What can be done to support mothers and babies in their rocky path of parenthood and early development? Temasek Shophouse Conversations have illuminated new insights on the importance of the first 1,000 days of a child’s life and the crucial role maternal mental health plays in facilitating growth.
It’s 3 a.m. and it’s been two hours since your newborn woke up crying hysterically, jolting you out of bed and into their crib. Cradling your bawling baby, exhausted and overwhelmed, you think of the million other things you need to do first thing in the morning – juggling all household chores like laundry, cooking, and cleaning, all while keeping your baby clean, well-fed, and happy – before night falls and the day repeats itself.
Many are aware of how challenging and physically taxing motherhood can be, but little know of the anxieties, guilt, and stress mothers face on a day-to-day basis. The foundations of a so-called “perfectly happy home” with a healthy baby and tidy house, may well be built upon the rubble of a crumbling mother.
But must perfect parenthood be achieved at the expense of mothers’ wellness? Can’t we protect both mother and child in the strenuous journey of parenting and growth?
What can be done to help mothers? What should be done?
The 3rd Temasek Shophouse Conversations, held on 7 June 2021, sought to answer these questions in their webinar “First 1,000 Days – Maternal and Child Wellness.” Gathering nearly 700 participants, the event featured international and local experts from research, clinical, and community sectors to discuss maternal wellness and child development, particularly during the first 1,000 days of a child’s life, to steer community calls-to-action, improve maternal care, and prompt conversations of parenting experiences.
The First 1,000 Days: A Critical Window
The first 1,000 days of a child’s life – from conception to the age of two – is often known as a critical period of rapid growth and development that offers a window of opportunity to lay the foundations of lifelong health, well-being, learning, and development.
Neuroscientists have also asserted the importance of the first 1,000 days as being the period where the brain develops most quickly and is most plastic or adaptable to change as a result of experience. During this window of time, synapses form, get pruned, and ultimately shape the child’s cognitive development.
Development plasticity, or the capacity to adapt to different social and physical environments, is an especially crucial process that requires careful monitoring. Since the moment of conception, the fetus has begun to adapt to the environment, responding and adjusting to physical, nutritional, and emotional stimuli in the womb.
However, this capacity that makes us versatile can also leave us vulnerable.
Dr. Tim Moore, Senior Research Fellow from Murdoch Children’s Research Institute (MCRI) explained that while development plasticity is retained throughout our lives, this adaptive capacity is greatest during the first thousand days.
This means that the adjustments we make, in response to both good and bad experiences, during early life can be permanently embedded and carried throughout life. This phenomenon takes place with the help of biological embedding, wherein both our brain and genes listen to the environment, taking in developmental and societal experiences that can permanently alter cognitive growth and produce lifelong health outcomes.
“Every aspect of our development is shaped by experiences and exposures during the first thousand days. It’s not just your neurological system that is affected. Every system, your immunological system, neurological, endocrinological, metabolic, cardiovascular [...] is affected. The whole mind, brain, and body are interconnected with one another,” said Moore.
However, making optimising the first 1,000 days of a child is not the only thing parents should do. New findings have revealed the importance of extending special care before, during, and even after the first thousand days, not only for babies but also for mothers and mothers-to-be.
Before the First Thousand: How Mothers Impact Children
Parents are familiar with the long list of baby essentials, do’s, and don’ts. To facilitate healthy growth, they are encouraged to prepare nutritious diets, engage in active play, and create safe spaces for their children among many other things. But recent studies have shown that there is more to healthy growth than just food and play.
Mothers’ health and wellbeing also play a major role in maximising the child’s ability to grow, learn and thrive.
A Closer Look on Depression, Anxiety & Stress
According to the Growing Up in Singapore Towards healthy Outcomes (GUSTO) study conducted by KK Women’s and Children’s Hospital, maternal antenatal depression and anxiety can impair fetal brain development and functional connectivity, as well as adversely impact epigenetic expressions, thus leading to compromised temperament and behaviour.
By observing changes in the connectivity of brain regions responsible for emotions, researchers discovered that when mothers expressed high levels of depressive symptoms before and after childbirth, children demonstrated behavioural difficulties. Non-clinical levels of depression were also found to affect the amygdala that is crucial for processing fear and negative emotionality.
“Maternal depression during and post-pregnancy can have devastating impacts on the fetal brain’s microstructure, leaving them vulnerable to anxiety and mood disorders later in the child’s life,” explained Zulkifli, the Minister for Social and Family Development and Second Minister for Health, in his keynote address.
Maternal anxiety has also become one of the most common struggles for new and experienced mothers alike, afflicting 1 in 7 mothers in Singapore. Maternal anxiety can impact the infant’s hippocampus, which processes emotional memories potentially resulting in stress disorders in later life.
Caregiving methods and parenting stress can also influence child attachment and behavioural outcomes, hence decreasing school readiness.
Shining Light on Maternal Trauma
Researchers have also indicated a link between historic trauma and epigenetic change, which refers to the external modifications to the DNA that can be passed down to children. This recent finding has led scientists to speculate that the traumatic experiences of mothers and even grandmothers can be passed down to their offspring through transgenerational epigenetic inheritance.
This means that parenting as we know it begins well before birth, and even before conception. Our experiences, both good and bad, can accumulate and exert lasting impacts on our children.
Dr. Ho Yiling, a clinical psychologist of KK Women’s and Children’s Hospital, has revealed that maternal exposure to trauma can increase the likelihood of perinatal depression, which can affect infant outcomes in terms of responsiveness, sleep or later emotional health.
Some studies have demonstrated that maternal exposure to childhood abuse can negatively affect the relationship, caregiving behaviours, and attachment with infants. Prolonged exposure to traumatic events during childhood can disrupt the mother’s stress response systems, which may lead to the release of high levels of stress hormones like cortisol before and during pregnancy. Lengthy exposure to cortisol “may impact fetal brain development [which] can increase the risk of emotional behavioural difficulties later on in life.”
“What they found was that women or mothers who have been physically abused as children were more likely to develop hostile caregiving behaviours towards their infants when they show distress over time,” Dr. Ho reported.
Severe childhood sexual abuse experienced by mothers were also found to be associated with less engagement and time spent with infants, as well as a diminished capacity in responding or being attuned to the infant’s needs.
A study investigated the brain activity of mothers with untreated traumas and found that in response to pictures of distressed infants, they displayed reduced brain activity in regions for emotional processing. In fact, repeated exposure to infant distress demonstrated triggering or traumatising effects for these mothers, which can erode their capacity to be attuned and responsive.
If these effects persist over time, researchers believe that the unmet needs of both mother and child can induce more stress, solidifying the intergenerational transformation of trauma.
As rightfully pointed out by Dr. Salam Soliman, Director of the Center for Prevention and Early Trauma Treatment, “Trauma not transformed is transferred, meaning that if one doesn’t resolve one’s history of trauma, one is bound to transfer it to the next generation.”
All these studies point to one conclusion: mothers are vital facilitators of a child’s growth and development. As such, it is crucial to place special emphasis on taking care of mothers as well as the child before, during, and after pregnancy.
With that in mind, how can we boost practical, social and emotional support for mothers and their babies?
Calls to Action
A cohort study done by S-PRESTO has demonstrated the need to strategise interventions for maternal depression and trauma as early as possible because of the stable trajectory of maternal mental health starting prenatally.
To achieve this, various support programmes have been launched and made available to support mothers.
KK Women’s and Children’s Hospital, for one, has launched a variety of programs like Women’s Mental Wellness Service, Postnatal Depression Intervention Programme, and SUREMUMS to support and empower mothers with home-based mother-infant therapy. They also recommend strengthening the attachment between mother and fetus by nurturing mother-child bonding activities to optimise developmental outcomes.
Findings have shown that attuned, nurturing interactions between mother and child can support children to develop individuality, better understand their needs and reasons behind their feelings. During early age, children rely on mothers to organise their feelings, and so when mothers explain to their children the reasons behind their emotions, they are provided with an organising framework to connect their feelings to the outside world. As such, it is important to strengthen the bond between caregiver and child; a responsive relationship can help protect the brain from the damaging effects of stress.
National efforts like MOH’s Child and Maternal Health and Well-being Strategy, and community strategies such as Temasek’s Community Milk Bank and ParentWise Programme, are also available to help to equip parents and caregivers with the tools, strategies, and support they need to help their children reach full potential, all while supporting maternal health and well-being.
“It is crucial to address the very real threat of compromised mental health by providing social support from as early as pre-conception, through pregnancy and then into motherhood in order to enhance the child’s development and learning,” said Zulkifli.
What We Can Do
The fact is, “no one [is] really born to be a mother,” said Jennie Wan, head of MindCare. And the journey of motherhood can be a lonely one if there is little support or proactive outreach from the community.
Healthcare workers and community groups are advised to remain vigilant of vulnerable mothers, actively screening for symptoms of depression during antenatal and post-natal check-ups for mothers and mothers-to-be.
Workplaces are also encouraged to extend more psycho-emotional support to employees and colleagues who are pregnant or transiting back to work after maternity leave, by providing more flexible work arrangements or being more understanding.
But we don’t need to wait for policies or services to take effect, we can begin with ourselves, in our own homes and neighbourhoods.
By playing an active role as helpful spouses, friends, relatives or neighbours, we can lend our support to mothers and mothers-to-be in their coping of psycho-emotional stress, and in doing so lift some weight off their shoulders. Online sources like HealthHub App and the Baby Bonus Parenting Resources are available to guide and provide us with the information we need to assist mothers in need.
While the saying goes, “it takes a village to raise a child,” Temasek’s 2021 Shophouse Conversations have shown us that perhaps it takes a village to raise a parent as well.
- Zulkifli, M. (2021, June 7). Keynote Speech [Webinar]. Temasek Shophouse Conversations: First 1,000 Days – Maternal and Child Wellness.
- Moore, T. (2021, June 7). The First 1000 Days: Why They Matter and What They Mean for Us [Webinar]. Temasek Shophouse Conversations: First 1,000 Days – Maternal and Child Wellness.
- Soliman, S. (2021, June 7). Healing Trauma Through Dyadic Relationship-Based Intervention and Concrete Supports [Webinar]. Temasek Shophouse Conversations: First 1,000 Days – Maternal and Child Wellness.
- Chen, H. (2021, June 7). Temasek Shophouse Conversations: First 1,000 Days – Maternal and Child Wellness.
- Wan, J. (2021, June 7). Sharing from the Ground [Webinar]. Temasek Shophouse Conversations: First 1,000 Days – Maternal and Child Wellness.
- Ho, Y. (2021, June 7). Sharing from the Ground [Webinar]. Temasek Shophouse Conversations: First 1,000 Days – Maternal and Child Wellness.
- Tan, K. (2021, June 7). Sharing from the Ground [Webinar]. Temasek Shophouse Conversations: First 1,000 Days – Maternal and Child Wellness.