co-sleeping | Motherworldly

28 Aug

Book review: Why Your Baby’s Sleep Matters, by Sarah Ockwell-Smith

I am full of admiration for Sarah Ockwell-Smith in her firm and thorough representation of attachment parenting, particularly around the difficult subject of infant sleep.

Her Why It Matters book tells us how infant sleep really works, with technical information in the early chapters, and then a good section on the historical context of social attitudes to sleep, advice, and “experts,” which really feels like the most important part of the book. Having read a great deal about the science of sleep, these sections give some interesting statistics, but didn’t really break any new ground for me. The chapter on the Science of SIDS however was particularly useful and gave me much to reflect on.

Ockwell-Smith writes with a tone of despair that sometimes comes close to contempt for the naivete of society and the many common misconceptions and misunderstandings about infant sleep, and while what she says is satisfyingly evidence-based, referenced and well-explained, I do think the tone could be kinder and more compassionate. The fact is that she pulls no punches, hence my admiration, but this might not be the first book on the subject that I would offer to a parent.

[Disclaimer: I was given a free review copy of this book by the publishers. You can buy it from their website, and get a 10% discount with the code SPROGCAST]

03 Mar

Book Review: Beyond the Sling, by Mayim Bialik

Mayim Bialik is a neuroscientist, an actress, and with this book a real spokesperson for Attachment Parenting. If you imagine a spectrum with absolutely routine-focused, parent-led families at one end, and completely baby-led, bed-sharing, nappy-free families at the other end, then Bialik is telling a story set right at the tip of the baby-led end of that spectrum. The title “Beyond the sling” tells us just how far along it is.

As she tells us at the start, this is not a quick-fix parenting manual. Although she clearly is writing about what, in her view, is the best way to parent, she delivers most of this through anecdotes about her own family. I spoke to a new mother recently who liked that because it gave her a new perspective to think about, rather than telling her what to do.

Attachment Parenting considers parenting to be “the most natural and instinctual event on the planet.” (p11), fostering respectful and loving relationships between parent and child, and ensuring a securely attached, happy individual. Bialik argues that this process is innate and this outcome biologically inevitable, and devotes one chapter to explaining some very basic science behind attachment theory. This section was disappointingly thin on actual science.

Part Two of the book is entitled “What a baby needs,” and covers birth, breastfeeding, babywearing, bedsharing, and elimination communication, which she feels gave her a deep intuitive connection with her children. These chapters are mostly evidence-based, however they frame this style of parenting very much within the limitations of natural birth, exclusive breastfeeding, and easily cleanable floors, which I fear would make her exhortations inaccessible to many parents.

Part Three is about what babies don’t need, and while there is much to admire in keeping one’s home free of battery-operated toys, I absolutely cannot get behind her “informed decision” not to vaccinate her children, and feel that the resources offered to support this very brief section are rather one-sided.

The chapter on discipline gave me a lot to think about; I felt like I violently agreed or disagreed with every other paragraph. There is much clear and logical thinking about how to deal with behavioural matters, but many of the anecdotes about how she and her co-parent implement this thinking seem not to line up with the theory. I think that a child would understand “not for Miles” (p195) to mean exactly the same thing as “no,” but perhaps it depends on the parenting context. I feel like I must be missing some very subtle nuance here.

I would be unlikely to recommend this book to someone who hadn’t specifically asked for something on Attachment Parenting. I am uncomfortable with dogma at any end of the spectrum. Bialik states that “this is not a judgemental book,” nor is it one of those books that “make me feel that I am failing and inadequate,” (p13); and yet this is exactly how I felt reading it – and this is from the perspective of a straightforward birth, bedsharing, full term breastfeeding, and a pretty good grasp of brain development myself. When Bialik claims that she does not need to put her own needs on hold to parent in this extreme way, she also contradicts herself by repeatedly telling us how tired she is, but that it is the right thing to do. I think it would be okay to be honest about the amount of sacrifice needed to parent in this extreme way, and that there are parents who will choose it anyway, or moderate their approach to meet both their own needs, and those of their children.

Disclosure: I was sent a free review copy of Beyond The Sling by the publishers Pinter & Martin. You can currently buy it on their website for £6.99.

08 Feb

Book Review: Helping your baby to sleep, by Anni Gethin and Beth Macgregor

Helping your baby to sleep is a book about being kind and gentle to your baby: a persuasive philosophy in anyone’s book. It is divided into two sections: the science of responsive parenting, and the practice of gently encouraging a baby to sleep. Its starting point is very much the argument that “bringing about change by causing a child to be distressed can never be considered a success.” (p.xxi)

Like many, many such books, authors Gethin and MacGregor explain the mechanisms of sleep: cycles of sleep, survival needs, and what exactly does “normal” mean, anyway? Each chapter has a nice summary of key points, useful if you are reading this as a sleep-deprived parent.

Having laid out the scientific support for responsive parenting, the case against sleep training in chapter four makes complete logical sense, if somewhat distressing reading in places.

Moving on to the practical section, they offer a range of “slow fixes” for helping babies to settle and parents to get a less disturbed night, appropriate for different ages and situations, as well as a chapter addressing most of the common sleep difficulties that parents experience.

The book finishes with a helpful section on self-care and support for parents, which really needs to be threaded throughout lest parents give up reading while it all still sounds rather onerous. Of course parents want to be gentle and responsive, but attachment parenting books can appear to ask a lot of parents at a challenging time in their lives. It really helps to have the science of brain development and attachment so clearly laid out, alongside quotations and ideas from other parents. The cartoon on page 130 seems very apt. Buy it and see for yourself!

19 Oct

Book Review: The Food of Love, by Kate Evans

The Food of Love is a fun breastfeeding guide full of Kate Evan’s clever pictures and even fuller with words. I think it is aimed at mums-to-be and new mums, but I think it’s also widely enjoyed by people working with new parents.

There is a lot to like about this book. Most of the cartoons are funny (some of them are a bit judgey), and it is jammed with a huge amount of well-researched information. Evans positions herself firmly at the Attachment Parenting end of the spectrum, and is more than capable of backing up her position with evidence. Unfortunately she doesn’t, always, which relegates a lot of her bold statements to opinion. The book would be much stronger if it was better referenced.

In the early chapters, Evans covers the basics of how breastfeeding works, using cartoons to demonstrate very clearly the mechanics of breastfeeding as well as a lot of the interesting sciencey stuff about breastmilk. The section on hand expressing is excellent; the section on positioning is surprisingly prescriptive – I’m sure laid-back Kate didn’t always sit bolt upright to breastfeed.

Evans’ passion and enthusiasm for breastfeeding comes across on page after page of often rather stream-of-consciousness text, as though she has scribbled down everything she can think of about breastfeeding, and when she runs out of that she goes on to talk about parenting in general, sleep, postnatal depression, relationship stuff, and toddler discipline. It’s a really useful general parenting book in that respect and could probably reach a wider market if sold as such.

I enjoyed the lovely bit on the evolutionary context of attachment theory, again illustrated with amusing drawings. Occasionally she follows a fairly idealistic opinion section with a contrasting realistic cartoon, for example the starfish baby in the middle of the bed showing the reality of co-sleeping for many parents.

We have the obligatory dip into alternative medicine (which if it worked would be called medicine), which is a shame when she’s so clear and comprehensive on brain chemistry and other sciencey stuff. The recommendation of homeopathic belladonna as a treatment for mastitis is a highway to a breast abscess.

The chapter offering solutions to common breastfeeding problems includes some excellent flowcharts (pp131-132), however the solutions offered are a bit garbled in places and there is no signposting to reputable breastfeeding support organisations such as NCT or ABM, nor any discussion of breastfeeding support groups (which surely would lend themselves well as subjects for caricature).

In summary, I loved parts of this book but not all of it. I probably would give it to a new parent, but not universally; I think some people might be more receptive to it than others. I’d love to see it repackaged as a general parenting book as it’s so good on attachment parenting. And I can strongly recommend Kate’s blog!

24 Nov

Book Review: Sweet Sleep, from La Leche League

Sweet Sleep is a La Leche League publication, written by some of the well-known names in the LLL world: Diane Wiessinger, Diana West, Linda J. Smith and Teresa Pitman; and as such it sets out a very definitely baby-centred philosophical position, as you might expect. It very nearly does manage to achieve a balanced tone with regard to the fact that not all families breastfeed, and even includes a chapter on how to cope if you don’t have this powerful parenting tool available to you (adoptive families, for instance), but its subtitle clearly states “for the Breastfeeding Family” and this is where its real strength lies.

There is a wealth of advice available online, from health professionals, and among families and friends, for parents who want techniques to “train” their babies to sleep. Sweet Sleep fills a gap for the parents who want to work within their babies’ normal development, with gentle nudges from stage to stage, but allowing for kind and responsive parenting.

Sweet Sleep is packed with practical suggestions, and sensibly begins with a chapter full of immediate ideas for getting more sleep tonight. It focuses straight away on the Safe Sleep Seven, which are rules for emergency bedsharing. Given that statistics show unplanned bedsharing to be far riskier than planned bedsharing, helping parents to plan for it is a really good place to start.

It goes on to explain normal sleep, drawing on anthropology, biology, and worldwide cultural practices. This is followed by safety information, gentle nudges for different ages and stages, and suggestions for different scenarios such as premature babies, twins and so on. The chapter on SIDS and suffocation is comprehensive and well-explained; and finally the book offers suggestions for talking to supportive and non-supportive people about an attachment parenting approach to coping with nights.

This book is well-referenced throughout, and illustrated with quotes from the authors’ own stories and from other families. Once too often I found myself frustrated that the authors touch on a point and promise to explain it more in a later chapter, making me dip about in the book rather than reading it through as I wanted to. I was not particularly surprised that the section on Getting Help/Giving Help only mentions La Leche League, when there are quite a number of other organisations, including NCT, who could also support parents in these situations.

On the whole I found this book useful both in terms of practical help for parents of co-sleeping/breastfeeding babies, and ways of thinking/talking about risk and responsiveness, which I find a lot of new parents and parents-to-be worry about. It’s good to have a book that supports parents to follow their instincts and find their own rhythms.

DISCLOSURE: I was sent a free review copy of this book by Pinter and Martin Publishers. To order your own copy with a 25% discount, just follow the link and use the discount code KH25 at the checkout.

23 May

Sharing a bed with your baby

This week a new study was published in the BMJ which gave rise to headlines regarding the dangers of sharing a bed with your baby: Bed sharing when parents do not smoke: is there a risk of SIDS? An individual level analysis of five major case–control studies.

The authors of this report combined the results of five studies done in different countries between 1987 and 1998. The amalgamation of these studies gave a sample size of 1472 babies who died, and a control group of 4679 babies who did not. Each individual study compares the conditions of the babies in the two groups. However the individual studies did not look at the same risk factors. The authors were able to draw out some significant factors, and show the level of risk for babies who were in their parents’ bed, compared with babies who were in their own bed in their parents’ room. The risk factors examined are whether the baby was breastfed or bottlefed, whether either parent smoked, the position the baby was put down in (front or back), whether the mother had had alcohol or illegal drugs in the previous 24 hours.

The report concludes that the lowest risk of cot death is where a breastfed baby of a non-smoking, non-drinking mother sleeps on his/her back in the parents’ room, but not in the bed. That is, in the absence of any of the risk factors studied here, the risk of cot death is 0.08 per 1,000 live births. When a baby with the same conditions shares his/her mother’s bed, the risk increases to 0.23 per 1,000 live births. This was reported in the popular press as “FIVE TIMES MORE LIKELY!!”

The Telegraph headline claims that this report “sheds new light on cot deaths”, which is interesting given that the studies in the meta-analysis are more than 15 years old. There are more recent studies the results of which do not support these conclusions. A number of known risk factors are missing from the meta-analysis, including smoking during pregnancy, use of legal drugs such as the strong painkillers often used in the early postnatal period, parental obesity, paternal alcohol use, prematurity, the conditions of the bed itself (was the baby between the parents or on mum’s side, was the baby on a pillow, were other siblings or pets also in the bed, etc). The authors are open about the fact that some of the drug/alcohol data was missing, so they “imputed” this. A cynical mind would define the verb “to impute” as meaning “to make stuff up.”

A huge flaw in the report, and in most studies of cot death risk, is the definition of a breastfed baby. In most cases “breastfed” includes partly formula fed babies. We know how fast the rate of breastfeeding falls in the UK (79% at five days; 58% at six weeks), so it is understandably hard to generate an appropriately large sample of exclusively breastfed babies. However all studies show a lower risk for breastfed babies compared with formula fed babies, therefore it makes sense to me that partly breastfed babies should be either a separate data set, or included with the formula fed babies. The report also implies that while bedsharing is associated with longer duration of breastfeeding, the risk of bedsharing is not cancelled out by breastfeeding and therefore this cannot be considered as a reasonable justification of bedsharing. This overlooks the fact that cot death is not the only thing that breastfeeding protects babies – and mothers – against. The long-term risks of not breastfeeding are well-documented, and may, for some parents, outweigh the 0.23 per 1,0000 risk of bedsharing.

Of course the media is generally more reticent in reporting the apparent protective effect of breastfeeding, lest we make mothers feel guilty. This delicacy does not appear to apply to parents who choose to share a bed with their baby* who appear to make up a similarly large group to the formula feeding parents. (This of course implies that huge numbers of bedsharing parents are also formula feeding parents, which is the higher risk). So here is the point at which I climb, with a sigh, on to my usual hobby horse of WHY ARE WE TRYING TO SET PARENTS ONE AGAINST ANOTHER? What is the use of demonising parenting decisions, banning common behaviours rather than informing about risk and how to reduce it?

Whether you choose to sleep with your baby in your bed, beside your bed, or in another room, it is important to be aware of safety guidelines. If you think you will NEVER sleep with your baby, it is still important to be aware of safety guidelines, as for a lot of parents this is not a planned thing, and that in itself increases the risk. Let us not make bedsharing a taboo subject, or a polarising argument. Let us accept that we all parent in different ways, and we are entitled to be well-informed, rather than dictated to, about risk.

*How many parents share a bed with their baby?
Data from both studies found that almost half of all neonates bed-shared at some time with their parents (local = 47%, 95% CI 41 to 54; national = 46%, 95% CI 34 to 58), and on any one night in the first month over a quarter of parents slept with their baby (local = 27%, 95% CI 22 to 33; national = 30%, 95% CI 20 to 42). Bed-sharing was not related to younger mothers, single mothers, or larger families, and was not more common in the colder months, at weekends, or among the more socially deprived families; in fact bed-sharing was more common among the least deprived in the first months of life. Breast feeding was strongly associated with bed-sharing, both at birth and at 3 months. Bed-sharing prevalence was uniform with infant age from 3 to 12 months; on any one night over a fifth of parents (national = 21%, 95% CI 18 to 24) slept with their infants.

06 Jun

What backlash?

The recent Time article has provoked quite a controversy, not least (in my opinion) the decision not to use that cover in the UK. According to The Guardian, this controversy about a photograph of a mother breastfeeding her 3 year old constitutes a ‘backlash against breastfeeding,’ and at the weekend they published Zoe Williams’ wide-ranging thoughts on this matter.

Williams’ article is littered with factual errors, assumptions, judgemental remarks, and references to ‘protests’ that never actually happened. She refers to extended breastfeeding in the first paragraph, but then goes on to discuss ‘breast is best,’ attachment parenting and government policy on health promotion, without ever coming back to her initial, rather impolite remarks that breastfeeding advocates are ‘evangelical to the point of dogmatism,’ and that she thinks we think ‘extended breastfeeders make [us] all look a bit weird,’ and that this is why we don’t discuss extended breastfeeding very much. In fact, we don’t discuss it much because it doesn’t happen much. If fewer than 2% of babies in the UK are exclusively breastfed at six months, just try and quantify the number who still get any breastmilk at all by the age of three years.

Williams goes on to dismiss the ‘benefits’ of breastfeeding as mostly syllogistic, methodologically flawed, and generally ignored by parents, while also noting that “I didn’t care whether of not the health benefits were real, I’d do it again even if it made the baby’s IQ go down,” thus negating the point of her entire argument against the ‘benefits’ of breastfeeding: like most mothers, she is not basing her decision on health or any other benefits. Mothers are biologically driven to nurture their young.

I use the term ‘benefits’ very cautiously. Breastfeeding is the baseline; it is formula milk that needs to prove its case. Research into breastfeeding may be methodologically flawed (because how can you carry out randomised controlled trials on babies?), but there is certainly no robust research showing health benefits for formula. As for the research, Analytical Armadillo has recently posted an excellent round-up of some very current research from a number of peer-reviewed journals. Williams’ guru in this matter is one Joan Wolf, who supports her view of parenting as a world of extremes, without nuance.

Moving on to attachment parenting, Williams quotes feminist criticism of co-sleeping which describes “putting the child in the bed between the father and the mother.” This is an unsafe practice, and UNICEF guidelines for safe co-sleeping can be found here. The feminist angle here seems pretty spurious, pitting notional extremes of motherhood against each other. Feminism, surely, means we all have the right to choose our own pathway?

Mothers do not divide neatly into two camps: Breastfeeding Mothers versus Formula Feeding Mothers. As Williams points out, the majority of mothers in the UK do initiate breastfeeding (though she quotes an imaginary 91%; the most recent Infant Feeding Survey gives an initiation rate of 81%). NHS South Central provides some interesting data on duration of breastfeeding; locally, we have a high initiation rate of 88%, down to 79% by five days, 72% at two weeks, and just 58% of mothers are still breastfeeding at six weeks. Therefore most of the mothers in the supposed Formula Feeding camp are mothers who have breastfed for at least some amount of time, some of whom will have made a positive decision to stop; but we know that 90% of the mothers who have stopped by six weeks would have liked to continue for longer. So it’s not the case, as William proposes, that the majority of people are not taking any notice of the public health messages about breastfeeding. In the 2005 Infant Feeding Survey, 84% of mothers said they were aware of the health benefits of breastfeeding; those who stopped before six weeks cited, in the majority, lack of support. Williams lightly dismisses the struggles and the disappointments felt by women who choose formula feeding because it’s the only choice they have.

Williams’ main premise seems to be that the government is trying to brainwash mothers into breastfeeding out of misguided social policy. She misses the point, and she misunderstands the research, but at least she gets a plug for her own book.