Mothers SHOULD leave babies to cry, because the study says so?

"Don't get up if your baby cries at night: Mothers SHOULD leave their babies to 'self-soothe' says leading expert "

Was the Daily Mail headline.  Science Daily went for:

"Let Crying Babes Lie: Study Supports Notion of Leaving Infants to Cry Themselves Back to Sleep"

Crikey, right!  What about dads or mum's partner, can they respond?  ;-)

Let's see the evidence...

From a study of 1200 infants

"66% of the children showed a flat trajectory of sleep awakenings from 6 through 36 months, with mothers reporting their infant awakening from sleep about 1 night per week. 

The second group, labelled Transitional Sleepers, included 34% of the infants. These children had 7 reported nights of awakenings per week at 6 months, dropping to 2 nights per week at 15 months and to 1 night per week by 24 months."

To summarise, 2/3rds of babies woke once per week, 1/3 woke seven times per week. Given a whole 1/3rd continued to wake, it was hardly a tiny minority.  What is also interesting to note is that the authors used data collected in 1991, that's 20 years ago!

This is significant as there was a dip in breastfeeding initiation rates in the late 1980s, followed by a return in the mid-1990s (1); ie breastfeeding rates were low at the time of data collection.  Are we basing our "normal infant sleep" on infants fed human milk or that of another species?  No idea as the study doesn't tell us that...

It does note:

"Compared with Sleepers, Transitional Sleepers were more likely to be boys, score higher on the 6-month difficult temperament assessment, be breastfed at 6 and 15 months old, and have more depressed mothers at 6 months old."

1.  "Score higher on the 6-month difficult temperament assessment":  A parental assessment (not independently validated), the flaws of which are discussed here, in a piece that discusses why "irritability" might actually be a positive behavioural trait:

"Humans often perceive infant crying as stress, but for infant animals irritability is a normal component of signalling to parents. The expression of offspring demand is part of a dynamic signalling system between parents and offspring, and has received much attention from zoologists studying a variety of bird and mammal species."

Philip Zeskind, an associate professor of psychology states:

"Although breast-fed babies are perceived to be more irritable than bottle-fed newborns, our results suggest that the behaviors of breast-fed infants are physiologically more desirable. Feeding infants formula may make them sleep more and may disrupt the smooth running of their arousal systems."

2.  "Be breastfed at 6 and 15 months old":  Given that we know beyond any doubt human infants are supposed to receive human milk at this age, if babies wake more frequently when breastfed this is probably the norm.

3.  "and have more depressed mothers at 6 months old":  Perhaps because they're constantly being bombarded with the notion their baby should be sleeping and that it's their fault if not?  Perhaps because nobody told them 1/3rd of babies continue to wake as per normal behaviour?

Professor Marsha Weinraub, from Temple University, Philadelphia, who led the study, said in an interview:

‘When mothers tune in to these night time awakenings... then he or she may not be learning how to self-soothe, something that is critical for regular sleep.’

Anyone else wonder how long it would be before we hit those infamous words "self soothing"?

The key mantra of baby tamers everywhere, seems key to this study too.  But that in itself is rather a stumbling block, as blogger "Uncommon sense" highlights in her piece "Self-soothing. Possibly the biggest lie ever foisted on parents".

But let's run with it for the moment and assume that Weinraubs can actually provide evidence in her study that a) mothers shouldn't tune in to night time awakenings; b) if they do this disturbs the baby's learning how to self-soothe which is critical.  Where does Weinraubs say we should be leaving them to cry as per the media reports?

Furthermore, perhaps we had better a) nudge all those teenagers who were raised responsively, but now enjoy sleeping until noon! b) let mothers across the world know this ASAP.  Because as Jared Diamond, author of the book The World Until Yesterday: What can we learn from traditional societies? explains:

“A cross-cultural sample of 90 traditional human societies identified not a single one with mother and infant sleeping in separate rooms.  The current Western practice [of separate rooms for mother and child] is a recent invention responsible for the struggles at putting kids to bed that torment modern Western parents.”

And that's the interesting thing, "sleep problems" appear to be a Western phenomenon.   In fact what constitutes a sleep problem seems based upon parental expectations, rather than any sort of official criteria:

"Healthy babies cycle through sleep stages, waking several times during the night. Generally, babies soothe themselves and return to sleep without alerting their parents (Anders et al, 1992; Goodlin-Jones, Burnham, Gaylor, & Anders, 2001)
When babies are not able to return to sleep on their own, they may signal their awakening to their parents. This signaling may take the form of either crying or calling out, and it alerts the parents to the child’s awakening. 

This signaling can be disruptive to parents (Karraker & Young, 2007) and considered a sleep “problem.” Some researchers see these sleep awakenings reported by parents to be sleep continuity problems (e.g., Sadeh & Anders, 1993). Although not all parents experience infant signaling upon awakening as problematic (Karraker & Young, 2007), describing and understanding sleep awakenings poses an important challenge for developmental psychologists".

So generally babies soothe themselves and return to sleep without alerting their parents?  Which babies are these?  How were they fed?  Where did they sleep?  Had they been "trained" to sleep?  It's certainly not what many cultures expect:

In a piece entitled "Why African Babies Don't Cry: An African Perspective" by Claire Niala, one of the key tips is:

• Co-sleep. Many times you can feed your baby before they are fully awake, which will allow them to go back to sleep easier and get you more rest.

Quite!  But should we be thinking about shipping some of our best therapists to Africa, as surely nobody will learn to sleep with parenting this responsive?

I decided to get the whole paper, but quickly regretted it.

It's all based around the notion that infants calling/signalling (ie crying) to their parents at night is disruptive, and therefore a sleep problem.  Which, if a good chunk of the world expects babies to wake, would explain why we're the only ones with problems!

The study starts by considering "Intrinsic Variables Related to Sleep Awakenings" - of course based on said assumptions.

"In particular, babies who breastfeed may find it difficult to soothe themselves and return to sleep in the middle of the night because they have become accustomed to falling asleep while nursing (e.g. Karraker, 2008). Early in infancy, breastfed babies may awaken more frequently throughout the night than formulafed infants (e.g. Elias, Nicholson, Bora & Johnston, 1986) because breast milk is digested more quickly; later in infancy, breastfed infants may awaken more frequently, not because they are hungry but because they have difficulty returning to sleep without the customary nursing (Karraker, 2008; Middlemiss, 2004)."

So babies who are fed as per the biological norm may find it difficult to soothe themselves because they fall asleep when feeding.  This is in part because breastmilk delivers a nice dose of sleepy, relaxing hormones; and also because they're snuggled up warm with mum, her scent, touch and taste.  Anyone who has breastfed a baby who isn't sleepy may  have noted the eye-rolling  "milk coma" breastfeeding can induce.  So we have to stop breastfeeding?

Let's flip the language:
"Early in infancy non breastfed babies may awaken less frequently throughout the night than breastfed infants, because formula is more difficult to digest.

And this is a good thing for babies?

We then do a U-turn as authors acknowledge:

"As capacity for self-regulation in the second and third years of life increases, most children resolve their early difficulties with sleep awakening (Bronson, 2000; Tikotzky & Sadeh, 2009)."

Aaaahh right, so perhaps instead of "resolving early difficulties", they just develop normally and transition towards independence as so many other cultures expect?  Cancel the therapists!

The study goes on to say:

"Difficult temperament appears related to sleep awakenings and sleep problems in general. According to Sadeh & Anders (1993), infants who are irritable and hypersensitive and have lower sensory thresholds may sleep for shorter periods and nap irregularly. Morrell and Steele (2003) suggested that difficult infants may elicit more active parent comforting, which may perpetuate night awakenings."

So babies who have a "difficult temperament" also tend to have disturbed sleep.  Note this doesn't suggest that disturbed sleep causes the "difficult temperament", only that the two are observed together.  In practice if something is making baby irritable during the day, it can also disturb sleep; it's hardly a ground breaking revelation (as millions of parents who have soothed a teething baby know).

Next up breastfeeding:

"Several studies have associated problems with sleep awakenings with factors related to breastfeeding— being nursed to sleep, having parental presence until sleep onset, or being fed on awakening (Lam et al., 2003; Touchette et al., 2005). Elias, Nicholson, Bora, and Johnston (1986), following babies for 2 years, reported that sleep awakenings were common in breastfed infants throughout the first 2 years of life; few studies have disputed this finding."

Uh oh, several studies have found our biological norm is to feed and wake frequently, like our closest mammalian relatives and other carrying mammals :O  So, ultimately what these studies confirm is that it is normal.

What's even more interesting is the paper (the one the media claim supports leaving babies to cry!) states:

"By 18 months old, not only are Transitional Sleepers able to sleep through the night without awakening their parents, but they are indistinguishable from the children who, from the beginning, had frequently slept through the night without signaling."

But hang on, I thought this learning to self soothe and stopping "signalling" early was critical?  Yet by 18 months all children slept the same?

It continues:

"The suggestion by Morrell and Steele (2003) that difficult infants may elicit more active parent comforting that may perpetuate night awakenings does not gain support from our findings"

And

"Most studies generally show that that maternal sensitivity is related to optimal and more desirable or advanced developmental infant outcomes (Davis & Logsdon, 2011). 

Here, we found that greater sensitivity was related to more awakenings at each assessment period. Infants whose mothers display sensitivity during play and structured interactions are more likely to continue to awaken more frequently than infants whose mothers are less responsive."

So there is nothing to support the theory babies wake because they are comforted, but studies show the less responsive the mother in general, the less the baby wakes.  Furthermore, responsive parenting has been repeatedly shown to "more desirable or advanced developmental infant outcomes".

It goes on to theorise:

"One explanation may be that generally sensitive mothers during the day are also more inclined to intervene when the infant shows signs of struggling with sleep. This may support Karraker’s (2008) suggestion that when mothers attempt to assist their children in returning to sleep, their responsiveness reinforce behaviors in the child that run counter to self-soothing and self-regulation.

One counter to this interpretation is that we find this relation between infant signaling upon awakening and maternal sensitivity as early as 6 months old, a time when infants might not be as sensitive to instrumental learning as after 9 months (Bell & Ainsworth, 1972). 

Alternatively, it may be that mothers who are more sensitive are more likely to hear their children signaling upon awakening, and they are therefore more likely to report these awakenings. Their behavior may not be instrumental in interfering with children’s self-soothing at all. "

So basically they don't know?

But wait.

Where is the evidence to support the comments researcher Professor Marsha Weinraub made about self soothing?  This study doesn't give us anything beyond an observation of sleep patterns of babies 20 years ago, mixed up with some hypothesising and possible theory making?

Again, we have no idea what percentage of these infants were sleep trained, where they slept or how they were fed, which aren't the only limitations of the study as the authors themselves acknowledge:

Findings from this study are limited by their reliance on data obtained from maternal report. We have no independent measures of infants’ sleep (e.g., polysomnography or observation) other than maternal report. In addition, we did not have direct measures of sleep routines or bedtime conditions that might affect nighttime sleep awakenings.

Did I miss the section that covers leaving babies to cry it out?  It must be in the paper somewhere given the media coverage?  Perhaps it's under the conclusion of the paper, the "Practical Implications":

"These findings suggest that parents and primary health care providers should be aware that some infants who are generally healthy and typically developing might nevertheless have mothers who report sleep awakenings that extend into their infant’s second year of life. 

Those infants more predisposed to early sleep problems are also those who are reported by their mothers to have difficult temperaments and to be breastfeeding. 
However, for nearly all healthy infants, sleep awakenings tend to abate by the middle of the second year. 

Because our study mothers described infants with many awakenings per week as creating problems for themselves and other family members, parents might be encouraged to establish more nuanced, carefully targeted routines to help babies with self-soothing and to seek occasional respite (Karraker, 2008)."

In short, healthy normally developing infants can wake into the second year of life, and for most these wakings abate by the middle half of the second year.  But given parents find waking problematic they can try routines to help break the habit of their children needing them and take occasional breaks if they need to. Did we really need a study to tell us that?

Lastly something the piece doesn't consider, is that a growing body of evidence from both science and history suggests that the eight-hour sleep may be unnatural.

Roger Ekirch of Virginia Tech published a seminal paper, drawn from 16 years of research, revealing a wealth of historical evidence that humans used to sleep in two distinct chunks. A first sleep which began about two hours after dusk, followed by waking period of one or two hours and then a second sleep. References of two sleeping spells started to wane in the late 17th Century, and by 1920 had receded entirely from our social consciousness.

However this may actually be our natural way to sleep. In the early 1990's, psychiatrist Thomas Wehr conducted an experiment in which a group of people were plunged into darkness for 14 hours every day for a month.  It took some time for their sleep to regulate but by the fourth week the subjects had settled into a very distinct sleeping pattern. They slept first for four hours, then woke for one or two hours before falling into a second four-hour sleep. Read more here

Consider this in light of the above study.  Breastfed babies who were responsively parented, were more likely to wake once per night, were more likely to fit the human norm.  Do we want long sleep stretches from our babies at any cost?  

Given what we know about SIDS, the longer term impact of not responding, and the fact that in the end those who woke frequently settle into longer sleep stretches anyway  - whose needs is that actually meeting?

References:
1. The Resurgence of Breastfeeding at the End of the Second Millennium 1,2 J. Nutr. February 1, 2001vol. 131 no. 2 421S-425S

Stop Weighing Babies Like Stranded Beetles!

Imagine the scene - you're a tiny baby and not long ago your home was warm and cosy, cushioned in every sense from the outside world.  Suddenly you're shunted into a bright environment, noises are no longer muffled and food is no longer delivered around the clock.

But it's OK, you're snuggled up with mum and her familiar voice, her skin and now her scent help you adjust as she tends your every need.  You've just settled down for a nap when out of the blue someone strips you starkers, then plonks you on a thin piece of paper, on top of cold hard plastic scale like a stranded beetle.  Your startle reflex is triggered, your hands come up to your face and you let out a big shout, WTF is going on?

You might kick your legs and wave your arms, why is nobody moving me you shout? Hello! I'm letting you know I'm really not OK with this!

As a result the numbers on the display dance a Cha Cha up and down as watchful eyes wait to see where it will land (if you lay still long enough).

Why do many insist on weighing babies in this way? I don't get it, especially given we don't use analogue scales for weighing anymore.

When I'm baking I could weigh fluid by tipping it all over my digital dinky number, or I could put a bowl on first - tare the scale and then add the liquid. 

The liquid weighs exactly the same whether it is in a suitable receptacle or not, yet one is far more practical than the other.

Why is weighing a baby different?

Why can't we pop a snuggly blanket on the scale, tare them and then place baby prone, a position they are generally much happier in.  Arms and legs are less likely to flail as the startle reflex isn't triggered - making everything quicker.

In fact do we even have to undress baby at all?

I'm not convinced we do and for some babies this may be even more important.  Premature infants for example need a cardigan, hat and blankets - even in a hospital.  Their skin is thinner and maintaining body temperature is something that can be hard work for them - stripping them off also often prompts lots of crying in these babies too, burning energy and generally stressing their system.

So, back to the baking analogy above.  If I put a bowl on the scale, a cup inside that, an egg cup inside that - tare them and then add fluid; the reading is just as accurate as it would be just with the bowl.

Applied to babies, if parents are aware their baby will be weighed why can't they dress baby in a vest and/or babygrow and/or hat depending on the weather/baby's age, and have a spare set of identical items on hand (as per multipacks)

Place the above along with a new identical nappy and a snuggly blanket on the scale and then tare   Remove the vest, romper and nappy and they will tip to a negative balance.

If you then place baby dressed in a clean nappy (ie change it immediately before weighing), vest and romper as above on top of the blanket prone - tada, you have the same reading as if you stripped baby butt naked and laid him flailing on his back.

Even if you do want to strip baby down, placing a young baby on his tummy on a soft surface, tucking his arms and legs underneath him if he is still quite fetal and curled can help lots.

Really, the stranded beetle is not an essential part of weighing your baby - remember, tummy to the scale if you don't want them to flail...

Slumber Bear - Depriving Newborns Of Contact?

I stumbled upon a forum the other day where "baby essentials" were being discussed. As you know I think there are very few things that are truly essential when baby is small - and as the discussion following the above entry highlighted, essential varies widely parent to parent, baby to baby.

But I did notice the "Slumber Bear" was mentioned several times so I went to check it out.

The description from Amazon:

"Designed by a doctor and used successfully in maternity wards for over 30 years, the Prince Lionheart Slumber Bear Plus has helped millions of newborns (and their parents) get a good night's sleep. The Slumber Bear Plus features a multi-function sound box playing womb sounds, lullabies, ocean waves and white noise. There is also a recordable feature allowing you to save your own unique message for baby. Comforting sounds lull baby to sleep in minutes and sound and motion sensors reactivate the recording when your baby cries or jostles the bear.

Each Slumber Bear Plus arrives with its own silkie. Parents can bond with baby by keeping silkie close to their skin, transferring their scent to the blanket. The scent then comforts and reassures baby when parents are out of reach and the soft, smooth texture provides beneficial tactile stimulation."

and

"How it was designed ... By placing a specially designed 8mm microphone inside a pregnant mother's uterus, directly next to the unborn infant's ear. Insertion of the microphone moments before the mother went into labor enabled Dr. Eller to record the major intrauterine sounds that the baby had been hearing for the last four to five months prior to birth. The recorded sounds were then clinically tested on thousands of babies in hospital nurseries, and proved to be a natural audio baby pacifier. Based on the knowledge that the birth experience and transition from the peaceful, quiet existence inside the mother's body is a very traumatic time for the newborn, it has been proved that the recorded intrauterine sounds produce a calming effect on the newborn infant after birth."

  Firstly I wonder how they define a "good night's sleep", is that by the newborn standards or parental norms?   Secondly why on earth do parents need to bond with baby via a piece of cheap cloth?  You can hold the cloth to transfer your scent, then this cloth can be reassuring to the baby?

Seriously how did the human race bond before?

Perhaps (just throwing random ideas out there) they held the baby, he was in turn comforted by the scent, touch and sounds of his mother or father - oxytocin was released all round and thus they bonded?

Now babies can't have free access to their parents, instead they have to learn to soothe themselves to sleep alone - with parent smelling material and a machine making parental sounds?

The trouble is it seems, that newborns need their parents - but that doesn't make money!  As is highlighted above, transition to the outside world can be traumatic for newborns; as a result they are meant to stay close to their mother - her scent, milk, voice all serving to ease that transition.

If a baby needed to hear womb sounds to settle appropriately, wouldn't our bodies make this sound?  Or maybe babies actually only need this if separated from their parents - if they can't have the real thing.  Doesn't it kind of trick babies into thinking they're close?

And is this a risk free plan?

Earlier this year a study by Nils Bergman 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."

Indeed 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."

 Read more here

From the description above, note how the product was developed and tested in hospital nurseries - places where babies are separated from their mother and placed alone in cots.

Read the reviews on Amazon and it's noted how great that when the baby makes a sound it restarts and soothes them!  No parental effort required, genius.  If the cot is next to you, give it a tap and away it goes.  I don't see any reviews from those sleeping with their baby, only from those having trouble putting their baby down alone or settling/sleeping alone.

"His Mummy wore the snuggle blanket down her top for a night to make it smell of her and now the combination works a treat.  The little man keeps hold of his snuggle blanket while asleep and if ever he wakes with a start the noise machine kicks in and soothes him back to sleep"

and

"Firstly I should state that this has been absolutely instrumental in getting my baby to sleep in her own bed and I would recommend it to anyone who's baby has trouble self soothing."

and

"Bought this as a last resort for our baby who would only ever settle in our bed, as soon as we tried to put him down he would scream. Now he falls asleep to the womb noises and also settles very quickly."

and

"We bought this for our son when he was 4 days old as he wouldn't settle in his crib at night."

and

"Slumber bear - only thing that got her to sleep in her basket"

Notice the pattern?

Plus some rather worrying ones:

"We had an eight week old baby who wasn't sleeping and thought, what the hell, we will try anything! Within a few nights we could see her settle."

and

"I credit this with helping my baby learn how to sleep. He is 4 months old now and has slept through the night (12 hours a night without waking up) since he was 2 and a half months old because each time he woke up at the end of his short sleep cycles not for a feed it helped him get straight back to sleep."

8 week old human infants aren't supposed to sleep for 12 hours without waking up - they're meant to wake and rouse (for a whole myriad of reasons).  Using something like this to induce abnormal sleep/wake cycles isn't "natural" or beneficial to the baby - even if it's convenient to parents who want their 12 hours!

Perhaps someone will come up with something so the parents don't even have to faff around feeding baby themselves, the other big newborn need.  Depriving baby of even more contact...

Oh wait, they did already!

So there may be risks baby will choke, but you know parents are busy nowadays!  Who has time to stop and feed a baby anyway - let alone get up and soothe one when you can kick the cot and have it done for you.  Babies are hardy, they will adapt with lots of gadgets to replace their parents right?

Nappy changing robot anyone?

PS - white noise can be settling to an overtired unsettled infant; vacuum cleaners, untuned radios, hairdryers, white noise machines and white noise phone apps are all available. Sure they wont restart when your baby murmurs, wont play womb noises but if these are more than occasional use items it makes more sense to address the cause of the fussyness and consider whether expectations are realistic.

Happy Mum = Happy Baby

How often do we hear this said?

But the question is does it really?

Whilst many would recognise it's not ideal nor desirable for a baby to have an unhappy mother, does that automatically mean the reverse is therefore true?

Nope!


I was a really happy mum when I brought home my first bundle of joy, didn't stop her screaming every evening for several hours though.  Happy mum didn't equate to a happy baby.

To all the mums who have reflux babies - would you singing, dancing and being extra happy create a happy baby?

Nope!

If all it took to make a baby happy was a happy mother, how much easier parenting would be!

But here's what I think happens....

The parent may start out zippee de do dah happy, but give them an infant who is unsettled, windy, squirmy and who wont be put down - mix in some breastfeeding pain, parents becoming increasingly sleep deprived and soon you have an "unhappy  parent".

Should I feel bad for doing "X" to cope asks the mother - even if evidence shows this isn't the "best"...

Absolutely not come the replies - happy mum = happy baby!

I hear it a lot in practice - I was a lot happier once we started doing "X".  But examine further and it isn't the introduction of X that has saved the day, but that it caused the cessation of "Y" ie whatever was actually the problem.  Ask them if they could have resolved "Y" a different way, would they still have chosen "X" - the answer is often no.

The other trouble with the "happy mum" statement, is that its assumption doesn't recognise there may be other ways to resolve "Y" or that there may be any longer term impact of the choice than happiness - either short or longer term.

Of course a mum shouldn't feel bad for needing to resolve a difficult situation - but does a truly informed friend assuage with false reassurance (after all doing X and making mum happy may not result in a happy baby)?  Or do they help mum explore all her options and pick the right path for her?

That Innocent Little Bounty Pack...

In the UK when pregnant, your midwife/GP/relevant Health Professional will usually give you the first Bounty Pack.   There are five in total:

• Pregnancy Information Folder
• Mum To Be
• Mum's Pack
• Newborn Pack
• Family Pack

Basically you are given or collect five different carrier bags full of "stuff".

A Bounty Pack - image shared by a mum on Facebook

The "stuff" varies regionally, some mums seem to get lots of items whilst others only one or two.  A tiny tub of Sudocrem, a disposable nappy and a washing tablet seems to be pretty standard - some have had mini cans of caffeine free coke or sample of toiletries.  Discount/money off coupons/samples for everything from follow on milk and weaning foods, to fabric softeners and antibacterial spray.  Leaflets and publications such as "Emma's diary" are enclosed and then lots more advertising  - one mum noted adverts to send off for stuffed toys from both Aptamil & Cow & Gate.

Bounty's site reads:

"Embarking on parenthood is a bit like being expected to find your way in a jungle with no map and no guide.
Wonderful, yes. exhilarating, life changing, enriching; no doubt. But boy can it be challenging. It’s bewildering, exhausting and scary at times too.
When any family sets off on this incredible journey, Bounty’s there, guiding the way.
We support families in the transition to parenthood, through each key life stage, from pregnancy to birth to toddler to pre-school. We aim to be the first place new mums turn to for advice, help, reassurance and information. We also welcome them into an online community where they can share problems, worries, tips and achievements with a support network of mums who are going through the same thing.
As well as providing new mums with the timely advice and expert knowledge new mums need, we introduce carefully chosen products and services to mum that we know, as parents, can be invaluable through the different key stages. Every mum that registers with us is eligible to receive a total of five Bounty packs; filled with free samples, money-off vouchers and useful information, plus three free guides offering practical, up-to-date information, advice and guidance from pregnancy and beyond."

And there's lots of information about charitable giving and so on.

But what many forget is that in exchange for a few pounds worth of product samples and leaflets/information of varying quality - you're giving them all your personal details.  Details that are more valuable than you might think.

Let's see what website http://www.starmedical.co.uk says about Bounty:

"Bounty is one of the largest advertising and communications companies in the world. For nearly 50 years they have been providing direct marketing and support services to major pharmaceutical companies and other services that target parents of young children.
The company was founded in 1959, based in London and had 6 employees. They now employ 590 people and distribute 3.4 million bounty packs every year.
Bounty works closely with the NHS, with Postnatal Bedside Caring Distributors who communicate with new mums and Ward Midwives. This role serves to inform the new mums and also to discreetly collect useful data from them. Bounty Health Network Advisors work with Community Midwives, Health Visitors, Practice and School Nurses."

Perhaps it's just me, but that doesn't seem quite as hearts and flowers as the site for parents?

Why do the NHS allow it?

The usual reason - money.

"Bounty sales reps are given exclusive access to maternity wards by trusts" 

and

"They also try to ask women for their contact details so they can sell them to other companies that provide services for parents, and hand out free packs containing small samples of nappy cream and washing powder, but which also include official Government forms that must be filled in to claim Child Benefit.

Several hospitals and Bounty itself face investigation by the data protection watchdog, the Information Commissioner's Office, for passing on private details of this newspaper's investigation.

Last night parenting experts and patients' campaign groups criticised NHS trusts and the firm for making money from women when they are at their most vulnerable.

Belinda Phipps, chief executive of the National Childbirth Trust, said: "It is absolutely appalling. When you go into a maternity ward to have your baby, you shouldn't be subjected to commercial pressures.

"But the hospitals turn a blind eye to Bounty because otherwise they will have to ask their trusts for more money." 

Bounty, which was sold to Barclays Private Equity in April this year for £54million, has been going for 50 years. 

Almost all hospital trusts have individual contracts with the company and are paid about £1 for each pack given out after birth.

"Bounty ladies", as the firm's staff are known, also visit mothers at their bedside and ask for their addresses and phone numbers, which they then sell on to other firms." From HERE 

Now consider if Bounty pay the hospital £1 - what must your details be worth?  They generate revenue from the companies who put samples, leaflets and coupons in the FIVE packs.  Then consider they distribute 3.4 million bounty packs every year.

Then they can sell your details to generate more profit; one mum on Facebook said:

"Someone on my facebook put on her status that she'd had a phone call from Eon talking about the fact that she's pregnant and had received a pack, she didn't realise Bounty could sell her details (and not just her name and address, but the fact she's pregnant as well)"

Doesn't this mean our NHS is ultimately delivering new mothers in to the hands of a commercial company?  Doesn't the NHS have any obligation to ensure something they endorse is in line with relevant codes and that the information within is always accurate and evidence based?

Given the NHS will NOT give out details of independent breastfeeding groups or services, it seems if money is exchanging hands the rules change....

One mum on Facebook said:

"I declined the Bounty Pack (which surprised the Midwife!). Later on, the sonographer handed me some little card wallets to put my scan pictures in, guess what - sponsored by Bounty! There were so many adverts in the antenatal waiting room too, I don't understand how these companies are allowed to be so ingrained in the system."

Double plus for Bounty is that this means their information also appears Government endorsed - the packs are given out by Health Professionals and Health Establishments, one pack contains a form required to claim child benefit and so on.

Bounty also released a statement according to  http://www.lancashirechildrenstrust.org.uk/:

"Bounty’s statement (October 09) that it will no longer promote weaning foods or
toddler milks from early 2010"

Yet when I ran a quick poll here on the blog - out of 147 mothers that had responded at the time of writing this blog, 53 (36%) said they did receive such marketing in 2010.  More worryingly 61 (41%) replied yes in 2011.  Only 33 (22%) of respondents said they didn't receive any.

This means either a lot of mothers made a mistake, or Bounty continued to supply such marketing materials after early 2010.

Furthermore, whilst Bounty stated they would stop promoting these items - does this mean they will stop selling details to these companies too?  I suspect not....

The document from Lancashire Childrens Trust, summarises the many issues with the NHS being associated with Bounty and is well worth a read.  So I want to move on to the issues parents raised on Facebook.

1.  Insensitivity from Bounty photographers:

"My daughter was badly bruised on her face from the very traumatic birth she had - the Bounty rep selling photos came round the ward and then when she got to me looked at my baby's face and said "Oh you wont be wanting any photos of her for a long time will you" and promptly left. I was very very upset, I should have complained. Disgusting that they allow sales reps for Bounty near very vulnerable ladies :-("

and

"I was in the middle of having an extremely uncomfortable procedure done on day 2 (you really don't want to know the details trust me!) when the Bounty lady came round. My husband who was outside the curtains took my pack on my behalf, but refused to give her my email address. She then tracked me down the next day and stayed in my room until I gave her an email address, I had just had a blood transfusion and was too tired and weak to tell her where to go. In the end I gave her an email address I don't use any more, have just checked email account I gave her and I have received an outstanding 211 bounty emails in 3 months! Madness!"

and

 "Very unimpressed that my husband wasn't supposed to be on the ward with me and our newborn (visiting hours for Dads is 12 noon until 8pm only) and we got a lot of hassle and bullying because he had got in at 7am and wouldn't leave (because I would burst into floods of tears at the mere mention of it) yet the Bounty woman was there handing out packs and taking photos - for sale, of course. How is she allowed to be there and not the father of my baby?!?!"

and

"How annoying! I've just been harassed by a Bounty Pack woman. A bit of background info for you-i'm in hospital on complete bedrest after PROM at 22 weeks. I'm now 24 weeks. Anyway, she came in asking if i'd had a pack. I said i'd had one off my midwife when i had my booking in appointment. She said that i needed the next pack and she needed my details. I said i wasn't interested but she kept going on telling me if i didn't have the pack i wouldn't be able to claim child benefit as i woldn't get the form." 

2.  Getting out of the "Bounty System" once you're in:

Despite the close NHS links, it is the responsibility of the parents to advise Bounty if they no longer wish to receive packs due to miscarriage or stillbirth. At a difficult time this can be the last thing parents remember to do.  Mums on Facebook said:

"I found it very upsetting that bounty still sent me vouchers to get their packs when I lost my baby. You would think they would get the idea when I didn't collect a hospital bag but they still sent me the voucher for it months after our baby had died."

and

"Bounty failed to remove me from their mailing list when I let them know our first baby had died in utero at 17 weeks- which meant I received (amongst other things) a tiny nappy sample through the post a few weeks after we had lost him.  I am not ashamed to admit that wee nappy had me weeping on my knees in the hallway."

and

"I lost my first son 20 weeks into pregnancy and the constant emails and post from Bounty and associated companies almost pushed me over the edge."

Again a problem that doesn't seem new - in a large discussion about Bounty on Mumsnet a few years ago one mum said:

"Bounty still sent me a pack every 3 months or so after my stillbirth and it was pretty upsetting to be honest. Once you are on their list it's virtually impossible to get removed."

3.  Environmental Issues?

I'm not a hardcore green activist but the one thing mums say over and over again when discussing Bounty packs is "I took out the samples and binned the rest".

Just a couple from the many on Facebook/online:

"I didn't mind the bounty packs, got a couple of fairy/persil coupons/samples and binned the rest, along with alot of the leaflets re bf, cosleeping, pnd etc

and

"We were all handed one in the waiting room for one of mu appointments. I kept the comfort pure samples and binned the rest"

and

"A load of stuff that I threw in the bin and some advertising material thinly disguised as 'parenting literature'. Seriously though, I really can't remember as it was all stuff I didn't want to use."

Even if every single person recycles, how much recycling does 3.4 million Bounty packs generate?

There is an alternative!
Blackpool PCT are currently trialling Mama Packs.

Mama Packs are cotton bags [RRP£2] & the United Kingdom's ONLY ethically influenced, trade marked Mum & Baby sample pack.
Mums get better freebies, no advertising bumf and no selling of details to third parties.

If you're pregnant or due to receive packs, I hope this helps you make an informed decision as to whether to sell your details to Bounty.

UPDATE July 2014: Mumsnet found 82% of those surveyed felt it was unacceptable for commercial companies access to patients. Therefore they've campaigning for a ban on Bounty sales reps in postnatal wards. Click here for details.

When is PND NOT PND? Part One

According to NHS direct:

"Postnatal depression (PND) is a type of depression some women experience after they have had a baby. It usually develops in the first four to six weeks after childbirth, although in some cases it may not develop for several months. There is often no reason for the depression.
There are many symptoms of PND, such as low mood, feeling unable to cope and difficulty sleeping, but many women are not aware that they have the condition. It is important for partners, family, friends and healthcare professionals to recognise the signs of PND as early as possible so that appropriate treatment can be given.
It is very important to understand that having PND does not mean you do not love or care for your baby."

And this is absolutely true - for women with PND it's important they get effective support as soon as possible; for those supporting mums to be aware of signs and help mum obtain the help they need.

But, I also wonder how often PND is MISdiagnosed.

Via Milk Matters I see lots of mums who have been struggling for various amounts of time with different problems, but what I've noticed is a large percentage are either diagnosed with PND, or it has been suggested to them they may be suffering from it.

It confuses me.

If someone is living in a really difficult situation - perhaps their baby cries excessively, or pulls off the breast mid feed to writhe and cry; mixed in with painful feeding plus perhaps discomfort between feeds. Throw in a baby who will never be put down and so parents are sleeping in shifts whilst the other holds baby on their chest, which after weeks creates extreme tiredness.  Add to the mix that the mum has often seen numerous health professionals and had either a) conflicting information b) numerous attempts at help none of which have worked c) mum feels like she is banging her head against a brick wall.

Do we expect her to be doing an Irish jig of happiness?

A mum last week springs to mind.  After weeks of feeding problems, pain and a constantly unsettled (ie screaming for long spells) baby, she had gone back to the doctor again about the ongoing agonising pains in her breasts.  She had already taken multiple courses of antibiotics, and so the pain was now assumed to be thrush and had been medicated accordingly.  As it still hadn't improved she had gone back to the doctor, by now pretty desperate, describing the pain as "unbearable"and the doctor recommended more antibiotics.

"How will that help?" She had asked confused, "baby becomes more unsettled each time I take a course - and it hasn't stop the pain before."

The Doctor advised the mum that if she did not like how he was treating her she was welcome to complain to the practice manager.

The mum, promptly burst into tears.

Do you think you may be depressed?  the Doctor had asked....

I don't feel depressed the mum told me - in pain, frustrated at the conflicting advice which never resolved the pain and utterly BEEPED off, yes!

Her story is not an isolated case.  Many mums who have spent weeks or months struggling, experiencing ongoing pain which can impact on how mum feels about baby (who may always want to feed as soon as he goes to mum, which for her equals pain) seriously broken sleep - not just with a frequently waking baby, but a frequently waking baby who cries for hours when he does wake are in a fragile emotional/mental state, but is that depression?

In many cases when the pain stops and the baby settles - mum describes it as "life changing".  When the situation that is so tough improves, so does mum.  Of course some women suffer true PND, but I also wonder if it isn't at other times a rather large sticking plaster for incompetent care.

How society judges our children...

My two are as opposite as chalk and cheese.

My eldest is dark haired, dark eyed,very tall and "forward" for her age; spirited, feisty, takes no crap kinda kid, kind, empathic and friendly.  Knows her mind and sticks to it - explain why something isn't OK and you're likely to get co-operation; bark instructions and you get a look of "And what are you going to do if I don't?".  At two she looked and sounded like an average four year old, I was often asked which school she went to.  Other children typically also think she's older and she's a make a friend everywhere you go type.

In contrast my son has blonde curls which were even whiter when younger, bright blue eyes, is angelic looking and small for his age (though not so much these days!), quite chilled out although can absolutely demonstrate his emotions with the best of them - does this in a different way to his sister.  Rather than voicing his objections loudly and with passion, he goes for ignoring something he doesn't fancy doing - or tries to appeal with smiles and winning you over rather than the head to head combat style of my daughter.  If someone becomes vaguely firm he will generally comply, if he still objects you know it's really important to him.

They're different socially too -  whereas my oldest always looks like she's having so much fun it seems to encourage children to gravitate to her, my youngest goes for sweet smiles and looking cute until someone befriends him.

My eldest voices her ideas about what and how they should play - my youngest is happy to join in with whatever someone else sets up.

I've discovered - society isn't anywhere near as keen on dark haired, older looking/sounding feisty girls as they are angelic looking cute boys, and sometimes I think it's really unfair.

As my eldest grew out of tiny babyhood, strangers would rarely speak to us in the supermarket - pretty normal I think.  But I would get comments like "You've got your hands full" as she vocally expressed her reluctance to sit and ride in the trolley, or the tutting and shaking of head as she dived under the clothes racks in M&S before shouting "NO!" when I asked her to come out.

I knew everyone assumed her much older than she was - but the problem was whilst her height and language skills were ahead,  her emotional development wasn't always up there, particularly if she was tired or unwell, or had had a long day.


When my son was smaller people would constantly approach us when out and about - just to say "Oh my he's gorgeous, he's like a cherub!!", "Aren't you just beautiful"; literally every time we went anywhere.  It really hit me how shallow many people are..

I have actually had people say "It's so unfair that as a boy he has that gorgeous curly blonde hair, I bet his sister would kill for that, wouldn't she?" - with both of them stood right there.  Um well actually no at 6 she hadn't yet twigged how important these things apparently are...

My son quickly learnt that lowering his eyes and looking up whilst fluttering his lashes got him even more of an "Awwwwwwwwwww".  When he got frustrated he would dissolve into really sad sounding tears - which grabbed the sympathy vote all round every time. Displaying the same emotion in a different manner - yet it was so interesting to see how society preferred "distress" to what was perceived as "disobedience".

People would look sympathetically and say "poor poppet", or try and engage him to soothe him themselves; looking to me as if I must have done something heinous for him to be upset!  I would find myself explaining, he's fine really, just a little upset he can't pull all the glass jars off aisle 5 and chew the handle of the shopping trolley....

He could cause chaos in the middle of a play centre, yet would never ever be blamed even when at fault - he would simply flash them a look as if to say I never would, and whatever had happened assumed a misunderstanding.

People often suggested I was "too soft" on my eldest, yet should be softer with my second - despite the fact my parenting style was far more "mainstream" when my first was a toddler, and most consider the more empathic style I now try and use as "softer".  When I got fed up of the "angelic" comments and pointed out he could have his moments like all children - people would say "never!", "I don't believe it!".

When my son crawled/walked/talked (v cute baby voice) - strangers showered him with compliments as to "how clever" he was (and of course how sweet and cute)- in actual fact his development was completely in line with typically normal in most areas; did have a thing for numbers but they didn't base their judgement on something he was ahead with, it was the bog standard normal developmental steps from this cute dinky looking kid

In contrast my daughter did do everything at the earlier end of typical and her language/sentence structure, verbal reasoning etc was advanced, including pronunciation - no cute baby voice.  However as everyone assumed her older, milestones were perceived as "age appropriate" and nobody commented - they simply judged her when her emotional response was that of her age (and still do) as an older child acting unreasonably.

Even teachers and carers in the past forget her age - leading them to expect so much more of her than her peers/brother at the same age.

Society was so judgemental of my daughter I had her custom shirts made "I am 2/3/4" as applicable. At a play place one day my daughter, sporting her "I am 4" shirt went into a 5's and under play area.  I saw two mothers move protectively towards their toddlers and asked her why she wasn't in the older area, this was for under 5's.  My daughter looked confused and pointing at her shirt said: "my shirt says I am 4".

"Yes" replied the mother, "but that's surely an old shirt?  You're not 4 now..".(It fitted!)
"Yes I am", she said (becoming more confused by the minute) "I was 4 two weeks ago and before that I was 3!".

The mothers raised their eyebrows and went back to discussing between themselves how she was clearly older.

My son at 5 now goes into these zones and mothers tell their children to "move over and let the bigger boy in".

Society expects boys to be more challenging, energetic, "cheeky monkeys", "little devils" and so on (as the racks of t shirts often show) loud, confident - these traits really aren't appreciated in young girls.  Sweet, cute, "easy" wins the day every time.

Yet what do we really want for our children as adults?  At what point does society deem it OK for women to become feisty?  Ever?  Do we really want our children to become compliant without question?  To always do as requested without challenge?  Do we hope that they will regain their "feistiness" at a later date, when we no longer are responsible?

Whilst I of course want my daughter to be an effective communicator, listen to the opinions and ideas of others and handle her frustrations productively - I also want her to challenge things when older, question, have her own opinions.  If she did everything I ask without question, what happens when I'm not the one "in command" any more?  When peers or boyfriends become more influential than mum, would she also follow them without question?  Would she be used to her opinion not counting?

Surely society needs a mix of characters to hope to function well?  Characteristics considered undesirable in young children can be valued in adulthood.

Next time you judge that child melting down on the floor - remember they may be much younger than you think, they may have a new sibling or something else that has rocked their world.  They could have autism or ADHD or something you can't see.  As the adage goes, you can't judge a book by its cover....

20 "Essential" Baby Items That Aren't Essential...

NOTE: Some people seem to have misinterpreted this article and feel I am suggesting no person ever needed the items below.  This is not the case.  I found with my first and second babies, my list of "essentials" was completely different; this meant with number 1 I had heaps of stuff sat around unused, and other stuff I needed to go and buy.  With number 2 I used some of the stuff I hadn't with the first, but there was still a heap I didn't and still stuff I had to buy.

Almost every baby website has a list of items every expectant parent needs or may want to have before the big day! Just how extensive the list of items is varies wildly list to list.

I'm going the other way, with a list of items you can do without - or at the very least buy at a later date when you know they're definitely going to be used.

Some people want or need to parent frugally, others want to go as environmentally friendly as possible - or perhaps both! Anyway hope this helps.

1.  Baby Bath - Many people already have a perfect sized baby bath.  One that is easy to drain, comfortable standing height and ready plumbed in - yep the sink.   Baby baths need draining one way or another - if you use them in the big bath, you then have to lean over the bath sides to wash a small slippery baby.  If you move them out of the bath, you need to carry a bath full of water somewhere, then back for emptying!  The sink can be a lot easier.

Another option (usually the favourite from baby's point of view) is to bathe/shower with baby; if you have a partner who would enjoy some 1-2-1 time with baby, this can be a perfect opportunity.  Heat and contact release oxytocin - which promotes good feelings and bonding.

Lastly a cheaper option than a dedicated baby bath is a washing up bowl - no built in drainage, but sit in the bath and tip it out when finished.

2.  Formula - Many parents who plan to breastfeed, feel they need to buy infant formula "just in case". You don't.  If a breastmilk substitute is required for medical reasons shortly after birth - this is provided by all hospitals in the UK.  Once you get home, or if you plan a homebirth - every supermarket, chemist, any numerous other places sell it if needed.  The other thing is if you have a bad night, mums report having formula on hand can be more "tempting", by the time the next day comes and they could go an buy some, they've changed their mind!

A more environmentally and pocket friendly option is milk donated from another breastfeeding mother (so it's same species rather than modified cow's milk)  There is lots of information online about milk sharing - a good starting point is this FAQ, and also this.  Details about how to flash pasteurise breastmilk at home can be found here

3.  Bottles & Teats - Logically it appears to make sense that if you plan to use bottles at some point,  you might as well add them to the baby list of things to buy when pregnant.  Not really so...

Firstly some mums never use a bottle - even if they planned to!  They move from breast to something like the doidy cup or a soft spout transitional cup such as this (Free of bisphenol-a (BPA), lead, PVC, nitrosamines, phthalates, melamine etc).

Even if you decide to use bottles, not all bottles suit all babies!  New bottles are released all the time, existing ones improved - you may want a different one when the times comes to use it.  If you've already bought a pack of 6/8 bottles it can be an expensive waste - at least if the need arises you can try a single first.

If you just want them to store breatmilk you can buy cheaper breastmilk storage bottles or bags.

4.  Breast pump - This seems to always make the essentials list with the assumption all mums will express at some point so someone else can feed the baby, and for some mums who are returning to work etc they may know in advance they want a pump to build a stash etc.  Other mums never end up using a pump - they may hand expressing works better for them, or find it works out easier for mum to just feed.  That's not to say others can't help out with baby, but it may be more convenient for them to nip baby back to mum for feeding when required.  Ultimately if you do decide you want one, the shops will still sell them then, and like bottles new pumps can hit the market.
.

In terms of buying second hand breastpumps, it's important to ensure they are is a CLOSED system - this means it is sealed to protect breastmilk reaching parts that cannot be adequately cleaned (which would be unhygenic for future users).

Medela systems are NOT closed as you can read here, and so I wouldn't advocate buying/selling one second hand.

5.  Bottle warmer - When using breastmilk substitutes guidance is now to make each bottle fresh, so I think this makes a bottle warmer pretty pointless.  Even if warming breastmilk (which is fine at room temperature) a couple of minutes stood in warm water and job done without an appliance that needs regularly de-scaling and takes up counter space.

6.  Nipple creams/ointments and nipple shields - Something else that can seem like a good idea just in case, but I have to wonder how many tubes get thrown away unopened if mum never has cause to use it.  Whilst this seems to go hand in hand with the notion everyone gets sore/painful nipples when they start feeding, this isn't true either.

Some nipple creams can contain a whole host of ingredients that you may not want baby ingesting eg Kamillosan contains:

"Extracts of chamomile 10.5% w/w standardised to provide 0.01% L-a-bisabolol. Other ingredients include maize oil, purified lanolin, yellow soft paraffin, beeswax, emulsifying wax and approved preservative (mixture of esters p-hydroxybenzoic acid)"

Yum!

And although Lansinoh, a pure lanolin ointment state:

"In the over 20 years that Lansinoh has been available, the company is not aware of a single documented case of an allergic reaction to Lansinoh HPA Lanolin. However, that does not mean that someone somewhere could have a possible reaction."

They clearly don't class all the comments online discussing reaction as "documented cases", and in practice I have seen  thrush type symptoms (burning/itching) following use that has ceased when Lansinoh did, whether repeat coincidence or not - why buy until you need?   Midwives in the UK will also often give you samples of nipple ointment if required.

7.  Nappy cream - Very similar reasoning to the nipple cream.  Neither of my children ever had any sort of rash on their nether regions and thus the tube of just in case cream (with my first) remained unopened. Even if your baby does get a rash, what type of rash may influence your choice of which cream to use and you might want something different to what you have!

8.  Steriliser - Many never question whether they will need a steriliser, it's assumed essential.  But it is really?

Sterilising is an old practice, and many nowadays are questioning whether it is required at all.

In the US & Canada, paediatricians like Dr Flanders now recommend sterilising before first use, following which a thorough wash with hot soapy water is adequate (having a Google this seems quite common US guidance)

A study entitled: Cleaning and sterilisation of infant feeding equipment : a systematic review found:

"National guidelines from six countries demonstrated variation and lack of evidence to support current guidance. Manufacturers did not report evidence of effectiveness to support their recommendations. Nine studies were identified; eight conducted between 1962 and 1985 and one in 1997. All had methodological weaknesses. Hand-washing was identified as fundamentally important."

The study goes on to say:

Authors of several of the included studies suggested that the ‘clean’ (washed with hot soapy water and rinsed with hot running water) method is a safe alternative to traditional ‘sterilisation’ techniques, provided the safety of the water is assured. However, three studies found higher numbers of organisms on teats, suggesting that they are more difficult to clean effectively than bottles. Gatherer indicated that bacteriology results were excellent using either thorough cleaning or sterilisation; this was attributed to the education provided for mothers

and

"Use of dishwashers has been implicated in the release of plasticisers following a relatively small number of washes"

What the study also highlights is there is a distinct lack of evidence as to what is "optimum".  If using chemical cleaners should they be rinsed?  Should items be dried or left to try.  Dishwashers clearly aren't ideal for plastic although of course glass bottles are an option if they are required - what is the difference in bacteria levels between plastic and glass?  Is a bottle brush a good idea?  Logically yes it helps reach inside teats etc, yet what bacteria do these harbour and what are bacterial counts with and without?

As the review above states, what is being cleaned ie a teat v cup makes a difference and also what substance is used ie breastmilk or substitutes is also likely to be significant.  Breastmilk is antibacterial whereas substitutes promote bacteria growth, and furthermore infants not receiving breastmilk are at increased risk of diarrhoeal disease.

Indeed a study examining diahorreal disease found:

"After adjustment for confounders, breastfeeding was associated with significantly less diarrhoeal disease. Associations were striking even in infants aged ≥ 6 months.  They did not vary by social class, but were greater in those living in rented council accommodation and in more crowded households." 

and

"In formula-fed infants, there was significantly more diarrhoeal disease in those not sterilising bottles/teats with steam or chemicals."
(however how well the bottles were hand washed appropriately was not measured)

Given how much money must be generated from the sale of sterilising equipment, do you not think someone might have bothered to confirm what's actually the most effective way of doing things?

If you want to sterilise and use sterilising tablets - any glass bowl will do, no special equipment required.  Ditto boiling in a pan of water.

If you breastfeed you may find you never need to sterilise anything!

9.  Pram/Travel System - The trouble with prams is that unless you buy right at the top end of the price range, it's really difficult to find the perfect pram from newborn to toddler.  Newborns need to go flat, so a carry cot you can attach, a lie flat option or the ability to attach a carseat is important.

The latter sounds practical but in practice they can be heavy to lift on to the pram base, and often fiddly to clip and unclip. The other big downside to these systems is they are often really heavy and cumbersome - ok for school runs and long walks, PITA for throwing in and out of a car boot (after you've checked they actually fit!)  A carry cot may also only be suitable for just a few months, before baby needs to switch.

Evidence also suggests young infants should face the parent - often prams do this with the carseat attached, before switching to front facing as they become older.  As these are typically more expensive, saving money on a carrycot or the function to allow a carseat to attach can be a good option for some.  The cheapest rearfacing I could find was this - but if you know of others please share.

Another option is to ditch the pram idea for a tiny baby and use a really good baby carrier or sling - fraction of the price (even more so if you get second hand as there is a large market - some people buy oodles and sell them on barely used).  If you get something like a wrap for a tiny baby, you can use it indoors as well as out, giving you hands free to eat etc!  You can tie it on in a morning and lift the baby in and out as required whilst leaving it in place (including during car journeys etc)  Tiny babies love being snuggled close, which means they're happy - and you can negotiate the shops without wheels! (which in busy clothing shops or suchlike with narrow aisles between racks can be more of a bonus than you realise.)

Even if you want to add say a pouch sling to your collection for easy on and off carries, it's still cheaper than a high tech pram.  Some mums even make their own!

As baby gets older although you may want to change your sling for something perfect for a heavier baby, perhaps so you can wear them on your back and cook safely etc, again it's cheaper than wheels.  But if you do want pushability as they get heavier, you can then opt for a light weight buggy that's significantly cheaper and lighter than something suitable from birth.

10.  Breastfeeding cushion/pillow - Honestly most are pants, they make feeding more difficult and can be incredibly restricting if you don't feel comfortable feeding without it.

11.  Special breastfeeding clothes - Whilst they're an option if you want, they're really not essential.  Milk Chic is a site dedicated to finding breastfeeding friendly clothes on the highstreet, with lots of tips and tricks about how to feed in different items.  From this you may well find loads in your old wardrobe that is easy and convenient to feed in.

If you feel conscious of your tummy, a simple elastic "boob tube" slipped down to your waist, can help you feel covered even if you lift your top to feed, and again save on purpose made clothes.  If you don't have one, you could make one here - or you can buy one made for the job called a bellyband here

12.  Cot/Moses Basket/Crib - Some parents think all the above are required.  Moses basket for downstairs, crib for upstairs when small, progressing to a cot.  Whether you ditch all of the above or slim things down, is really a matter of personal preference.

Some breastfeeding mums choose to bed share - wear the sling during the day and none of the above are required.   You can add a bedside guard like this if desired.

Another option is a cot that sits snug next to your bed, so you can have the benefits of co-sleeping ie baby is arms reach, whilst having your own "sleep space".  Not having to sit up, lean over, retrieve baby, feed, try and lower them back into basket/crib (which in young babies triggers their startle or Moro reflex) however many times a night is a real bonus when you're living it!  You can buy special cots for this purpose such as this, and this at a snip of the price but only has two height levels (so check suitability) - but there are also tutorials online as to how you can adapt other height adjusting cots to suit, by matching matress height, removing a side and securing to the bed.

However you sleep it is important to ensure there are no gaps baby could become trapped or wedged down, and that there is no possibility of anything shifting to create a gap.  More information available here.

13.  All associated bedding for above - OK so unless bed sharing and you switch your own bedding to sheets and blankets, you will probably need some dedicated bedding for baby at night; but kitting out even one cot is cheaper than cot, crib, moses basket and pram.  Don't forget that as well as the fitted and loose sheet, you need numerous blankets for babies if they're in prams or sleeping in a cot/basket day as well as night.  You need several sets of each too due to sickness/nappy leakages etc and if using natural fabrics as recommended can quickly add up cost wise.  Of course if you're frugal and talented you can knit your own!

14. Lots of baby toiletries - The section is huge, but some are now questioning longer term links with health.
To read more about what's worth avoiding and alternatives this is a helpful page.

Guidance in generally that most things shouldn't be used on newborns who have thinner more porous skin than an older baby or adult. Some parents use virgin coconut oil for both bathing/moisturising afterwards - it's not the cheapest thing in the world but a little does go a long way when warmed on the skin.  Otherwise, plain old tap water works just fine!

15.  A special "baby bag" - If you're breastfeeding you may find all you need to carry is a spare nappy, no need to carry around everything required to prepare substitutes safely.  Even if you want to take water wipes, a change of clothes and a nappy, many bags can fit this in easily, with different compartments for if you're using reusable nappies.  If you end up using formula and need a bag with dedicated thermal pockets and big enough to fit in formula, water, bottles, teats (for as many feeds as will be required when out) bibs etc you could again get one if needed.

16.  A swing, rocker or bouncy chair - The reality 98% of all young babies surveyed preferred a sling ;) But seriously, it's impossible to know what your baby will like before they arrive.  Some hate a sideways rocking motion whilst others love it, ditto swings and bouncy chairs. If you  wait until baby arrives you can at least try them out in it and also evaluate how much you would actually use it.

Again a good reason to wait until needed is to get maximum use - some bouncy chairs are only suitable up to 6-9 months of age eg this is six months.  So if baby is 4-5 months before happy to even sit in it, it has a very short usage.  Others such as the Baby Bjorn at least can be adjusted into a chair for a child up to two, so if you did decide it an essential with an older baby, check out how long you will be able to use it for.

17.  Bibs - Whilst at some point most people will probably pop a bib on their baby, small babies don't always need them.  Whilst some posset regularly, others like my first never do (nor did she drool)  and so lots of "essential" bibs were never worn.  Again it's worth buying if/when you need as what sort of bib is more appropriate again changes with age - tiny baby ones are, well, tiny and often v soft if just catching milk.      For an older baby or one eating solids you may want something with sleeves or that you ensure will protect clothes well.

18.  Muslin Cloths - I know many people states these as invaluable, suitable for over shoulder burping plus loads of other uses.  Yet I didn't use them at all with my first, they just sat in a drawer.  As she wasn't a sicky baby I never needed anything over my shoulder.

18.  Baby Brush/Comb - I wondered if I was the only person who didn't consider these essential with a young baby, but a chat on Facebook highlighted many babies had bald heads or very fine hair for quite some time!  Some used the soft brush for cradle cap, others the comb for the odd baby with longer hair that became knotty, some found despite having long hair it didn't get knotty and was never brushed (my second has hair like this) so again it would seem more sensible to buy if/as you need.  If they're an older baby you may find a toddler brush more useful than the very ultra soft brush designed for use on a tiny baby.

19.  Bath Thermometer - Maybe we had a dud one, but the water felt cold at the "approved" temp and baby ended up shivering!  Used once then ditched.   We have a built in thermometer - the elbow.

20.  Nappies - Ok so to many there is no question over whether a nappy is essential, but some mums have the ultimate "eco bot", using a method called "Elimination Communication".  Some use nappies part time such as at night or when out, whilst others are completely nappy free - if you're passionate about the environment and/or budget it may be something you want to explore.