16 Nov

Book Review: Trust Your Body Trust Your Baby, by Rosie Newman

Rosie Newman’s book aims to inspire confidence and trust in a mother’s own instincts, through pregnancy and birth, feeding and mothering. It is a book for women who need help with the paradigm shift of becoming a new parent. One of the things that really comes across is the value of surrounding oneself with like-minded, positive people. Newman is well-read and draws extensively on the literature of attachment parenting and straightforward birth.

Trust Your Body Trust Your Baby is sensibly structured with a logical progression, starting with a practical chapter on preparation for the baby’s arrival. The birth chapter gives an interesting history of obstetrics, an explanation of the role of hormones, and a valiant attempt to convey the reality of labour.

The following chapters cover life after birth: establishing breastfeeding, sleep, attachment, and the emotional and psychological adjustment. All of this is extremely good stuff that I would recommend to new parents; it is well-referenced and although it comes from a firm base in attachment parenting, and includes a great deal of Newman’s own experience, it is written with empathy and compassion for both the mother and the baby.

The last chapter is on elimination communication, and might make some new parents wonder if this really is the book for them, or whether it is too far from the mainstream. My clients tend to think The Baby Whisperer is a “a bit of a hippie,” so I’m conscious of wanting books like this to be accessible. Of course there is a huge part of me that really doesn’t want to pull any punches, too.

I was writing this review at a very quiet breastfeeding drop-in. Two mothers came in and we were talking about the conflict between trusting your instincts as a mother, and coping with the pressures of modern life, lack of sleep, lack of support, and the weight of expectations that babies should behave in a certain way by a certain age (both babies were 3 months old and not behaving in a certain way at all). So I gave one of them the book; may it help her find her way.

[Disclosure: I received a free review copy of this book from the publishers. You can get your own copy here, and a 10% discount using the code SPROGCAST at the checkout].

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]

05 Jun

Book Review: The Sensational Baby Sleep Plan – Alison Scott-Wright

I have come across this book a few times, and eventually someone gave me a copy so that I could read it cover to cover at my leisure. Having flicked first to the breastfeeding section and read the advice not to drink champagne lest it give the baby wind, I was tempted to drop it straight in the bin. But no, I persisted, so that you don’t ever have to.

Alison Scott-Wright is very much from the same school as Clare Byam-Cook, whose awful book she recommends; and really you don’t need to know much more than that. If you consider your baby to be a time-consuming, manipulative bore with no feelings, the Plan will suit you just fine. However if you wish to meet your tiny human’s needs following your parental instincts and the best available evidence, and your well-meaning aunt has given you a copy of this book, perhaps treat it as a “how not to parent a baby” guide.

Feel free, in the latter case, to ignore ASW’s basic premise that breastfeeding is really too difficult to bother with; a position that must be continually supported with anecdata from clients having trouble getting breastfeeding to work under the rules she prescribes. Feel free not to ensure your legs are at a 90 degree angle to your body (p41), not to restrict feeds to 3-hourly as soon as possible (p43), not to express five times in 24 hours in addition to breastfeeding on demand (p46), and take with a huge pinch of salt that breastmilk may be made unnatural and impure by environmental pollution. Amuse yourself instead with the mental image of cows living in clinical conditions, wearing nappies and using the finest organic antibacterial gel on their udders at milking time. Should you decide to use formula, please please disregard her instructions for making up bottles in advance, which is in direct opposition to evidence-based guidance from the NHS.

None of her terrible advice about feeding has very much to do with sleep, so let us move on to ignoring what she says about that. ASW likes to cherry-pick the research and twist it to fit her entrenched opinions. So for example she quotes Sue Gerhardt on early emotional development and uses this to argue in favour of her cruel and neglectful plan. If she had read more than the back cover of Why Love Matters, she would find herself in the uncomfortable position of having to reflect on how damaging her advice must be.

ASW does not, however, make any reference at all to the UK’s foremost authority on infant sleep, the work of Professor Helen Ball and Doctor Charlotte Russell at the Durham Infant Sleep Lab, where they undertake rigorous research and provide useful evidence-based information to support parents. And for this reason, the reader may also be at liberty to ignore the “baby’s daily sleep requirements” (p72), fully debunked by Charlotte Russell on Sprogcast last year. On p80, ASW dangerously disagrees with current safe sleeping guidelines, overruling the Back To Sleep campaign on the basis that she tends to believe that the babies for whom her plan does not work must surely have reflux; and also ignoring the increased risk of SIDS for a baby sleeping in their own room before the age of six months. It would also be absolutely acceptable to take no notice whatsoever of her claim that she “often advises introducing solids… from 16 weeks,” (p85) or her recommendation that parents water down formula or limit breastfeeds at night as early as 4 weeks, thereby depriving the baby of essential nutrients and comfort – surely a far more serious risk to the child’s physical and emotional wellbeing than that posed by sleep deprivation.

All parents can definitely disregard the long parent-blaming list of ways they can get their babies’ sleep wrong on p155; and unless the baby has a medical diagnosis of reflux, they can also take no notice of the 50 pages devoted to that subject. In fact, even with such a diagnosis, it might be wise to ignore the unqualified ASW’s unqualified opinions on this matter, and seek the support of a trained specialist.

ASW’s promise is that if you follow her “flexible” plan TO THE LETTER, then your baby will sleep through the night by 8 weeks. She has had 100% success with this. The only reasons why this incredible plan might not work are if the baby has reflux, or if the parents have been doing it wrong. Even teething “should not be used as an excuse” (p92). But never fear, silly parents, if you have got yourself into such a “hopeless situation” (p157), there is still hope! You can adopt her cosily-named “sleepy time” reassurance technique (p170) which is basically leaving the baby to cry, even if they “vomit to order” (p193).

This sleep is indeed sensational: sensationally cruel, ill-informed, and quite possibly harmful. I do not recommend this book.

17 Mar

If only someone had told me…

In the first few weeks and months of parenthood, new mothers and fathers very often comment on the range of knowledge they were missing, and skills they didn’t have, to cope with this new experience. If they paid for antenatal classes, at least they have someone to blame for the gaping mismatch between expectation and reality; but the majority of new parents do very little formal preparation, and unsurprisingly say the same sort of things.

To misquote Tolstoy, “each new family is new in its own way.” This presents a challenge when it comes to helping a couple to prepare for parenthood. Living in the midst of extended family, as they might have done 100 years earlier, the whims and wiles of the newborn baby would have been somewhat less mysterious; or at least the family elders could have helped to unravel some of those mysteries. New mothers might have found themselves less isolated. New fathers might have had more clearly-defined roles. And there would have been none of this pesky research into attachment and brain development, less pressure to have it all, and not so much of an expectation to be the perfect parent.

“I wish someone had told me that cluster feeding is normal… that formula isn’t evil… what ‘broken sleep’ really means…” they say, or write, with the authority of the first fully enlightened human being to have studied this matter. Emerging from the newborn fug into the crystal clarity of a new mum or dad who is finally getting a bit of sleep, the simmering resentments about the truly unexpected turns in their road, and the vast range of surprises that society simply forgot to mention, become pronouncements upon The Things I Have Learned, From Which You Too Must Benefit.

As an antenatal educator, I am often advised of the many ways in which I failed to prepare people for what it’s really like to have a baby, and find yourself relentlessly on call to a tyrannical but adored bundle of cute, who speaks no language that you know, and for whose health and well-being you are entirely responsible.

And I know I would have mentioned cluster feeding, and can think of any number of reasons why they might not have really taken it on board: were they focused on the impending birth to the extent that this was too abstract to be meaningful? Did they think this would never happen to them? Was it one small forgotten detail, many weeks ago now, lost in the fog? Is it actually possible to convey the real intensity of early breastfeeding, with the language we have at our disposal?

I also know I didn’t say that that formula was evil. In fact I may well have given examples of making a positive decision to use it. I explained about milk supply and responsive parenting and feeding cues, but I don’t believe that formula is evil, so why would I have said it? Is it perhaps that they expected me to say that, and didn’t really listen to what I actually said? Or did someone else say it, and they misremember it as being me?

As for sleep: well, some babies sleep, and some babies don’t sleep, and your interpretation of broken might be different from mine. The challenge is to drill down through platitudes and unrealistic expectations, without frightening the living daylights out of people who can’t predict what’s coming their way. In a society where people with some medical or scientific authority still insist, in the face of the evidence, that babies “should” sleep in a certain way, it’s not surprising that the sporadic and uncontrollable nature of newborn sleep should be hard for parents to manage.

I call for people to carry on being this honest about their experiences as new parents, but not to assume their experience is universal, nor to blame the people offering information and support for the fact that parenthood is not, in every way, as you expected. Join your voice to ours in increasing the support available. Ask the government not to cut funding to essential services such as Children’s Centres and breastfeeding support groups. And don’t be part of the problem by telling other parents-to-be what to do: every new family is new in its own way.

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!

11 Nov

Sleep! Sleep! Beauty Bright – Poem by William Blake

Sleep! sleep! beauty bright,
Dreaming o’er the joys of night;
Sleep! sleep! in thy sleep
Little sorrows sit and weep.

Sweet Babe, in thy face
Soft desires I can trace,
Secret joys and secret smiles,
Little pretty infant wiles.

As thy softest limbs I feel,
Smiles as of the morning steal
O’er thy cheek, and o’er thy breast
Where thy little heart does rest.

O! the cunning wiles that creep
In thy little heart asleep.
When thy little heart does wake
Then the dreadful lightnings break,

From thy cheek and from thy eye,
O’er the youthful harvests nigh.
Infant wiles and infant smiles
Heaven and Earth of peace beguiles.

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!

12 Oct

Book Review: Baby Sleep Solutions, by Netmums with Hollie Smith

Baby Sleep Solutions is one of several problem-solving books produced by helpful parenting website Netmums. It is packed with information and suggestions, but is largely placed at the non-attachment end of the parenting spectrum, despite its claims to sit within the evidence base.

Its introduction decries the plethora of conflicting advice that new parents receive from friends and family, then introduces its own team of experts. The whole book tries hard to balance a parent-centred approach with some quite directive advice, generally followed by a proviso basically saying “if you don’t want to do it that way, that’s ok.” What I get from this is an understandable but still slightly confusing melange of approaches. Hopefully what a new parent gets is a range of options, and the possibility of picking and choosing the solutions that feel right to them.

Early chapters include a general explanation of sleep cycles and babies’ needs, then chapters for newborn, 6 weeks to 6 months, 6 months plus, older babies and toddlers. It starts from a very baby-centred point of view, with a straightforward and thorough discussion of where babies sleep, safety, and coping with the normal challenges. As the age ranges go up, the advice becomes more parent-centred, very focused on feeding (especially breastfeeding) being only for food, and other comfort needs now described as “wants” or “habits.” If I had read at 6 months “as long as she’s getting loads of love and cuddles from you in the daytime – she should also be emotionally secure enough to cope without you at bedtime and through the night too,” (p103) I would have felt horribly anxious about what terrible mistakes I was making, that my son clearly still needed me at night.

This, for me, is the difficulty in turning towards sleep training. If it doesn’t work, you’ll feel it’s your fault, you’ve done something wrong. If it works, you thank the expert who told you how to do it, and continue to doubt the effectiveness of your own instinctive parenting. We have to be so careful of the tone we use and the way we present “solutions” that try to find quick fixes for normal behaviours, rather than ways to understand, cope with, and support our babies’ needs.

So, from six months, the book advises you to “ditch” the night feeds, missing the point that breastfeeding is a relationship, not just a nutrient-providing process. It recommends cold turkey on the night feeds, and baby in his/her own room; and then goes on to suggest controlled crying, which it describes as “heart rending” but “gets results fast” (p109) What a dilemma.

Responding to your child is seen here as a “reward” – a concept understood by parents but probably not by a 6 month old baby. The book frequently (but inaccurately) refers to a lack of evidence that these levels of stress do harm, but let’s not forget that this does not equate to evidence that they do not harm. I might have been inclined to present the gentler solutions earlier in the chapter, with controlled crying coming as a last resort rather than the go-to plan.

For older babies and toddlers there is a range of behavioural strategies, and these chapters cover maturing sleep patterns, tips for moving the child out of the parents’ bedroom, cot-to-bed tips, sibling situations and separation anxiety. Finally, it looks at more specific problems including teething, illness, and the ubiquitous reflux; and then the typical parenting book dip into alternative therapy. Which, if it worked, would be called “therapy.”

Despite my detailed reservations, I quite liked parts of this book, where clear suggestions are made and there are matter of fact discussions of the challenges of coping with your baby’s sleep. The fact is that parents who are happy to “go with the flow” (p37) would probably not pick up this book in the first place. Parents who need help will find lots of options here, and may also be reassured by the many quotations pulled from the Netmums forums, from mothers experiencing or moving on from similar situations to their own. I would like to have seen more on coping, not just fixing; including gathering effective support, frontloading and daytime coping, and learning to maximise the sleep for as many members of the family as possible, without increasing levels of distress. It’s worth a read to get basic information about infant sleep, but I’d recommend ISIS as a better and more evidence-based source on this.

It’s available in kindle format from Amazon here, though I bought the paperback for a penny.

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.

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.