Brain Rules for Babies — book review

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Brain Rules for Babies by Dr. John Med­i­na

Seat­tle WA; Pear Press. 2010

I strong­ly rec­om­mend this book and its accom­pa­ny­ing web­site by the author of the NY Times best­seller, Brain Rules. http://www.brainrules.net/.

The new text brings togeth­er much of the dis­parate research on fetal-infant-child brain devel­op­ment of the last few decades into a read­able whole. At the same time, it asso­ciates these find­ings with effec­tive, con­crete prac­tices and pro­vides tips for new and expect­ing par­ents. What are some of the big, take-home mes­sages of this text? Sur­vival, or safe­ty, is the pri­ma­ry goal of the brain. Hap­pi­ness is most close­ly linked to hav­ing friends. Aca­d­e­m­ic suc­cess is asso­ci­at­ed with self-con­trol. And, reward­ing effort pro­duces the great­est pos­i­tive feed­back. There’s a lot more here and on the web­site. Plus the web­site has pages of ref­er­ences and a ter­rif­ic quiz for par­ents. Links: Brain Rules for Baby: http://brainrules.net/brain-rules-for-baby. Brain Rules for Baby Quiz: http://brainrules.net/brain-rules-for-baby-parenting-quiz.

Dr. Med­i­na starts with that noto­ri­ous parental con­cern:  How do par­ents raise a smart, suc­cess­ful, calm and hap­py child? He con­sid­ers the job of par­ent­ing to be sup­port­ing healthy brain devel­op­ment – some­thing achieved large­ly by liv­ing a healthy and emo­tion­al­ly acces­si­ble life! He has the facts to back this up. Start­ing with preg­nan­cy, he pro­vides infor­ma­tion to demon­strate that the com­mon ear­ly preg­nan­cy issues of tired­ness and nau­sea serve the fetus’ need to be left alone to fol­low the genet­ic code for pro­duc­ing the body’s organs and sys­tems.

The sec­ond half of preg­nan­cy, he notes, is large­ly con­sti­tut­ed by the devel­op­ment of the sens­es, which bring infor­ma­tion to the brain, and – in the last months – the expan­sive growth of brain cells and the ear­li­est phas­es of neu­ronal con­nec­tion. He dis­pels the myths about com­mer­cial prod­ucts aimed at improv­ing IQ in utero, reviews find­ings on the adverse effects of stress, poor nutri­tion and a seden­tary lifestyle dur­ing preg­nan­cy, and reminds us that we are faced with cer­tain pecu­liar­i­ties of human birth. Ever since we became erect, we have had to get that brain out of the pelvis before it is real­ly ready.

Dr. Med­i­na moves on to the rela­tion­ship dynam­ics of the par­ents and/or extend­ed fam­i­ly and its impact on the off­spring brain. Most fam­i­lies expe­ri­ence dis­tress when an infant arrives. Rela­tion­ships are out of bal­ance, demands increase, com­fort is less­ened and there are a lot of unknowns about the nature of this new being. Learn­ing, he reminds us, takes place best when the num­ber one brain demand is met: Safe­ty. Sit­u­a­tions fraught with stress and con­flict are keen­ly sensed by infants and mit­i­gate against a sense of safe­ty.

Much of this dis­cus­sion rein­forces recent find­ings about the impor­tance of vagi­nal birth, skin-to-skin con­tact and breast­feed­ing – chem­i­cal, mechan­i­cal and emo­tion­al needs that appear in the moments sur­round­ing birth that, when met, set the stage for a bond of trust (safe­ty) that enables devel­op­ment of high­er func­tions. He reminds us that the best pre­dic­tor of aca­d­e­m­ic suc­cess is impulse con­trol, a behav­ior that results part­ly from genet­ic pre­dis­po­si­tion, but is equal­ly gleaned by observ­ing adult behav­ior from the first moments of life. This sets the stage for much of the rest the book’s dis­cus­sion using a Seed/Soil metaphor, akin to the tra­di­tion­al nature/nurture dis­cus­sion – that some of what a child becomes is inborn, and some is envi­ron­ment.

Med­i­na focus­es on preg­nan­cy through age 5. He notes that will­ing emo­tion­al respon­sive­ness com­bined with appro­pri­ate demands or expec­ta­tions appears to pro­duce the most effec­tive learn­ing con­di­tions in young chil­dren. Once they are in a safe state of mind/brain, infants learn quick­ly by watch­ing [he cites Ban­dura]. Empa­thy and clear delin­eation of bound­aries fall into line behind safe­ty as fea­tures par­ents need to pro­vide for healthy psy­chic devel­op­ment. Med­i­na gives a num­ber of exam­ples, includ­ing one about empathiz­ing with a child who needs a drink of water when there is none avail­able by say­ing: Yes, how thirsty you must be and if I could, I would get you a big drink. I’m glad you let me know how thirsty you are so we can work on fix­ing that first chance we get. [NB: I have para­phrased here for the pur­pose of my own learn­ing]. This sort of response feeds back the child’s expe­ri­ence, lets him/her know he/she is heard, sup­ports the child’s state, but lets him/her know that the solu­tion is still a bit off and that the par­ent expects the child to coop­er­ate.

There are many top­ics cov­ered with just this sort of technique…empathy and expec­ta­tions. Among them is the descrip­tion of pos­i­tive and neg­a­tive rein­force­ment. I find it is fre­quent­ly dif­fi­cult for par­ents to grasp the notion that if a child has a tantrum and the par­ent yells and screams and makes a big deal about it, that is pos­i­tive rein­force­ment, which encour­ages the child to behave that way again. Where­as walk­ing into anoth­er room and doing some­thing else till the child is qui­et – that is neg­a­tive rein­force­ment.

I like Medina’s way of explain­ing it with sci­ence bet­ter than my own, which requires too much explain­ing about how nerve cells trans­mit infor­ma­tion and how neur­al path­ways become hard­wired. His relies on more macro expla­na­tions (he is a devel­op­men­tal mol­e­c­u­lar biol­o­gist, so I real­ly bow to him on this one). Basi­cal­ly, he tells us to praise behav­ior that is good and also to praise the absence of “bad” behav­ior, because praise for effort feels good. He also tells us to let the flow of events do the pun­ish­ing. Either let a child con­tin­ue to walk around in the snow with no shoes because s/he will fig­ure out it hurts and is a ter­ri­ble idea, or remove a child from the table when s/he refuse to eat because it is bor­ing alone and s/he will fig­ure out one can get hun­gry that way. The for­mer is pun­ish­ment by appli­ca­tion; the lat­ter is pun­ish­ment by removal.

In case you are won­der­ing what these rules might be, here they are:

EXERCISE | Rule #1: Exer­cise boosts brain pow­er.
SURVIVAL | Rule #2: The human brain evolved, too.
WIRING | Rule #3: Every brain is wired dif­fer­ent­ly.
ATTENTION | Rule #4: We don’t pay atten­tion to bor­ing things.
SHORT-TERM MEMORY | Rule #5: Repeat to remem­ber.
LONG-TERM MEMORY | Rule #6: Remem­ber to repeat.
SLEEP | Rule #7: Sleep well, think well.
STRESS | Rule #8: Stressed brains don’t learn the same way.
SENSORY INTEGRATION | Rule #9: Stim­u­late more of the sens­es.
VISION | Rule #10: Vision trumps all oth­er sens­es.
GENDER | Rule #11: Male and female brains are dif­fer­ent.
EXPLORATION | Rule #12: We are pow­er­ful and nat­ur­al explor­ers.

Ina May’s Guide to Childbirth – book review

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Ina May’s Guide to Child­birth by Ina May Gaskin.

NY; Ban­tam, 2003.

The phys­i­ol­o­gy of birth is com­pli­cat­ed and still not well under­stood. Our sub­jec­tive expe­ri­ences of birth are rich­ly tex­tured. Per­son­al accounts spill over with com­bi­na­tions of intense sen­sa­tions, strong emo­tions, vague impres­sions and fine details. What is aston­ish­ing about Ina May’s Guide to Child­birth is how exquis­ite­ly she traf­fics in the lan­guage of an inter­nal land­scape to describe and explain this com­plex process. She tru­ly cap­tures the unique­ness and uni­ver­sal­i­ty of birth. I am adding this book to the list of rec­om­men­da­tions I give my clients, as well as sug­gest­ing it to oth­er teach­ers.

Devot­ing near­ly the first third of the book to pos­i­tive first-hand birth sto­ries pro­vides a sub­stan­tial ground­ing. Many times I found myself think­ing: Yes! That woman is describ­ing this or that essen­tial bit of wis­dom I want to impart to my clients. Let me point out one exam­ple.

On pages 24 and 25, one of nar­ra­tors describes 3 slices of her expe­ri­ence. First, she got advice not to read or learn too much and not to make a plan because the more details she had in mind, the less like­ly she would get what she want­ed. Too much read­ing would inter­fere with her abil­i­ty to go with her body, she was told.

Sec­ond, she describes her expe­ri­ence of being in a tub and how she need­ed a lot of reas­sur­ance because she was both scared and aware of the great pow­er in her body. The phys­i­o­log­i­cal phe­nom­e­na occur­ring in her brain and motor sys­tems indeed would be described as these sub­jec­tive states of being. She def­i­nite­ly per­ceived what was hap­pen­ing.

Third, she describes turn­ing from look­ing at things dur­ing a con­trac­tion to lis­ten­ing because look­ing made her think, while lis­ten­ing allowed her to feel and be instinc­tive, which felt bet­ter than think­ing and was not so over­whelm­ing. Thus, she was going with her body. We see her process in this nar­ra­tive.

The sto­ries all got me think­ing about whether I am telling my clients too much or too lit­tle! One of my teach­ing goals is to insure that clients dis­tin­guish between strat­e­gy and tac­tics. Exam­ple:  In the case of the sto­ry above, the strat­e­gy was to go with her body. The tac­tics she used were to not get too much infor­ma­tion so she did not have too many expec­ta­tions and to use sound rather than vision as her way of con­nect­ing inner and out­er real­i­ty.

As a teacher, I see my job as insur­ing that my clients who might hear this sto­ry do not think that they must use sound rather than vision in order to go with their bod­ies, but rather that this was a piece of the process for this woman to reach her objec­tive. It might work, but it might not. To get this across to clients, I tell sto­ries about births in which I have been present when oppo­site tac­tics accom­plished the same strat­e­gy or where the same tac­tic led to dif­fer­ent out­comes.

The mul­ti­tude of sto­ries she presents in part I allow part II – the text­book part – to come to life. Whether she is dis­cussing stages of labor, pain or release, she calls up sto­ries and because the read­er is already recep­tive to the notion of exam­ples, the illus­tra­tions help the read­er grasp what­ev­er point she is mak­ing about the process.

How­ev­er, the com­plex phys­i­o­log­ic sequence of birth, includ­ing its vari­a­tion from woman to woman, is less well served – in part because there is still so much to be learned about how birth hap­pens, and in part because the birth com­mu­ni­ty in gen­er­al (whether hav­ing had pro­fes­sion­al or aca­d­e­m­ic train­ing) is not as well versed in nor­mal phys­i­ol­o­gy as it could be.

Let me focus on two issues: One is pain/pleasure and the oth­er is hormones/behavior. Regard­ing pain/pleasure, Ina May makes a lot of impor­tant points, among them that how we expe­ri­ence an intense­ly sen­sa­tion­al expe­ri­ence depends to a great degree on our prepa­ra­tion and that dif­fer­ent women have dif­fer­ent pain/pleasure expe­ri­ences dur­ing birth. What she doesn’t tell us, though (and I sus­pect because it’s not com­mon knowl­edge), is that some of the fac­tors that con­trol how we expe­ri­ence sen­sa­tions are beyond our con­trol. We expe­ri­ence pain/pleasure through a series of sen­sa­tions, men­tal foci and behav­iors such as breath­ing and mus­cle release. These nerve impuls­es are for­ward­ed through­out the brain, some sen­sa­tions tak­ing on emo­tion­al con­tent – some ter­ri­fy­ing and oth­ers ecsta­t­ic – depend­ing on the neur­al pat­tern. This is the basis of both the fear/tension/pain syn­drome and the orgas­mic pat­tern. But the pre­cise pat­tern is depen­dent on genet­ics, as well as envi­ron­ment and behav­ioral train­ing.

Some indi­vid­u­als become aware of sen­sa­tions at a very low neu­ro­log­i­cal thresh­old; oth­ers do not. Some indi­vid­u­als quick­ly find sen­sa­tion of which they are aware to be uncom­fort­able or emo­tion­al­ly intol­er­a­ble; oth­ers do not. Some peo­ple need com­fort mea­sures for their dis­com­fort soon; some lat­er, or not at all. Tol­er­ance of what final­ly becomes pain or plea­sure (or just a sense of stretch­ing or motion through space) is also vari­able from per­son to per­son. Thus, the point at which we start has both bio­log­i­cal and psy­choso­cial deter­mi­nants with­in this already vari­able process. In describ­ing the vari­a­tion in how women expe­ri­ence pain and plea­sure in labor, Ina May is great at giv­ing us exam­ples and iden­ti­fy­ing psy­choso­cial or cul­tur­al vari­a­tions iden­ti­fied in research, but not so enlight­en­ing on the biol­o­gy of why and how. This may or may not mat­ter to the read­er.

The issue of hor­mones that gov­ern the vicious cycle we call labor is much less well under­stood. We have a pret­ty good con­cept of how prostaglandins, oxy­tocin and endor­phins are stim­u­lat­ed and affect the process, and Ina May describes these in acces­si­ble ways. But while adren­a­line is thought to inhib­it ear­ly release of oxy­tocin, there has been lit­tle dis­cus­sion of its impor­tance in the push­ing or ejec­tion phase (she does cite Michel Odent’s notion that adren­a­line might play a part in the ejec­tion reflex when a labor is slow­ing down). But, there is lit­tle recog­ni­tion out­side of the phys­i­ol­o­gy field that what hap­pens in tran­si­tion is our ener­gy sys­tem shift­ing to a sym­pa­thet­ic [adren­al] source to give us more pow­er to push. That’s why con­trac­tions change, why some women have a rest peri­od between, and why – back in the day – we used to say to a woman hav­ing dif­fi­cul­ty culling up her resources to push that she could get mad! Going through the effort and dis­com­fort is key to induc­ing the rush of beta-endor­phins. We know this, in a sci­en­tif­ic way, from research that tells us run­ners who lis­ten to music (relax­ing and dis­so­cia­tive) expe­ri­ence low­er rates of beta-endor­phins at the end of the run than run­ners who do not lis­ten to music, but work through the effort and dis­com­fort they expe­ri­ence (stress induc­ing).

One of the things that makes Ina May’s book so valu­able, in my mind, is the dis­cus­sion near the end about mid­wifery, sta­tis­ti­cal sup­port for nat­ur­al birth and enu­mer­a­tion of the risks asso­ci­at­ed with sur­gi­cal birth that are often glossed over when a fam­i­ly expe­ri­ences dys­to­cia. There are many ele­ments with­in the birthing com­mu­ni­ty striv­ing to cre­ate an acces­si­ble spec­trum of choic­es for birth. Let’s face it, birthing at home for low risk women, seam­less trans­port alter­na­tives, birthing cen­ters attached to med­ical facil­i­ties, and read­i­ly avail­able med­ical options when emer­gen­cies arise, would be a won­der­ful future. Birth atten­dants with uni­ver­sal accep­tance, vari­able but rig­or­ous train­ing, and delin­eat­ed scopes of prac­tice would be ide­al. Whether we get there remains to be seen, but I am glad Ina May exists, has her track record and is being lis­tened to in this effort.