Sleep-Training Considerations: Part I

sleep training

If you’re a parent, you know sleep-training is a hot topic. Fueled with passion from both sides, some swear by it and claim that it’s the only thing that can be done to teach a child to sleep, while others say it’s not necessary and that baby will learn over time, without it. There’s so much talk about whether it’s right or wrong that folks don’t sit back, take a deep breath, and consider the implications of sleep-training and how it feels for them personally, away from all the chatter.

The two most-recommended sleep training methods are: 1) extinction, often referred to as cry-it-out (CIO), where a parent puts a child down awake and does not return until morning, and 2) the Ferber-method, where a parent puts down a drowsy child and increases the duration of time baby is left alone while periodically checking-in when baby is distressed; offering some reassurances (verbally, picking-up and putting back down, pats on the head or back, etc) until eventually the parent stops re-entering the room at all. Being that these two are the most popular and the methods that come with such heated debate, these are the two being considered for the purpose of this post. Now that we’re on the same page, let’s unpack what this looks like.

 

Night-feedings

It’s no secret that babies need to eat frequently. Some people try to convince parents that once babies have achieved a given weight or once babies hit a certain age, night-feedings are no longer necessary. The issue with this, particularly for nursing babies up to a year old, is that the intervals at which they feed and the number of feedings needed in a 24-hour period depends largely on Mom’s biology, namely her breast storage capacity and breast fullness. By prematurely cutting out night-feedings in the hopes of more sleep, baby’s total daily caloric intake is reduced. This has the potential to negatively affect baby’s growth, mood, and overall well-being. Additionally, it introduces the possibility of creating clogged ducts, mastitis, or supply issues for Mom.

 

Nighttime Parenting

As parents, clocking-in and clocking-out just isn’t an option. We need to have a realistic expectation that we’ll be up through the night with our babies for at least the first year, perhaps even longer. Reframing the idea of the often frustrating parental night-waking into “nighttime parenting” is helpful. While the sun is no longer shining and the goings-on of the day have wound down, the parent is still on-call, the baby is still fully dependent on the caregiver for all of the same things the caregiver provides during daylight hours. With that in mind, it’s important to reflect on how you respond to baby during the day. Do you let baby fuss for several minutes before responding? Do you wait to respond until baby is crying heartily, obviously needing attention? Do you tune out the cries and wait for baby to sort it out on her own? As parents, while we may deeply desire uninterrupted sleep, we don’t clock out at the end of the day. We’re always on and babies are relying on us. When considering how differently nighttime presents itself; the dark, the quiet, baby is often totally alone; one can clearly see how baby’s needs are likely to increase, rather than decrease. Instead of nighttime lending itself to a hands-off approach to parenting, nighttime is a time of high need for baby. High need for baby means the need for high responsiveness from parents.

 

Physiology of Distress and Self-Soothing

Babies are tiny humans so their bodily systems operate similarly to an adult’s. Being so much smaller however, babies’ bodies are more easily overcome by physiological changes than are our adults’ bodies. As babies cry and then cry harder, their physiology responds the way ours would as we get increasingly upset. Blood pressure increases, body temperature increases, heart rate increases, cortisol levels rise, respiration increases, skin may flush, sweating ensues. Baby may begin to get a headache, nose will run, voice will become hoarse.

No parent wishes this type of physical distress on their baby. However parents will willingly allow this to occur when convinced that baby is manipulating them or that baby is “only” frustrated and needs no intervention. Parents, with broken hearts and large glasses of wine, sit outside the door of their hysterical baby because they’ve been told that without this, baby will simply never learn to sleep-through-the-night.

The phrase “self-soothe”  is mentioned again and again; along with the idea that babies can only learn this skill by working it out alone through tears, screams, and sobs. However, when taking a step back, one can see, as is pointed out in this chart, that a baby’s capacity for soothing is virtually totally limited to reliance on the parent. And of course, the younger the baby, the higher that reliance.


Reflect on How it Feels

You’ve waited 40 long weeks (give or take) to hold this sweet baby in your arms. Now that your baby has arrived it seems like everyone is encouraging you to treat her like a hot potato. Don’t hold the baby while he sleeps, you must get baby sleeping in her own room, you must teach the baby to self-soothe, you’re going to spoil him, the baby will never learn to sleep along if you’re always holding her. How does that advice feel for you? When you hear your baby crying, does it feel in your heart like you want to tune the cries out or do you feel drawn to your baby? Do you feel a strong urge to snuggle your baby up and soothe the baby through nursing or rocking or patting? If there weren’t all the outside noise blaring well-intended advice at you, what would you do instinctually?

We need to find our way back to our natural leanings as parents rather than listening to so-called “sleep experts” and well-meaning friends and family members. We are physiologically hard-wired to be hear and respond to our children. To attempt to desensitize one’s self to the calls of our offspring can prove detrimental to both parent and child. This period of such high physical need, while admittedly challenging, is short-lived but vital to a child’s attachment to parents and overall trust and security.

 

How Did We Get Here?

If the claim is that we’re being coerced to deviate from natural responses to our children, it begs the question why. What has happened in our culture that some parents have made a choice to tune out a crying infant in order to catch some Z’s of their own? Are these heartless parents? No. These are desperate parents! Parents desperate for sleep, desperate for routine, desperate for the ability to function on the job.

This desperation is at least, in part, rooted in the fact that our society does not value parents in actionable ways. There is a major lack of support for parents in our country. Mothers are expected go back to work at 6 weeks postpartum; the “lucky” ones who can manage financially without pay, go back around 3-4 months postpartum. Neither is  enough time to establish one’s position as a parent, let alone get the hang of breastfeeding, become accustomed to frequent night-waking, fully embrace the notion of being totally responsible for sustaining another human life. These are all huge emotional and physical undertakings and there is little to no cultural understanding of that. Then when returning to work, it’s often a struggle for breastfeeding mothers to fit in time for pumping and can require a lot of legwork upfront to get approval and space for pumping breaks.

The challenge for mothers to be able to perform at work without falling asleep at their desks in-between their rushed pumping sessions is very real. This weighs heavily on these women who are trying so hard to manage a very new and very stressful lifestyle. Going home at night only to lose precious sleep once again is enough to wear anyone down. Something has to give and oftentimes the promise of more sleep makes sleep-training seem like the only option.

 

Is there an Alternative?

There is an alternative to traditional sleep-training that improves sleep for both Mother and baby! Keep an eye out for Part II of this post which will address that.

The Call for Limiting Ultrasounds During Pregnancy

ultrasound pregnacy

Fetal ultrasound is a method of viewing a fetus while in the womb. Ultrasound technology uses
sound waves, that bounce off the baby’s mass, to produce a picture of the baby. While both the
American College of Obstetrics and Gynecology (ACOG) and the Food and Drug Administration
both agree that limiting fetal ultrasound is important, some doctors continue to insist on
frequently looking at baby in-utero without caution.

To avoid unnecessary viewing of your unborn baby, ask why an ultrasound is necessary.
Oftentimes, doctors utilize certain technology simply because it’s readily available without taking
into account the potential risks at-hand. In the case of fetal ultrasounds, it seems that
obstetricians, especially those with direct-in-office-access to ultrasound technology, like to “take
a peek” at baby in-utero far more frequently than may be clinically-indicated. Some women have
a fetal ultrasound performed at nearly each prenatal visit. Patients, trusting the doctor, don’t
always question why the ultrasounds are being conducted, and understandably so, enjoy being
able to view baby. However, if there is not a clear clinical need to have these images taken,
these ultrasounds are better off being declined.

What are the potential risks you’re even avoiding if you were to decline an ultrasound? In this
FDA article, Dr. Shahram Vaezy, an FDA biomedical engineer, states that,
“Ultrasound can heat tissues slightly, and in some cases, it can also produce very small bubbles
(cavitation) in some tissues.” Dr. Vaezy also warns that, “…prudent use of these devices by
trained health care providers is important.” Ultrasound has also been utilized recently to help
heal fractured bones and is also used to “blast” away kidney stones. Something that has the
potential to change the tissues of a developing fetus should be used with caution and operated
strictly by a trained health professional. This means that not only should the storefront
“keepsake” ultrasonography shops be completely avoided but frequent viewing of baby under
any circumstance increases risks to the fetus.

A trained ultrasound technician should be the only person performing these scans but it’s not
just the operator that holds significance. The length of time the ultrasound takes place is also of
significance. The longer the fetus is exposed to ultrasound, and the longer the fetal temperature
is altered, the higher the potential risks. The ACOG, in an October 2017 “ACOG Committee
Opinion” release note specifically that, “Ultrasound imaging should be performed efficiently and
only when clinically indicated to minimize fetal exposure risk using the keeping acoustic output
levels As Low As Reasonably Achievable (commonly known as ALARA) principle.”
Worth noting is that fetal Dopplers, often used by care providers to listen, not look, at baby in-
utero, also utilize ultrasonic sound waves to pick up baby’s heartbeat. These monitors carry a similar risk to visual ultrasound and also carry warnings as to be used only by healthcare
professionals. By purchasing this type of monitor, many mothers feel reassured by being able to
listen to baby’s heartbeat at any given time. However, Doppler monitors have not been
designed for at-home use.

The decision for frequency of ultrasound exposure during pregnancy remains with the patient.
With information regarding both risks and benefits of this medical intervention, one can make an
informed choice as to how she wishes to proceed when ultrasound is recommended by her care
provider. It is always important to have an open dialogue with your provider regarding any
concerns about recommended procedures. Only when the patient is comfortable and in
agreement, should a non-emergent procedure take place. As a patient, you have the right to
decline any or all ultrasounds recommended by your care provider. You also have the right to
question what the provider is hoping to find through the recommended imaging and how the
imaging itself would affect future medical recommendations.

While ultrasound is widely accepted in the medical community as being safe and carrying little
to no risk, it is still wise to proceed with caution. Let us not forget that several decades ago, X-
rays were used readily for a host of reasons, including fetal imaging and were considered “safe.”
Of course, now more is known and there is great caution with X-ray use. This is a good lesson
in why, for a healthy pregnancy, less medical intervention is often the best choice.

Babywearing: The Holiday Helper

babywearing

With the holiday season in full-tilt, those of you with new babies may be feeling a bit hesitant about taking your little ones to holiday gatherings or to community events. Concerns range from not wanting Aunt Susan to sneak your baby a taste of that pumpkin pie to trying to avoid kisses from every well-meaning friend and family member.

Prevent the Pass-Around
Of course you want to show off your little bundle, but you want to do it on your terms. It feels uncomfortable to have baby being passed around from person-to-person. Cue babywearing! People are far less likely to reach out for baby when baby is snugly wrapped or strapped to Mom or Dad. It offers an unspoken barrier stopping people from requesting a chance to hold baby since it’s clear that baby is very comfortable and secure. This gives the caregiver the ability to offer baby up for a snuggle if one so desires rather than having to refuse the request or even worse, oblige the request even though it’s not what you want to do.

Don’t Miss Feedings
With the hustle and bustle of holiday events, it’s far easier to accidentally skip a feeding. As babies get a bit older and more easily distracted, all the noise and goings-on of a holiday celebration could result in baby bypassing her typical feeding cues. While baby might not even fuss at the missed feeding, a nursing mom may experience engorged breasts and even risk mastitis. With baby held closely in a wrap, sling, or carrier, the physical proximity helps keep caregiver and baby attuned to feeding needs.

Do Miss Unwanted Feedings
There’s always that one relative who feels it necessary to give baby “just a little taste” of the whipped cream or “just a pinch” of Grandma’s beloved holiday cookie. It’s frustrating to find out, after-the-fact, that your baby has been given something that his sensitive gut might not be ready for yet. Thankfully, with baby comfortably enjoying the party secured to your chest, no one can sneak an unwanted taste to your baby.

Avoid Overstimulation
Babywearing provides a grounding experience for baby: the rhythmic sound of the wearer’s breathing, the steady heartbeat, and the gentle movement. All these things offer baby a familiar, safe, and comfortable environment even when the surroundings may be totally unfamiliar. It even allows baby to snuggle in for a much-needed nap with music and laughter and chatting in the background.

Babywearing is the ultimate holiday helper. You can attend your holiday event with the peace of mind knowing baby is cozy, comfortable, and insulated from unwelcomed circumstances. Even better, you can keep baby close with your hands totally free. That means more trips through the buffet line for you. That alone is a reason to celebrate! Happy holidays!

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