Expressing emotions is an essential part of building strong connections.
The Nurture Science Program (NSP) is a partner in the COVID-19 Mother-Baby Outcomes (COMBO) Initiative at Columbia University, which has been studying the effects of the pandemic on moms and babies since March of 2020. Among COMBO’s many preliminary findings is a worryingly low rate of emotional connection, which is critical for physical, mental, relational, and developmental health in mother-infant pairs.
Deep emotional connection involves body-to-body sensory and emotional communication between two people. For moms and babies, there are many wonderful interventions that promote the sensory side of this equation (like skin-to-skin holding and kangaroo care). Often, these practices leave out the emotional communication so important in building strong connections. And usually, they focus on helping either mother or baby, without giving support to the pair.
NSP has developed and tested a successful intervention—Family Nurture Intervention (FNI)—that promotes mother-baby emotional connection by encouraging two-way sensory and emotional interactions. FNI was first tested in the NICU, where preterm babies and their mothers endure prolonged separation and stress. FNI was the first NICU care approach shown to lower the many risks of separation and stress for both mother and baby over a long period of time.
But even healthy full-term babies and mothers are experiencing increased separation and stress during COVID. And interestingly, in preliminary studies, COMBO has found that emotional connection can only be observed in about 20% of four-month-olds born during the pandemic, even in healthy full-term babies and moms.
So now, COMBO has started a clinical trial of Family Nurture Intervention in the well-baby nursery to establish critical early emotional connection for all families.
Here, Dr. Martha G. Welch (Director of the Nurture Science Program at Columbia University) and Dr. Dani Dumitriu (Director of Translational Research at the Nurture Science Program, and Chair of the COMBO Initiative) discuss the importance of emotional expression in building emotional connection.
Why Does Family Nurture Intervention Involve Expressing Your Emotions?
Dr. Welch: It’s very popular to tell mothers to protect their babies from negative feelings. But we’ve found that this actually creates a huge distance—I call it “the Grand Canyon”—between mother and baby.
Our intervention in the NICU starts with mom telling the baby the story of their premature birth. Now, that’s not always a comforting story. An early birth is very scary, and then mom and baby have to be separated. The mothers feel terrible about it; they often feel guilty, and they want to protect the baby from that. But instead of protecting the baby, by bottling up their emotions, they actually withdraw from the baby. And that makes it harder to establish their emotional connection, which has impacts on mom’s mental health, baby’s development, and both of their overall health and stress resilience.
But what we’ve found is that if the mother tells the baby the story, the mother generally becomes emotional. As soon as the emotion is expressed, the baby becomes alert, orients toward her, and makes eye contact. And that starts the connection. In fact, the mother expressing her deep emotions is often the first time the baby makes eye contact with her. It’s extremely moving just to watch it happen.
Dr. Dumitriu: Emotional speech matters immensely, but part of emotional expression is facial expression. Face-to-face interaction is how babies learn emotional connection and develop their emotional range and emotional intelligence. In COMBO, we’re finding that babies have extremely negative reactions to seeing their mothers wearing masks, because they can’t see their moms’ expressions. (To be clear, we definitely believe in wearing masks during this pandemic! But there are things we can do to buffer any negative effects they may be having on our babies and relationships. If you need to wear a mask around your baby sometimes, it’s important to reconnect.)
Dr. Welch: The other senses are important, too—smell is deeply emotional (and there are ways to connect after a loss of smell due to COVID); tasting the mother’s skin and milk is calming and nurturing for babies; and touch is foundational to connection.
In the NICU, we encourage this dual approach of sensory-emotional exchange by having the mother reach into the incubator, hold the baby around the torso in a firm and comforting way (as if the baby were being held to her chest), and to have this emotional exchange that starts the baby being interested in the mother. We’ve had wonderful descriptions from the mothers of feeling that a weight has lifted off.
I remember a mother who was not connected at all. Her baby couldn’t breathe very well. He was getting older and older and still couldn’t get off respiratory support, and she would go home from the NICU and cry for hours. I explained the Grand Canyon concept to her, and that she mustn’t save her emotions for home, but rather experience them with her baby. So she started expressing herself to the baby while she was still in the NICU and within a couple of days, the baby was not having any problem breathing and could go home. Now, that could be a coincidence, of course. But the mother didn’t experience it that way, and it sure helped her connect with her baby.
So the bottom line is, we’ve found that the full range of expression unites, rather than divides. And this isn’t just from these studies. I have been helping families for almost fifty years, and I’ve seen over and over again how the parent’s full expression of emotion allows the child to learn full expression of their own emotions. When you hold back negative feelings, you can’t connect.
Dr. Dumitriu: Of course, you’re not directing negative emotion at the baby; you’re just showing it to the baby.
How Does the Full Range of Expression Unite Us?
Dr. Dumitriu: I really want to emphasize how Dr. Welch and I connected on this point, because it’s one of those interesting things that is still a little bit controversial. One of our core features is that we tell each other the truth. And the moment I heard why you were hypothesizing that showing the baby the negative emotion was helpful, I immediately connected with this.
I find it extremely intuitive, both within my own work and also growing up in Communism. During my childhood in Romania, people were incredibly emotionally connected. And Romania was one of the most oppressed countries in the Eastern Block. When Communism fell in ’89, I was twelve, and I had just moved to Sweden. But I remember going back just a year later, and people were no longer as connected. That connection just immediately started breaking apart. And I always thought it was because during Communism, everybody had this one thing that they hated—this one thing they showed each other their full range of emotions about. You know? They would always talk about how oppressive the government was, and they would get together, have parties, and make jokes. The oppression that caused them so much anxiety and so much trouble in their daily lives was the thing that they all connected on.
I don’t have a lot of interaction with my native country, and I don’t really have too much family left there. But to this day, Romania is not what it was when I was a kid. And of course I’m not pro-Communism. But at the same time, this concept of having something that you have a negative feeling about, and sharing that with somebody—I really think that’s a fundamental concept of emotional connection.
Dr. Welch: Yes. And of course it’s not just sharing negative feelings (or positive feelings); it’s sharing all your feelings.
Dr. Dumitriu: Absolutely.
Why Is It Important to Share Your Full Range of Feelings?
Dr. Welch: The trouble is, if you’re not sharing your negative feelings, it’s as if you can’t access your positive feelings. We have this analogy of a bottle with a cork in it:
All the feelings are in the bottle—the good feelings and the negative feelings. In the cork are three main elements stopping the emotions from coming out—anger, fear, and not knowing (not knowing is really important, because if you’re not connecting to your own feelings, you can’t connect with another person about your feelings). The idea is to pop the cork so the feelings can flow and be shared and dealt with. Then, you can get to the very positive feelings, which have been blocked by this cork of anger, fear, and “I don’t know.”
What about Babies Expressing Emotion—Is That Important?
Dr. Dumitriu: Emotional exchange goes both ways—listening to our children’s feelings helps them process their emotional range. But this does not mean we should let babies cry. This is really important: there is no such thing as spoiling a baby in their first few months of life outside the womb. Responding to all of the baby’s needs in the first few months is absolutely critical, not only to the emotional connection between parent and baby, but also to the growth of the baby’s brain.
The brain doubles in size during the first year of life, and grows lots and lots of new neural connections. During that time, if you’re letting the baby cry, you’re just bathing that brain in stress hormones like cortisol, which literally blocks the growth of neurons and connections between neurons.
But if you’re soothing the baby—responding every time they cry by talking to them, singing to them, feeding them, and looking them in the eyes —then you’re bathing their brain in good hormones like serotonin, dopamine, and oxytocin. And what do those things do? They grow the brain even better. It’s true that you can spoil a child later on, so there are absolutely important concepts in terms of parenting and rule-setting. But not in the first few months of life. During that time, all you’re doing is bathing the baby’s brain in either positive or negative hormones during a time that they cannot form the associations we call “memories.”
These pandemic-era drops in emotional connection can have really significant impacts on mother and baby’s health and resilience. Responding to your baby and building that emotional connection is the best way to protect both of you. We have all these individuals who have contributed to both NSP and COMBO in the last year, because they are dedicated to the ultimate goal of protecting moms and babies—protecting the emotional connection, building an empathic society, and recovering from COVID.
Dr. Welch: Being emotionally connected includes getting disrupted. That’s part of life. But you must repair the disruptions that cause the lack of emotional connection. It becomes easy to do when you do it all the time. It’s a state we move in and out of—the trick is to move into it as often as you can. Emotional connection happens through emotional expression. Especially for moms and babies at the start, it can set them on the best developmental path.