Amazing Video

So many times I am asked "What is a doula?" This video sums it up perfectly

Rub It In: Making the Case for the Benefits of Vernix Caseosa

I just found this article, and LOVED it. Great read on the case for keeping the vernix on the baby.

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Rub It In: Making the Case for the Benefits of Vernix Caseosa

December 3rd, 2010 by Kimmelin Hull

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Childbirth educator, doula and midwife apprentice Cole Deelah recently posted her thoughts on the beauty of vernix caseosa on her blog site Sage Beginnings. Referencing a 2004 study published in ACOG’s Journal of Obstetrics and Gynecology, Deelah reminds us of the protective benefits vernix provides to the fetus and newborn–some of which include antimicrobial activity and maintenance of skin hydration following birth. I’d like to look a little deeper into the benefits of vernix, and make a case for rubbing in versus washing off this innate host defense substance.

The 2004 study, referenced above, came out of Cincinnati Children’s Hospital by Dr. Henry Akinbi, et. al, and looked at the type, function and distribution of antimicrobial peptides (protein building blocks) contained in both vernix caseosa and amniotic fluid (AF). Despite some concerns[i] over this study, I found the methods of analysis and conclusion intriguing: in the [suspected] absence of chorioamnionitis, vernix and AF contain a mixture of antimicrobial peptides which are biologically active against several common bacteria and fungal agents. Specific antigens tested included E. coli, Group B Strep, Staph aureus, Pseudomonas aeruginosa, Candida albicans, Listeria monocytogenes, Serratia marcescens and Klebsiella pneumonia. Without diving into the microbiology of these nasty agents, I will simply remind you these make up the lion’s share of microbes that can cause severe diarrheal illness, pneumonia and meningitis in the newborn (or anyone, for that matter). The assumption this study was chasing involved the idea that the sebaceous (oil) glands of the fetus produce these peptides during the third trimester to act as a host defense mechanism, providing a barrier-type protection from the above-listed agents while in utero. Of interest to me, was the discovery that the combined amount and distribution of these peptides (think: natural antibiotics) in both AF and vernix were found to be most effective against the bacterial and fungal microbes when compared to the successful antimicrobial activity of each peptide subset, alone.

Likewise, another interesting finding brought forth in the Comments section of the study was the fact that the immune proteins found in vernix and AF are similar to those found in breast milk. The researchers linked this to the evolutionary similarity between mammary glands and cutaneous (skin) glands.

Furthermore, it has been known for some time that as pulmonary surfactant levels increase in the amniotic fluid, vernix begins to detach from the fetal skin—increasing its components into the surrounding AF.[ii],[iii] As the fetus continues swallowing and “practice breathing” in the womb, this antimicrobial peptide-rich mixture enters the fetal lungs and digestive tracts. The postulation I draw here, which is also hinted at in this study, is the likelihood that the vernix-AF antimicrobial peptide mixture prepares the GI tract for acceptance of the similar peptides found in breast milk—thereby preparing for the process of establishing normal flora within the gut (and perhaps digestion processes, themselves) and prepping the immune system for an important, pending transition. In short, a heightened defense mechanism plays a key role in making the transition from purely innate defense barrier mechanisms to adaptive defense mechanisms.

These findings are furthered by this 2005 study which appeared in Cellular and Molecular Life Sciences 2005 (62: 2390-2399). With the goal to not only confirm the presence of the 20 different protein host-defense-enabled-proteins which had been isolated in previous studies, this study also looked at the interaction between proteins and lipids (fats) found in vernix. We have known for some time (and likely taught to our pregnant students/patients) that the fatty, creamy nature of vernix acts as a moisture protectant to the fetus while in utero—not to mention (if rubbed into the skin immediately following birth) a wonderful emollient to prevent excessive drying of the newborn skin in the days following birth. But this study by M. Tollin, et. al discovered that the lipid component of vernix actually enhances the functionality of the antimicrobial peptides.

One of the peptides identified in the process of Tollin’s study is the Human Cationic Peptide LL-37. This particular peptide works both as an innate defense mechanism and an adaptive one. As a result, vernix caseosa contains a microbiological element that helps a fetus (and then, newborn) bridge that gap between basic and complex(adaptive) immune function.

The Tollin study proved to have some additional methodological benefits. While still small in numbers (vernix samples were analyzed from eighty-eight newborns; n=88) the analyses were done following vaginal births and vernix-AF analysis was completed on like mother-baby duos. Similar to findings in the ’04 study, the interaction of antimicrobial peptides in both the vernix and AF displayed heightened effectiveness in comparison to isolated peptides from AF and vernix samples alone. Because the 2004 study examined AF and vernix samples from immediate post cesarean birth participants, and the 2005 study assessed samples from vaginal birth participants, an appropriate follow-up study might be to compare innate and adaptive antimicrobial effectiveness between babies born via cesarean section versus vaginal birth.

The second study discussed here revealed similar results in the effectiveness of antimicrobial activity against several bacteria and fungi—found to be colonized on the newborn skin within minutes of birth (samples were collected immediately following birth, before any wiping/washing off was performed). Additionally, the study authors postulated that

“The antimicrobial property of vernix may also act to facilitate colonization of normal flora following birth and to block colonization of unwanted microbes or pathogens. For example, psoriasin which is identified in vernix, directly kills E. Coli…”

So…how do we implement all of this into our own practices? My suggestion: teach the expectant parents with whom we interact the enormous benefits contained in that cream cheesy stuff their babies will be covered in (to one degree or another) following birth. Encourage them to facilitate or request rubbing the vernix into the baby’s skin, rather than wiping/washing it all off. Born covered in a complex of antibacterial and antifungal elements, babies bring with them into the world additional mechanisms to boost their own immune function than what we once thought.

Posted by: Kimmelin Hull, PA, LCCE

2011 Hypnobabies Classes

Here is the schedule for the first quarter of the new year

SLC (Murray)

January Class:

Tuesdays from 6-9pm 5 spots left

January 4, 11, 18, 25, February 1, 8

February/March Class:

Tuesdays from 6-9pm 5 spots left

February 15, 22, March 1, 8, 15, 22

April Class:

Tuesdays from 6-9pm 5 spots left

March 29, April 5, 12, 19, 26, May 3

Pleasant Grove

January class:

Saturdays from 9am-12pm 5 spots left

January 8, 15, 22, 29, February 5, 12

February/March Class:

Saturdays from 9am-12pm 5 spots left

February 19, 26, March 5, 12, 19, 26

April Class:

Saturdays from 9am-12pm 5 spots left

April 2, 9, 16, 23, 30, May 7

Great article on breastfeeding

Should Milk Sharing Among Mothers Be Encouraged?

My guest poster today is Karleen Gribble, PhD, Adjunct Research Fellow in the School of Nursing and Midwifery at the University of Western Sydney in Australia. She also serves as one of Lactnet's listmoms and is well-known worldwide for her research and writing on adoptive and long-term breastfeeding, the risks of formula-feeding, and infant feeding in emergencies. Thank you, Karleen, for weighing in on this hot topic.

The recent launch of the peer-to-peer breastmilk sharing group Eats on Feets has brought the issue of women sharing human milk to the attention of health authorities. Due to safety concerns, organisations such as Health Canada and the U.S. Food and Drug Administration have warned mothers not to use another woman’s breastmilk unless it comes from a milk bank. Individuals associated with milk banking have gone so far as to describe peer-to-peer milk sharing as “very unsafe” and “dangerous”

The discussion about peer-to-peer milk sharing has much in common with the discourse that surrounds bed sharing. We know many mothers bring their baby into bed with them at night.¹ Bed sharing makes breastfeeding easier² and breastfeeding mothers get more sleep.³ It also allows mother-baby interaction to continue throughout the night and may protect the infant against the long periods of deep sleep thought to contribute to SIDS.^4,5

However, we also know that bed sharing is not always safe. We know that if a mother smokes, if she has consumed alcohol or other sedatives, if the baby is formula fed, if the sleep surface is a sofa or water bed, or if the bed is also shared with other children that a baby sleeping with his or her mother is at heightened risk of SIDS or accidental death. Infant deaths that occurred as a result of bed sharing under these circumstances have resulted in health authorities such as the American Academy of Pediatrics recommending that parents not sleep with their infants.⁶ It is ironic that not only does blanket condemnation of bed sharing potentially make parenting unnecessarily more difficult for some mothers, it also has the unintended outcome of increasing deaths in places other than beds, such as sofas. This has occurred because due to fears of falling asleep while feeding in bed, some mothers have gotten up to feed on a sofa, fallen asleep there, and infants have died as a result.^7,8 Thus, it seems that bed sharing should not be promoted nor condemned. Rather, parents should be given information about how to bed share safely as well as its risks so they can examine their individual circumstances and decide for themselves where their baby sleeps.

It’s much the same with milk sharing. There is a growing awareness of the importance of breastmilk to the normal health, growth and development of children and of the unavoidable risks associated with the use of infant formula. There are also women who are unable to provide their child with all the breastmilk they require because they have had breast reduction surgery or a double mastectomy or because they have insufficient glandular tissue or are extremely ill. These women have the choice of either obtaining breastmilk from peers or using infant formula. Health authorities who have condemned peer-to-peer milk sharing have told these mothers to obtain human milk from milk banks. But banked donor milk is an extremely rare commodity available to only a tiny number of (usually hospitalised) infants.

The only real alternative to obtaining human milk from a peer is using infant formula, and the evidence for short- and long-term negative impacts on infants from exposure to infant formula is overwhelming.⁹ It is interesting that the same health authorities who condemn peer-to-peer milk sharing have not condemned the use of infant formula. One wonders why the risks of formula are somehow more acceptable than the risks of milk sharing. Is it because formula feeding is so entrenched in our cultures, while breastfeeding remains marginalised? It is ironic that nearly all of the risks Health Canada identified as applying to breastmilk from a peer (http://www.hc-sc.gc.ca/ahc-asc/media/advisories-avis/_2010/2010_202-eng.php) also apply to infant formula. But a similar health advisory on the use of infant formula does not exist.

Milk sharing allows mothers to avoid the risks associated with formula feeding. For some this may be particularly important, for example, those with a family history of diseases associated with formula feeding (diabetes or asthma), the death of a formula-fed baby from necrotising enterocolitis or SIDS, or a baby with formula intolerance. In most cases, milk sharing is not something a woman does lightly or without good reason. For one mother’s story, click here.

When mothers use human milk, they avoid the risks associated with infant formula. However, they potentially expose their child to a whole different set of risks. Fortunately, most of these risks are manageable and some very easily eliminated altogether. (Although very few diseases can be transmitted via breastmilk, one of them is HIV. Fortunately, however, a simple home pasteurisation process destroys HIV.¹⁰) The Eats on Feets website provides extensive information on managing and minimising risks associated with peer-to-peer milk sharing.

As with bed-sharing, peer-to-peer milk sharing should not receive either a blanket endorsement or condemnation, because the safety of the practice depends very much on the situation. An alternative to endorsing or condemning it is to acknowledge the reasons women want to milk share (banked donor milk unavailable, infant formula deficient), provide information on how to manage the risks (recognising that the risks are manageable) and affirm that it’s the parents’ decision. Just as with bed-sharing, as James McKenna noted: “It remains the right of parents to make informed decisions, which requires access to unbiased information exchanged within an appropriately relaxed and non-judgmental educational venue.”⁵

http://www.nancymohrbacher.com/blog/2010/12/6/should-milk-sharing-among-mothers-be-encouraged.html

Discounted Hypnobabies Classes

Because the holidays are right around the corner, and The Doula House is about to start their Holiday series of classes; we are offering a $25 discount on our classes. That bring the cost to $275, which is a great deal for an 18 hour childbirth course

What is Hypnobabies?

Hypnobabies is a complete childbirth education course. Hypnobabies uses real medical hypno-anesthesia, the kind they use to put people under for surgery. Hypnobabies uses “Eyes-Open” hypnosis which allows the mother to move about during birth, while staying in a deep state of relaxed hypnosis. Using Hypnobabies will teach you how to stay in a deep state of hypnosis, and how to tell your body how to work best during your birthing time.

Hypnobabies is a complete childbirth Education class, covering everything from nutrition, and optimal fetal positioning.You will learn about informed consent and how to make the best choices for you and your baby. We help our fathers or birth partners know how to best help our hypno-moms.

Hypnobabies can be used in a hospital delivery setting, a birthing center, or a home birth.

The Course includes 6 3 hours classes held once a week. This is the optimum to allow the subconscious mind to reprogram belief systems about birth. Hypnosis can be used not only for the birthing, but for morning sickness, turning babies, and getting the birth process started when you are past-due.

Please call or visit our website for the dates of the next scheduled class.
www.TheDoulaHouse.com
Marinda Lloyd 801-548-2917

Co-sleeping? Check out this article

Cosleeping and Biological Imperatives: Why Human Babies Do Not and Should Not Sleep Alone

Posted by dlende on December 21, 2008

By James J. McKenna Ph.D.
Edmund P. Joyce C.S.C. Chair in Anthropology
Director, Mother-Baby Behavioral Sleep Laboratory
University of Notre Dame

Where a baby sleeps is not as simple as current medical discourse and recommendations against cosleeping in some western societies want it to be. And there is good reason why. I write here to explain why the pediatric recommendations on forms of cosleeping such as bedsharing will and should remain mixed. I will also address why the majority of new parents practice intermittent bedsharing despite governmental and medical warnings against it.

Definitions are important here. The term cosleeping refers to any situation in which a committed adult caregiver, usually the mother, sleeps within close enough proximity to her infant so that each, the mother and infant, can respond to each other’s sensory signals and cues. Room sharing is a form of cosleeping, always considered safe and always considered protective. But it is not the room itself that it is protective. It is what goes on between the mother (or father) and the infant that is. Medical authorities seem to forget this fact. This form of cosleeping is not controversial and is recommended by all.

Unfortunately, the terms cosleeping, bedsharing and a well-known dangerous form of cosleeping, couch or sofa cosleeping, are mostly used interchangeably by medical authorities, even though these terms need to be kept separate. It is absolutely wrong to say, for example, that “cosleeping is dangerous” when roomsharing is a form of cosleeping and this form of cosleeping (as at least three epidemiological studies show) reduce an infant’s chances of dying by one half.

Bedsharing is another form of cosleeping which can be made either safe or unsafe, but it is not intrinsically one nor the other. Couch or sofa cosleeping is, however, intrinsically dangerous as babies can and do all too easily get pushed against the back of the couch by the adult, or flipped face down in the pillows, to suffocate.

Often news stories talk about “another baby dying while cosleeping” but they fail to distinguish between what type of cosleeping was involved and, worse, what specific dangerous factor might have actually been responsible for the baby dying. A specific example is whether the infant was sleeping prone next to their parent, which is an independent risk factor for death regardless of where the infant was sleeping. Such reports inappropriately suggest that all types of cosleeping are the same, dangerous, and all the practices around cosleeping carry the same high risks, and that no cosleeping environment can be made safe.

Nothing can be further from the truth. This is akin to suggesting that because some parents drive drunk with their infants in their cars, unstrapped into car seats, and because some of these babies die in car accidents that nobody can drive with babies in their cars because obviously car transportation for infants is fatal. You see the point.

One of the most important reasons why bedsharing occurs, and the reason why simple declarations against it will not eradicate it, is because sleeping next to one’s baby is biologically appropriate, unlike placing infants prone to sleep or putting an infant in a room to sleep by itself. This is particularly so when bedsharing is associated with breast feeding.

When done safely, mother-infant cosleeping saves infants lives and contributes to infant and maternal health and well being. Merely having an infant sleeping in a room with a committed adult caregiver (cosleeping) reduces the chances of an infant dying from SIDS or from an accident by one half!

Research

In Japan where co-sleeping and breastfeeding (in the absence of maternal smoking) is the cultural norm, rates of the sudden infant death syndrome are the lowest in the world. For breastfeeding mothers, bedsharing makes breastfeeding much easier to manage and practically doubles the amount of breastfeeding sessions while permitting both mothers and infants to spend more time asleep. The increased exposure to mother’s antibodies which comes with more frequent nighttime breastfeeding can potentially, per any given infant, reduce infant illness. And because co-sleeping in the form of bedsharing makes breastfeeding easier for mothers, it encourages them to breastfeed for a greater number of months, according to Dr. Helen Ball’s studies at the University of Durham, therein potentially reducing the mothers chances of breast cancer. Indeed, the benefits of cosleeping helps explain why simply telling parents never to sleep with baby is like suggesting that nobody should eat fats and sugars since excessive fats and sugars lead to obesity and/or death from heart disease, diabetes or cancer. Obviously, there’s a whole lot more to the story.

As regards bedsharing, an expanded version of its function and effects on the infant’s biology helps us to understand not only why the bedsharing debate refuses to go away, but why the overwhelming majority of parents in the United States (over 50% according to the most recent national survey) now sleep in bed for part or all of the night with their babies.

That the highest rates of bedsharing worldwide occur alongside the lowest rates of infant mortality, including Sudden Infant Death Syndrome (SIDS) rates, is a point worth returning to. It is an important beginning point for understanding the complexities involved in explaining why outcomes related to bedsharing (recall, one of many types of cosleeping) vary between being protective for some populations and dangerous for others. It suggests that whether or not babies should bedshare and what the outcome will be may depend on who is involved, under what condition it occurs, how it is practiced, and the quality of the relationship brought to the bed to share. This is not the answer some medical authorities are looking for, but it certainly resonates with parents, and it is substantiated by scores of studies.

Understanding Recommendations

Recently, the American Academy of Pediatrics (AAP) SIDS Sub-Committee for whom I served (ad hoc) as an expert panel member recommended that babies should sleep close to their mothers in the same room but not in the same bed. While I celebrated this historic roomsharing recommendation, I disagreed with and worry about the ramifications of the unqualified recommendation against any and all bedsharing. Further, I worry about the message being given unfairly (if not immorally) to mothers; that is, no matter who you are, or what you do, your sleeping body is no more than an inert potential lethal weapon against which neither you nor your infant has any control. If this were true, none of us humans would be here today to have this discussion because the only reason why we survived is because our ancestral mothers slept alongside us and breastfed us through the night!

I am not alone in thinking this way. The Academy of Breast Feeding Medicine, the USA Breast Feeding Committee, the Breast Feeding section of the American Academy of Pediatrics, La Leche League International, UNICEF and WHO are all prestigious organizations who support bedsharing and which use the best and latest scientific information on what makes mothers and babies safe and healthy. Clearly, there is no scientific consensus.

What we do agree on, however, is what specific “factors” increase the chances of SIDS in a bedsharing environment, and what kinds of circumstances increase the chances of suffocation either from someone in the bed or from the bed furniture itself. For example, adults should not bedshare if inebriated or if desensitized by drugs, or overly exhausted, and other toddlers or children should never be in a bed with an infant. Moreover, since having smoked during a pregnancy diminishes the capacities of infants to arouse to protect their breathing, smoking mothers should have their infants sleep alongside them on a different surface but not in the same bed.

My own physiological studies suggest that breastfeeding mother-infant pairs exhibit increased sensitivities and responses to each other while sleeping, and those sensitivities offers the infant protection from overlay. However, if bottle feeding, infants should lie alongside the mother in a crib or bassinet, but not in the same bed. Prone or stomach sleeping especially on soft mattresses is always dangerous for infants and so is covering their heads with blankets, or laying them near or on top of pillows. Light blanketing is always best as is attention to any spaces or gaps in bed furniture which needs to be fixed as babies can slip into these spaces and quickly to become wedged and asphyxiate. My recommendation is, if routinely bedsharing, to strip the bed apart from its frame, pulling the mattress and box springs to the center of the room, therein avoiding dangerous spaces or gaps into which babies can slip to be injured or die.

But, again, disagreement remains over how best to use this information. Certain medical groups, including some members of the American Academy of Pediatrics (though not necessarily the majority), argue that bedsharing should be eliminated altogether. Others, myself included, prefer to support the practice when it can be done safely amongst breastfeeding mothers. Some professionals believe that it can never be made safe but there is no evidence that this is true.

More importantly, parents just don’t believe it! Making sure that parents are in a position to make informed choices therein reflecting their own infant’s needs, family goals, and nurturing and infant care preferences seems to me to be fundamental.

Our Biological Imperatives

My support of bedsharing when practiced safely stems from my research knowledge of how and why it occurs, what it means to mothers, and how it functions biologically. Like human taste buds which reward us for eating what’s overwhelmingly critical for survival i.e. fats and sugars, a consideration of human infant and parental biology and psychology reveal the existence of powerful physiological and social factors that promote maternal motivations to cosleep and explain parental needs to touch and sleep close to baby.

The low calorie composition of human breast milk (exquisitely adjusted for the human infants’ undeveloped gut) requires frequent nighttime feeds, and, hence, helps explain how and why a cultural shift toward increased cosleeping behavior is underway. Approximately 73% of US mothers leave the hospital breast feeding and even amongst mothers who never intended to bedshare soon discover how much easier breast feeding is and how much more satisfied they feel with baby sleeping alongside often in their bed.

But it’s not just breastfeeding that promotes bedsharing. Infants usually have something to say about it too! And for some reason they remain unimpressed with declarations as to how dangerous sleeping next to mother can be. Instead, irrepressible (ancient) neurologically-based infant responses to maternal smells, movements and touch altogether reduce infant crying while positively regulating infant breathing, body temperature, absorption of calories, stress hormone levels, immune status, and oxygenation. In short, and as mentioned above, cosleeping (whether on the same surface or not) facilitates positive clinical changes including more infant sleep and seems to make, well, babies happy. In other words, unless practiced dangerously, sleeping next to mother is good for infants. The reason why it occurs is because… it is supposed to.

Recall that despite dramatic cultural and technological changes in the industrialized west, human infants are still born the most neurologically immature primate of all, with only 25% of their brain volume. This represents a uniquely human characteristic that could only develop biologically (indeed, is only possible) alongside mother’s continuous contact and proximity—as mothers body proves still to be the only environment to which the infant is truly adapted, for which even modern western technology has yet to produce a substitute.

Even here in whatever-city-USA, nothing a baby can or cannot do makes sense except in light of the mother’s body, a biological reality apparently dismissed by those that argue against any and all bedsharing and what they call cosleeping, but which likely explains why most crib-using parents at some point feel the need to bring their babies to bed with them —findings that our mother-baby sleep laboratory here at Notre Dame has helped document scientifically. Given a choice, it seems human babies strongly prefer their mother’s body to solitary contact with inert cotton-lined mattresses. In turn, mothers seem to notice and succumb to their infant’s preferences.

There is no doubt that bedsharing should be avoided in particular circumstances and can be practiced dangerously. While each single bedsharing death is tragic, such deaths are no more indictments about any and all bedsharing than are the three hundred thousand plus deaths or more of babies in cribs an indictment that crib sleeping is deadly and should be eliminated. Just as unsafe cribs and unsafe ways to use cribs can be eliminated so, too, can parents be educated to minimize bedsharing risks.

Moving Beyond Judgments to Understanding

We still do not know what causes SIDS. But fortunately the primary factors that increase risk are now widely known i.e. placing an infant prone (face down) for sleep, using soft mattresses, maternal smoking, overwrapping babies or blocking air movement around their faces. In combination with bedsharing, where more vital normal defensive infant responses and may be more important to an infant (like the ability to arouse to bat a blanket which momentarily falls to cover the infants face when its parent moves or turns) these risks become exaggerated especially amongst unhealthy infants. When infants die in these obviously unsafe conditions, it is here where social biases and the sheer levels of ignorance associated with actually explaining the death become apparent. A death itself in a bedsharing environment does not automatically suggest, as many legal and medical authorities assert, that it was the bedsharing, or worse, suffocation that killed the infant. Infants in bedsharirng environments, like babies in cribs, can still die of SIDS.

It is a shame and certainly inappropriate that, for example, the head pathologists of the state of Indiana recommends that other pathologists assume SIDS as a likely cause of death when babies die in cribs but to assume asphyxiation if a baby dies in an adult bed or has a history of “cosleeping”. By assuming before any facts are known from the pathologist’s death scene and toxicological report that any bedsharing baby was a victim of an accidental suffocation rather than from some congenital or natural cause, including SIDS unrelated to bedsharing, medical authorities not only commit a form of scientific fraud but they victimize the doomed infant’s parents for a third time. The first occurs when their baby dies, the second occurs when health professionals interviewed for news stories (which commonly occurs) imply that when a baby dies in a bed with an adult it must be due to suffocation (or a SIDS induced by bedsharing). The third time the parents are victimized is when still without any evidence medical or police authorities suggest that their baby’s death was “preventable,” that their baby would still be alive if only the parents had not bedshared. This conclusion is based not on the facts of the tragedy but on unfair and fallacious stereotypes about bedsharing.

Indeed, no legitimate SIDS researcher nor forensic pathologist should render a judgment that a baby was suffocated without an extensive toxiological report and death scene investigation including information from the mother concerning what her thoughts are on what might or could have happened.

Whether involving cribs or adult beds, risky sleep practices leading to infant deaths are more likely to occur when parents lack access to safety information, or if they are judged to be irresponsible should they choose to follow their own and their infants’ biological predilections to bedshare, or if public health messages are held back on brochures and replaced by simplistic and inappropriate warnings saying “just never do it.” Such recommendations misrepresent the true function and biological significance of the behaviors, and the critical extent to which dangerous practices can be modified, and they dismiss the valid reasons why people engage in the behavior in the first place.

For More Information:
A Popular Parenting Book
Sleeping With Your Baby: A Parent’s Guide To Cosleeping by James J.McKenna (2007). Platypus Press.

The Scientific Perspective
McKenna, J., Ball H., Gettler L., Mother-infant Cosleeping, Breastfeeding and SIDS: What Biological Anthropologists Have Learned About Normal Infant Sleep and Pediatric Sleep Medicine. Yearbook of Physical Anthropology 50:133-161 (2007)

McKenna, J., McDade, T., Why Babies Should Never Sleep Alone: A Review of the Co-Sleeping Controversy in Relation to SIDS, Bedsharing and Breastfeeding (pdf). Paediatric Respiratory Reviews 6:134-152 (2005)

Motherhood and the $13 Billion Guilt

Since this month's publication of my paper "The Burden of Suboptimal Breastfeeding in the United States" in Pediatrics with Arnold Reinhold, I'm often asked by reporters what the US can do better to improve our breastfeeding rates. I've also gotten quite a few comments asking if this research just makes moms feel guilty if they couldn't breastfeed.

The answers to both these queries are intimately related, and are best illustrated by the following Tale of Two Births. As you will see, if you compare what should happen when a woman gives birth, versus what actually happens, you can appreciate how tough it can be for US women to breastfeed, but how much easier it could be if only things were a little different around here.

Birth number 1: Having a baby in the ideal, family-friendly United States:

You give birth with the help of a birth doula. She helps you avoid a c-section or vacuum assisted birth, which is why your hospital hired her. Your baby is wiped off, then put directly onto your chest, skin to skin, with his head between your breasts. The nurse puts a blanket around you both, and then your partner cuts the cord. The nurse evaluates his initial transition to life outside the womb as he rests on your chest. As you lay semi-reclining, happy and exhausted, your baby uses his arms and legs to crawl over to your breast and he starts nursing. You and your partner are left undisturbed for an hour to enjoy your new baby, who has now imprinted the proper breastfeeding behaviors thanks to this initial breastfeeding. You are then transported to your post-partum room with your baby on your chest.

The nurse returns and weighs, measures, and examines your baby right there in your room. You are with him as she gives him his vitamin K shot and antibiotic eye ointment. Your baby is handed back to you, and again placed on your chest skin to skin. He stays in your room with you until you go home. From your prenatal class, you knew in advance to ask most of your visitors wait until you go home, so that you can get some rest, and you turn the ringer off your phone, so that no phone calls will wake you. Before you leave the hospital, your baby's routine heel-stick blood test is done while he is nursing, and you are amazed to see he doesn't cry at all. You are discharged with clear instructions around breastfeeding, and phone numbers to call if you need help. You are not given samples and "gifts" from a formula company.

Two days later, you see your pediatrician, who is a little concerned about the baby's weight, but your baby otherwise looks healthy. He quickly refers you to a licensed International Board Certified Lactation Consultant, and all you pay is your standard co-pay. She does a careful assessment and advises increasing the frequency of nursing for a few days, and that does the trick.

You enjoy three months paid maternity leave, at 80% of your usual pay. Your baby sleeps within arm's reach of you, and because you taught yourself how to breastfeed lying down in the dark, you awake fairly refreshed every morning.

When you return to work, your employer allows you flex time. Your employer has a policy that allows new parents to bring their infants to work, so often you bring your baby with you. As in other companies with such policies, your coworkers enjoy having a baby around, and you feel happy, calm, and productive.

When your baby gets more active, you put him in the daycare near your worksite so you can nurse him during lunch, and you can pump milk in the lactation room at work. You bought a nice pump with your insurance's Durable Medical Equipment allowance. After 6 months, you introduce solids. A few months later, you really don't need to pump any more and you and your baby enjoy breastfeeding for another year. Your baby is so healthy that you've never had to miss a full day of work.

Does that sound like your birth experience, or does this?

Birth number 2: Having a baby in the real United States:

Your give birth to a healthy baby, and you've never heard of a birth doula. The umbilical cord is clamped and cut before anyone can say, "It's a boy!" Immediately, your baby is whisked across the room to the warmer where Apgar scores are assigned, he's given a shot of Vitamin K, and antibiotic eye ointment is slathered in his eyes, clouding his vision. He's placed on a cold scale and weighed and measured. He is examined by his nurse, who takes him to a different room to do her evaluation. He is bathed, washing off his mother's scent. At last, he's professionally swaddled into a nice tight parcel and handed to you to hold, cradled sideways in your arms.

He's not skin to skin, and he can't move his arms and legs to crawl to the breast. Before you know it, an hour has passed since his birth, and since he's missed the window of "alert time" after birth, he slips into a deep sleep without having spontaneously breastfeed. You attempt to interest him in the breast, but he is really too tired to try very hard. Because he's wrapped up and has been given a bath, he can't use his sense of touch and smell to crawl his way over to find your breast. You don't know enough to unwrap him and feed him immediately after birth, because your prenatal class didn't stress the importance of skin to skin contact during the first 3 days of life. That was all discussed in a separate breastfeeding class and you didn't really have time or money to take two classes.

Just as you're getting to know your new bundle of joy, the staff decides to check his temperature and his blood sugar. His glucose level is 45 -- normal for a newborn, but low for an adult. His temperature is a little low, too -- all that time in the bath, the cold scale, the swaddling, and the time away from his mom's body heat has led to hypothermia.

Hypothermia and hypoglycemia can be signs of a serious infection, so immediately he is taken from your arms down to the nursery, where he gets what's known as a sepsis evaluation. Lying under a warmer down the hall from you, he gets his blood drawn, and then is left in his bassinet in the nursery to be observed for a few hours so you can't spend time with him as you recover from giving birth. He gets a 2 ounce bottle of formula, most of which he vomits, since the stomach of a five-hour-old baby is no bigger than a teaspoon, the perfect size to digest the colostrum your breast secretes for him in the first few days.

Finally, your baby's brought back to you, swaddled in a nice package. He's more alert, but never imprinted breastfeeding very well, and he's very stressed from all the day's events. He might be full from the formula he's given, and doesn't breastfeed well. He tries later in the day. The nurses try to help you, but it feels like they all give you different advice, much of it conflicting. Little do you know, their advice is based on their personal experiences rather than any scientific evidence because they haven't had much training in breastfeeding. You don't know what to believe. Finally, your baby goes to the nursery for the night "so you can sleep," and he is brought in for you to feed him. He doesn't like it in the nursery, so he cries, and you don't get much sleep either.

You have some pain when he latches on, and you're told that's normal. You're so excited about his birth that you talk to everyone by phone, and lots of people come to visit. They pass him around. Maybe someone wants to give him a bottle, and you figure, ok, why not. He's chewing on his fist, but no one ever told you that means he's hungry, so you give him a hospital-issued pacifier to suck on instead of his hand. You don't know that giving formula and pacifiers in the hospital will undermine your efforts to breastfeed. It's surprising the nursing staff doesn't inform you of this, and you didn't learn it in your prenatal class. You're too embarrassed to feed him with everyone there. Finally, your guests leave, but by this time, your baby's frantic, and nursing doesn't go well as a result.

Overnight, as he stays in the nursery, he gets weighed, and he's lost more weight than he should have. The doctor says it's because your milk isn't in yet, and recommends more bottles. He still sucks happily on a pacifier and sleeps in the nursery despite his alarming weight loss, and no one suggests that you nurse him more often, room in with him, get rid of the pacifier, or see a lactation consultant, all of which would help put him back on track with breastfeeding.

An hour before you're due to go home, the lactation consultant comes in briefly to check on you, but because her department is so understaffed, she couldn't see you earlier when you needed it most, and she has little time to spend addressing your problems. On your way out, a nurse hands you a marketing bag from a brand-name formula company, complete with free samples of formula and information on breastfeeding that makes it sound a little hard and scary. She tells you if you have any questions, to just call your pediatrician.

The first night at home, things don't go well. It's the middle of the night, and your baby won't stop crying when you try to breastfeed. You wonder if you should just give up. You reach for that ready-made bottle and his crying mercifully stops. The problem is solved, at least for now.

You are really motivated to breastfeed, so in the morning, you try to find a lactation consultant. You talk to someone you find in the yellow pages called a "lactation counselor" who is willing to help, but your insurance won't pay. You find someone else called a "lactation consultant." You have no idea what the difference is between a "lactation counselor" and a "lactation consultant." Since these professionals aren't licensed in any state, you have no way of knowing if they know what they are doing.

You meet with the lactation consultant, but have to pay out of pocket. She helps you. Afterwards, you have to file a claim with your insurance company and hope they reimburse you, all while caring for your newborn. The lactation consultant recommends pumping with a double electric pump to help you build up your milk supply, which is now threatened because of all the formula the baby got, and because his breastfeeding technique is not really good enough yet to extract milk well, since he didn't learn properly right from the beginning. Your insurance won't allow the breast pump to come out of your Durable Medical Equipment allowance, and you try to pay for it with your Flexible Spending benefit card, but it's denied. You pay $250 out of pocket. Good thing you had a gift card to pay for all that!

You go to your pediatrician for follow up. Since your pediatrician got very little training on breastfeeding, he doesn't know how to help you, but is concerned that your baby has lost too much weight, and advises giving some formula. You don't know what to do because the lactation consultant's advice was different.

Ugh!!! This is really hard, you think. Eventually, things miraculously end up working out, just because you persevere through thick and thin, and your partner and family and friends are very supportive. By about 4 weeks, your baby is now exclusively breastfeeding, and gaining well. And you are enjoying what time is left of your unpaid leave under the Family Medical Leave Act. But, you have only two more weeks before you go back to work. You can't afford any more time off.

You start pumping to build up a stash of frozen milk for your return to work. You arrange with your employer a place to pump -- how lucky you are that it won't be a bathroom! You go back to work, and before long you discover your milk supply is dwindling and now your baby wants to nurse all night long. You are exhausted.

You call the lactation consultant who tells you that it's common to see a drop in milk supply when moms go back to work. She explains that pumps aren't as efficient at removing milk as your own baby is, so your milk supply may drop, and your baby makes up for it by nursing more when you are with him -- it just so happens that that's at night. "It's called reverse cycle feeding," she tells you. You wonder why you never heard about this before, in any of your follow-up visits with your pediatrician or OB.

You want to see the lactation consultant again, but your insurance will only reimburse you for visits during the newborn period. Well, you think, at least my insurance paid for something -- my friend's insurance doesn't reimburse anything for lactation help.

You nearly fall asleep at the wheel driving to work. "This is crazy," you think. "My baby needs me to be alive, more than he needs me to be breastfeeding." Finally, you give up. You just can't do this anymore. You are very sad and disappointed.

You become a statistic: one of the 41% of US mothers who wean before 3 months. You feel guilty as hell, especially when all you ever hear is how great breastfeeding is, and now how that new study shows it could save the US economy $13 billion/year, and how everyone says it saves lives and how it will make you healthier too. You just wish all these people would just shut the heck up.

So, now that you've heard the difference between what your experience could have been like, and what it was actually like, you tell me:

Do you feel guilty for not breastfeeding? Or do you feel angry because it didn't have to be this way?

And if you answered "angry," then take that anger, and write to your hospital -- tell them you want them to become a Baby-Friendly hospital, so that no one else will have to go through what you did just to feed your child. Write to your state and federal legislators -- tell them to support laws that make breastfeeding easier, like licensing of lactation consultants, and the requirement that insurance companies reimburse for lactation care and services. And write to your US representatives and senators, and tell them you want tax-credits for onsite childcare, and that you don't want the US to continue being the world's only developed country without paid maternity leave.

Yes, I'm a researcher and a physician, but I'm also a mother. Since I live in the United States, you can probably guess what my birth experience was like. Maybe you've heard me on the news saying that moms shouldn't feel guilty. I've been there. So take that guilt and turn it inside out, and do something positive so that other moms don't have to go through what you did. We all deserve better.

A Peaceful Revolution is a blog about innovative ideas to strengthen America's families through public policies, business practices, and cultural change. Done in collaboration withMomsRising.org, read a new post here each week. Submission inquiries to Nanette@MomsRising.org.