Wednesday, March 31, 2010

The Other Happy Babies On My Block

A few people have asked me my opinion on the enormously popular "Happiest Baby on the Block" book, as well as the associated DVDs, CDs, even classes. I think it's fair to say it's practically being branded in the lifestyle sense.

In a nutshell: seriously mixed feelings. I am NOT categorically opposed to the approach as a whole, not at all, and certainly not to its components a la carte. I like Dr. Harvey Karp a lot, I think he means well, and has good information and experience. We even covered his "method" in my postpartum doula training. There are good tools there - if those tools are needed. Parents of colicky babies (more on that in a bit), or other intensely high-needs babies, may find them lifesaving coping strategies.

TOTALLY NICE GUY! Great intentions. Valuable tools, even.

But I have reservations, I do.

For one thing, I think the emphasis on swaddling (while I TOTALLY recognize that for some babies it's the only thing that works) detracts from the miracle that is skin-to-skin contact. For that matter, sometimes I feel like parents don't really understand what skin-to-skin means, either, and care providers are not explaining it adequately - that it's not just holding your baby and making general contact through layers of clothing, it is actual SKIN to SKIN that does the magic. And yes, it means unbuttoning your shirt and stripping baby to a diaper, covering you both with a blanket and putting baby right on your chest. (Bliss, if you ask me.) I think so many more dyads (and dads) could benefit from increased skin-to-skin, especially while establishing breastfeeding.

For another thing, I think the emphasis on swinging instead of slinging detracts from the benefits and convenience of babywearing. So many babies are crying out for connection, and that need could be met so beautifully by putting baby in whatever close-contact carrier works best for the parent. If you use a mei tai, you can go topless with a button-down blouse or cardigan on over it and get skin-to-skin time to boot. Instead, because the parents are following The Method, they may get plunked in a plastic swing with a piece of plastic in their mouth. Yes, baby might eventually calm down, but it seems to me that the means of achieving that calm is often through OVERRIDING their needs instead of actually MEETING them.

Don't get me wrong here! I myself used a swing sometimes too, especially during the long solo parenting stretches that were part of our first 7 months, for weeks at a stretch. You can do a lot while babywearing, but not taking a shower or cooking hot foods and such. I don't think the tools themselves are a problem. It's the overreliance on them, and putting artificial constructs in place of instinctive, responsive parenting.

I'll give you a real-life example of mine: Anonymous client, coping with newborn. Dad is very into the 5 S's, and is alleged to be a great swaddler. Mom is not quite as adept with the swaddling. They're also adamant about making sure baby does "tummy time". So, one evening I was over there doing a shift, and after baby had been fed, mom swaddled baby and put baby in bassinet to sleep. Within a few minutes, baby was fussing and squirming and the swaddling came undone. Mom was partially occupied and unsure whether to pick baby up or what to do. I had brought my mei tai, so I offered to put baby in the mei tai and carry on with what I was working on.

Baby's response? Instant calm, and a great period of awesome wide-eyed quiet alertness, doing that cool pushing himself up on his forearms movement and finding balance with his head action that also fulfills everything that tummy time does, for a good 20 minutes or so. Then he conked out completely, content as can be.

I'll take it a step further - back to the colic piece of it: I do know it can help with a colicky baby. BUT. I also know that a lot of colic can be structural in nature, especially if birth trauma was involved, and many colicky babies have gotten so much relief from chiropractic care that I worry about the underlying problem never getting addressed, because the parents are getting by with the 5 S's. I worry similarly about issues with possible food sensitivities or allergies getting overlooked.

I don't mean to come down on the book or parents who use it too harshly. It's not sleep training or crying it out, it's not "Babywise" or the danged "Baby Whisperer", for crying (it) out loud. I even think that it's compatible with AP in a very general way. And every baby is different, there is NO question. Some babies, even after adjustments and evaluation of diet, still need the extra help. There is absolutely nothing wrong with that. But I fear that its appeal to a lot of people is based on it being a neat and tidy system, using products.

I also think it appeals greatly to fathers in particular, who are often at a loss as to how to help an overwhelmed mom cope, and at a loss as to what you even do with an infant, and this gives them a System, a set of specific, orderly tasks to perform. I can understand why this is appealing and certainly applaud their intentions. It's also being promoted by a pediatrician, and for some it might make a subtle, subconscious difference that it's a male pediatrician, too (and I'd like to introduce Dr. Sears to those parties).

And I don't mean to oversell attachment parenting, because for some people for whom components of it are not a good fit, this might feel like pushing just another "system" and set of practices. I get that. But let's take a look at how the practice of babywearing, in itself, compares to the 5 S's.

Here they are, as described by Happiest Baby On the Block:

  • Swaddling - Tight swaddling provides the continuous touching and support the fetus experienced while still in Mom's womb.
  • Side/stomach position - You place your baby, while holding her, either on her left side to assist in digestion, or on her stomach to provide reassuring support. Once your baby is happily asleep, you can safely put her in her crib, on her back.
  • Shushing Sounds - These sounds imitate the continual whooshing sound made by the blood flowing through arteries near the womb. This white noise can be in the form of a vacuum cleaner, a hair dryer, a fan and so on. The good news is that you can easily save the motors on your household appliances and get a white noise CD which can be played over and over again with no worries.
  • Swinging - Newborns are used to the swinging motions that were present when they were still in Mom's womb. Every step mom took, every movement caused a swinging motion for your baby. After your baby is born, this calming motion, which was so comforting and familiar, is abruptly taken away. Your baby misses the motion and has a difficult time getting used to it not being there. "It's disorienting and unnatural," says Karp. Rocking, car rides, and other swinging movements all can help.
  • Sucking - "Sucking has its effects deep within the nervous system," notes Karp, "and triggers the calming reflex and releases natural chemicals within the brain." This "S" can be accomplished with breast, bottle, pacifier or even a finger.
And now let's look at how the practice of babywearing (which is really a very simple and instinctive thing, when you strip away the cultural and consumerist societal influences), and how it fulfills the 5 S's ALL BY ITSELF:
  • Swaddling - Cozying baby right up to your body in wrap or sling, right on your chest, also fulfills the feeling of snugness and security that swaddling offers. The startle reflex won't be triggered, arms and legs are tucked in, and, as per their description above, it "provides the continuous touching and support the fetus experienced while still in Mom's womb".
  • Side/stomach position - I think the major benefit of this position is that it's not laying baby on her back, which, while recommended for SIDS prevention, is also more likely to let her startle and feels much less protected and secure. Sling takes care of all that. If gas is an issue, doing some bicycle legs beforehand can help with that, too.
  • Shushing Sounds - The whole idea of white noise is to mimic the sounds that baby experienced in the womb. Soooooo . . . why not put baby right on your chest and let them hear your heartbeat and breathing, in addition to feeling your softness and smelling your scent? Use a mei tai or Moby wrap and you also get skin-to-skin. Some babies DO need louder, stronger sounds, it is true, especially when they're falling asleep, so there's nothing wrong with introducing white noise as needed; my point, again, is how slinging alone can fulfill this need unless more stimulus becomes necessary.
  • Swinging - The natural rhythmic swaying of Mom walking around lulls baby to sleep just the way it did in utero. What could be more perfect during the fourth trimester? Above, they state specifically that the need for this comes from their fetal experience of mom's motion: "Every step mom took, every movement caused a swinging motion for your baby. After your baby is born, this calming motion, which was so comforting and familiar, is abruptly taken away. Your baby misses the motion and has a difficult time getting used to it not being there." Exactly. I can't think of a better explanation of why wearing your baby is such a perfect transition into the outside world.
  • Sucking - This one isn't DIRECTLY met by slinging, but the fact that you can nurse so easily in the sling - once you get the hang of it; it takes a little practice at first - facilitates the suckling while making life easier for mom. (Don't even get me started on pacifier enabling! Again, it's not about using a tool as needed, that much is understood, it's about supplanting something natural with something artificial when it's not called for that's the concern.)
See what I mean?

At the very least, I propose there be not 5, but 7 S's, or at least two more alternate S's: Slinging and Skin-to-Skin.

Or you can just try doing all the S's at once with the Uber-S that is Slinging.

So, as a postpartum doula, what do I do? This is the parent's choice, after all. They've read the book and/or watched the DVD, and have decided that this is The Method that they will implement. And that's fair enough, I know; I don't have to 'approve' every parenting practice for them, of course. I do perform a mentoring function, and of course attachment parenting is where I'm coming from, but no matter how many benefits there are to it (with new evidence in its favor coming out all the time), parents will and should make their own choices.


Anyway, what do you think? Do I make any sense here? Am I making a mountain out of a molehill? I'm a little nervous that I may be attacking a sacred cow, and a relatively gentle one at that. Like I said, it's not as though it's "Babywise", and is kind of AP in a sense. Parents who practice this are responding to needs, in their own way. And yet . . .

There was a wonderful article by Kittie Frantz in Mothering Magazine a while ago, in which she addressed some similar concerns. The whole article is worth a read; the first part is mostly about sleep-training, but read on. This in particular rang true, especially in regard to the role of the father as discussed above:
The AAP's statement on breastfeeding recommends that pacifiers be avoided until breastfeeding is "well established." The AAP doesn't define "well established," but many feel that it takes at least the first six weeks. Still, what will Dad's success with a pacifier, swaddling, loud shushing, and jiggling the baby away from his chest and onto his thighs do to the breastfeeding?

In my practice, when fathers were successful in calming their babies, I found that their infants fed only six of the needed minimum eight times in each 24 hours. This resulted in lower weight gain for the baby, more initial breast engorgement for the mother, and a slow start for the milk supply. The infant was missing at least two needed feedings.

Patricia Franco published a study in the May 2005 issue of Pediatrics that shows that swaddling caused infants to spontaneously awaken less often. I often have to scramble to convince parents to hold off on the calming until after the breastfeeding. My generation didn't have to calm our babies after feeding; we nursed them to sleep, which takes less time than bouncing, wrapping, shushing, and pacifying.
Note that the author of this very article is the source of one of the best quotes about parenting ever made: "Remember: You're not managing an inconvenience, you're raising a human being."