they brought Ava home, and all anxiety broke loose. “I was terrified,” says Tammy. “I was handed this little baby, and it was a complete shock. I was so tired and so scared; I felt like I was in a whole other world,” she continues. “And I was terrified of making a mistake.” As for baby Ava, well . . . “She was like a strange little alien.”1
Such is the coming-home of many, alas most, newborns who are long awaited and eagerly welcomed. Before women even have time to complete a full sigh of relief signaling the end to forty weeks of awkward discomfort, they find themselves facing even greater challenges. Only now, with actual infants in their arms, they have far less control. Ava, like any newborn, was barely equipped to stay alive. Tammy and David were suddenly face to face with the most neurologically immature of all the earth's primates, born months before she was anywhere near ready to function in the world.
Parents around the world who welcome mysterious new life in this way encounter a significant void in up-to-date scientific information about the first days and weeks of infancy. With fingers crossed, they confront their uncertainty and fears.
This book presents a new paradigm of a baby's early life that shifts our focus and alters our priorities. It shows that this window of time, specifically the first three months of life, has more in common with what came before than with what follows. The fourth trimester is an outside-the-uterus period of intense development that is an extension of the work begun during the first nine months. A newborn human is not so much a baby as a final-phase fetus living through a time of transition as he gives up the comforts of the uterus and gradually adjusts to the wonders and challenges of the world. Further, during this period infants and mothers need to stay almost as tightly bound together as biology dictated during the first three trimesters. In this book, I use the model of a fourth trimester to show how parents, caregivers, doctors, and students might understand this period by looking at it through a new lens.
Throughout, I talk about the essential bond between a loving, committed, and attentive adult and a baby. Sometimes that attachment is biologically unique to birth mother and baby. Born recognizing her voice and her smell and, for most of human evolution, dependent on her milk, an infant bonds most quickly with his mother.
But in our complex and ever-changing society, it's important to think broadly and not give short shrift to any woman or man who “mothers” an infant. An adoptive parent—mother, father, married, single, gay, or straight—can read references to “mother” and “father” in these pages and know it speaks to them just as it does to biological parents. Be assured, this is not simply lip service. Though biology counts for a lot in favoring birth mothers, the book's importance to fathers and nonbiological parents represents more than an artifact of the past few decades of a changing culture. The bond between parents and non-biological offspring represents an evolutionary moral and medical breakthrough on parenting that no doubt is being, and will increasingly be, studied over generations.
Within this book, the advice and much of the science can apply to all who give birth to or adopt babies, as well as to those who watch over, nourish, nurture, and protect an infant in the first hours and days of life. Under that wide umbrella, I mean to give respectful due to all kinds of parents—birth mothers and fathers, adoptive parents, same-sex partners, single parents, grandmothers, grandfathers, and all manner of kith and kin. Any one person or pair or team of people responsible for the nurturance, care, and protection of a newborn is fully able to provide, and can be equally expert in providing, the love, diligence, and attention that every baby needs.
Infants are nothing if not flexible, ready to respond to love. Here's an analogy. I had a cat once, a calico, that loved me best. She curled up on my lap. She slept in my bed. She was as cozy with me as a cat can be. But once, she disappeared from the house for a few days. I put up posters, and soon a man was at my door holding my Irma. What surprised me was how quickly she had switched allegiance. She was curled up in this stranger's arms as though he were the love of her life. I almost hated to separate them as he handed her back to me.
This is not just the sentimental musing of a pet lover. Certainly, newborns are a lot more complicated, but in some ways they're a bit like my fickle cat. An infant will love the one she's with. And long before she can show love, she will respond to the one she's with. He can be fed with a tender touch, with locked-in eye contact from a birth father or mother. She can have her diaper changed to the accompaniment of chipper conversation by an adoptive parent and, in the blink of an eye, will recognize his voice above all others even though she didn't hear it in the womb. He can listen as a same-sex couple sings a lullaby duet. The mother who supplied the egg responsible for half his genetic makeup—but whose uterus did not house him—can soothe him. The father who devotes himself to the baby, regardless of whose sperm fertilized the egg all those months ago, can rock her to sleep. Newborns will thrive even as the definition of family changes to incorporate not only traditional marriages and adoptive parents but also gay marriages, single-parent families, combined families, grandparents raising second generations of children, and as many configurations as loving people can come up with to create the protective, nurturing nest that is a family.
Combining contemporary science with the personal stories of dozens of parents I interviewed—as well as a few of my own—I've attempted to write to all who nurture. Science has a lot to say to each and every one of them about the hows and whys of caring for a newborn. The word caretaker or caregiver is hardly sufficient to describe a person who changes diapers, is at the ready at all hours, sings, soothes, tries to project a calm front despite his own worry, plays, feeds, rocks, cradles, and would throw himself under a bus to protect a newborn. But loving caretaker and caregiver are convenient shorthand terms I sometimes use. Know that these are written with profound respect for all the people who love and tend to every need of a newborn throughout the fourth trimester.
The infant, amazingly competent yet totally dependent, needs all of them. The nine-month gestation prepared the fetus well, but incompletely. A newborn can hear, but cannot sort through the din. He can discern light, shadow, and contrast, but cannot “see” as we understand vision. She can feel, but the womb provided protection and warmth that she continues to need postpartum. In the uterus, taste and smell filtered through amniotic fluid, making him recognize the odor of colostrum and the taste of mother's milk. The newborn is prepared to begin learning the new world she's entered, but this period, which is closely linked to fetal life and is beginning to prepare her for real life, is one of transition during which she needs close, constant, and loving attention.
This book is primarily intended for new parents and caregivers who want more than to be told how to care for a newborn. They want to understand the reasons behind the advice. It will also be useful to anyone called upon to give guidance (doctors, nurses, teachers) and to those with a personal interest in understanding the well-being of a newborn (friends, relatives, grandparents). Each chapter of this book translates the most current science in a specific area of early infant development into a rationale for appropriate care. In a field where opinion and trendy advice are seldom connected to evidence, this book presents a clear and much-needed alternative.
Journalism skills, honed over a thirty-year career in medical reporting, helped me to arrive at this reasoned and evidence-based alternative. Journalists are adept at following all leads while pursuing a range of sources. They get an overview of an issue—not merely the pediatrician's view from the clinic, the scientist's view from the lab, the parent's view from the nursery, or the investigator's view from reading the latest research. The knowledge and wisdom of all those players inform the chapters, synthesized and interpreted for the curious new parents and caregivers eager for this information.
A report by the National Research Council and Institute of Medicine on children and brain development, published in 2000, became my starting point. The report's conclusions have rippled through every aspect of science, medicine, and education and into family homes. This report, From Neurons to Neighborhoods: The Science of Early Childhood Development, says, “Although
