Parenting Under Pressure – Learning to be Mum in Neonatal Intensive Care

Catriona Ogilvy of The Smallest Things is one of three speakers who will be leading our session on Parenting Under Pressure.  The session is part of our conference in October which aims to explore expectations and evidence around the early days with baby.  “Growing Families: Facts, Fiction and Other Stuff” is a not-for-profit event, and you can read more about the aims and organisers here.  The conference is taking place in Manchester on Thursday 6th October – please click here to book your place or join our Facebook event to register your interest.

In this post, Catriona explores what it is like learning to be a mother on NICU.

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When you are expecting your first baby you begin to imagine how your life might be; you think about holding your baby for the first time, dressing them in their babygrow, caring for them and nurturing them. You think about introducing them to the wider family, of the celebrations you will have and of the new ‘mummy’ friends you will make.

Sometimes though, things don’t always go to plan.

When a baby is born with complications, or like my first son, born prematurely, everything you had imagined and dreamed of is shattered in a matter of moments. The moment I gave birth to my tiny son he was whisked away. He was resuscitated on a table beside me for over six minutes as my husband was torn between caring for me and helplessly looking over at the medical team desperately trying to ventilate and stabilise our baby.

I had become a mother for the first time, yet I did not have a baby in my arms. Arriving 10 weeks early with little warning I was in shock.

We had landed in the world of neonatal intensive care; a world of medical devises and babies housed in perspex boxes. This would be parenting under pressure!

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I remember leaving my baby for the first time. He was only a few hours old. I held his tiny fingers through the incubator portholes and whispered ‘see you soon’. That night I climbed into bed at home and an overwhelming sense of emptiness consumed me. I was numb and grieving for the baby who I had left behind.

He was in the care of an exceptional medical team and wonderful nurses cared for him 24 hours a day as if he were their own. Their kindness made leaving him a little more bearable each day, but behind the safety and warmth of his incubator I was a mother, but he was not really mine.

For weeks I would ask permission to hold him; on occasions I would be told I was holding him too much. Nappy changes were done on a strict timetable and feeding was scheduled around charts and numbers. The unit where he slept was behind security doors and rigorous hand washing became the norm. Hours were spent beside his incubator, yet I was not able to do those seemingly basic mummy tasks of cuddling, consoling, feeding, bathing and dressing him. I cared for him as best I knew, but he did not feel like mine and I did not feel like a mother.

I still remember the nurse who helped me to be a mum in NICU. She not only showed me how to change a tiny nappy, she understood how nervous I was. She got how scary it was to move your babies stick thin limbs, and how the sound of alarms and buzzers terrified me as I contend with tangle of wires and tubes.

I remember the nurse who asked if I’d like to dress my baby for the first time; how she helped me to manoeuvre him limbs and lines into tiny sleeves. He started to look like my baby, dressed in an outfit I had chosen.

Parenting under pressure? NICU takes parenting to the very edge of extreme!

But, it is a NICU nurse who can give you hope. A NICU nurse who can provide reassurance. And a NICU nurse who can meaning in a world that at times can seem so empty.

Finally, when parenting under pressure it is a NICU nurse who can help you to be the most important person to your baby – mum.

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Catriona Ogilvy
June 2016

Parenting Under Pressure – When Family & Friends Really Count

When I started to plan the Growing Families conference I knew that I wanted to make it inclusive for those families who are facing additional stressors on their parenting journey. Having a premature baby, having a baby with a serious illness or a disability – these things add many challenges to the already life changing experience of having a child. Parents in this situation often report feeling as though they couldn’t take part in “normal” antenatal classes as their experience was likely to be so different from the other families present. And whilst there is a lot of focus on the medical issues faced by these children and their parents it can be forgotten that those parents will still be, first and foremost, mums and/or dads. And what about the grandparents? The aunts and uncles and friends? How do they get involved and fulfil their role in this growing family, when they may not fully understand the medical situation or the journey that their loved ones are on?

This is why one of the breakout sessions at our event in October is entitled Parenting Under Pressure. The session will be led by me, by Catriona Ogilvy of The Smallest Things and by Lynne Barton of Entrust Care Partnership. We will be exploring what happens when the parenting journey has these additional twists and turns, and anyone with an interest in, or with experience of, this is very welcome to join us.

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What is my personal interest in this subject? Well my youngest son David has a congenital heart defect, Hypoplastic Left Heart Syndrome. Essentially the left side of his heart doesn’t work, it’s a waste of space. His condition is one of the conditions that you will see referred to in the media as the child having “half a heart”. What did this mean for our parenting journey? Well suffice to say he wasn’t born at home like his older brother was! No, David was born by caesarean section at St Mary’s Hospital in Manchester, spent a night in NICU and was then whisked off to Alder Hey Children’s Hospital at one day old. When he was just five days old he had open heart surgery, and he had another operation at five months. David is now two and a half, and he has one more surgery to go, probably when he is around three or four years old.

We have been incredibly fortunate. David is so healthy and strong, and has so far given us very little to worry about, as far as having a child with HLHS goes! But as you may be able to imagine, that is a very different scale from the scale of worry most parents face. For a start we have had to sit for six or seven hours waiting to see if our child has survived surgery. And we have had to do that twice. We have had to wait and see if he is able to feed orally or whether he would need to be fed through a tube in his stomach. We have seen him desaturate rapidly on ICU so that at one point he stopped breathing. We have seen him hooked up to monitors and with big tubes stitched into his chest to drain the fluid. And we have spent a fair few hours on our local children’s ward getting him checked every time he had the slightest snuffle. Which as you know happens regularly with even the healthiest newborn!

As I say, in the scheme of HLHS children, we have had it easy. But in the scheme of parenting as a whole we have definitely faced additional pressures. I have written so much about my experiences of breastfeeding David and the campaign that grew out of that. I have written about those early days and the shock and the stress. I have written about how milestones become all the sweeter when your starting point was not knowing if your baby would come home at all. But today I would like to share with you my experience of how friends and family can really make a difference when the pressure is on, and how grandparents, relatives and friends most definitely have a role to play to support families in situations like ours.

As I am sure you can imagine, there are some “don’ts” in these situations, things that parents would probably rather you didn’t do if they are facing stressful times. I think that this article on the “Silk Ring Theory” sums up so well the importance of giving support, but reaching out elsewhere if you need support yourself. Parents in these situations can barely support each other, and they are using every ounce of their strength to keep strong together and to support their children. If you need support, and as grandparents or close friends then it’s likely you will, please reach out elsewhere and don’t ask the parents to hold you up at this time.

But what about the “dos”? Well I can only speak from my own experience but these are some of the fantastic things that friends and family did for us, that made such a massive difference when David was in hospital:

  • Do practical tasks: so many people asked me what they could do to help, and in reality what they could do was pick up those things on the “to do” list that needed to be done but which I just couldn’t manage. My eldest son needed a backpack for Playgroup – one of my friends sorted that. There were a couple of things we needed to have with us in the hospital – another friend sorted those. There were tiny tasks that on an ordinary day would have been no problem at all, but when your child is in hospital you do not have the headspace to even work out how to do them let alone get them completed. Our friends took those on with efficiency and made life so much easier.
  • Cook! But please be organised about this if you can. One evening a friend of mine brought round a home cooked meal, and as she was there a relative also brought round some food and we mentioned that we still had something in the fridge from the day before. My friend quickly realised that we were going to be inundated with food and would no doubt end up throwing some away and then not having enough in the freezer. So she organised a dinner rota with our friends in the area. I cannot stress enough how amazing this was. Every single day delicious home cooked food was delivered to our house, and this carried on until a week after David came home from hospital. It only stopped when we said that we were okay to take on the cooking again. Not only did this mean that our eldest son was fed healthy food at a time when otherwise he would most likely have lived on toast, but it also meant that we were eating healthily. This kept us going, it stopped us from getting run down, it kept up my supply of breastmilk…. It was just the most wonderful thing.
  • Accept the tone that the parents want to set. We are not doom and gloom kind of people. We are not melodramatic people. For us it was important to keep a positive outlook, take the good things as a win, to keep laughing and to face events with a sense of perspective. So we needed those around us to do the same. Anyone approaching us with drama and excessive emotion was not helpful, and we were fortunate that everyone did their very best to match our tone. For others the exact opposite could be true. If you need people to take on board the enormity of what you are going through, to understand the emotion and the heartache, then the last thing you want is someone bouncing in full of how you should “look on the bright side”. So please try to see what tone the parents are trying to set and understand that that is their way of approaching events.
  • Accept what the parents can give you. When a child is in hospital there are so many people who are interested in how things are going, and for us we needed those people, we needed them to know what was happening and we needed them on our team. But there was no way that we could phone them all individually, update them all on a daily basis with personalised messages and long drawn out conversations. The only way we could keep people in the loop so that they knew what we were going through was to send out mass text messages and updates on social media. Even close family members often had to update each other via chain phone calls rather than each receiving an update from us. And we were so fortunate that everyone understood this and was just happy to hear from us as and when we could communicate. It doesn’t matter how close you are to a family, when they are under pressure please don’t assume that you have a right to personalised updates and messages. It just might not be possible.

I would like to say an enormous thank you, once again, to all of the people in our lives who helped us in those early days, and who are helping and supporting us still. The things you did enabled us to focus on being mummy and daddy, to focus on loving and nurturing our two boys whilst the medical team did their stuff. We may have been under pressure but you helped us to still be parents.

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My beautiful boys in 2016

Helen Calvert
June 2016

“Growing Families: Facts, Fiction and Other Stuff” is taking place in Manchester on Thursday 6th October 2016.  For ticket price information and to book your place please click here.

Why is breastfeeding so bloody hard?!

This post by Growing Families organiser Elena Abell was originally shared on her personal blog platform, Trust Your Baby.  Elena works as a Business Unit Director for healthcare communications company Watermeadow Medical in Witney, Oxfordshire. Her background is molecular biology having studied to PhD level at Imperial College London, and she is also a qualified babywearing consultant.  You can find out more about Elena and the other three members of our conference team here: https://growingfamilies.co.uk/conference-team/

We are incredibly fortunate to have Emma Pickett IBCLC leading our breakout session on breastfeeding in October – sign up for this session to find out how to give yourself the best chance of meeting your breastfeeding goals, whatever those might be.  Expecting a baby? New to parenting or wanting to explore more about what you know? About to become a grandparent? Supporting new families?  Then this conference is for you!

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At 2 ½ weeks into breastfeeding my newborn son, I was ready to jack it in. I developed an excruciatingly painful cracked nipple (think toe-curling, eye-watering pain!), and I dreaded every single feed. Not exactly the easy, picture-perfect breastfeeding experience I had imagined. Far from it….It was a very dark time and I felt like an utter failure for considering giving up. I’m happy to say I managed to persevere through sheer bloody mindedness and some fabulous peer support but since then, it has really bugged me…

Why is something that is supposed to be so ‘natural’ so bloomin’ difficult?

Well….as it turns out, we really shouldn’t be blaming ourselves, AND it’s not just humans that find nursing their newborns difficult…..all the great ape species do. Here’s a little story for you….In 2012, at North Carolina Zoo in the USA(1), a captive born and raised chimpanzee called Maki gave birth to her first baby. Baby Nori was the first baby chimp to have been born at the zoo in 12 years but it soon became apparent that Maki wasn’t able to nurse her baby effectively. Eventually, baby Nori had to be taken away and hand-reared. Spare a thought for poor mama Maki though; in her short, captive life, she had never even seen a baby chimp before, let alone observed any other chimp mamas nursing their offspring. No wonder she found nursing difficult. She had absolutely no idea what she was doing. Research shows us that primates (yep, that includes us) who have never observed or experienced nursing  face a strong likelihood of failing to nurse successfully.(2,3)

By comparison, for ‘lower’ mammals such as cats, dogs, horses and cows, nursing is instinctual (meaning it’s not a learnt skill, it just comes naturally) and they make it look easy. The offspring of lower mammals are relatively well developed and mobile at birth and their babies are able to root, find a nipple and latch with pretty much no help from mum at all. Primates however are an exception to the rule of easy nursing.(4) Most primates require a period of learning in order to successfully nurse their babies,(5) and for humans at least, this may be the price we have paid for having evolved a relatively large and flexible brain that is capable of learning lots of new skills. In fact, the greater the intelligence of a primate, the greater the need for learning, and as it turns out, humans may be the most problematic nursers of all primates, if not all mammals.(4)

Interestingly, primate researchers have found that for apes living in captivity, being reared by an ape mother and observing other ape mothers means that new ape mums are more likely to successfully nurse and raise an ape infant.(6) In fact, there is evidence that specific training programs aimed at teaching maternal skills to apes can significantly improve their ability to appropriately care for and nurse their infants.(7) Sounds scarily like NCT courses for apes! But seriously, we’re no different to our ape cousins and almost certainly, like most other primate females, human mothers do not have an instinctual knowledge of how to feed their baby, meaning we need appropriate support in order to ‘learn’ to breastfeed.(4) In fact, research shows that on balance it’s TWICE as challenging for humans to learn to breastfeed properly as it is for other great apes.(6,4) How very unfair! Basically, there is a perfect storm of factors that make it spectacularly difficult for humans to breastfeed.(4)

  • Human intelligence: it may be that humans face an extra disadvantage when it comes to breastfeeding, because of our heightened intelligence. Having a larger brain that is ultimately more flexible, and more capable of learning than other apes, may result in an increased reliance on learned behaviours over instinctual behaviours.(4) It seems that humans and other primates ‘lost’ the ability to breastfeed by instinct very early on in our evolutionary history.(4)
  • Human breast shape: This is a classic case of form over function. We all know that human males love boobs, right? In our evolutionary history, men would have been more attracted to women with the most prominent boobs as this would have signaled fertility and health.(8) Because we use our boobs as sexual ‘signals’,(9,10) our boobs are now more rounded compared with our flat-chested primate cousins. However, this rounded shape means that human infants rely on a more complex set of mouth movements to retrieve milk from a human breast than other primates and mammals.(4,11-13) Although this complex sucking action in human babies is instinctual for them, they generally require assistance from the mother in order to successfully translate that reflex into successful breastfeeding.(14)
  • Infant development and mobility at birth: Humans evolved to walk on two legs but this means we have a relatively narrow pelvis and birth canal. As such, human babies need to be born relatively underdeveloped so that the brain and head are still small enough to pass through the birth canal. All this means that human babies are much more helpless at birth than other primate babies and it’s almost impossible for human babies to breastfeed without some assistance from mum. For example, without help from mum, newborn human babies find it very challenging, at least at first, to insert the nipple far enough back into their mouth to avoid seriously stressing out mum’s nipple and making it sore.(4,15) That means that if our technique is even a bit wrong, we’ll have very sore nipples, something very many of us mums have experienced I have no doubt. A helpless baby also means smaller, weaker jaws, which, as mentioned above are trying to carry out these more complex sucking movements than our primate cousins,(4) so it’s no wonder that we, as human mums find breastfeeding tricky.

Breastfeeding was crucial to the survival of our ancestors, yet it’s clear that humans face potentially significant challenges associated with breastfeeding. This is an evolutionary dilemma – breastfeeding is essential for survival, yet it requires (potentially variable or absent) learning and support.(4) Our human ancestors found the perfect solution to this problem however. We evolved to live in large, stable and supportive groups meaning that baby care could be shared among not only the parents, but extended family and other members of the group.(4) You might have heard the traditional African proverb ‘it takes a village to raise a child’? How very, very true this is.

It takes a villageSimilar to other primates, this predictable, group environment allowed human women to observe and learn the techniques of breastfeeding from other women. Evidence for this ancestral ‘group’ approach to breastfeeding comes from traditional cultures, where breastfeeding is the norm and women are frequently exposed to it.(4) In these cultures breastfeeding initiation rates are almost 100%, and after 6 months, breastfeeding rates of 98% are still seen.(4,16,17) Compare this to a woeful 74% initiation rate in the UK, which falls to 47% after only 6-8 weeks.(18)

Our ancestral history suggests that the support and instruction provided by breast feeding ‘peer supporters’ and the experience of family and friends may be a crucial part of any new Mum’s plan to successfully breastfeed.(4) Modern and international pro-breastfeeding organizations such as La Leche League (who teach and promote breastfeeding techniques), hospitals and midwives are playing an increasing role in reviving this ‘group’ breastfeeding culture. However, all too often I think new mums expect that they should just instinctively know how to nurse, and be able to just ‘get on with it’. If new mums are not adequately prepared, or set up with help and support from the beginning, they can end up feeling like utter failures, if or rather when they encounter problems. It shouldn’t be like this. The onus should be on society as a whole to create that ‘ancestral’ group support that helps teach and encourage new mums to breastfeed successfully. For those of us who are or have been nursing mothers, it’s also super important that we share our experiences with other women who are just beginning their breastfeeding journeys. Like our human ancestors and primate cousins, we ALL need support and encouragement to learn how to breastfeed.

If you’re a mum-to-be or new mum (or know someone who is!), here’s my 5 point plan to help prepare for the ancient art of breastfeeding.

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Elena Abell
June 2016 (first published October 2014)

1. http://www.zooborns.com/zooborns/2010/08/baby-chimp-doing-well-at-nc-zoo.html. Accessed 21/09/2014.
2. Abello, M; Fernandez J. International Zoo Yearbook, 2003; 38: 186-191.
3. Harlow, H;  Harlow, M. Bulletin of the Menninger Clinic, 1962. 26: 213-224.
4. Volk, A. Journal of Social, Evolutionary, and Cultural Psychology, 2009; 3(4):305-314.
5. Smith, H. Parenting for Primates, 2005. Cambridge, MA: Harvard University Press.
6. Abello,, M; Colell, M. International Zoo Yearbook, 2006;40:323-340.
7. Desmonde, T; Laule, G; Zoo Biology, 1994;13:471-477.
8. Møller, A. Ethology and Sociobiology, 1995;16:207-219.
9. Barber, N. Ethology and Sociobiology, 1995;16:395-424.
10. Morris, D. The naked ape: A zoologist’s study of the human animal, 1969. Toronto: Bantam.
11. German, R; Crompton, A. Brain, Behavior, and Evolution, 1996;48,:157-164.
12. German, et al., Journal of Experimental Zoology, 1992;261:322-330.
13. Woolridge, M. Midwifery, 1986;2:164-171.
14. Fisher, C.  Journal of Maternal & Child Health, 1981;6:52-57.
15. Righard, L; Alade, M. Birth, 1992;19:185-189.
16. Houston, M. Journal of Advanced Nursing, 1981;6:447-454.
17. Lee, R. B. The !Kung San: Men, women and work in a foraging society. 1979. Cambridge, UK: Cambridge University Press.
18. https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/206553/Breastfeeding_Statistics_2012-13.pdf. Accessed 21/09/2014.

The practicalities of sharing a bed with your baby

This post by Growing Families organiser Elena Abell was originally shared on her personal blog platform, Trust Your Baby.  Elena works as a Business Unit Director for healthcare communications company Watermeadow Medical in Witney, Oxfordshire. Her background is molecular biology having studied to PhD level at Imperial College London, and she is also a qualified babywearing consultant.  You can find out more about Elena and the other three members of our conference team here: https://growingfamilies.co.uk/conference-team/

You will see that Elena references the University of Durham Parent-Infant Sleep Lab in her post: we are incredibly fortunate to have Professor Helen Ball as one of our main session speakers at the conference in October.  Expecting a baby? New to parenting or wanting to explore more about what you know? About to become a grandparent? Supporting new families?  Then this conference is for you!

With thanks to the Infant Sleep Infomation Source website and photographer Beverley Latter for the image at the top of this page.

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Newborns have a terrible habit of not wanting to sleep where National guidelines say they should be sleeping (i.e. in a cot).(1) It’s not terribly surprising when you think about it though. Newborn babies are working on instinct, programmed over millions of years of evolution, and what a baby’s instinct is telling it is that ‘mum’ means safety, warmth and food. In fact, research on human and nonhuman primate infants has demonstrated that an infant’s most fundamental physiological systems such as breathing, heart rate, sleep, and temperature regulation are affected by the presence or absence of parental contact.(2-5)

Given all this, why on earth wouldn’t a baby want to sleep anywhere else but right next you?

So, if through trial and error (like so many new mums) you find that the only way to get your newborn to sleep is having them sleep on or right next to you, then you’re not alone; BUT, chances are you might also be totally unprepared for doing so safely. Even if you have made a conscious decision before baby arrives that you might like to sleep with your baby in bed (bedsharing), there’s surprisingly little information out there on the purely practical aspects of HOW to do it, for example, what position is mum supposed to sleep in relation to baby, what sort of covers are you supposed to use and where exactly do the covers go, where does dad figure in this whole bedsharing plan, how do you stop baby rolling out of bed and so on and so on. It seems to me, many of the books reviewing bedsharing are so intent on providing all the research evidence, that the practical side of bedsharing (i.e. exactly HOW to do it) tends to be a bit of an afterthought. To me, describing the practical side of things (including some good diagrams), is one of the most important aspects of safer bedsharing and I know I would have benefited from some straighforward information on what to buy in preparation for bedsharing, and how to do it as safely as I possibly could.

Let’s just get something straight first though…..there is no absolutely ‘safe’ place for your baby to sleep. Just because anthropologists and infant sleep researchers (and me) argue that mother-baby contact during sleep is a biologically ‘normal’ human behaviour does not mean it is inherently safe (although arguably neither is sleeping alone in a cot).(6,7) As Prof. Helen Ball from the University of Durham Parent-Infant Sleep Lab so eloquently puts it….

“As with many aspects of daily life from preparing food to crossing the road, it is the context and manner in which these activities are conducted that make them safe or unsafe.”(8) 

What I aim to do in this post, is provide some very practical suggestions (with diagrams!) for setting up a mother-baby sleep environment, that is as safe as it can be, and is in line with the latest published research evidence and guidelines.

First up, let’s look at some of the big DON’Ts as per the latest guidelines and research evidence.(9-12)

Bedsharing Donts

So now we’ve had a look at some of key ‘DON’Ts’ let’s have a look at some of the ‘DOs’, including exactly HOW breastfeeding mothers and babies sleep next to each other. There are many publications on mother-baby sleep behaviour showing that when a breastfeeding mother and a baby routinely sleep in physical contact, they sleep very close together facing each other, and tend to wake up and go back to sleep at the same time.(5,13) Breastfeeding mums who bedshare tend to lie on their side facing their baby, curled around them adopting a protective C-shape (see diagram below).(adapted from 13) The baby is positioned level with their mother’s breasts, and the baby sleeps in the space created between the mother’s arm (positioned above her baby’s head) and her knees (drawn up under her baby’s feet).(14-16)

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In fact, current evidence suggests that this C-shaped position is a universally exhibited, instinctive behaviour, adopted without previous instruction or discussion by breastfeeding mothers in order to protect their newborn babies.(13,17)

Before we go on, I should mention that the practical advice provided here is for mothers who are exclusively breastfeeding their babies as this seems to reduce the risk of SIDS.(18) This is likely to be because breastfeeding mothers and babies sleep together in very different ways than do non-breastfeeding mums (i.e. those bottle feeding using formula or expressed breast milk).(15) Formula-feeding mothers appear to spend less time facing their baby and they do not adopt the ‘protective’ C-shaped sleep position as consistently as breastfeeding mothers. Breastfeeding mothers and babies seem to arouse from their sleep together, more frequently than formula feeding mothers and babies and breastfeeding mothers and babies also wake more often.(15) It is not currently known whether non-breastfeeding mums are likely to maintain the same level of vigilance and synchrony during sleep that is exhibited by breastfeeding mothers. So, for the time being it is recommended that non-breastfeeders put their baby down to sleep in a cot by the bed.(5)

So we’ve had a look at the mother-baby sleep position, but what about the bed area itself? The TrustYourBaby safe sleep environment diagram below considers 7 main factors for a mother sleeping with a singleton baby in a bed:

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1) Other people in bed: Baby should never be left in an adult bed unsupervised. By far the safest way of sleeping with your baby is for the mother and baby to sleep in a bed on their own.(19) If dad or partner is to sleep in the bed as well, then baby should be placed on the mother’s side of the bed not between the mother and the father/partner until the baby is at least 6 months old. This is because fathers (or partners) are generally much less aware of their babies. It is generally not advisable to have other children in bed with you and your baby.

2) Baby anti roll-out protection: A mechanism to stop baby falling out of bed should be installed on the mother’s side of the bed. The ideal option is a bedside cosleeper where the cosleeper mattress is contiguous with the main bed mattress (see the NCT website for an excellent and comprehensive review of cosleepers available to buy). Another way of stopping baby rolling out is to push the bed up against a wall but there should be no gaps between the wall and the mattress. Toddler bed rails on the other hand, should be avoided until babies are least 1 year old as there appears to be an increased risk of entrapment between the rail and the mattress.(20) If you do use a rail, mesh rails are better than those with slats as the slats can pose a strangulation risk.

3) Back to sleep: The back to sleep advice(11) still applies even with bedsharing and while it’s safe to assume baby will be lying on their side to breastfeed as per the ‘instinctive’ mother-baby sleep position described above, baby can be rolled onto their back once they are safely asleep

4) The bed: A queen, kingsize or super kingsize bed is the ideal size for bedsharing if both parents are in the bed with baby. If mother is on her own in the bed with baby then a double bed is OK. The mattress on which you place your baby should be firm, and you should not sleep with your baby if your bed is a waterbed or other very soft surface.

5) The bedcovers: Light bedclothers such as a duvet cover with no duvet inside, or a summer tog duvet should be used. Bedclothes should come up no higher than the babies middle, and mum can use the hand that is uppermost to control the position of the bedclothes during the night.

6) Mother and baby’s clothing: Depending on the season, light bedclothes will mean mum perhaps needs to wear additional nightime clothing than she might normally, for example a longsleeve top that keeps her top half snug. Baby should be placed in the same number of layers as mum to prevent overheating.

7. Pillows: Baby should be placed well below the level of mum’s pillows. If done correctly, the C-shaped protective position adopted by the mother should stop baby creeping up under the pillows as mum’s arm is placed above baby’s head.

I’ll leave you with some sage advice from the amazingly good ISIS (Infant Sleep Information Source) website (seriously, EVERYONE with a baby ought to read the info on this site):(21)

“There is no easy ‘one size fits all’ advice for the complex issues surrounding a topic such as bed-sharing as the risks and benefits vary greatly from family to family

Parents need information with which to make informed decisions, and should be encouraged to weigh up any potential risks and benefits of bed-sharing in light of their own individual circumstances. This information is clearly detailed in the UNICEF leaflet ‘Caring for your baby at night’, on the NCT website and via La Leche League.”

Elena Abell
June 2016 (first published October 2014)

1. http://www.nhs.uk/Conditions/pregnancy-and-baby/Pages/reducing-risk-cot-death.aspx Accessed 5th October 2014.
2. Korner AF, Thoman EB. The relative efficacy of contact and vestibular-proprioceptive stimulation in soothing neonates. Child Dev 1972;43(2):443-53.
3. Christensson K, Siles C, Moreno L, et al. Temperature, metabolic adaptation and crying in healthy full-term newborns cared for skin-to-skin or in a cot. Acta Paediatr 1992;81(6-7):488-93.
4. Ludington-Hoe SM, Johnson MW, Morgan K, et al. Neurophysiologic assessment of neonatal sleep organization: preliminary results of a randomized, controlled trial of skin contact with preterm infants. Pediatrics2006;117(5):e909-e923.
5. Ball H. Research Overview: Bed sharing and co-sleeping. http://www.nct.org.uk/sites/default/files/related_documents/2009-Ed48-Bed-sharingandco-sleeping.pdf. Accessed 5th October 2014.
6. Drago DA, Dannenberg AL. Infant mechanical suffocation deaths in the United States, 1980–1997. Pediatrics1999; 103: e59.
7. McKenna JJ, McDade T. Why babies should never sleep alone: A review of the co-sleeping controversy in relation to SIDS, bedsharing and breast feeding. Paediatric Respiratory Reviews 2005;6,:134–152
8. Ball H, Blair PS, Ward-Platt MP. “New” practice of bedsharing and risk of SIDS. The Lancet 2004;363
9. Hunt CE. Small for gestational age infants and sudden infant death syndrome: a confluence of complex conditions. Arch Dis Child Fetal Neonatal Ed 2007;92(6):F428–9.
10. Sullivan FM, Barlow SM. Review of risk factors for sudden infant death syndrome. Paediatr Perinat Epidemiol 2001;15(2):144-200.
11. http://www.unicef.org.uk/Documents/Baby_Friendly/Leaflets/caringatnight_web.pdf Accessed 5th October 2014.
12. Carroll-Pankhurst C, Mortimer EA Jr. Sudden infant death syndrome, bedsharing, parental weight, and age at death. Pediatrics 2001;107(3):530-6.
13. McKenna, JJ et al., Mother-infant cosleeping, breastfeeding and sudden infant death syndrome: what biological anthropology has discovered about normal infant sleep and pediatric sleep medicine. Am J Phys.Anthropol. 2007;Suppl 45:133-61.
14. Baddock SA, Galland BC, Bolton DP, et al. Differences in infant and parent behaviors during routine bed sharing compared with cot sleeping in the home setting. Pediatrics 2006;117(5):1599-607.
15. Ball H. Parent-infant bed-sharing behavior: effects of feeding type and presence of father. Human Nature2006;17(3):301-18.
16. Richard C, Mosko S, McKenna J, et al. Sleeping position, orientation, and proximity in bedsharing infants and mothers. Sleep 1996;19(9):685-90.
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18. Hauck FR, Thompson JM, Tanabe KO et al., Breastfeeding and Reduced Risk of Sudden Infant Death Syndrome: A Meta-analysis. Pediatrics 2011;128(1):e103–10.
19. Hauck FR and Herman SM. Bed sharing and sudden infant death syndrome in a largely African-American population. Peadiatr Child Health 2006;11 (Suppl A):16A-18A.
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21. https://www.isisonline.org.uk/hcp/where_babies_sleep/parents_bed/Accessed 5th October 2014.

5 Things New Mothers Need

Maddie McMahon is leading our breakout session on Doula Care at “Growing Families: Facts, Fiction and Other Stuff” this October.  It is a one-day event for all expectant and new families – mum, dad, grandma, grandad, aunts, uncles, supporters – and the professionals who work with them. This is a not-for-profit event, created by four mothers, two of whom are also healthcare professionals. Our mission is to tackle the postnatal information that desperately needs covering for new families. To explore expectations and evidence around the early days with baby. To keep ticket prices low, with no expectation of making a profit, in order to open up the event to as many people as we can. To ensure that support for the event comes from ethical organisations and those who share our interest in evidence based information and family wellbeing. To give new families the confidence to face the challenges ahead.

Please click here to book your place: https://growingfamilies.co.uk/prices-booking/

Here Maddie discusses what she feels new mothers need.

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Back in 1999, pregnant for the first time, I sat shyly in an older mother’s living room at a summer barbecue. The men were in the garden, poking the fire, while I sat with the women, non-alcoholic drink in hand, telling the assembled group of friends and acquaintances that I was 3 months pregnant. The woman next to me on the sofa visibly blanched, clutched me by the arm and hissed through clenched teeth: “get an epidural”. Thus, I was initiated into the complex world of motherhood.

Looking back now, through the lens of 13 years as a doula, I understand why I felt so deflated, so filled with trepidation and so at sea for my whole pregnancy and for years as a mother of 2 small children. With hindsight I think I’ve got a pretty good handle on what I think I needed. I do know we’re all different and nothing can be universal, but here are my top 5 things that new mothers might need. Do let me know if you agree.

1. Chuck out the fear
Instead of fear, some positivity would have been nice. Some belief in my body to grow a child without incident. A pinch of faith that my child could be born without drama. It might have been nice to hear “good on yer” from time to time, instead of the hollow laugh of “you’ll soon find out….” Insert the excruciating pain of childbirth/how stupid you are to think you can have a natural birth/how utterly exhausted and bitter you’ll feel about having kids…

Perhaps it would have been nice to be celebrated for the immense achievement of making new life. Maybe my community could have gathered around and honoured me. Rather than suddenly feeling invisible and no longer a productive member of society, perhaps I could have been rewarded for the gift I was giving and patted on the back. Instead of being accused of being a drain on society and perpetually asked when I was going back to work and the ‘real world’, it could have been pointed out what an immense joy it is to become a parent and what an enormous contribution parents make to the perpetuation of the species.

2. Treat her like a grown up
In no particular order, things that diminish and undermine pregnant and new mothers:
“Pop up on the bed for me” and other, equally infantilising language. Is that an order or a request? Why and what for? Anything I need to give consent for?

“Down there”, “Tail end”. No, it is my vagina. The seat of more power and creativity and pleasure than you can possibly imagine. Use her name, she deserves it. And while you’re at it, use mine too. I am not “mum”. I am a full person, with a name and a life. Please don’t diminish me by using one of my roles as my definition.

“You need to”, “You have to”, “You must”. More orders? Don’t I have a say? How can I decide if you haven’t talked me through the pros and cons? Anyone who tells you that you are, or are not, allowed to do something hasn’t grasped a pretty fundamental notion: that this is your birth, your body, your baby. Parents, when they have access to good quality, evidence-based information, make safe and appropriate choices for themselves and their babies. So you get to do the allowing, the choosing and the calling of the shots. Hey, Mama, you’re the boss!

Then there’s the “You’ll make a rod for your own back” thing. I’ve never really understood this mythical rod and why it’s so universally used as a means of scaring parents into being (usually) as dictatorial as the person gloomily threatening the dire consequences of relaxed parenting. I fed my kids when they were hungry, helped them fall asleep in a way that worked, cuddled them as much as I and they wanted, took the line of least resistance, picked my battles carefully and tried to say ‘yes’ or ‘what do YOU think’ more than ‘no’. I generally tried to respect their emotions and their opinions and practised a form of benign neglect that appears to have resulted in a pair of pretty well-balanced teenagers. Despite all the dire predictions, I can’t seem, for the life of me, to find this rod. Maybe we should be asking parents how THEY want to parent rather than heaving out another tired old clichéd bit of homespun advice.

3. Help her find her tribe
We are a tribal species. We didn’t evolve to do this on our own. Find the old crones that make you feel safe and understand the processes you are going through. Find your sisters who will wipe your tears and pick you up on a bad day. Find your mother figure who will love you and cradle you through birth and beyond. Once, we had the collective wisdom of a whole village of women. We would gather in the red tent and menstruate together, birth together, laugh, cry and eat together. Today, that kind of support is all too often absent from women’s lives. Where once we would have seen birth, sat amongst nursing mothers and cared for many babies before having our own, now we come into motherhood devoid of experience and sisterhood.

As famous midwife Sheena Byrom says, “Find a good midwife or doula and stick to them like glue.” A guide through the maternity maze can help you understand your choices and support you on the journey. She can help you carry some of your heavy luggage so it doesn’t weigh you down on the way. She can be there to celebrate your achievements and hold you up when things feel tough. Most importantly of all, she can believe in you. Friends, old and new, can be there too, to listen and accept you, just as you are, with unconditional love. When women become mothers and babies are loved and worshipped as they should be, everything usually blossoms beautifully.

4. Forget the Clocks
The minute we find out we’re pregnant the numbers start crowding in; how many weeks am I? When do I have my scans, my midwife appointments? What is my fundal height? My HB? When is my ‘due date’? Age 40? Over 40 weeks? By the time we actually go into labour, whether that is naturally, or induced to someone else’s clock, we can have been hypnotised by the numbers.

So what’s the problem? Why can’t we quantify our bodies and our babies; measure them in minutes and hours, in centimetres, millilitres, in pounds and ounces? Why can’t we define, confine, analyse, portion and fix this journey? Can’t we take the uncertainty out of this life-changing event? Measuring also means controlling something. If we can explain and describe something, suddenly we have power over it, the fear is replaced with understanding – isn’t this a good thing?

Perhaps. Except that to truly measure and understand the butterfly, you have to pin it to a board.

Numbers come from our modern human brains, our neo-cortexes, the part of our brain we use to pay the mortgage and remember our PIN. Thing is, we don’t grow our babies, give birth or mother with this part of our brain. We do all that with our primal, mammal brain, the brain that is all instinct and deep, ancient knowing. The brain we can’t describe, define or quantify. It can help when mothers are supported to understand that each body and each baby is different. Some births are slow and some are fast. Both can be perfect. 2cm dilated right now doesn’t mean you won’t have your baby in your arms very soon. There is no magic number of minutes at the breast that will ensure a baby is well fed. There is no ‘right’ centile for the baby to follow. You, and your baby, are unique and special. Numbers might sometimes help flag up possible problems but let’s use the numbers as a tool instead of allowing them to rule us.

5. Have a Babymoon and a 4th Trimester
You just grew a person! For a whole 9 months, your body changed and rearranged itself. This baby was born from your body; a stupendous effort, however the birth plays out. You are a superstar, Olympic athlete, astronaut returning from a heroic mission to the moon! You deserve some time out from life, to rest and recuperate, for every organ in your body to navigate its way back into place, for your bones to close and your breasts to learn their new job.

Just as a honeymoon gives us space and time to lay down the foundations of a new relationship, to celebrate and honour the union and to forge ever-closer bonds by spending time together, a babymoon allows for mother and child to become motherbaby; to stare into each other’s eyes, to spend time in bed in skin-to-skin contact, to let milk and love flow in equal measure; for the baby to explore his new habitat from the safe vantage point of his mother’s chest and for mother to tentatively try on motherhood for size.

This is a time for motherbaby to be nurtured and for the union to be celebrated. When people come, they should come with food and a ready hand to help with household chores. In many cultures, mother and baby are washed and massaged regularly. The mother’s job is to rest and gain confidence in her mothering skills as she feeds and cares for the baby.

It is during this time that parents can be supported to understand the innate and immutable needs of a newborn baby; that for the first 3 months at least, the line of least resistance is often to imagine how it would feel to be small, helpless, a bit freaked out at being in the big wide world, with a very small tummy, hyper-sensitive skin, and a ‘normal’ that was warm, dark, wet, moving, noisy, heart-beat-throbby. This is the 4th trimester of pregnancy; seeing this new addition to the family as still ‘foetal’, not quite ready for the world, still needing near-constant contact with his mother’s body to grow and develop.

When we see our babies as cups that need filling with love and touch, as tiny creatures who just have needs that ache to be met and who do not have the cognitive ability to manipulate us, they can seem much easier to understand. With support, parents can then work out how to care for their own needs, as well as the baby’s, to make the most of the baby’s rhythms and adjust to the new-normal pattern of family life.

Anything I’ve missed? Five points was a number picked at random for the benefit of this article. What do YOU think mothers need? And what about fathers, I hear you say. Well, that’s another article!

Maddie McMahon 
June 2016

Growing Families6

Expecting a baby? New to parenting or wanting to explore more about what you know? About to become a grandparent? Supporting new families?

Then this conference is for you!

A funny thing happened when we went out for pizza…..

Many of you will know from the recent musings of @heartmummy, that ‘Growing Families’ came into being following a discussion held one night over a pizza.

I’m sure we started as we usually do… each offering our own strong opinions on whatever the latest news was, chatting about the trials & tribulations faced by many families we know or have been made aware of, as they make their journey to & through parenthood. From what I can recall, the conversation was peppered with passionate outbursts & strong declarations of what ‘should’ be happening to support them…. For those of you that know either or both of us, that’s no revelation!

So there we were, two like- minded souls creating the ‘new world order’ when Helen mentioned an idea she had had, something that had grown from deep within, from personal experience & from her very great passion…. An event, for families (old, new & those still on the way). I remember thinking “Yes! Yes! Yes!…. we can do this, it must happen, it will happen”,  I think Helen may have laughed at me. But by the time we reached ‘the idea’ everyone else had left the restaurant, the chairs were on the tables & the floors were mopped (not sure when that happened?!) ..  We were escorted out of the building into the dark night… reluctant to leave our animated conversation we stood in the cold November air & talked some more. When we parted ’the idea’ was fermenting in our brains….. By March 2015… we had settled it (& been escorted from the same pizza restaurant for a second time at midnight!)… by October we had our first face to face meeting with our new colleagues Emma Jane Sasaru & Elena Abell. The location this time was the lounge of a motorway hotel near Northampton & it was here, after much discussion (cake & coffee) that the name ‘Growing Families: facts, fiction & other stuff” was born.

Maya Angelou said  “Do the best you can until you know better. Then when you know better, do better”

Well,  in order to do better, we have had to learn (a lot!), grow (a great deal!), make mistakes (many!), ask for help (often), make decisions, be fair & perhaps not always popular (it’s happened), not make judgements about others, be nice to each other even when frustrated, trust, be honest & acknowledge that in reality this wasn’t always going to go exactly to plan. How could it? We didn’t have an instruction manual & this conference of ours was a stranger to us, a living thing in which we have all invested….it is our baby. Yet, it was only when I sat down to write this first post that the penny finally dropped… the whole process from conception to infancy has been a journey & one for which we were not always prepared. Humans are social animals & our lives are interwoven with the relationships we form. As a new ‘family’ people have offered us well meaning advice, words of wisdom & plenty of opinions… but we have maintained our integrity & we have grown as parents, we chose our ‘parenting style’ a long time ago & we are holding fast to it. We  have selected & been drawn to the people that form our ‘tribe’ as we take this journey & others have found us along the way. The naysayers have been heard & so have the countless kind & generous souls that are supporting us in our efforts to make this happen –  from logo design to the listening ears – we are truly grateful.

June 1st marks the start of our blog series – 4 months & 6 days till we watch ‘Growing Families: facts, fiction & other stuff’ take its first steps into the big wide world (no hand holding). So we are going to make the most of our time with you & will be sharing thoughts from our speakers, sponsors & Growing Families friends as we myth bust, discuss facts and explore the topics relevant to parents today & the professionals who work alongside them.

Welcome to all, whether father, mother, grandparent, friend or doula, if you are deciding to become a family for the first time or are weaving together two families, if you work as a health care professional, or are just interested in learning more, please come in. Join us, read about the realities of becoming a family, share evidence-based information, promote choice, provide opportunities for conversation & support one another … Help families to grow in confidence, strength & love.

June 2016

“Growing Families: Facts, Fiction and Other Stuff” is taking place in Manchester on Thursday 6th October 2016.  For ticket price information and to book your place please click here.