Babies may not come with instruction manuals, but you can learn a lot just by watching them.
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The Responsibility Project
When Lisa Pauli gave birth to her first child, her husband was defusing bombs in Afghanistan. A veteran herself, she had been wounded when an explosive blew up her Humvee. She had just moved to a rural area, far from neighbors or family, and drove herself to the hospital. Her baby arrived five weeks early, creating extra medical challenges. She struggled to nurse and soothe him, and wondered if she was doing something wrong.
All this could have made Lisa Pauli a candidate for the “baby blues,” or even post-partum depression. She might have fallen into a downward emotional spiral where she pulled away from, rather than bonded with her child. Fortunately, a pre-emptive cure for her situation arrived at Pauli’s door. It wasn’t medicine or a fancy therapy. It was a woman named Lee McKinnon, who performed something called the NBO: the Neonatal Behavioral Observation.
The NBO was developed by Kevin Nugent, an Irish-born pediatric psychologist and director of the Brazelton Institute in Boston, who at age 70 still coos happily over every baby he sees. The author of “Your Baby Is Speaking to You” (Houghton Mifflin Harcourt, 2011), Nugent studied under and worked with T. Berry Brazelton, a pediatrician, researcher and author who was one of the first to recognize that newborn babies, contrary to teaching at the time, actually have a lot to communicate. Scientists and doctors still use the “Brazelton Scale” he created to assess 46 responses in a newborn, from grip on the examiner’s finger to tracking of a red rubber ball. It reveals a baby’s well-being, but also something of its personality.
In the course of their research, Nugent and Brazelton noticed that the Brazelton Scale not only collected data; it also improved interaction and awareness between parents and their babies. So they shortened and simplified it for non-doctors and created the NBO, which Nugent teaches to people all over the world. Now, trained delivery-room nurses, social workers, and new-parent educators such as Lee MacKinnon can administer it in half an hour.
MacKinnon, 58, has gray-brown, shoulder-length hair and a big smile. When she visits a newborn baby and parents in their home, she’s not using the NBO to measure anything; depending on the situation, she may or may not run through all of the 18 “observations,” such as how the baby reacts to a rattling box of beans and the beam of a flashlight. She will, however, develop a sense of the baby’s temperament. Is she able to quickly soothe herself? Does he need to be tightly swaddled? Is she highly sensitive to sound?
MacKinnon says that new parents often ask her, “‘Why doesn’t this being come with an instruction manual?’” They might not be able to figure out why their baby won’t stop crying, or why it doesn’t sleep, and what to do about it. She says, “It’s really hard to know what a newborn baby is trying to tell you.”
So while chatting with the parents and interacting with the baby, MacKinnon tries to show parents the ways that their child is not only responding to their behavior, but also talking to them. “From the minute they’re born,” she says, “babies are communicating.”
These signals can be extremely subtle: changes in color, stiffening muscles, or splayed-out fingers and limbs all suggest stress. Like adults, babies breathe more slowly when they’re calm and more quickly when upset. If a newborn gazes off into the distance, most parents think that she’s looking at something. In fact, the baby is trying to say that it is over-stimulated and needs a break. By helping parents to see these details, MacKinnon helps them to do the thing that will head off a full-scale fuss.
The NBO process also reveals a baby’s ability to self-soothe, a crucial skill for sleeping through the night. Little fists gathered on her chest and fingers in her mouth show a baby who’s learning to calm herself. Parents find it reassuring to hear from an objective source like MacKinnon that their baby’s fussiness or trouble sleeping might be the result of his ingrained personality, and not something they’re doing wrong. She can then help them find ways to cope, such as a tightly wrapped swaddling blanket or making the nap room dark and quiet.
MacKinnon’s primary goal, however, is not to be an expert so much as to help parents see how much expertise they already have. “I go in and say, ‘Tell me about your baby.’ When they recognize that they already have a lot of skill and information, it gives them a lot more confidence.” The NBO process shows parents how even day-old babies can grasp a finger, bicycle their legs when held in a crawling position, and move their heads sideways when on their bellies to get air—that they’re not as fragile as they might seem.
The NBO also demonstrates to parents that their baby is already attached to them. When a two-day-old baby turns its head towards its parents’ voice, MacKinnon says, mothers and fathers “recognize that they’re a special person to this baby already, and that’s really powerful.”
Building this early baby-parent attachment, many studies show, benefits babies, parents and all of society. According to the American Psychiatric Association, more than a quarter of new mothers get the “baby blues,” characterized by days or weeks of sadness, crying spells, irritability and anxiety. Perhaps another 10 percent fall into full-fledged postpartum depression, a long-term illness generally requiring medical treatment with psychotherapy and drugs. Postpartum depression alone costs the nation hundreds of millions of dollars each year in expenses and lost wages, and children of depressed mothers can show more negative behaviors when they grow up, from aggression to crime.
A study of the NBO, however, found that it could reduce the risk of postpartum depression by over 75 percent. Kevin Nugent considers this study to be small and preliminary, but it nonetheless suggests that the NBO could improve the lives of hundreds of thousands of women every year not with drugs or therapy, but with knowledge.
“It’s a great tool for parents to get to know their babies right from the start,” MacKinnon says. “And the research is clear that a newborn’s interaction with the parents is key to brain development and happiness.”
Lisa Pauli, who just had her second baby, agrees. MacKinnon, she says, taught her various tips for nursing and swaddling, and how to recognize different cues her son was giving her about whether he wanted to eat or sleep. Without the NBO, her life could definitely have gone from hard to worse. The NBO, she says, allowed her to ask questions, talk about feeding and sleeping, and gain confidence. “You get to feel like you’re not the only one going through these issues,” she says. “It helped a lot.”
Nathaniel Reade has been an editor and writer for scores of magazines, including GQ, Spirit and SKI, on subjects ranging from West Nile Virus to snowshoeing in Labrador. The comic young-adult novel he recently wrote with his 12-year-old son, The Pencil Bandits, has been described as “Oliver Twist meets The Marx Brothers meets The Boxcar Children.”