The first 1001 days in a child’s life is known to be a critical time for development and midwives are crucial in the early days to set the foundation stones of care. Stephanie Kinder, Specialist Midwife, North Bristol Trust, describes the use of the Brazelton approach to help parents in their initial relationship with their baby.
The 1001 critical days from conception to two years old, a notion that we, as midwives, are well versed in, is embedded in policy making for health and social care services; it acknowledges the incredible window of opportunity, laying the foundations for lifelong emotional, social and physical wellbeing. Midwives possess a unique and privileged position to be offering maternity care for a significant proportion of those 1001 days. Work from the eminent neuroscientist Dr Bruce Perry, further highlights the first 8 weeks of life as a period of both great vulnerability for the baby and opportunity for clinicians.
Neonatal Behavioural Observations
In 2023, I was fortunate enough to be awarded a bursary to train in Newborn Behavioural Observations (NBOs) with the Brazelton Centre UK, and I really have never looked back. The Brazelton Centre introduced me to knowledge that has transformed my approach to supporting families to get to know their babies and gave me a much deeper understanding of babies, specifically their capabilities and their capacity to communicate with those around them.
The NBO is fundamentally a relationship building tool, designed to help facilitate the sensitive observation of a baby’s unique behaviour, and interpret it as the baby’s first language. The NBO seeks to elicit a range of behaviours, such as muscle tone or response to face and voice; the practitioner then endeavours to interpret the responses, which may give implications for care giving, such as a baby’s preference for handling. The NBO can be undertaken across settings – on the wards, or in the community.
Not ‘another task’
Far from just another task to undertake whilst providing postnatal care on busy wards or home visits, the NBO offers the opportunity for rich and meaningful conversations around many of the key public health topics we aim to talk to families about:
- Observing a baby’s shoulder and neck tone and the crawling response offers the perfect opportunity to talk about safe sleeping positions, and the reason that we recommend babies sleep on their back.
- When observing crying and soothability, you can weave in discussions around ICON messaging and coping with infant crying.
- Observing sucking and rooting lends perfectly to discussing responsive infant feeding and feeding cues.
- Observing muscle tone in the arms and legs can lead to in depth discussions around safe handling and babies’ need for touch, contact and emotional warmth.
- Observing babies’ responsiveness and orientation to visual and auditory stimulation leads seamlessly into discussions around communication cues and social interaction.
An NBO is not a clinical assessment, screening for pathology or a task to undertake; it is a strength-based relationship building tool. An NBO has the potential to transform a discharge discussion or a first visit at home from a semi-scripted tick list to a family-centred transformational interaction.
An infant focused and family-centred system
Through coming together with parents and care givers to observe their incredible, unique babies, the NBO has enabled me to connect and engage with parents in a way that I hadn’t experienced before in my midwifery practice. It’s also a meaningful occasion to truly include partners and other care givers – making partners and fathers a more visible part of perinatal care has been a priority for some time, and by making the NBO part of my practice, I have seen firsthand the positive impact it can have, not only on the relationship between the infant and their care givers but between care givers and myself. This is borne out in the evidence – the NBO has been shown to strengthen the practitioner-parent relationship and facilitate practitioners modelling the reflective capacity we are asking of parents.
Nurturing the nurturers
As midwives, we are always aiming to build therapeutic relationships, in which the women and families that we are caring for feel safe, heard and that they can trust us. These are also the relationships that we are promoting between parents and carers and their babies. When we model these relationship building skills, the families can feel the benefit of feeling nurtured, valued and listened to and we can hope that they consequently aim to provide that for their babies too.
Using the Brazelton approach also encourages us to approach all interactions as an open and curious observer, trying to respond to what we are being told. This principle can then also carry through to how we communicate with women – by maintaining an open and curious outlook, without prescriptive agenda, we can listen more actively and provide more holistic, person-centred care.
Beyond Postnatal Care
By having a deeper understanding of babies and their behaviour, their uniqueness, capacity and competence, I have found that no area of my practice has gone untouched. How I deliver antenatal care and education, undertake systematic examination of the newborn and NIPEs, and offer feeding infant feeding support have all been transformed.
I would highly recommend undertaking the training in the NBO to all midwives that get the opportunity, and would encourage anyone interested to apply for a Brazelton Centre UK bursary, with applications opening again later this summer. I would also implore our educators, leaders and commissioners to look more closely at the potential long term benefits that embedding the NBO into midwifery care could offer to the families that we care for.
Stephanie Kinder, Specialist Midwife, North Bristol Trust
July 2025
Watch and listen to Stephanie talk on Midwifery Hour here: