Co-sleeping, a failed account? Part Two

Our night-time sleeping was very different from our naps. While he would refuse to nap longer than twenty minutes in a place other than mommy’s arms, he refused to sleep there at night.

Well, let me back up…

Like I said before, at about a month old he started having trouble sleeping at night. Cutting dairy really helped, but the biggest fix at that point was to co-sleep. We have a king-size bed (best investment ever), so instead of him sleeping in the Arm’s Reach, I just had him snuggle. Most of the time, I slept on my right side, with little man snuggling there between me and the co-sleeper. Sometimes, he slept between my husband and me, but with my husband’s sleep apnea, I was more comfortable with the other set-up.

While little man co-slept with us, I was amazed at how our sleeping patterns worked together. Even just having him in the room accomplished this. Babies have shorter sleep/wake cycles than adults, allowing them to wake, eat, and keep getting the calories necessary for growth. Short sleep/wake cycles may also have a protective effect in regards to oxygen levels and adjusting to life outside the womb.

The difference in sleep/wake cycles is what makes parents so tired with new babies, but here mothers have an advantage. Having baby in the room allows these sleep cycles to be synced: beneficial for both mama and baby. Some research suggests this may be protective against SIDS. And for the mother, the added benefit is waking more easily rather than from a deep sleep.

For us, here’s how it worked. Little man would feed and drift off to sleep snuggled in my arms. I’d drift off around the same time. A couple hours later, I would wake. My deep sleep cycle was shorter in response to his, so most of the time I felt pretty good. I would look down at little man, who was still asleep but begging to root around and stir. This gave me time to get ready for feeding. He would then feed and re-settle, much of the time never fully awakening. I would then drift back off as well. This synchronization may be part of the reason breastfeeding mothers get more sleep than formula feeding mothers.We had this great set-up until little man was about three and a half months old. He started by feeding. Then he would arch his back and squirm. He would touch and explore my face. He’d coo and squeal, discovering his own voice. As cute as it was, he was starting to go from tired at the beginning of the night feed to wound up by the end. Eventually he would drift off, but he was fussing more during the drift off period. Sometimes we would have to give up for a bit and try again later, as late as 11pm.

One night, probably a week or so after this change, I cleared out the Arm’s Reach. After he fed, I scooted him over into it. At first he fussed, but after a few nights, it was getting better. If the fussing seemed to be “sleepy-time fuss,” I let him be. If it was “I need mommy, I’m scared!” fusses, I’d pull him back over and snuggle. For awhile our sleep routine came to be starting out in bed, then the Arm’s Reach for part of the night, back in bed for the rest. I tried my best to read his cues and let him sleep where he seemed to settle the easiest. After a few weeks I noticed he was spending less and less time snuggling with me in bed and more and more time sleeping contentedly by himself in the Arm’s Reach. Along the way he had realized he was definitely falling asleep snuggled with a warm mommy, but he could coo and be cute and “fight it” a little longer by himself.

Knowing the independent part of his personality, this all doesn’t surprise me too much now how easily he self-weaned from co-sleeping. At the time I was surprised and even a little embarrassed. Co-sleeping was an important part of my nurturing parenting philosophy, and I felt I must not have done it right for him to have weaned so early.

But for us, this was exactly right. He was ready and let me know in his own way. Around six months he settled into sleeping in the crib at night since he was able to crawl out of the co-sleeper. I attribute his good sleeping habits now to the security he had sleeping then. Falling asleep at a young wasn’t scary; he wasn’t hungry, cold, or wet; and he knew mommy would be right there if needed.

Recently, we got to co-sleep again. We went to the Columbus Zoo, and little man was having trouble sleeping in the hotel room. My husband suggested we have him in bed with us, so we decided to try. He took his sippy, coo’d, explored my face, and drifted off with me sleeping on my right side again. It was uncomfortable, as a sleeping toddler is much more mobile than a sleeping two month old. But it was beautiful and I loved it. I miss our nightly snuggles, but I’m glad I listened to what he was ready for.

Co-sleeping, a failed account?

 I was so fortunate that prior to pregnancy I had learned about many safe sleeping practices, one of which was co-sleeping. In the end, we just decided we would “go with the flow,” and that crying out wasn’t an option.

I highly recommend that approach.

However, I really expected our co-sleeping story to be different than how it actually played out. I’ll go through our story and talk a little about why I think it worked for us.

Around the time my son was born, we were staying with our pastor and his wife (fun stuff like our new home not being ready on time necessitated that). At the same time, my husband’s mother and grandmother were in from Mexico.

It was a hard way to start out with a new baby. I was in an unfamiliar environment, with a slight pressure to perform. (Side note: I love my husband’s family, and the pressure didn’t come from them but from my own self-consciousness). My husband and I were sleeping is separate twin beds so I could recover from surgery and little man slept in a Pack N Play at my feet.

Not my ideal set-up to be sure, but necessary at the time.

Little man was swaddled for the first week, but after that we simply had light blankets covering him. We stopped swaddling because he started to hate it, probably as his startle reflex was calming down. He slept at naps and at night, which was unexpected.

By the end of his birth month, we had moved home. My husband’s family was still to be with us a few more days as we settled in. We put up our Arm’s Reach Co-sleeper with our King-sized bed.

Elias was still doing fine with our set-up of alone naps and nights until right before my husband’s family. He was starting to be more restless at night a bit irritable during the day. Where he had previously been a greater napper, sleeping three hours at a time, he was now cat-napping twenty minute sessions.

Finally, one night he literally refused to sleep. At 2am we had him in the car, trying to lull him done. He gave in but was up as soon as we were in the house. That night we pulled the swing into our room and let the rocking work its magic.

The next day I starting cutting dairy from my diet. I also held him for naps. He would nap without me holding him, but he napped much longer in my arms. At night, I started cuddling with him in our king size, using the Arm’s Reach as a table.

Later, I discovered Elizabeth Pantley’s No Cry Sleep Solution. I had heard of it, but at this point I finally bought it. I was desperate for something to help him sleep without me, but refused to try “crying it out.” We had seen a crying fit from him on the six hour drive from Washington D.C., and the pain and terror he was in was not going to “work.”

Pantley simply confirmed to me that all was actually ok with our sleeping situation. When he cat-napped, he wasn’t getting adequate sleep, making night times more difficult. I charted his sleeping habits and made my decision.

We’d keep going with the flow.

I started keeping track of his eating and naps (I kept a note pad on the armrest of the recliner) and continued to hold him for every nap, for the entire nap, until he was five and half months.

People thought I was crazy. I got nothing done during his naps.

Around five and a half months, we started trying the crib for naps only. I would rock him while he ate and then laid him down when he was fully asleep. At that point, being fully asleep was key; generally about ten minutes after he appeared to be “asleep,” he was ready to go down.

It worked. Within a few days, he was comfortable sleeping in the crib for naps. Night time was another story…

Common Sense Labor Practices - the Walsh argument

It looks like I’ll be finished reading Denis Walsh’s Evidence-based Care in Normal Labour and Birthing soon. I’ve really enjoyed it.

One thing I really like about this book is the underlying theme of using common sense to return to normal labor and birth. The author seems to come back to this idea at least once in each chapter, but I think it is best displayed in the argument surrounding the following topic: Movement in Labor and Birth.

Why is it that we seem to need randomized clinical trials to show us that moving and using gravity in upright positions would be good for birthing?

I was really struck when I was reading about this concept. Well, duh. Of course, even those promoting natural birth do forget about this. We try and try to prove that this works, but why is that we must prove something so common sense? Are we that far away from good birthing practices?

Quite simply: Yes. [insert a number of choice words]

As a culture, we have truly become a nation that absolutely relies on medical intervention. It’s pervasive. We go to the doctor with flu symptoms and find ourselves getting chest x-rays, bloodwork, and antibiotics (Let’s not forget that the flu is a virus. Antibiotics are for bacterial infections, not viruses). Our child gets a bad bump on the soccer field, and he’s in the ER for a CT scan (see this article).

Recently, we took my son to the doctor (not our pediatrician), for a suspected ear infection. Fortunately, he didn’t have one, but the doctor offered us a prescription for something just in case. When I declined, he replied that was fine, and that he offered because some people feel unsatisfied if they come to the doctor and don’t get something, even if nothing is wrong.

Novel idea, I know, but if you’re not sick, you don’t need something.

And this is much of what Walsh is arguing. If not sick, which pregnancy and labor should never be considered pathologies, then why are we doing randomized clinical trials to prove that natural labor needs natural things? (The same argument can then made against IVs, routine AROM, monitoring…)

I’m not making a new argument of course. I’m simply reiterating what many are already saying.

Pregnancy, labor and birth are normal the vast majority of the time. They require normal, common sense things. If they cease being so, then we’ll call for something else. Don’t do anything just to say that you’ve done something.

Preventing ALL Death and Injury?

I’m currently reading Denis Walsh’s Evidence-based Care for Normal Labour and Birth. In my reading this week, I was struck by the chapter called “Fetal Heart Monitoring in Labour.” I understand that fetal heart monitoring is not proven beneficial, though it continues to be in widespread practice. I was familiar with much of the information presented, but the following reference caught me off guard.

Walsh discusses a number of studies and reviews throughout the book, and in this particular case, the review being discussed brings up one (of many) possibly disadvantages for continuous electronic fetal monitoring. Walsh quotes directly, as will I, the following: “[it] shifts staff focus and resources away from the mother and may encourage a belief that all perinatal mortality and neurological injury can be prevented.” (Reference below).

Can I just stop and say “WOW”?

Of course, it makes perfect sense. This attitude is pervasive in western culture. All death should be prevented until natural causes in old age. All other death is negligent and/or preventable by future technologies.

Again, WOW.

I come from this culture of course, and I struggle constantly with the idea. Late last year, my dad was diagnosed with prostate cancer. His prognosis was very good: he was (and is) in excellent health, and it was caught very early. He had surgery and has thus far done well without any other treatment.

My mother, of course, panicked with this diagnosis. Current research suggested to her that even with surgery and complete removal of the tumor, it only extended my dad’s life expectancy ten years. She was distraught.

Let’s put the above in perspective. This year, my dad will be 66. Ten years is 76. My dad (due to good health) probably had a previous life expectancy of 80.

Was surgery helpful? Certainly. Would my dad have died sooner without it? Yes, probably. He has a genetic risk for prostate cancer, so his cancer was likely vigorous. Does he have cancer now? Nope, not as far as we can tell.

Should my mom still be concerned about his life expectancy? Nope, not in my opinion. He will die eventually anyway.

That’s heartless sounding of course, but it’s true. Some of us will die from cancer. If we cure cancer, it’s likely some will die of other causes, beyond the “natural.”

My point is, as a culture, we are terrified of death. We string ourselves out at the end of life, struggling for each breath in some sterile hospital, without being allowed to die in dignity and grace surrounded by family and friends at home.

Unfortunately, birth is no different. Birth is a symbolic act of life beginning in another (though I would argue the life began long before, it just needed constant care in a different environment before birth). It is logical that once life begins, it will certainly eventually end. And as much as we would like to, many times we cannot prevent it, not should we.

I do not believe there will ever be a time when NO women and NO babies die in childbirth. That would be like saying there will never be any more SIDS or miscarriages. As tragic as these things are, they happen. They are a part of the life cycle.

Therefore, we need (as much as possible considering the culture we’ve been raised in) to attempt to lose this idea of preventing all perinatal mortality and injury. It will likely never happen. Our focus should be on healthy normal childbirth so we can recognize when it goes astray. When it goes astray from normal, we should focus on doing what we can, WITHOUT CAUSING FURTHER INJURY OR HARM to either the baby or the mother. After that, we should focus on supporting and counseling the family through a difficult life event.

Reference: Alfirevic, Z., Devane, D. and Gyte, G. (2006) Continuous cardiotocography (CTG) as a form of electronic fetal monitoring (EFM) for fetal assessment during labour. Cochrane Database of Systematic Reviews, Issue 3.

Breastfeeding Misinformation begins with Doctors and Nurses

As some of you may know, I have recently gone back to school. I've applied to a local RN Associate Degree program and am working on related coursework. One of my courses this semester is Nutrition and Diet Therapy, and as part of the course requirements, we're presenting group projects. Yes, pregnancy nutrition was taken by the time I got to sign up, but I managed to snag breastfeeding.

I started by scanning my textbook (which is required as we're primarily presenting the text information and supplying research to compliment). I came across this gem: "The adjustments [of breastfeeding comfortably] are easier if supplemental formula feedings are not introduced until breastfeeding is well established, after at least 3 to 4 weeks. Then it is fine if a supplemental bottle or two of infant formula per day is needed." [Contemporary Nutrition: A Functional Approach]

I had a few choice words and then set out to find the research to disprove it. I'm presenting that here.

First - The statement goes directly against current breastfeeding recommendations. WHO states that "exclusive breastfeeding is recommended up to 6 months of age, with continued breastfeeding with appropriate complementary foods up to two years of age or beyond" (Citation) American Academy of Pediatrics goes this far: Supplements (water, glucose water, formula, and other fluids) should not be given to breastfeeding newborn infants unless ordered by a physician when a medical indication exists.” and “Pediatricians and other health care professionals should recommend human milk for all infants in whom breastfeeding is not specifically contraindicated and provide parents with complete, current information on the benefits and techniques of breastfeeding to ensure that their feeding decision is a fully informed one.  When direct breastfeeding is not possible, expressed human milk should be provided." (Citation) Healthy People 2020 Targets are exclusively breastfeeding through 3 months - 46.2% and exclusively through 6 months - 25.5% (Citation)

Second: Formula Supplementation has been linked to early breastfeeding cessation: “Partial breast-feeding (supplementing more than one bottle of formula per day, measured at 1 month postpartum) was associated with shorter breast-feeding duration. This latter effect was minimized by frequent nursing (seven or more times per day), despite formula supplementation.” (citation) 

And finally: “Clinicians who recommended formula supplementation or who do not think their advice about how long to breastfeed is very important may be sending signals that exclusive breastfeeding is not something that mothers should value highly. In addition, our results indicate that many clinicians do not feel confident in their skills to support breastfeeding and may have limited time to address the issue during preventive visits. As for mothers, experiencing problems with the infant latching on or sucking seems to be a risk factor for not exclusively breastfeeding.” (Citation - I found the full article through Ebscohost and cannot link it directly. You can comment/email me for the file and I will be happy to supply it.)

I'm excited to use the information I've found to disprove such a fallacy and educate other nurses. Let's hope they listen...

New book - look out for similar titles!

Just came across a new book in our local library titled The Birth Partner Handbook.

Do not be confused!!!!

This is not The Birth Partner!

I highly recommend The Birth Partner. This new one (by a different author), not so much at all. Very much in the vein of whatever the doctor says must be right.

Educate yourself and get The Birth Partner instead!

Recommended Reading for Pregnant Women

Nearly as soon as a woman is pregnant, she begins looking for books to help her fill-in-the-blanks between doctor appointments and ultrasounds. This is no easy task considering all the books that are out there. Here is a short list and review for some of the books I found most helpful, as well as some to avoid.

Pregnancy, Childbirth, and the Newborn by Simkin, Whalley, and Keppler.

This is one of the best books I read while I was pregnant. It's easy enough to read straight through it, but it's also a great reference book. Unlike many pregnancy books, it goes into the first few months of your newborn's life rather than ending at birth and the hospital stay.  My copy is full of highlights and marks.

The Birth Partner by Simkin

Amazing book. . It’s aimed specifically to birth partners (as though you couldn’t tell), but I found as an expecting mother it was very valuable for me as well. Good book to read through together and discuss. Also good to toss into the birth bag for reference as needed. It’s even designed for this with “tabs” on the pages so you can flip through and find what you need.

The Doula Book by Marshall Klaus, John Kennell, and Phyllis H. Klaus. - A great book to acquaint you with the idea of a trained labor companion. Doulas don’t replace partners; they support the whole family in birthing.

Ina May’s Guide to Childbirth by Ina May Gaskin - Sure she’s a bit of a hippie, but she knows birth. This book is full of birth stories to empower and encourage. It also discusses pregnancy, labor, and birthing in a way that makes you feel like a real, powerful, strong woman

The Thinking Woman’s Guide to a Better Birth. By Henci Goer - A great book for women and partners on the edge with hospital interventions. Henci has thoroughly researched common procedures, outlining risks and benefits. She also gives alternatives and discusses how to talk to your care provider about these things.

The Nursing Mother’s Companion by Kathleen Huggins and The Ultimate Breastfeeding Book of Answers by Jack Newman and Teresa Pitman - Great references for the breastfeeding mother. If I had to pick one, I’d go with the first. It’s a simpler read (though both are very readable) and has easy to skim organization of topics.

The Hidden Feelings of Motherhood. By Katheleen A. Kendall-Tackett. - A must read during the postpartum period. This book helped me acknowledge my own post-partum depression and worries. Can be checked out from the library.

The Baby Book. By Sears. The Vaccine Book by Sears. - Though I haven’t read all of the Sears library, I’ve read these two. The Baby Book is huge and comprehensive, not something you can read through easily, but great to have around. The Vaccine Book is very balanced if you’re just curious about the whole debate. It’s an easy read as well.

The No-Cry Sleep Solution. By Elizabeth Pantley and William Sears. - As we are beginning to learn that the cry-it-out approach doesn’t work for all and may cause damage to those it seems to work for, here’s a great alterative. Teach your child how to fall asleep rather than to get so tired they have no other choice.

Books I suggest you avoid:

The What to Expect Series. While I’ve not read them, general consensus has it that these books tend to promote fear. You don’t need any added stress. If a complication occurs in your pregnancy, you can seek information as needed. Don’t scare yourself with all the what-ifs. There are better books out there.