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Ask Rachel – Using Bottles

On an almost daily basis, people introduce me as an independent midwife and lactation consultant when I would never describe myself as either! In fact, I struggle to describe myself in any particular way – some days I am like this, and some days I am like that and some days I barely know who or what I am!

Always looking slightly from the outside of any particular pigeonhole, I avoid belonging to tribes. They seem, to me, to be about exclusion as much as about inclusion and this makes me feel deeply uncomfortable. I can sign up to some elements of a club, but am always at variance with others and so then feel at conflict with the other club members. If I belong to any tribe, it is the one where its members could sign the “any other” category.

So it is with feeding our babies. If you are known as a mum who suckles her baby, it is ten to one that people assume you also an “earth mother”, that you demand feed and co-sleep, that you “baby-wear”, and that you do not want a routine-led household.

If you bottle-feed, then there is an assumption that you want a more separate relationship from your baby, that you will start weaning at four months, that you rigidly work towards a four hourly schedule for feeding etc. etc.

So what about those “any other” mums who want to mix and match? Those who suckle their babies but want to work towards a daily routine in due course or those who bottle feed their babies but want to co-sleep, throw out the clocks and “wear” their babies until they are ready to sit their GCSEs?

Today, I speak to those mums who use bottles (always or occasionally) for feeding their babies but want to better fit in with their baby’s naturally evolved way of being.

Q. What sort of bottles should I buy?

A. Once you step into the world of “Baby”, you really are at the mercy of advertisers. Their job is to make you believe that their product is best. They have many thousands of pounds to spend and they are good at their job. The latest fashion is for bottles that “stop colic” and teats that are “more like a breast”. Don’t be fooled! Anti-colic gimmicks in a bottle are just that, gimmicks. Furthermore, they require additional cleaning and sterilising. Remember that colic is hormonally driven and an evolutionary, inbuilt protective strategy to ensure survival. Read my other blogs for lots about colic and evening crying behaviour and you will see that a bottle really couldn’t and shouldn’t cure your baby of being a baby.

What you need, quite simply, is a device for holding the milk, and then a good feeding technique. Stick to a simple bottle that is cheap to replace regularly and you won’t go far wrong. Your bottle will need to be thoroughly washed and sterilised every time you use it (if you only bottle feed your own milk then a hot wash with soapy water will suffice), so the plastic will not last for ever. Tiny cracks develop over time and these can harbour bugs. If your bottle is looking well-loved, buy a new one.

Teats are an important buy so choose smartly. The “closer to nature” type are nothing of the sort and can interfere with the normal feeding motion of the tongue. See the pictures here for the type of teat I am talking about – all fancy promo and nothing positive for baby:

When a baby boobles, he gets a lot of boob flesh into his mouth and then compresses it. This causes a good, broad pressure from the boob against the roof of his mouth and, over time, the palate develops a great shape for both speech and hearing. Babies who suckle on teats miss out on this broadening and spreading of the palate and the speech can be less clear and the baby can be more prone to ear problems. The “closer to nature” style teats look great but actively prevent the baby getting the broad part of the teat into the mouth and working it, so the baby is forced to slide back onto the thin nipple of the teat. If he tries to suckle on the broader part then, often, the teat deforms and milk splurges all over the best rug, missing the bemused cat by inches!

Look for a teat with a high, fat bulb beneath the nipple bit. Get the teat out of the pack and squeeze it (you know you want to anyway!) The bulb should be easy to squeeze when the teat is on the bottle, and there should not be any deforming of the teat under the retaining ring. The idea is that the baby works the bulb and the nipple bit sits right back against the soft palate. That will give your baby a more normal work-out for the tongue and jaw and, whilst you will not be able to fully replicate the way a baby is evolved to suckle on a boob, you will have a better chance of him broadening his palate for speech and hearing. Have a look at these pictures to get an idea of what I mean by a high, fat bulb:

Q. What sort of formula should I use?

Here again, you are at the mercy of multi-million pound companies, all competing for your attention. The dangers here are potentially greater than with teat buying. So, here is some really important information for you to read, re-read and read again …

The law in this country states that ALL infant formula milks MUST offer your baby her complete nutritional requirements. Notice that I did not say “minimal requirements”. So every formula marketed, including those made from goat’s milk or soya MUST, by law, give your baby absolutely every vitamin, mineral, carbohydrate, protein and fat that she needs. Sure, not one of them gives your baby the protection to fight infection or a whole host of other stuff in mum’s milk, but you know that! What you almost certainly do not know is that the milk manufacturers add a heap of other stuff, over and above the legal limit, in order to be able to boast to you and make you think that their milk is superior. But the other extra stuff is not only “surplus to requirement” but we genuinely do not know if it is ok for babies. The companies do not provide adequate evidence to say that their magic ingredient is safe to give eight times a day for many months to your baby. The “not needed” stuff adds cost to the milk which goes into further promotion and new products in order to boost profits.

Remember that, no matter how annoyed you feel about that midwife who bent your ear about breastfeeding, she does not make a single penny out of you if you choose to suckle. She gets the same wage whether you booble for a week, a month or a year. Nor does she lose out if you choose to formula feed. It is no skin off her nose. This is the very opposite of the formula folk. Every extra tin of their milk that you buy, goes towards their profit margin. If you drift towards another brand, they lose out. This is why the manufacturers advertise so hard and why they add unnecessary ingredients – it’s a marketing dog-eat-dog world out there!

In essence then, if you buy the supermarket own-brand formula, your baby will get all her nutritional needs completely and totally met. Buy one of the top brands and your baby will get more than you bargained for, and not necessarily in a good way. Your posh formula may well be a more risky choice for your baby’s health than your supermarket cheapo.

Avoid buying according to your tribe (and those well known brands are very tribal – some are more popular amongst the middle classes and some amongst the working classes and some amongst vegetarians) and, instead, buy thoughtfully for your baby. If you can’t bear to see your friends turn their noses up at your choice, either don’t tell them what milk you use, lie (lying is not illegal if you are not the president of the United States) or transfer your formula to a sterile, air tight container so no-one has any idea of which brand you have chosen. Which formula brand you choose is your business alone and mothering is tough enough without the unsolicited opinions of other people to contend with.

Finally, don’t be duped into thinking that you should choose your formula and then stick to it. Most women, and most healthcare professionals, believe that changing formulas leads to tummy problems. This is no more true than I get tummy ache if I have toast for breakfast and rice for lunch (my tummy ache is caused by pigging out on vast quantities at each meal and then topping off with chocolate ice cream).

In fact, because each formula is slightly different in taste and texture, you could be doing your baby a favour by ringing the changes now and then (or even through the day or week). Exposure to different flavours (through mum’s milk or by using different formulas) can make life easier when it comes to weaning. The baby who has had the same flavoured meal six to eight times a day for six months can really struggle with the complex flavours of family foods. The companies which make formulas also make endless expensive but very bland weaning foods to give to those babies whose palates have never been challenged.

You are a savvy, modern woman so resist the pull of the advertisers and buy smart, not posh, and vary the formula when the mood takes you. Finally, if you want more information on smart bottle feeding, including how to give a feed in a way that reduces wind, vomiting and over-feeding, take a look at chapter 5 in my book “Your Baby Skin To Skin”.

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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.