world during the first three months outside the uterus. In these pages, readers will come to understand the fascinating and rapidly unfolding body of research from biologists, neuroscientists, developmental scientists, evolutionary anthropologists, and physicians that both explains why this new human being is so unformed and lays out what he needs during the fourth trimester. Parents, caregivers, and health care workers will gain confidence in knowing that, just as infants are equipped—with massive help from adults—to handle the transition to life outside the womb, these adults, too, are naturally prepared to provide exactly what babies need.
Armed with knowledge of the natural workings of infants, parents will be able to sort through the advice and opinions of friends, family, physicians, and a $10-billion-baby-product-marketing industry that tries to convince people that their products will make babies happier, calmer, and most assuredly, smarter.
This is not to say the work of the fourth trimester is easy. It isn't. Babies clearly are not trouble-free. Indeed, there will be twenty-four-hour demands, and nights that feel like endless struggles. But with an understanding of infants’ needs, limitations, and development during the fourth trimester, new mothers and fathers can begin their steady march down the parenting path with a maximum amount of self-assurance and a minimum amount of fear. As an understanding of one's mysterious newborn grows, so will the confidence needed to make the hundreds of daily decisions that will influence her growth and development.
Each healthy newborn is ready to begin this fascinating journey And each loving parent and caregiver, too, has what it takes to confidently provide everything a baby needs.
CHAPTER TWO
Crying
The Wakeup Call That Says Everything Has Changed
“I have never hurt him and don't believe I will, but I have had to leave the room he was in, go somewhere else and just breathe for a while, clenching and unclenching my fists,” author Anne Lamott writes of her son's crying.1
When a baby screws up his face, squeezes his eyes shut, and throws his head back for a full-throttled wail, it's normal. Healthy newborns cry an average of one to three hours a day, though to any parent it seems like a lot more. Even a colicky baby, who cries more than three hours a day, will usually outgrow it in three to four months.
Small comfort.
The sound itself is so jarring, so unsettling, that it has qualified as torture, according to Dr. Jerome Groopman, author and chair of medicine at Harvard Medical School.2 Quoting British social anthropologist Sheila Kitzinger, he says in his New Yorker article: “The sound of a crying baby . . . is just about the most disturbing, demanding, shattering noise we can hear.”
But we now know that every newborn cry of life ushers in a human being who isn't quite ready to be separated from his mother's womb. It is his first and, for a while, only tool of communication to signal hunger, fear, or discomfort—needs that were effortlessly met in the three trimesters that preceded birth. His very survival during the transition that is the fourth trimester depends on this signaling cry.
THE BABY'S POINT OF VIEW
Think for a few moments about what birth is like for a newborn. If parents are overwhelmed at this time, we can only imagine the surprise of their infant. Emerging from a snug, temperature-controlled, and highly customized personal sac, she is suddenly in an alien environment. All she knows and craves—food, warmth, and security—has been left behind. In the uterus, she didn't have to ask for a thing. Now, during this phase of development that is so closely linked to her fetal life, her only way of asking is to cry. She's been a contented parasite for forty weeks, and though she's ready for life, she can handle it only with lots of help and definitely on her own demanding terms. It's up to parents and caregivers to quickly figure out what those terms are.
Her lungs fill with air for the first time, taking over respiratory function from the placenta. The amniotic fluid and mucous in the respiratory tract may not have been fully cleared by the forceful compression of the chest during birth—an even greater likelihood if the birth is cesarean—so her nose has to be cleared. Eyedrops make it hard for her immature visual system to see even the outline of her mother's face. The delivery room is filled with light, brighter than anything she's experienced before, and with sounds louder than anything she's heard before.
And yet, despite all the fussing that goes on immediately after delivery, some things are familiar to the baby. Colostrum, the first breast secretion before milk comes in, and the scent of her mother's nipples, both influenced by the food a mother eats, remind the newborn of the smells and tastes of amniotic fluid, also influenced by diet. That smell represents a sturdy bridge between fetal life and this new phase of development.
He hears mom coo, “Welcome, my boy,” and the singsong, high-low pitch of the words is familiar. The sound is clearer now, without the muffling effect of amniotic fluid and layers of uterus and skin, and it's yet another bridge between “then” and “now.” He understands nothing, but he's getting his first crude lesson in the yearslong effort to learn a language—that sounds make words. But for now the sounds are all strung together, and, like his mother, the baby is so exhausted from his birth adventure that he will probably fall sleep.
When he wakes, he feels something damp, but it's unlike the constant and soothing wetness of his nine-month amniotic-fluid bath. This is a wet, soggy, and perhaps chilly diaper, and he cries for help. His cries release cortisol, and his heart rate and temperature rise. He's picked up and cuddled within the warm circle of loving arms, and this feels vaguely familiar. His cries lessen. Then he is on a changing table, his clothes changed, and a dry diaper fastened around him. At the same time, he feels hunger pangs. His cries increase.
From the newborn's point of view, there's a lot to complain about. It's little wonder that, almost immediately, newborn infants add their own sounds to the mix of worldly noise around them—their cry of life. They are in an alien world and need help adjusting to it. Their cry is their first insistent request that attention must be paid, that care must be taken.
WHY NEWBORNS CRY
Babies are supposed to cry. It's the primary tool they have with which to communicate about a messy diaper, an empty stomach, and a need for reassurance or human connection. A baby's health is initially measured, in part, by a strong, lusty cry. Her cries communicate—loudly—her feelings, her needs, and her wants. Adults can't help but sit up and pay attention.
Research shows that normal, healthy infants have two cries.3 They have a basic cry and a pain cry. The two are distinct enough to show up differently on printouts of acoustical analyses of infants’ cries. The pain cry is urgent—usually high-pitched and loud. It comes on suddenly and includes long periods of breath holding. It's that pause between one loud, high-pitched waaah and the second outburst that puts parents on edge. They most likely are running to the infant's side as the next waaah comes through, signaling that the infant is still breathing. That's an instinct worth trusting. When the cry sounds like the baby is signaling pain, a physician should check to see if there's a physical cause. But an urgent cry of pain is also the cry of colic—signaling that parents might be in for a short-term, bumpy ride.
The other cry, the basic cry, is for everything else—hunger, discomfort, a need to be held. It is somewhat lower in pitch with a more gradual buildup in intensity. There are no interminable periods of breath holding, and overall, there's a less frantic sound to it.
By about six weeks, the infant has gained enough control of his vocal cords that
