“Zero Separation” to increase the survival of small and premature babies
by Carmela K Baeza, MD, IBCLC
As I was looking at images of mothers with facemasks and their newborns, I kept wondering what kind of a shock this would be for the baby. Babies are wired to look at their parents´ faces and learn to read and to express emotions from birth. A perinatal psychiatrist pointed out to a colleague how this seemed to her like the still-face experiment.
In 1975, Edward Tronick and colleagues described a phenomenon in which an infant, after a few minutes of sitting face to face with a non-responsive expressionless mother, “rapidly sobers and grows wary. He makes repeated attempts to get the interaction into its usual reciprocal pattern. When these attempts fail, the infant withdraws [and] orients his face and body away from his mother with a withdrawn, hopeless facial expression.” This finding is consistent and has been one of the most replicated findings in developmental psychology. Results of meta-analyses confirm the classic still-face effect of reduced positive affect and gaze, and increased negative affect in the infant.
What does all this mean?
When a mother holds her newborn in her arms, when she looks into his eyes and speaks to him in motherese, it´s not just a cozy moment. Baby is learning to understand expressions, matching her tone of voice to her smile to her gaze. Baby is mirroring mother, and learning what response he obtains when he smiles or pouts. Mother and baby are laying, with these interactions, the foundation for secure attachment and positive social affect.
Processing facial expressions is an essential component of social interaction, especially for preverbal infants. Studies have shown that maternal mirroring of infant facial gestures is central to the development of a neural matching mechanism for these gestures. Maternal mirroring strengthens mappings between visual and motor representations of facial gestures, which increases infant neural sensitivity to particularly relevant cues in the early social environment.
“It´s the quality of the interaction with the mother that the baby´s brain models,” write Newman and cols in their study. “The quality of early emotional interaction and the context of attachment relationships shape early development. Specifically the quality of the caregiving relationship shapes both neurological and psycho-social development.”
Early experiences of care and emotional interaction impact directly on brain growth and organization, and early attachment relationships may set up both resilience and risk for mental disorder. “Specifically, emotional and stress regulation occur in a dyadic context and infant neurological organization is shaped by the experience with the caregiver,” state Newman and cols.
So… what happens if the parents are wearing masks? If baby cannot see facial expressions, neither the ones her parents are projecting to her, nor her expression mirrored in theirs? Is this a COVID version of the still-face experiment?
Not only that but, how does baby´s reaction impact mothers?
In a personal communication, Dr Rosario Alomar, perinatal psychiatrist, commented to our director Ibone Olza: “A patient suffering from postpartum depression and severe attachment difficulties, who was getting better, expressed sadly to me that since she had been advised to wear a mask, she had felt a regression in her baby´s responses. It is like an eternal still-face! It is so sad, mother and baby had worked so hard, then she was infected with COVID and it was either mask or separation – even during breastfeeding, which we managed to maintain, fortunately, with a lot of hard work.”
How can we help?
We must come up with ingenious solutions to this problem. Perhaps mothers required to wear a mask could wear a transparent face cover like those worn by some restaurant workers when interacting and talking to the baby. Perhaps a solution similar to these transparent masks that were designed for the hearing impaired who need to read lips….
In some way, we must assure that mothers and their babies can have a chance at a normal expressive interaction.
Image courtesy of Irene and Julia
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