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.

20 Nov

Swaddling your baby

Swaddling is surprisingly controversial. Many parents find that it helps their baby to settle, particularly if they have a strong moro reflex that disturbs their rest, but there is some research suggesting that swaddling might be problematic for a baby’s hip development, and could increase the risk of cot death.

NCT provides a how-to-swaddle video, and some further guidelines on doing it safely are offered by ISIS.

If you are going to swaddle, the Lullaby Trust recommends the following:

  • use thin materials
  • do not swaddle above the shoulders
  • never put a swaddled baby to sleep on their front
  • do not swaddle too tight
  • check the baby’s temperature to ensure they do not get too hot.

Views expressed here are my own, and do not represent the views of NCT.

17 Nov

Safe Sleep

Many new parents want more sleep, and one way to get that would be if their babies would sleep peacefully through the night. In fact, so often when asking a new parent how they’re getting on, well-meaning friends, relatives and complete strangers in the street focus on how much the baby is sleeping: “is she good?” usually means “does she sleep through the night?”

In fact it’s completely normal and, biologically speaking, healthy for newborns not to sleep through the night: a difficult truth for new parents to hear. The stomach capacity of a newborn is 5-7ml, and breastmilk is highly digestible, so it’s normal and necessary for a baby to wake to feed at least two or three times a night. All that feeding supports the rapid growth and brain development that goes on in this stage, as well as helping to boost the mother’s milk supply. Formula fed babies could also be fed little and often to mimic this frequent refuelling which is appropriate to the baby’s growth and capacity.

SIDS research also shows that babies’ light sleep helps them to arouse quickly in response to any changes or risks in their environment. This may reduce their risk. This is why it’s recommended that babies who sleep alone are put down to sleep on their backs, where they may not sleep as deeply or as long, but are at a lower risk of cot death. It’s also recommended that babies sleep in their parents’ bedroom until six months of age, when the risk levels drop.

The other safe sleeping guidelines are:

  • Place your baby on its back to sleep, in a cot in a room with you
  • Do not smoke in pregnancy or let anyone smoke in the same room as your baby
  • Do not share a bed with your baby if you have been drinking alcohol, if you take drugs or if you are a smoker
  • Never sleep with your baby on a sofa or armchair
  • Do not let your baby get too hot or too cold, keep your baby’s head uncovered, and place your baby in the “feet to foot” position
  • Breastfeed your baby

There are some great resources on sleep, including the Infant Sleep Information Source, which is fully-evidenced. We haven’t even got into some of the more controversial practices such as bed-sharing and swaddling here, but perhaps those are posts for another day.

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.