Intro

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.

Wednesday, 30 November 2011

Breastfeeding Problems? Remember One Question...

The mantra of three year olds everywhere, "but wwwwwwhhhhhhhhyyyyyyyyy?", "why is the sky blue", "why do I have to put shoes one", "why can't I eat my sandwich doing a headstand next to the dog?".  Their pursuit of "why" is relentless as anyone who has been in that position will tell you - even when you think you have the best answer ever, they toss back a "why?" to that too!
A very common theme amongst the mothers I see are cracked/damaged/bleeding nipples (as those who read my last blog entry will remember.)  Yet bizarrely a huge percentage have also been told "latch is fine/good/great" - which sort of begs the question, why then is the trauma occurring?

If you bought a pair of shoes and got huge blisters, and the shop assistant said well the shoes fit absolutely fine - would you not ask why then you had blisters on your feet?

Breastfeeding is no different.

The other day it went like this (I paraphrase as I can't remember the exact wording):

Midwife: Your positioning and attachment is great, latch looks fine.
Mum: My nipples are very sore and bleeding
Midwfe: Ouch they look sore, put on plenty of lanolin
<Our Visit>
Mum (to midwife) The IBCLC I've seen has suggested my baby has lots of indicators of tongue tie
Midwife: No your baby isn't tongue tied (no examination/assessment) it's just down to positioning and attachment.

Woah, so we've gone from it looks great - to that's the root of the problem in the blink of an eye.

I wonder what the midwife would say if the conversation went like this:

Midwife: Your positioning and attachment is great, latch looks fine.
Mum: My nipples are very sore and bleeding
Midwfe: Ouch they look sore, put on plenty of lanolin
Mum:Why are my nipples bleeding if positioning and latch are good?

This can be applied to any area - why is my baby not gaining weight, why does he feel to be slipping off, why is she clamping/grinding etc, why does he never seem settled?  Then listen to see if you get an answer that satisfies you; it's normal or that's just what some mums experience does not qualify as an explanation, regardless of how nice the person is delivering it.

If you don't get an answer that makes sense and resolves the problem - be inspired by the  toddler phase of  "but why?".   Ask to be referred to someone who can help, or do your own digging to locate support, problems are never "just because", that answer is just as unsatisfactory when supporting a mum as it is to a three year old..

Friday, 25 November 2011

How I Think The Milwaukee Sleep Ads Should Look....

I'm sure most have now seen the Milwaukee Sleep Ads:

Here's how I think this one should look:

This is what the research shows, why demonise all bed sharing?

and


"You can say that half the deaths occurred while babies slept with their parents. You could also say that half the deaths occurred while babies were alone in their cots, he says, but: "I don't see anybody saying, 'Don't put your baby in a cot.'"

Professor Flemming, Hazardous cosleeping environments and risk factors amenable to change: case-control study of SIDS in south west England BMJ. 2009; 339: b3666.

Wednesday, 23 November 2011

The Duracell Bunny Baby

The Internet at times seems to have two distinct camps - the "expect them to sleep 12 hours" side, and the "it's normal for babies to only nap for half an hour, never want to be put down/sleep on a chest and wake every hour at night" side.

I (as usual) don't fit in either.

I often read from other mothers that very broken sleep must be normal, because their baby does it - some babies, even teeny weeny ones just don't need sleep!  If mums have had several children and some slept great, others not - this reinforces the belief it is personality; and in the past I would have agreed.  We call these babies "spirited" or "high needs", Sears writes a whole chunk about them here; and I think his descriptions are fantastic; but I think we can break it down even further and am not convinced personality is the whole explanation.  Yes babies are meant to be held close on a chest - does this mean that it's therefore normal they never want to lay down?  Babies are meant to sleep next to mum, but did cave woman sleep standing up?

Partly I think this has arisen as direct opposition to the "expecting 12 hours sleep camp", IE embracing baby's cues and being responsive.  But for me responsive parenting can also include exploring if there is a reason baby may be struggling to relax, if the parents feel that's something they need to explore.  That is not the same as suggesting not addressing the reason will lead to "bad sleep habits" or a baby that never sleeps better, babies change a lot as their brains and bodies grow.  Some will naturally iron things out as they mature going into the second half of the first year, some may be nearer 3 or 4 and some may continue to struggle to get to sleep/rise early, although the signs may become more subtle as sleep requirements reduce.

I'm not talking about training them to sleep, leaving them to cry or enforcing strict routines - but really watching baby's body language and cues to see if this is normal personality stuff, or, if he is desperately trying to convey something with constant waking and/or an intense need to suck.

Many parents I have discussed this with are those who have posted seeking advice - and they've mentioned replies are often to co-sleep, sling wear etc; but as they pointed out, what if they're already doing all that and still feel they have an issue?  Some say mum shouldn't ever expect a good chunk of sleep, that this is parenting and again I agree that there will be times baby is fussy and unsettled at night, certainly it's normal for babies to nightfeed - but does that mean therefore that it's typical for a baby to never be settled and sleep for longer than an hour or so?

With a first baby this may be easier, mum can nap when baby naps, head off to bed with baby at 6pm should she fancy - but throw 2,3,4,5 or more other children in to the mix, and/or work outside the home - and things can be very different, some mums are so exhausted they can barely function.

Whilst reassuring mums things are normal can be helpful, and there is a wide range of normal, there is also a range of what parents can cope with -  some may stop co-sleeping/breastfeeding/responsive parenting in a bid to save their own sanity or because their gut instinct is something isn't right, yet they have no idea what.  Whether these "work" in terms of changing behaviour or not is irrelevant, the impact to baby can be significant.

I'm of the belief there can be several reasons for consistently very disturbed sleep patterns or indeed a spirited/high needs infant, none of which involve bad habits, breastfeeding to sleep or baby needing to sleep in a cot to (say it with me) create positive sleep associations.  My feeling is that frequent wakers seek comfort, not that they wake due to a habit or reliance on said comfort to remain asleep; but what I want to focus on today, because it's a matter close to my own heart is the Duracell Bunny Babies (DBB).

How do you know if you have one of these?

Generally if the comment: "just go with the flow, babies will always sleep when they're tired" makes you laugh out loud, it's a pretty good indication; well they might, but no longer than 35/40 minutes in one nap (consistently), even if exhausted.  In exchange they might take lots and lots of little naps, day and night - or may stay awake for most of the day from a very young age and then wake frequently at night too.

The reality is that some babies do not sleep well despite being tired.  Nope, Nada no way - DBB are called such because they rarely seem to run out of energy!

DBB's according to Sears are:
"HYPERACTIVE"
"This feature of high need babies, and its cousin hypertonic, are directly related to the quality of intensity. Hypertonic refers to muscles that are frequently tensed and ready to go, tight and waiting to explode into action. The muscles and mind of high need children are seldom relaxed or still. "Even as a newborn, I could feel the wiry in him," one mother related
."
Whilst many would recognise this in a toddler, being "tense and tight" are not characteristics we typically link with the label hyperactivity.  I like "hyper switched on/hyper alert", as I feel it's more descriptive.  Their muscles are often frequently tensed and tight - their muscles and minds do seldom relax, but is this always easy to recognise this in a baby?  I've put together some of the indicators I think define a DBB.:

Signs of a DBB:

  • Baby appears very physically strong - many comment they head their head very early, sometimes from birth.  When they arch and push with their legs they feel strong and many are very early movers.  This is not related to size - baby may appear unusually strong for age/size.
  • Baby is very alert from a very young age - being "very alert" is very difficult to describe, but many mums of DBB comment how alert their baby is (and often others have too) they are often described as "very switched on".
  • They don't show tired cues - whereas when a typical baby starts to become tired, they slow down start to relax and show tired cues; the DBB is opposite.  They flip from awake to asleep without the relaxing/showing cues/unwinding.  One minute they can be playing happily, the next rubbing their eyes (an overtired cue) and if you have a tool like feeding to sleep/pram at this point, will typically suddenly zonk for a power-nap. Many DBB in my experience use either feeding/motion to sleep - not through habit but because it assists relaxation, they tend to be like marmite when it comes to  prams/carseats/motion, and either love or hate it.
  • Hyper when overtired - some have a slightly longer window of doing the stage above than others, some flip straight to the almost hyperactive behaviour a very overtired baby displays.  They may struggle to keep still, fidget, fuss and cry a "tired cry".  Some resume play seemingly full of energy again although they may be short tempered or as one mum described "manic" flipping from laughing to crying in quick succession.  The parent ultimately feels the baby is tired yet wont sleep!
  • Struggle to stay asleep - all babies have periods of unsettled sleep, for DBB's it's consistent and persistent month after month and comes with other signs here (as mentioned above babies can have unusually disturbed sleep for other reasons).  Baby may show signs of exhaustion with purple/blue bags appearing under eyes (whilst this may be a sign of food intolerance, lack of sleep will give you them too!) yet still no longer naps or stretches appear.  In fact often the more tired a DBB becomes, it seems the less they sleep!
  • Co-sleeping makes no difference - baby still consistently wakes 1-2 hourly, it's likely to be more bearable but DBB's may want to be awake and playing in the middle of the night, regardless of where they are.  Others have an intense sucking need and are described as "Velcro babies who would stay permanently attached given a choice."
  • Constantly moving - sit and watch a DBB and you will note they never keep still, even when tired  they do not relax.  A leg may be bouncing, an arm wiggling - but they're in some way always constantly on the move when not asleep.
  • Mum feels baby is tired - some mums will acknowledge their baby isn't sleeping the huge stretches many mainstream books state they will, but that they are happy, settled and content with the sleep they are receiving.  Others though have a gut feeling their baby is just not getting enough sleep and desperately want to help them sleep better.
  • Baby is very sensitive to mum's emotions - something I've noticed is that if you take an already tense baby, and you add a tense/frustrated mum, a lot of DBB's will become even more tense/unsettled and will struggle even more to settle; for some even just laying there willing baby to sleep seems to be enough to unsettle them!  If you're beginning to feel this way & are holding baby "change of arms" can help IE passing to partner can work, if no spare arms available laying down next to them on your bed or suchlike can be an alternative.  If you're "sleep willing", try and do some relaxation/breathing exercises yourself (great to teach DBB if they're still struggling in toddler hood too) to clear your mind and truly relax yourself, and you can sometimes be amazed how quickly this will help baby to settle too.  If all else fails taking a shower with baby is something many mums comment can be a good stress buster if home alone.
  • May cry before sleep or upon waking - especially if tired, some DBB can seem prone to almost needing to cry to settle and again when waking ie they wake fussy and grumpy not happy and well rested.  Parents sometimes say he cries whether I'm holding him or not so I may as well put him down, but crying in arms is very different to crying alone.
Identifying why your baby is struggling to relax is perhaps the hardest piece of the puzzle because it can be several causes or just one, so finding someone to help work through things can be difficult; reasons can range from an undiagnosed tongue tie, food sensitivities, cranial or structural discomfort from birth and so on.  Something I believe can help these babies in the meantime is.....wait for it......*whispers* a rough sleep routine *sharp intake of breath".

Before you hit close hear me out!

Just because baby doesn't show sleep cues, doesn't mean they don't have a window of time in which it is easier for them to settle to sleep.  Some studies have suggested when a baby becomes overtired their bodies produce adrenalin and other "stay awake" chemicals, which is why they can appear to become suddenly energetic.

My own Duracell bunny had a predictable wake up time - OK so it was 5am, but it was predictable.  By playing with the gap from wake up to sleep, rather than watching her cues - I found trying to assist sleep at a particular time had more success than others; with the highest success rate before she showed any sleepy cues at all (the window was so small from this to overtired, she didn't get the "wind down" time she needed).  I started with the morning nap and then worked my way through the day, once I had a rough idea of times I then adjusted accordingly this based on how well she had napped earlier.

Of course the easiest way to do this with a younger baby is sling wearing - most sleep in a sling so they are "in position" for when they start to become tired.  Contact and movement can help many DBB's relax (some resist contact and the sling and arch away) and with many carriers a small adjustment can be made to manoeuvre material, and help cut out visual stimulation for baby (which some DBB seem to really need).  Some slightly older babies seem to prefer a back ride to a front carry; resting their head sideways on the wearers's back to nod off.

If this isn't possible/doesn't work/baby is older and wants to be down playing -  you can try putting baby in the sling at what you've worked out as the "optimum times".  Despite what any book tells you this will be variable for each baby. As an example when my daughter was taking three naps, she needed to be relaxed and ready to sleep two hours after she woke for the first sleep, despite books etc saying she should have a longer gap for her age.  

Clock watching is a total pain - if you have a baby that is happy without, I wouldn't recommend it to anyone!  But if you're struggling it's something you can try and which may help a little..

The last thing I would add is that the DBB can easily seem to get stuck in a cycle when overtired, the less sleep they get, the more frequently they wake.

Something that can sometimes help is "sleep cramming", which is doing anything and everything that works to maximise sleep for a day or two IE laying down with them when they nap, feeding them back off if they stir (and you're breastfeeding) long walks in the sling/pram.  Sometimes helping them catch up during the day can pay dividends at night/early morning wake up time - but with some it can be easier said than done.  White noise, reducing stimulation eg colours, sounds etc can also help "switch off", whilst I would never endorse baby napping in a dark quiet space as important (it's oftenblooming inconvenient)- for some DBB in my experience it does make a big difference; in my daughter even encouraging her to turn and face the wall instead of gazing around her room had a dramatic effect.

Above all remember your baby is not waking to manipulate you or because of anything you have (or haven't) done.   They're not trying to be spirited, or "high needs", or challenging, or whichever term you prefer to use,    in fact they're just as bewildered as you (if not more so).  Instead of being left to cry or trained, these babies in fact need more understanding and sensitivity than your average bear; whilst I've met many mothers who have regretted not responding more, I'm yet to meet one who wishes they had responded less - regardless of what the mainstream books say.

Thursday, 17 November 2011

24 Hour Speed Raffle For Children In Need!!

RESULTS!


CONGRATULATIONS:


254, 216, 4, 338, 59, 139, 258, 209
I will email you in turn re prizes!

CLOSED
1 Ticket = 50p, 5 Ticket = £2
Upon receiving your donation we will reply with your ticket numbers.
Winners will be drawn using a random online number selector tomorrow evening, and results added to this blog post.

That's only 24 hours to buy a ticket!

Prizes: Each of the SEVEN winners will select a prize in turn until they're gone!  However one prize is a mystery prize....May be great, may be not great - that's the gamble!


Prize 1 = Pudsey Bear

Prize 2 = Pudsey's Beary Best Friend - Blush Bear 



Following the success of last year’s campaign that sold over 11,500 bears, Pudsey and Blush Bear are back and now available at Build-A-Bear Workshop® stores nationwide.

Pudsey and Blush fans are able to make their beary own BBC Children in Need mascot at any of 55 Build-A-Bear Workshop® stores across the UK with £5 from the sale of each Pudsey and Blush Bear going directly back to the national charity Appeal. Blush Bear who is Pudsey’s ‘BBF’, likes playing the drums and dancing and is on hand to help Pudsey with his busy fundraising schedule, lending him a well needed paw when he needs it. Blush loves to have fun and comes with magnetic paws to help her cover her rosy cheeks.

In 2010, Build-A-Bear Workshop donated a bear-illiant £135,000 to BBC Children in Need through the sale of Pudsey and Blush Bear and this year they’re hoping to do even better with the addition of new clothing for the furry pair. Every penny raised helps to make a positive difference to the lives of disadvantaged children and young people right here in the UK.

Prize 3 = A triple chain of aventurine, sodalite and citrine gemstone chips, with a lobster clasp.


Cluster jewellery produce handmade crystal & gemstone jewellery:
"Jewellery-making started off as a hobby of mine about 8 years ago and quickly turned into a mini-obsession! I really enjoy making pieces and go out of my way to source the best quality components: I only use silver- or gold-plated findings, some sterling silver as well; no nickeland nothing cheap and nasty. I use genuine Swarovski crystals, real gemstone chips, freshwater pearls and beads and some lampwork and glass beads."


Prize 4 = A custom twiddle buster nursing necklace 


Originally designed for nursing and babywearing mamas, Monkey Mama Necklaces are perfect for any mama who wants jewellery that offers style, safety and durability. The lightweight nature makes the necklaces easy and comfortable to wear.  Each necklace is created with handmade resin beads, with the lush colours of a candy store and the visual softness of seaglass

Monkey Mama Necklaces are created using super tough cotton cording and incorporate strong knotting techniques for extra security. The feature resin beads are completely non toxic and highly durable.  The beads that make up Monkey Mama necklaces are handmade in a small Indonesian craft business. They are fairly traded on every step of their journey to you.  Prize is a custom made twiddler in the colours of your choice!

Prize 5 & 6 = 2 x Brugo Mug
From Brugo Mug!

As I've given one of these away before, you can read the full lowdown on the mug here.  Brugo have in fact contributed numerous mugs to our mum and baby gift bags, so big thanks to them!

In short the mug  incorporates "Thermodynamic Technology", which in English means
not only does it keep drinks warm for several hours, it also cools some to the perfect temperature for you to drink....clever huh!

The lid has three options; lock, sip and tip and cool. When you first make your drink if you want to drink some straight away, you can twist the lid to the tip and cool setting. Tip the cup away from you for a few seconds and some of the liquid moves into the patented temperature control chamber.

You then swill with a "brandy" motion and that sip is instantly adjusted to the perfect temperature, while the remaining liquid in the main chamber stays hotter.

Prize 7......Mystery Prize......More details soon!


Wednesday, 16 November 2011

Why breastfeeding is NOT like taking a dump!

Earlier this morning whilst scanning the news, I spotted this article.  It outlines how a Michigan judge chose to publicly humiliate a mother; not for neglect, drug abuse or some other heinous crime judges like this must come across - but because she went to the back of the court room and began discreetly breastfeeding her fussing, unwell young baby.

When the mother defended her position by pointing out breastfeeding in public was her legal right, the judge claimed state laws did not apply in his court:
“Ma’am, it’s my courtroom, I decide what’s appropriate in here. Come on up, okay? You have to understand that a judge — the laws don’t apply in a courtroom. The judge’s law applies, do you understand that?
If this is indeed true, surely all attending should be given full details of what the the judge's whims laws are, otherwise how can anyone ensure they remain "judge's law" abiding?

Clearly anyone carrying a baby should be specifically told the  "breastfeeding is forbidden" rule - otherwise how are the mums supposed to know?  Given every health authority in the world (including the US) recognises the alternatives carry risks and so advise mums to breastfeed for a minimum of six months - why would anyone suspect a different US government building would defy state laws in order to prevent it?

The first comments that followed the piece were just as incredulous:

"Yes, breastfeeding is a natural bodily function vital for survival. 
So is taking a dump. 
But we don’t rail on about people’s right to do it in public. 
I’m sorry, as a woman and a feminist and a college-educated female feminist, I still think breast-feeding should be a private act and I fail to see why it’s such a horrible anti-feminist, anti-woman and anti-baby stance."
Had this been the first time I had ever had the misfortune to read such an ignorant rant, I would probably have just closed the page.  But comparing breastfeeding to toilet habits seems to be a pretty standard argument against public breastfeeding (particularly if you've ever picked up the Daily Mail) frankly it's crap, if you excuse the pun.

"As a woman and a feminist and a college-educated female feminist"

OK we get you're female and a feminist (twice) but it seems college clearly didn't adequately cover "bodily functions", so let's go right back to basics.

Feces

Feces, faeces, or fæces is a waste product from an animal's digestive tract expelled through the anus or cloaca during defecation. The word faeces is the plural of the Latin word fæx meaning "dregs".
The distinctive odor of feces is due to bacterial action. The perceived bad odor of feces has been hypothesized to be a deterrent for humans, as consumption or touching it may result in sickness or infection.[4]

Human breast milk

Breast milk is the milk produced by the breasts of a human female for her infant offspring. Milk is the primary source of nutrition for newborns before they are able to eat and digest other foods; older infants and toddlers may continue to be breastfed, either exclusively or in combination with other foods. 

After 3 to 4 days, breasts will begin producing milk that is thin, watery, and sweet. This quenches the baby's thirst and provides the proteins, sugar, and minerals that the baby needs. Over time, the milk changes and becomes thick and creamy. This satisfies the baby's hunger.[16]


The first contains potentially harmful pathogens that can cause sickness or infection, hands need thoroughly washing afterwards and thus a bathroom is a sensible idea; not to mention, where would you put a random dump in a court room?

The second is an antibacterial, antimicrobial substance that has been shown to actively kill infections - hands do not need washing post breastfeed; milk goes into baby.

I'm hoping I don't need to point out the differences between an anus and a breast!

Breastfeeding is no less hygienic than anyone else sat eating (and a great deal more so than some people's "washing machine style" of food processing that I frequently have to witness).  If the mum was sat squirting it around the room rather than into her baby's mouth, I could perhaps see the issue!

Next, does any one else see the irony in someone purporting to be a feminist, yet who also supports the suppression of women using their breasts for their intended purpose?

Isn't that rather like someone calling themselves an "advocate for same sex marriage", right before adding "as long as they are only a couple in private and don't rail on about wanting rights to be affectionate in public" ?  Then claiming they fail to see why that is an anti-homosexual stance....

Feminism

Feminism is a collection of movements aimed at defining, establishing, and defending equal political, economic, and social rights and equal opportunities for women


Yet men can even go topless in public right?
Breast Bottle
What makes it a private act, why is a real breast so much more inappropriate than a plastic replica of a breast and nipple, or just a nipple in the form of a pacifier? Would it have caused such a brouhaha had the mum pulled out either of those instead of the genuine article?
What should this mother have done? She presumably had to attend the court, she had to take her unwell nursling - had she denied his cues to feed, he would likely have cried, loudly; is that appropriate for a court room? Would that not have disturbed proceedings far more? No doubt then the "dump brigade" would have been tutting and muttering about how inappropriate the noise was.  Perhaps babies just shouldn't be allowed in public full stop?

Society needs to realise that milk of our own species is the normal way to feed a baby, and if it's a location a baby is permitted, a mother has a basic human right to be able to feed her baby as he requires without doing so in a toilet or a stinky nappy changing room.  Why should a hungry baby incapable of waiting, have less right to eat than an "educated female feminist"?

Related Posts: 
Breastfeeding mums should use a bottle in public!

Breastfeeding in public is offensive - see for yourself!



Tuesday, 15 November 2011

Emma's Pregnancy Diary - Armadillo Style


When the lovely Emma (who helps as an admin on Facebook) rang me to share some news, I thought it would make perfect blog fodder to share with you all.  Ever modest Emma wasn't sure people would want to read her story, but after a little harrasement asking nicely, she kindly agreed <grin>.  


Whilst we see lots of journals shared by first time mums, I thought hearing from a mum of two planning her third addition might be of interest to those who already have children and perhaps are thinking about more! :D

Over to Emma:

I'M PREGNANT....Well, it’s a good start. That was the plan. We’ve been “trying” for quite a few months, but as my periods haven’t started since the birth of son #2 and I’d had no signs of ovulation so I didn’t think that we were going to get anywhere fast.

The Armadillo is chuckling heartily at this point, because I recently rang her recently to discuss my nursing son’s fussy behaviour and tiredness. When she asked if pregnancy was a possibility, I assured her it wasn’t – because of course, I was sure it wasn’t.

Quite how I came to find out I was pregnant is another story in itself - so here’s what happened.

Given that I knew quite clearly I could conceive on my first ovulation, I was looking out for signs of egg laying (fluids, cervix position and Mittelschmerz, I wasn’t bothering with temperatures). I pride myself on being pretty switched on with this stuff; Which as they say, comes before a fall!

So I didn’t notice any signs of ovulation, and was assuming that they were still suppressed by son #2’s breastfeeding. I’d been chatting to my breastfeeding counsellor about ways to trigger ovulation, and we were aiming for a 5 hour gap within each 24 hour period as for some women this is enough to get things going.

However, given, I thought, that I may just miss that I’d ovulated, and given that I might just conceive on that first cycle, I thought I’d be very smart and be one step ahead of myself. So I ordered 20 cheapy ebay tests for about £2 so that I could take one test every 2 weeks, thus knowing for sure when I wasn’t pregnant, so I would then know how far on I was when I did get pregnant.

They duly arrived and I quickly did one, just to get a job out of the way, and nearly passed out with shock when the pink line appeared. It’s a good thing that I bought 20, as I used the next 10 straight away (well, you never know). It’s a good thing that hubby works from home so I was able to go straight up and tell him. That put a grin on his face.

So the next question is – how pregnant am I?

I’ve been really, really tired for about three weeks now and just not managing to keep up with my normal “stuff”. So, I’m guessing 7-8 weeks would be about right. I’ve obviously conceived on my first ovulation post delivery, which is great, which would make it about 13 months without periods. Good old breastfeeding.

Now to see if I’m right…



24th October
I’ve booked in with the midwife this Friday. I’ve actually moved surgeries to do so! I am a peer supporter and one group that I sometimes cover has a midwife drop-in at the same time. The midwife is really pro home birth, and a few months ago was running a big fun day at the local Children’s Centre to raise money for homebirth pools. I was very happy to be able to help, running a stand for our local NCT group. A friend made an amazing cake with a waterbirthing mum and baby on top! That went into the raffle and was very much admired including by one small boy (not mine!!) who decided to try to have a taste. It was a good day. I liked the midwife so much that I decided to find out which surgery she was at, so this afternoon saw me filling in new patient forms for me, Son #1 and Son #2 (hubby is sticking with his GP, thank you very much).

The receptionist asked me how pregnant I was and I was very embarrassed to say that I had no idea, but I guessed 7-8 weeks. Hopefully my midwife will be able to give me a better idea!

UPDATE TWO

28th October
Midwife booking appointment - she was as lovely as expected and delighted to take me on as a homebirth booking. We had a good chat about my last two births and how things didn’t go as planned, and why I was so determined to home birth this time. She explained about the Trust’s obligations to provide a home birthing midwife and how to be firm on the day should it be necessary.

We discussed some of my really big concerns, such as the PPH (post partum haemorrhage) that I’d had last time and how she would handle it and was extremely reassuring. In both my last deliveries I’ve aimed for an unmanaged third stage. With Son #1 they got very jittery and scared me after an hour had passed, and persuaded me into the injection. With Son #2 they were very encouraging and supportive, and all was fine, but then I did start to lose blood which was rather worrying for everyone and I ended up very weak after birth and anaemic for some months afterwards. It was all fine, but I think a bit less messing around with me and a bit more letting me get on with it would have ensured the contractions would have racked back up more quickly and limited the blood loss.
So after all of this, out came the pregnancy wheel and she asked me when my last period was. I don’t think that “2009” was helpful! So she then asked me if I’d any idea of my dates and I had to make a full confession: not only did I not know how pregnant I was, I’d not actually thought I was pregnant when I took the test!

Once we’d established that I for one couldn't help with dates, I popped up onto the couch and she had a rummage around.

Shock number two – she estimates 12-14 weeks. Aarrgghh!

31st October
Emergency scan at a private scanning clinic as the NHS can’t offer me a scan for another 2 weeks. We want the nuchal scan (Down’s Syndrome test) and if I’m really that far on then that might be too late for the nuchal. Despite been here twice before with Sons #1 and #2 it didn’t make it any easier. In a sense we didn’t really know why we were doing it because if it came up as high risk, what then? It’s not a diagnostic scan, just a screening giving a risk, not an answer. We really don’t want to have an amniocentesis with the risk of miscarriage. I think we’re both burying our heads in the sand a bit and hoping for the best.

On the other hand it all seems a bit silly, because there are so very many ways in which a baby may have problems, so why a low risk result would be reassuring I don’t know! Still, it was wonderful to see that the pink pregnancy test line had magically morphed into a cute little baby shape, complete with heartbeat and nasal bone (which apparently is a good thing on the Down’s test). Baby measures at 14 weeks! It seems to get longer every time! I have a blood test taken to get the most accurate screening results which we’ll get in a few days.

We drive home armed with lots of fuzzy piccies of a rather skeletal looking baby and memories of the sound of the heart beat, hugely happy and excited and just ever so slightly embarrassed. Or I am, at least. Hubby really can’t believe that I’m over 3 months pregnant and didn’t know. So much for me being “in tune” with my body. Much ribbing was undertaken.

3rd November
Flu jab. I’d been told in no uncertain terms that contracting flu could be quite dangerous for a pregnant lady so after some research I decided to go for it. I’ve never had one before so was hoping I wouldn’t have a reaction to it. Everyone seemed to be really pushing it at the surgery and saying that it was totally safe, etc etc, until I actually got to the nurse who did the jab who then proceeded to tell me that it was untested in pregnant women (because it’s unethical – but apparently quite ethical to just dole them out), we don’t know if it’s safe for the baby, blah blah. I made some comment about how it’s been around for a while now and we’d have heard about any significant problems to which she replied, “well we’d hope so” which didn’t fill me with confidence! I asked if my having the vaccination would pass any immunity onto Son #2 through my milk, which she didn’t know but she did then pull out all her documents to see if it was safe for lactating women (which it is, apparently. Either that, or untested!). Nice that she didn’t bat an eyelid that I am breastfeeding a toddler (who was with me causing havoc and destruction as is his norm).

4th November
UK Association for Milk Banking Trustees meeting today. We’re planning some awareness campaigns including one in May so I fessed up to the fact that I was likely to be busy on or around the 1st May. A fellow trustee with 3 children made it clear that I was totally nuts by joining the club J. Ah well, at least we know it’s not twins.

And we got the results from the nuchal scan! Excellent result – risk of 1:21,000 compared to my age-related risk of 1:175. It is a relief and yet I can’t help but wonder why. There are so many disabilities out there, so why did we put so much score on just one? And then there was the awful question of what would we do if the risk factor came back as a high risk? This is a screening test, not a diagnostic test. Would we then risk the diagnostic test with a miscarriage rate of between 1:100 and 1:200? And let’s say we did that, and it came back as positive for Downs. Then what would we do?
 
These questions, in one form or another, are questions that most pregnant mums or couples will need to work through, even if it’s only to decide that they’ll have no screening at all. For us, we chose to bury our head in the sand and wait for the screening results, feeling that there was no point in trying to resolve the “next step” questions unless necessary.

I feel very lucky in many ways that we have reached this point in this pregnancy without having the weeks of anticipation. I think one of the hardest things is finding people to discuss it with because of the high levels of emotions involved with all “options”. We can now close this door and move on – at least until the 20 week scan. But many people can’t, and that’s tough to think about.

I wish that a more open discussion about the euphemistic “options” was possible. I don’t think that anyone can imagine themselves being the parent of a child with a serious disability, but the idea of aborting one’s child is also abhorrent. For some it would never be an option and for others it would be the only choice. Emotions, quite rightly, run so strongly on both sides that to even think about mentioning it risks deep distress – and yet not talking about it leaves mums approaching screening in a state of confusion and worry. This is why I have written this post. I don’t have any answers but I know I’m not alone in wishing that there were some.

Friday, 11 November 2011

The Dangers Of Demonising Bed Sharing

To bedshare or not to bedshare - this is the question that is often hotly debated on parenting forums.  Guidelines (including those just released by the AAP) often state "in a different bed in the same room", ie no sharing; which would appear to support the notion it's generally a risky business, ties in neatly with many mainstream books and thus socially "sits comfortably".

However what is the evidence behind these guidelines?  Explore it (including new research out this month) and we find a very different and more detailed picture about infant sleep; hence debate ensues.

The trouble is that just like the starting solids guideline - official recommendations have to be a short snappy piece of information that everyone can understand.  A guideline cannot be detailed, discuss different risk factors and provide information so parents can review and act accordingly.

Therefore don't bedshare is considered a "key" message.  A fact FSID don't dispute.

Joyce Epstein, director of FSID, says:
 "If you can get people's attention for more than three seconds you would like to give the whole story every time, but at what point do you lose everybody?"
From their perspective, the simple direct message – put your baby to sleep in a cot near the bed, not in the bed, is the key.
But I'm not sure the message is actually all that safe - and here's why....

This is what the AAP guidelines actually state if you go beyond the bullet points:
"Bed Sharing 
There are some reports of infants being suffocated by overlying by an adult, particularly when the adult is in an unnaturally depressed state of consciousness, such as from alcohol or mind-altering drugs. Co-sleeping on sofas has emerged as a major risk factor in 1 study.  Others have shown bed sharing with multiple family members in an adult bed to be particularly hazardous for the infant. Although overlying may be the mechanism in some of these cases, soft sleep surfaces, entrapment, and the likelihood of rolling to the prone position in such circumstances also may have a role. The risk of SIDS associated with co-sleeping is significantly greater among smokers.  Some behavioral studies have demonstrated that infants have more arousals and less slow-wave sleep during bed sharing, but no epidemiologic evidence exists that bed sharing is protective against SIDS. (remember the bold bit I will come back to that in a moment)"
But is there any evidence at all to suggest an infant is more likely to turn prone when co-sleeping than when in a cot?  Why don't the AAP tell us what the actual risks of co-sleeping are in a prepared environment ie not on a soft sleep surface (ie waterbed/pillows and heavy bedding near baby) no risks of entrapment/entanglement, no drugs/alcohol, no unplanned cosleeping ie mum falling asleep sitting up, baby next to mum alone and not in the middle of a family bed AND exclusively breastfeeding - where are these figures?

Now scroll down the AAP guidelines to "Proposed Mechanisms of SIDS":
"It is generally accepted that SIDS may be a reflection of a variety of causes of death. A leading hypothesis for a large proportion of SIDS cases is that SIDS may reflect a delayed development of arousal or cardiorespiratory control."
and
"The hypothesis is that certain infants, for reasons yet to be determined, may have a maldevelopment or delay in maturation of this region, which would affect its function and connectivity to regions regulating arousal. When the physiologic stability of such infants becomes compromised during sleep, they may not arouse sufficiently to avoid the fatal noxious insult or condition."
Right - but as nobody has done an epidemiological study to prove bedsharing is protective (remind me again where the studies are proving cot sleeping is protective?  Wasn't SIDS called cot death for long enough?), we don't acknowledge any link here? Has there been a a study proving safe bedsharing isn't protective?

Just this month a study published in Biological Psychiatry found:
"Heart rate variability in 2-day-old sleeping babies for one hour each during skin-to-skin contact with mother and alone in a cot next to mother's bed. Neonatal autonomic activity was 176% higher and quiet sleep 86% lower during maternal separation compared to skin-to-skin contact."
In basic terms this means separating mother and baby caused significantly more "anxious arousal" and less "quiet sleep".

Dr Bergman, co-author states:
"What is desirable for newborns is to have 'sleep cycling,' which means an even distribution between active sleep and quiet sleep, in periods of about one hour," 
"In our study, sleep cycling in separated babies was mostly absent, and in six of 16 babies that did show some quiet sleep when separated, it was shorter and shallower."
The scientists also noted concern that the disrupted sleep patterns and stress to the heart could make it difficult for them to form relationships.
This research addresses a strange contradiction: In animal research, separation from mother is a common way of creating stress in order to study its damaging effects on the developing newborn brain. At the same time, separation of human newborns is common practice, particularly when specialized medical care is required (e.g. incubator care).
Dr Bergman added:
"When babies are smothered and suffer cot deaths, it is not because their mother is present.  It is because of other things: toxic fumes, cigarettes, alcohol, big pillows and dangerous toys."
 Dr. John Krystal, Editor of Biological Psychiatry, commented on the study's findings:
 "This paper highlights the profound impact of maternal separation on the infant. We knew that this was stressful, but the current study suggests that this is major physiologic stressor for the infant."
This larger study echoes what Dr Sears found when he conducted a very small experiment of his own:
"Our study revealed that Lauren breathed better when sleeping next to Martha than when sleeping alone. Her breathing and her heart rate were more regular during shared sleep, and there were fewer "dips," low points in respiration and blood oxygen from stop-breathing episodes. On the night Lauren slept with Martha, there were no dips in her blood oxygen. On the night Lauren slept alone, there were 132 dips. The results were similar in a second infant, whose parents generously allowed us into their bedroom."
Dr Mckenna has written extensively on the subject as to why he feels infants are more at risk sleeping alone - yet mainstream media and literature barely gives a nod to these significant findings.

He states:
"Mechanical breathing teddy bears placed next to apnoea-prone human newborns, which replicate what the mother’s body provides, have the effect of reducing infant apnoeas sometimes by as much as 40–60%, in addition to physically drawing infants to sleep next to them.39
Many studies similarly show that infant mammals, including human infants, appear to be pre-sensitised to receive sensory signals linking them to a co-sleeping partner.40–43  All have been shown to change infant physiology, including heart rate and breathing patterns including increased arousals yet the cessation of excessive night-time crying.
Until recently, all human infants experienced access to at least one cosleeping adult body, usually the mother 45,46 so it is not surprising that maternal contact stimulates a variety of significant ‘hidden regulatory processes’ that are clinically advantageous to infants."
Dr Mckenna has also noted the mother's sleep patterns differ when separated from her infant:
"We found that bed-sharing infants face their mothers for most of the night, and that mother and infant are highly responsive to each other's movements, wake more frequently, and spend more time in lighter stages of sleep than they do while sleeping alone.  Co-sleeping makes it easier for a mother to detect and respond to an infant in crisis."
Interestingly mum also hits more restful sleep phases for longer.

So here we have internationally recognised doctors (not just a random unqualified baby tamer who has written a book) stating actually co-sleeping may be protective against SIDS.  That cot sleep may in fact be more risky?

This all seems rather a far cry from "don't bedshare" doesn't it?

However, people are comfortable demonising bed sharing....

On 14th July 2009 here is what hit the news:
"Co-sleeping dangers.  54% of cot deaths due to co-sleeping! More than half of cot deaths happen when a baby is sleeping with a parent, a study has revealed."
At a glance that leaves many parents content they use a cot and off they go..

But even if we take this statement at face value and look no further - it's surely immediately obvious that if 54% of infants were co-sleeping, 46% were in a cot?  Hardly a compelling demonstration of cot safety?

The professor involved with this study was not happy at the headlines however. He hit back in a Guardian article days later. They reported:
"Yes – the study found that 54% of cot deaths occurred while the baby was co-sleeping with a parent. But although the risk was strong if they had crashed out on the sofa, it was only significant among those in a bed if the parent had drunk more than two units of alcohol or had been taking drugs."
Professor Fleming himself commented:
"You can say that half the deaths occurred while babies slept with their parents. You could also say that half the deaths occurred while babies were alone in their cots, he says, but: "I don't see anybody saying, 'Don't put your baby in a cot.'"
Quite!

When babies are shown to have suffocated due to a fabric comforter - the guidelines are updated to say don't use comforters.  Ditto cot bumpers and duvets/pillows under one year old.  Yet when a baby has been shown to become entangled and suffocated on inappropriate bedding when bedsharing, the guideline isn't "address the problem",  but "don't bedshare!"

There is also an underlying assumption cots are safe. This article highlight two strangulation deaths of infants with the electrical cords from baby monitors. This the risk of blind cord strangulation when unsupervised (including in cots) I have read stories of babies pulling heavy or dangerous items in on top of themselves, or worse this poor boy who died after becoming entrapped when climbing out.  Yet nobody ever suggests not using a cot, instead parents are advised to ensure appropriate measures are taken to make the area safer.

Furthermore going back to the study, if only 54% were co-sleeping to start with, once you remove known risk factors and compare the revised figure with those sleeping in a cot, the picture is very different.

What's really interesting is that same study found ONE QUARTER of infants were swaddled. A whole 25% - yet where was the news article highlighting this? Why are popular parenting books who are so anti cosleeping, still promoting swaddling without any mention of this? (nor is this the only study that has demonstrated a link as the second half of this article highlights)

Even if we move the debate away from the simple argument of which location is safer in terms of statistical outcome. We also need to consider the knock on effect, and therefore possible risks associated with where parents place their baby to sleep.

We know that when we tell parents co-sleeping is unsafe, many decide their baby will sleep in a cot. The very real danger with this is that a parent falls asleep sitting up in bed, or on a sofa. Something the above study found was a massive risk factor with regard to SIDS. Every parent of course believes they would never fall asleep when feeding - yet nature delivers a huge hit of sleepy hormones when mum breastfeeds (strange if mum isn't supposed to be sleeping on the job ;)) and despite best intentions many many mums report accidentally falling asleep - including myself (who didn't co-sleep due to ignorance and official guidelines with my first).

One mum commented she had to play with her iphone to ensure she stayed awake, others try moving from bed to an upright chair to prevent temptation.

The knock on effect of this may be minimal if you have a baby who only rouses infrequently.  Throw a frequent waker into the mix however and there is a good chance the mum will a) become overly tired which in itself is listed as a SIDS risk, b) give up breastfeeding believing she needs more sleep to function than the current (PITA) night ritual provides.

Yet not breastfeeding is not only linked with SIDS but other significant health outcomes too.  In fact the one significant risk factor the vast majority of studies fail to adjust for is feeding method ie breastfed, breastmilk or formula.  Those that have demonstrate a compelling link - therefore any that do not, are potentially fundamentally flawed from the start?  The definitions of co-sleeping and bedsharing are often blurry, known risk factors not adjusted for and so are parents really getting the big picture?

Professor Fleming shares the same concerns with regard to the "no bedshare" message::
"The study showed that sleeping with the baby on a sofa really is a risk. Yet seven of the parents whose baby died say they had gone to the sofa to feed, aware that bedsharing is said to be dangerous, and had fallen asleep.
Any advice to discourage bedsharing may carry with it the danger of tired parents feeding their baby on a sofa, which carries a much greater risk than co-sleeping in the parents' bed," 
To sum up a quote from Dr Mckenna:
"The possible hazards of co-sleeping must be assessed. Is the environment otherwise safe, with appropriate bedding materials? Do the parents smoke? Do they use drugs or alcohol? (These appear to be the main factors in those rare cases in which a mother inadvertently smothers her child.) Since co-sleeping was the ancestral condition, the future for our infants may well entail a borrowing back from ancient ways."
  UNICEF Bedsharing Guidelines

Wednesday, 2 November 2011

"Me Time" - When did it become critical?

"Me Time" - we hear a lot about it.  It's the essential time every mum must have, without which one cannot possibly mother adequately the rest of the time.  The Baby Whisperer (original) clearly recognised this and handily built her routine EASY (Eat, Activity, Sleep, Your Time) - to of course help keep parents sane.

I recently heard of a mum of a four week old baby, who had decided to place her daughter in nursery part time as she needed "me time".  This was a much awaited and longed for child, yet only four weeks in mum was so overwhelmed she planned separation.

Marketing bods of course also recognise mothers are busy and desire "me time", and so design a whole host of tools to assist - from dummies that attach to the mattress so a baby can put them back easily without requiring a parent, to ready made bottles and then bottle holders to feed the baby, because clearly feeding is a chore that can be delegated to an inert third party.

But recently I began thinking about a book I read a while back, "Call The Midwife" - a recount of 1950's East End London from the perspective of a midwife.   These women had up to 14 children, they had communal washing/drying areas, their husbands were typically working or at the pub (no sharing of house work) and I wondered when did they get "me time"?

Washing, mending, baking, - all without the many gadgets we have today; would they not marvel at how easy we have it in comparison? (and yes many mums work, but few do in the very early weeks)  I wonder just how much "me time" these mothers had and how they managed without being committed to therapy?


Whilst I'm not suggesting we revert to 1950's style parenting, or implying any mum who has an interest outside the home is anything other than normal, but is it realistic to expect lots of "me time" with a young baby?

I began wondering does it in part come down to expectations?  The reality is that first babies ARE an all consuming life changing experience - new parents often tell me how overwhelmed they feel and I remember being there!

Perhaps today's typically smaller families mean there's a lot less first hand experience when young of what younger siblings were like?  Perhaps the more nuclear set up means many have no direct experience of life with a baby pre their own?

For whatever reason many parents pre baby believe he/she will just slot neatly into their existing lives,  but this doesn't generally mean popping baby in a sling and taking them along.  Instead it means their behaviours will be convenient to the parent - they will nap alone for X hours to give "me time",  they will self soothe and cut night feeds ASAP so the parent's sleep is not disturbed.  But 99% of babies didn't read the manuals their parents did; so they often need "training" or "manipulating" to conform; those that recommend this often failing to address longer term potential impact of their methods.

Breastfeeding and responsive parenting may be biological norms, but I think there is a huge chasm between this and social norms and thus expectations.

In order to come close to social norms, a whole host of books and gadgets may also be required - with parents feeling they are doing something wrong if they can't get their baby to fit!  They can be told they are making a rod for their own back or must get tough - despite the fact this really is quite illogical!  Which other mammal is born and fed by a holder (sometimes milk of another species), comforted by a plastic replica or cloth reminder of their mother, expected to put themselves asleep, and stay asleep for a specific amount of time somewhere away from their mother?

Yet in comparison to many mammals, humans are extremely immature; the newborn's brain is only about 25 percent of its adult weight at birth, while most other mammals are born having 60 to 90 percent of theirs.  Think how soon after birth some walk!

James McKenna, Ph.D., professor of anthropology at Notre Dame University explains that when primitive women evolved to stand up on two legs, the shape of the female pelvis became narrower and resulted in human babies being born three to four months earlier, before their heads grew too large to pass safely through the birth canal.

This has led to many believing there is a "fourth trimester" once baby arrives - the baby's only real needs warmth, comfort and nutrition.

In some ways "baby rearing" is actually far more simple in less developed areas; mothers simply pop baby in a sling, feed them when hungry and they sleep when tired.  No routines, schedules, expectations or rod making...It seems the more sophisticated our lifestyles become, the more we need time "off" to cope.