New Cochrane review evidences that cuddles help reduce pain in neonates…

small_316690350I have the very greatest respect for my esteemed colleagues who have authored the newest birth-related Cochrane review which shows that skin-to-skin care (the technical term for cuddling) can help reduce procedural pain in neonates (Johnston et al 2014).  It’s a great review and of course it is important to consider how we can reduce the pain of interventions such as the heel prick test, other blood tests or injections. The full version can be found here.

But I also struggle a bit with the fact that I live in a world dominated by a medical paradigm in which skin-to-skin care (or, as it is known in less medicalised circles, cuddling) has come to be viewed as an intervention which needs to be evaluated for effectiveness. Part of the rationale for such reviews is that a significant majority of parents who have babies in special care units feel that their role is somewhat eroded and that they want to play a greater part in being able to comfort their baby and provide pain relief (Johnston et al 2014).  Are we really so lost that we need evidence in order to sanction and approve of this?

My concerns don’t stop there.  The review processes used and promoted as the gold standard within the paradigm that currently dominates health care (through absolutely no fault of the reviewers) necessitate consideration of the potential downsides of ‘interventions’ such as cuddling.  Even if no downsides are found, this has still introduced the idea that there may be a sinister or harmful element to human warmth…

quote 0129Such denigration of the value of human warmth is not new. Parents have long been separated from their babies for an entire buffet of spurious reasons purported to relate to the baby’s wellbeing.  In every case that I am aware of, evidence later shows that such separation does far, far more harm than good.  Surely those of us who care for families have reached a high-enough vantage point on the evolutionary ladder that we can see the fallacy of a worn-out paradigm and accept and embrace the value of parental love and bodily contact (in a form appropriate for the individual baby and her stage of development) as a fundamental pre-requisite which should be welcomed and encouraged at every opportunity?  It is the professional interventions which are the optional add-on, not the other way around!

Within the context of the use of cuddling as pain relief, surely the really appropriate question is: is normal human cuddling enough, and/or when do we need to consider forms of medical pain relief? And if you have the time and inclination to read such reviews in depth, you can get a sense that, often, the reviewers are well aware of the complexity of the debate.  If you just read the headlines, however, you might miss this…

small_82840013The authoritative nature of the modern medical worldview means that such things will need to be evaluated for effectiveness for some time to come.  So I would argue that we need to create spaces in which we can keep a sense of perspective. Otherwise, because of the way in which these frameworks lead to the (essential and unavoidable) abbreviation of huge and complex debates into short summaries, the context of such evaluation can easily gets lost.  And we might forget that we should all give and get cuddles as the default position.  Without there needing to be an indication.

Human warmth and contact is surely an essential element of everyday life, not an intervention to be medicalised, quantified, measured and prescribed…

Johnston C, Campbell-Yeo M, Fernandes A, Inglis D, Streiner D, Zee R. Skin-to-skin care for procedural pain in neonates. Cochrane Database of Systematic Reviews 2014, Issue 1. Art. No.: CD008435. DOI: 10.1002/14651858.CD008435.pub2.

photo credit: baby by atomicshark and mum/child by Mydaas! via photopin cc and cc

 

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