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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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Desperate about your young baby’s behaviour?

Sunshine follows rain, night follows day, cats sleep on newspapers and babies cry all evening. Such is life in all its glory. Every parent I see will accept that, when they announced that they were planning a family their news was met with smug grins and a threat of “just you wait for those sleepless night!” And yet, when those sleepless nights arrive before the ink is dry on the hospital birth notes, parents quickly come to the conclusion that their baby is unusual, broken, poorly or just plain naughty!

Erratic, fussy, irrational and impossible to soothe, the young baby is the same the whole world over and once you understand exactly why your little one keeps you on your toes (don’t you dare sit down) all evening, you will be more able to accept that what you need are coping strategies rather than a non-existent cure.

Colic is the name given to the particular pattern of crying and fussy behaviour seen in the Baby in the first 3-4 months of life. The pattern starts towards the end of the first week following birth and is characterised by regular, nightly crying bouts between about 5pm and midnight and then again between 2-3am and 4-5am. The baby draws up his legs and appears to be in pain. Suckling and rocking appear to help for short bursts but nothing gets the baby to sleep for long, until the end of that particular colic bout when baby falls soundly asleep.

It seems that colic has been around since the dawn of time and, from an evolutionary point of view, makes perfect sense for the survival of the species. After all, noisy babies get cared for, quiet ones get put in a corner (of a cave) and left alone …

You will hear all sorts of explanations for colic – wind, reflux, silent reflux, naughtiness, manipulation, poor milk quality, stress in the mother, but none of these make sense when looked at from a scientific, rational standpoint.

Colic simply means spasm and this is exactly what your baby is experiencing – painful gut spasm caused by high blood levels of hormones that make the smooth muscle of the gut contract. These hormones are circulating in all of us – they cause labour contractions, amongst other things. They are at their lowest between about 7am and midday, which is when your baby will be most settled and pain-free, and peak daily between 5pm and midnight and 2-5am. The evolutionary reason for a baby to be settled in the warm morning hours when the sun is up and mum is busy out hunting and gathering, and then demand to be kept very close in arms and soothed continually in the dark, cold nighttime hours are pretty obvious when you stop and think about it.

Happily, evolution has given us built-in soothing strategies – skin to skin, suckling and breastmilk, and when a baby comes to our boob all these three things happen together automatically. Suckling creates an endorphin release into baby’s bloodstream and, also, human milk contains endorphins. These natural opiates RELAX smooth muscle and therefore ease gut spasm, but they also wear off very quickly – in about 5-10 minutes. So the picture a mum typically sees is… baby in pain with gut contractions; baby gets driven through reflex behaviour to give suckling cues; baby suckles and produces endorphins at the same time as receiving a little endorphin-rich milk; baby’s gut relaxes; baby stops suckling; endorphin level drops off over about 10 minutes; gut contractions return; baby gets driven to suckle again, and so on and so forth. It is easy to see how mums think that somehow their breastmilk is actually causing the problem whereas, really, the baby is self-medicating on endorphins with each return to suckling.

People call this behaviour “cluster feeding” but in reality it is “cluster SUCKLING”. Because babies need to stay close all night to keep warm and safe, their highly-evolved, spasm-ing gut keeps them on high-suckle alert. Suckling alone produces endorphins and so babies do not actually need lots of milk during these hours – if they could get lots of milk every time they suckled overnight, they would either vomit huge amounts or you would be pushing them to school in a wheelbarrow in a few years! So, as mums correctly perceive, when a baby is at her most suckly, mum’s supply adjusts down. In the less suckly morning hours, mum’s supply adjusts up. In this way, babies can suckle as much as they need to and also get, over 24 hours, just the right amount of milk.

Now, how to deal with the problem. Firstly, it can help to know that there is no cure; only coping strategies until baby develops out of this very vulnerable state and is more able to cope for longer periods without skin to skin and suckling. This developmental stage arrives at around the 4 month mark. Next, it is useful to remember that colic is definitely not caused by wind or foods (with a couple of notable exceptions, for which, see later) seeping into the milk. In fact, all the weird and wonderful ideas you’ll hear about food really don’t bear scrutiny: human milk is made from our blood and our blood cannot become gassy, acidic or spicy and nor, therefore, can our milk. The trick is to keep endorphin levels as high as possible as this is what relaxes the painful gut. Now, as suckling raises endorphins and human milk contains endorphins, boobling will always be the most obvious solution, and you cannot put the baby to the boob too often. Baby will simply do lots of non-milk boobling and then, periodically, when a really bad spasm hits, he will draw a little endorphin-rich milk out to supplement his own suckling endorphins.

Other tricks that will stimulate your baby to produce her own endorphins are massage, skin-to-skin, rocking and jiggling, firm bottom patting, car rides, warmth (such as a bath), and stimulating her senses with certain white noises such as the hoover! Just remember that endorphins have a very short half-life, so every time you stop doing the soothing, you have about 10 minutes or so before the spasm and crying will return. Simply put, if you stop soothing your baby, your baby will stop being soothed!

Trying to cure a baby of his colic is like trying to cure him of being a baby. He will grow out of it at about 3-4 months no matter what you do (everything or nothing) when his immature nervous system stabilises. Of course, if you try different remedies, whichever one you are trying when baby is 3 months old will be hailed as a miracle cure and you will urge all your friends to try it.

Some great news about colic is that the baby who spends all evening and night soothe-suckling and in close skin to skin contact at the boob is less likely to get infections or suffer SIDS. Colic also seems to badly affect the brighter, more sociable babies – again, all that time in arms being rocked and talked to brings dividends. So much so that, even if your baby seems much calmer than your average baby, it is worth treating her as if she were really colicky and keeping her in arms as much as possible.

Colic can be more obvious in the atopic baby so, if you have eczema, asthma, hay fever or migraines on either side of the family, then your baby may be more severely affected. Many atopic people are sensitive to dairy, and cow’s milk protein is one of those rare exceptions where tiny food proteins can pass into mum’s milk and cause upset in very sensitive babies. The atopic mum might find that cutting out all dairy in her diet may possibly cut down the severity of the colic bouts. However, it is also very possible that the teeny weeny exposures to dairy proteins via breastmilk might actually help prevent dairy sensitivity when older. Remember though, the idea that the foods you eat can make your baby windy or cause your milk to be too acidic or spicy is simply not true – mums milk comes from your blood and your blood cannot be windy, acidic or spicy!

So, to sum up, your highly evolved baby survives the early, vulnerable first months by ensuring he spends long periods in arms, suckling. This arms-seeking behaviour is driven by painful hormonally-triggered gut spasms, particularly in the evening and night hours. As well as keeping him safe, this prolonged in-arms, soothing phase of life forges strong bonds and developmental leaps in language and socialisation. The mum who can just can trust her own instincts to pick up her baby up and soothe him continually helps rather than hinders this stage, and her milk carries soothing, gut-relaxing endorphins to ease the pain.

Your colicky baby will almost certainly turn into an outgoing, physically active baby (the more severe the colic, the more the baby may be likely to fit this personality type) who is an utter delight to mother (although you’ll need your wits around you as the little trouper raids every cupboard in sight!) There is light at the end of the tunnel – best to batten down the hatches for 3 months and emerge when the storm has passed and the sun is shining!

“There was never a child so lovely, but his mother was glad to get him asleep …”
Ralph Waldo Emerson

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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”.

The Book Launch!

My cheeks are aching from full-on smiling and I have an unmistakable bounce in my step this week.

After a year of really full-on work, my first book has finally launched and I have been partying!

Two years ago I was mooching about the kitchen trying to cobble together a supper from the can of beans and a bendy carrot that told me that it was Friday and a “big shop” was overdue. The phone rang, I handed the wooden spoon over to my husband and picked up. A voice I didn’t recognise told me that she had heard along the grapevine (namely, she had been drinking coffee with my sister) that I had some very interesting ideas on babies and parenting and that I had a book I wanted to write. “Er. No! I do write leaflets for my clients and I do have a somewhat unique approach to supporting women with their babies, but I hadn’t planned to write a book.”

I agreed to email over my leaflets and so began a relationship I was not looking for and a new line of work which I had never anticipated. Both have turned out to be unexpected joys.

It took a year of nagging from the mystery caller, who turned out to be a literary agent (Jane Maw), before I finally said “yes” to writing. By then there was a publishing house (Crimson Publishing) interested and I felt that I couldn’t keep people waiting any longer. Having decided what my theme would be, I was asked to write a book proposal. A what?? Jane sent me a “How to …” guide and I went through step by step. I clearly remember the anxiety of sending off my proposal, wondering if I had come anywhere close to what was being expected of me. It seemed that I had studied my guide correctly and the green “GO!” button got pressed.

Panic set in. No going back …

As always, when faced with a seemingly insurmountable task, I decided to make it into a project: I set down specific goals in my diary for the weeks and months ahead, decided how and where I was going to work and then I moved my other work around to make sure I could follow my plan. All that was left was to write.

The writing was actually the easy bit. My days are spent submerged in the world of the worried parent and so I simply drew on the thousands of conversations I have had over the years and just “talked” onto my keyboard. I was certain of my aim – to provide a reassuring read for mums and their partners to say “You are not alone, every new baby behaves like this and every new parent has the same worries. You are highly evolved to mother just beautifully and your baby is highly evolved to be perfect at being a baby. You are safe, so relax and enjoy getting to know one another.” I decided to root the book in the theory of evolution via a primitive back-story of a newly birthed mother. In this way I hoped to draw the reader’s eye back to her basic humanity, to learn to trust her own instincts as well as those of her baby, and to listen to her deepest and most primitive knowledge. A book then to say, “Stop reading this book and start reading your baby! Put down this book and pick up your baby!”

I am lucky enough to be a fast typist and also to work best when getting my head down for a long stretch – not for me the 20-minute burst of action followed by a break. When I write, I keep going without raising my eyes for up to six hours. Keeping to my schedule was not difficult and I found that I really enjoyed being locked away with my smart-tablet and my thoughts.

After the book was written, various people appeared as if by magic and the work got thoroughly edited (this was a very long, joint process between my editor and myself); a wonderful cover was designed; people were asked to read and provide testimonials; the font, text size and layout were all carefully chosen and then the book began the long round of promotion and publicity (another joint effort, this time between the publicist and myself). After all that, my book still wasn’t finished – a last-minute decision to drop the working title and find a new one resulted in the final perfect polish before “Your Baby Skin to Skin” went on sale.

So, there I was on Friday evening last week, dress, heels, make-up and hair duly on display, walking into the Bell Bookshop in Henley for a celebration, a party, a huge thank-you, and a grand letting-down of my carefully coiffured hair. And there, right in front of me on the bookshop shelves were myriad copies of my book! It looked so beautiful – clean, fresh, modern and utterly buy-able. It was simply thrilling.

Surrounded by family, friends, colleagues and my amazing production team, the evening went in a buzzy blur of book-signings, hugs, laughter, speeches and more than a little prosecco. Not a shred of nerves, just a happy delight in the knowledge that a job has been well done and that I have had the love and support of a whole army of people to see me through. It has been the ride of my life …

Routines

I sit here now, somewhat browner than the last time I put digit to keyboard, thinking back on my recent holiday to escape the long, UK winter. It tickles me that, even though I was many, many miles away from my home, I continued to hang onto my set routine: a cup of tea in bed before breakfast, heading for lunch at 1pm, catching up with the nightly news on TV and reading a couple of chapters of my book before turning out the light at night. New routines also quickly formed: always the same spot for my sun lounger, dragging myself away from my book for a morning session of pool volleyball and tip-toeing quickly across the scorching sand mid-afternoon to dash into the sea and float out for a quiet, bobbing moment of briny mindfulness.

Humans are creatures of habit. We love patterns and see them even when they are not really there – holding onto them like a security blanket to warm us against the cruelty of our mortality.

When our lives are rocked by the entrance into our universe of a new baby, we quickly search for any semblance of a pattern that we can latch onto to steady and reassure ourselves. Many books tap into this need and promise to help us get our newborns into a routine when they have barely drawn their first breath. After all, if humans are lovers of routines, surely babies should be a doddle to steer towards one?

There is no doubt that even very young children and babies seem to really feel reassured and more settled when each day is much like the last, and parents the world over will tell you that children thrive when they can relax, knowing that their boundaries are set and that dinner will always hit the table at 5pm. So why do all your attempts to get your teeny tiny into a regular routine fail?

If you read back over the earlier blogs you will start to see that the very young baby is hard-wired, through millions of years of evolution, to survive. She is driven to do anything it takes, for as long as necessary, to get what she needs to make it through to tomorrow. Your need for a regular bedtime or an undisturbed morning shower have no interest for your little earthling. And your opinion on what her routine should be impresses her not one iota. She has emerged into this world vulnerable and in the hands of someone who has little idea who she is and what she needs. So she had better teach that person pretty jolly quickly!

So, for the first three months of life, the human baby has a set of survival strategies that fundamentally fight the drive towards a routine. The systems that normally keep us settled and comfortable are turned to high alert and so the new baby has an irregular breathing pattern, irregular heartbeat, feisty reflexes (see those jazz hands go!) erratic temperature control, an oversensitive and spasm-ing gut and an inability to fight any bugs that come her way. On top of this, her immature system is hyper-aware of all these erratic goings on inside her skin, driving her to distraction.

Now, in order for these systems to settle and calm, the new baby needs to be in close contact with a fully working older human and guess who that might be. Every time you pick up your writhing, squalling baby, he begins to calm a wee bit and, the more you jiggle, pat, soothe and suckle him, the more his breathing, heart rate, reflexes, temperature and gut calm the heck down. Until you put him back in his crib, at which point he kicks off again …

So a baby survives the early months by doing everything it takes to stay close in arms and frequently suckled. More about this crazy picture in the next blog.

For now, simply be aware that, in the first three months of life, if your little one was able to learn a routine, he would be able to spend longer out of arms and this would work against his inbuilt survival strategies as set down by millions of years of evolution. So stop fighting evolution for a while. Your baby is a human being after all and, in time, he will enjoy a routine as much as the next Homo sapiens but for now, he needs to just do whatever it takes to stay close to you and be soothed for survival.

Over these first three months, because parents find they have no choice but to adapt to their baby, their expectations and behaviour gradually change until, by about the forth month, they automatically carry their little one everywhere and suckle her at the drop of a hat. They pass the baby around the family all evening without giving it a second thought and are so used to the long, long sucklings that the next stage completely throws them!

Between months four and five, the baby, who has now beautifully imprinted herself entirely on her doting parents, begins to settle. She no longer needs to work day and night to keep her parents protecting her – they do it automatically. This is what we call “attachment” and “bonding”. Now she can begin to look out towards the wider world. Her systems governing breathing, heartbeat, reflexes, temperature and infection all settle down and the soothing effects of long hours skin to skin at the boob are no longer necessary. Now that she is a little safer in the world, the evolutionary drive to survive can allow for learning of habits and routines. Before this, no matter what you do, a baby is simply incapable of learning a routine: survival must come first. Sure your friend tells you that her little one-month old baby has a routine, but every study that has looked into newborn behaviour tells us that your friend is simply seeing a pattern where there is none – she has thrown a dice ten times and each time she has turned up a “six”. Or she interprets her baby’s behaviour according to her world view (when her little one settles at 8pm she declares that “my routine-setting really works” and when her baby screams through 8pm and doesn’t settle until 10pm she worries that “her wind is really bad tonight. Nothing I have done has eased it and it has really thrown her usual routine!”). External observers just don’t see the pattern that the mother declares is present due to her brilliant parenting efforts!

As month four merges into month five and month five slides into month six, you will start to see patterns of wakefulness solidify and regular sleep cues for naps emerge. You will also start to see a more reliable bedtime appear. Her ability to get off to sleep without help is not innate so do not expect a settled pattern of behaviour to bring a break from rocking and soothing your baby to sleep but, should you feel it is right for you, now is the time to explore the option of helping your baby to learn self-soothing strategies. So called “sleep training” can work for most parents from the end of month five onwards but it is entirely up to you as to whether or not you do this. Some parents continue to help their baby navigate their way through a day and night-time routine and some choose to go the path of “sleep training” – neither choice defines you as a parent.

So, if your baby is three months and under, hang loose – nothing you do will help your baby to learn a routine but you might well exhaust yourself, and those who love you, by trying. If your little one is four or five months, start to watch for those tell-tale signs that he is maturing towards a more structured life – fewer evening hysterics and noticeable sleep cues such as ear-tugging and eye-rubbing. And, if your baby is six months or more, your efforts to get your life back into a more recognisable routine is likely to succeed.

I can’t promise you time to float on your back in the sea, but a quiet sit down for twenty minutes every morning with a cup of tea and a digestive biscuit is a distinct possibility!

,

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.

Resolutions

Happy New Year!

The fireworks have fizzled away, the chink of glasses is a distant memory and now it is back to work as usual. I remember the start of each new January school term as a child – newly sharpened pencils, school socks whiter than white and with springy elastic irritating my ankles, the sweet tang of anxious excitement as I strode out, full of good intentions to keep my pencils ever sharp and my socks permanently clean. A week in my pencils were chewed and my stained socks hung despondently over the tops of my scuffed shoes.

New Years Resolutions: I hate them! The cold, dark mornings and the dank evenings hardly inspire us to get out and get fit, or to eat more salad. The bar, set too high, is destined to fall as we crash, hungover, cold and miserable, headlong into it. I save my tough resolutions for the summer when I feel energised and sharp-minded. My January resolutions are of a more sumptuous kind – “eat more chocolate”, “always have a drink of red wine in the bath”, “enjoy sneezes” …

However, this year is a little different. Amongst my various charming and indulgent resolutions, I have snuck in a challenging one and so far, so good. I have resolved to avoid using the word “breastfeeding”.

I have long had a difficult relationship with the word: breast sounds so formal and joyless as well as simply not being the word we women use in everyday life. All the women I know only have breasts when they are poorly: as in “doctor, I have a pain/lump/weird thing in my breast”. At all other times we have boobs or tits. Some lucky women have bosoms. I do not possess anything ample enough to be granted that title so I have boobs. The word “breast” alienates young and old alike, not to mention our partners who, having enjoyed living with a frisky, fun-loving boob-owner, suddenly discovers he is living with a breast-owner and that screams “fusty old matron”! Certainly “breast” does not reflect the smoochy, squirty, crazy world of babies on boobs.

And “feeding”. This word, paired up with “breast” has, I believe, done more to harm women’s belief in their ability to nourish and soothe their own child than any other I can think of. Constantly drawing us to consider amounts and measurements, from the very outset women are destined to feel a failure.

Because babies don’t go to the boob to feed. Anyone who has ever lived with the muddle we call a baby knows that. They dive in at the slightest provocation  – too hot, too cold, too bored, too excited, morning, afternoon, evening, evening, evening, evening …

Babies want to suckle. It is at the boob that they can keep warm, settled, protected from infection, and safe from everything this scary new world can throw at them. Suckling causes a huge release of endorphins into the baby’s bloodstream to calm his nerves and relax his immature, spasming gut. If he needs extra soothing, he will squeeze down to make the boob give up some milk which is rich in this soporific drug and he will spend a few happy moments transported away to a sleepy boob heaven before the endorphins wear off and he comes to to start suckling again.

Evolution doesn’t need your vulnerable baby to feed and then come off and sleep in her crib. That would never do. Your little one cannot manage any of her systems right now. Her breathing, heart rate, thermostat, reflexes, immunity and gut are all completely erratic, deregulated and this is what keeps her safe: her little erratic system creates an internal chaos that drives her to do anything she can to get into arms and she will wriggle, root, writhe and yell until you can’t stand it anymore and haul her to your chest. Out plops a boob and this instant skin to skin calms the frantic systems down. Now her breathing, heart rate, temperature, reflexes and gut all quickly settle and her risk of infection plummets. This is called survival.

If a baby simple went to your boob to feed, she would guzzle her milk, go down in her crib happily and then spend too long away from this skin to skin security. So young babies have evolved to take any milk they might need interspersed with many long moments suckling but not taking milk.

Just like me when I have a damn good book to read but only £2.50 in my pocket, I can while away many a happy hour in Costa: a sip of coffee and then a minute or ten lost in a chapter, another sip and then an idle while spent in a pleasant reverie before returning to my book, then a swirl of my drink followed by a glug before heading back to my book again. Safe from the rain outside and without a care in the world. Why would I rush out to do battle with the germs and traffic?

So take a tip and ditch the terms “feeding”, “breastfeeding” and “cluster feeding” and choose a more honest one that doesn’t create unrealistic expectations that your “Coffee-Shop Baby” can never meet: suckle, nurse, cwtch, soothe, smooch, snuggle.

Stuffed!

Three days on from Christmas and my stomach is stretched beyond comfort and my head is aching from lack of sleep (I lay awake until 3am on Boxing Day doing the maths to work out if 2017 is a prime number – it is, as I had suspected for a couple of weeks now). I swear that I will not over-eat ever again and that I will swim my socks off regularly until all those extra unnecessary calories are burned.

One of the questions I hear every week from at least one parent is “How do I know when my baby has had enough milk?” If you have not spent much time in the company of babies, this would seem an easy question to answer: when a baby stops suckling, he has had enough! But, as all new parents know, it is not that straightforward. Babies suckle in weird ways: in the evening (and sometimes all through the day) they can spend over an hour boobling merrily away, suckling for a short while before dozing for a longer while and then waking and having another good nosh. Rinse and repeat ad nauseum.

Then they come off, immediately start rooting and squeaking again, go back on, decide it was a bad idea; come off again; yell and wiggle some more, have another good go on a boob or two, come off and and then chuck back what seems like a week’s worth of milk before diving back onto the boob all over again. Occasionally, when I have over indulged over the festive season, I think, somewhat wistfully about the Roman love of the vomitorium and how much easier it might have been be than all the post-Christmas exercise. Some babies seem to have retained the Roman habit! When my first son was tiny he could vomit so splendidly that it seems that I might as well simply run around the room gaily squirting my milk directly at the walls and soft-furnishings and cut-out all that time spent lovingly nursing my boy!

The idea put about by health care professionals that babies “feed” for half an hour on each boob and then come off and settle happily for a couple of hours is quite obviously information about an alien species. This may be how babies hang loose for those first couple of days in hospital but, within a week of being at home, things are very different. I will look at the causes of the constant evening boobling and nonsense in the next blog but let’s think about that vomiting.

Many mums are now told that their babies have “reflux” and that they can medicate it away. If their baby displays the rest of the miserable picture described above but doesn’t throw back any milk, they may be told that their baby has “silent reflux” which can also be medicated away. I sometimes have groups of mums at the local South Oxfordshire drop-in with 100% hit rate for reflux (silent or otherwise). Some pharmaceutical companies are laughing all the way to the bank at the same time as many parents are crying all the way to the shops to buy yet more useless medication.

Reflux simply means “bringing back”, so it is perfectly accurate as a diagnosis when there is vomit all down your back but that does not mean that the vomiting is abnormal or needs medicating. If your clothes are a sick-free zone then, if your baby is doing the suckle-squirm-yell-suckle dance all evening then chances are that your baby has the normal, healthy and life-protecting horror we used to call “colic” (about which much, much more next time).

So, if your baby is peeing lots, being happily dirty with a nice splurge of yellow or greeny-yellow poo every day or so and is otherwise well, then the vomiting is simply nature’s highly evolved way of ensuring that your little one does not over-eat. Why does she take down too much in the first place? Because, your milk contains lots of gut-soothing endorphins which calm her hormonally-sensitive gut from its immature spasms. She takes down the milk, gets the gut-calming benefits from the endorphins and then splurts back the unneeded milk. And, of course, being permanently at the boob, snuggling away, keeps your tiny one warm and safe from all those hunting bears in the forest which come out at dark …

Now human milk is also highly evolved (natch) and is super thin and easy to throw back. Babies need to keep their stomach only lightly full because, if it stretches up too much, it can make breathing more difficult. Evolution is about survival so stop worrying that your baby is a slightly wonky model that needs fixing and accept that, whatever it looks like, evolution has actually put some pretty damn fine protection strategies in place. No need to try to cure evolutionary protective strategies with medicine that can make your baby constipated. No need to give thickened formulas which stop the protective vomits. You will soon find that your baby will gain weight even when he is a happy chucker: my biggest vomiter – number one son – also gained weight the best. He just was very, very colicky and so soothe-suckled far more for those great milk endorphins and the needed to off-load all the unnecessary de-endorphinised milk.

If you have a baby that pees loads, vomits regularly, is otherwise well but gains weight very slowly, there may well be a pesky posterior frenulum (some people call this a tongue-tie but that is not my favourite term). I will cover tongue-tie in due course but, for now, if you think this is you, get checked by a specialist.

In short, lots of pee tells us that your baby is getting and keeping down plenty of milk and the vomiting is just your baby’s way of being a Roman!

Now, where did I put that last mince pie?

The Solstice

The Winter Solstice and I’m sitting here in bed, nursing my morning cup of tea brought to me, as ever, by my husband. He knows me well enough to understand that, for the first hour of my day, I am best left in my own space with a hot beverage to gently recover from my “it’s too early” fog. Best not to poke this particular bear before she has had a dribble of caffeine …

The Winter Solstice is my favourite day of the year. Not because I relish its dank gloom and oppressive chill but because it brings the promise of the next phase of the seasons – the gradual return of the sun; a lifting of spirits brought low by too many damp days; the day before we humans can emerge, blinking into the light to welcome what should surely be the real start of the New Year. And, paradoxically, on this darkest of all days in our northern hemisphere, I feel emotionally light, finally able to embrace the snuggle-down, wrap-up-warm, melancholy of Winter.

The beauty of the dark is in the awakening of our deeper senses. Robbed of light, we are more aware of the pleasure of touch, the depth of odours and the crackle of ice in the night air. Those senses that get bleached out in the glare of the sun, get their moment to romance us.

So on this, my very own New Year’s Eve, I turn, as always at the end of one year and the start of the next, to think about what the new year might bring to me and what I, in turn, might bring to it.

There is much that I hope the year will bring to me: more time to spend with my beautiful grandson to watch him discover the world with fresh eyes; exciting new learning opportunities as I step ever deeper into the world of publishing, culminating, on my husband’s April birthday, with the launch of my first book, “Your Baby Skin To Skin” (what a celebration that will be!); and more singing – much more singing. Singing with my close friend around her grand piano and sinking into our shared passion of classical music-making calms my ever-fidgety soul and soothes my needling anxieties in a way that nothing else can. More singing then …

What can I bring to the year?

Pondering my relationship with my work, quirky as it often is and steeped as I am in the world of hormones, peach-fresh babies and the milky haze of suckling, I feel that the time is right for me to create a new way of reaching women and their families, and the professionals who hope to support them. Some way of providing advice, ideas, tricks of the trade and simple across-the-ether hugs when it is 2am and the baby is crying AGAIN, or in the middle of the day when the pain from a bitten nipple threatens to derail a mum’s snatched moment of calm over a cappuccino.

I cannot always be at the end of a phone and my vast texting and emailing time spent supporting women sometimes threatens to overwhelm me to the point where there is no song long enough to settle my exhausted nerves.

There needs to be a place to go, quickly and privately, to find answers to those parenting questions that seem to attract endless conflicting advice and mythology when all that is needed is clarity and honesty.

So this blog will be that place. Somewhere I can bring my daily work worries which I have inherited willingly from my clients and offer up my ponderings. A place where women and their partners, and professionals can come when they are feeling worried, alone and vulnerable. They can come here, flailing for answers and, hopefully, find some. Those who know me well will not expect the conventional wisdom or earnest sops. My somewhat sideways look at life and my often irreverent language are legendary and as this is my blog, expect my voice, my language, my ways.

Over the year, I hope to build a body of posts covering every aspect of early parenting and infant feeding: from skin-to-skin to bleps and from sling-making to weaning. If your problem or worry or question is not listed here, let me know. This blog will be my offering to the year. A hand in the darkness and gloom so that we can journey along more confidently together.

Happy Solstice!