Thursday, May 23, 2013

Observations and theories about bonding.

The history of this research.
I first worked with Amish and Hutterite settlements in the Midwest in the early 1980s. I would describe myself today as a midwife-turned-anthropologist, turned author and doula. During my years in Minnesota, Wisconsin, and North and South Dakota, I observed under-served populations of mothers and children, and mis- and undiagnosed genetic disorders which disturbed me very much. I was granted a Bush Leadership Fellowship in 1989 which enabled me to complete an internship in midwifery at a free-standing birthing clinic in El Paso, Texas, which also served the neighboring city of Ciudad Juarez, Mexico, and prepared me for the Texas State midwifery boards and licensure held that same fall in September, 1989. (Also see under March stories at this blog the story called, "What a midwife should not do: A lesson in destroying bonding.")
My grant from Bush also gave me the credentials that I needed to be accepted into the medical community, who in turn gave me unconditional backup and support for my work. With that support I was able to identify Amish women who had experienced multiple stillbirths and with appropriate referral were able to receive early intervention during subsequent pregnancies and now have healthy (grown) children. The isolated Hutterian communities had more complicated histories compounded with intermarriage and a mistrust of the medical facilities in their districts. As a woman I was able to gain their trust and teach childbirth education, self-breast examination (which none had ever been introduced to), and perform pap tests, often for the first time, for the women of all ages in each colony I visited, with laboratory back-up in Minneapolis.

In 1970 - '71 I worked with Mother Teresa of Calcutta and upon her death in September 1997, reflected on that experience in an article (Plough Publishing, November, 1997) and in a public lecture later that fall in New York City sponsored by The Samuel Dorsky Symposium on Public Monuments Spirituality Symposium at Columbia University. I believe this amazing opportunity helped form some of the insights I bring to my work today.

In the late 1970s and early ‘80s by volunteering through Macalester College in St. Paul, Minnesota I began working with Hmong refugees as they arrived in Minnesota. I learned to speak Hmong (a pre-literate Chinese language) and was on-call at Regions Hospital (then St. Paul Ramsey) in their emergency, and labor and delivery departments. I also acted as liaison in the
Minnesota justice system and at funeral homes. At that time my husband and I founded Abraham’s House, later called, The Mustard Seed, a liaison service to the refugee community. While working with the Hmong community I soon began seeing young Hmong couples who had been, up until that time, unable to conceive children. One theory we held at the time was that the chemicals used during the Vietnam War, 'Agent Orange' in particular, which was sprayed over Southeast Asia indiscriminately, both on military as well as civilian populations, might be responsible for this high male infertility rate. China is now experiencing a similar male infertility phenomenon which research has confirmed is being caused there by the high levels of unregulated air pollution throughout the industrialized districts. I began teaching basal temperature charting (in Hmong) to these couples in order to target fertile days within the woman’s cycle. Together with an eminent gynecologist in Minneapolis we were able to treat many infertile couples successfully.

Since 2002 I have wondered about my observations of other refugee populations, Somali in particular. I began to try to understand what appear to be problems unique to the Somali population. At the top of this list is the (apparent) unprecedented occurrence of autism in the Minneapolis Somali community. As a midwife I can’t help but compare behaviors between the two groups – Hmong and Somali. One thing I came across very early in my observations was the fact that the Hmong as a group had lower rates of autism than non-refugee populations in Minnesota (reported to be the lowest) while at the same time the Somali community has an unacceptably high number of autistic children, (the highest occurrence both in Minnesota and Sweden*.) I believe I may be the first/only researcher to have the unique opportunity of being able to intimately access both groups simultaneously. I am also very aware that this significant, tiny window of opportunity is quickly closing as Somalis assimilate into American society.

I questioned my observations in the beginning sure that what I was seeing was biased, based on my midwifery context/frame of reference, so I enlisted an independent observer, a chiropractor who agreed to observe Somali mothers. She had no previous experience with immigrants or refugees. What she said when she returned was, “My Gosh! They are all engaged everywhere except with their babies.”

I can already hypothesize that the lack of attachment we are seeing is affected, if not caused by an interruption or perhaps absence in the bonding process – in Somali women as well as other mothers regardless of race, social or economic status. The greatest disparity between the Hmong mothers during their first two decades in Minnesota, and this first 10 - 20 years of most of the Somali mothers I am seeing is in bonding. I was puzzled by the fact that I encountered so many of what I would call non-bonding behaviors in Somali mothers and their babies. A lack of bonding is not one of the current theories that hold, i.e., that certain newborns are hypersensitive and thereby easily over-stimulated causing them to physiologically withdraw from external stimuli, thus all the autistic spectrum behaviors. Other popular theories include genetic causes exclusively, though none have been identified as of this writing; neurological reactions to vaccines are also suspect, although both Hmong and Somali children have been/are immunized on exactly the same Public Health age-appropriate schedules in Minnesota; allergies to environmental pollutants and food allergies are also being considered.
Doctors in Sweden are puzzling over the same questions as they also have a significant Somali population who are experiencing the same (reportedly) disturbing rates of autism in children there. They are currently exploring treatment using large doses of vitamin D and blaming a lack of sunlight exposure in their northern hemisphere upon a people from an otherwise equatorial region, (even though the babies affected were born in Sweden.) In New York in the last 2 years we have noticed studies that are finding that women in cultures that suggest total covering, i.e., Amish, Mennonites, Plain churches, Hassidim, Muslim, etc., are also lacking in vitamin D consistently, and recent recommendations there are that all women be tested and offered supplements. There are also some alternative doctors in the U.S. who are treating autistic children with a host of experimental treatments; their desperate parents are paying millions of dollars to these practitioners for these and other ‘cures’.

Related to this bonding question is another premise I hold that babies actually bond before birth, having no external stimuli to interfere with continual bonding which has only increased until the moment of birth when the baby is the most mature thus far. S/he has bonded unconditionally up until the moment of birth and unless the mother bonds in return, responding in kind, at the same rate of attention from/as the infant, then the disconnect on her part may cause the lack of bonding we are seeing here. So when we see a mom propping a bottle for her infant in a crib parked in from of a TV, or while pushing him, strapped into a stroller, while looking away and talking to a cell phone, the baby learns a new behavior and imitates this in her own baby way. Perhaps he too will ‘check-out’, avoid eye contact, reject skin contact, bond with inanimate objects, relate to imaginary people as he 'reads' the mother doing.

Talking or singing to her baby, in utero, as well as other prenatal bonding behaviors can help prepare mothers for bonding. Articles are being published, and numerous classes offered at present in mothers’ and parents’ magazines in the U.S. and the U.K., teaching parents how to talk to their babies, both before and after birth. This has already been recognized as a major problem affecting early learning. After moving to Minneapolis in 2010 and interacting daily with Somali women, I decided to propose using a model that is called treatment-guided research. I did not know that this had ever been used before, particularly in autism work, but discovered Dr. Martha Herbert’s article in Autism Advocates, 1st edition, 2008. I would like to take this even one step further and I now envision a prevention and treatment-guided research, teaching total bonding to groups of Somali women -- pregnant, new mothers, sisters, aunts, and grandmothers, so that even when a mother has to return to school or work, the infants’ caregivers will continue care with the same tools learned in prevention/treatment. Treatment-guided research reverses the assumption that treatment must follow extensive clinical trials, but rather, first implements viable treatment/prevention and then later asks, Did this work?  For whom did it work?  And, how did it work? Phase II or the second year of implementing this would be used to continue bonding education and also begin to gather data from the participating clinics and hospitals both here and in Sweden, and chart our findings then.

The most disturbing, consistent observation/comparison I have already made is in seeing the number of gadgets and things that distract the Somali mothers when they could be interacting with their babies. Some researchers hold the theory that by clearing an autistic child’s entire environment of all external ‘trash’ --  all toys, junk food, superfluous clothing, books, bedding, room decorations, electronic devices, etc., they advocate that then the parents will have a window of access to begin to re-form a bond with their child, while they are taught and learn bonding behaviors. We can wonder that multi-tasking and bonding are not compatible. Another Minnesota researcher, Anne Harrington, has had considerable success with her Floor Time initiative with autistic children and their parents.

The noted psychiatrist, Dr. Oliver Sacks, also recognized these earliest bonding connections or disconnections as observed in autistic children, but was berated by defensive parents for labels such as ‘‘chilling relationship with mother.’’ See An Anthropologist on Mars: Seven Paradoxical Tales, published by Alfred A. Knopf, 1995. Other researchers have also noted similar findings. In “Bad” Mothers, by Molly Ladd-Taylor and Lauri Umansky, New York University Press, 1998, chapter 11, in an essay by Jane Taylor McDonnell, she talks about labels like, “refrigerator mothers”.

On Blame
This subject is surrounded by much controversy. I propose that any and all blame or guilt is held by the medical community alone, and not bad mothering in the Somali or other moms. Before we knew what damage cigarettes caused to infants in utero, or alcohol (FAS), or the deadly risks of Thalidomide, the drug notorious for severe flipper-like birth defects seen in the 1950s, we, the medical community, could not warn pregnant women of the risks and dangers. Likewise, we are not able to teach/warn/look for clients at risk until this study and others like it are conclusive.

Evolution and Bonding in Minnesota
So, we have the Hmong (over 35,000) arriving in the U.S. during the late 1970s, having traveled from Laos via Thailand refugee camps, all congregating in Minnesota (despite the U.S. plan that each state absorb 500+ immigrants), all new to written language, with only a small percentage of (only) men knowing Lao or any other dialect. I am finding that for Somalis, English is not their second language, but actually 3rd, 4th, or more, many having lived in Kenya, learning Swahili, Amharic, or Arabic there, and in other surrounding countries before finally arriving in the U.S., sometimes years later. I cannot say yet what part education may play in a mother’s instinctual bonding, or the loss/interruption of it. I believe there is a threshold somewhere between the ‘primitive’ bonding behaviors I noted in the 70s and 80s in the Hmong mothers, before the next generation of Hmong attempted assimilation, and the wave of (over 70,000) Somali immigration to the U.S. in the early 21st century. I have made contact with two researchers in Stockholm, Sweden working on similar observations among Somali children there whom I hope to work with, and also three women doctors in Mogadishu, who will be able to advise us on cultural and pre-immigration statistics from Somalia.

Threshold factors
The most basic factors that influence bonding are touch or skin contact, smell, eye contact, attention, sound or hearing and taste. We don’t know yet which factors in what order affect an infant’s earliest development, i.e., whether touch is primary, or if language comes on the bottom of the ladder. We don’t know if 100,000 words in a given time frame are required to ensure normal, adequate development, or if only 5,000 will do, though a recent 2010 study has shown that more educated mothers do directly address their children more than poor mothers, and the outcomes are notably better. We don’t know if 40 hours of skin-to-skin contact in the first month is enough to guarantee a proper level of bonding or if 400 hours of some form of touch is required. Recently a study found that more blind children have significant incidences of behavioral and developmental problems that their sighted peers do, starting in infancy. This may be accounted for by the absence in these babies of the opportunity to use their eyes for cues both from the baby and from his mother. Unless other cues are able to make up for the loss of this one factor or (over-) compensate for the deficit, perhaps we should be viewing eye contact higher up along with touch as a necessary bonding receptor.

We don’t know what the exact formulae is in combining these factors that are necessary for successful bonding, but what I am observing is that somewhere between the high levels of all factors in the Hmong in the first years, and the present poor connection on all levels of all the factors** that I am seeing in the Somali mothers, there is a threshold that is being left behind. Taken one step further, consider our foremother, Lucy (who currently resides at the Ethiopian National Museum in Addis Ababa, Ethiopia), whose babies had to be carried, and in constant contact with her, 24 hours a day, day and night, for at least 2 years or until they could walk. Had she put them down, they would have been mauled or eaten. And we would not be here today.

For the first decade or more that Hmong mothers were in Minnesota, I did not see any using strollers, walkers, cell phones, laptops, reading books or magazines, (they were universally illiterate), Walkman appliances, pacifiers, bought toys, teething rings, etc.  Babies were always worn on mom, dad, auntie, or grandma in a body-conforming wrap/baby carrier (vs. American-style knapsack with rigid frame back packs). Mothers generally breastfed until 1 year if not longer, only occasionally using bottles and formula given upon hospital discharge. I also observed numerous times that mothers fed each other’s babies when the baby’s mother was away shopping, etc. My own breast fed infant whom I brought with me while I was on home visits was also nursed by Hmong women before I ever heard him wake up or cry. Extended families were the norm. I did not see any bought toys in those first years in Hmong homes. I saw babies without diapers, often not wearing anything in warmer weather (notable skin contact), being carried by numerous family members, talked to and played with by all members of both genders of the extended families. There were no cribs or playpens, high chairs or swings, or hand-held carriers. The babies were often kissed or sniffed - more common - by both sexes of all generations. Until they could walk they were carried while awake, or while sleeping placed on beds on the floor or on mats in the same room as where the adults were visiting. All babies were breastfed. When I brought my own infant during one visit to help the family with paperwork to apply for a visa for another relative, I put him with the other babies on the mat once he fell asleep. Over an hour later I wondered why he had not wakened to nurse, but when I looked over at him, Khou Her was nursing him! Rather than let him cry, and interrupt my ‘more important’ work for her relatives, she fed him. When he had drained one breast she offered her other one to her own baby. When the youngest child was replaced by a subsequent newborn, the grandmother (usually paternal) became the toddler’s primary caregiver, carrying, feeding and bathing the child. A place was made in the grandmother’s bed so that she could continue to care for the toddler even at night. (I need to ask if they also let this baby pacify himself at her breast during this transition away from mother.)

Since I began observing Somali mothers I have seen only 1 baby being worn in a baby carrier or wrap on the mother in 8 years. I have asked and been assured that all babies in previous generations were ‘worn’ on their mothers. I continue to see strollers, pacifiers, cell phones, blue tooth phone ear attachments, laptops, Walkman with ear plugs, mothers driving cars (Hmong women did not drive until much later assimilation), and already owning their own businesses.  The babies in the strollers are wearing new clothes, using pacifiers, and toys from local department stores. Many of these women are so economically successful that as of October 2010, they had already attracted the attention of a delegation of businessmen and women, led by Dr. Benny Carson from Sweden, who flew to Minneapolis (where Somali women own a shopping bazaar called Karmel Square) to learn from the them how they had become so business savvy so soon, with the hope of replicating this in Sweden where there is also a large Somali population who have not been as successful there, though they blame the Swedish business laws for much of the delay. I believe I am seeing a group of fiercely independent women. Unfortunately, by adding our 21st century, technological culture to this mix, we have women unconsciously multi-tasking during the earliest bonding opportunities, eager to rejoin or compete with other Somali women in their new-found freedom, social status, and economic independence. The only time I have seen a Somali mother kiss her child was recently in a store after I introduced myself to her and her grossly disfigured daughter. The child had the most profound maxillofacial disfigurement I had ever seen, with a concave nose, convex eye structure, and only 4 webbed fingers on each hand that appeared larger than appropriate for her apparent age (around 2). She could follow me with her eyes, could not smile but did pucker repeatedly, which was quite cute, and when she did that her mother kissed her repeatedly.

This research will not only impact the Somali populations in Minnesota and Sweden, but may, hopefully, change the way we view bonding and attachment. I know I am proposing a paradigm by wading into uncharted waters and this is an unconventional, totally out-of-the-box approach, but perhaps a different look at the problem from a completely different angle is the key to this puzzle. I believe it is.

I do not have a degree in mental health or extensive training in child development studies, but I do have exactly as much experience in the discipline of research as both Jean Liedloff, explorer and author (The Continuum Concept) and Dr. Jane Goodall, British primatologist, ethologist, and anthropologist did when they began their research; none even had a laptop.

When I have completed this research and a curriculum is ready for publication and being implemented which will become a teaching tool for all childbirth educators, labor and delivery nurses, physicians, doulas, midwives, and lactation specialists in Minnesota (and Sweden) next to The Ten Steps of Successful Breastfeeding; when every Somali woman giving birth in Minnesota is using a birthing room unless complications arise, rooming-in with their babies, and nursing beyond the 3 month failure rate (as documented by the Minnesota Women’s Coalition on Breastfeeding, 2007) with a support network in place, what I will have in the end is the satisfaction of knowing that with the help of sponsors and dedicated co-workers we were able to significantly address the fragile maternal-infant attachment in the Somali community, as we see it today. I further believe that others more experienced than I will be able to transfer these findings and thus be able to successfully add our research to the pool of information needed to address and alter how we think about bonding and see a change for the better in our lifetime.

I envision a plan where total bonding education can be added to existing Somali parents’ childbirth education classes in all targeted hospitals; where Somali mothers can be introduced to the importance of bonding during prenatal visits; where prospective Somali couples can tour and be encouraged to request bonding-friendly choices in birthing rooms, rooming-in, and breastfeeding support, all prenatally. I hope to expand these services by disseminating educational tools both in Minnesota and in Sweden by holding seminars simultaneously, and share the information I already have on bonding, and I hope to continue to collect results with the help of the medical community in Minnesota, and then follow the outcomes of these Somali mothers and babies. I hope to collaborate our findings with those working with these same tools in Sweden, both at the beginning of this project and again later in our work.

Wisdom comes only when you stop looking for it and start living
the life the Creator intended for you. - Hopi

* SAAF (Somali American Autism Foundation) reports 1 in every 28 children and rising, not including an estimate of about 3,000 additional ‘closet’ cases in Minneapolis, where parents are not enrolling children in preschool for fear of having them identified with autistic traits, which they already note but wish to deny, though this is being investigated at this time by the NIH.
**For my own purposes I have written a rough assessment tool or bonding grid/rating index© 
Stephanie Sorensen
umuliso (Somali for midwife)

COMING SOON: This and other stories will appear in Stone Age Babies in a Space Age World:§ Babies and Bonding in the 21st Century© pending by Stephanie Sorensen.

§ This phrase was first coined by Dr. James McKenna, used here with permission and gratitude for his work. A world-renowned expert on infant sleep – in particular the practice of bed sharing, he is studying SIDS and co-sleeping at his mother-infant sleep lab at Notre Dame University. He is the author of “Sleeping With Baby: A Parent’s Guide to Co-sleeping”, 2007, Platypus Media, Washington, D.C.

Humankind has not woven the web of life. We are but one thread within it. Whatever we do to the web, we do to ourselves. All things are bound together. All things connect. Chief Seattle (1780 - 1866) 

Sunday, May 19, 2013

Cherish and Jewel: Babette’s* Story

I met Babette last summer when I was given her referral by our agency for prenatal education, support and doula care. We get referrals for low income women many of whom are teenage and single moms and recent immigrants. Babette is a nurse from Ghana, Africa with limited English. Her husband has a master’s degree in economics. They speak Dagbani. They had been in the U.S. less than 6 months when she became pregnant with twins. She had recently been advised to agree to have an amniocentesis test which showed an abnormality with (then) Baby A. An omphalocele was viewed on a prior ultrasound just before her 6th month. Put simply, this is when part of the intestine and sometimes other organs like the stomach or kidney grows outside of the abdominal cavity and the body. We could see this one next to or on the umbilical cord at the navel on this baby during the ultrasound. The results from the ‘amnio’ had not come back yet, but the hospital testing unit’s doctor advised Babette that Baby A had a serious abnormality which might also involve Trisomy 18, and other genetic disorders and she was told that because the babies were possibly identical twins, that Baby B most likely had genetic anomalies too, and -- all in the same breath -- they were offered early termination of the pregnancy, before the studies had even come back. She might or might not be carrying two very handicapped babies but nothing had proven anything yet.

Babette was understandably seriously depressed when we met for the first time and asked me if “the hospital would be mad at us if we don’t abort” as they perceived they were being advised. I told them no, that they had every right to carry to term if that was their wish and that even no action was an option for them, letting nature take its course if they don’t live, or dealing with a disability after birth. I told them they could also switch doctors or even hospitals, that those were their rights in our country. I also apologized for the hospital’s actions. I told them that I strongly disagreed with the way it was presented to them, especially since the studies had not yet confirmed anything at all, only that a small omphalocele was visible on the ultrasound on one baby only. They were both greatly relieved and asked me to accompany her to all prenatal visits after that, which I did. I often ‘translated’ the medical reports as they came in and did home visits in between to address other concerns like finding cribs and so on. At one point we visited a dermatologist as she had a severe case of pregnancy-induced acne which left permanent scarring on her face. This was also very distressing to her. Their little 4 year old boy was perfectly OK so I wondered that the geneticist said they very well could have a hereditary syndrome going on. I am not a geneticist, nor a doctor, but the way this case was being handled seemed particularly cruel and uncaring to me. Would they treat me this way in her place?

When the studies came back, they didn’t tell us much more than we already knew, except that any form of Trisomy was NOT indicated, nor Down Syndrome but other concerns continued. They told us that there was an 80% chance that the girls were identical, they could not be 100% sure, so they may not be mirroring the same problems, though they persisted in their theory that Baby A might be similarly affected with whatever they might find wrong with Baby B in the future. Babette refused all further tests from that point on except for regular ultrasounds. After that first devastating news, Babette had gone home and Googled the list of horrors the doctor predicted as possibilities. She was alone that afternoon as she watched photo after gruesome photo of babies with all the terrible complications that the doctor had named. An educated woman, Babette had read everything about each lethal or fatal anomaly: the expected life span of each disorder, the complications and probability of incidence of each syndrome.

In the circles of higher academia I have noticed a startling new trend: People in the field are questioning, some for the first time, the connections between the rocket science levels of medical technology that now makes tests available that can even tell us if our as-of-yet unborn child might have a gene that can elevate his/her probability of seeing symptoms of x, y or z diseases by the time they turn 40, or 20, or 5 years old. Even more disturbing are the findings by these scientists and doctors that conclude that once a parent has been warned that such and such might exist in this particular baby’s DNA that their parenting styles can actually change. No longer is this a much-anticipated addition to their family, but rather a huge problem. Their lives stop at this unforeseen juncture; they delve into their own extensive research on the intruder. They no longer attend the local mothers’ groups to compare baby teeth and diapers but rather join support groups with other parents dealing with the same disabilities. And I would wager here that prenatal bonding too, looks very different, even before baby is born. Babies are treated no longer as lovable, huggable, adorable little clones of our selves but suddenly parents become experts on every congenital or hereditary anomaly affecting the human race. I think pity takes the place of the funny faces and absurd sounds new parents make at their newborns. And fear. Hardly the stuff conducive to continuum bonding.

Some of these scientists and physicians are aware of this redirection of attention by parents and the possible devastating effects on babies. In her recently released book, Testing Baby: The Transformation of Newborn Screening, Parenting, and Policymaking Rachel Grob pleads this case on behalf of our children. Another equally brilliant work is called, Saving Babies? by Stefan Timmermans and Mara Buchbinder, in which the authors question whether the benefits of these screenings outweigh the stress and pain they sometimes produce, especially given the high number of false positives – inaccurate results that can take a brutal emotional toll on parents before they are corrected, if ever. Finally the American Academy of Pediatrics together with the American College of Medical Genetics has put in place a statement to curb the testing of children that is used to identify genetically inherited childhood diseases and those that can occur when they become adults. They further recommend that doctors should discourage testing in children for adult onset genetic disease, especially if there is no treatment to give during childhood to prevent the disease, siting that the screening tests often don’t provide definitive answers, but whether they do or not,  this may only lead to anxiety and more questions.

As we neared her due date Babette expressed the wish that she had very much hoped it could be a VBAC but was scheduled a C-section for 4 weeks early. Baby B had dropped lower than Baby A and were re-tagged at this point, so the baby with the omphalocele would be born first. The doctors were concerned that one of the babies didn’t appear to be practicing her breathing in utero, which signals immaturity and the possibility that if she is not, that she may be better off outside of the womb where she can get their help, though they also could not tell us if she never practiced breathing, especially if she had been sleeping during the ultrasound that particular day. To get a definitive answer as to the maturity question, they now proposed another amniocentesis to assess the overall lung function of the babies, but particularly now Baby A. Babette was understandably worried by all of their speculating. She asked me what I thought, and I told her that this one wasn’t up to me. Perhaps the doctors were right in trying to avoid additional problems, or maybe doing nothing would be right for her. I assured her I would support whatever she chose. So she went with the test after being informed of all the possible complications from another amnio, though somewhat less risk than doing it in the first or early 2nd trimesters. After all that, the test told us that the babies’ lungs were thankfully mature so they didn’t need to be born early.

But by evening, Babette called me and told me she was ‘leaking.’ The amniosentesis had ruptured the bag of water and it was not going to reseal itself back up. So much for letting them go to term. A C-section was deemed safest at this point by the powers-that-be, though when nailed down one of her doctors did admit to us that there really was no reason not to try a VBAC. Excited by this tiny hope, I asked Babette if she was up to that. She told me she was tired. Tired of being pregnant. Tired of the questions. Tired of false hopes. Tired of imagining the future: the possibility of her being a prisoner in her dusty housing project, stuck at home year after year with two very sick babies and no hope of ever having a career again, or of living the life they had dreamed of having in America. She wanted to get it all over. She didn’t care what they did at this point. She didn’t have any energy left.

I attended her birth on November 12th, 2012. Both babies had acceptable Apgars and were doing exceptionally well after birth. The ‘well’ baby, now Baby B, latched and nursed well in recovery. I went with Baby A (now called Jewel) at the parents’ request first to the NICU and then to another children’s hospital the next day where I stayed for surgery at 24 hours and the first few days in the NICU there. Babette stayed in the first hospital with Baby B, whom she called Cherish. The father stayed with their 4 year old boy – a delightful little guy who climbs into my lap without any invitation, sings to me in Dagbani and thinks I am his grandma.

At the children’s hospital and also later at her hospital’s neonatal unit I asked the neonatologist if he also noticed some of the same markers I observed in Jewel. (Incidentally, Babette told him after the birth about his hospital telling her that she should/could abort these beautiful babies. He appeared to be very disturbed by this and apologized. He also strongly encouraged her to go to the patient advocates and register this complaint.) He agreed with what I was questioning and said he had already sent more blood work to the genetics lab but hadn’t told the parents this. I agreed to also wait and not tell them yet what my concerns were for Jewel. The tests came back confirming a diagnosis of Beckwith-Weidemann syndrome which occurs in about 1 in 15,000 births. I had done some research and the next time I visited Babette and Cherish I noted similar visual markers in Cherish – which I didn’t mention to Babette. I called the doctor back who assured me that Cherish was fine; that twins rarely both carry it, and that he did not feel that testing her was warranted at that time. 

At about 2 months old, Babette asked me to go to a follow up visit at a pediatric clinic (not one of the hospitals they had already been to) with the family. A pediatrician saw us and was very happy with both babies’ weight gain, feedings, etc. I asked this doctor to refer Cherish for a genetic work up at the university hospital (over the other doctor’s head on my part) which he readily agreed to after I listed the anomalies I thought I was seeing and he further examined her and saw also. I told the parents I wanted to be sure so that any early interventions that might help her would be in place. I tried not to convey any deeper concerns. They agreed and were referred and the blood work for Cherish was sent in. The parents were recently called and told that it is confirmed that Cherish does indeed have the same syndrome as her sister Jewel, though her chances were also only about 1 in 15,000.

Even before the birth, Babette confided to me that she felt she was doomed to spend the rest of her life in the housing project with 2 severely handicapped babies. She had hoped to go back to work after this pregnancy. She had planned to first become proficient in English and then apply to graduate school here for any credits she might still need to transfer her degree from Ghana. I applied for a grant and got an English independent study course for her to do at home which they have both since completed. I explained that she can find daycare for her babies and will be able to go back to school and that in the U.S. her babies will go to school even if it is an adapted program. I also got her husband the resources and he is in the process of applying for SSI for both babies (hopefully to pay for respite care in the home and/or day care). Their application for a visa for Babette’s mother to visit and help with the babies was recently denied by U.S. Immigration. The couple questioned the denial and were told, "but she might decide to stay illegally then." They tried to challenge the decision, but didn’t get any further. We have found a lawyer at this point who feels confident we can get grandma here on a visitor's visa and will help us re-apply.

I last visited the family at Christmas time. They seemed happy, but I felt that Babette had not bonded as well with Jewel who is having problems breathing because of a very large tongue that the hospital has recommended reduction surgery for. Babette is very unsure about agreeing to the surgery. At one point she and I were alone in the kitchen and she said, “I just want to go back to Africa and leave the babies with him. He can put them in daycare.” I asked if she just needed a vacation or did she want to run away? She said, "both."

I recently spoke with a clinic also located at the university here that addresses postpartum depression. I am very concerned about Babette. To back up a bit, when we went to the OB testing unit at the hospital week after week earlier in the pregnancy, she was routinely asked at each visit, “Are you depressed?” This became a running joke between us, actually. She didn’t think she was depressed. She should know – she is, after all a nurse and has a degree. She told me that the babies were in God’s hands and that she was happy she had been blessed with two. After their son was born, they had planned to only have 2 children, even before this pregnancy. She said God would take care of them, even if they were handicapped (the family is Christian). Once when I called her up and asked if she was depressed, we both cracked up laughing. Now, I realize we may very well be in hot water as the reality of these two sweet, beautiful little babies is sinking in.

*All names and any identifying characteristics have been changed to protect privacy

COMING SOON: This and other stories will appear in one of these books soon: Call The Doula! a diary© and Stone Age Babies in a Space Age World: Babies and Bonding in the 21st Century© pending by Stephanie Sorensen

Life only demands from you the strength you possess.  
~ David Hammarskjold 

Thursday, May 16, 2013

Thou Shalt Spoil Thy Baby: Have American Parents Got It All Backwards?

FROM the new book: Parenting Without Borders: Surprising Lessons Parents Around the World Can Teach Us by Christine Gross-Loh
 The eager new mom offering her insouciant toddler an array of carefully-arranged healthy snacks from an ice cube tray?
That was me.
The always-on-top-of-her-child's-play parent intervening during play dates at the first sign of discord?
That was me too.
We hold some basic truths as self-evident when it comes to good parenting. Our job is to keep our children safe, enable them to fulfill their potential and make sure they're healthy and happy and thriving.
The parent I used to be and the parent I am now both have the same goal: to raise self-reliant, self-assured, successful children. But 12 years of parenting, over five years of living on and off in Japan, two years of research, investigative trips to Europe and Asia and dozens of interviews with psychologists, child development experts, sociologists, educators, administrators and parents in Japan, Korea, China, Finland, Germany, Sweden, France, Spain, Brazil and elsewhere have taught me that though parents around the world have the same goals,
American parents like me (despite our very best intentions) have gotten it all backwards.
We need to let 3-year-olds climb trees and 5-year-olds use knives.
Imagine my surprise when I came across a kindergartener in the German forest whittling away on a stick with a penknife. His teacher, Wolfgang, lightheartedly dismissed my concern: "No one's ever lost a finger!"
Similarly, Brittany, an American mom, was stunned when she moved her young family to Sweden and saw 3- and 4-year-olds with no adult supervision bicycling down the street, climbing the roofs of playhouses and scaling tall trees with no adult supervision. The first time she saw a 3-year-old high up in a tree at preschool, she started searching for the teacher to let her know. Then she saw another parent stop and chat with one of the little tree occupants, completely unfazed. It was clear that no one but Brittany was concerned.
"I think of myself as an open-minded parent," she confided to me, "and yet here I was, wanting to tell a child to come down from a tree."
Why it's better: Ellen Hansen Sandseter, a Norwegian researcher at Queen Maud University in Norway, has found in her research that the relaxed approach to risk-taking and safety actually keeps our children safer by honing their judgment about what they're capable of. Children are drawn to the things we parents fear: high places, water, wandering far away, dangerous sharp tools. Our instinct is to keep them safe by childproofing their lives. But "the most important safety protection you can give a child," Sandseter explained when we talked, "is to let them take... risks."
Consider the facts to back up her assertion: Sweden, where children are given this kind of ample freedom to explore (while at the same time benefitting from comprehensive laws that protect their rights and safety), has the lowest rates of child injury in the world.
Children can go hungry from time-to-time.
In Korea, eating is taught to children as a life skill and as in most cultures, children are taught it is important to wait out their hunger until it is time for the whole family to sit down together and eat. Koreans do not believe it's healthy to graze or eat alone, and they don't tend to excuse bad behavior (like I do) by blaming it on low blood sugar. Instead, children are taught that food is best enjoyed as a shared experience. All children eat the same things that adults do, just like they do in most countries in the world with robust food cultures. (Ever wonder why ethnic restaurants don't have kids' menus?). The result? Korean children are incredible eaters. They sit down to tables filled with vegetables of all sorts, broiled fish, meats, spicy pickled cabbage and healthy grains and soups at every meal.

Why it's better: In stark contrast to our growing child overweight/obesity levels, South Koreans enjoy the lowest obesity rates in the developed world. A closely similar-by-body index country in the world is Japan, where parents have a similar approach to food.
Instead of keeping children satisfied, we need to fuel their feelings of frustration.
The French, as well as many others, believe that routinely giving your child a chance to feel frustration gives him a chance to practice the art of waiting and developing self-control. Gilles, a French father of two young boys, told me that frustrating kids is good for them because it teaches them the value of delaying gratification and not always expecting (or worse, demanding) that their needs be met right now.
Why it's better: Studies show that children who exhibit self-control and the ability to delay gratification enjoy greater future success. Anecdotally, we know that children who don't think they're the center of the universe are a pleasure to be around. Alice Sedar, Ph.D., a former journalist for Le Figaro and a professor of French Culture at Northeastern University, agrees. "Living in a group is a skill," she declares, and it's one that the French assiduously cultivate in their kids.
Children should spend less time in school.
Children in Finland go outside to play frequently all day long. "How can you teach when the children are going outside every 45 minutes?" a recent American Fulbright grant recipient in Finland, who was astonished by how little time the Finns were spending in school, inquired curiously of a teacher at one of the schools she visited. The teacher in turn was astonished by the question. "I could not teach unless the children went outside every 45 minutes!"
The Finnish model of education includes a late start to academics (children do not begin any formal academics until they are 7 years old), frequent breaks for outdoor time, shorter school hours and more variety of classes than in the US. Equity, not high achievement, is the guiding principle of the Finnish education system.
While we in America preach the mantra of early intervention, shave time off recess to teach more formal academics and cut funding to non-academic subjects like art and music, Finnish educators emphasize that learning art, music, home economics and life skills is essential.
Why it's better: American school children score in the middle of the heap on international measures of achievement, especially in science and mathematics. Finnish children, with their truncated time in school, frequently rank among the best in the world.
Thou shalt spoil thy baby.
Tomo, a 10-year-old boy in our neighborhood in Japan, was incredibly independent. He had walked to school on his own since he was 6 years old, just like all Japanese 6-year-olds do. He always took meticulous care of his belongings when he came to visit us, arranging his shoes just so when he took them off, and he taught my son how to ride the city bus. Tomo was so helpful and responsible that when he'd come over for dinner, he offered to run out to fetch ingredients I needed, helped make the salad and stir-fried noodles. Yet every night this competent, self-reliant child went home, took his bath and fell asleep next to his aunt, who was helping raise him. In Japan, where co-sleeping with babies and kids is common, people are incredulous that there are countries where parents routinely put their newborns to sleep in a separate room. The Japanese respond to their babies immediately and hold them constantly.
While we think of this as spoiling, the Japanese think that when babies get their needs met and are loved unconditionally as infants, they more easily become independent and self-assured as they grow.
Why it's better: Meret Keller, a professor at UC Irvine, agrees that there is an intriguing connection between co sleeping and independent behavior. "Many people throw the word "independence" around without thinking conceptually about what it actually means," she explained.
We're anxious for our babies to become independent and hurry them along, starting with independent sleep, but Keller's research has found that co-sleeping children later became more independent and self-reliant than solitary sleepers, dressing themselves or working out problems with their playmates on their own.
Children need to feel obligated.
In America, as our kids become adolescents, we believe it's time to start letting them go and giving them their freedom. We want to help them be out in the world more and we don't want to burden them with family responsibilities. In China, parents do the opposite: the older children get, the more parents remind them of their obligations.
Eva Pomerantz of the University of Illinois at Urbana Champaign has found through multiple studiesthat in China, the cultural ideal of not letting adolescents go but of reminding them of their responsibility to the family and the expectation that their hard work in school is one way to pay back a little for all they have received, helps their motivation and their achievement.
Even more surprising: She's found that the same holds for Western students here in the US: adolescents who feel responsible to their families tend to do better in school.
The lesson for us: if you want to help your adolescent do well in school make them feel obligated.
I parent differently than I used to. I'm still an American mom -- we struggle with all-day snacking, and the kids could use more practice being patient. But 3-year-old Anna stands on a stool next to me in the kitchen using a knife to cut apples. I am not even in earshot when 6-year-old Mia scales as high in the beech in our yard as she feels comfortable. And I trust now that my boys (Daniel, 10, and Benjamin, 12) learn as much out of school as they do in the classroom.

Tuesday, May 14, 2013

Goat Soup and Bonding

To be born with an insatiable curiosity – be that a blessing or as I see it, as a curse. I needed to understand what I was seeing. My only frame of reference was the past 30 years as a midwife volunteering for the jobs hardly anyone else wanted. During those first years in the mid-1970s I was virtually fearless; I was simply too curious to be scared. I never feared for my own safety when arriving at a housing project in the middle of the night to visit a Hmong or Cambodian refugee family that didn’t speak English.

Fast forward to 2010, Minneapolis. It turned out that the Somali grandmas were as curious about me as I was about them. But how do you gain access into what appears to be a closed society? They are Muslim, there is the language barrier, and I am pigment-challenged (Eastern European ‘white paper’ as one Nigerian summed me up once.) I wondered if their world was indeed closed to me or if I would be able to gain entrance. I have no degree in sociology or psychology. I had no list of behaviors to check off; no lectures to recall; no protocols to remember. No vast store of previous research papers from eminent scholars. I didn’t even know what I was looking for. But I could look and wonder. And ponder. And listen. I bought a paperback English-Somali-English Dictionary and I was off.

I attended a strange gathering last year of a very unlikely group of alumni from the Bush Fellowship Foundation, all radical ‘outside the box’ thinkers. The keynote speaker put it perfectly. His talk began with, “You are an unreasonable people.” I wondered, ‘where could he be going with this?’ He continued: “You will not take NO! for an answer.” He was right. We were doctors, teachers, scientists, business women and men, Native People, Asians, Orientals, Africans, and a mixture of other races, all of whom had been confronted with a unique problem in our own field and did not just give up, but demanded an answer and did not stop till we found or figured one out. Money? No problem. Where there’s a will there’s a way.
Years before I had entered the world of Hmong refugees as they began arriving in Minnesota in the late ‘70s. I simply, perhaps naively assumed that if you approached anyone different from yourself with humility and respect, they would react in kind. Years later an old Hmong elder told me that the reason they didn’t like social workers here and wouldn’t cooperate with them was basically “because they won’t come and eat our rice with us.” And I would. That really opened my eyes. They looked at it this way: “they don’t accept our hospitality and spend time eating with us” but the ‘outsiders’ looked at it totally differently: “They have all sorts of diseases, they are illiterate and their houses are dirty [though they had never been inside of one to know that], they eat out of a common pot and I might catch something. They can come to our classes first and we will educate them about hygiene and cleaning methods since we know better about these things, don’t we?”

After about the 3rd year of being with our Hmong friends (and I still had not contracted TB or hepatitis) we were lounging in one of their living rooms after a big meal one summer evening as the grandpas lit up their bamboo hookahs and the smoke swirled in ringlets above our heads, watching our toddlers playing with each other on the floor. My little boy Avi was playing with Caana, a chubby little girl the same age. They were so cute together. Children don’t worry about language or cultural barriers at all. At one point Caana’s father became serious and asked me in his broken English, “Stephanie, what you think? Avi and Caana get married someday?” I realized this was actually the ultimate test of our true feelings for them. We had hoped from the beginning that they didn’t think we felt superior to them in any way, though we are educated and privileged Americans. We had tried hard not to judge anything they said or did against our own standards. We tried to give them every opportunity and advantage that we ourselves enjoyed, helping them to overcome difficulties as they arose. We had eaten squirrel and pigs ears with them, (pigs’ ears feel and taste like rubber bands) and rooster foot soup.

So I thought for a moment and then said, “If they want to. If they love each other, yes. What do you say?” I think he was taken aback. I don’t know why he wouldn’t expect that answer from me. I thought he knew me well enough by then. I can only guess that in his mind, by my asking him also for his permission I had more than passed the test.

So how do you get to know a group of Somali women? (There are over 70,000 African refugees in Minnesota as of this writing.) You first go to where they shop I suppose. That would be Karmel Mall, dubbed here The Mall of Somalia, a takeoff on our own world-famous Mall of America. Over 100 tiny stalls all partitioned inside a warehouse-size building, arranged around 3 central aisles. I would say it looked like 90% of the little shops were owned by grandmas, and maybe the remaining 10% by men who were either tailors or merchants selling imported men’s clothes or barbers whose little shops looked more like mini courts filled with men solving the world’s problems of the day while they watched TV from Nairobi or Mogadishu. I didn’t see any women sewing. You buy a skirt or dress and take it to one of the tailors that same day, having him pin the hem or mark an alteration. You would leave it with him, go to the coffee or snack bar and visit down there with the other women for a while, picking up your finished garment later.

Ok, I will check out the snack bar. I ordered a coffee latte for $1 and walked around the mall. I would say hi to each lady who would ask what I was looking to buy. Some had a bit of English under her belt (or hijab). Most didn’t. I would smile and move on to the next cubicle, staying to watch a woman painting a young girl’s arms with henna designs, moving on to wonder at the stall piled high with herbs and potions. When I asked what they were for the proprietress patted her head, then her tummy, then her knees. Some sold wedding clothes from Egypt, some had scarves and hijabs from Pakistan, the traditional head coverings. Others had sandals from Jordan and jewelry from India. Some had ornate harem-style curtains and rugs and floor pillows that could turn any American apartment into a proper Muslim home. There were shops with pots and pans and tea services for 20!

I did that every day for about a week. By week 2, I was getting a little bolder and would introduce myself and ask what their names were. A very few didn’t even try to exchange names, but most had learned enough English for introductions. Some seemed miffed that I never bought anything but just wandered around smiling and sipping coffee. One day I asked the waiter at the café in the mall what kind of soup were they serving. Goat soup, you wanna some? Sure. To go? Yes. One dalla. So that is how I started eating goat soup.

By week three I had a routine down. Take the train to Lake Street. Transfer to the number 21 bus and ride 45 minutes though the Hispanic business district to the Somali neighborhoods and the mall. Stop at the café and get a goat soup to go. Walk around and prove that I had indeed learned their names: Farhia, Fadoomah, Marium, Hikmet, Fowsiyo, Hanan, Jamad, Hafso, Yeshigeta, and Fatimah. I looked up the Somali word for midwife, umolisa, pronounced oom-moe-LEE-sah; my very first Somali word. My second Somali word was easy: HAH! Yes! Then I learned the traditional greeting: Assalamu alaikum – the peace of Allah be with you. The appropriate response is "Wa alaikum assalaam" And upon you be peace.

At one point one of the grandmas invited me to come and sit with her in her little stall. She asked first what I was sipping. I told her goat soup. She wanted to know if I liked it. I said I did; it was spicy and warmed me up. We chatted about this and that and used the dictionary when one or the other got stuck in the discussion. I asked her what dyed her hands and nails red. She didn’t have all the words that she wanted to use to explain it to me, so instead took me by the hand, abandoning her shop, to one of the other ladies further down the aisle. There was a brief exchange, I was sat down and the old lady proceeded to smear my finger tips with a greenish paste out of a paper cup. It looked like wet golden seal powder to me, or ground up tea. We left it on while they chatted in Somali for a long time. There were no clocks. They also didn’t open or close according to any time it seemed. Lunch breaks were random. Your neighbor would watch your stall if you needed to buy a snack or coffee or tea, or if you wanted to go to the mall’s prayer room to attend one of the 5 daily prayers there, announced over the intercom by the mall’s muezzin.

After what seemed like at least an hour, the old lady made a motion that I understood to indicate that I should rub my hands together and flake off the now-dried herb. I did that and asked if I shouldn’t rather just wash my hands. NO! they shouted in unison. Next they took some oil from a bottle and dribbled it onto my hands to rub into my now dark bright red fingers and nails. The old lady smiled and I thanked her, taking her hand and kissing the back of it as I had seen the women do when greeting one another. She in turn took my hand and returned the kiss. 

So I now knew how to greet other women. It was not done lightly, like when first meeting someone, I noticed, so I reserved the hand kiss for women who I felt were becoming friends. It would not be for another whole year before they started calling me ‘Sister’ though, as they referred to one another.

I started shopping at their little neighborhood groceries, even though the bananas and vegetables weren’t as fresh or as cheap as the big supermarkets throughout the city. But I wanted to support the family-owned groceries in my own area so I shopped there. I bought a package of ingera one day, a pancake-like wheel about 20 inches in diameter that serves as a plate and is stacked with honey and yogurt for breakfast, and meat and rice or bean curry for lunch and dinner. We liked it a lot, so I would pick up a package about once a week. Most families bought it fresh everyday but we didn’t use that much. It is made out of a protein-rich grain called teff and prepared like a thick pancake batter. It is cooked on a flat iron not unlike a tortilla maker, but only on one side, leaving it wetter and softer than a tortilla. I skipped buying my ingera one week and when I returned to the store the proprietress roundly scolded me: “You haven’t come in all week! I thought maybe you were sick! Are you OK?” I told her that although I liked it very much, we weren’t using it every single day. Then she voiced what the whole neighborhood had been gossiping about: “Your African husband wants his ingera every day, surely?”  Oh, dear! They couldn’t figure out why else an older pigment-challenged American would be buying ingera unless she was married to an African! I laughed and told her, “No, we are Americans, and he is not African, but we really do like your food! It is healthier, too, than our processed white bread.” Mystery solved, but she said it really is better fresh and don’t stay away so long next time.

Another day as I strolled around the mall, another woman waved me over. We are from a Plain church, similar to the Mennonites, and I wear a head scarf tied in the back when I go out. This particular woman wanted to know if I was “Arabi” perhaps, their word for Saudi Arabians who, though Muslims are light skinned. Then she asked if I was Muslim. I said, no, I am a Christian. She said she had never seen a Christian who wore a scarf and long skirts before. I said there are a few of us around and that I like to sew my own clothes. She was surprised and asked if our tailors have enough work to feed their families if American women can sew. Another shop keeper walked into the stall at this point and chatted in Somali with her without taking her stern eyes off of me. They talked for quite a while. During a pause I asked my new friend what they were talking about. She said, “She wants to know if you are Muslim. I told her you aren’t, so she wants to know if I am going to convert you. I said you are OK – you are a Christian, the real kind. So she said, ‘well she is dressed like us, she is half way to Muslim already! You might as well convert her!’” I laughed. The old woman didn’t.

Another day another woman named Jamad waved me into her stall to sit with her. Her English was choppy, but again, with my dictionary we were able to talk. When I told her I was a midwife she really relaxed and talked about all of her recent bladder problems. She hauled out a purse from under the counter and lined up all the pill bottles she was recently given. She wanted to know what I thought of each one and what they were for. She got out a spiral lined pad of paper and had me help her write out all her questions for the next time she goes to see her doctor: “AUK-rite, tell me to say, ‘what is pill for?’” and “AUK-rite, how me say, ‘when I stop pill?’” So I printed out a whole page of English lines for her. She was delighted and dashed out of the booth, returning shortly with a Somali coffee latte loaded with cardamom, ginger and sugar to thank me. I kissed her hand and had mine kissed in return. I helped her say ALL-right over and over until I thought she got it, but she still says, AUK-rite to this day. OK. I understand what she means.

Later that week I met her early one morning as I was ordering my goat soup. The cook came to the counter and put it down as I handed him a dollar bill. She snatched up the bill and handed it back to me while shouting at him in Somali. Then she took my hand and led me back to her stall. I asked, “What was that all about?” She explained, “I told him, ‘She likes us. She is teaching us English and helping us. You can’t charge her anymore.’” Period. That was it. I was never charged for goat soup again but would be handed my cup to go every morning whenever I appeared at the counter.

One morning I wandered into a beautifully arranged little shop that I hadn’t noticed before. The woman came out from behind the counter and greeted me. We chatted for a while and then she asked me if I was a Muslim. I went through my explanation once again, but to my surprise, I got a sound lecturing instead of approval. How can I call myself a follower of the Virgin Mary if I don’t imitate her in her modest dress, especially her head covering that carefully hid her ears and neck, too? Did I want every man seeing me like THAT? This tirade went on and on. True, my neck was not completely covered but my blouse was buttoned up to the top and I thought it was modest enough. No, she insisted, and I should buy one of her large shawls to cover myself properly.

I felt myself blushing and feeling like a rebellious 15-year old once again. Wow! I wondered if her daughters unveiled themselves once they went through the door at high school like my three girls did a decade earlier; (my sons’ suspenders got stashed in a bush at the bus stop with hopes that they wouldn’t be recognized as  ‘woodies’ at school, the name the other kids dubbed the kids from our church.) Marium gave me a free DVD before I left that day. I took it home and watched it, fascinated by a history of Islam I had never heard before, called “The Message.”  It is an historical epic that concerns the birth of the Islamic faith and the story of the prophet Mohammed directed by Moustapha Akkad (1977). I watched all 177 minutes of it completely entranced, but if you are wondering, no, I have not adopted the hijab. Yet.

On my way to the mall one morning several months later I was waiting at my bus stop with an older Somali man. He kept stealing sideway glances at me. Finally he spoke: “You Arabi?” I said, “no, I am a Christian.” He looked puzzled, “Why your head (scarf), your dress?” I explained that some Christians dress this way. He thought about that and said, “Same as us.” I said, “yes, we have many common beliefs, you and I.” Then I added, “That is why you are my brother!” At that he seemed visibly jolted. He pondered that a moment and then a huge grin spread across his face and he said, “Yes!”

I continued to visit Jamad in her little stall. I started bringing snacks to share. She loved grapefruit so I made sure to bring some to share. I knew most American processed foods were forbidden and are called haram  (حَرَامْ "unlawful"). Like my grandparents’ strict adherence to kosher laws, Muslims only eat foods that are halal (حَلَال "lawful") and which have been officially approved. I found their food to be very fresh, not unlike how my grandparents would prepare it. One day Jamad appeared at her little shop with a take-out box. She announced, “we eat lunch together today. Somali spaghetti!” She proceeded to lay down a little carpet and arranged the box in the center. Then she put down 2 bananas. I still have to ask about the bananas. Every meal no matter what it is, is accompanied by a banana by each setting. Then she (tentatively I thought) laid out two plastic spoons. I looked at her a minute, knowing this part was not usual. I had seen the men in the café using their hands to eat, the right hand only, that is. The left is reserved for ‘dirty’ uses. I had even noticed that some Somalis held a napkin in the left hand while eating and wondered if this was a reminder not to eat with that hand. Jamad then said, “do you use this one?” I answered with a question: “You don’t, do you?” She laughed a little nervous laugh. I continued, “I want you to show me how you do it. Put the spoons away”. She seemed relieved and proceeded to show me how it is done. The three middle fingers of the right hand are extended with the thumb and pinkie held back and touching each other.
The three middle fingers scoop up the spaghetti, sauce and meat and twirl it around until there are no strings hanging down. Then the thumb acts as a ‘pusher.’ You open your mouth at this point and shovel the bunched up spaghetti into your mouth with the thumb. All of it. She did it expertly, of course, but when I did it, I got a few strands stuck to my chin and the sauce dribbled down my neck. She burst into loud guffaws. I mumbled as I chewed, “you’ve probably never had to teach a grown woman how to eat!” She got her breath back finally and said, “No, nevah!” rocking back and forth, laughing. You would have thought it was the funniest thing she ever saw.

One time I was invited to lunch at Fatimah’s apartment. I had finally found their apartment on the 14th floor of a 28-storey building in a low income housing project. The Somalis call this place ‘the cages.’ No wonder all of them work two jobs or more to save for their own homes. They can’t wait to get out of there. I watched with great interest one day as she called her 2 children and two other little girls she was babysitting for to come to lunch. They sat in a circle on the bare floor as she set down a huge platter piled high with noodles, covered with bits of goat meat and a tomato sauce. Around the edges were the ever-present bananas. They waited with their hands in their laps for her to begin. Then she asked them in Somali, “which hand?” Three out of the four held up their right hands. She nodded. The littlest girl had held up her left hand. Fatima patiently took the raised hand and put it back into the little girl’s lap and held up her other hand, smiling. “This one,” she said. 

After our lunch, Jamad whisked away the banana peels, lunch box and napkins. She went down to the mall’s lady’s room and washed for prayer. There was a utility sink with a hose where one could wash your feet and prepare for prayer. She returned and proceeded to say her midday prayers. The little prayer rug is equipped with a tiny compass attached at the center to help one remember which direction is East or toward Mecca (where the holy Kaa'ba is), an important prerequisite to Muslim prayer. I asked if I should also pray with her or just sit and say my own prayers. She said I could do either, so I followed her lead, bowing, kneeling and touching my forehead to the rug, standing, and bowing again. 
Then Jamad rolled up the little rug and unrolled a larger one. She pulled the curtains at the entrance to her little booth and proceeded to lie down, grabbing her oversized purse to use as a pillow. Then she announced we should have a short nap. I had brought a book so I read for a while. She promptly fell asleep. When I got home later that day I rummaged around my sewing closet and found a square of foam that was left over from an upholstery project I had done earlier that year. I found a zipper and made a cover for the foam piece. The next time I visited Jamad I presented her with the little pillow for her nap time. From that day on we tried to out-do each other with little presents. We talked about many things in those early days: where we bought our groceries, what we were making for our husbands’ supper that night. Why teenagers in America reject their heritage; why our daughters are so anxious to defy our values. I think we both discovered how very much alike we women are, no matter what country we come from.

Finally I asked the one question I had been wondering about. Why aren’t the Somali moms nursing their babies? The Minnesota Coalition on Breastfeeding declared it a ‘disaster’ in 2007 in the Minnesota Somali community. I’ve even had nurses from the University Hospital ask me how they can get the Somali moms to room-in with their babies. When I found out that the Somali community has a 1 in 28 incidence of autism in their babies according to the SAAF or Somali American Autism Foundation, compared to the 1 in about 110 in the rest of us, I realized what I was here to look for. I knew that the Hmong had even lower stats than that during their first decade of assimilation. Thus began the research that has led me to believe that the biggest disparity between the two immigrant communities lies in bonding or maternal-infant attachment. I wrote a 6-paper in 2011 to the NIH (National Institute of Health) arguing that this significant, tiny window of opportunity here in Minneapolis (and present nowhere else in the world) is quickly closing as Somalis assimilate into regular American society. The NIH came to Minnesota in January, 2012 to conduct the official study, though the university they are working with has thrown out all other theories except genetic causes. 

And so I find myself writing a book I never dreamed of writing, about a subject I had no particular interest in before eating goat soup.

Stephanie Sorensen
Umulisa (midwife)

COMING SOON: This and other stories will appear in Stone Age Babies in a Space Age World:* Babies and Bonding in the 21st Century© pending by Stephanie Sorensen

*This phrase was first coined by Dr. James McKenna, used here with permission and gratitude for his work. A world-renowned expert on infant sleep – in particular the practice of bed sharing, he is studying SIDS and co-sleeping at his mother-infant sleep lab at Notre Dame University. He is the author of “Sleeping With Baby: A Parent’s Guide to Co-sleeping”, 2007, Platypus Media, Washington, D.C.