The Continuum of Touch Infancy Adulthood and Old

The Continuum of Touch Infancy Adulthood and Old age From prebirth

History of Touch - perhaps the first form of medicine - described in ancient texts in China, India & Egypt - described by Hippocrates in 400 BC - touch is considered a form of therapy in many parts of the world

Touch Therapy Shiatsu Reflexology

Massage Therapies Infant Massage Thai Massage Ayuverdic Massage

Kangaroo Care

Kangaroo Care

Infant Co-sleeping

Doula

Mailman Center

Touch Research Institutes • Established in 1992 by Dr. Tiffany Field with a grant from Johnson & Johnson. • The TRI was the first center in the world devoted solely to the study of touch and its application in science and medicine. www. JJPI. com

Touch Research Institutes To date, we have conducted over 100 scientific studies on touch therapy effects and we have established two other TRIs (Philippines, Paris). www. miami. edu/touch-research www. JJPI. com

Continuum of Touch From Pregnancy …. . to Labor …. . to Infancy

Pregnancy Massage Field, Hernandez-Reif, Hart, et al. , (1999), J of Psychosomatic Obstetr Gyn Field, Diego, Dieter, Hernandez-Reif, et al. , (2004), Infant Behavior & Dev. Field, Hernandez-Reif, Diego, et al, . (2004), J of Psychosomatic Obst Gyn

Progressive Muscle Relaxation (PMR)

Study Design • two 20 -minute sessions per week of Pregnancy Massage or PMR for 5 weeks starting in 2 nd • focus on the head, neck, back, arms, legs, and face

Pregnancy Anxiety * *

Pregnancy Back Pain *

Pregnancy Disturbed Sleep *

Pregnancy Supplemental Sleep (Naps) *

Birth Outcomes * *

Pregnancy Depressed Mood *

Pregnancy and Depressed Mood 10 -30% of women are depressed during pregnancy

Pregnancy Depression on Maternal Cortisol *

Prematurity and Depressed Pregnancy *

Low Birthweight and Depressed Pregnancy *

Dieter, Field, Hernandez-Reif, et al. , (2002).

Prenatal Depression Effects on Neonate * *

Prenatal Depression *

Prenatal Depression F 3 F 4

Depressed Pregnancy Effects Include: For mothers: - Elevated cortisol (stress hormone) Greater chance of having a preterm baby Greater chance of having a lowbirth weight baby

Depressed Pregnancy Effects Include: For fetus: - Greater fetal activity For infants: - Elevated cortisol & greater chance of being born preterm or low birthweight - Greater Indeterminate sleep - Greater relative right frontal EEG activation

Partners Massaging Depressed Pregnant Women

Demographics • N = 84 depressed pregnant women • Mean age = 28. 8 (SD = 5. 7) • Mean g. a. = 22. 9 wks at recruitment • 46% Caucasian, 39% Hispanic, 12% African American and 3% Asian

Pre-Post Test Design Recruited from Ob Gyn clinics in 2 nd semester & assigned to Massage, PMR group or control. Massage Therapy (by partner) • Two 20 min. massages per week for 16 weeks at home. PMR • Two 20 min. relaxation exercise sessions per week for 16 weeks.

Maternal Cortisol Change (ng/ml) Massage PMR Control -5

Obstetric Complications (higher score is optimal) *

Mothers’ Anxiety *

Mothers’ depression *

Infant Depressed Symptoms On Brazelton Neonatal Assessment Scale (BNBAS) *

Overall Conclusions Pregnancy massage is a safe and effective intervention for depressed and non-depressed mothers: stress hormones (cortisol) anxiety and depressed mood disturbed sleep Obstetric complications and postnatal complications, hence improving neonatal outcomes, including reducing the incidence of prematurity. **These data also highlight the efficacy of using a significant other to deliver the massage intervention.

Touch Therapies during Labor

Continuum of Touch therapies during Labor – Doula - companion woman who stays in touch with the laboring mother (stroking, holding, speaking to her). Studies from the 1980 s by Klaus & Kennell revealed that 127 of 128 non-industrial societies included a woman present with the mother-to-be during labor.

Doula vs No Doula Klaus et al, 1986 (Study on 417 laboring women in Guatemala)

Doula vs No Doula Klaus et al, 1986 (Study on 417 laboring women in Guatemala)

Benefits of a Doula Present at the Birth of a Child (Stein, Kennell & Fulcher, 2004) • 50% reduction in C-sections • 40% reduction in use of forceps • 60% reduction in epidural analgesia • 25% decrease in labor length 23% 14%

Labor Massage by Partner Field, Hernandez-Reif. et al. , (1997). J of Psychosom Ob Gyn.

Labor Massage Conducted by partner every hour for 5 hours 20 -min sequence consisting of stroking for 5 min each of the following regions: 1) head, 2) neck, shoulders and back, 3) hands and arms and 4) legs and feet. Control group who did other activities (breathing exercises), but no massage.

Labor Massage (MOOD 1 st session) *

Labor Massage (Pain 1 st session) *

No. of Hours in Labor * 8. 5 11. 3

Post Labor Depression * 15. 4 19. 8

Skin-to-Skin (Kangaroo care) • KC - consists of holding the infant (in diaper) against the bare chest with an over-covering. • This practice started in Bogota Colombia by Drs. Rey and Martinez in the 1970 s, because of overcrowding in their NICU, few resources and high mortality and infection rate. • KC was introduced to the mother (benefit of access to breastfeeding) who did KC for 24/7 and later to the fathers • Can begin in the delivery or recovery room between 30 -40 min postbirth to help stabilize the infant or can begin earlier.

Research Benefits of KC • Thermal synchrony – maternal temperature regulates infant’s temperature • Regulate heart rate and respiration • More deep sleep • Fewer days in incubators • Greater weight gain and earlier discharge.

Preterm Infant Massage Therapy • Can be started as soon as preterm infant is stable • Can be taught to parents or performed by nurse • Takes 15 minutes and involves rubbing & flexion and extension of limbs (kinesthetics)

Introduction Premature infants receiving massage therapy: – Have shorter hospital stays – Show a 21 -47% greater increase in weight gain

Proposed mechanism for the effects of massage therapy in stimulating preterm infant weight gain Massage Therapy Pressure/ Bar Receptor Stimulation Vagal Activity Food Absorption Hormone Release GI Activity Weight Gain

Method (Participants) 48 Medically stable premature infants assigned to • • • Massage therapy (n=16) SHAM massage therapy (n=16) Standard care control group (n=16) Group assignment based on a random stratification procedure designed to ensure equivalence across groups on the following variables: (a) (b) (c) (d) (e) Gestational age (± 2 wks) Birthweight (± 150 g) Gender Days in the NICU Study entry weight

Method (Procedure) Massage Therapy: Baby on stomach: 1 st & last 5 -min. Rubbing the head, shoulders, back, legs and arms Baby on back: 5 min of flexion and extension of the arms and legs and SHAM massage: • Identical to the massage therapy procedure exception that the light pressure rubbing was used.

Weight Gain (gms p/day)

Vagal Activity

Gastric Motility (2 -4 cpm EGG) Gastric Motility Control 8. 0 Massage SHAM A 7. 0 A A A A 6. 0 Pre During Post

Preterm Infant Massage Effects • Has been replicated in Taiwan, Philippines, Israel, and China • Nurses and parents can be trained to conduct therapy and has been shown to reduce mothers’ depression. • Simple to do, safe and reduces hospital costs because of earlier discharge.

Fathers’ Massaging Babies • 32 fathers (M age = 33) and their infants (R: 3 -14 mo) were studied. • Predominantly middle class • ½ were taught to do infant massage and the other half were on a wait-list Cullen, Field, Escalona & Hartshorn (2000). Early Child Dev. & Care

Fathers’ Massaging Babies Cullen, Field, Escalona & Hartshorn (2000). Early Child Dev. & Care

Fathers’ Massaging Babies Caregiving Score (feeding, cleaning, playing, etc)

Touch can Span Across the Ages