrupts development of
new neural pathways
Skin-to-skin contact –
our developmental
environment.
Contrary to old beliefs:
the human newborn is profoundly
sentient and perceptive,
at birth and thereafter.