Helping Parents Make Room For Uncertainty

A program for parents and infants in Pittsfield, Massachusetts. The Hello It’s Me Project shines a spotlight on these tender new relationships, investing resources around the birth of a baby with the long-term goal of building a healthy community from the bottom up. When world-renowned child development researcher Dr. Ed Tronick spoke in the spring of 2018 for an audience of a wide variety of practitioners in Berkshire County who work with children and families, he began with a quote from Steven Hawking, “One of the basic rules of the universe is that nothing is perfect. . . .Without imperfection, neither you nor I would exist.”Perhaps best known for developing the Still Face Paradigm, an experimental manipulation designed to demonstrate the young infant’s tremendous capacity for connection and communication, Dr. Tronick shared his decades of research, revealing not only the inevitability, but also the necessity of imperfection in human interaction.In contrast to the expectation of a kind of mythical idealized attunement, he found, through detailed microanalysis of interactions in our primary love relationship, that healthy, typical parent-infant interactions are in fact mismatched 70% of the time. Through the repair of these moment-to-moment mismatches we develop sense of agency and hope, a sense that “I can act on my world to make it better.”

Psychologist Dr. Jayne Singer continued the afternoon presentation for the community, sharing the Touchpoints model, developed by Dr. Tronick together with pediatrician T. Berry Brazelton, who passed away in March 2018 at the age of 99.  Touchpoints offers a way to apply the core concept of mismatch and repair beyond infancy in a range of clinical settings. Pediatricians, early intervention specialists, educators, child protection workers, home visitors, literacy advocates from Berkshire United Way, and others from across Berkshire County engaged in lively discussion. Bringing home the importance of investing in early relationships, Dr. Singer showed a picture of a newborn infant, saying, “This is early literacy.” She encouraged audience members to suspend certainty inherent in being the “expert” and to instead create a space for listening with curiosity.

On the Saturday and Sunday that followed this event, another group gathered for a Newborn Behavioral Observations (NBO) training. While the medical model of care often puts the professional in the role of expert, this intervention seeks to shift that mindset, mobilizing parents’ unique capacity to tune into and respond to their newborn. The 18 neurobehavioral observations of the NBO are not an assessment or evaluation. Rather, they offer a frame in which to support parents’ earliest efforts to get to know their baby.Community practitioners from a wide variety of disciplines learned from Dr. Claudia Gold and Dr. Kevin Nugent, who developed the NBO, about listening to a baby’s earliest communications. On the second day the group devoted time to thinking together about how to collaborate to provide a holding environment for vulnerable families such as those struggling with opiate addiction. We acknowledged the need to support all families, recognizing the “normative crisis” of the transition to parenthood and the need to de-stigmatize asking for help.

Dr Gold is collaborating with the Family Birth Center at Fairview Hospital, supporting the efforts of the maternity nurses, who have all been trained, to incorporate the tool into routine care. As Doreen Hutchison, RN, vice president of operations and patient care wisely observed, “We want parents to go home with their baby feeling confident that they know their baby best.”The Hello It’s Me Project will offer NBO training to all nurses on the Mother-Baby Unit of Berkshire Medical Center with the aim of integrating the NBO into routine care of newborns and their family. Partners in the project include Berkshire Obstetrics and Gynecology where the program will be introduced in the prenatal period. Recognizing critical role of home visiting in promoting health parent-infant relationships the trainings will be offered to Healthy FamiliesPediatric Development Center, and Parents as Teachers, and Berkshire Nursing Families with the aim of integrating the NBO into their respective programs. Recovery coaches in FIRST (Families In Recovery SupporT) Steps Together, a peer recovery and parenting support program for pregnant and parenting women with current or past opioid use disorder, will attend the trainings. The first two of three annual trainings are scheduled for September 2019 and March 2020.The NBO bring the idea of “play,” with its inherent imperfections, into parent-infant and sibling relationships right from birth. Many parents today are burdened by an expectation of perfection. When we can protect time to listen to parent and baby together, we convey the idea that, in contrast to a “right” way, they will figure things out together. Growth happens through repair of inevitable mistakes we make along the way.

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