Monday, November 30, 2009

Ask an IBCLC

Our International Board Certified Lactation Consultant is Marlene Giel, a RN here in Aruba at The Horacio Oduber Hospital. She's been a L&D Nurse since 1995 and did her specialization in Obstetrics&Gynecology. She Graduated in 2002 from the Erasmus Medische Centrum Rotterdam. Always having had a passion for breastfeeding, she took on a new title that of Certified Lactation Consultant since beginning her studies in 2006. She is in the course of completing absolute certification for IBCLC. 

Q: My baby is two months old and is nursing on average about 7 times a day. I'm going back to work an 8 hour shift and I was wondering how much expressed breast milk I should leave for him.

A: In the beginning it is a try out to find out how much expressed breast milk you should give the baby. Maybe the baby will drink only 10 cc but also he can drink 100 cc .

A guideline to use is the following:

A baby should get 150 cc per kg bodyweight per day. For example a baby of 5 kg who is nursing about 7 times a day can have:

5 kg x 150 cc= 750 cc
750 cc : 7 = about 100 cc every time. ( 1 oz is 30 cc )

Because breast milk is easily digested it can be that the baby will drink more than 100 cc every time.

Saturday, November 28, 2009

Risks of controlled crying

Taken from

Posted by Bridget in - Bonding with baby -

Position Paper 1: Controlled Crying

Issued November 2002; Revised March 2004
The Australian Association for Infant Mental Health Inc. (AAIMHI)
AAIMHI aims (in part) to: improve professional and public recognition that infancy is a critical period in psycho-social development, and  work for the improvement of the mental health and development of all infants and families.


Controlled crying (also known as controlled comforting and sleep training) is a technique that is widely used as a way of managing infants and young children who do not settle alone or who wake at night. Controlled crying involves leaving the infant to cry for increasingly longer periods of time before providing comfort. The intention of controlled crying is to let babies put themselves to sleep and to stop them from crying or calling out during the night.  AAIMHI is concerned that the widely practiced technique of controlled crying is not consistent with what infants need for their optimal emotional and psychological health, and may have unintended negative consequences.

Background to AAIMHI’s Concerns

This statement is premised on an understanding of crying to mean crying that indicates distress, either psychological or physical, rather than the “fussing” that many babies do in settling or adjusting to different circumstances. Babies have to adapt to a totally new world and even small changes can be stressful for them. Leaving babies to cry without comfort, even for short periods of time, can be very distressing for them.  Crying is a signal of distress or discomfort from an infant or young child. Although controlled crying can stop children from crying, it may teach children not to seek or expect support when distressed.  Infants from about six months of age suffer from differing degrees of anxiety when separated from their parents. This anxiety continues until they can learn that their parents will return when they leave, and that they are safe. This learning may take up to three years.
Almost all children grow out of the need to wake at night and be reassured by three or four years of age, many much earlier than this. Infants are more likely to develop secure attachments when their distress is responded to promptly, consistently and appropriately. Secure attachments in infancy are the foundation for good adult mental health.  Infants whose parents respond and attend to their crying promptly, learn to settle more quickly in the long run as they become secure in the knowledge that their needs for emotional comfort will be met. The demands of Western lifestyles and some “expert” advice has led to an expectation that all infants and young children should sleep through the night from the early months or even weeks. In fact infants have the potential to arouse more often in the night than older children or adults because their sleep cycles are much shorter. These short sleep cycles allow infants to experience more rapid eye movement (REM) sleep, which is considered to be important for their brain development.
Many parents become distressed and exhausted when their infants and young children cry at night, in part because of the physical strain of getting up and going to their babies to re-settle them, and sometimes in part because of the unrealistic expectation that babies “should” sleep through the night. Many infants and parents sleep best when they sleep together. There is no developmental reason why infants should sleep separately from their parents, and in most parts of the world infants do sleep with their parents or other family members, either in the same bed, or in a cot next to the parents’ bed. There are certain conditions under which bed sharing should not occur, for example when a parent is affected by drugs or alcohol, or where the bedding is overly soft. Parents should check current information about safe sleeping; or for more information.
Many parents find controlled crying helpful and this is one of the reasons for its popularity. For other parents it does not work, or causes so much distress for the parent and the infant that it is discontinued. There have been no studies such as sleep laboratory studies, to our knowledge, that assess the sociological stress levels of infants who undergo controlled crying, or its emotional or psychological impact on the developing child.

AAIMHI – Controlled Crying Principles

It is normal and healthy for infants and young children not to sleep through the night and to need attention from parents. This should not be labeled a disorder except where it is clearly outside the usual patterns. Parents should be reassured that attending to their infant’s needs/crying will not cause a lasting “habit”. Waking in older infants and young children may be due to separation anxiety, and in these cases sleeping with or next to a parent is a valid option. This often enables all to get a good night’s sleep. Any methods used to assist parents to get a good night’s sleep should not compromise the infant’s developmental and emotional needs.
If controlled crying is to be used it would be most appropriate after the child has an understanding of the meaning of the parent’s words, to know that the parent will be coming back and to be able to feel safe without the parent’s presence. Developmentally this takes about three years. This varies between children so observing children and responding to their cues is the best way to assess when a child feels safe sleeping alone. Full professional assessment of the child’s health, and child/ family relationships should be undertaken before initiating a controlled crying program. This should include assessing whether in fact the infant’s crying is outside normal levels. All efforts should be made to link parents with community supports to minimize isolation and frustration felt by many parents when caring for a young child.
Other strategies, apart from controlled crying, should always be discussed with parents as preferable options. If an infant or child has already experienced separation from a parent due to sickness, parental absence or adoption, or if he or she becomes very distressed, the method should not be used. This is because children who have already experienced traumatic separation are more vulnerable to negative effects from the kind of stress caused by controlled crying.
Where parental stress due to infant crying may lead to risk of abuse it is essential that parents be linked with social supports and therapeutic intervention. Parents should be told that the controlled crying method has not been assessed in terms of stress on the infant or the impact on the infant’s emotional development. Where it is used recommendations should be for exercising caution and playing safe. For example, paying attention to level of distress rather than number of minutes baby has to be left to cry, or not continuing with any technique if it does not feel right.

For further information about this document, contact Pam Linke on Tel: (08) 8303 1566.

Suggestions for alternatives to controlled crying:
Fleiss PM, Hodges FM & Phil D (2000).
Sweet Dreams: APediatrician’s Secrets for Your Child’s Good Night’s Sleep. Los Angeles: Lowell House. Hope M (1996).
For Crying Out Loud! Understanding and Helping Crying Babies. Randwick NSW: Sydney Children’s Hospital. McKay P (2002).
100 Ways to Calm the Crying. Melbourne: Lothian. McKay P (2002).
Parenting by Heart. Melbourne: Lothian. Pantley E (2002).
The No-Cry Sleep Solution. NewYork: Contemporary Books. Sears W & Sears M (2003).
The Baby Book: Everything you need to know about your baby – from birth to age two. New York: Little,
Brown and Company. Tracey N et al. (2002).
Sleep for Baby and Family. Sydney: PIFA.Tel: 02 82301646.A wide range of articles for parents can be found on: Dr Sears has some other

The list below is not specifically for studies on the impact of controlled crying on infants because there are no records of such studies. The list has sources of general background information related to sleep and to understanding children and stress.
Bell SM & Ainsworth MD (1972). Infant crying and maternal responsiveness.
Child Development 43, 1171-1190.Blurton Jones N (1972).
Comparative aspects of mother-child contact. In: Blurton Jones N (Ed).
Ethological Studies of Child Behaviour. Cambridge: Cambridge University Press. Bowlby J (1973).
Attachment and loss: 2. Separation. Harmondswroth, Middlesex: Penguin. Dolby R (1996).
Overview of Attachment Theory and Consequences for Emotional Development. In: Seminar 15. Attachment: Children’s Emotional Development and the Link with Care and ProtectionIssues. Sydney: Child Protection Council. Hope MJ (1986).

Selected Paper No. 43: Understanding Crying inInfancy. Kensington, NSW: Foundation for Child & Youth Studies. James McKenna’s Mother-Baby Behavioural Sleep Laboratory. Keller H et al. (1996).
Psychobiological aspects of infant crying.Early Development and Parenting 5, 1-13. Lamport Commons M. & Miller PM. Emotional learning in infants: Across-cultural examination. Leach P (1994). Children First: What we must do, and are not doing – for our children today. London: Penguin.
McKenna J & Gartner L (2000).
Sleep Location and Suffocation: How Good Is The Evidence? Pediatrics 105, 917-919. McKenna J (2000).
Cultural Influences on Infant Sleep (abbreviated chapter) Zero To Three 20, 9-18. Mitchell EA & Thompson JMD (1995).
Co-sleeping increases the risk of SIDS, but sleeping in the parental bedroom lowers it. In: Rogum TO (Ed). Sudden infant death syndrome: new trends in the nineties. Oslo: Scandinavian University Press. Odent M (1986).
Primal health: A blueprint for our survival. London:
Century Hutchinson. Perry BD. Memories of Fear: How the Brain Stores and Retrieves
Physiologic States, Feelings, Behaviors and Thoughts from Traumatic Events. Memories.ASP>Perry BD & Pollard R (1998).
Homeostasis, stress, trauma, and adaptation: a neurodevelopmental view of childhood trauma. Child and Adolescent Psychiatric Clinics of North America 7, 33-51. Trevathan W & McKenna J (1994). Evolutionary environments of human birth and infancy: Insights to apply to contemporary life.Children’s Environments11, 88-104.

Friday, November 27, 2009

Home birth - Better safe than sorry?

A topic of much heated debate is the one of birth at home. An option that I myself once considered to be for 'bush-people'. After the birth of my daughter, however, I started to see things in a different light. Even though I learned and heard about home birth in a favorabe light in my Childbirth education class, I couldn't help but think of how unsafe it was, or how 'olden-time' it is... little did I know...

I treasured the experience of childbirth so much that a few months after my daughter was born, at just 19 years of age, I decided to enroll in long distance training to certify as a Childbirth Educator. I loved it, I threw myself deep into the birthing world and as I grew and became more knowlegeable about the birthing process my thoughts and opinions surrounding home birth changed drastically as well. To begin with, I don't view midwives as 'bush-doctors' anymore nor do I view obstetricians as demi-gods either. When some people hear us talking about ob/gyns and birth some may conclude that us birth advocates are 'anti-obstetrician' but as Henci Goer put it, I'd like to think of it this way : " I believe the injudicious use of technology is doing considerable physical and psychological harm to mothers and babies."

A brief history of hospital birth

For years the American Academy of Obstetricians and Gynecologists have officially opposed home birth on grounds of safety. If the argument for universal hospitalization for childbirth is that it is safer, then it is reasonable to ask: Has moving birth into the hospital decreased the risks?

It all began in the 18th century when male midwives (equivalent to today's obstetricians) needed someone, anyone, to practice their skills in childbirth and began offering free hospital care for poor and sometimes homeless women. The first lying-in hospital was established in Dublin in 1745, which then spread to other parts of Europe and the U.S.

Doctors argue that the decrease in mortality and morbidity rate rates as moved into the hospital proves that the hospital is safer.(1)(2) Even if that statement were true, it would not mean hospital birth was responsible for the decline, but the claim is false. In the 1920s middle-class women began having babies in hospitals partly on grounds of safety. By the mid-1920s half of urban births took place there, and by 1939, half of all women and 75% of all urban women gave birth in hospitals. Even though the majority of birth took place at the hospital, maternal mortality did not drop below the 1915 levels of 63 maternal deaths per 10,000 births until the 1930s, when sulfa drugs and antibiotics to treat infection were introduced and more stringent controls were placed on obstetric practices. During that same time period, urban maternal mortality rates, where hospitalization for birth was more common, were considerably higher than overall rates: 74 deaths per 10,000 births (3). Infant deaths from birth injuries actually increased by 40%-50% between 1915 and 1929 (4).

Despite such progress in techniques and technology in the birth field, hospital birth is still not safer than home birth. Contemporary defenders of universal hospital confinement point to statistics showing higher perinatal mortality rates for out-of-hospital births (5)(6)(7), but these were raw statistics and included unintended home births and births without a trained birth attendant. No study has ever shown that planned home birth with a trained attendant who took proper precautions increased the incidence of poor outcomes among low-risk women compared with low-risk women in the hospital. The issue of the safety of home birth cannot be settled by research. While research has failed to show that home birth is dangerous, research cannot conclusively prove it to be safe. It comes down to a matter of individual choice.

Home births become dangerous only when doctors and hospitals fail to provide backup services, thus, their failure converts an imaginary risk into a real one (8)(9) which we all know results from lack of good communication and team-work which stems from the ob's often pompous attitude of always having to 'save their necks' (referring to the midwives).

From personal and others' experiences, the more I hear about births in our hospital ( yeah, any hospital for that fact) the more determination and resolve I have to birth my second and yet-to-be conceived baby at home. I cringe in horror when I hear of women's forceps or vacuum extraction deliveries, and I become more convinced to stay the heck out of a hospital in the perinatal period as much as possible.

 "No study has ever shown that planned home birth with a trained attendant who took proper precautions increased the incidence of poor outcomes among low-risk women compared with low-risk women in the hospital."

In absolute random order, off the top of my head here is why I am having the next one at home with a capable midwife with expertise in home birth and a doula :

  • Decreased risk of cesarean ( honey, just by walking into a hospital for birth increases your chances of c/s)
  • Decreased incidence of unnecessary interventions
  • No back and forth to the hospital in early labor
  • Your home, your rules, no hospital "protocol"
  • Relaxed atmosphere translates into undisturbed birth
  • No pressure to 'hurry up 'cause other women gotta get them babies too'
  • Increased initiation rates and overall success in breastfeeding
  • When openly communicated, undisturbed bonding for at least one hour after birth in the absence of a medical indication.
  • When you're ready you can get up and shower in YOUR clean shower (as opposed to a complete stranger sponge bathing you on your bed as if you were an invalid) and get in your warm bed with baby
  • Free and encouraged to move around and change positions during labor and childbirth
  • No arbitrary visiting hours (though I wouldn't want a crowd at home right afterwards)
  • No having to check out of the hospital, lugging a humongous car seat with a barely 24-hour episiotomy stitched up
  • No strange faces every 8-hour shift change
  • Your wishes for your birthing experience are more likely to be honored in a home birth setting
  • You can eat and drink freely as you wish during labor
  • Most midwives don't carry around any sort of narcotic pain relief so you won't even be tempted to think about it (which is good for me because that in turn decreases more of my risk for an unnecesarean)
  • Any amount (or none) of loved ones and supporters can be there at my opposed to the meager 2 that our hospital is currently allowing

What are my credentials for asserting such things (with accuracy) as the safety of home birth? "I can read" said Henci Goer. I can too, and so can you...

Here are some more trusted sources for information on home birth from all over the world.

  • Campbell R and Macfarlane A. Place of delivery: a review. Br J Obstet Gynaecol 1986;93(7):675-683
  • Murphy JF et al. Planned and unplanned deliveries at home: implications of a changing ratio. Br Med J 1984;288(6428):1429-1432
  • Tew M. Place of birth and perinatal mortality. J R Coll Gen Pract 1985:35(277):390-394
  • Campbell R et al. Home births in England and Wales, 1979: perinatal mortality according to intended place of delivery. Br Med J 1984;289(6447):721-724
  • Burnett CA et al. Home delivery and neonatal mortality in North Carolina. JAMA 1980;244(24):2741-2745
  • Hinds MW, Bergeisen GH, and Allen DT. Neonatal outcome in planned v unplanned out-of-hospital births in Kentucky. JAMA 1985;253(11):1578-1582
  • Schramm WF, Barnes DE, and Bakewell JM. Neonatal mortality in Missouri home births. Am J Public health 1987;77(8):930-935
  • Damstra-Wijmenga SM. Home confinement: the positive results in Holland.J R Coll Gen Pract 1984;34(265):425-430
  • Wood LAC. Obstetric retrospect. J R Coll Gen Pract 1981;31:80-90
  • Shearer JM. Five year prospective survey of risk booking for a home birth in Essex. Br Med J 1985;291(6507):1478-1480
  • Howe KA. Home births in south-west Australia. Med J. Aust 1988;149(6):296-302
  • Crotty M et al. Planned homebirths in South Australia 1976-1987. Med J Aust 1990;153:669-671
  • Woodcock HC et al. Planned homebirths in Western Australia 1981-1987: a descriptive study. Med J Aust 1990;153:672-678
  • Tyson H. Outcomes of 1001 Midwife-attended home births in Toronto, 1983-1988. Birth 1991;18(1):14-19
  • Mehl LE et al. Outcomes of elective home births: a series of 1,146 cases. J Reprod Med 1977;19(5):281-290
  • Sullivan DA and Beeman R. Four years' experience with home birth by licensed midwives in Arizona. Am J Public Health 1983;73(6):641-645
  • Koehler MS, Solomon DA, and Murphy M. Outcomes of a rural Sonoma County home birth practice: 1976-1982. Birth 1984;11(3):165-169
  • Anderson R and Greener D. A descriptive analysis of home births attended by CNMs in two nurse-midwifery services. J Nurse Midwifery 1991;36(2):95-103
  • Duran AM. The safety of home birth: the Farm study. Am J Public Health 1992;82(3):450-453
  • Parrat J, Johnston J. Planned homebirth in Victoria, 1995-1998. Aust J Midwifery. 2002;15(2):16-25
  • Johnson KC, Daviss BA. Outcomes of planned home births with certified professional midwives: large prospective study in North America. Br Med J. Jun 18 2005;330(7505):1416

(1)Phillip E. Planned and unplanned deliveries at home. Br Med J 1984;288:1996-1997
(2) Adamson GD and Gare DJ. Home or hospital births? JAMA 1980;243(17):1732-1736
(3)Dye NS. The medicalization of birth. In The American way of birth. Eakins P, ed.Philadelphia: Temple University Press, 1986
(4)Wertz RW and Wertz DC. Lying-in: A history of childbirth in America. New York: Schoken Books, 1977
(5)Brown RA. Midwifery and home birth: an alternative view. Can Med Assoc J 1987;137(10):875-877
(6)See #1
(7)See #2
(8) Treffers PE and Laan R. Regional perinatal mortality and regional hospitalization at delivery in the Nethderlands. Br J Obstet Gynaecol 1986;93(7):690-693
(9) Ford C, Iliffe S, and Franklin O. Outcome of planned home births in an inner city practice. BMJ 1991;303(6816):1517-1519

Some books on home birth

Gentle Birth, Gentle Mothering - Sarah J Buckley
Ina May's guide to Childbirth - Ina May Gaskin
The thinking woman's guide to a better birth - Henci Goer
Obstetric myths versus research realities - Henci Goer

All Images Courtesy : Google Images

Wednesday, November 25, 2009

Healthy spinal development for the slingbaby

Recently, I've been very involved with slings and helping moms try them out and figuring out how to use them. I've had the privilege of seeing many moms, some of them, 2nd and 3rd time moms who've never used pouch or ring sling before, get into it and absolutely love it. The way their face lights up when they feel relieved that they can still have that closeness and warmth that carrying a baby gives but still get things done in and out of the home is priceless. A question or concern I hear a lot from mothers is that the baby looks 'tight' or squeezed in. I get asked if that position is really ok for the baby. I gently remind the moms that when baby was in utero, he was accustomed to that warm, dark and tight environment and grew to love it, and that now that he lives in a world with bright lights, cold surfaces and open spaces, anytime you re-create the 'feel' of the womb, the baby almost immediately settles down, and either goes to sleep or goes into a state of quiet-alertness. To further emphasize on the benefits of having your baby in an appropriate pouch or ring sling, or wrap, or ergo carrier, here is something note worthy to look found at Babes in arms on Facebook.

If you are an expectant mom, or a seasoned pro and would like to start wearing your baby, you may be wondering which type suites you best. It is not specifically necessary to go out and buy all of the carriers on the market and do it by trial and error. If you go to the Babes in arms website, they give an extensive review of which carrier you can buy and try out. Sometimes though, it may be necessary to try out the carriers of your friends of which you don't have or are planning to buy if at all possible. Contrary to popular belief, there are only benefits to baby wearing, both for the parent and the baby. So check it out and give it a try!

Monday, November 23, 2009

Seashells - Do WHAT with them?
Web Exclusive - May 30, 2008
By Amanda Dumenigo

I knew that I wanted to breastfeed my baby, but I wondered if the lactation consultants, educational sites, instructional videos, La Leche league, and the rest of the somewhat overwhelming array of resources were necessary. After all, breastfeeding is ancient and totally natural. Wouldn't my body and my baby tell me what to do? This proved to be my first-time mother's enthusiastically naive perspective. After my son's birth, when the reality of the endeavour presented itself, I found myself shocked to actually need several meetings with a lactation consultant, much online research, and advice from friends. Eventually, I cobbled together a body of knowledge and techniques to successfully feed my newborn the time-honored, natural way.
There is no substitute for learning proper latching and baby-holding techniques from an expert, but the most surprising, breast-saving tip for the first few months was to place seashells on my nipples between feedings. Seashells? The idea captivated my imagination—after all, if we are gifted with a more voluptuous postpartum figure, isn't it fitting to wear Botticelli's Venus' undergarments? I liked the notion of having this potent feminine energy from the ocean and the tides at my breasts.

The suggestion came from my very modern, logical, Swedish, friend, Annika Granholm, who swore that seashells saved her aching, cracked, and bleeding nipples. Annika admitted her own initial resistance to such a non-Western remedy had prevented her from heeding a friend's advice for several months—until she was on the verge of quitting breastfeeding altogether and compromising her commitment to attachment parenting. While word-of-mouth had failed to persuade her, mounting physical pain and a Swedish midwife eventually did. In fact, in Scandinavia you can buy natural seashells from maternity shops, online, and at midwifery centers.

Patella vulgata shells have been worn by Norwegian, Danish, and Swedish mothers for thousands of years. These valuable limpets exist from the Arctic Circle in the north to Portugal in the south and can be found on all coasts of Great Britain and Ireland. The shells are an ancient remedy for nipple sores, ranging from splits and cracks, to bleeding and blisters. According to a Swedish online site that sells the shells, they create a soothing microclimate so that nipples soften and are moisturized by breastmilk—which contains lactoferrin—known for its antiviral and antibacterial healing properties. It is advised to air-dry the area prior to applying the shells and to boil them between uses if treating any infection or open sores.

Most seashells are made of calcite or calcium carbonate (CaCO3), also the primary mineral component in cave formations. Metaphysical uses for calcite, determined by its color variations, include recuperation, relaxation, energy enhancement, and emotional uplift. Calcite is credited with calming fears by soothing the psyche, as well as with helping a person to let go of emotional stress. It is said to expand our capacity to freely give and receive love, aid during transition, integrate the new into the physical plane, and ensure that power is properly used. Fortunately, most shells contain a rainbow spectrum of calcite, and although I was an amateur mom, intuitively I just knew that all of these qualities would be beneficial to mothering.

Walking along the beach in Jupiter, Florida, my partner and I handpicked a variety of native shells. We found Alternate Tellin, Buttercup Lucine, and Atlantic Surf Clam varieties that all proved suitable for protecting tender nipples. We selected only those with similar shapes and sizes to my breast anatomy. These local shells seemed to be custom-made by Mother Nature herself as they were as comfortable as a second skin and provided many additional benefits beyond preventing sores. They also served as a barrier for my highly tender areolas and nipples while I adapted to my baby's near-constant suckling. They were an oceanic armor against chafing from clothing. Unexpectedly, they also helped rebuild my self-esteem by bringing me a feeling of empowerment: wearing the seashells was like channeling the strength of the Earth Mother, which enabled me to embrace my new and divinely feminine role as a giver and sustainer of life.

Friday, November 20, 2009

Our Moedergroep of November 19th 2009

Topic:  The Father's role in the breastfeeding relationship
Attendance :  +/- 19

Every month Fundacion Pro Lechi Mama Aruba organizes what we call a "Moedergroep". It's where expectant parents, and 1st, 2nd, 3rd time parents come together to receive the most current and up-to-date information on all topics that are breastfeeding related. We also invite the moms and dads to join in and relate their experiences about the topic in discussion. It's a place not simply to learn stuff, like a class room, but more like a support group for those who are breastfeeding or who plan to do so. Those present from Pro Lechi Mama are professionals in the lactation field, ready to answer all of your questions. Let's look at some outstanding points from last night's discussion.

Minouche Lopez opened the moedergroep and discussed how

  • a father may feel left out in the beginning of the breastfeeding relationship.
  • Babies see their moms only as "tietie" or the source of nourishment and thus a strong attachment to mom
  • Fathers shouldn't feel unduly concerned or guilty about this but that as the baby grows and gets older, this will change and the child will develop and forge stronger bonds with the father
Wendy Martijn and Noortje van Pelt continues :

  • A question is asked to a mom who has had a child before " How did your husband support your decision to breastfeed?"  - Mom's experience : "He didn't. I received the most help from my mom"
  • The father's role is extremely important and can mean the difference between breastfeeding and formula feeding.
  • Many mothers cite their reason for not continuing with breastfeeding was the lack of moral or support where house-hold chores are concerned. Fathers in our culture need to generally be more supportive, assuming more household duties during the first six turbulent weeks when breastfeeding cessation is at its highest risk. 
  • Fathers also need to recognize and be assertive when guests who come to visit, stay for too long, by taking his partner and baby's needs into consideration and politely asking the guests to return at another time.
  • A father does well to understand that, as difficult as the first weeks and months are on him, his wife/partner needs his full support to be able to continue. 
  • Many mothers need and deserve the moral support of her partner  reassuring her with words such as "You're doing such a fantastic job nursing" or "I know these problems are very painful and exhausting for you, but keep it up, and these problems will subside, I know you can get through it!"
  • The more children the couple has, the more essential and important the role of the father becomes. With each subsequent baby, it is harder for a mother to successfully breastfeed her baby. A supportive father does well to help as much as is possible around the house and with older children, to give the new mom and baby a good rest and chance to recover from the birth. 
  • As one father there relates : "We had our children close together in age. My wife tandem fed both, I tried to help out as much as I could. While one child fed, I was with the other, playing and bonding. If for example, my wife needed to rest by herself at night, I would go and sleep in the other room with the baby, and bring the baby to her whenever he needed to feed and then return to sleep with the baby, giving my wife the much needed space and rest for that night."
  • Sometimes a new mother needs her rest without the baby. What can dad do? Simple. After the child has nursed at the breast, proceed with the baby to another room to let mom rest. Having a sling is a life saver many times. Secure the baby in the sling close to you, grab a vacuum , and clean away! The white noise will lull any fussy baby to sleep, you'll get chores done all the while having one-on-one time with your baby!

We hope to see you at next month's moedergroep! Stay pending for the invitation

Sleeping Like a Baby: How Bedsharing Soothes Infants

By Miranda Barone
Issue 114 September/October 2002

father and child sleepingThe image of a sleeping infant personifies tranquility and serenity. Most parents have experienced that unique sense of happiness when they gaze into the face of their sleeping infant. The advertising industry certainly has capitalized on this image, using phrases like "sleep like a baby."
But what does it mean to sleep like a baby? Does an infant stay in these peaceful positions throughout the night? What happens when nobody is watching? Does being alone make a difference? These were some of the questions prompting a study of mother-infant sleep behaviors in solitary and bedsharing conditions.1
The study used the same mother-infant pairs as those used in the original bedsharing study conducted for the National Institute of Child Health and Human Development.2,3 That original study looked specifically at the physiological aspects of infants in solitary and bedsharing conditions; our study focused only on the social and behavioral aspects of solitary and bedsharing mother-infant pairs.
During the behavioral portion of the study, we explored and compared sleep behaviors of routinely solitary and bedsharing mother-infant pairs under both solitary and bedsharing conditions. The observations were made from videotaped recordings, over a three-night span, of nocturnal sleep behaviors and sounds from the mother-infant pairs in solitary and bedsharing conditions.
Significant differences were observed between infants placed in solitary versus bedsharing conditions in the sleep laboratory. Infants in solitary night conditions were more restless (see Figure 1). They revealed continuous large and small limb movements (e.g., arms extended, legs kicking, back arching, full-body stretching), often accompanied by repetitive side-to-side head rotations. This physical activity tended to be clustered, with infants in solitary conditions exhibiting more prolonged bouts of activity than infants in bedsharing conditions, often followed by long periods of quiet sleep. Solitary infants experienced more full and prolonged physical arousals when separated from their mothers, due perhaps to the absence of soothing sensory stimulation that the mothers' presence provided. When aroused from their sleep, these infants remained aroused, possibly alarmed, most likely from the lack of the mothers' presence.
Bedsharing infants, in contrast, experienced a physically calmer and more soothing sleep, although transient arousals and short awakenings, measured by EEG recordings in the studies by Mosko et al., demonstrated that this calmness produced moderate physiological arousals, many of which were not necessarily visible.4
Our studies highlight a concern that constant moving throughout the night by solitary infants produces stress or fatigue. Sleep research on adults has found that increased levels of fatigue could increase deep stages of sleep, and studies have postulated that increased stages of deep sleep may be one potential risk factor for sudden infant death syndrome (SIDS).

Prolonged physical arousals occur as the infant senses the mother's absence (lack of warmth, physical touch, odors, and physiological sounds), and increased physical activity and a full awakening or crying may result. In fact, the most obvious differences between solitary and bedsharing infants included increased sounds from the infant (grunts, squeaks, and moans) (see Figure 2) and crying (see Figure 3). Crying is a very powerful attachment behavior that infants use to elicit care and proximity from a caregiver. Yet for most of the 20th century, experts admonished Western parents not to "spoil" infants by responding.5 Those opposed to bedsharing assumed sophisticated manipulative skills on the part of infants. Actually, their needs are basic: the warmth and security of being close to the caregiver.

On the other hand, crying evokes physiological responses that increase the production of stress hormones. Crying infants experience an increase in heart rate, body temperature, and blood pressure. These physiological reactions are likely to overheat the infant, and overheating is considered a potential factor in SIDS.6
Most psychologists agree that physical contact between infants and parents creates reassurance that will make children more secure in life.7 A large amount of research has confirmed the importance of developing a healthy and secure attachment between infant and parent in the waking hours. Our studies indicate that attachment as a behavioral system operates 24 hours per day and does not deactivate during sleep, where infants spend up to 60 percent of their time.
The most striking difference that we observed between solitary and bedsharing infants was the frequency of sleep startles. These startles were short, spontaneous contractions of limb and trunk muscles that looked like vigorous thrashings of the extremities and a curvature of the spine, followed by a deep breath and a sigh. This cannot be a pleasant event. In most cases, startles were observed only in solitary infants, and rarely during bedsharing (see Figure 4).

The study of infant startles is relatively recent, and examining their occurrence in different conditions, such as solitary and bedsharing conditions, has assumed special importance. Researchers first assumed startles were needed to arouse an infant beginning to experience respiratory distress.8 However, these studies observed only infants in solitary conditions. It is equally possible that the mother's presence during bedsharing has soothing effects that moderate the occurrence or need for startles, or that arousals induced by the mother are sufficient for the infant.
Our study also observed that maternal behavior differed in solitary and bedsharing conditions. Mothers were more likely to respond to aroused infants in solitary conditions with intense soothing, such as rocking, bouncing, or walking. Soothing behavior of this type is necessary to calm the infant from heightened arousal, which supports our theory that infants in solitary conditions were more distressed than infants in bedsharing conditions. In contrast, bedsharing mothers were more likely to engage in affectionate behavior with their infants. The soothing effect kept infants calmer throughout the night, resulting in infants who were less physically active but more physiologically aroused, as measured by EEG.

One behavior not observed in our study was the one so feared by opponents of bedsharing-the overlying of the infant by the mother. In more than 1,000 hours of observing 40 mother- infant pairs, no mother was ever even remotely close to overlying or suffocating her infant. Instead, maternal and infant behaviors were beautifully synchronized-when one moved, the other responded, without fully awakening.
There has been much written in the press about the dangers of bedsharing. As early as 1993, the Consumer Product Safety Commission (CPSC) released a report on infant suffocation and its increased danger in bedsharing.9 Recommendations were made against cosleeping and bedsharing from a retroactive analysis of infant deaths on death certificates. The report neglected to include scientific information about or discussion of the benefits of safe bedsharing practices, and it did not identify the dangers present when infants sleep in solitary conditions. Retroactive analysis of death certificates is problematic, as descriptions of an infant's alleged suffocation were anecdotal accounts of what may have occurred. The CPSC report also failed to address relevant and important issues relating to the environment of sleep, who was present, and the parent's motivation to bedshare. Many childcare experts believe that once an infant is allowed to sleep in the parental bed, he or she will experience increased night awakenings and bedtime protests if the parent is not present. According to this argument, the pathological dependence on parents creates an impediment to the development of necessary movement toward autonomy and independence. In fact, no research exists to substantiate these claims. Studies have demonstrated that bedsharing is associated with family nurturance, less use of transitional objects, flexibility in family structure, and parental reports of higher adaptive functioning on the part of the children.10 In a Massachusetts survey, bedsharing was found not to be as rare as previously reported and not related to standard behavior problems in children.11 Another study compared a group of psychiatric outpatients with a control group and found that bedsharing was not a predictor of outpatient status.12 A survey of military families found that bedsharing was associated with parental reports of better adaptive functioning and less psychiatric treatment.13

Of course, any surface on which an infant is placed can present dangers. Responsible parenting aimed at creating a safe environment, whether a solitary crib or a shared adult bed, is paramount. Advice to parents regarding sleeping arrangements should reflect all of the known advantages and disadvantages of bedsharing and solitary sleep conditions; it should be devoid of cultural biases and should focus on the infant's physical and psychological well-being.
Our study found fundamental differences between solitary and bedsharing conditions. The differences in infant sounds, physical activity, startles, and maternal soothing techniques all indicate that bedsharing provides a calmer and more soothing environment for the infant, and probably for the mother, too. When we look at the angelic face of a sleeping infant in photos and advertising, we should remember that the infant is probably not sleeping alone.

1. M. Barone, "Mother-Infant Sleep Behaviors in Solitary and Bedsharing Conditions," PhD thesis, Claremont Graduate University, 2001, in Dissertation Abstracts International, 3020867.
2. J. McKenna et al., "Bedsharing Promotes Breastfeeding," Pediatrics 100, no. 2 (1997): 215-219.
3. J. McKenna, "Sudden Infant Death Syndrome in Cross-Cultural Perspective: Is Infant-Parent Co-Sleeping Protective?" Annual Review of Anthropology 25 (1996): 201-216.
4. S. Mosko et al., "Infant Sleep Architecture during Bedsharing and Possible Implications for SIDS," Sleep 19 (1996): 677-684.
5. R. Ferber, Solve Your Child's Sleep Problems (New York: Simon and Schuster, 1985).
6. E. A. Nelson et al., "Sleeping Positions and Infant Bedding May Predispose to Hyperthermia and the Sudden Infant Death Syndrome," The Lancet, no. 8631 (January 28, 1998): 199-201.
7. J. Bowlby, Attachment (New York: Basic Books, 1969).
8. B. T. Thach and A. Lijowska, "Arousals in Infants," Sleep 19, no. 10 (1996): 271-273.
9. J. Kemp et al., "Unsafe Sleep Practices and an Analysis of Bedsharing among Infants Dying Suddenly and Unexpectedly: Results of a Four-Year, Population-Based, Death-Scene Investigation Study of Sudden Infant Death Syndrome and Related Deaths," Pediatrics 106, no. 3 (2000): e41.
10. L. Witman-Flann, "Parent-Child Co-Sleeping: The Impact on Family Relationships," Dissertation Abstracts International, 1991.
11. D. Madansky and C. Edelbrock, "Co-sleeping in a Community Sample of 2- and 3-Year-Old Children," Pediatrics 86 (1990): 197-203.
12. M. S. Olenick et al., "Early Socialization Experiences," Archives of General Psychiatry (1996): 15.
13. J. Forbes et al., "The Co-Sleeping Habits of Military Children," Military Medicine 157, no. 4 (1992): 196-200.

Miranda Barone, PhD, is a psychologist who currently teaches at California State University, Long Beach. She lives with her husband, Peter, and their two teenaged sons, Matthew and David, in Southern California.

Figure 1. Proportion of minutes with infant behaviors, including continuous large limb movement, small limb movement, and head rotations, on solitary nights (SN) and bedsharing nights (BN) for infants who routinely sleep in solitary (RS) or bedsharing (RB) environments at home. There were 13 mother-infant pairs in each group. Results obtained by M. Barone were based on data collected by observing videotaped recordings from the original research funded by NICHD, S. Mosko and J. McKenna, principal investigators.

Figure 2. Proportion of night's sleep with infant vocalization on solitary nights (SN) and bedsharing nights (BN) for infants who routinely sleep in solitary (RS) or bedsharing (RB) environments at home. Results obtained by M. Barone were based on data collected by observing videotaped recordings from the original research funded by NICHD, S. Mosko and J. McKenna, principal investigators.

Figure 3. Proportion of night's sleep with crying on solitary nights (SN) and bedsharing nights (BN) for infants who routinely sleep in solitary (RS) or bedsharing (RB) environments at home. Results obtained by M. Barone were based on data collected by observing videotaped recordings from the original research funded by NICHD, S. Mosko and J. McKenna, principal investigators.

Figure 4. Proportion of night's sleep with startles on solitary nights (SN) and bedsharing nights (BN) for infants who routinely sleep in solitary (RS) or bedsharing (RB) environments at home. Results obtained by M. Barone were based on data collected by observing videotaped recordings from the original research funded by NICHD, S. Mosko and J. McKenna, principal investigators.

Thursday, November 19, 2009

Bring a loved one, friend, or Doula for continuous support

All images Courtesy: Google Images

This is the second time Aruban Breastfeeding Mamas is participating in Lamaze International's Healthy Birth Blog Carnival. These "Blog Carnivals" are based on Lamaze International's - The six Lamaze healthy birth practices. The third healthy birth practice is

Bring a loved one, friend, or Doula for continuous support

Having emotional, physical,comforting and informational support during labor can be empowering and can prove to be a blessing to the laboring woman. We will answer the following questions throughout the course of this blog, ; What are the benefits of having someone there to support me during labor? Why should I consider childbirth education classes and encourage my labor partner to attend with me? What is a Doula, and why should I consider hiring one? When meeting with a prospective labor Doula, what questions should I ask?

Benefits of having your partner/loved one/best friend there with you
 When a woman has an informed, caring and experienced labor support team/person there during childbirth it helps the mother to feel safer, more comfortable and relaxed during labor. Research supports that when a woman is calm, positive and assured about her labor, it increases the body's production of  hormones that ease the pain of contractions and help a mother to cope better.Women who are fully supported physically as well as emotionally, report feeling better and more satisfied about their birthing experience.

Why should I consider childbirth education classes and encourage my labor partner to attend with me?
Childbirth Education classes is a wonderful resource that can provide you and your labor partner with knowledge of pregnancy and childbirth, and can be a place to go to find support during pregnancy and get to know other pregnant couples/women. Childbirth Education classes offer a variety of benefits to you as well as your partner, even in subsequent pregnancies. If you have any questions and you need trust-worthy and current information, you can turn to your Childbirth Educator to provide the answers for you or will guide you to websites or books that contain the answer. In CBE (childbirth education) classes you will be taught the normal physiology and progression of pregnancy and childbirth and breastfeeding basics. Also included are coping strategies for pain and/or anxiety during labor. It's important that you as well as the person supporting you during labor (be it your partner, mother, sister or best friend) attend these classes together. Many a women report 'forgetting' what they learned in their class once labor begun. In such instances, a well educated and well informed labor partner can help the laboring mother to recall and implement all that she has learned.

What is a Doula, and why should I consider hiring one?

The word "doula" comes from the ancient Greek meaning "a woman who serves" and is now used to refer to a trained and experienced professional who provides continuous physical, emotional and informational support to the mother before, during and just after birth; or who provides emotional and practical support during the postpartum period.

A Birth Doula
  • Recognizes birth as a key experience the mother will remember all her life
  • Understands the physiology of birth and the emotional needs of a woman in labor
  • Assists the woman in preparing for and carrying out her plans for birth
  • Stays with the woman throughout the labor
  • Provides emotional support, physical comfort measures and an objective viewpoint, as well as helping the woman get the information she needs to make informed decision
  • Facilitates communication between the laboring woman, her partner and her clinical care providers
  • Perceives her role as nurturing and protecting the woman's memory of the birth experience
  • Allows the woman's partner to participate at his/her comfort level

Study findings indicate that, compared to women who do not receive continuous labor support, women who receive continuous, one-to-one support are less likely to:
  • have cesarean surgery;
  • give birth with vacuum extraction or forceps;
  • have regional analgesia (e.g., an epidural);
  • have the need for any analgesia (pain medication); and
  • report dissatisfaction with or negative feelings about their childbirth experience (Hodnett et al., 2007).
Two previous reviews of the research on continuous labor support had similar findings (Leslie & Storton, 2007; Simkin & O’Hara, 2002). The authors of all three reviews found that, compared to care from hospital staff nurses or midwives, continuous labor support is more effective when the person providing labor support is not a member of the hospital staff (Hodnett et al., 2007; Leslie & Storton, 2007; Simkin & O’Hara, 2002). In one review, increased benefits were found when continuous support started early in labor (Hodnett et al., 2007).
Research findings suggest that the benefit of labor support has no economic or cultural boundaries. In one study, continuous support reduced pain for low-income women who would have labored alone if they had not had a doula present (Simkin & O’Hara, 2002). Another study found that fewer cesarean surgeries and less need for epidural analgesia occurred when middle-class, laboring women and their male partner had the support of a doula (McGrath & Kennell, 2008). The same study also found that women and their partners were more satisfied with their birth experience when a doula provided support. Higher rates of early initiation of breastfeeding were found in an urban, multicultural setting when a doula was present (Mottl-Santiago et al., 2008).

My husband is worried that our Doula will take over his role
The doula is also responsive to the needs of the father and respects his level of involvement. First-time fathers are usually inexperienced in understanding and reacting to the normal behavior of a woman during labor and they appreciate the reassurance the doula offers. An experienced father may also appreciate a doula. While he cares for the mother, the doula performs peripheral tasks such as getting ice, juice, or blankets for the mother. She also fills in for the father if he needs a break, gives him an occasional back rub, and supplies supportive information. Since each labor presents its own unique challenges, even experienced birthing couples benefit from the services of a doula. A doula may also provide these kinds of support for others who support a mother in labor, such as friends or other family members.
The doula's calm presence and commitment to the mother's well-being helps counteract the effects of stress hormones (adrenaline and noradrenaline) which are released when a woman in labor becomes anxious, fearful, or insecure. Elevated stress hormones cause labor to slow down or stop while heightening the perception of pain. A trusting, relaxed mother continues to produce oxytocin (the hormone that causes the uterus to contract). She has more effective contractions, but with less tension in her body, she feels less pain. With quiet reassurance, the doula helps the laboring mother and her partner to draw on their own unique talents and strengths.

A good doula takes her cues from the labor partner. If your partner is sitting close to you, holding your hand, and providing eye-to-eye contact and supportive words, the doula will not interfere. Instead, she will support and encourage both of you.

When meeting with a prospective Birth Doula, what questions should I ask?
  • What training have you had? (If a doula is certified, you might consider checking with the organization.)
  • Do you have one or more backup doulas for times when you are not available? May we meet her/them?
  • What is your fee, what does it include and what are your refund policies?
When interviewing a birth doula
  • Tell me about your experience as a birth doula.
  • What is your philosophy about birth and supporting women and their partners through labor?
  • May we meet to discuss our birth plans and the role you will play in supporting me through birth?
  • May we call you with questions or concerns before and after the birth?
  • When do you try to join women in labor? Do you come to our home or meet us at the place of birth?
  • Do you meet with us after the birth to review the labor and answer questions?

It is a good idea for both you and your partner to meet doula candidates to decide if they are compatible with your family. Are they kind, warm and enthusiastic? Are they knowledgeable? Do they communicate well? Are they good listeners? Are they comfortable with your choices or do they seem to have their own agenda? Do you feel at ease with them?
The way that you feel with a doula is more important than the number of births that they have attended or how many new families they have nurtured. You may want to interview more than one doula and make comparisons before choosing your doula.

How do we do it here in Aruba?
The concept of a Doula is fairly new in Aruba. The lady who was my childbirth educator offers Doula services, and as far as I'm concerned, I think she's the only one. She focuses more on CBE classes though and keeps her work as a doula at a minimum. There are two women who are interested and are in the course of persuing doula training to be able to offer these services exclusively.  

Not using a Doula? Depending on your husband/partner, mother/sister or best friend for labor support? No worries! Here is Lamaze International's Birth partner cheat sheet., showing some guide lines and principles of how your labor partner can best support you and your choices. Remember, it's not always possible to be ready for any twist or turn that may pop up in labor, but by having the fundamental principles, your labor partner can assist you, come what may!

Healthy Birth Practice #3. Lamaze International and Injoy bring you the Lamaze Healthy Birth Practices on video. For more information, visit:



Hodnett, E. D., Gates, S., Hofmeyr, G. J., & Sakala, C. (2007). Continuous support for women during childbirth. Cochrane Database of Systematic Reviews, Issue 3. Art. No.: CD003766. DOI: 10.1002/14651858.CD003766.pub2 (This review is available at no charge on the Childbirth Connection Web site at
Leslie, M. S., & Storton, S. (2007). The Coalition for Improving Maternity Services: Evidence basis for the ten steps of mother-friendly care. Step 1: Offers all birthing mothers unrestricted access to birth companions, labor support, professional midwifery care. The Journal of Perinatal Education,16(Suppl. 1), 10S–19S.

Simkin, P., & O’Hara, M. (2002). Nonpharmacologic relief of pain during labor: Systematic reviews of five methods. American Journal of Obstetrics and Gynecology, 186(Suppl. 5), S131–S159.

McGrath, S. K., & Kennell, J. H. (2008). A randomized controlled trial of continuous labor support for middle-class couples: Effect on cesarean delivery rates. Birth, 35(2), 92–97.

Mottl-Santiago, J., Walker, C., Ewan, J., Vragovic, O., Winder, S., & Stubblefield, P. (2008). A hospital-based doula program and childbirth outcomes in an urban, multicultural setting. Maternal and Child Health Journal, 12(3), 372–377.

Wednesday, November 18, 2009

Breastfeeding : Instinct or Instruction?

Ayala Ochert and Suzanne Colson
From New Beginnings, Vol. 26 No. 2, 2009, pp. 32-33

Learning in Pregnancy

"Breastfeeding is natural but not instinctive; mothers need to learn how to do it." When I was pregnant I read this many times in various different places. It didn't make complete sense to me but I knew I couldn't ignore it -- too many people I knew had been unable to breastfeed despite desperately wanting to. So I read the books and attended the workshops -- I even went along to a La Leche League meeting. I was prepared, or so I thought...
When my baby arrived, the reality of breastfeeding came as quite a shock and none of that preparation seemed to help. None of the books mentioned the frantic head bobbing that made it so difficult for my baby to latch on. And what was I supposed to do with those little arms that kept getting in the way? Once he got on the breast, my baby's latch-on looked so perfect it could have adorned the cover of a breastfeeding manual, but it still hurt me.

Biological Nurturing

Several weeks later, still in pain, I had a visit from Suzanne Colson, midwife and researcher at Canterbury Christ Church University and the woman behind the term "biological nurturing." She got me to lie back and get comfortable on my sofa and then draped my baby on my chest. Again he did his head bobbing thing, but this time there was a difference. He "bobbed" into position and latched on. Lying along the length of my body, his arms were no longer in the way. "How does that feel?" Suzanne asked me. "Er, fine... It feels okay," I replied, hardly daring to believe the words as they left my mouth. Breastfeeding felt completely different. Having been used to his vise-like grip up to that point, I found it hard to conceive that he was actually getting any milk with this soft sucking.
As my baby fed, like he'd never fed before, Suzanne and I chatted. She explained that he had been displaying the primitive neonatal reflexes that all healthy babies are born with. In the traditional breastfeeding positions -- mother sitting bolt upright with baby in cradle hold, for example -- these reflexes are often suppressed or even get in the way of a good latch-on. In the biological nurturing positions and postures, these reflexes actually stimulate the newborn to latch on, stay latched on, and feed well.

Postures and Positioning

I was fascinated to know more about the theory behind this approach, so this February I went along to Birkbeck College in London for a one-day workshop run by Suzanne, entitled "Initiating Breastfeeding. The Biological Nurturing Toolkits." The participants included breastfeeding counselors and teachers with decades of combined experience. I was the only one in the room with no formal training. Most of us were aware of the importance of skin-to-skin contact in the first hours after birth but, as Suzanne explained, it is not the actual skin contact that triggers babies to latch on well. It is the postures that mothers adopt during skin-to-skin contact and the positions they hold their babies in that really matter, she maintains. Mothers generally lie back with their baby in the "tummy-to-mummy" position when they are practicing skin-to-skin, and this is the essence of biological nurturing.
Because the mother is lying back, at whatever angle she finds comfortable, gravity ensures that every part of her baby's body is closely applied to hers with no gaps between them. When the primitive neonatal reflexes get triggered in the biological nurturing positions, the baby will often latch on chin first automatically, getting a good mouthful of breast, without any help from mom. In the traditional upright and side-lying breastfeeding positions, gravity doesn't play a role in keeping the baby close so mothers have to apply pressure across the baby's back to keep him in the tummy-to-mummy position. While there are just a handful of traditional breastfeeding positions (cradle hold, cross cradle, rugby, etc), Suzanne likes to say that there are 360 different biological nurturing positions (thinking of the breast as a clock face). Of course, in practice, some of these may be a little impractical!

Newborn Reflexes

During the workshop we were introduced to a few of the many newborn reflexes that have been identified by neurologists. Some of these, such as the rooting reflex (triggered by touching the baby's cheek) are familiar and obviously involved in feeding; but Suzanne believes that many more primitive neonatal reflexes have evolved to help babies latch on and feed. For example, if you brush the top of a newborn's foot he will lift it and place it, so this reflex may help him crawl to the breast. Feet seem to be especially important, says Suzanne: "There is a strong foot-to-mouth connection." If you stimulate a newborn's feet it causes him to latch on to the breast and start sucking.
After being introduced to the theory behind biological nurturing, we got to see it in practice as we watched a few of the many videos of mothers and babies Suzanne has recorded over the years. Years ago, Suzanne first noticed that some women seemed to take to breastfeeding naturally and without any help. Driven by the huge surge of oxytocin experienced after a natural birth, these women seemed to be acting instinctively, and biological nurturing was simply what these mothers did with their babies. The videos showed mothers who were being helped to try out biological nurturing positions. It was interesting to see the change that came over them once their babies started feeding in the biological nurturing positions -- the mothers would suddenly relax and lose interest in talking to Suzanne. They began preening their babies, gazing at them lovingly, playing with their toes -- in other words, nurturing them.

Behavioral State

There is more to biological nurturing than just the mother's posture and baby's position. The baby's behavioral state is also important, explained Suzanne. She has found that the best time to try biological nurturing is when the baby is in a light sleep, when the baby's reflex movements tend to be smoother. Babies are able to breastfeed in their sleep so there is no need to wake a sleepy newborn for a feed. Of course, it is possible to try these positions when the baby is awake, but by the time he is crying the window of opportunity may have been missed and he may not latch on. Suzanne also recommends round-the-clock biological nurturing for the first three days of a baby's life, when he is making the metabolic transition from being fed continuously via the placenta to feeding at longer intervals outside the womb. These three days of non-stop biological nurturing can also help whenever there are feeding problems during the first eight weeks, she adds.

Encouraging Mothers to Continue Breastfeeding

The three main reasons that women give for stopping breastfeeding in the first few weeks are problems latching on, sore or painful nipples, and lack of milk. Biological nurturing can help with all three -- when a baby uses his inborn reflexes to latch on, he latches on well and sucks deeply. For several decades it has been assumed that the way to encourage breastfeeding is to teach mothers about correct positioning and attachment, but Suzanne claims that this approach has not actually improved the rates of uptake. Mothers and babies both have instincts that enable them to breastfeed successfully, but it can be hard to forget what we "know" and tap into those instincts. Perhaps the new mantra should be: "Breastfeeding is natural, it is instinctive, and some of us need to unlearn how to do it."