All content of this blog is my own opinion only. It does not represent the views of any organisation or association I may work for, or be associated with. Nothing within this blog should be considered as medical advice and you should always consult your Doctor.

"Don't feel guilty" does the phrase really help?!

"Don't feel guilty" - a statement often uttered by those trying to reassure/comfort someone feeling bad about something.  Like much language it's often tossed about frequently online, particularly parenting forums, "mommy blogs" - anywhere a collection of women (who typically feel guilt far more frequently than men) group around an emotive subject.
But it hit me recently that "don't feel guilty", can actually provoke feelings of guilt.  It can in itself imply a person is or should be feeling guilty.

I was chatting to my mum whilst driving, I can't even remember what about and it's not relevant anyway; what I do remember is I was expressing upset/sadness over a situation and my mother's reply - "well don't feel guilty".  Up until that point I hadn't felt at all guilty, it was a situation completely beyond my control, but the fact my mum had said what she said, obviously implied she thought I could be feeling guilty. Otherwise why mention it?

Here's how it often goes online:
"I'm feeling really down today as I had to give little x a bottle today, we're just really struggling with the breastfeeding and he hasn't gained enough weight.  I'm in agony so will be sad to stop breastfeeding but think it's time to throw in the towel."

The reply often goes along the lines of:
"X don't feel guilty, you have done your best, happy mum = happy baby etc etc etc".

The mum didn't express guilt, she expressed upset, sadness but not guilt.  Telling her not to feel guilty isn't going to help or empower her to become less sad/upset is it?

Furthermore even if the mum was feeling guilt - since when did saying "don't feel <insert whatever emotion here<" ever stop anyone feeling it? Oh well yes now you've said that, all is dandy!

Still not convinced?

If you ever find yourself in a position of trying to breastfeed and your midwife/health visitor/breastfeeding counsellor is sat with you - yet it STILL hurts, or baby isn't gaining or settled or whatever; and then they say something along the lines of "well it appears OK",  without giving you any practical help you resolve your problem or give you answers as to why you're struggling.  Reverse the situation and say "it's OK don't feel guilty you can't help me". What reaction would you expect?

Oh and don't forget to add "please refer me to someone who can" ;)

Why I'm concerned about Tizzie Hall's Breastfeeding Advice - PART TWO

Continued from PART 1

What we also need to throw into the mix of Tizzie's breastfeeding advice is that she also recommends limiting the duration of feeds too:
Before milk comes in:
"Day 1: Feed every three hours from both breasts - 6 minutes per breast
Day 2: Feed every three hours from both breasts - 9 minutes per breast
Day 3: Feed every three hours from both breasts (if milk not in) 12 minutes per breast
Day 4: Feed every three hours from both breasts (if milk not in) 16 minutes per breast"

We know how important colostrum is for babies, it's often called "liquid gold".  Why would anyone want to limit the amount of this their baby receives?  Containing more white blood cells (antibodies) than blood, examine its properties further and you soon realise if it was bottled and sold we would be advised to encourage baby to consume as much as possible!

Once milk is in the routine is first breast 25 minutes, then second 15 minutes every 3 hours (alternating which you start with) then a shorter gap of 2 hours between 4-6pm followed by a 3 1/2 hr gap to 9.30pm.  By six weeks there is a 4 hour gap between the first and next feed and this extends until the gap is 4 hours throughout the day by 10 weeks (with 3.45 mins before the last feed) although it does switch to 25 minutes each breast at 6-8 weeks and then the timings just vanish from the routine (I'm assuming you can go wild and feed as long as you want at this point!)

Tizzie feels feeds need time limits so nipples can "toughen up" and "helps avoid cracked, sore or bleeding nipples, which can be horribly painful".
"Other babies are very sucky and if given the chance will stay sucking on the breast all day and night.  The mother could end up very sore and even cracked and bleeding nipples, especially if she is too exhausted to correctly latch her baby onto the breast."
To a new mum this may seem to make sense - but I feel it's based on myth as this blog post explores.  

Furthermore, science has examined this theory:
"To investigate the effects of the frequency and duration of breastfeedings on nipple soreness we studied two groups of mother-infant pairs during the first 10 postpartum days. Mothers in the control group fed on a 3- to 4-hour schedule and those in the experimental group were encouraged to breastfeed as frequently as the infants desired. All mothers recorded the time and duration of each breastfeeding for the first 10 days after delivery and gave their own daily assessments of nipple discomfort. Although mothers in the experimental group nursed significantly more frequently (10 vs. 7.4 feedings/24 hours, p >.0001), they did not experience more nipple soreness. There was no significant correlation between the frequency or duration of feedings and the degree of nipple soreness."
Does the Duration and Frequency of Early Breastfeeding Affect Nipple Pain?
Manoel de Carvalho M.D. Steven Robertson Ph.D. Marshall H. Klaus M.D.

Setting these sort of limitations on a newborn is quite mind boggling - but it doesn't seem to give any consideration to a baby not feeding well.  This is the group I'm passionate about as these tend to be the people I see/hear from day in and out.

If a baby is not for whatever reason transferring milk well - it's rather like you or I drinking from a squished straw.  Sure you get some liquid, but it makes your face ache and you stop long before you would if you had a normal straw.

These babies may fall asleep quickly at the breast - yet aren't really asleep and wake showing hunger cues as soon as they've moved.  They can spend an age at the breast and suck and suck, whilst consuming very little - a lot alternating between sucking, crying and cat napping..

In this situation the mum can develop sore/cracked nipples - but not from the constant feeding,  but from constant incorrect feeding.  If something is preventing the baby from performing the correct action, they can compensate with suction!  Some have a crushing very strong suck (as shown on ultrasound) which will absolutely crack and damage nipples.

Some feed very quickly but are hungry again half an hour to an hour later, or even sooner with feeds rolling from one into the next and the baby unable to settle.  I meet parents who say, I don't know what's wrong, it can't be hunger because he's been feeding for two hours!  Yet the baby would need to be attached 24/7 to take enough milk with how inefficiently they're feeding.  If you feel your baby never appears full or settled - seek help from someone appropriately qualified such as a breastfeeding counsellor or lactation consultant (I.B.C.L.C.).  This is not typical, but does not mean the only option is a strict routine.

I found Tizzie's book confusing in how one should deal with this though.

Firstly the baby falling asleep quickly:
Q.  My baby keeps falling asleep during a feed - what should I do?
A.  This is what I call a sleepy feeder.  If she dozes off before taking enough milk to get her to the next feed, you will start to have problems if trying to follow a routine.  Try changing her nappy or taking some clothes off as the cool air might rouse her.  You could also try putting her down somewhere safe to rest for ten minutes and then try the feed again.
Ok so what next?  If baby is not transferring milk well they WILL keep falling asleep - even after a 10 minute rest.  Then what happens if it gets near sleep time?

In one section of the book entitled "settling your new baby to sleep", it discusses a newborn not settling doing the "emotional cry" (ie the one Tizzie feels indicates a need).
"This cry I would never ignore.  Get the baby up and look for a problem, and if there's no visible problem I would offer some more milk".
I was quite heartened to read this although I did wonder which breast and how many minutes.

However still under "feeding in the first two weeks" it says:
"If you believe he is hungry between feeds and you have no expressed milk, just offer an extra feed for a few days no closer than two and a half hours after the last one."
Which suggests expressed milk is preferable if possible, but also seems to contradict the statement before?

The trouble with tiny babies is when they take insufficient calories the first thing they do is signal to feed; if this is ignored or their intake has dropped for another reason, they do one thing - sleep.  The more calories drop, the harder it is to rouse them to feed - especially at night. They stop spontaneously waking, and a mum has to start setting the alarm to "remind" her infant to feed.  It's also easy for a mum to think she has a "good" or "content" baby (because how long they will sleep now seems to define that in our society) who can't be hungry otherwise he would wake.  When she tries to wake him he struggles to rouse, compounding her belief he simply doesn't need to feed.

Whilst on Tizzie's Facebook group, I've read parents of young infants 7/8/9 weeks announce hurrah, their infant is sleeping 12 hours!  The response is often "great parenting", yet Dr Sears suggests otherwise:
"One thing we have learned during our years in pediatrics is that babies do what they do because they're designed that way. In the case of infant sleep, research suggests that active sleep protects babiesSuppose your baby sleeps like an adult, meaning predominantly deep sleep. Sounds wonderful! For you, perhaps, but not for baby. Suppose baby had a need for warmth, food, or even unobstructed air, but because he was sleeping so deeply he couldn't arouse to recognize and act on these needs. Baby's well being could be threatened. It appears that babies come wired with sleep patterns that enable them to awaken in response to circumstances that threaten their well being. We believe, and research supports, that frequent stages of active (REM) sleep serve the best physiologic interest of babies during the early months, when their well being is most threatened."
Dr Sears, 8 Infant Sleep Facts Every Parent Should Know

As clearly the above would for many ring alarm bells about supply, Tizzie recommends expressing alongside for the first 8 weeks.

In addition for the first two weeks until baby has regained their birthweight, mum has to set an alarm at night allowing a sleep of no longer than 5 hours.  After this mum can stop waking baby, but until 4 weeks she has to express after 6 hours if baby hasn't woken for a feed - but only needs to remove an oz (I'm not sure what this figure is based on)
"I strongly believe expressing in the early days is a key factor to having a good milk supply while following a routine."
"I encourage all my clients to express first thing in the morning and at other times in the day.  This is for two reasons.  One, this milk can be given in the bottle later in the day and some of it an be frozen and stored for when your baby has a growth spurt"
"After a few days your breasts will start to regulate and produce only the amount he is taking.  This is fine initially, but when your baby goes through a growth spurt in the early weeks you may not have enough milk to satisfy his needs.  This would result in you having to feed him more often and will get your routine off track.  It may also result in you feeding your baby too close to sleep time resulting in him using the feed as a going-to-sleep-aid."
Tell me, if it's so normal for a baby to follow the routine, why does one need to express to maintain a good milk supply?  Isn't expressing a lot more time consuming than just feeding more frequently when baby wants to up supply - the way he's supposed to?  Really is the world going to end if the routine goes out of the window for a few days?

The other issue I notice when young babies feed from very full breasts (which may happen following a 3-4 hour gap) is wind.  It seems Tizzie has noticed this too as she suggests mums should wind their baby every three minutes during a breastfeed.  By my calculations if a feed is as Tizzie advises 25 mins one breast and 15 the other - that's 13/14 windings per session!

My OH asked an interesting question after reading this entry, he said if you have to feed for 40 mins as per the routine, and you have to wind 13 times, if each winding is only 2 minutes - this is 26 minutes of winding.  Is this on top of the 40 mins feeding making each feed 1hr and 6 minutes or is it included?  ie 14 minutes actually feeding?

Looking at the routine

But none of it considers how unique each breastfeeding dyad is; that we know some mums have a larger initial store than others (although most can make roughly the same over 24 hours), that babies feed with different levels of effectiveness and that some mums have a bullet proof supply whilst others don't.

The last reason Tizzie gives for suggesting scheduled feeds is quality of milk - we are compared to cows in a dairy and our milk is claimed to be "similar to that of a cow" - which is eyebrow raising on so many levels.  Tizzie proposes that dairy farmers say the quality and quantity of milk increases if they stick to two set expressing times per day -" is it such a leap to assume that's so for babies?"

Tizzie that's not a leap, it's a freaking pole vault, of Olympic standard.

A dairy is not the normal environment for a cow you know?  When they have calves the farmer doesn't stand in the field with a stop watch, signalling when to start a feed and when to swap udders!

According to a dairy farmer, modern equipment allows the cows to choose their own milking times - and stated the times were set previously because of how long it takes to put a full herd through the milking process.  Hand reared calves are fed two - three times per day, and then also are offered hay and grains within a few weeks!  Bovine milk is designed to develop bulk not brains, because they're cows not humans.  In contrast, gorillas feed on demand as frequently as the guidelines suggest humans do.

Humans don't drink cow's milk because it's vaguely comparable (don't know about you, but I have just the one stomach!)  The protein size is cow sized not human, in fact sheep and goat's milk would be more comparable in some ways to human (although still not close)  Humans drink cow's milk because cows can produce vast amounts of milk whilst being cost effective to keep and docile enough to allow it.  Cow's milk has to be massively modified so a human infant can tolerate it and along with wheat is listed amongst the most common allergens.  Each mammals milk is species specific, the antibodies, hormones and everything else is only of use to the same species.  This is why there is a movement of mothers sharing human milk.

I appreciate Tizzie's book is opinion not a "science journal", but when your opinion is influencing how people raise babies isn't there some sort of ethical or moral obligation to at least consider how this sits with  the evidence?   I can understand areas where there is mixed evidence that it can come down to opinion, but some throw away comments are I think misleading:

When talking about prems:
"Often these babies are fed by tube or parents are advised to give their feeds from a bottle until the babies are strong enough to suck from the breast".
In an effort to refute the widely held assumption bottles are easier than the breast, one study sequenced babies to alternative between feedings at the breast and by bottle.  During bottle feeding infants showed:
  • Poorer coordination of sucking, swallowing and breathing
  • A greater number of oxygen desaturations
  • A significant fall in skin temperature
  • Shorter duration of feeding.
Meier P, Bottle and breastfeeding: effects on transcutaneous oxygen pressure and temperature in preterm infants.

Another study found bottle feeding increased the incidence of desaturation episodes compared to cup feeding (1) whilst another found a 10 fold increase in desaturation episodes to <90%, compared to "no change" whilst cup feeding (2)

When talking about multiples:
"Most mothers are capable of producing enough milk for more than one baby.  But it's also important to look at both your individual situation and your family's needs.  There is no point trying to breastfeed if you are finding yourself too tired to enjoy your babies, or you spend all your time worrying about whether they are getting enough food.  If you are concerned about this, talk to your health professional about their weight gain.  If they are all gaining enough weight, settling and sleeping well, then you know you are producing enough milk,  And remember, some breastmilk is better than none.  With this in mind, a lot of my clients have decided to give a mixture of breastmilk and formula."
Hang on, I thought the whole point of the routine was supposedly to "stop mothers feeling too tired to enjoy their babies?"  But to suggest there is "no point" if tired or concerned about weight seems really quite bizarre to me.  Mums don't need to stress about whether their infants are "getting enough" if they are peeing, pooping and gaining as expected, just like with a singleton; why does "sleep and settling" come into play?

To Tizzie's credit she does suggest mums struggling can contact the breastfeeding organisations, and gives further details of who they are - my only concern is that if mums contact them, they may end up extremely confused as the first thing they will say is "have you considered feeding your baby by cue, not a routine?"  The training to man these helplines includes looking at all the reasons a routine isn't the ideal for a breastfed baby.

Lastly here are the recommendations from the World's main sources of health care advice:

UNICEF's Baby Friendly Approach clearly states
"There should be no restrictions on the frequency or length of breastfeeds."
The NHS breastfeeding website reads:

"Feed your baby as often as they want. This is called baby-led feeding (it's also known as 'on-demand'). Let your baby decide when they’ve had enough. It's not necessary to time the feeds. In the beginning, it can seem that you're doing nothing but feeding, but gradually, you and your baby will get into a pattern of feeding, and the amount of milk you produce will settle.

It's important to breastfeed at night because this is when you produce more hormones (prolactin) to build up your milk supply. At night, your baby will be safest sleeping in a cot in the same room as you."

The Department of Health lists good practice as:
"Encourage breastfeeding on demand."
The American Academy of Paediatrics' breastfeeding policy states:
"To nurse whenever the newborn shows early signs of hunger, such as increased alertness, physical activity, mouthing, or rooting. Crying is a late sign of hunger. Nondemanding babies should be aroused to feed if 4 hours have elapsed since the beginning of the last nursing. Time limits for breastfeeding will be avoided"
The World Health Organisation recommends:
"Breastfeeding on demand – that is as often as the child wants, day and night."

1.  Rocha NM et al.  Cup or bottle for preterm infants: effects on oxygen saturation, weight gain, and breastfeeding.
2.  Marinelli KA et al.  A comparison of the safety of cupfeedings and bottlefeedings in premature infants whose mothers intend to breastfeed,

Win with Merino Kids!

We've talked lots recently about bedding - too much, too little, what type!

One thing I think most agree on is that natural fabrics are typically the best way to go at night.  We first discovered this when my youngest was born at 34 weeks and in a heated cot.

After the first few days he became better at regulating his own body temperature without the heater, when suddenly one evening out of the blue it started becoming unstable again prompting concern - so much so they had to flick the heater back up to earlier levels.  Whilst I sat the next day waiting for the doctor, one of the lovely SCBU nurses came on shift - the old school type.  I explained what had been happening and she immediately checked his bedding; under the top fleece layer was not a wool/cotton blanket (the white layer you can see in the photo), but a second fleece.  She explained that standard bedding was one cotton or wool blanket on top of baby and another wool OR a fleece blanket on top of that (wool were in shorter supply!) When he had been sick the night before, I remembered the nurse swapping the soiled wool blanket for a fleece.  We swapped it for wool and within an hour they could flick the heater on his cot down again.

I then remembered visiting a mum recently who passed me her baby in the most amazingly soft sleeping bag, so much so I commented and discovered it was Merino wool.  Again I thought little more of this until recent discussion regarding the use of synthetic fabrics next to baby at sleeptime.

Fleeces and sleeping bags are now very popular, but if they're synthetic can this impact on how warm/hot baby is at night?

I contacted Amie at Merino Kids - a company specialising in Merino Wool items for babies and children.  We chatted about my SCBU experience and Amie explained why sleeping with synthetics can cause problems - baby gets hot, they sweat, the moisture can't escape and thus they end up cold (or in a cold sweat)
Benefits of sleeping on/in merino

OK so it's actually a bit more complex than this and it turns out there are a whole host of reasons to pick Merino, but this page covers it fully:

I was also quite excited to learn Merino make their own sleeping sack range!  "Standard weight" which covers 18-30 degrees and "Duvet weight" for temperatures 16-20 degrees.  No other sheets or blankets required!

What's more I discovered that agresearch, New Zealand’s largest Crown Research Institute – an independent government-owned research and development organisation has explored this very area!  Nifty!

"Product Comparison of Merino Wool and Polyester Baby Sleeping Sacks: Dr S R Collie, Dr A Tasker and M F Hnat."

You can read the full report here

Some quotes from the report:
"The Merino Kids sleep sack has moisture vapor absorption (MVA) that is approximately 80-times greater than the Halo"
"This intrinsic ‘breathability’ of the merino fiber, and hence the Merino Kids sleep sack, would better allow moist air to move away from the body’s micro-environment, preventing dampness and potentially chilling, while keeping the warm air around the body from escaping via convection."
"In the product comparison reported here, clear differences in thermophysiological comfortrelated performance have been identified between the merino wool Merino Kids and polyester Halo sleep sacks." 
"The Merino Kids sleep sack had much higher moisture vapor absorption, approximately equal moisture vapor transmission and much lower air permeability, all of which indicate a much more sophisticated level of ‘breathability’ of the merino system, with it likely to be better at transferring moisture away from the baby while reducing convective heat loss and mitigating the chilling effect of drafts." 
"These test results, coupled with the outcomes of previous research into sleeping comfort and the well-known low flammability and volatile absorption properties of wool indicate that merino is an ideal material from which to construct sleep sack bedding systems for infants."
It seems to me there is little point having natural flat sheets and top sheets, plus perhaps a blanket - if the item right next to baby is causing the problems discussed.

Instead why not use one natural item?

Merino kids have very kindly offered a gorgeous international award winning Go Go Bag for one lucky winner!!  

Choose either Newborn to 2 years or 2-4 years - further details below:

To enter share any article from this blog somewhere online and then post a message letting me know where.  Please only share somewhere you are a regular (ie please do not spam somewhere you don't normally visit)  Each share will get you one entry - the more shares the more entries.

Winner will be drawn Wednesday 31st August and announced on this page and on Facebook.  If the winner does not contact me within 16 days from date of draw, I will re-draw.

Why I'm concerned about Tizzie Hall's Breastfeeding Advice - PART 1

I'm going to make this two part entry my last for a while on the subject of Tizzie Hall. I mentioned in my last blog post that I wanted to cover one particular section of her breastfeeding advice - an area which concerned me. However this post ended up so long I have split it in half so you can stand a chance of getting to the end ;)

Part 1 which is below, explores restricting breastfeeding frequency, some of Tizzie's ideas and why I think mums planning on following Tizzie's advice should be cautious...

In her book "Save Our Sleep", Tizzie firstly suggests that feeding "on demand" may be linked to obesity in later life.
"If your baby knows you will keep offering him a snack every couple of hours, he will never feel the need to have a full feed.  Putting your baby on a routine gets him into the habit of filling right up when you offer the breast or bottle, because he soon learns it will be quite some time before you make the offer again."
"Teaching bad habits:
If you feed your baby every time he cries, you run the risk of teaching him that the answer to all his emotional ups and downs is to eat, irrespective of whether he is actually hungry.  For example, if a baby is tired and crying because he doesn't know how to put himself to sleep, feeding teaches that he needs to eat in order to fall asleep.  If a bored and crying baby is picked up and fed he starts to understand that if he is bored then eating will help.
My problem with this is that as your baby turns into a toddler, his whingeing will see you starting to replace bottles or breastfeeds with a piece of fruit or a biscuit which reinforces the regime of feeding him when he cries.  Perhaps that is one of the reasons why we now see a lot of obesity in children and teenagers, and why others eat to solve emotional imbalance."
What doesn't get a mention in the "obesity ponderings" is that not breastfeeding has long been linked with increased risk.  But that aside really just how healthy is "filling right up"?  Don't recommendations now support responsive feeding regardless of how an infant is fed?

Breastmilk is digested within a couple of hours, so a baby eating every couple of hours isn't "snacking" -  but eating normally.  Little and often is actually exactly how humans are supposed to eat, it keeps blood sugars stable and promotes normal metabolism.  Paul Mckenna's whole diet theory is based on adults learning to re-recognise when they are full, but at what point did they forget?  Milk is all an infant gets, their tummies are much smaller than ours - yet I wonder how many people reading ensure no food or drink passes their lips unless three hours has passed?

Lynne Daniels, a professor of nutrition at Queensland University of Technology, Australia, and researcher with the Early Prevention of Obesity in CHildren (EPOCH) collaboration, has demonstrated routine fed infants were heavier at 14 months than those fed responsively.

The professor said: 
"If the mother is responsive, she is responding to the child’s cues of hunger and not over-riding them.  Whereas, if a mother feeds in schedule, she decides whether or not he is hungry."

Tizzie goes on to say:
"I don't want to infer that demand  feeding won't work for everyone.  In the end, all parents have to do what it best for them and if you are one of the lucky ones that can interpret your baby's cries, that's great."
It's fascinating that someone calling themselves a "Babywhisperer" thinks babies need to cry to tell you they're hungry.  Crying is the last cue of hunger - one that only comes out to play if all his earlier signs are ignored..

Secondly - Tizzie expects mothers to tell the difference between a "protest" (which she defines as the equivalent of a temper tantrum) and an "emotional" (has a need) cry, based on a description in her book - but then states mothers who can interpret cries are the lucky ones.  Confused yet?

Thirdly it assumes breastfeeding is all about calories.  It's not.

Truth is that the breast meets every need a newborn has except a dirty nappy - the skin to skin regulates their temperature and other vital stats, so baby doesn't need to expend energy doing so.  Milk is a live substance and at night contains properties that induce sleep, whilst the act of feeding releases hormones to relax both mum and baby (strange if we aren't meant to feed our infants to sleep or during the night!).  If baby is hungry or thirsty it nourishes, and it provides the ultimate security for a newborn who only has 25% of his brain fully developed at birth and who is working at a very primal level.

Furthermore breastfeeding is recognised as pain relieving, and in the early days has more antibodies than blood.  If baby is feeling under the weather he often turns to the breast, and with good reason.  The germ is passed to mum, she makes relevant antibodies and then passes them back to baby at subsequent feeds.

It is a baby's first "vaccination" and the most nutritionally complete food they will ever consume.

Let's look at Tizzie's list as to what she states prompts an "emotional cry" in her TV appearance with Kerry Ann::
  • Discomfort 
  • Hunger
  • Tiredness
  • Wind
  • Thirsty
  • Hot or Cold
Yep - breast takes care of those.  And want to know what else?
"It is now known that high levels of melatonin in breast-milk appear during the night and low levels during the day. Since melatonin is the hormone that regulates the sleep/wake cycle, these changes in breast-milk will doubtless be the signal to help the baby adapt as quickly as possible to the day/night versus sleep/wakefulness environment. (1-4)"
Yaha - so the breast even helps them start to regulate sleep cycles.  Top that Tizzie ;-)

What did bemuse me a little is how simplistic Tizzie's list of needs that can cause an emotional cry is - what about scared, lonely, needing a cuddle?   Tizzie claims in one of her TV interviews that she doesn't support "controlled crying" - the act of leaving a baby to cry but checking in with them every so many minutes. She states that if you return to an infant when they're "protesting", they will then start an "emotional cry", feeling rejected they've been left.

Yet walking in and out wouldn't cause any of the list above, which would seem to prove that babies cry an "emotional cry" for not only the six tangible reasons Tizzie claims, but also for reasons we can't label quite so neatly - rejection being one.  Interestingly in her book she adds a seventh item to her list which is "bored" - we can accept an infant can be bored, but not scared?  or that they might indeed use a cry with gaps to signal a great deal more than a "protest" or "temper tantrum".

The book describes a child falling asleep protest crying (this is from the section advising to leave a newborn to "protest" for a minimum of two minutes):
"If you are able to watch your baby without him seeing, you will see him shut his eyes and nod off before jumping and yelling again, as though he has realised he is falling asleep"
Why would any animal not want to sleep? Especially a tiny baby. Why would it be normal for them to half fall asleep, realise, panic and start "yelling" again?

All I do know is I don't observe any of this fighting, crying or jumping awake realising they're falling asleep when baby does so in a sling or next to mum.  Perhaps because baby feel safe, isn't scared to sleep - ultimately is where he is supposed to be?

Tizzie talks about how many mothers nowadays don't have the community that passes down tips and knowledge - but if we follow that logic right back, Stone Age women used slings...

The psychology of how adults respond to cries is also very interesting, in studies adults responded similarly to different pitch and frequency of crying - different types of cry clearly evoke different feelings and I suspect this is for a reason; the more urgent the cry, the quicker the response (pretty important if there's a tiger near by and you're a baby on your own!) but does this therefore mean as Tizzie suggests that non intense crying, or crying with gaps should be ignored, particularly if they trigger an instinct in mum to respond?

Tizzie warns:
"it's not fair on baby to be taught that someone will respond to every protest because, as your baby grows up, other people won't like this behaviour."
What behaviour? a child who expects his feelings to be acknowledged?  Yes perish the thought.  I do hope Tizzie never has cause to visit Mongolia - because there babies are wrapped up like parcels and put to the breast everytime they squeak for the first six months.  Imagine their behaviour! (not to mention of course they must all be obese).

Regardless, what Tizzie seems to fail to realise is that over the coming days and weeks as the mother learns her newborn and he develops - the relationship progresses so mum can understand his cries, and he soon develops lots of new ways to express himself too; which doesn't result in a comfort eating toddler!  This would make no sense as the entire population would be obese prior to the introduction of scheduled feeding (which took off in Victorian times).

It also assumes toddlers "whinge", and that a mum would respond to this with food instead of communicating with her child, and that a toddler will eat a piece of fruit if not hungry - what are these assumptions based on?  Clearly not cue fed infants as that results in a toddler who has retained the ability to regulate their own appetite (as long as starting solids hasn't been handled insensitively) which I guess will mean he also won't need to buy Paul's book when older....

Click Here To Read Part Two. which explores Tizzie's recommendation to also limit the duration of feeds.

RELATED POST: Suck a finger with Tizzie Hall...

1. Illnerová H, Buresová M, Presl J. Melatonin rhythm in human milk. J Clin Endocrinol Metab 1993; 77: 838–841.

2. Cubero J, Valero V, Sánchez J et al. The circadian rhythm of tryptophan in breast milk affects the rhythms of 6-sulfatoxymelatonin and sleep in newborn. Neuro Endocrinol Lett 2005; 26: 657–661.

3. Cubero J, Narciso D, Aparicio S et al. Improved circadian sleep–wake cycle in infants fed a day/night dissociated formula milk. Neuro Endocrinol Lett 2006; 27: 373–380.

4. Aparicio S, Garau C, Esteban S et al. Chrononutrition: use of dissociated day/night infant milk formulas to improve the development of the wake–sleep rhythm. Effects of tryptophan. Nutr Neurosci 2007; 10: 137–143.

WBAW post - Are newborns helpless and struggling to communicate?

or are we just failing to understand?

I've written this piece for for World Breastfeeding Awareness Week - the topic of which is communication.

I often hear it said that newborns are helpless. I also hear it said they need to “learn to feed”, or that feeding is a learning process for both parties – and at times the latter at least is true.

But it makes little sense that whilst every other mammal can feed without instruction – humans supposedly amongst the most advanced, are not born equipped with the skills for survival. That we need hours of “training” about how to hold our infants and attach them to the breast, in order to facilitate good milk transfer without pain.

We often hear that this is because breastfeeding is no longer held as the norm in modern western society, and that previously sisters, mothers, aunts and cousins would all have had handy tips and tricks to help along the way. Without doubt this of course impacts, but what if we’re missing something big along the way – what if it isn’t that an infant is utterly helpless, but that we have lost the skill of understanding?

When pregnancy and birth are “typical”, infants are born with every reflex and instinct they need to find the breast and feed – all without a whisper of positioning and attachment. We know that if we pop a healthy term infant on his mother’s chest and wait – and he will crawl to the breast, self attach and feed.

“Immediately after birth the child was dried and laid on the mother's chest. In the control group a regular behavioural sequence, previously not described in the literature, was observed. After 15 minutes of comparative inactivity, spontaneous sucking and rooting movements occurred, reaching maximal intensity at 45 minutes. The first hand-to-mouth movement was observed at a mean of 34± 2 minutes after birth and at 55+ minutes the infant spontaneously found the nipple and started to suckle.”
Widström et al, 1987 – first written observation of the breast crawl.

And that often is the key – to wait, but in modern society that often seems oh so hard to do! Babies are wiped, examined away from mum, weighed and dressed – each act killing a little more of those natural instincts. Even mothers who have their infants delivered onto their chest often only have a brief spell before they are whisked away for the above.

“Of 17 babies kept in the Breast Crawl position and kept in uninterrupted skin-to-skin contact for 1 hour, 16 attached to the breast correctly. Fifteen babies in the other group were separated after about 20 minutes for routine measuring and weighing procedures. After an interval of approximately 20 minutes, they were returned to the mother. Only seven babies in this group attached correctly (Table 4). These findings are crucial because the early suckling pattern is of prognostic value for the duration and success of breastfeeding)”
Righard and Alade, 1990

Suck a finger with Tizzie Hall?

I've received a number of emails and Facebook comments following the blog entry examining Tizzie Hall's methods and SIDS, asking since breastfeeding is a topic I frequently cover - do I plan to address the inaccuracies in her breastfeeding information? So I looked at a few of the breastfeeding PDFs, I watched at a couple of clips of her on TV,  and I thumbed through my copy of the book (second hand natch).  The truth is even as a relatively prolific dedicated "mommy blogger", I'm simply not sure if it's a task even I can face!   The job of tackling it all is mind boggling, the man hours it would take overwhelming - maybe I need some £300 per pop forums to fund the process? ;).

So let's suck a finger with Tizzie!

Self styled "international baby expert" Tizzie Hall the "International Baby Whisperer," has decided that despite others training for numerous years to become lactation experts - a bit of self experience (two children is it?) and a good marketing team does her an expert make.

The most obvious place to start was Tizzie's Facebook group - and almost immediately I found this message posted by Tizzie.
"If following my breastfeeding guide before you milk comes in you will slowly get your nipples used to the baby sucking on them which will stop you getting sore cracked, bleeding nipples or engorged breast, which can happen if a baby is feed too often and for long periods of time before the nipple is conditioned for breastfeeding. You can test this theory by picking one finger and sucking on it for 20 minutes every 2.5 hours in a 24 hour time frame for 5 days and pick the same finger on the other hand and follow the sucking times in my routines and compare the difference in the fingers.
No this wasn't a joke, yes she really was asking people to suck their finger for 20 mins, every 2 1/2 hours - both day and night for five days.  Some agreed to start it and I would love to know how many completed the challenge!

I had to reply:
Hi - so many flaws in this theory without testing it out. I'm slightly concerned that when lacking understanding of the very basics such as this, you've produced a "breastfeeding guide". What qualifies you to do this please?
Firstly, babies don't suck nipples to obtain milk, they milk the breast.
Fingers are not made for regular sucking, they do not become erect when rubbed nor stretch and give as a nipple does.  Fingers are not surrounded by sebaceous glands that secrete a waxy, lipoid fluid to lubricate, moisturise and protect the areola and the nipple - look at your nipple and your finger, do they look vaguely similar to you? 
When feeding the infant's tongue grooves to support the nipple, fat pads stabilise and the nipple is drawn back to the point just before the hard and soft palate meet.
This is NOTHING like sucking a finger!!
IF a mum is experiencing sore/cracked nipples, her baby is not for whatever reason attaching and feeding effectively at the breast, we know this because when the baby has the nipple in the correct place - there is nothing to rub/cause friction or indeed damage the nipple. (see image above)
Engorged breasts are a separate issue to nipple trauma and occurs after milk has "come in" when mum has a supply too large or baby is not effectively draining the breast - which they wouldn't be if  sucking on it like a finger!
IF a baby is wanting to suck constantly, for loooong periods and all the time - establishing WHY is essential, nipples no more need conditioning for breastfeeding than a penis does for intercourse or a mouth does for talking - it's their biological function.
Please if you have a problem and are experiencing engorgement, soreness or cracked nipples - understand this is NOT just something that happens when you start breastfeeding. Seek help from someone fully qualified to help - ensure they have the letters IBCLC after their name!
I should of course also have mentioned breastfeeding counsellors and so on, but generally that raises discussion from someone who thinks they've seen a breastfeeding counsellor, but have actually seen a peer counsellor (as this discusses) and it seems to easily end up messy, so I went for short n direct .  What happened next is rather a shame as a mum who had experienced difficulties asked a question, I linked her to some free relevant information that could help her understand why she had struggled so much - and that plus following responses were immediately deleted.

Cover image expansion
Journal of Human Lactation
It genuinely baffles me when it comes to breastfeeding advice how so much evidence can just be dismissed in favour of opinion.  If you are sick you see a doctor, if you have a psychological illness you might see a psychologist and so on - within those professions you will have great and not so great practitioners, but the qualifications identify a basic level of training.  Furthermore few people would consider them qualified to start writing books on either of those subjects, particularly if they had no qualifications whatsoever and their ideas flew in the face of decades of science; even fewer I suspect would follow that advice if their own health was in question, particularly if their GP was pointing out all the flaws in the theory.

Yet infant feeding, which can be hugely important both for mothers who want to do it and from a health perspective, seems a free for all.  Despite the fact that unlike many other areas of parenting it's not "opinion based", milk production and transfer is of sound scientific base (the formula companies have spent bucket loads in exploring breastfeeding and breastmilk in their attempts to mimic it - what has been learnt in just the past twenty years is staggering).

The problem is that as a new mum, many can't tell good advice from bad; because those who don't fully understand breastfeeding see certain people still succeed even following the advice; that reassures them it must be good and if it doesn't work for them put it down to "some people just can't breastfeed".

In reality the amount of people who really can't breastfeed biologically is tiny, in practise the amount of people who really can't breastfeed is huge - because for whatever reason nobody managed to identify their problem and resolve it.  I have met mums who really couldn't breastfeed, but we have always worked as hard as possible to establish why (involving other health professionals and doctors as required).  If there is a true physical explanation for what is happening, whilst a mother may feel grief at the loss of a desired nursing relationship - she can begin to understand and be supported through the rest.

Leaving mums who wanted to breastfeed with no answers, opens the door to them feeling bad when the subject of infant feeding comes up - that perhaps they should have put up with agony or constant feeding or crying baby for longer, or defensive because they know what they endured and that it really wasn't working!  It hurts to read about risks of something they felt they had no other option but to do - and that sucks...Bigtime.  The system that failed to support them soon forget the mum they didn't help - but the mum has that experience for life.

Sadly this creates a catch 22 situation - some experts sell the notion it doesn't really matter (appealing to the biggest chunk of their market in most cases) because otherwise they would risk making mothers feel guilty and thus their market and ultimately profits would fall.  Instead they sell what they think mothers want to hear.  And so the cycle of passive and frankly often "never going to work" support continues....

Telling a mum with cracked/damaged nipples that her baby is attached perfectly is akin to suggesting trainers that causes huge blisters fit brilliantly.  The suggestion of finger sucking beyond bizarre.

Whether you follow Tizzie Hall as her biggest fan or not, if you have breastfeeding problems and want to succeed, please contact an expert.


Why I'm concerned about Tizzie Hall's Breastfeeding Advice - PART 1

What an attached parent is, and isn't.

"Attached parenting" (AP) evokes images of hippies, lentils and mothers knitting their placentas whilst the toddlers run wild; no respect, routine or reliability and never sleeping until midnight.  Babies constantly attached to their mother's breast in a ring sling whilst she steps over the cluttered house she will surely never have time to tidy.

Like most stereotypes, this is no more accurate than any other - so let's look at how AP is actually defined.

From Attached Parenting International (API)
"The essence of Attachment Parenting is about forming and nurturing strong connections between parents and their children. Attachment Parenting challenges us as parents to treat our children with kindness, respect and dignity, and to model in our interactions with them the way we'd like them to interact with others.
Attachment Parenting isn't new. In many ways, it is a return to the instinctual behaviors of our ancestors. In the last sixty years, the behaviors of attachment have been studied extensively by psychology and child development researchers, and more recently, by researchers studying the brain. This body of knowledge offers strong support for areas that are key to the optimal development of children, summarized below in API's Eight Principles of Parenting."
So - on to the 8 principles:

Prepare for Pregnancy, Birth, and Parenting - become emotionally and physically prepared for pregnancy and birth. Research available options for healthcare providers and birthing environments, and become informed about routine newborn care. Continuously educate yourself about developmental stages of childhood, setting realistic expectations and remaining flexible

Feed with Love and Respect - breastfeeding is the optimal way to satisfy an infant's nutritional and emotional needs. "Bottle Nursing" adapts breastfeeding behaviours to bottle-feeding to help initiate a secure attachment. Follow the feeding cues for both infants and children, encouraging them to eat when they are hungry and stop when they are full. Offer healthy food choices and model healthy eating behaviour.

Respond with Sensitivity - build the foundation of trust and empathy beginning in infancy. Tune in to what your child is communicating to you, then respond consistently and appropriately. Babies cannot be expected to self-soothe, they need calm, loving, empathetic parents to help them learn to regulate their emotions. Respond sensitively to a child who is hurting or expressing strong emotion, and share in their joy.

Use Nurturing Touch - touch meets a baby's needs for physical contact, affection, security, stimulation, and movement. Skin-to-skin contact is especially effective, such as during breastfeeding, bathing, or massage. Carrying or babywearing also meets this need while on the go. Hugs, snuggling, back rubs, massage, and physical play help meet this need in older children.

Ensure Safe Sleep, Physically and Emotionally - babies and children have needs at night just as they do during the day; from hunger, loneliness, and fear, to feeling too hot or too cold. They rely on parents to soothe them and help them regulate their intense emotions. Sleep training techniques can have detrimental physiological and psychological effects.

Provide Consistent and Loving Care - babies and young children have an intense need for the physical presence of a consistent, loving, responsive caregiver: ideally a parent. If it becomes necessary, choose an alternate caregiver who has formed a bond with the child and who cares for him in a way that strengthens the attachment relationship. Keep schedules flexible, and minimize stress and fear during short separations.

Practice Positive Discipline - positive discipline helps a child develop a conscience guided by his own internal discipline and compassion for others. Discipline that is empathetic, loving, and respectful strengthens the connection between parent and child. Rather than reacting to behavior, discover the needs leading to the behavior. Communicate and craft solutions together while keeping every one's dignity intact.

Strive for Balance in Personal and Family Life - it is easier to be emotionally responsive when you feel in balance. Create a support network, set realistic goals, put people before things, and don't be afraid to say "no". Recognize individual needs within the family and meet them to the greatest extent possible without compromising your physical and emotional health. Be creative, have fun with parenting, and take time to care for yourself.

I don't think the principles are really that out there?  It doesn't mean you have no routine, never put your child to bed, carry them 24/7 and aren't "allowed" to put them down, nor do you have to breastfeed!  It purely means you're up for taking a look at the evidence and responding sensitively to your infant.

Responding doesn't turn babies into spoilt brats who will control you ever more, on the contrary Penelope Leach, doctor of psychology has reviewed more than 150 scientific sources and believes the opposite is true.  One study in particular examined outcome when three sets of parents looked after babies in different ways.

The first group fed their children on demand, carried them around with them, slept with them, and responded instantly to their crying. The second group was attentive but strove for the beginnings of some separation. And the third operated on the Fordesque “controlled crying” basis, only picking children up to be fed when the routine allowed.
And at three months the distribution of crying was as you would predict,” says Leach. “The babies who were picked up most, cried less.”
So often the view of babies and children in our society seems so negative - they will attempt to control, manipulate, want to stay up all night if they possibly can (why  the assumption they don't want to sleep rather than for some reason they can't?).  Some propose ignoring the child's requests or cues enforcing a set routine - even though we know a one size approach doesn't fit all.  To say we see ourselves amongst the smartest mammals - we seem to have almost Victorian view of babies that is so far set from a large body of scientific evidence it's baffling.

So back to the hippy earth mother that is apparently the "AP" - and a few images of some who practice AP:  Angelina Jolie, Nell McAndrew & Miranda Kerr.  Just a few who clearly have brains and beauty!  And a thought - if the above 8 characteristics define an attached parent, is the opposite a detached parent?