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Posts Tagged ‘breastfeeding’

I have just read this article in the Guardian and sighed when I read it. It refers to an article published a couple of weeks ago in the British Medical Journal (here is the article, but it requires a subscription/payment to read it all) where a research group (Fewtrell et al) questioned the policy in the UK to recommend exclusive breastfeeding of infants for six months. Just to be clear, exclusive breastfeeding means that for the first six months, an infant is given breast milk only: no solids, no formula, just breastmilk.

This follows the WHO guidelines, and the Australian government recommends the same. I should emphasise that the researchers are not recommending formula over breastmilk, and they are talking about the introduction of solid food, not formula.

What are they worried about? Well, the researchers are worried about links between late introduction of solids and iron deficiency, a potential increase in food allergies, and of coeliac disease.

I’m sure that this is going to confuse mothers even more. Any new mum knows that they are bombarded with a huge amount of advice from friends, families, and experts. I know that when I had my first child, I spent a lot of time consulting baby books and the internet for every little thing. But with my second child, I didn’t have the time, or inclination, and used a much more intuitive style of parenting.

I didn’t manage to exclusively breastfeed for six months, despite knowing that it was recommended, and despite having every intention to do so. My first child started solids at about five months, but my second was grabbing food from my plate at four months and I knew she needed more than breastmilk. I didn’t believe that something magical happened at six months of age that was missing at five and a half months, and so I did what I thought was best for my children – which is what mothers have been doing forever.

I’m curious about how many mums do actually manage to breastfeed exclusively for six months. I am very pro-breastfeeding, and had every intention of doing so, but for us, it didn’t work out and I did start solid food earlier (even though I continued breastfeeding for about a year with them both).

Did you manage?

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In dealing with newborn infants, I have found the concept of the fourth trimester very helpful. This is a phrase that I associate with Dr Harvey Karp, who has previously commented on this blog. He talks about the need to create an atmosphere similar to that of the womb while the newborn adjusts to life in the outside world, and his suggestions include swaddling, settling the infant on their side, suckling, and white noise. This phase lasts for the first few months of the infant’s life.

I also like the ideas of Dr William Sears, who advocates for attachment parenting. I have previously discussed his book ‘Nighttime Parenting’ on this blog, and his suggestions include frequent breastfeeding and co-sleeping, both of which I have used (note: co-sleeping is not recommended by ‘Sids and Kids’ or the health department.)

From an evolutionary point of view, it makes perfect sense that a newborn baby wants to be held all the time. I have blogged before about mother-infant attachment, and this is linked to the belief that infants are hard wired for survival. Survival for a tiny baby means being close to their mother. Being alone in a quiet room would be frightening for an infant, as they have absolutely no means of surviving on their own – their only chance is to display attachment behaviour which allows them to be in close proximity to their mother. My number one piece of baby equipment, and the one I recommend to everyone I know, is a sling: these help infants to feel safe and secure, and also allows the parent’s hands to be free to get things done around the house.

There is a perception in our culture that things like feeding/rocking/cuddling babies to sleep, responding to every cry, holding them all the time, or co sleeping creates ‘bad habits’ or ‘spoils’ babies, which is ridiculous. They are not infants for very long and our job is to help them transition from being completely dependant to secure children and adults.

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Kangaroo care refers to early skin to skin contact between a mother and her newborn infant. It involves the newborn infant being placed straight onto the mother’s chest immediately after birth. The infant is covered with a blanket on top, but has bare skin to skin contact with mum for as long as the mother and infant are happy.

There seems to be a culture in our society of taking the baby away to be weighed and examined, cleaned up and wrapped before being given to the parents to hold. Obviously if there is any concern about the infant’s health, then they need to be given the appropriate treatment, but in healthy babies, there is now evidence of the positive benefits of early skin to skin contact.

The Cochrane Library publishes systematic reviews of existing studies on particualr topics. By collating all the data and assessing the methodological merit of the studies, they aim to provide evidence based papers. They have a review, last updated in 2007, on early skin to skin contact (Moore ER, Anderson GC, Bergman N. Early skin-to-skin contact for mothers and their healthy newborn infants. Cochrane Database of Systematic Reviews 2007, Issue 3. Art. No.: CD003519. DOI: 10.1002/14651858.CD003519.pub2).

This review found statistically significant evidence that early skin to skin contact had positive effects on the success and duration of breastfeeding, and trends towards positive effects on maternal affection behaviour during feeding and attachment. The infants also cried less and one group (late preterm infants) showed more stable cardiorespiratory function.The authors  also commented that there were no negative associations found.

It is completely natural and instinctive for mothers and their young to be in close contact after birth, and it makes sense that this creates the optimal physiological state for the pair. I am not against hospital births at all; both my children have been born under obstetric care in modern hospitals and personally, I wouldn’t have had it any other way. However, within that medical system, there are ways to make sure that you and your infant start your relationship in the best way possible, and one way is to make sure you have early skin to skin contact.

 

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‘Nighttime Parenting: How to get your baby and child to sleep’ by William Sears (La Leche League International book)

Penguin, 1999 (Revised edition)

Dr Sears makes a very valid point in this book when he says that “sleep problems occur when night waking exceeds your ability to cope”. In contrast to much of the parenting advice which says what your child ‘should’ be able to do, Dr Sears is refreshing as he emphasises that your night waking child is normal, and discusses ways to increase your ability to cope with it rather than ‘train’ the child.

Dr Sears is a paediatrician and a father to eight children, and strongly advocates for ‘attachment parenting’ as opposed to ‘detachment parenting’. After birth, this involves breastfeeding, child led weaning, co-sleeping, and responding to your baby’s cries promptly (as well as other emotional commitments and preparation). He is opposed to letting babies ‘cry it out’ or enforcing routines onto infants, which is a reason why this book resonated with me.

In terms of his advice about sleep, he begins by explaining the basic science of sleep and how it differs between adults and parents, and why babies wake at night. As well as listing possible medical causes, he explains the survival and developmental triggers for waking. In contrast to the advice that most mothers — including me — were given, he encourages us to ‘parent’ our children to sleep, whether that be by rocking or breastfeeding, and he also strongly suggests that we sleep with out babies in our beds.

This book is written in simple, gentle, encouraging language and it certainly gave me a feeling of peace and reassurance. Dr Sears states clearly that our culture’s expectations of infant sleep are too high, and that as parents we must expect to rearrange our lives to cope with night waking. There is some sensible advice about ways to stop night feeding, and a great chapter reminding fathers of their role in parenting.

I am not sure how helpful this book would be to someone who was not breastfeeding, as one of his main suggestions feeding your baby back to sleep, and there is no discussion about bottle fed babies. His other big suggestion is bringing baby into your bed, and for families who are not willing to do this, it may again have limited use. This clearly is aimed at parents who are not looking for a quick fix, and unfortunately, so many parents now have expectations which are just too high.

However, for mothers who breastfeed and are opposed to parent-led routines, and know that it is not right to leave your child to cry, it is a lovely book which affirms and reassures you that your instincts are correct. Dr Sears reminds us that the long term gain for your child from responding to her cries is worth the sleepless nights.

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I think that all parents have times when they want – or do – leave their babies to cry in the hope that they’ll fall asleep. I think for anyone considering ‘controlled crying’, this is required reading:  Australian Association for Infant Mental Health’s position statement.

Infants whose parents respond and attend to their crying promptly learn to settle more quickly in the long run as they become secure in the knowledge that their needs for emotional comfort will be met.

Infants from about six months of age suffer from differing degrees of anxiety when separated from their parents. This anxiety continues until they can learn that their parents will return when they leave, and that they are safe. This learning may take upto three years…If controlled crying is used it would be most appropriate after the child has an understanding of the meaning of the parents’ words, to know that the parent will be coming back and to be able to feel safe without the parents’ presence. Developmentally this takes about three years.

Night waking won’t last forever, and we all need to remind ourselves in the wee hours that this is what we signed up for, and it will end…

 

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