Ab Initio International | The NBO and Postpartum Depression

by Claudia M. Gold, MD., Director of the Early Childhood Social Emotional Health program, Newton-Wellesley Hospital, Massachusetts and Brazelton Institute faculty. Also author of Keeping Your Child in Mind.

I was asked to see a mother-baby pair in the NICU at Newton Wellesley hospital in my role as behavioral pediatrician running a new program, the Early Childhood Social Emotional Health program. I am introducing the NBO to the doctors and staff, with the hopes that the OT and PT staff can be trained and include it in all of their assessments. To protect the patient’s privacy, I have changed identifying information, but the details of the NBO are unchanged.

The nurses suggested a consult when they observed that the mother of this former 26-weeker, now 37 weeks, was becoming depressed. In addition to her son, she had a three-year-old daughter at home and was at times overwhelmed.

I arrived shortly before a scheduled feed. I sat and spoke with Mom for a short time. We then observed that the baby was moving around and waking up, and she went to change the baby’s diaper. The baby was wide-awake, so I took out the red ball. Even while Mom changed the diaper, he fixed on the ball and followed it for several sweeps. I commented to Mom on his level of alertness even in the face of the distraction of having his diaper changed. Mom had mentioned that they had a dog. I suggested that his level of engagement with his surroundings indicated he would probably love all the activity in a house with another child and a dog.

After the diaper was changed, I held the baby while Mom did the rest of the orienting items. At first he did not turn to Mom’s voice, but seemed to be turning towards my hand where it had touched his face. Mom said, “He likes the red ball better.” I reinterpreted, saying he was hungry and perhaps his rooting reflex was taking over. Mom began to talk to him in a soft voice while moving from side to side. The baby became enthralled with his mother’s face and voice together. He followed with rapt attention and made what looked to be a small smile. At this point the nurse, who was watching the whole time, told us that the baby’s oxygen saturation was up. I commented that the baby seemed calm and organized with Mom engaging him in this way. Was it possible that this was accompanied by increased pulmonary blood flow?

We put the baby back in the bassinette for the rest of the items. Mom had not been aware of grasp reflex and was thrilled at how strongly the baby held on to her finger. As the baby continued to be wide-awake, I did not do the habituation items. But we did take the opportunity to discuss what can happen at home regarding sleep when the baby is accustomed to lots of light and sound at all times.

When I later spoke with the nurse to get the details, she told me that the baby’s oxygen saturation usually ran in the mid 90’s, but that for the whole time we were handling him it was in the upper 90’s, even reaching 100% at one point. Then after we were finished, it went back in to the mid 90’s. The nurse commented to me how nice it was for Mom to see this. The NBO had worked its magic!