Studies and Scientific Work
The baby wrap
A way of recreating the biological, default behaviour when caring for newborns, infants and small children
Professor J. Büschelberger, Orthopaedic Consultant, Dresden
A wrap is an easy-to-use way to recreate the natural mother-child relationship (dyad). Using a wrap makes it much easier to care for children from birth up until their second birthdays. Carrying the child in a wrap facilitates her mental and physical maturity and development and prevents perinatal developmental hip dysplasia as well as other symptoms caused by being removed from the mother’s womb. Furthermore, recreating the mother-child dyad is a particularly intensive and long-drawn-out continuation of rooming-in care offered by maternity departments and ensures that the child is integrated as easily as possible into the life of society.
When looking for biological determining ways to prevent perinatal hip dislocation, you inevitably end up stumbling upon the problems of the mother-child couple. This couple, termed the ‘dyad’ by the sociologist Simmel, creates a closed system in which reciprocal feedback takes place with each of the two being an addition to and learning from the other.
This learning begins immediately after birth during a very critical period, the length of which is determined by the timely and situation-appropriate contact between the mother and child. These sorts of obligatory learning processes are known as imprinting and most likely involve all five senses to a greater or lesser degree. Postpartum imprinting serves recognition purposes and cements the bond with one another. This bond is most intense when the unwashed newborn is placed on the mother’s body immediately after birth so that skin-to-skin contact is made and the baby can also nurse at the breast. Through this skin contact and by suckling the teat, the newborn absorbs the bacterial flora of her mother though her skin and into her digestive organs. She is immune to this bacteria due to the placenta, which nourished her before birth, and the breast milk, which nourishes her afterwards. From a bacteriological point of view, the baby is extensively protected from hospitalisation.
The first environment a newborn experiences is her mother. Phylogenetically, humans are nidifugous; physiologically though we are born ‘early’ and, to a certain extent, have to spend at least 12 months in statu nascendi at our mother’s breast in order to mature and develop appropriately. In many ways newborns are adapted for life snuggled up to their mothers. This can be seen in the total kyphosis (roundedness) of the spine, the intra and extrauterine shape and position changes of the hip socket and coxal ends of the femur – so-called ‘indirect development’ – as well as the physiological limitation of hip extension. This limitation and the strong antetorsion of the femur neck enable newborns to cling to their mother’s body. In the straddle position, the child’s legs are bent at the hip at an angle of more than 90° and are abducted by around 25° from the sagittal plane. The femur neck axes radiate almost vertically into the entry level of the hip socket. In this position, equal pressure is exerted on all areas of both joints – femur head and hip socket – something which is necessary for the development of their ossification centres and thus the normal formation of the ball shape of the caput femoris and the hollow ball shape of the acetabulum.
The inherent looseness of the joints is, however, insignificant when the baby’s legs take on the bent-spread-position as is the case when being carried on the mother’s hip or if a wide nappy or a hip dysplasia harness is used. In this position, the femur heads are pushed into the centre of the socket and not against the upper-back sections of the soft, cartilaginous socket walls and as the capsular ligaments are relaxed as much as possible they cannot be overstretched. Hips that are unstable from birth can become stable on their own during the first days of life, however it cannot be determined in advance which of the hyper-mobile hips will become stable and which will remain loose. For this reason, it is necessary, even in a newborn, to bring the child’s legs into the physiological bent-squat position. This happens most naturally by recreating the mother-child dyad with the help of a baby wrap.
Concerned parents often ask if using a wrap can harm either the mother or the child and from what age an infant can be carried in a wrap.
The question regarding age is often asked as newborns cannot support their heads and because they sit in the wrap with rounded backs. Although newborns cannot support their heads, it is possible – and highly recommended – to carry them in a wrap. The mother should rest the head of the child against her breastbone, pull the wrap up to it and if necessary support it with her upper arm. By being carried in a wrap, the baby quickly learns how to support her head. Reisetbauer and Czermak reported both in writing and visually that newborns lying on their fronts begin to straighten up immediately after birth by performing head-lifting movements. Wustmann gave the following description of indigenous South American children: “One day we visited Aueti who had just given birth. […] the baby latched on to the nipple after a few hours, was carried around on the mother’s hip and after two days was able to support her head.’
No damage can occur to the baby’s spine when she’s being carried in a wrap. The intra-uterine posture and the total kyphosis of the spine, remain after birth for a long time when the child is carried in a wrap. With the strengthening of the neck muscles and through absorbing social contact with the world beyond the dyad, the natural curvature of the cervical spine develops while the sections of the lumbar column and the thoracic spine remain in kyphosis until the child begins to walk.
Life in a wrap gives an older child the opportunity to get to know her initial surroundings, her mother and generally get to know those around her without forfeiting the feeling of secureness she gets from being close to her mother. However, the advantages of using a wrap are not only limited to the absolute prevention of perinatal hip dislocation, other womb withdrawal symptoms and a healthy mental development with the closest possible social contact; a wrap can also be extremely practical in everyday life. Being carried in a wrap and/or experiencing physical contact with the mother means that children can be ‘transported’ to doctor’s appointments in a calm state and thus put up little or no resistance to the examination.