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Skin-to-Skin Contact, Breastfeeding, and Perinatal Neuroscience Hollister Breastfeeding Program 2006

Skin-to-Skin Contact, Breastfeeding, and Perinatal Neuroscience Hollister Breastfeeding Program 2006 Boston, MA Denver, CO Redlands, CA Mission Viejo, CA. Skin-to-Skin Contact, Breastfeeding, and Perinatal Neuroscience Dr Nils Bergman

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Skin-to-Skin Contact, Breastfeeding, and Perinatal Neuroscience Hollister Breastfeeding Program 2006

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  1. Skin-to-Skin Contact,Breastfeeding, and Perinatal Neuroscience Hollister Breastfeeding Program 2006 Boston, MA Denver, CO Redlands, CA Mission Viejo, CA

  2. Skin-to-Skin Contact,Breastfeeding, and Perinatal Neuroscience Dr Nils Bergman M.D., D.C.H., M.P.H., Ph.D. Cape Town, South Africa www.kangaroomothercare.com

  3. Skin-to-Skin Contact,Breastfeeding, and Perinatal Neuroscience: Implementing Best Practice in U.S. Hospitals Boston, MA Denver, CO Redlands, CA Mission Viejo, CA

  4. KANGAROO MOTHER CARE IMPLEMENTATION PRACTICAL POTENTIAL POLITICAL

  5. Declaration of Alma-Ata on Primary Health Care … based on practical,scientifically sound and socially acceptable methods and technology made universally accessible …. … individual self-reliance and participation., making fullest use of resources…

  6. Primary Health Care: … is based on the application of relevant results of social, biomedical and health services research and public health experience; … addresses the main health problems (Prematurity factor in two thirds of all perinatal mortality ………)

  7. Declaration of Alma-Ata on Primary Health Care … based on practical, scientifically sound socially acceptable methods and technology made universally accessible ….

  8. Primary Health Care: … is based on the application of relevant results of social, biomedical health services research and public health experience

  9. BIOMEDICAL SOCIAL HEALTH SERVICES

  10. SOCIAL Socially acceptable BIOMEDICAL Scientifically sound HEALTH SERVICES practical

  11. BIOMEDICAL Thai protocol: PMTCT (for HIV) Give AZT from 36th week 4 weeks, twice a day Provide AIF, no breast REDUCES HIV by 51% ! Implemented 1999 WCape

  12. PROBLEM 1: When is 36w GA ? Many only started 38w GA Many delivered at 38w GA or before!! NOT PRACTICAL !! HEALTH SERVICES

  13. PROBLEM 1: PROBLEM 2: When is 36w GA ? COMPLIANCE !! Many only started 38w GA Many delivered Side effects … at 38w GA Resistance … or before!! NOT PRACTICAL !! NOT EFFECTIVE !! HEALTH SERVICES

  14. PROBLEM 3: Enormous social STIGMA ! Tablets could be hidden But “tins = HIV +ve” Tins sold on station … NOT ACCEPTABLE !! SOCIAL

  15. PROBLEM 3: Enormous social STIGMA ! Tablets could be hidden But “tins = HIV +ve” Tins sold on station PROBLEM 4: Mixed feeding HIV transmission NOT ACCEPTABLE !! INCREASES !!! SOCIAL

  16. BIOMEDICAL Thai protocol: PMTCT (for HIV) SOCIAL HEALTH SERVICES

  17. Thai protocol: PMTCT (for HIV): scientifically sound YES – BUT NOT practical, socially acceptable

  18. Primary Health Care: … is based on the application of relevant results of biomedicalresearch YES – BUT ALSO socialresearch, and health services research

  19. BIOMEDICAL Changed to NVP single dose in hospital SOCIAL Encourage Strict Exclusive BF & M2M2B HIV transmission about 8% HEALTH SERVICES

  20. “There is currently great emphasis on grounding medical practice on sound research evidence.” …. the most credible research on health care outcomes is from randomised, controlled, double blind clinical trials.”

  21. “There is currently great emphasis on grounding medical practice on sound research evidence.” …. the most credible research on health care outcomes is from randomised, controlled, double blind clinical trials.” AGREED ???

  22. The biomedical paradigm IS TOO NARROW !!

  23. “There is currently great emphasis on grounding medical practice on sound research evidence.” …. the most credible research on health care outcomes is from randomised, controlled, double blind clinical trials.” = FALSE ASSUMPTION !!

  24. Declaration of Alma-Ata on Primary Health Care … based on practical, scientifically sound socially acceptable methods and technology made universally accessible ….

  25. Primary Health Care: … is based on the application of relevant results of social, biomedical health services research and public health experience

  26. What determines a paradigm ?? Tradition Culture Experience Research Science

  27. What determines a paradigm ?? Tradition Culture Experience Research Science Fashion !!!!

  28. Basic assumptions come from: Tradition Culture Experience

  29. Neuronal Plasticity “the first three years are decisive”  platform for subsequent development of higher cognitive functions. Attachment Regulation Emotion Control Arousal Appetite Sleep

  30. BASIC ASSUMPTIONS: PLATFORM / FOUNDATION / BASE

  31. PARADIGM CONSTRUCT Paradigm has internal Intelligence Honesty Integrity Consistency BASIC ASSUMPTIONS: FOUNDATION / PLATFORM / BASE

  32. What determines a paradigm ?? Tradition Culture Experience Research Science

  33. PARADIGM CONSTRUCT Paradigm has internal Intelligence Honesty Integrity Consistency BASIC ASSUMPTIONS: FOUNDATION / PLATFORM / BASE

  34. PARADIGM CONSTRUCT Biomedical model: reductionist Odent’s “circular research” If challenges paradigm: Odent’s “cul-de-sac research”

  35. Impact of Birthing Practices on Breastfeeding EXAMPLE : Mary Kroeger’s book: challenges paradigms: cul-de-sac “LINKAGES decided there were ‘too many gaps’ in solid scientific literature to warrant publication” = paradigm reinforces itself: circular

  36. PARADIGM CONSTRUCT Paradigm has internal Intelligence Honesty Integrity Consistency BASIC ASSUMPTIONS: FOUNDATION / PLATFORM / BASE ‘too many gaps’ in solid scientific literature to warrant publication”

  37. WHAT NEW INFORMATION ? challenged paradigms: cul-de-sac Without awakening to assumptions and “basic belief system” New information cannot be grasped !!

  38. SEPARATION VIOLATES THE INNATE AGENDA OF MOTHER AND NEWBORN

  39. “Why do doctors use treatments that do not work?” Jenny Doust , Chris Del Mar. British Medical Journal, 28th February 2004

  40. “Why do doctors • use treatments • that do not work?” • Clinical experience • Over-reliance on surrogate outcome • Natural history of the illness • Love of the pathophysiological model (that is wrong) • Ritual and mystique • A need to do something • No one asks the question • Patients’ expectations (real or assumed)

  41. “Why do doctors • use treatments • that do not work?” • No one asks the question • Paradigm = basic assumption, • things we take for granted ….

  42. Culture Science BIOMEDICAL SOCIAL RCT Stigma EBM Disease HEALTH SYSTEMS Efficiency / effectiveness

  43. Culture Science BIOMEDICAL SOCIAL RCT Stigma EBM Disease ? HEALTH SYSTEMS Efficiency / effectiveness

  44. Culture Science BIOMEDICAL SOCIAL RCT Stigma EBM Disease 8% HEALTH SYSTEMS Efficiency / effectiveness

  45. Culture Science BIOMEDICAL SOCIAL RCT Stigma EBM Disease HEALTH SYSTEMS Efficiency / effectiveness

  46. Culture Science BIOMEDICAL SOCIAL ? RCT Stigma EBM Disease HEALTH SYSTEMS Efficiency / effectiveness

  47. Anthropology Culture Values Science BIOMEDICAL SOCIAL Ethics PHC RCT Stigma Disease EBM Costs HEALTH SYSTEMS Efficiency / effectiveness

  48. Anthropology Culture Values Science BIOMEDICAL SOCIAL Ethics Centre of excellence RCT Stigma Disease EBM Costs HEALTH SYSTEMS Efficiency / effectiveness

  49. Anthropology Culture Values Science BIOMEDICAL SOCIAL Ethics PHC RCT Stigma Disease EBM Costs Reductionist Territorial Outcome issues Affordability Ethics (1 vs many) Values issues HEALTH SYSTEMS Efficiency / effectiveness

  50. Anthropology Culture Values Science BIOMEDICAL SOCIAL Ethics PHC RCT Stigma Disease EBM Costs Reductionist Territorial Outcome issues Affordability Ethics (1 vs many) Values issues HEALTH SYSTEMS SOCIAL is also SCIENCE Efficiency / effectiveness

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