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Could baby massage courses for staff improve morale, empathy and job satisfaction?

About three years ago, here are Baby in Mind, we were involved in a research project conducted by Angela Freeman, from University of Canberra. Working at the Canberra-based perinatal depression support service, PANDSI, Freeman’s research evaluated the effects of a short, low-cost, multi-disciplinary program for women and their babies facing severe and complex postnatal depression and anxiety. What we didn’t count on or plan for, were the effects of the baby massage component of the program on staff.

Freeman’s THRIVE model was a major success for women and their families. The women in the study were referred by their doctors, based on complex and significant difficulties associated with postnatal mood disorders which had not been resolved solely with the usual supports and intensive services available in the community and public health system.

However, one of the side-effects of this program was not anticipated and is evident only in the anecdotal accounts of the staff who delivered Freeman’s THRIVE program. And this side-effect was the impact on staff of witnessing the gentle, loving interactions that took place each week between mothers and babies in the infant massage component of the group. The effects discussed by staff, over lunches, debriefing sessions and in the tea room, ranged from increased feelings of general well-being and calm, to feelings of improved focus and empathy.

Not surprisingly, these sensations contributed to an extraordinarily strong camaraderie, morale and motivation among the practitioners and educators who were recruited to deliver the THRIVE program.

The THRIVE team consisted of clinical psychologists, perinatal infant mental health specialists, and nurses, two of whom also hold nationally accredited qualifications in cue-based infant massage education, and all of whom had decades of clinical experience. Even among such an experienced group, none were were quite prepared for the feelings that they experienced in this program. So much so, that it became a talking point and other staff in the organisation also wanted a taste…they began to come into the baby massage component of the group: sitting quietly and witnessing these profoundly simple, but moving, interactions taking place between mothers and their babies.

And this would, perhaps, remain a curious and fun little anecdote to reminisce over now and again…except that there is a growing body of research suggesting that, in fact, something quite profound happens (neurologically speaking) when we witness other people touching.

This is perhaps best summarised in an article published by Scientific American Mind about the same time as the THRIVE program was being developed.

The article highlights:

A recent line of research has demonstrated that seeing other people being touched activates primary sensory areas of your brain, much like experiencing the same touch yourself would do. What these findings suggest is beautiful in its simplicity—that you literally “feel with” others.

One of the THRIVE team talks about this experience:

“I remember in one of the groups was a very sweet mother, who had faced many stresses and challenges in her life. For her, even the thought of interacting with her baby was not only difficult – but so distressing that she couldn’t go there. She was utterly frightened of her baby. 

On the first day in the group, she had an extremely intense panic attack and literally ran out of the room when it came time to undressing the babies for a massage. The team had to provide her with a very high level of support just to help calm her enough to simply watch the activities. It really was one of the most extreme panic reactions I have seen a mother have in response to her baby.

It was happening for her all the time – dozens of times through the day whenever the baby moved or needed feeding – and she was utterly exhausted. The little boy was just shut down and not putting on weight because no-one was interacting with him or responding to him.

But over the coming weeks, with support that looked very subtle – but that was in fact highly skilled –  the mother gradually began to connect with her baby. By the end of the THRIVE program, she was interacting in the most natural, gentle, and connected way.

I can’t tell you what that felt like to watch that transition, that change. I still remember the first time they made eye contact in the baby massage group without any sense of force or panic – just a gentle connection between two people learning to love each other. Gradually, it progressed to her touching him, and eventually they were both fully engaged in the massage activities of the First Touch Program. 

The whole thing just brings something over me. Maybe it’s partly intellectual – because from a clinical perspective you know exactly what you have helped that mother turn around and prevent.

But it’s more than this too – it’s an almost overwhelming feeling of hope and joy and goodness that comes through your heart and your body, a feeling that the world is not going to the dogs after all: it’s still possible to do something worthwhile, meaningful…it’s the rare chance to be part of something so deeply human that it just stays with you.”

But perhaps this is more than just feel-good vibes. As highlighted in the Scientific American Mind article:

…consider a study published earlier this year, which provides evidence that this sensory mirroring is in fact linked to our self-reported ability to empathize with others. Michael Schaefer and his colleagues also scanned their participants’ brains while they were watching movie clips of touches applied to human hands. Consistent with earlier results, participants’ primary somatosensory cortex (the brain’s representation of the body surface) responded vicariously to the observation of touch.

However, participants also completed the Interpersonal Reactivity Index (IRI), a paper-and-pencil test measuring four specific dimensions of our ability to empathize with others. And guess what? The higher participants scored on the “Perspective taking” subscale of the IRI, the stronger their primary somatosensory cortex reacted to observed touch.

These data suggest that the brain’s mirroring responses are in fact associated with personal empathic ability. How much you empathize with other people seems to reflect how strongly your brain—your primary somatosensory cortex—“feels with” them when you see them being touched.

Or, as highlighted by the Baby Massage Educator in the THRIVE program:

“I often marvel at the researcher’s wisdom of putting the Baby Massage session before the group-work activities. I’m not sure if it was intentional – but to have a room full of people doing and watching these beautiful interactions for an hour is a bit like swimming in a huge, soupy bath of oxytocin…it left us all feeling in a wonderful state of mind.

Given what we know about the role of oxytocin and trust, social bonding and empathy I’d be inclined to wonder if this played a role in also enhancing the experience and effectiveness of the group-work part of the program for both staff and parents…as well as playing a role in how synchronised and connected we were as a team?”.

In either case, it would wonderful to think that we might be able to change the lives of families and bring a greater sense of morale, connection and satisfaction to our health and community workforce simply by offering baby massage programs frequently and openly.

The First Touch Program is an evidence-informed, cue-based (infant-led) baby massage program. The program is delivered by a trained facilitator, where parents gain confidence and skills in interpreting their baby’s cues and signals, and in responding to their needs using a range of touch, massage, voice and movement interactions. The program is both culturally and contextually adaptable. It is grounded in principles of relationship-based and strengths-based practices, and uses a peer (parent-to-parent) education philosophy.

About the THRIVE Program

THRIVE is a short model of support and intervention for women experiencing significant symptoms associated with Postnatal Depression and Anxiety, developed and tested by clinical psychologist Angela Freeman.

The initial focus of THRIVE was to develop a psychologist-led group program, drawing from evidence-based and evidence-informed interventions in Cognitive Behavioural Therapy and development of some foundation mindfulness skills.

Freeman’s intention was to balance the group with a “light” activity each week – yoga, baby massage, baby sign language, for example – to support the women’s social connections. However, on reviewing the available research, it became apparent that infant massage was supported by a more significant body of research, and might potentially play a role in the clinical outcomes the program was seeking to achieve.

Freeman approached Baby in Mind to participate in the study, to adapt the First Touch Program (an evidence-informed cue-based infant massage program) and provide an experienced facilitator to deliver the program, alongside the psychologist-led therapeutic group.

Freeman tested the THRIVE program several times, and the results for the women were spectacular.

All women in the group showed marked improvements in their mental health following their participation in the program. Importantly, risk factors for the babies – commonly associated with maternal postnatal depression – were all but eliminated. Although only a preliminary evaluation of a pilot project, the results of this research strongly indicate that further research and more formal trials using this approach are warranted if we are serious about supporting families in their recovery from postnatal depression.

The THRIVE trial was hosted by PANDSI, an ACT-based organisation that supports hundreds of men and women who face pre and postnatal depression and anxiety, every year. The pilot was funded by ACT Medicare Local (now known as Primary Health Networks).

Despite the success in providing a low-cost, effective program for women with complicated postnatal depression and anxiety and their babies, the program was not funded on an ongoing basis.

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