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The Anniversary – Part 2

Here, to celebrate the first anniversary of the launch of my book, is the second part of my gift of the first chapter (see March 2018 blog post for part 1):

YOUR BABY SKIN TO SKIN

Chapter 1 (continued)

Coming into the World: Your Highly Evolved Baby

The first moments

Hello, little one

Mothers with their still-damp babies inhale deeply, instinctively drinking in the musky aroma of their own and their baby’s body scents mingled together like some heady cocktail. The high adrenaline level in both mother and baby heightens their awareness and ensures that these aromas fix themselves deep in the memory for good. Even months (and, indeed, years) after birth, a lot of time is spent burying their noses into each other. As sweet and cosy as this is, it is simply evolution’s solution to ensuring that a mother and baby know each other in the dark of the night and that we protect our own genetic inheritors first. Remembering this with the birth of my first son, I now find myself sniffing my grandson in a way I have never felt moved to do with the thousands of babies I have held as a midwife. I already know his unique smell and can sometimes catch it on myself days after seeing him.

Much the same happens with our baby’s first cries: they move us so deeply to respond. Even if we have never held a baby before, we hear those first tiny gasps and mewls and immediately our hands begin to hold, stroke, soothe and reassure. We slide our baby up closer to our face so we can whisper in the tiny ear and kiss the top of the warm head. The higher female voice being particularly ‘keyed into’ the baby brain, and the mother being particularly triggered by her new baby’s cries, further two-way bonding and imprinting takes place. Our baby will take a little while to learn the unique look of our face but she already recognises the particular pattern and timbre of our voice from those months listening to the bath-like echoes inside the womb. During the early hours and days, the imprinting deepens and mothers find that they are completely unable to relax until they have responded to their baby’s cry and feel anxious when separated for even a very short time. Seeing someone else holding their crying newborn will make them twitchy and want to grab her back – this complete stranger already a permanent resident in their heart.

Skin to skin

In the modern birthing environment, irrespective of how the baby made her entrance, women are encouraged to enjoy prolonged ‘skin to skin’ time. While this automatically happened before the times of mass hospitalisation, during the 1970s and early 1980s increased medicalisation led to babies being bathed, dressed and wrapped before their exhausted mothers got to hold them after birth. By the mid-1980s ‘bonding’ was all the rage, and women today still ask me if the purpose of skin to skin is to help them ‘bond’. In fact, those early hours when we hold our peach-soft, damp, warm bundles of wiggliness on our chests do very much more than give us sniffing time. This is where our baby picks up more friendly bacteria – the ones that we have bred to protect us from the harmful bacteria we always carry on our bodies. So our babies gain protection from the bugs in our homes that we have as our companions.

More than that, skin to skin time calms the baby’s autonomic nervous system (ANS) right down. We will look at the ANS in great detail in Chapter 6 as it tells us so much about why our babies behave in the seemingly random way that they do, but, for now, you just need to know that skin to skin helps the newly birthed baby to stay soothed, warm and safe while you get to know each other.

Falling asleep during skin to skin

The first in-bed snuggles after birth are often wide-awake ones as the adrenaline that has permeated labour hasn’t quite left yet. Women describe staring at their newborn baby for hours; right through the first night together. However, you might fall asleep on a sea of endorphins and oxytocin and you need to keep yourself and baby safe. The safest way to share a bed in these early hours is skin to skin together under light covers (a hospital sheet and light blanket or, if you are at home, your summer duvet tucked under your elbow); don’t swaddle your baby in your bed and don’t try to limit her movement with pillows or tucked-in sheets; if she is tucked up with you like this, she really doesn’t need a hat!

If you are bottle-feeding formula milk or are still under the influence
of labour drugs, sleeping with your baby is not safe: set an alarm on
your phone to buzz after about 20–30 minutes so that, if you do nod off despite your best efforts to stay awake, you will wake pretty soon and can put your baby in a crib. If you are at home, make sure that, if your partner is in bed with you, he or she is not drunk or been smoking.

Your baby, after the first post-birth suckling, may sleep for many hours and, as long as she is kept skin to skin, she will wake when she is ready to suck again.

 

The first suckling

Even more soothing and calming for both the baby and her mother is suckling. As we saw with our primitive baby, soon after birth, the newborn, lying seemingly helpless on the mother’s chest, starts to instinctively search out the breast. She isn’t thinking ‘I must feed. I must get just the right amount of calories and nutrients inside me and I know just the restaurant!’ She is driven by primitive reflexes and instincts, just like every other mammal on the planet, to search out a nipple. Smells, sensations and sounds guide her and, to begin with, her journey can seem pretty random. But as she gets closer to the breast, that enticing contrast line of the paler flesh against the dark edge of the areola catches her eye, and off she heads to explore. Women often tell me when I ask about the first feed that ‘It just happened. I don’t really remember doing anything. She just knew what to do!’ Of course. It would be a bit of a disaster if our primitive mother, having just given birth in the dark shadows of a cave shelter and still needing to urge out the afterbirth, had to know how to get a baby onto her breast to suckle. This baby can’t wait around for her mother to practise and learn! In any case, in the low light, the mother wouldn’t be able to see much of what she is doing. The baby can do this solo.

We are really not very far away from this early setting, and evolutionary adaptation ensures that the newborn baby, driven by a rooting reflex, hunts and snuffles around until eventually she finds the nipple and, after prolonged head-bobbing and faffing, draws it in and sucks. Endorphins and oxytocin flood the bloodstream of baby and mother, taking away the pain of birth and replacing it with a deep relaxation and sense of calm, at the same time causing contractions in the womb to push out the placenta and stop bleeding. With the surge of the placenta contraction, the mother pulls her baby in even closer to her chest and the baby suckles more deeply. There is no need to help or direct the baby and, in fact, she will manage better without you doing very much except what comes instinctively. She has a reflex and, just like with a sneeze, if you try to help it might get a bit messy!

 

Love at first sight?

You may believe you should feel an immediate thunderbolt of love hit you when you first hold your baby or, at the very least, soon afterwards.

And if you don’t, you feel there’s something wrong with you. In my experience, although many women do indeed feel an almighty rush of instant love at first sight when they first hold their baby, for just as many it isn’t like that at all. So, whereas for some new mothers it feels like an instant recognition of a loved one – ‘Oh my word, it’s YOU! I know you and I love you so much!’ – it may feel more like ‘Oh! Hello. Not quite sure what you mean to me. I’m pretty puzzled right now because I really don’t know you at all. Who ARE you?’ or ‘Hmm, you’re a funny- looking thing! Not at all what I expected and I’m not sure quite how much I care about you at the moment. We will have to muddle this one through …’

Sometimes relationships simply take a while to grow, settle and cement. Don’t worry. Your baby doesn’t have any of these worries and doesn’t care about your musings (she doesn’t know that you feel somewhat ambivalent right now). She will show you how to mother her. As you feed her and change her over the days and weeks, her smells and her cries and her searching eyes will gradually, bit by bit, get inside you if you just relax into what it is rather than try to wrestle it into what you think it should be.

 

Partner ponderings

Although much of this book inevitably looks at mothering, there is plenty here for partners. Reading through the whole of the chapters will help you understand things from your child’s mother’s perspective. It may help you make sense of her hormonal swaying, explaining why it can seem at times as if the woman you love has left the building and been replaced by a stranger! At the end of each chapter is a bit just for you, to help you discover your unique and essential role, different as it is from that of the mother. Your baby needs you and your partner to be different; this helps build flexibility of thinking and, in time, your baby will grow into a child who understands how to respond differently to different people and how to understand emotional needs.

Labour

During the labour, birth and first minutes and hours, the birthing woman is completely awash with hormones, driven by instinct and reflexes to bring your child into the world safely. It can be tough to watch. Many partners feel a huge need to rescue their birthing woman, but there is no need. She needs your strong emotional and physical support right now. She is quite safe with the midwives and doctors, who are expertly trained to do the checking and rescuing (if necessary) so that you can be the support coach to the marathon runner. There is nothing to be scared of – this is simply what we look like and sound like when we are pushing another human being into the universe. It’s fine to ask the midwife if you can watch your baby’s head emerging if you like (and if your partner doesn’t need you to hold her while she pushes) and even to ask if you can help hold the baby as she is finally born. If all is going well, most midwives are only too happy to guide your hands. Or simply watch in awe …

The first moments after birth

The moments immediately after the birth can be very emotionally mixed. Exhaustion and adrenaline mix with shock and delight. Watch now as your partner and baby, driven by deep, deep instinct, discover each other. This is millions of years of evolution laid out in front of you. Your baby may take some time to splutter and cry. Don’t worry: the cord is still pulsing with oxygen and nutrients and she will breathe for herself in good time. Stay close to your partner and just be. It’s fine to join in the gentle touching and see if you can smell those musky tones too. Your partner’s senses are massively heightened to ensure that she knows her baby’s scent from the very beginning. It won’t be so strong for you – you have a different role to play – but you may still be surprised by how powerful and good your baby’s smell seems.

Refreshments all round

When your baby starts to nuzzle and move around, searching for a nipple, don’t feel moved to help: the baby needs to take her own journey in her own time and her mother will ease her up without even thinking. Instead, while your baby sets about foraging, you can ensure that your partner is warm and nourished. Pop a warm blanket or towel over the snuggling couple first and then sort out refreshments. If she needs stitches, you will need to wait until these are done before sorting out food. You and your partner will need plenty to eat and drink, but keep it light. Tea and toast is the usual order of the day. A very newly birthed woman will tell you that the first cup of tea after birth is the best cup of tea in her life, EVER. If you make it, rather than leaving the job to the care assistant, you will get the kudos!

Skin to skin

Eventually, after much nuzzling and eating and chatter, most women want a shower and you can finally enjoy some skin to skin time with your baby. Simply put a hat on her head, pop a nappy on her bottom and then carefully pass her down your T-shirt until just the top of her head is sticking out. That’s it! Talk to your baby, kiss her, smell her, or just grin and enjoy this moment in silence.

 

Questions and answers

At the end of each chapter you will find some answers to common questions. Tempting though it is to turn straight to this bit, do read the full chapter as it will help you make sense of the answers.

Caesarean

I am expecting to give birth/have given birth by Caesarean. How can I ensure that my baby gets the friendly bugs?

Evolution has done a brilliant job of getting us here, but there are still inevitable glitches (that kind of defines how evolution works), and medical interventions give us a means to survive these glitches. Caesarean-section (C-section) births, forceps births, ventouse births, epidurals: these things have dramatically improved the lives of thousands of mothers and babies. For our part, we need to look at the bits that science can’t yet replicate and add those in as best we can. Compared with vaginally born babies, those born by C-section are more likely to develop asthma, allergies, eczema, type 1 diabetes and coeliac disease. They are more likely to be hospitalised with tummy bugs. While some of this may be attributable to the greater likelihood of these babies having formula milk in the early days, there is growing interest in the notion that babies born by C-section just don’t get the good bacteria from the mum’s vagina and perineum. Some maternity units now encourage mothers expecting to birth by C-section to collect friendly bugs from their vagina before the operation. If your unit does not suggest this to you, just put it in your birth plan and do this:

  1. Take a piece of gauze soaked in normal steriles aline.
  2. Fold it up like a tampon with lots of surface area and insert it into your vagina.
  3. Leave for one hour, remove just prior to surgery, and keep it in a sterile container (the sort of pot you collected your pee in during pregnancy is ideal).
  4. Immediately after birth, simply wipe the swab around the baby’s mouth, face, then the rest of the body.

Note: It is really important that you only do this if you are free from HIV, thrush, group B strep and any STDs or other infections. If you are in any doubt, talk to your midwife.

Also, as soon as possible, get skin to skin and stay that way with your baby for as long as possible (hours rather than minutes and days rather than hours). There is no reason not to have skin to skin while the post-op stitching is completed unless you are too poorly to hold your baby. If this is the case, your partner could, if possible, hold your baby skin to skin on you or on themselves. Let your baby suckle freely and don’t feel the need to bathe her for at least 24 hours. If possible, take your own linen into hospital and don’t be obsessive about you or your partner forever cleaning yourselves! Just normal daily hygiene is enough.

Special care

My baby is in special care! What now?

It is incredibly stressful for everyone when a baby is too poorly or too little to be with her parents and needs the care of a neonatal unit. The newly birthed mother can feel split between gratitude that her baby is in safe hands and misery that her arms ache to cuddle her newborn. This upset can be made even worse when a baby has to stay in hospital after the mother has been discharged. There is clear evidence of the benefits of ‘comfort holding’ and ‘kangaroo care’ for premature and sick infants. ‘Comfort holding’ can simply mean touching your baby with your warm hands on her skin while she rests in an incubator and it can also extend to sitting quietly in a chair with her lying on your chest. This can bring rest and comfort to mother (or partner) and baby and is also a simple, effective way of reducing stress for both when a baby has to have unpleasant procedures like blood tests.

‘Kangaroo care’ is an extension of ‘comfort holding’ and involves putting the baby, skin to skin, with mum or her partner, either sitting in a chair or while they are getting on with something else. Skin to skin has a profound positive impact on babies and their parents, settling breathing and heart rate, reducing stress and managing temperature as well as helping to protect against infection by increasing the baby’s exposure to those essential friendly bugs. As well as getting close to your baby as often as possible, express your milk for her. Even tiny amounts of your milk will protect her from infection and soothe her emotionally. Read Chapter 4 on feeding for tips on expressing.

Skin to skin during stitching

I want to keep my baby skin to skin for a long time after birth, but what if I need stitches?

If we hold and suckle our babies while we are stitched, have blood taken, have ‘after pains’ or are upset for any reason, we get a rush of endorphins and oxytocin and feel better! Most women simply don’t ask or, if a midwife says ‘I need to give you a few stitches – maybe your partner would like to hold baby?’, they don’t say ‘Thank you very much for your kind offer, but I’d like to keep her with me and feed her.’ If needs be, get your partner to hold your baby against your bare skin. Of course, your partner could hold the baby skin to skin with themselves, but the ideal is for baby to get your friendly bugs first and foremost. There will be ample time ahead for cuddles with others.

No skin to skin

I had a vaginal birth but didn’t get any skin to skin time. Is it too late?

No! Things just don’t always go according to plan. We have tougher labours and births than anticipated, we have drugs that make us and our babies sleepy, we are too sore or poorly just after birth to hold our babies … so don’t panic! Just let the dust settle and then catch up. Strip your baby down to her nappy, strip yourself off down to your pants and get snuggling. Don’t worry about your baby getting cold: as long as her tummy is skin to skin with yours and her back is snuggled under your blanket, you will share your body heat and smells with her. Explore her with your hands and face or simply relax and read a good book – you will quickly discover that those ‘lost’ moments just after birth will fade.

I hope that you have enjoyed reading chapter 1 “Your Baby Skin to Skin”. To enjoy the rest of this unique look at the first year of your baby’s life, follow this link to buy a copy …

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The Anniversary – Part 1

To celebrate the first anniversary of the launch of my book, my March & April blogs will be a gift of the first chapter:

YOUR BABY SKIN TO SKIN

Chapter 1

Coming into the World: Your Highly Evolved Baby

Reaching back …

Some days ago, in the dark of the late evening, not long after the sun dropped suddenly below the horizon, a young woman, hidden with her group in the protection of some fallen trees, felt the first cramps of her impending labour. Deep in her belly and back, sporadic waves of tension grew and eased. She rested and fidgeted through the night and walked through the days, stopping occasionally to eat, drink and rest. Her companions stayed close but un-interfering, busy as they were with surviving and finding a suitable shelter for the safe birth of their newest member.

Now, a few days later, the cramps gradually strengthen and lengthen, grabbing her attention and driving this woman into herself on waves of endorphins. As bright as the midday sun is, inside the labouring woman’s head the lights gently dim as she becomes quieter and more settled. Her companions help her into a cave shelter where she creeps into a hidden corner and hunkers down, moaning with the waves of intense power that flow through her. As the day wears on, her moans grow louder and more urgent. She is up now, swinging her aching hips, pressing her hot brow against the cold stone wall of her shelter and hanging on the shoulders of her strong companion. Oblivious to the world, she is wrapped entirely in her own experience as the hours slip by. And then, just before dusk, the cramps stop and she sleeps for a few delicious moments, listening to the reassuring hum of gentle activity around her.

So, here we are, at the very dawn of time, watching in wonder, and waiting for the moment …

Suddenly she wakes; urgent, adrenaline- filled eyes; frantically trying to get up on her haunches. Her animation alerts her companions, who now gather around her, supporting her weight and watching as she starts to gasp, grunt and urge. Throwing her head backwards, arching her back and heaving again. And now, the wave gone, she is quiet again, but attentive. And another, bigger urge, greeted with deep, throaty groans and gasps. And another, and another. It seems like forever, and just when she thinks she is nearly ready to birth, another great wave hits and the groans deepen and intensify. A sudden gasp and yelp, and now she is panting quickly with the shock of her baby’s head stretching her open with a hot burn that takes the breath out of her body. The woman, numb from the stretch, breathes silently, eyes focused steadily ahead as the moment lingers. Now the urge builds again, the stretching starts and then, emerging slowly, glistening and dark amid the wolf-like howling, a head! The baby faces away from its mother and she looks straight ahead, searching for reassurance, almost oblivious now to the nature of her work and suddenly freed for a moment or two from the stretch that made white stars dance in her eyes.

Perfectly still, silent, the baby stays, head out, aware of the cool air around its face; its body held tight inside the mother for a minute before gently turning slightly to bring it around ready to emerge. As the baby’s body turns inside, the head turns too, bringing the tiny, scrunched-up face into view. Dark skin, bubbles of fluid popping at the mouth, eyes clenched tightly shut. The mother, wondering what is emerging from her body, reaches down between her legs and the baby, in response to its mother’s touch, wiggles its head ever so slightly. Shocked, the mother draws her hands away, holding sticky fingers star-like in the air as the urgent, irresistible force of another wave rocks her body one last time.

On a wave of shiny fluid, accompanied by one long, low hum, like a grateful hymn, the baby finally slips out onto the dusty floor. The baby, lying like a landed fish between its stunned mother’s legs, takes a minute to respond. Its mother, likewise, does not grab her new baby but looks lost, unaware momentarily of quite what has happened …

… and now she moves. Hands between her legs, searching, finding her baby and drawing it up into her hot arms, close to her, where she can just see in the dim light of her cave shelter that she has a girl! The thick cord hanging warmly from her daughter’s belly to her own vagina, swollen and numb from the birth, still pulses with blood from the placenta, giving her baby enough time to adjust to her new surroundings. Even now, as she starts to cough and cry little bubbly cries, her heart is adjusting to the outside world: her circulation changing as some valves snap shut for good, no longer needed now the baby is starting to breathe for herself and her once-blue body gradually infuses to pink.

Now the new baby smells her mother, like a small, snuffly hedgehog in the dark. Her own amniotic fluid, still warm and slippery, mingling with her mother’s salty sweat. Her tongue creeps out and licks around, catching the sea tang of her mother that seals her forever-knowledge of who she must cling to now. And at the same time another sound, another sniff but this one long and deep, like the drawing in of the first sweet air of morning. The newly birthed mother, sticky hands steadying her slippery eel-child on her chest, is smelling her too! She doesn’t even know she is doing it. As the mother–baby dance begins, the new cries build and the mother, high on a sea of adrenaline, learns it by heart in that moment. From now on this cry will touch her in a way that no other baby cry has before. It is part of her own experience, a reminder of the struggle she endured to bring this baby into the world. While others may be able to turn away from this noise, it will reach straight into her heart and wrench at it until she responds. Even now, that first cry is working its purpose: mother shushes gently into her daughter’s ear, muttering and gently calling to her. No words are needed; the gentle sounds, mixed with the warm smells and touch, signal that this is sanctuary.

Before the cord has even broken, or the afterbirth pushed out, the baby bobs her head about. Her hands opening and shutting, grasping at flesh, legs pushing over and over against her mother’s damp, warm skin, gradually moving her just-landed body, heavy in the air, over her mother’s chest. She snuffles and bobs, cries and then falls quietly asleep for a moment before moving again. Creeping around, more sniffing, more bobbing. Slowly, so slowly, she searches for something of which she has no knowledge, no understanding: a nipple. Her eyes opening in the easy natural just-light, she is drawn to an area of contrast, where the flesh of her mother’s chest meets the darker flesh of her areola. No smudged line here but a sharp edge between light and dark, with an oily aroma that tickles her nose. Irresistible. She reaches her destination and then falls asleep, again! Her tired but alert mother wraps her close, beginning to feel cramping again, softer now than the sweeping torrents an hour ago but intense all the same and accompanied by a deep fullness in her vagina. Moaning and grasping at her baby, she lurches upright and the warm afterbirth falls heavily out. Another second of surprise before she turns back to her baby, who has, while her mother’s attention was away, drawn herself onto the dark nipple, pulling it deep into her mouth.

Adrenaline seeps slowly away as endorphins start to flood mother and her newborn. Eyes glazing over, the mother starts to shiver and her companions, having broken the cord and hidden the placenta from the attention of hunting animals, cover the pair and snuggle up nearby for added safety and warmth. The mother and baby, the two who have had the hardest of days, are wide awake, staring at each other in the dark, eyes just inches apart.

We will leave our primitive family now and check back over the next few days and months. They remind us of where we came from and can help us find our own way back to a calmer, more settled experience of parenting in the modern world.

 

Highly evolved beings

Modern life can look so very different from that of the earliest humans, but some things bind us together in our experience. Birthing our babies, bringing a new human being into the world, discovering our child for the first time – none of this has changed in thousands of years. Whatever our birth story, we are linked, down through generations as far back as you care to go, to our mothers, grandmothers, great-grandmothers, to our friends and to strangers. All highly evolved to carry, birth and protect the next generation. This simple knowledge is at the heart of this book: you and your baby are the highly evolved survivors carrying, silently and without realising it, the knowledge and ability to do just fine.

Of course, life is complex and noisy and we can’t get away from that – the house must be cleaned, the car must be serviced, the shopping must be done, not to mention the emails that must be answered! But mothering our baby does not need to be scary or fraught with impractical rules. If we can relax and watch evolution at play, just as we did at the start of this book, we will realise that, far from needing to learn how to wrestle our newborn into some book-invented, regulated creature to save us from creating ‘a rod for our own back’, our babies will show us perfectly well what it is to be a new human and we can find ourselves just simply responding. So scary to think that we should know what to do and how to teach this tiny being; how much more fascinating and creative to watch and learn from evolution itself.

The newborn baby comes with its very own set of reflexes and instincts. These have evolved over many millions of years for one purpose: to ensure survival. The process has been long and messy: in order to achieve the survival of the fittest, a lot of weaker babies have been lost along the way. This is how evolution works, whether we like it or not. Other branches of early human-like creatures became extinct while our own branch strengthened and evolved, gradually getting better and better at adapting and surviving. We developed language and social structures, discovered fire and cooking, and learned to control our environment. The rate of the explosion of knowledge and learning has been staggering and we now feel so sophisticated and smart in comparison to our early ancestors that we forget that they had to survive against the odds.

But our babies are not sophisticated like us. They are not able in their earliest weeks to make choices and conscious efforts to control their environment. They are little bundles of instinct, without critical thinking, and this is what keeps them safe.

 

Birthing instincts

Think about a modern birthing scene. Mentally strip away the buzzers, lights and machines, and you will see the same things happening as in our primitive birth scenario – even in assisted births, many of these things still happen, and are noticed by the midwife, although the mother may not be aware of them. Here we’ll examine what the mother may experience while birthing her baby naturally, and what she may feel without any epidural. If you had an assisted delivery or Caesarean, you may feel robbed of some of the emotions and experiences described above and grieve for them even though your baby was born safe and healthy. Turn to the Q&A section of this chapter for more on how you can capture some moments of wonder, whatever your birth story.

 

The importance of healthy bacteria

The baby comes into the world, generally speaking, facing downwards towards the mother’s bottom, the mother’s pelvis perfectly shaped to help this happen. This may seem odd – why wouldn’t the baby want to see the mother looking down at her? But in our ancient scenario the gloom would make seeing a face difficult, and babies cannot clearly see that far (they have no need to). There is something more important right now to the baby’s long-term survival: this baby is just about to exit a bug-free environment and enter a very dirty world! Facing the mother’s bottom as she emerges into the world allows the baby’s face to pick up some of the mother’s gut bacteria, which contain, among the bad bugs, millions of helpful bacteria that will get into the baby and help her to fight infection during the early days. What a brilliant adaptation!

But when I first trained as a midwife, and we knew a baby was about to be born, we swabbed the mother’s thighs, perineum and vulva enthusiastically with cleaning solutions. Apart from the horrible sensation of having cold water sloshed onto your delicate vulva during maximum stretch and concentration, it prevented the baby from naturally obtaining protection from the very bugs we were swilling away. Somehow we thought that babies should be born into a sterile environment because they lack the ability to fight off bugs, when all the while, had we looked back, we would have seen that evolution had taken care of things for us. Happily, we stopped doing this many years ago, but women still worry about being dirty when they give birth. Of course, the very first labour contractions usually cause the bowels to empty well before birth and, in any case, once the baby’s head is in the pelvis there really isn’t room for anything else, so pooing is not an issue. The vagina and perineum, uncleansed with chemicals, provide just the right number, type and mix of bugs to ensure that the infant skin and gut become quickly inhabited and protected.

 

How the ‘ouch’ of crowning protects us and baby

The birth of the head takes a few contractions, giving the vagina time to stretch gently and the baby to adjust to the different pressures in the outside world compared with those in the tightest parts of the pelvis. A very fast birth of the head can cause your baby to have quite a headache, so evolution has sorted that out for us and slowed it all down just enough. Women have huge, irresistible reflexes and urges and, in most cases, need absolutely no guidance as to how to birth their babies. Over millions of years we have evolved to do just the right things to keep us and our little ones safe. So, as the head crowns, the intense heat of the stretch causes women to gasp and pant, which, in turn, slows down the speed at which the head slides out, thereby adding protection. Women will often instinctively bring their thighs together a little as they gasp and pant away the burning and stretching and this adds further protection by steadying the pace and taking a little of the stretch off the perineum, protecting against tearing. We may wish the head could pop out double-quick, but this wouldn’t serve us or our baby at all well. And then, at the exact second the head finally births, as women we know for absolute certain exactly how a champagne bottle feels when the cork has been popped! The relief is instant, the contraction has ended, there are a couple of minutes before the next contraction comes, and, awash with adrenaline, women often start to talk animatedly, telling the midwife about their latest shopping trip while seemingly unaware that there is a baby’s head just outside their vagina! A midwife’s job is often a surreal one.

With the next contraction the baby’s body slithers out with a sudden rush, which can leave us feeling as if ‘someone has just walked over our grave’. More often than not, the midwife either quickly puts the warm newborn on the mother’s chest or suggests that the mother ‘takes’ the baby herself. Sometimes a midwife will let the baby lie, just as in primitive times, between the newly birthed mother’s thighs. In any event, the same thing happens if you watch closely: there is a brief moment during which the mother is not quite ready or aware. She doesn’t immediately engage with her baby but time stops for a tiny moment, a brief suspension in the clatter and noise. And then she shakes back to reality, takes her baby onto her chest and the sniffing begins!

 

Head back here next month to read the second part of chapter 1 “Your Baby Skin to Skin” and, if you can’t wait ’til then, follow this link to buy a copy …

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Sleep!

A couple of nights ago I hunkered down with my trusty laptop and a bunch of people that I could neither see nor hear (they actually numbered around a thousand!) and chatted about sleep, or, to be precise, the lack of it. This was my 5th Mother&Baby Facebook Live and, as always, it was friendly and fun as well as, I hope, informative and reassuring.

It says something about our cultural expectations that it was the 2nd M&B Facebook Live on sleep and that this is the 3rd blog on the subject (see blogs #4 and #5 for more). We value our shut-eye and guard it closely. We check our clocks on waking to see how long we’ve slumbered and fret before our first coffee hit of the day about how we’ll cope when our precious night has been broken.

When it comes to our babies, the phrase “when will he start sleeping through?” enters our vocabulary at about the same time as our stitches heal and the visiting frenzy tails off. Books line the shelves promising to show us how we can train our babies to sleep more, to get into a routine, to self-soothe before they have even had their births registered! So we expend vast amounts of emotional energy searching for the secret to getting our babies to sleep from dusk til dawn without disturbing our beauty sleep.

Now, of course, humans have evolved over millions of years and, despite our little individual quirks and unique personalities, we’re actually all a pretty standard model – we all eat breathe, poo and sneeze in much the same way, have a head at the top end and toes at the other and hit developmental milestones along a surprisingly similar curve. How we, as humans experience and develop sleep patterns is also staggeringly similar, and understanding the fundamentals can shed some light on how we can support our babies and children to gain good sleep hygiene and social behaviour around bedtimes.

Your baby comes to you hardwired for survival and with the evolutionary “expectation” that mum will be a pretty instinct-driven cave woman. The hormones which give us our circadian rhythm and different sleep states are deregulated under about 4 months of age and the similarly deregulated autonomic nervous system (see blog #5) ensures that your little one spends many hours each day, and certainly most of the night, snuggled safely in your arms or suckling. Despite your 21st century sensibilities and the insistence of books and relatives that you should stop picking her up, your baby’s cries dig deep into your primitive soul and twist it until you respond, again and again and again.

Your newborn’s sleep is made up of lots of power naps – she suckles whilst dozing on and off, then falls deeply asleep in your arms for half an hour or so before waking up, refreshed and ready to spend more time being rocked, patted and suckled. She can sleep anywhere, as long as it is in arms!

Those parents who learn to trust evolution, relax, and spend their time honing their soothing strategies rather than attempting the impossible (and potentially risky) task of “teaching” their tiny baby to learn to be alone, find that life is far less stressful and far more conducive to a happy home life. They know that, in time, their baby will follow a human developmental curve and sort their sleep out.

From the very end of the third month the hormones and body systems which govern human sleep start to coordinate and settle and the erratic power-naps of the newborn are gradually replaced by sleep cycles. It is this emergence of cycles which puzzles parents – they expect that their teeny tiny should be starting to “sleep through” (after all, that’s what the books and your mother tell you) but nights now seem even worse: your baby wakes every hour and cannot resettle without a lot of help from her parents.

So let’s get this straight – none of us sleeps through! There, I’ve said it …

We all wake at quite frequent intervals through the night and then doze back off again. Some of us remember these wakenings (I certainly do), and some don’t. But we all have them. Each cycle is made up of different types of sleep, including deep sleep and dream sleep (R.E.M. sleep) and we need to go through the deep sleep part of the cycle in order to feel refreshed. Even those of us who feel we are plagued by insomnia actually do achieve enough sleep to survive – it is as basic as breathing.

What marks babies out as different from adults is that they need support to get back to sleep after each wakening. They can’t self-soothe. Developing the ability to self-soothe takes time and experience and, until around the six-month mark, babies are not even developmentally able to learn how to self-soothe. This is good news! You can simply stop worrying about what you should be doing to sleep-train your baby and just do whatever you know works best for him. He can’t learn good habits for sure, but this also means that he can’t learn bad habits.

Between three and six months, as the sleep cycles gradually emerge, babies also start to show distinct sleepy cues. Typically these are nose-rubbing, eye-rubbing, ear-pulling and tired noises. Parents always spot them but often don’t realise what they are.

From around six months, babies start to develop the ability to get into routines and self-soothe. But they still need help and support from their parent.

So, what CAN you do?

Well, for the first three to four months, simply soothe your baby whenever he needs it in whatever way works best. More often than not this involves rocking, patting, white noise and, of course, suckling. Certainly arms will always work in a way that a crib cannot. What you do so beautifully during these intense months is give your baby the experience of what it feels like to be distressed … and then soothed. This will set the groundwork for him to develop his own self-soothing strategies in due course. You see, the only way a baby can confidently soothe themselves is if they know how it feels to be soothed. So soothe away without the guilt and anxiety that usually pervades and poisons the parenting space.

Months four to six are about patience and watching as the changes take place. Many parents find that safe co-sleeping returns (if it ever went away!) as the only way for everyone to get any rest whilst the littlest member of the household, beset by changing systems, wakes almost every hour. Try to learn your baby’s unique sleepy cues and, as soon as you see them, start soothing your baby to sleep and continue to soothe, in whatever way works at that moment, until she has had a full cycle (this will lengthen gradually over the months from as little as half an hour, up to a couple). Some babies start to prefer a quieter, more still space to nap and sleep so try to be sensitive to these emerging needs and fulfil them as best you can.

From around six months, you should start to see distinct nap and bed times emerge. Generally the first sleepy cues of the day show about one and a half to two hours after the start of the day and then again after the same interval from the end of the first nap. Babies can often go two to three hours in the afternoon before showing sleepy cues and they often have a very late nap at around 6-7pm which parents mistake for bedtime. Bedtime itself is often around 9pm and this will move earlier as the year goes on.

At this point you get to choose: carry on providing the soothing strategies for your baby or set about giving him the opportunity to discover his own. Whatever you decide is not written in stone (you get to change your mind as often as you wish – it’s a parent’s prerogative!), and it doesn’t define you as a parent or person.

If you want to remove a soothing strategy (maybe you no longer want to offer the boob at every overnight wakening) then, until your baby can self-soothe, you need to replace it with another. That might be picking your baby up and patting him, or offering a dummy, or hauling him into your bed to snuggle down to safely co-sleep (for useful links, see below).

If you choose to give your baby the opportunity to develop self-soothing strategies, then you will need to gradually remove your support over a period of weeks or months and give your baby just enough space and time alone to find what he can do to get himself to sleep, but not so much space and time that she is overwhelmed (never a good way to learn).

In time, your highly-evolved human will learn that, in your house, people repeat the sleep needs of other people and sort themselves out at night rather than waking the whole household! This takes time and patience but she will get there. After all, she is only human …

NOTES:

  1. Chapter 10 in my book “Your Baby Skin To Skin” covers both these approaches in detail if you want to explore a little more deeply.
  2. Safe co-sleeping advice:
    CLICK THIS LINK to read the parent information leaflet on caring for babies at night from UNICEF babyfriendly.org and then …CLICK THIS LINK to read information to healthcare professionals from about the evidence behind the leaflet.
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Ask Rachel – Sleep

There is, we are told, nothing new under the sun and, in my work, it seems to be true. Women worry when their baby sleeps too much and they worry when they sleep too little; they fret when their little one suckles all day and then fret all over again when they barely give the boob a second glance. Women worry and always have done. Women call this “being neurotic” or “ridiculous” or “silly”. I call it being conscientious.

Every now and then, as an aid to all those conscientious mums and dads out there, I will fill my blog page with some answers to the most common questions that come my way on a daily basis, always accompanied by “you’ll think I’m being silly but …”

Today’s questions are about sleep.

Q. When will my baby “go through the night?”

A. This must be the number one question. The fact that everyone asks this should tell you that every young baby is keeping her parents up half the night!

Babies lack the hormones that help us sleep in the way we do and these do not start to kick in until the third to fourth month and then continue to be erratic for some years. Now, let’s be clear, no-one sleeps through the night. All adults sleep in cycles of around about 1.5-2.5 hours and each sleep cycle is split into bits of light sleep, R.E.M. (dream) sleep and deep sleep. We wake at the end of a sleep cycle and then return back to sleep for the next cycle. Some of wake fully in between cycles and remember these wakenings and some of us don’t wake so fully and then don’t remember in the morning. These lucky people think that they have slept right through. As one of the former, married to one of the latter, I know that my bloke wakes repeatedly through the night, bothers about and grumbles for a while, punches his pillow into submission and then drifts back to sleep. He believes that he sleeps soundly, unbroken for eight hours.

When you wonder when your baby will sleep through the night, what you really want to know is: “when will she do whatever she needs to do through the night without telling me about it?” It seems that very few babies are able to self-soothe and, until about 5-6 months old, a baby is unable to learn a routine or habit (when you think you have taught your young baby a routine, you’re just having a few lucky throws of the dice, or have a naturally settled baby).

After 5-6 months, you can, if you wish, start to use a sleep-training strategy and, whichever one you choose, you have a good chance of your baby developing self-soothing strategies. However, every time your baby cuts a tooth or has a cold or visits granny etc, expect the routine to slide and you will have to re-train. If you choose to go with the flow then it really doesn’t matter because all babies, whether sleep-trained or not, become more reliable at leaving her parents alone at night at the same age – about five years old.

Q. Why is there so much conflicting information about co-sleeping?

A. Quite simply because there is so much conflicting evidence. It is very hard indeed to find evidence that only looks at safe co-sleeping (see below) and, because numbers of SIDS and co-sleeping deaths are so low, analysing data can be tricky. Furthermore, because so few women exclusively suckle their babies, the info has to be geared to the general population who happen mostly to mixed or exclusively formula feed. On top of this, frustrating as it is, most health care professionals do not choose to specialise in infant feeding and so their attention is elsewhere and they may not keep so informed as those whose anoraks are clearly labelled “infant feeding geek”!! If you like to read studies, here is a link to the evidence on the topic of where babies sleep from the “Born in Bradford” study.

So what do you need to know? Firstly, babies aged 0-4 months do more suckling between 5pm and 5am than between 5am and 5pm. Not more feeding, just more suckling. There are good evolutionary reasons for this – of course, anything that affects all babies must have an evolutionary basis for protecting survival. The drive to suckle keeps a baby skin to skin where the heart rate, breathing, reflexes, temperature, gut and infection control are all brought to normal (remember that small babies are unable to regulate these things). Furthermore, suckling protects the rather odd sleep that, in turn, protects against SIDS. Being driven to stay close to mum in the darkness hours is an evolutionary survival strategy to protect a baby from cold, hunger and predators during the hours of pitch-dark at the equator where the sun dives below the horizon at 6pm and rises with the larks at 6am.

Mums, on the other hand, have evolved to nod off to sleep when they suckle at night and the sleep of a suckling mum is hormonally altered to maximise her deep sleep whilst ensuring she is hyper-protective of her baby. Fighting evolution is a fool’s errand. Millions of years of evolved protective strategies are not easily overcome. This is why mums who nurse their babies find that they end up co-sleeping by accident.

If you are exclusively feeding your baby on your own mum’s milk (suckling or expressing) then, because you are evolutionarily driven to nod off when you hit night-time suckles, always lie down to suckle (or for night-time cuddles) and, because you may well nod off in spite of your best efforts, ALWAYS prepare for safe co-sleeping even if you plan to put your baby back into his crib – better to be safe than sorry. Safe co-sleeping: make sure you are sharing a firm mattress (not a waterbed or very soft, squidgy mattress) bring baby in skin to skin with you; have baby under your own light covers (a summer duvet or comfy sheets and light blankets) and pin the covers under your elbow to prevent your baby’s head getting wrapped; don’t try to limit your baby’s movements by pushing the bed against a wall or putting a pillow behind his back or tucking in the covers around him; no-one in the bed should have been smoking or be drunk or drugged; never leave baby in bed if you are not there (your partner will not be hormonally altered so will not naturally protect baby). Finally, NEVER risk falling asleep with your baby on the sofa. This is dangerous.

If you are formula or mixed feeding, or do not want to co-sleep, then still prepare for safe co-sleeping if bringing baby into bed for soothing, but set an alarm on your phone to vibrate after 30-40 minutes so that, if you nod off despite your efforts, you will quickly wake-up and be able to put your baby back in his crib. Now, of course, he has a cave brain and so he will simply wake after a little while as his evolutionary survival strategies kick in and send him howling back into your arms. Such is life with a little baby!

Finally, remember that the risks people are talking about when co-sleeping is discussed are not to do with SIDS : SIDS is sudden and unexplained. It is a worry about accidents in the bed such as over-lying. Women who exclusively feed their own mum’s milk are, as we have seen, so hormonally altered that they behave in a very different way at night compared to other adults. The evidence that these hormonally-changed mums will cause harm to their babies when co-sleeping in the way described is not available. Can you ever reduce your baby’s risk to zero? No. But remember that giving your baby your own milk reduces the risk of SIDS by up to 50% and that safely co-sleeping for the purposes of suckling appears to lead to better weight gain in babies, better sleep for both parents, more months of baby getting mum’s milk and so a reduction in all the risks associated with giving formula.

As adults, we have to look at the available evidence (as conflicting as it can sometimes be), consider our own lives and stresses, assess our own actual risk and our perception of risk and then make an informed choice, accepting that no choice is risk-free.