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Posts from the ‘Book’ Category
Low vaccination rates have allowed a recent resurgence of the measles virus. In my family, measles is part of a personal tragedy. My dad's younger brother, Frankie, died of encephalitis caused by measles in 1956, at the age of 6.
I, for one, am not sad to see 2013 go. It’s been a rough year for me. I haven’t been blogging about it – haven’t been blogging about much of anything, actually – and I think it is time for an update. 2013 started with a miscarriage in progress, finally ending with a D&C on January 4. I grieved that lost pregnancy openly on this blog. It was therapeutic for me to blog about it and to feel support from women who had had similar experiences, or at least had empathy for the magnitude of love and hope that comes with a pregnancy. I started to feel better. I was confident that I would be pregnant again soon, and that was the obvious way to fill the gaping hole in my heart.
In the spring, I watched seedlings poke through wet dirt. Our neighborhood burst with color and new life, and I felt hopeful. But as the days grew longer and hotter, I felt sadder and sadder. I still wasn’t pregnant. My previous due date came and went, now just another day, but such a heavy one for me. Cee and I sorted through newborn clothes in our hot attic, not for a new baby for our family, but to lend to a friend. Cee asked to keep a few onesies for her baby doll. I showed her how to fasten the snaps and then sent her downstairs so I could cry.
In August, I had another miscarriage, this time very early. Then, another one in October, early again (and thankfully spontaneous) but far enough out that I let myself think ahead to another summer due date. That one really crushed me. I know miscarriage is common, and it’s easy to chalk the first up to bad luck. But by the third time around, I had really lost faith in my body. It has failed, repeatedly, to do one of the things I feel it was always meant to do. I’ve always wanted children, and the family that I have, for which I am exceedingly grateful every day, doesn’t feel complete. There’s still a gaping hole here, and it’s only gotten bigger.
Meanwhile, Cee turned three in November. I know my sadness has affected her, and it’s affected my parenting, because my emotional reserve is just plain depleted. I am working hard at being enough for her and at assuring her that she is enough for me. (And she is. She really is. I’ve come to terms with that, most days anyway.) Read more
I meant to do skin-to-skin with Cee after her birth, I swear. It was in my birth plan. But after a long labor, Cee was born blue and limp, and the understandable concern about her health trumped any ideas I’d had about optimizing our postpartum experience. Cee was whisked away to a warmer on the other side of the room and encircled by the NICU team. Thankfully, I heard her cry within a few moments, and she was in my arms soon after. But by then, she was wrapped in a pink and blue flannel blanket, and I was too overwhelmed and taken with her to think of unwrapping her. Instead, I held her, and we gazed into each other’s eyes. She started rooting and was nursing within a couple of minutes. It was a magical first meeting, and it wasn’t until later that I realized that I’d screwed up and forgotten to do skin-to-skin.
I’ve been researching this topic for a chapter in my book about the postpartum period. I’m writing about what we know and don’t know about getting to know our newborns, establishing breastfeeding, rooming in, and yes, skin-to-skin. When I started working on this chapter, I thought the skin-to-skin thing was a slam-dunk, maybe even too obvious to be of much interest to my readers.
Modern-day interest in skin-to-skin, also called kangaroo care, began in 1978 in the NICU at San Juan de Dios hospital in Bogotá, Columbia. For every 10 premature babies born there, only 3 survived. There weren’t enough incubators or nurses. Babies were tucked two to three at a time in incubators, and infections were rampant. Parents weren’t encouraged to be involved in the babies’ care, and having little emotional connection to them, many abandoned their sickly babies at the hospital. Kangaroo care was a desperate attempt to care for these vulnerable babies. Mothers were essentially asked to be their babies’ incubators, holding them skin-to-skin 24 hours per day and breastfeeding on demand.
The results were astounding. The kangaroo care babies in Bogotá grew well, were more likely to be breastfed, and were less likely to get severe infections or be abandoned. The power of kangaroo care for low birth weight babies has since been confirmed in multiple studies. A 2011 Cochrane review concluded that skin-to-skin helps stabilize premature newborns, reduces mortality, infections, hypothermia, and length of stay in the hospital. These benefits are particularly clear in developing countries, but many hold in industrialized nations as well.
With the impressive success of skin-to-skin care for preemies, it seemed natural to assume that full term babies would benefit from it as well. But the research in this area is disappointing. Read more
Last week, I received a sweet email from a reader, saying that she was missing my posts and that she hoped everything was okay. And this morning, my Facebook inbox was graced with a photo of an adorable toddler, son to one of my most loyal readers.
I LOVE getting these little notes. I’m completely flattered and honored that there are parents around the world who have let me into their parenting lives and think of me even when my blog has grown quiet. But getting these notes also make me feel a tad bit guilty: “Crap! I should be blogging more! I need to be more of a resource! People are counting on me!”
At the moment, I have a few other projects that are taking precedence over blogging. I’m hard at work on my book, and that is pretty much consuming most of the energy I have for writing. It is harder work than I thought it would be. I’m falling deep into topics that I thought would be much simpler to sort through and translate into readable chapters. It’s really interesting and fun, and I can’t wait to share it with you. I had imagined that I would be able to whip off quick blog posts about my book research, but I haven’t been able to pull it off. But, I promise you, once I get this manuscript in (which admittedly, may be a while), I will get back to blogging regularly. I’m keeping a list of post ideas, which pop up a few times per day while I’m working on the book.
I’m also teaching a couple of nutrition classes at my local community college this summer, and we’re working on buying a house (and soon – moving!). And… it’s summer. The Oregon rain has nearly stopped. (Although, for some reason, we signed up for swim lessons starting last week, and we’ve been shivering at the outdoor pool in 60°F, drizzly weather these last few days.) We’re making time for camping, hiking, leisurely walks to the park, and picking strawberries.
As a side note, let me just tell you that I’m having lots of fun parenting right now. Cee is two-and-a-half. She’s stubborn and independent, and most of the time, I love it. And oh! Read more
I’ve been thinking about bedsharing and sleep safety for the last few months. I have devoted an entire chapter of my book to this topic. Not only is it an important question for parents, but it’s an issue with so much complexity — wrinkles and folds of factors like breastfeeding, bonding, instinct, culture, and just plain reality.
I think it is vitally important to understand the relationship between bedsharing behavior and risk of SIDS and accidental deaths. But our ability to tease apart every factor that might impact sleep safety is imperfect; there will always be factors that aren’t quantified in these studies, not to mention the fact that case control studies have some inherent limitations. You’ve probably heard about the study published this week by Carpenter et al. in BMJ. It combines 5 historic case control data sets from Europe, the U.K., and Australasia to specifically look at the risk of bedsharing in breastfed babies in nonsmoking households. It concludes that bedsharing poses an increased risk of SIDS, even in these ideal situations. I think it’s an important study, but it also has some limitations and doesn’t answer all of our questions with certainty. In fact, no study will probably ever do that. (You can read some critiques of the Carpenter study here and here.)
But even if we accept that bedsharing increases a baby’s risk of dying unexpectedly during sleep, we still have to answer the bigger question of how we translate this information to families living in the real, difficult world of infant sleep. Many families value bedsharing as a cultural practice; others choose it because it feels right. Still others bedshare because it is the only way that anyone gets any sleep at night, and we all know that sleep deprivation carries some risk, too, as does falling asleep on a couch with your baby. This is the reality.
Pediatricians face this reality in their clinics every day, when they talk with parents of new babies about sleep. In my book, one of the questions I explore is how pediatricians handle this conversation, given that their professional organization, the American Academy of Pediatrics, recommends against bedsharing. Several months ago, I sent some questions to one of my favorite pediatrician bloggers, Dr. Melissa Arca of Confessions of a Dr. Mom. She had initially agreed to a Q&A, but then she didn’t respond with her answers. It was the height of the busy flu season, and I figured that she was just busy. Then, this week, she surprised me with her responses. She had been thinking about bedsharing given the news of this recent study, and she was inspired to restart this conversation. We’ve cross-posted our Q&A on both our blogs. Check out her post for more about her initial hesitancy to address these questions, and please feel free to share your experiences in the comments below.
Alice: How did sleep look for your two children?
Melissa: My first child was a challenge to say the least. He is the one who made me question the safety of bed-sharing in the first place. For the first 6 months of his life, sleep was virtually non-existent (or at least that’s the way it felt to me) because he needed my arms and constant soothing throughout the night. But I was terrified to bedshare. I was literally at the end of my sleep deprivation rope. I had tried everything. And instead of listening to my instincts, I was fighting them. Because I was scared.
I never envisioned myself as a bedsharing parent. As a pediatrician, I was adamantly against it. But it was exactly what my baby needed and we struggled and limped along until I finally realized that.
My second child was a breeze and that’s no lie. She was always (and still is) an “easy sleeper”. She needed her space and showed clear signs of being tired. When she was tired, that was it. I didn’t need to bedshare with her. She slept in her own bassinet next to our bed during her first few months of life before being transitioned to her own room.
They could not have been more different in the sleep department. Same parents. Same environment. Different children.
Alice: As a pediatrician, how did you feel about bedsharing before having children? Did becoming a mother change that?
Melissa: I didn’t think it was safe. At all. I had read the studies and the official recommendations. Back to sleep, crib and/or bassinet in the same room with no hazards such as loose bedding, pillows, etc.
I never thought in a million years I would have become a bedsharing parent. But kids don’t have our same agendas. Read more
Yesterday, I posted an excerpt from Nicholas Day’s new book, Baby Meets World. If you missed it, check it out to learn how modern hunter-gatherer societies raise children, and how that task is supported by not just by hard-working mothers but the entire culture. It’s good stuff.
After reading his book, I had lots of questions for author Nicholas Day. Today, I bring you our conversation about his book and on the roles of science, culture, and instinct in parenting.
Alice: Becoming a parent changes all of us. What was it about your particular transition to fatherhood that made you want to research and write this book, to dive into the history and the science of parenting in a way that extended beyond your own reality of parenting?
Nicholas: In a way, I think it was the part of me that wasn’t changed that led to this book: I had stupid questions about babies in the same way I have stupid questions about everything else. (It’s a personality flaw.) I didn’t see why I had to think of babies as simply problems to be solved. Most baby books have what I think of as the leaky faucet approach: if your baby is dripping, we recommend this socket wrench. And there were many, many times when all I wanted was that socket wrench. But I also thought babies were interesting subjects all on their own. I wanted a book that acknowledged that. And I wanted a book that was wide-angled. The study of infancy is highly compartmentalized: the different disciplines don’t talk to each other. The few good books about babies tend to be highly focused: they look at babies through the lens of a cognitive scientist, say, or a developmental psychologist. But there are so many lenses out there! It seemed a shame to only see a baby as like this or like that. There’s so much left outside the frame. So this book tries to show readers the many different versions of a baby that people have seen—and still see today.
It’s strange. You wouldn’t think that babies would be an obscure subject: they are everywhere. (In our highly fertile neighborhood, I sometimes feel like Hitchcock’s The Birds is being reenacted—but this time with babies.) But they’ve been weirdly neglected. This is sort of hard to believe: any book about babies has to clear the high hurdle of being another damn book about babies. (Right? Like that’s what we need. Also, we totally need more diet books.) But I concluded that we really did need that. Babies are still strangers in our midst.
Alice: Your book focuses on four basic facts of infancy: “suck, smile, touch, toddle.” How did you choose these topics? Why not “eat, sleep, poop, cry,” for example?
Nicholas: I joke about this at the end of the book—that there’s so much going on in infancy I could easily have chosen spitting, shitting, screaming, sharing.
Part of why I went with these topics was that I actually wanted answers about them: I really wanted to know where a smile comes from and what a first smile might mean, for example. But I also thought these subjects had been overlooked. There’s been an enormous amount written on sleep, for very obvious reasons: any new parent is obsessed with sleep. But there’s very little written about smiling or walking. It’s the leaky faucet problem: because a smile can’t be fixed, no one writes about it. Read more
I’m working on the “sleep strategies” chapter of my book. This chapter is about the strategies that we use to help our babies sleep and how these practices correlate to the development of baby’s sleep patterns.
I’m fascinated by cultural variation in nighttime parenting strategies. However, according to some accounts, there’s a simplistic dichotomy in the way parents around the world help their babies sleep. In most of the world, mothers sleep with their babies and breastfeed on demand throughout the night. Sleep is not a problem, because babies simply aren’t expected to sleep through the night. We in the West, however, don’t understand normal infant sleep. We bend over backwards with all sorts of tricks and gadgets to help our newborns sleep, often alone. (I’m looking at you, swings, bouncy seats, strollers, drives in the car, exercise balls, washing machines.) Then, a few months later, we tire of the antics, grow intolerant of night wakings, and turn to sleep training as the answer.
There is definitely some truth to this. It’s something that I’m writing about in greater detail in my book. But we also know that nothing is as simple as it seems, and infant sleep is no exception. I think it’s helpful to know that parents everywhere struggle with their babies’ sleep or lack thereof, and that’s true regardless of sleep customs or cultural expectations (Sadeh et al. 2011). No matter where they’re born, babies have to acclimate to a world that grows dark and quiet at night and bright and busy during the day. We might use different strategies to help our babies sleep, but there are many similarities as well.
I ran across one of these similarities in a paper I read yesterday (Anuntaseree et al. 2008). Thai researchers surveyed parents of three-month-olds born across the country in 2000. They asked the parents how their babies fell asleep, where they slept, how they were fed, and how often they woke during the night. The parents of more than 3700 babies responded to the survey.
Most of these babies – 68% – shared a bed with their parents. The rest slept in a separate bed but in the same room. Putting babies to sleep in a separate room was nearly unheard of. Of 3700 babies, only two slept alone (a whopping 0.05%). About half were exclusively breastfed, and another quarter were fed a combination of breast milk and formula. On average, these three-month-old babies woke their parents 2.7 times per night, but there was of course a lot of variation here. Nearly 50% woke just one or two times per night. The researchers wondered which factors were related to waking more often, and they found significant correlations with these: male gender, more than three naps per day, falling asleep while feeding, exclusive breastfeeding, and the use of a swinging or rocking cradle.
The gender and napping associations are a little odd and not supported by other studies. However, the rest of it isn’t surprising. It is well accepted that breastfed infants wake more often during the night. Human breast milk is more rapidly digestible than formula (Cavell 1981), so breastfed babies need to feed more frequently. It’s also a common finding that feeding to sleep increases waking (or more accurately, waking the mother) during the night.
But I was really interested in learning more about the swinging or rocking cradles mentioned in this paper. It turned out that 88% of babies commonly started their night in such a cradle. Here’s how the paper described it:
“Use of a swinging or rocking cradle for infant sleep is traditionally used in many Asian countries including Thailand. The typical “getting the infant to sleep” situation in Thailand is for parents to use a cradle as a sleeping aid, and then when the infant falls [to] sleep, transfer the infant to the bed. There has been no previous study regarding the effect of this custom on night waking; our study is the first to demonstrate this association.”
I was curious about what a Thai swinging cradle might look like, so of course, I Googled it. The only photos I found showed a pretty extraordinary contraption: Read more