It’s a sunny Wednesday as I walk underneath the tall trees to the main entrance of the health center. My interviewee today, youth healthcare doctor Kelli van Gerven, has a consulting room on the top floor. She is waiting for me and we walk the last part together. It is special to meet again after such a long time. As she makes tea for both of us, we notice that it feels like yesterday that we were talking about our concerns regarding advice about excessive crying. More recently, we have been in touch about a document that did not seem to do justice to children’s need for a deep sense of safety.

I tell Kelli that my colleague and I had a conversation with a healthcare professional earlier today about the first 1000 days and stress in early childhood. A while ago, Kelli was also at a meeting on this topic. Scientific insights into the needs of children in the early stages of life have been greatly expanded in recent decades. Regularly, they appear not to correspond with what is often still being told to parents and the general public in western societies. During the meeting, Kelli noticed that the consequences of this new knowledge for day-to-day practice still met with a lot of resistance from some people. This is understandable, because it demands a lot from professionals when new insights require a change in the usual working methods. It calls for reflection: ‘How have I always done that?’, ‘What have I taught parents?’, ‘How did I approach this in my own family?’ The answers to such questions can be confrontational, because on closer inspection, you may no longer endorse your own previous choices. You may be struck that the new advice clashes with how you always handled things professionally and personally. In addition, a different approach may require knowledge and time that are not available within the current system.

Kelli says: “You may be right to… how should I put it… ‘disapprove’ of your own former course of action… even if that is too strong a word, but with additional knowledge you can decide to make a shift to something new. This requires you to become aware of these changed insights, that you allow their impact to sink in and that you do not oppose them, because that makes change very difficult. Well, of course such changes are certainly not easy. Taking an eye test or weighing a child… that is fairly easy. When it comes to things that are more parenting-related, such as sleeping and crying, it is much more complicated. That is why I always hope that at policy meetings there are not only managers and supervisors present, but also the people who actually do the work with the parents. They can then share their valuable experiences and from there you can look at how changes might be implemented, based on the new evidence.”

We talk about how behind certain things, such as an eye test, there is not so much an ideology or a belief that you can disagree on. “That’s certainly an aspect of it,” says Kelli, “because I myself find that sometimes I get annoyed by the way children are viewed in some documents. If I, as a parent, go somewhere with my child, I expect the care provider to be aware of the latest scientific developments. If I should notice that this is not the case and I receive advice that I do not agree with at all, then that is very difficult. Maybe they don’t match with information I have collected myself and with my own world view. I can understand that in such a case, parents might think: “Why am I going there, to the well-baby clinic?” Such feelings undermine their willingness to take advantage of that care. I think that is something that deserves attention from us as professionals.”

I ask how she navigates through those difficult situations. Kelli: “I almost always manage to get on the same page with parents. I slip into the parenting role with them and then it rarely happens that we cannot work things out together. In my experience, finding that common ground is often much more difficult between fellow professionals. For example, I was once at a training about brain development in children and the question was raised whether or not certain forms of damage are reversible, so whether you can undo them. The impression was created that this is always possible. That did not match what I had learned about it, so I kept asking. The speaker then indicated that there are indeed certain processes that become so ‘built-in’ in the brain that they are irreversible, or at least very difficult to reverse. To me, that seems very important information, because it means that we as care providers have to handle such processes very carefully. However, the speaker’s answer led to a lot of angry unrest in the room: how I could have asked that, what I did to parents, that I had gone too far… I noticed that the subject was very triggering for many of those present.
What I missed afterwards was that we all come together to talk about why we are so strongly disturbed by the idea that certain forms of approaching and treating  babies cause damage that is difficult to undo. Those are dynamics that I never really have with parents that way, barring extreme situations and exceptions. The fellow caregivers believed that it is too harsh to say to parents that certain things are harmful, but that wasn’t my point. I agree that care and sensitivity should be at the heart of discussions with parents. In my opinion, this does not alter the fact, however, that we must first establish that some things really are undesirable or even harmful. We need to have that discussion first and then move on from there. Such criticism does not affect me personally, but I hope that with such a question I can contribute to a thinking process that we really have to go through with each other about the underlying principle: the most recent insights are the basis for plan A, the best scenario. If Plan A does not work, sometimes you have to go for plan B and then you make the best of that second-best option. Now it sometimes seems like plan B is the first choice and that if you advocate plan A, you hurt parents or overask them, while I believe that parents have a right to the information of plan A. They have to choose what they want to do and we guide them in doing so.”

I ask Kelli how parents react when she discusses these topics with them.
“That depends a lot on which parent is sitting in front of me. One thing is always certain: we sit together in that consulting room because everyone wants the best for that child. Often in such a conversation, a question arises from the parents, for example regarding disagreements about where the child sleeps and whether they should learn to sleep alone. Then the goal is for me as a youth doctor to work in accordance with the JGZ guidelines. Parents will be influenced and informed by these guidelines to the extent that information leaflets are made for them on the basis of those guidelines. Parents do not always have the same employee in front of them at the ‘consultatiebureau’ (well-baby clinic). Continuity, therefore, largely comes from applying the guidelines, but not everyone interprets them in the same way. What I do then is that I explain that there are multiple visions and that the choice for how parents want to approach their child is of course always theirs. I explain the basics of what a baby or young child needs and provide additional information. What I think is important is that they dare to put everything on the table that they struggle with or about which they have questions, so that we can discuss it. After all, those parents have to do it together! After the consultation, they should not go home with the idea that they have to do what the doctor says, but with the idea that they have enough information to continue to put the puzzle pieces together, also in contact with others in their social environment. I think those conversations are very nice, because you notice that you have something in common, which is the well-being of the child. When there are concerns about issues such as possible child abuse, that is a different story, but of course that is not the case for the majority of parents. They want to see what is the right thing to do. I enjoy that interaction and because of that, you get a positive exchange with each other. I never say, “This is how we are going to do it”, because it is not about what I want; after all, I am not the one who has to feed the child, change the nappies and carry the responsibility for the daily care, right? These parents should be comfortable in their roles. Guiding that process… that I find really fantastic!”

Next week in Part 2 you will read about the challenges Kelli experiences in contact with parents and with guidelines and the way in which she sees scientific insights embedded in daily practice.

Last week we started a conversation with youth health doctor Kelli. This week, even more aspects of her work are discussed, such as the challenges she experiences with parents and guidelines, as well as embedding new insights into daily practice.

We talk about how intense stress completely disrupts a person’s ability to absorb information or understand advice properly.
Kelli: “Yes, it certainly can, and in many settings it is the same as with the guidelines here: if you stick too much to your own programme and certain standard procedures, you don’t see the most important thing, or see it insufficiently, namely: what is going on for the person sitting in front of you? The question then is: do you dare to let go of that structure? Do you dare to be open to the fact that sometimes things go differently? That is actually quite exciting. After all, you also have time pressure; the next person does not want to wait endlessly, so that is often a quest.”

I ask what aspects of her job she likes most and what really makes her happy. She explains that this is very broad and that her idealism plays a major role in it, the wish that parents and children have a good time together: “I wish people more happiness and health, especially because that prevents so much difficulty later on. I know that is a very idealistic idea, but that is ultimately my motivation.”
And the counterpart… which is the hardest?
She looks a bit more serious: “Hmm… then I think of the families that live in excruciating poverty and partly because of that start quarreling, that you look at their situation and think… they are really stuck. How on earth are they supposed to keep their lives in order? Against politics and policy, you still have to look for concrete solutions. In any case, you always look at the individual situation. If there are two children in a family who are constantly arguing, then perhaps they can go to daycare on different days, so that they are not together all the time and there is some peace in the family again. I then organise those kinds of things together with other partners in the healthcare chain, who also know the ‘social map’ well.”

How does Kelli see the biopsychosocial insights embedded in healthcare or in society as a whole?
“Unfortunately, I don’t feel that it is very different now than it was ten years ago. With the help of social media, it is now often easier for parents to find like-minded people or to find professionals with a more holistic view and that can give parents a lot of support. I myself also read along to see what is being discussed on these platforms, but I do not yet have the feeling that there has been a total change in mentality from a policy point of view. Although there is clearly more attention for Infant Mental Health, I still often see that the behaviourist approach is endorsed; that still seems to be ‘main stream’. I do see small undercurrents with more awareness about the impact of toxic stress, but they are small branches that seep through somewhere and I don’t see them becoming waterfalls everywhere.”

We talk about how to deal with what parents indicate on social media, such as: ‘I go to the well-baby clinic, but I don’t listen to what they say there, so in one ear and out the other.’ How can employees deal with that?
“Sometimes parents don’t want to have a consult with certain professionals because they don’t feel heard there. Some parents are more vulnerable than others and are more likely to feel negatively treated, rightly or wrongly. At the same time, the interaction can create conflict for employees: they are trained to properly follow national guidelines, but if the parents want to deviate from these kinds of advice, either for scientific or intuitive reasons, the relationship with the parents can come become strained. We now know that a baby is not a person without feeling, but rather a very sensitive being. If you have crying parents sitting in front of you because their child is crying so much and they have nowhere to go, you want to help find a solution. And that is where friction can arise. We can all happily say that ‘it takes a village to raise a child’, but many parents don’t have a village; they are almost alone. This often leads to a switch from plan A to plan B and to an attempt to ‘adjust’ the baby to the circumstances instead of vice versa. Maybe the parent and the professional are happy then, but the baby is not. Many of the methods used are much ‘easier’ in the sense that you don’t have to change the whole system or get a village around you…” She hesitates, interrupting herself: “Well, easier… I would not be able to, because hormonally I would be driven crazy by the crying…”

Is knowledge about the influence of the social environment on health sufficiently seen, or does the idea that health depends on genes still prevail?
“I do not like the term that we have an individualistic society, but you do see instances of that. For example, I know of a family whose children showed externalising behaviour and this was seen as disruptive at school and at the sports club. The parents were blamed for it: ‘Go and raise your child!’ However, I knew that those parents were doing very well with their children. In such situations it should be possible to surround such a family as a ‘village’, not from the idea of ​‘you are doing it wrong’, but from the question ‘how can I help you?’ People’s lives are often lived separately than together, but I fully realise that is not something you can resolve personally. Political decisions also play a major role in this. This is ingrained in the healthcare system and in the idea that everyone has to stand on their own two feet. Somehow you would hope that parental support would grow organically in a community and that you would not have to set it up as an institution, but that turns out to be difficult in everyday practice.”

This topic brings us to the intergenerational aspects of parenting problems. Parents sometimes seem to be individually ‘blamed’ when things do not work out, but in most cases they try really hard and have been through many things themselves, which makes it difficult for them to provide the child with what they need. Does that kind of knowledge seep through to practice, I ask Kelli.

“One of the tasks of the youth health doctor is to refer to the GGZ if more support is deemed necessary. If there is one thing that is difficult to say to parents, it is that you think that not only the child, but also the parents themselves or others within the household need support to solve their problems. However, it is very difficult to raise the issue if parents themselves are not yet aware of certain bottlenecks and there is no request for help. This is especially so because in principle I am the child’s doctor, and not the parent’s. Only when parents learn to see that their own attitude influences the functioning of their child, will things change. That is sometimes really a ‘pink elephant’ in the consulting room and there is certainly progress to be made there…”

We look at the terms ‘toxic stress’ and ‘trauma’ and what you could or should understand by them.
“Trauma is very common, but it is often still thought that the word is about a serious event, such as a difficult birth. That it can also be about more insidious forms, as a result of your attitude towards the child, that is more difficult. That touches people in a more intense way and can feel like failure. I think the same applies to toxic stress. I don’t use that term much, but I did read some work by Jack Shonkoff about it. I think we can imagine what it does to a child to be systematically belittled or beaten or not given food, but I think more subtle forms are more difficult to grasp.”

I ask Kelli what, in her opinion, should change with regard to policies in order to work more on prevention of problems.
She thinks and smiles: “Well… if you look at it very utopian way, then of course you would like us to create a society in which children can grow up in an environment that suits them and that guidelines to that end provide state of the art knowledge, and that invasive, heavy interventions are reserved for the few situations in which they are necessary, and are not part of standard documents. A real step needs to be taken there, so that parents receive less conflicting information. But then…” She hesitates, looks at me and grins broadly: “… these are of course monstrously large social issues; you can’t just change that!” We laugh together at her term ‘monstrous’. However, she does see achievable goals: “On a small scale, of course, you hope that you can always give parents something with which they can manage their own situation as well as is possible.”

I notice that Kelli regularly brings up the guidelines and I ask about their influence.
“Well… in principle, those guidelines form the frameworks within which we work. Not everyone can interpret this in their own way. So you want the summary to actually represent the latest insights. This gives professionals the feeling that they are acting responsibly. Therefore, there needs to be more awareness regarding the influence of early childhood and of its nuances. Everything that goes badly wrong later on, starts somewhere small, when things are not so intense yet, and that is where you want to be present. Every euro invested now, you will eventually get more than tenfold back through prevention, but many policies are linked to four-year cycles… so to the short-term, actually.”
Finally, Kelli indicates that her own motherhood has taught her a lot that she experiences as valuable. She hopes to be able to support other parents as well with such a learning process in which the children are a strong motivational force.

We wrap up and I thank Kelli for her time and her beautiful story!

Last week we finished with the importance of building a physical, non-verbal foundation for managing stress and emotions. We also discuss the role of breastfeeding in this.
Beatrijs says that two things are important to her when it comes to breastfeeding: ‘I think sex education starts at birth. The baby’s brain is saturated with oxytocin in an important phase, which is good for your stress coping system. And all the so-called nutritional benefits…’ She hesitates, challenges the lactation consultant in me and says: ‘… Fine, sure, whatever!’ Now she is bursting with laughter. She then continues on the value she sees in the breastfeeding relationship between mother and child for later sexual development. “I see sucking the nipple as the first form of kissing, of really close physical intimacy. Following the biological blueprint, a child can enjoy that for two years or even longer. All the while, the child may delight in that breast, the smell and the mother’s body, while its brain is drenched in oxytocin, endorphins, and prolactin. That total delight… and the surrender, the self-regulation, the drinking and meanwhile just stroking it with that little hand… and reaching for the mother’s face and mouth… fantastic! In my opinion, that is the foundation of a sexual education.”

She sees an important learning process for both boys and girls there. “Boys who are breastfed for a long time develop an enormous admiration and familiarity with the female body and its limits. They get abundant amounts of oxytocin and endorphins through the milk and through suckling, which supports a favorable wiring in their brain. Through their mothers , girls can learn to give the same non-verbal oxytocin showers to their own child. Oxytocin is the word – I’m from the Oxytocin Church!” We laugh about it together, because I too am a passionate admirer of this important hormone.

I ask if there are things she found difficult in her job.
“Because of the foundation that I have been given, there is a lot of confidence in my body and I could always use that in my profession. That has always helped me in my work and because of that there are no big things that I found difficult. I did most of it on my intuition and it worked great!”
Yet this question brings her to her own childhood, in which she grew up in a large Catholic family in the province of Brabant. She was the fourth of eight, with a mother who was actually constantly overworked in caring for the children and the family doctor’s practice of her husband, Beatrijs’s father. “The summer I was born, my mother happened to have a very good assistant in the practice and three good maids in the house, which made her feel relaxed and I breastfed longer than the others. So I’ve been lucky enough to have a good base, I think. My mother was a very sweet woman, but she was always overworked and too busy with everything. My father was a real patriarch, who was afraid of intimacy. Although I have enjoyed his intellectual inspiration and my mother’s gentleness and pursuit of personal growth, as children we have sometimes been lacking in personal attention. As a result, self-doubt can sometimes strike enormously under high voltage.”

Another major traumatic event in her young life comes to her mind that has affected how she handles things. As a four-year-old girl, she got viral meningitis and not just herself, but all the children in the family. At first they were all isolated, but when some of the kids were allowed to go home and she was left with her little brother, she didn’t see her parents for weeks. She and her brother thought their parents had forgotten them; they felt utterly abandoned, were unable to walk in the end, and only had the comfort of each other’s closeness. When they were picked up and brought home after six weeks, everyone seemed very happy and that didn’t match at all with how she felt. “I think that was my first depression. I imploded to survive and in difficult situations in my life I still find it hard to deal with those emotions. I can hold on for a very long time, but if everything goes wrong and it really doesn’t work out… then I have to be careful that I don’t implode.”

She says she got a nasty knock from it at the time, but was still able to develop well because she already had the strong foundation of the years before. In this context, we talk about how she views the importance that is attached in the Netherlands to those early years of life. Beatrijs: “I think this is not seen enough. This is evident from the duration of women’s maternity leave. Some feminists often call me out on this: ‘There you have Beatrijs Smulders again with her sow leave!’ They make a swear word of it! I think the lack of continuity of care in childcare for small babies is harmful.”

This topic touches on the idea of ​​safety or lack thereof and I ask her if she knows the concept of ‘toxic stress’.
“Most certainly, yes! What I understand by this is that a child goes through drastic things and experiences severe stress and does not have the tools to absorb that stress and cannot turn to their parents for this. We need a certain amount of adversity to grow. That is inevitable; that’s how evolution works. Children are born as fragile gold nuggets and you should try to keep them intact for as long as possible. The development of our stress coping system through the protection of our parents is of vital importance. However, parents can’t keep protecting you, so you also need to develop a healthy ego that fills that function later in life. And when there is a setback, you hope that your stress coping system is strong enough on a fundamental level to allow you to grow through it. Sometimes you don’t succeed. Then people break. Women who were abused by their father as children… that is something a child can hardly cope with. Then you close and break and it takes a lot of effort to become whole again. The insecurity you experience as a result will affect the rest of your life.”

I explain that trauma is also described as a deep wound in the mind, a broken connection with the self, and loss of authenticity. When a wound can heal properly, there is less scar tissue. This is important, because the properties of scar tissue are that it is not so flexible, that it does not grow like the rest, that it puts things under tension when everything else does grow, and that it has few nerve endings and therefore lacks sensitivity. These are characteristics that can also become visible in the personality through trauma. Beatrijs sees her trauma from the hospital as a scar: “Fortunately, the rest is so healthy that I can live with it! But people are vulnerable and sometimes you only have to hear three times in a very vicious way that you are worth nothing and then you are already traumarised somehow, because your sense of security is damaged, which can have major consequences. Then it comes down to the strength of the early foundation to get you through.”

Finally, we discuss briefly what Beatrijs considers important for the policy for a good start in life.
“I think the autonomy of midwives in primary care is very important, so that they can continue to practice their wonderful profession and continue to support pregnant women and women in labour. Across the board, I think it’s time that women get to play a bigger role in society and work towards change. Unfortunately, women do not always have access to that power; they are sometimes put up against each other in unsolidary ways with the wrong means of power,  and are not raised and socialised into supporting other women in making a head start and rising in the speed of nations. But things are getting better; luckily there are hordes of women ready to take on a role as change agent in society, women who can make a world of difference for newborn children!”

We wrap up; I thank Beatrijs for her time and the fun we had together. It is wonderful to see that in so many disciplines, there are champions who advocate for the importance of a healthy, safe first 1000 days in a human life. Through her book ‘Blood’ people can get an insight into the start of her life as a midwife. In time, the second and third parts of the trilogy will appear, parts that Beatrijs is now working on daily.

The sun is shining when I arrive at Amsterdam Central. I open my folding bike and ride across the busy station square on the center side towards the Prins Hendrikkade. Just after the Odebrug, I turn right towards the canal house of today’s interviewee. With my now folded bicycle I climb the eight steps of the stairs to the front door. From behind the wrought-iron gate around the platform at the top, you can look out over the ships moored in the canal and the buildings on the other side of the water. I ring the bell at the left of two identical mirrored doors with beautiful wood carvings, both of which have brass letterboxes a third from below. The top two thirds consist of an opaque relief glass window decorated with a cast iron artwork with flowers and circular curls. To the left of the door on the wall, which is covered with white glazed tiles with flowers in two shades of blue, hangs a small glass case altar with prayer candles and a statue of the Virgin Mary. After I ring the bell, I hear firm footsteps on the floor in the hall. Then the front door opens with a swing and a broadly smiling Beatrijs Smulders stands in front of me. She welcomes me warmly and after I have parked my bike in a corner, we walk across the white marble floor through the long corridor to the back, to the spacious kitchen where we already talked to each other before. We chat for a while, while Beatrijs makes tea and then we get started.

I would like to hear from her how she got into this profession. That is currently a much discussed and widely read story, because the first part of the autobiographical trilogy she is writing has recently been released and is entitled ‘Bloed’ (‘Blood’). She describes in detail her fascination for the profession. “It took me a while to realize this was my destiny and actually I got into it through sexuality. As a girl, I already took a quite cheerful stance regarding that subject; I always carried with me a positive idea about sexual energy. Years later, once I was a midwife, I realised that I actually see a child as the materialised result of sexual energy. You make love together, which leads to conception, and essentially that is a form of love that is being materialised through sex – the most precious thing you can have, the connection between two people who love each other and from which a gold nugget emerges. I sometimes have a discussion in my head with Rutger Bregman, who says in his book ‘De meeste mensen deugen’ (‘Most people are virtuous’) that most people are good, but I say that all people are virtuous at birth. After that, unfortunately, much of this inner goodness can be damaged and many people become traumatised. At the moment, I still see a lot of oppression and too much lust for power in society. These are the themes that I have been working on in my profession all my life.

What I see is, among other things, that we are increasingly medicalising childbirth in western healthcare. For many women, this makes giving birth a disempowering experience. That is very unfortunate, because if you guide women in a positive way during childbirth, then birthing a baby is an empowering event, something that makes you experience a positive energy. Then the pregnancy and childbirth work love-unleashing, definitely also when that child comes out of your body. This affects you throughout your life, both you yourself and your child. The hormones during an unmedicated birth help with this: oxytocin, prolactin, endorphins… they help in the development of feelings of love and the ‘love gaze’, the first glance that mother and child exchange when they are both completely intoxicated by that beautiful mix of hormones. The breastfeeding relationship is a continuation of this. For months after the birth, a breastfed baby’s brain and body are marinated in oxytocin and endorphins, the hormones of happiness, connection and empathy. I am convinced that breastfeeding promotes future feelings of empathy in a child. A child who is allowed to breastfeed for a long time, thus receives a gift for life. Such a child is given the opportunity to optimally develop body awareness in the non-verbal stage of life. That helps to enjoy directly what is there, without the intervention of the compulsion of words and thoughts. No mindfulness training can compete with a start like that!”

I ask her how she views that good start, what period she associates with it.
“That first year is crucial. That we, as a society, still inflict upon women and children this routine of taking these little ones to a daycare setting after three months… that is something I consider a big digression. It is important to invest in a child’s first 1000 days. This means that both partners should be able to work less, not only mothers, but also their partners, so that partners can support the mothers in caring for the baby. This is important for bonding and for the development of the brain, which grows so incredibly fast in the early years. During the entire pregnancy, the child was in the womb and a sensitive hormonal adjustment has developed, which continues during the delivery and afterwards through the breastfeeding relationship. No one can take over that role; no one can replace that breast. Human children are all evolutionarily born premature; a baby is, as it were, still a larva, which, like the great apes, should simply be stuck to the breast for at least another nine months. Our intellectual, rational, feminist frames say: ‘No! After three months, the child can go to daycare!’ I experience that as the contemporary alienation that women are forced into by the law. I am happy to see that in addition to the mothers, there are also many fathers in the Netherlands who start working part-time when their children are small. That’s great and working from home during the corona crisis has made it clear that much more is possible there than we thought.”

Beatrijs pays tribute to women such as Hedy d’Ancona and Sigrid Kaag, who, once their children were older, plunged into politics and built wonderful careers. She believes that women should have the courage to plan their careers together with their partner and to ensure that both of them devote time to taking care of the children. She realises that not everyone sees it that way, but “breastfeeding is crucial for the human foundation, not only for nutrition, antibodies and bonding, but above all for healthy brain development and a healthy stress coping system. For a long time, that was a statement that could be harshly criticised for, but by now, science has clearly shown how important stress regulation is in the early years, so I’d like to make that point anyway!” She laughs out loud and resolutely bangs her fist on the table.

We talk about what Beatrijs sees as the essence of her work as a midwife.
“Well, I see two things… I think it’s important to support and promote women’s autonomy so that giving birth is a sexual, liberating and empowering experience. In addition, I see such a birth also as a way to heal old pain, to become whole, as a woman and as a mother. Becoming a mother is an important process in a woman’s life and when you can do it in an empowering way, it is love-unleashing and a reinforcing factor in your harmony with yourself. And that, in turn, helps in bonding with the child and with the harmony between you and your child. This nurtures the non-verbal bond of trust. You fall in love with your child and that infatuation, that unleashing of love, forms the basis, whatever terrible things can happen afterwards. If a child is allowed to discover the world in safety and security during the first few years and can learn from the parents how to deal with stress and emotions in a good way, then you lay a wordless, non-verbal physical foundation. That is then in your body. You can always fall back on it when you are under stress; you radiate that. It is in the wiring of your brain and that supports a strong stress coping system.”

Next week we will further discuss the role of breastfeeding and oxytocin, the importance of a good foundation for overcoming traumatic experiences, and the importance of security.

Last week, together with social psychiatric nurse Carla Brok, we looked at the importance of paying attention to the context. In fact, this is the biopsychosocial approach that we have discussed before, an approach that recognizes that the physical, the mental and the social constantly influence each other. This week discusses how passion for your work helps to shape your way of working.

I start telling about someone at a foreign campsite who joked about a work appointment during holidays: “Ah well, vocation… vacation… it’s all the same if you love your work!” Working from ‘vocation’, from a calling, often does not feel like work, but simply like a passion and keeping the flow of things going. That is a wonderful way to fill in your work. The idea of ​​calling and passion reminds Carla of a very special situation that she recently supervised, in which the extremely remarkable behaviour of the child turned out to indicate very serious problems and to be partly caused by severe trauma in one of the parents. If she had only looked at the ‘outside’ and the superficial signs, she would have reached a completely different conclusion than what her intuition now led her to: ‘there’s a lot more going on here and it’s really, really serious’.

Eventually, this required a serious intervention, and Carla put in a lot of time, because the story she was told filled her with compassion for the parent’s trauma. “These are difficult situations and it takes courage to dare to see what is really going on”, she says thoughtfully, “and if you can look through the child’s eyes with genuine curiosity, then you can feel compassion, without feeling the need to emphasise shame and guilt. At the same time, you can acknowledge that certain ways in which we organise our society create power differences that cause harm to the child. What the one parent did… that was really wrong, but I managed to keep my interest in their life story. I don’t just accept everything; in fact, I think that I accept very little, but as the years go by I am allowed and able to bring in more and more softness and that benefits all parties. I see the process of becoming milder and softer as a task belonging to getting older.” I think out loud and wonder if bringing in more softness means less defensive behavior in the other person, making it much easier to discuss difficult matters with less need for normative judgment. Guilt and shame can be paralyzing and are hard to face. Without them, one can build a sense of security, that makes reflection possible, paving the way to growth and development.

We broaden our conversation and go from Carla’s experiences with individual families to the question of how she sees the attention for early childhood in Dutch health care. “That depends on the perspective; it has developed enormously since I started working, but at the same time I think it is still far from being enough. I think there is still too much normative thinking about how you should treat a baby. Feeding and sleeping, carrying and cycling, bottle or breast, toys, diapers, how a baby or a mother should behave… everyone thinks about everything and has a judgment about it. How helpful is that for parents?” I express my hesitation and say that I feel some tension regarding this. We have gained many insights over the last decades and we know that we should learn to see through the child’s eyes. Based on the biological blueprint, we also know that some biological setpoints are more difficult to adjust later on. This means we can conclude that some practices actually are more or, in turn, less beneficial. Hitting your child does not seem like such a good idea, to give an example, although that is a normative judgment. Here, Carla agrees: “Oh yes, certainly; parenting is by no means trivial. When someone says ‘We don’t hit that often’ … my alarm bells ring and then I reflect on how to respond without judgment, because I want to hear the story. After all, parental behavior also occurs when I am not there, so enforcing my norms onto the family situation would not work, while at the same time I do want to ensure that the situation improves for the child. If parents think that hitting is a solution to problems, then chances are there are many more things that are not going well.”

Carla is of the opinion that scientific insights are still clearly insufficiently integrated in practice. The current (COVID-related) impoverishment of perinatal care does not improve this either. She tries to navigate these aspects: “It is my responsibility to organize my schedule of care. Some problems are of a different order, of a different importance, and I will not let another person determine how to serve the family interest. I’m too stubborn for that.” That sounds like ‘daring leadership’, to quote Brené Brown, as a deliberate choice to guarantee continuity of care based on deeply felt professional ethics. That takes courage; that requires a willingness to stick your neck out and make time for it, something that fits Carla’s previously mentioned stage of life of generativity: transferring wisdom to the new generation. “And I also think,” she continues, “that there is still far too little attention in the training courses in this line of work to the fact that the parent-child relationship is always reciprocal. It is very important that the child is heard and seen. This sometimes requires thinking and acting outside the lines that are still often drawn in training and practice. Guidance and education for young children is so important; as a society, we should reward that much better. In those early stages, so much can go wrong, but also incredibly much can go right, as long as we make sure that the professionals are well trained and can see and interpret the signals that children give. As a professional you need the feedback of the child, the story of the child, to determine how to proceed in a difficult situation. I can sort of panic if I can’t ‘translate’ the child, if I can’t pick up on the child’s signals. I need them and they form the basis for how I try to keep in touch with the parents so that they and I can give the child what it asks for and what it is entitled to.”

We talk about how difficult it can be, to develop your basic ability to keep seeing perspective. This requires not only compassion towards the other, but also towards yourself – after all, you shouldn’t burn out as a result of disappointment about everything you can’t change. Carla: “I experience it as very important to keep my own social life in order, because that is the source from which I recharge when work demands a lot from me and I encounter many sad situations. Mindfulness helps me with this, as does trust in my intuitive perceptions and my old tendency to look a little further than what is directly observable. I actually keep working on those skills, because you really need them. I succeed better at that as I’m getting older. I move along with what the different phases of life require of me and they all have different accents when it comes to meaning. And in order to continue to experience life as meaningful, you need to be able to co-regulate with other loved ones, so that you regain your balance when you have lost it for a while. Walking with a friend, drinking tea with someone, telling your story to an attentive listener … those are very precious experiences in life.”

Due to another appointment we have to wrap up, but we conclude that we could have easily explored many more themes. I thank Carla for her time and her openness; I say that I have heard many beautiful things and that I look forward to working out her story!