Humans are social creatures, seeking interaction with their families and their societies. We have already seen how crucial social support is during pregnancy; social interaction may become even more important once the child is born.

Before birth, developing humans already affect their families through fetal movements and hormones that trigger maternal nurturance (food aversions, increased sleep, and more). At birth, a newborn’s appearance (big hairless head, tiny toes, and so on) stirs the human heart, evident in adults’ brain activity and heart rate. Fathers are often enraptured by their scraggly newborn and protective of the exhausted mothers, who may appreciate their husbands more than before, for hormonal as well as practical reasons.

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Newborns are likewise responsive social creatures in the first hours of life (Zeifman, 2013). They listen, stare, cry, stop crying, and cuddle. In the first day or two, a professional might administer the Brazelton Neonatal Behavioral Assessment Scale (NBAS), which records 46 behaviors, including 20 reflexes. Parents who watch the NBAS are often amazed—and this fosters early parent–child connection (Hawthorne, 2009).

Technically, a reflex is an involuntary response to a particular stimulus. Humans of every age instinctively protect themselves (the eye blink is an example). That definition makes reflexes seem automatic. Not quite true. Actually, the strength and reliability of newborn reflexes varies depending on genes, drugs in the bloodstream, and overall health. (See Visualizing Development, p. 126.)

Other reflexes are not necessary for survival but signify the state of brain and body functions. Among them are the:

These reflexes are responses to experiences, not unlike an adult’s sudden fear, or lust, or anger.

The senses are also responsive: New babies listen more to voices than to traffic, for instance. Thus, in many ways, newborns connect with the people of their world, who are predisposed to respond (Zeifman, 2013). If the baby performing these actions on the Brazelton NBAS were your own, you would be proud and amazed; that is part of being human.

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About half of all women experience significant physical problems soon after birth, such as healing from a c-section, painfully sore nipples, or problems with urination (Danel et al., 2003). However, worse than any of these physical problems are psychological ones. When the level of birth hormones decreases, between 8 and 15 percent of women experience postpartum depression, a sense of inadequacy and sadness (called baby blues in the mild version and postpartum psychosis in the most severe form) (Perfetti et al., 2004).

With postpartum depression, baby care (feeding, diapering, bathing) feels very burdensome. The newborn’s cry may not compel the mother to carry and nurse her infant. Instead, the mother may have thoughts of neglecting or abusing the infant, thoughts so terrifying that she is afraid of herself.

The first sign that something is amiss may be euphoria after birth. A new mother may be unable to sleep, or to stop talking, or to push aside irrational worries. Some of this behavior is normal, but family members and medical personnel need to be alert to the mother’s emotions. After the initial high, severe depression may set in, with a long-term impact on the child.

But postpartum depression is not due to hormonal changes alone. From a developmental perspective, some causes of postpartum depression (such as financial stress) predate the pregnancy; others (such as marital problems) occur during pregnancy; others correlate with birth (especially if the mother is alone and imagined a different birth than actually occurred); and still others are specific to the particular infant (such as health, feeding, or sleeping problems). Successful breast-feeding mitigates maternal depression (Figueiredo et al., 2014), one of the many reasons a lactation consultant is an important part of the new mother’s support team.

As we have seen, fathers-to-be help mothers-to-be stay healthy, nourished, and drug-free. The father’s role in birth may also be crucial.

At birth, the father’s presence reduces complications, in part because he reassures his wife. I observed this when my daughter, Elissa, birthed Asa (now 5, as noted in the opening of this chapter). Asa’s birth took much longer than his younger brother’s; Elissa’s anxiety rose when the doctor and midwife discussed a possible cesarean for “failure to progress” without asking her opinion. Her husband told her, “All you need to do is relax between contractions and push when a contraction comes. I will do the rest.” She listened. He did. No cesarean.

Whether or not he is present at the birth, the father’s legal acceptance of the birth is important to mother and newborn. A study of all live, single births in Milwaukee from 1993 to 2006 (151,869 babies!) found that complications correlated with several expected variables (e.g., maternal cigarette smoking) and one unexpected one—no father listed on the birth record. This connection was especially apparent for European Americans: When the mother did not list the father, rates of long labor, cesarean section, and other complications increased (Ngui et al., 2009).

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Currently, about half of all U.S. women are not married when their baby is born (Monte & Ellis, 2014), but fathers are usually listed. When fathers acknowledge their role, birth is better for mother and child.

Fathers may experience pregnancy and birth biologically, not just psychologically with stress, worry, and so on. Many fathers have symptoms of pregnancy and birth, including weight gain and indigestion during pregnancy and pain during labor (Leavitt, 2009). Among the Papua in New Guinea and the Basques in Spain, husbands used to build a hut when birth was imminent and then lie down to writhe in mock labor (Klein, 1991).

Paternal experiences of pregnancy and birth are called couvade—expected in some cultures, normal in many, and considered pathological in others (M. Sloan, 2009). A recent study in India found that most new fathers experienced couvade (Ganapathy, 2014). In the United States, couvade is unnoticed and unstudied, but many fathers are intensely involved with their future child (Brennan et al., 2007; Raeburn, 2014).

Fathers are usually the first responders when the mother experiences postpartum depression; they may be instrumental in getting the support the mother and baby need (Cuijpers et al., 2010; Goodman & Gotlib, 2002). But fathers are vulnerable to depression, too; other people need to help. Indeed, sometimes the father experiences more problems than the mother (Bradley & Slade, 2011).

Remember John and Martha, the young couple whose amniocentesis revealed that their fetus had trisomy-21 (Down syndrome)? One night at 3:00 a.m., after about seven months of pregnancy, Martha was crying uncontrollably. She told John she was scared.

“Scared of what?” he said. “Of a little baby who’s not as perfect as you think he ought to be?”

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“I didn’t say I wanted him to be perfect,” I said. “I just want him to be normal. That’s all I want. Just normal.”

“That is total bullshit…. You don’t want this baby to be normal. You’d throw him in a dumpster if he just turned out to be normal. What you really want is for him to be superhuman.”

“For your information,” I said in my most acid tone, “I was the one who decided to keep this baby, even though he’s got Down’s. You were the one who wanted to throw him in a dumpster.”

“How would you know?” John’s voice was still gaining volume. “You never asked me what I wanted, did you? No. You never even asked me.”

[Beck, 1999, p. 255]

This episode ended well, with a long, warm, and honest conversation between the two prospective parents. Each learned what their fetus meant to the other, a taboo topic until that night. Adam, their future son, became an important part of their relationship.

Their lack of communication up to this point, and the sudden eruption of unexpressed emotions, is not unusual, because pregnancy itself raises memories from childhood and fears about the future. Yet honest and intimate communication is crucial throughout pregnancy, birth, and child rearing. Such early communication between new parents helps to form a parental alliance, a commitment by both parents to cooperate in raising their child.

The parental alliance is especially beneficial when the infant is physically vulnerable, such as having a low birthweight. The converse is also true: Family conflict when a newborn needs extra care increases the risk of child maladjustment and parental divorce (Whiteside-Mansell et al., 2009).

To what extent are the first hours after birth crucial for the parent-infant bond, the strong, loving connection that forms as parents hold, examine, and feed their newborn? It has been claimed that this bond develops in the first hours after birth when a mother touches her naked baby, just as sheep and goats must immediately smell and nuzzle their newborns if they are to nurture them (Klaus & Kennell, 1976).

However, the hypothesis that early skin-to-skin contact is essential for human nurturance has been proven false (Eyer, 1992; Lamb, 1982). Substantial research on monkeys begins with cross-fostering, a strategy in which newborns are removed from their biological mothers in the first days of life and raised by another female or even a male. A strong and beneficial relationship sometimes develops (Suomi, 2002).

This finding does not contradict the generalization that prospective parents’ active involvement in pregnancy, birth, and care of the newborn benefits all three. Factors that encourage parents (biological or adoptive) to nurture their newborns may have lifelong benefits (Champagne & Curley, 2010).

The role of early contact has become apparent with kangaroo care, in which the newborn lies between the mother’s breasts, skin-to-skin, listening to her heartbeat and feeling her body heat. Many studies find that kangaroo-care newborns sleep more deeply, gain weight more quickly, and spend more time alert than do infants with standard care (Feldman et al., 2002; Ferber & Makhoul, 2004; Gathwala et al., 2010). Father involvement may also be important, including father–infant kangaroo care (Feeley et al., 2013).

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Kangaroo care benefits babies, not only in the hospital but months later, either because of improved infant adjustment to life outside the womb or because of increased parental sensitivity and effectiveness. Which of these two is the explanation? Probably both.

Implementation of many strategies, especially for fragile infants and their parents, is especially needed in developing nations, where kangaroo care and other measures could reduce deaths by 20 to 40 percent (Bhutta et al., 2008). From a developmental perspective, the most difficult time for high-risk infants occurs when they leave the hospital, days or weeks after birth. At this juncture, measures to involve parents in early care are crucial. As we will see in later chapters, the relationship between parent and child develops over months and years, not merely hours. Birth is one step of a lifelong journey.

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