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What in the world is a Lotus Birth?

What in the world is a Lotus Birth?

A Lotus Birth is the practice of keeping the placenta intact and attached to the baby for the first few days of the baby’s life, until the cord dries out and naturally falls off on its own, just like a cut umbilical cord would, usually within 3-10 days of the birth.  When I first heard of this practice, back in 2002 as a nursing student, I was completely aghast. Why in the world would anyone want to do something like that?? What do you do with the rotting and mouldering placenta that’s still attached to the baby? How do you dress the baby and care for the baby with the cord still attached?? I had a million questions, and the entire concept seemed completely alien.

(Photo courtesy of Danella Jade, 2018)

Further research into the subject, though, has changed my mind. It turns out many indigenous and aboriginal cultures honour the placenta, which makes a lot of sense when you think of the placenta as a guardian that has nourished and supported the baby in utero. Moari tradition buries the placenta on tribal land to help foster a connection in the child to that land. In the Hmong tribe in South East Asia, it’s believed that the placenta must be retrieved by the spirit after death, in order to ensure physical integrity in the next life, and therefore the placenta is always buried under the house where the baby was born so that the spirit will know where to find it (Buckley, 2003). In Zimbabwe, the placenta is buried by the family home to ensure that the child will always want to return home, and in Cambodia people believe that the child will stay safe so long as they are always near to their placenta (Buckley, 2010).  In Bali, the placenta (as well as the cord, amniotic fluid and blood) are called ‘Ari-Ari’, which means “younger siblings”, and these tissues–and in particular the placenta–are treated with the utmost respect, often bound in a coconut shell or placenta bag with herbs and flowers and buried outside the home (where it’s marked with a stone and then later a prickly bush is planted on top to help protect it).  A Balinese child will greet their placenta in the morning, and pray to it for protection at night, and the spirit of the placenta is thought to live on as the child’s guardian throughout their lifetime (Buckley, 2010).

(Photo credit: Nick and Vanessa Fisher)

In Western culture, the placenta is mostly seen as medical waste, and is often collected into biohazard bags and disposed of or incinerated by the hospital. The newer trend of placenta encapsulation, as well as some couples wishing to follow more traditional practices such as burying their child’s placenta under a tree in their garden, has led to more placentas being requested and brought home from the hospital than ever before.  Lotus Birth was first documented among chimpanzees, but was never practiced by humans until Claire Lotus Day (inspired by some of Jane Goodall’s research) sought an alternative to the routine cutting and clamping of the cord in 1974 and found an obstetrician who was willing to honour her wishes and leave the cord and placenta intact until they fell off naturally (Buckley, 2003; Lim, 2001). Since that time, Jeannine Pavarti Baker, Shivam Rachana and Dr. Sarah Buckley have all been proponents of Lotus Birth, and more recently Michel Odent has also spoken about the advantages of it.  While I can completely understand that this practice might not be for everyone, there are many good reasons to at least consider it.

First and foremost, a Lotus Birth would ensure that optimal placental transfusion occurred. At birth, one third of the baby’s blood supply is located in the placenta, and this vital supply of blood, oxygen, nutrients and stem cells rightly belongs to the baby (and is not waste!).  Left undisturbed, Mother Nature will gradually perfuse the baby with the remaining blood over the next several minutes while the placenta is still attached to the uterine wall; eventually, the cord will stop pulsing and the perfusion will end, often heralding signs of placental separation, followed by the delivery of the placenta. (I’ve written a lot more on physiological management of the third stage of labour in a different post). In hospitals right now, there is a big push to better support optimal cord clamping as we learn more about exactly how important this blood is to the baby. Recently, both NICE and WHO changed their guidelines to reflect the new research on this topic, urging practitioners to wait at least a minute before cutting the cord to allow placental transfusion to occur (a practice known as ‘delayed cord clamping’). However, other clinicians like Amanda Burleigh, founder of the “Wait for White” campaign, argue that a 1 minute delay isn’t nearly long enough to allow full placental transfusion, and believe that we need ‘optimal cord clamping’, which involves waiting until the cord has turned white before cutting it (more information on this can be found at Blood to Baby and in this fabulous podcast with Amanda). Unfortunately, there’s still a lot of room for improvement in this area, and lots of cords are STILL getting cut way too soon. But opting for a Lotus Birth would ensure that this would never even be a question, as the baby would receive their full portion of blood and the cord would never be cut (too soon, or otherwise).

Additionally, a Lotus Birth helps preserve the mother-infant bond, and helps enforce a “lying-in” period, or a “breaking-forth”, as Dr. Sarah Buckley calls the time between when the baby is born and when the cord naturally falls off (Buckley, 2010).  It’s hard to get out and about with a baby who’s still attached to a cord (although not impossible, as placenta bags are portable and easy to use), and the practice ensures that the first few days unfurl at a slower, more gentle pace, with the mother taking it easy and spending the majority of her time resting and bonding with the baby. A baby who’s still attached to the cord is a visual reminder to visitors that the baby is still new and needs to be protected, and also helps prevent the baby being passed from one excited relative to the next (potentially to the mum and baby’s detriment). It’s also a bit harder to fully dress a baby who’s cord is still attached, which gently encourages skin-to-skin bonding to keep the baby warm, rather than dressing, and we know how important uninterrupted skin-to-skin is when it comes to establishing breastfeeding.  Anecdotal reports have emphasised the calm and peaceful transition Lotus Birth allows for, as well as the calmer and more relaxed temperaments of babies who are still attached to their cords (although this might be influenced more by the uninterrupted bonding and attachment fostered by a Lotus Birth, rather than the actual physical presence of an intact placenta). Author Shivam Rachana has written about how babies seem to automatically flinch or cry out or grab their cord as it’s being cut, and Robin Lim, international midwife and founder of the Bumi Sehat birthing center in Bali, reports on a Lotus Birth where the placenta was seen to pulse at the same time that the baby was breastfeeding (Lim, 2001). The father of that baby, himself a PhD biochemist, was amazed by this discovery, stating: “I am certain that something here is being communicated. I am not fooled by the dry appearance of the cord, deep in the center there is life. Something essential is being provided to my baby by his placenta,” (Lim, 2001). In the same article, Robin Lim beautifully sums it up:

Midwives are the guardians of normal birth. Yet in these times we may have forgotten what normal is. We are certain that a close bond between mother and child is normal. My experience is that Lotus birth facilitates that bond. Yes, it is inconvenient to move around with the baby attached to her placenta. So mother lies in, close to the baby and placenta; breastfeeding is established in this sacred circle of quiet, restful seclusion. Yes, few visitors feel welcome while the placenta is still attached. It is during this space out-of-time that family may be invented, and that the new mother reinvents herself.

 

(Photo credit: Veronika Richardson, Fox Valley Birth & Baby, “Tranquility”, 2018)

So what about the practicalities? How does one actually have a Lotus Birth?  This article is great for answering many frequently asked questions (with lovely images of Lotus Birth to boot).  According to Lotusbirth.net,  first you wash the placenta in warm water after it’s been delivered (and after it’s finished pulsing/ transfusing all its blood to the baby) and then pat it dry. Then place the placenta in a sieve over a bowl for about 24 hours to allow it to drain. After this, the placenta can be placed in a nappy or cloth and covered with salt and herbs like dried goldenseal, lavender, turmeric or sage, with more salt and herbs added daily and the nappy changed daily (if you have a placenta bag, the nappy can be placed inside the bag). There are no reported cases of infections being transferred from a degenerating placenta to a baby, although RCOG states that there is the potential for infection and advises that practitioners should act quickly if any signs of infection in the baby are noted. Many anecdotal reports state that the placentas dried out and remained surprisingly odourless for days when salt was used to preserve them.

Naturally, Lotus Birth won’t feel right to many women, but if this appeals to you, don’t hesitate to ask for it. As midwives, we need to be able to support all women’s birth choices, including Lotus Birth.  As quoted from a Guardian article on Lotus Birth: “Unsurprisingly, lotus birth is a minority home birth activity, says Mervi Jokinen of the Royal College of Midwives, although there is no reason you couldn’t ask for it at a hospital birth. “The people who do this are happy to see the experience as a life event and a natural thing. It’s difficult to make a clinical comment on this because there are no studies.” Which is all just to say that even if it’s an unusual practice, it’s absolutely something that midwives can (and should) support. We didn’t have a Lotus Birth with either of our home births, but looking at all of this information now, part of me wishes that we had!

 

Buckley, S. (2003) ‘Lotus Birth: A Ritual for Our Times’, Midwifery Today, 68 (Autumn 2003), pp. 36-38.

Buckley, S. (2010) The Amazing Placenta. Available at: http://www.mothering.com/articles/the-amazing-placenta/. (Accessed 8 March 2018)

Lim, R. (2001) ‘Lotus Birth–Asking the Next Question’, Midwifery Today, 58 (Summer, 2001), pp. 14-16.

Student Midwives Need More Exposure to Continuity

Student Midwives Need More Exposure to Continuity

(I wrote this post for the Continuity Matters campaign being run by the very inspiring Michala Marling–something which is very dear to my heart, and the gold standard for midwifery care.)

What if I told you that there was a new, magic intervention that was guaranteed to lower the rate of epidurals, cesarean births, instrumental deliveries, preterm births, miscarriages and even neonatal deaths? Sounds too good to be true, right? This intervention is so miraculous, though, that not only does it reduce all of those risks above, but it also increases the likelihood of having a normal, uncomplicated vaginal delivery. It even shortens the duration of labour, and women across the board not only feel more positive about their births, but also more satisfied with their care in general. Sounds incredible, right? If you were a pregnant woman, you’d definitely want to make sure that you received this intervention, right? You would be clamouring to get your hands on it!

But here’s the rub—this intervention already exists. It isn’t new—it’s been studied for decades, and all of the evidence is quite clear. It’s even something that the RCM and RCOG both agree on! The magic intervention? Relational continuity with your health care provider during your pregnancy, labour, birth and postnatal period. That’s it. Continuity of care and carer. Meaning that every time you have an antenatal appointment, it’s with the same midwife. When you go into labour, the midwife you know and trust is the one supporting you at your birth, and she continues to care for you during the first several weeks after the delivery as you weather the normal postnatal ups and down during your transformation into a mother. Continuity of care and carer. That’s all we need for better outcomes across the board. That’s the magic bullet.

And women don’t just need this, but midwives need this as well. Study after study has shown that when midwives are able to provide continuity of care to women (known as case-loading midwifery here in the UK), there is less burn-out, more job satisfaction  and more autonomous practice. Continuity of care is the one magic intervention which will improve maternity services across the board, in all areas, for women AND midwives. It really is that simple.

Except that it’s not. Very few NHS trusts provide a case-loading model of care for their maternity services. In fact, unless you’ve hired an independent midwife or a private midwife through a company like Neighborhood Midwives, chances are good you won’t receive continuity of care in your NHS trust. Which means that the majority of women in the UK aren’t receiving this amazing, life-changing, magical intervention. Because of this, increased continuity of care is a priority in both Midwifery 2020 and the Better Births Initiative.

I first experienced continuity of care as a brand new midwife working in Brooklyn with some of New York City’s most vulnerable women who were attending a Medicaid-only public hospital for their care. It wasn’t complete continuity of care and carer, but it was pretty close. In the antenatal clinic, when you did an initial booking visit with a woman, she would then follow-up with you for all of her future visits (assuming she was appropriate for midwifery care; any women in need of obstetrical care were transferred to the obstetrical team). Which meant that as her pregnancy progressed, you really got to know her, even though you only had 15 minutes per visit. In many cases, towards the end of the pregnancy, when you were seeing her on a weekly basis, you knew her so well that you recognised her name on sight, and knew all of her history without needing to consult the notes. You knew her birth plans, her hopes and desires for her birth, as well as her concerns and fears. You often also knew the names of her older children that she always brought with her to the visits, and in many cases, you knew her partner too. You could greet her with a familiar smile, answer her questions, and pick up conversations that you had left off the week before. It also meant that there was time for the relationship to grow and for trust to develop between you. In some situations, this meant that as she got to know you, she would finally feel comfortable enough to confide in you about domestic violence, substance misuse or other issues going on in her pregnancy—things she hadn’t been comfortable discussing at the earlier visits, and things she probably would never have mentioned if she was seeing a different provider for each antenatal appointment.

It wasn’t a perfect system by any means—the visits were still too short, and while there was continuity in the antenatal and postnatal setting, there wasn’t continuity on labour ward, which meant that we worked shifts on labour ward and delivered whoever happened to be in labour that day, rather than being called in for our own clients when they went into labour. However, sometimes, when I was lucky, one of the women I’d cared for in the antenatal clinic would be in labour during my shift, and then I was able to provide her with complete continuity. The look of joy lighting up her face when I would first come into her room as she laboured was always priceless—and it was a look of joy that was always mirrored in my own face as well, since it was an absolute pleasure to be able to care for women that I knew well and had formed a relationship with. In fact, many of my clients would inquire about my schedule during the weeks around their due date, and in some cases would try their best with acupuncture and spicy food and lots of sex to go into labour on the same days as my shifts.

I also had an opportunity to provide complete continuity of care briefly during a 5-month stint as an independent home birth midwife in Brooklyn. I was a younger midwife joining the established practice of an older midwife who had been providing continuity of care on her own for years. Unfortunately, she and I never really gelled as a team and the partnership was very short-lived, but the experience of providing care for women that I had an opportunity to really get to know well during (luxurious!) hour-long antenatal visits at their homes was indelible. As each woman approached her due date, at each visit, there was growing anticipation leading up to the birth, and when the phone call finally came that she was in labour, my first thought was often excitement and joy for her, rather than disappointment that I would have to leave my warm bed or whatever activity I was currently doing. This made the on-call slightly easier to bear, despite the fact that it was pretty brutal (we had to take on six births a month in order to be able to cover our salaries and our indemnity insurance, which, trust me, is A LOT of work in a month). I missed Thanksgiving, Christmas and New Year’s that year, and was sometimes away from my 1 year old son for up to 30 hours at a time. It wasn’t sustainable, but the continuity did provide enough joy to almost (almost) balance it out.

I was also lucky enough to be on the receiving end of continuity of care with both of my pregnancies. With my first pregnancy in the States, I knew from the very beginning that I wanted to have a home birth, so this automatically meant that we were going to have to seek out private midwifery services, since home birth is not provided in the US through any hospital-based system. My husband and I interviewed several midwives providing private services and finally settled on a two-midwife team that lived fairly close to us, and who seemed to click with us on every level. Over the course of my pregnancy, my visits were split between the two of them, so that I had an opportunity to get to know both very well, and by the time I went into labour, I felt equally comfortable with both of them. These two midwives took turns with the call, meaning that one of them would always be available by phone at any point in my pregnancy, and while I didn’t have to avail myself of their on-call services much during the pregnancy (except for one really bad case of the flu around 20 wks), it was a tremendous comfort to know that I could speak to my midwives at any point, whenever I felt like I needed them. It was also a tremendous comfort to know that when the big day finally arrived, it would be someone who knew me and my pregnancy well who would be picking up the phone to answer that call. And thank goodness for that! My first labour was a 56 hour marathon, during which time I lost hope on several occasions. However, because I knew and trusted my midwives and had a relationship of trust and respect with them, I believed them when they told me that things WERE progressing, that everything was normal, that we didn’t have to transfer to the hospital (in my labour-haze I had determined that hospital augmentation, or possibly cesarean birth, was the only way I was going to deliver). If I hadn’t known them and trusted them as much as I did, I don’t know that their words would have carried as much weight with me at a time when I was seriously doubting my ability to give birth. And lo and behold, they were right: 56 hours later, I did indeed give birth in my living room, surrounded by this loving circle of support!

With my second pregnancy, here in the UK, I was really excited by the fact that home births were a service provided by the NHS, and something that wasn’t viewed as inherently risky or completely crazy—what a relief to be in a country that valued evidence, had a thriving midwifery presence, and a long history of midwifery care as the norm for all pregnant women! However, when I began to inquire into what the NHS home birth service looked like in my trust, I was very disappointed. Yes, the NHS would absolutely support my desire to have a home birth, but the majority of my care would be provided at the antenatal clinic at the hospital, following the usual schedule (and since I was a multip, this meant fewer visits with midwives than I would have been having as a primip). I would meet the community midwifery team for the first time at 28 weeks for one visit, and then again at 36 weeks, but this meant that I wouldn’t have much of a chance to get to know them at all, or even meet everyone on the team. Since there were 6-8 midwives on the team, chances were good that when I did go into labour, a complete stranger would be answering the call and coming to our house. I also learned that sometimes if the ward was very busy, the on-call community midwives were asked to come help out on the ward, and that when I went into labour, if the community midwife was on the ward at that moment, she would ask me to come to the ward for my birth. Not ideal! Even though it was absolutely within my right to put my foot down and insist that the midwife come attend me at home instead, the thought of having to make a decision like that while in labour (and to selfishly pull a midwife away from a busy ward where she was caring for other women) filled me with dread. Having had a taste of true continuity of care, it’s hard to settle for anything less than that the second time around. So in the end, we decided to hire an independent midwifery team for our second birth as well, and he was born in our downstairs loo into the loving hands of our midwives, whom we had gotten to know and adore through 9 months of unhurried antenatal visits in our home. It was expensive, but we were lucky enough to be able to afford it, and to my way of thinking, it was worth more than every pence we paid for it, especially when my son became very sick with a bout of viral meningitis on Day 5 and we ended up in the hospital with him—being visited daily by our independent midwives, whose familiar faces and support made such a difference to us during such a stressful time in our lives!

Giving birth with someone you know and trust is transformative, and it makes perfect sense: labour strips you down to an incredibly vulnerable place, by necessity, and it’s much easier to remove your armour and surrender to that vulnerability when you’re surrounded by people you trust. Additionally, labour is hormone mediated, which means that the more relaxed a woman is, the more easily the hormones of labour can unfold, without cortisol (a stress hormone) blocking the effects of the love hormone oxytocin (which is responsible for uterine contractions, among many other things). Women are incredibly sensitive and perceptive when they’re in labour; even small levels of anxiety are sometimes enough to disrupt contractions. Many women experience this when they first transfer to the hospital, discovering that their labour, which was booming along in the comfort and safety of their home, suddenly stalls over the journey and admission to the hospital. Continuity of care can help buffer these effects, though. When a woman is with a team that she knows and trusts, the message her labour brain receives is one of safety and security, rather than stress and anxiety, and this encourages the labour to progress without intervention (and is probably one of the reasons that continuity models have higher numbers of spontaneous vaginal deliveries, and lower numbers of augmentation, instrumental deliveries and cesarean births).

Therefore, with all of this in mind, I was really excited to learn that continuity of care would be part of our learning experience as a student midwife, and I envisioned myself giving care to women as part of the community midwifery team and getting to know them over the months of their pregnancy. However, I quickly learned that in the trust that I’m working at, continuity of care is the exception and not the rule. While a new case-loading model for high-risk women is going to be trialled at our trust over the next year, at the moment, the hospital-based antenatal care is often done by a different midwife at each visit—often midwives who are part of the same community midwifery “team”, but still different midwives. In some situations, there is antenatal continuity, especially in smaller satellite clinics which are run by the same midwife every week, but at the main hospital this is not often the case. And unfortunately, there is no continuity between the antenatal team and the labour ward team. When a woman finally goes into labour and comes to Labour Ward, she is greeted by brand new midwives she’s never met before, who are then tasked with the difficult job of building rapport and learning about the woman’s history and birth plans on the spot, while she’s in labour, which isn’t exactly the ideal time to be doing this crucial relationship-building. (For the record, though, the labour ward midwives work exceptionally hard at immediately building trust and rapport with the women when they come in, and are often able to provide exemplary care in spite of this significant hurdle—kudos to them! It’s not an easy task at all!). Additionally, the home birth on-call schedule is shared between the entire community midwifery department, which again means that when a woman calls to say she’s in labour, the community midwife who attends her birth will most likely be someone she’s never met before. If the woman is lucky, she might be cared for in the community by the same midwife for each of her postnatal visits, but again it’s common for different members of the same community team to visit her on different days, depending on which days they’re working.

As a student, we’re required to case-load at least one woman every year of our education, but our programme defines case-loading pretty loosely: one antenatal visit, caring for the woman in labour, and then one postnatal visit is all that’s required, although we’re certainly welcome to see the woman/ family more often than that if we can manage it (and if our schedule allows!). Even this minimal requirement is difficult to achieve, though, because we’re not allowed to give the women we’re case-loading our mobile number due to privacy/ confidentiality/ legal issues. Which means that it’s really hard to know exactly when she goes into labour! There are brightly coloured stickers which we put on the outside of the woman’s chart which have our contact details on them, in the hope that the midwives will call us when she arrives in labour at the hospital, but this doesn’t always happen. In fact, I case-loaded four women antenatally, each of whom I was lucky enough to attend two antenatal visits with, but I was never called by Labour Ward when they arrived in labour (despite the stickers on the front of their charts with my name and mobile number on them)— so I missed their births. In the end, to fulfill the requirement for case-loading in my programme, I “case-loaded” a woman who I saw once in triage in early labour, who was then sent home (this counted as my antenatal visit), who then returned to the hospital later that day and was admitted in labour. I attended her birth and helped catch her baby, and then saw her the following day on the postnatal ward (which counted as my postnatal visit). This isn’t exactly true case-loading or continuity of care, by a long shot! But if you’re a student in a trust where true case-loading doesn’t exist, this might be the best you can do in a less-than-ideal situation. If I hadn’t already experienced case-loading in a professional capacity as a midwife in the States, or as a pregnant woman receiving it, I’m not sure I would understand that continuity of care looks a lot different to what is being offered in my trust. Which is by no means suggesting that the care women are receiving in this trust is bad care–on the contrary, I think it’s very GOOD care, all things considered–but it’s not true continuity of care, and there’s plenty of room for improvement in that regard.

Continuity of care is meant to be an integral part of the student experience, but unfortunately it’s nearly impossible to ensure that students are exposed to this model of care. I’ve spoken to many students who have had the blessing of experiencing true continuity of care—Michelle Marling, the author of the Continuity Matters campaign, was lucky enough to discover this early in her student experience, which she has written about before. Once you’ve had a taste of the joys of continuity of care, it’s a lot harder to settle for anything less! But if you’re never exposed to true continuity of care as a student, you never learn that there is another model of care out there. You never learn to treasure it, to seek it out, to make it happen, to fight for it if necessary. You grow up in the system as it stands, learning how it works, growing confident in your skills and competence within that system, and all the while never know that other options exist. And it all boils down to a chicken-and-egg sort of question. If student midwives aren’t exposed to continuity, they won’t want to provide that type of care. They won’t clamour for creating continuity models in their trust, they won’t be keen to sign up for case loading teams, they won’t want to provide that type of care—and then, less of that care will exist, and even fewer students will be exposed to it. And around and around it will go. This is how systems are perpetuated, and why creating systemic change is always so challenging.

Thankfully it does seem like the message of continuity is starting to seep into the system, with the RCM, RCOG, Better Births and Midwifery 2020 all promoting it (and even the World Health Organization recommending it in their most recent intrapartum guidelines). My fingers are crossed that the high-risk case-loading trial at our hospital will be a rousing success, and we can start to roll this type of care out for low-risk women as well. The evidence speaks for itself. What’s more difficult to combat is the perception that case-loading is too difficult, that case-loading midwives never have down-time or chance to see their families, and that case-loading leads to burn-out. In part, I think burn-out occurs because not enough midwives want to case-load (in part because they weren’t exposed to it), which means that too much pressure is put on the few midwives who do. If the work of case-loading is spread out over many midwives, in small teams or in buddy systems, the work is much more manageable (but again, this is easier said than done in a system that’s already 5,000 midwives short). (Better births tries to help prevent this by suggesting caps for case-loading teams, putting a ring-fence around their work so that they can’t be pulled to different units, and allowing the midwives to manage their own schedule and diary.) Nevertheless, despite these challenges, this is the future I long for: a world where all women can receive true continuity of care and the many benefits associated with it, and all case-loading teams are staffed robustly enough to allow each midwife the important down-time and off-duty she needs to recharge her batteries and return to work refreshed and ready to give her all again. This is the case-loading dream! But if students aren’t exposed to this type of care, how will we know to shoot for it?

Safe Co-Sleeping

Safe Co-Sleeping

Unfortunately, there is a very sad article making the rounds on Facebook and several of my news feeds at the moment about a 7 week old baby who tragically died while bed-sharing with his mother. I don’t want to minimise this terrible loss in any way whatsoever, and I completely understand this mother’s desire to share what happened to her child with others as a way of trying to prevent such a tragedy from occurring again (and I can’t even imagine her heartbreak she must be feeling).  However, a lot of the information in this article is not evidence based, and it’s piling a whole lot of fear onto the words “bed sharing”, which isn’t helping when there’s already so much fear and misinformation out there in the first place. (I’ll put a link to this article at the bottom of this post so you can read it for yourself if you want).

First, the article doesn’t mention if this mum made a deliberate choice to co-sleep with her baby, and had therefore baby-proofed her sleep environment with that in mind, or if instead she had accidentally fallen asleep with her baby in her bed. We know that accidentally falling asleep with a baby in an unsafe sleep environment is much more dangerous than making the sleeping environment safe, and planning on sleeping with your baby in your bed. The mum doesn’t say that she was co-sleeping or bed sharing. She says that she fell asleep with her baby, and the baby slipped off the breast.  These are two very different scenarios.

We don’t know if this mum was exclusively breastfeeding or not. The recommendations we do have make it very clear that co-sleeping should only be done in an exclusively breastfeeding relationship. Even one or two bottles of artificial baby milk a day can put babies into a deeper sleeping pattern that is harder for them to rouse from, and it also weakens the mum’s instinctual awareness of her baby in bed with her.

Waking up repeatedly to breastfeed a baby and accidentally passing out from exhaustion in a chair or on a couch is actually much more dangerous for your baby than deliberately planning on co-sleeping safely with them.  There are hormones released during breastfeeding which are designed to help both you and your baby to fall asleep, so it’s very common to nod off while breastfeeding. It’s better to plan for this occurrence to happen in a safe environment, rather than fighting against sleep (and most likely losing the battle) propped up in a chair or on a couch.

Also, the title of the article itself makes it sound like *breastfeeding* was the reason that this baby died, when actually it wasn’t the breastfeeding, it was unplanned bed sharing. In reality, all the evidence we have tells us that exclusively breastfeeding is some of the best protection we have against Sudden Infant Death Syndrome (SIDS).

The article keeps linking to a parents.com article as evidence, saying things like “experts have found…”. Unfortunately, parents.com are not experts on co-sleeping, bed sharing or breastfeeding. Professor Helen Ball and Dr. James McKenna are experts on co-sleeping.

And finally, we need to remember that co-sleeping is not a “trend”. Parents aren’t doing this because it’s cool. They’re doing this because it’s the biological norm for our human species, and the way that we’re supposed to feed our human babies. It’s also the best way to get more sleep as an exhausted new parent, IF you’re exclusively breastfeeding, and IF you make the sleeping environment safe.

So how do you safely co-sleep?

In a nutshell: you need to be exclusively breastfeeding, make sure the mattress is firm and not something you sink into, and that any cracks between the headboard and wall are packed with rolled up towels or clothing so there are no gaps. Duvets and pillows need to be kept well away from the baby (including snoozepods and snugglers and sleep positioners), and the baby should zipped into a sleep sack rather than swaddled, with their head uncovered (and their arms free) The temperature of the room should be about 18 degrees Celsius, and the baby should be dressed appropriately so that they don’t overheat. The baby needs to have been born at term, and should be placed on his/her back to sleep. And obviously, mum and dad both need to be nonsmokers and sober.

Want better evidence than my word alone? Professor Helen Ball’s research from Durham University is one of the best places to start. She has a fantastic website you can visit which talks more about where babies sleep, and how to make their sleeping environment safe.

La Leche League has a check-list you can use as well, called The Safe Sleep 7.  La Leche League also has great article called Safe Sleep and the Breastfed Baby.

Dr. James McKenna, director of the Mother-Baby Sleep Laboratory at the University of Notre Dame, also has an excellent guideline on how to make the sleeping environment safe.

And finally, if you are an exhausted new parent who is combination feeding (i.e. breastmilk and artificial baby milk) and wanting to co-sleep but unable to do so because of these guidelines, putting the baby in a side-car cot that attaches next to the bed (so that they have their own separate sleeping environment while still being very close to you) is a good option, or else a bassinet close to your bed. You could also look into using a baby box in your bed with you, which research from Finland is supporting (although if you’re going to use a baby box, there shouldn’t be any extra padding, blankets, bumpers or pillows with the baby, just a baby and a zippered sleep-sack).

(And finally, the article in question can be found here.)

Notes to Self

Notes to Self

We’re beginning the clinical portion of our midwifery education now, after a very intense, action-packed 8 weeks of theory and classroom work. For the next 8 weeks, we’ll be in the clinical setting, on our placements, learning by doing, helping and shaping the antenatal, birth and postnatal experiences of the women we meet.  I’m SO EXCITED to begin actual midwifery work again! But on the eve of my clinical placement, it seemed like a good time to write a few notes to myself (and my fellow students on the eve of this exciting milestone):

Clinicals are going to challenge you in ways we can’t even imagine yet–even though you’ve done parts of this before, it’s still going to be challenging, and new. You’ll need your mind, your ability to think, your ability to feel, your ability to see clearly, to watch and wait, to put 2+2 together, to use all of this knowledge we’ve been working so hard to acquire.

But remember that birth isn’t in the textbook. It’s in the mother, sweating with exertion, it’s in the partner, whispering words to encourage her, it’s in the baby, liminal and waiting.

Remember that wherever you stand in that labour room, no matter how chaotic, you stand in a holy place. Your heart has called you to this profession, this path, this work. Let your heart shine–your wisdom, your strength, your love.

 

 

Sleep and “Self-Soothing” Roundup

Sleep and “Self-Soothing” Roundup

There is so much conflicting information out there on sleep, and so many messages you’ll hear on why having your baby “sleep through the night” is the holy grail of parenting and that if your baby isn’t hitting this milestone by (insert whatever age you like here), it’s a disaster or they’re not a good baby or you’re not a good mother or you’re allowing them to create bad habits etc. etc.  But the truth is that every baby is unique, sleep needs vary tremendously between kiddos, and learning to “sleep through the night” is a developmental milestone that you can’t really force a baby to hit before they’re ready, just like you can’t force them to sit up or crawl before they’re ready. Also, it’s important to remember that even as adults we wake up several times in a night (because we’re thirsty, or hot, or cold, or have to use the toilet, or had a bad dream, or heard a loud noise, or are stressed about something, or uncomfortable, or or or…), but the difference is that as adults we have learned to roll over, self-soothe and go back to sleep. Babies are still learning this skill.  It takes years for them to fully master it, and until they do, they often still need our help, input and reassurance to fall back asleep. Meeting a baby’s needs is not “creating bad habits”; it’s being responsive and attentive to the baby’s needs, which in the long run will create more security and independence.

Strangely enough, discussing sleep and self-soothing is a very “controversial” topic. On parenting boards and facebook groups and public forums, there are strong advocates for sleep training, using either “controlled crying”, “gradual extinction” or “crying-it-out” (CIO) methods as a way of teaching a baby to sleep through the night. There are equally strong advocates against these methods. Because every parent is exhausted (EXHAUSTED!), there is an unending market for books, sleep gurus and training methods as desperate parents (understandably) look for ways to get more sleep. And not surprisingly, the message you get from mainstream sources, news articles and “how to get your baby to sleep” books suggest that a baby who isn’t sleeping through the night by (insert whatever age you like here) is a problem that needs to be fixed. But what I am more interested in looking at is the actual science behind these differing approaches. Research into sleep, such as what Professor Helen Ball at the University of Durham is doing through the Infant Sleep and Information Source, is still a relatively new field, but there is a growing body of evidence which is beginning to refute the claims of the many (insanely popular) sleep experts and authors and gurus who recommend this or that sleep training technique.  The following is a round-up of some of these articles.   

First, Sarah Ockwell Smith has a great article on realistic sleep expectations for babies. As you can see, there is A LOT of normal variation in this, and even if one baby is ready to sleep through the night at 8 months, another baby might not be ready to do so at all. Each kiddo is unique and has different needs. 

Sarah Ockwell Smith also has a good article on what’s really happening when you teach a baby to “self-soothe”. Unfortunately, sleep training methods don’t really teach our babies to self-soothe. This is a developmental skill which they can only learn with time and maturity. Instead, it teaches a baby to stop signaling her distress. Babies are smart and they very quickly learn that if crying doesn’t bring a response, it would be better to conserve their energy instead and not use a method that doesn’t work. A study done in 2012 by Middlemiss et. al. monitored the cortisol levels (i.e. stress levels) in 25 mom+baby pairs and found that at the beginning of the study, the mom and baby were synchronised in their stress response, meaning that when the baby was stressed and signaled this to the mother, the mother responded to this with a rising cortisol level of her own. In other words, if baby was distressed, mom was distressed, and their cortisol levels were in sync. By Day 3 of the study, after using a gradual extinction sleep training method, the researchers found that the baby was no longer exhibiting stressed behaviour, but the baby was still distressed (as demonstrated by high cortisol levels). Meanwhile, because the baby was no longer signaling its distress, the mom’s cortisol levels had decreased, indicating that she was no longer in sync with her baby (at least in terms of cortisol levels).

Calm Family wrote a very detailed response to the BBC One’s recent airing of Panorama, Sleepless Britain, which addresses many of the ways “sleep issues” are portrayed in the media.

The Analytical Armadillo, another IBCLC blogger, has also written a good analysis on what happens during self-soothing, and that even though it works (and it does work), it’s not necessarily harmless.

Evolutionary Parenting looks at the science behind exposing our kids to stress, and what’s actually going on neurochemically in their brains when this happens. 

Uncommonjohn also looks at the science behind self-soothing

The Milk Meg writes about the many reasons our babies wake so frequently in the night.  

And while this doesn’t actually get into the science behind it, Mama Bean Parenting documents quite…succinctly…the many, many, many messages we receive in our society which tell us that a baby that doesn’t sleep through the night is a “problem”.

Finally, Dr. Sears has some good suggestions on ways to get more sleep without using CIO methods, as does Dr. Jay Gordon in this article. The Milk Meg also has some ideas on ways to gently night-wean breastfeeding babies.

And one final disclaimer, since I know this is an incredibly sensitive subject for many parents. I understand the desperate need, the overwhelming desire, to somehow find a way to get more sleep! We’ve all been there. Many of us are still “there”.  Parenting is exhausting, and waking frequently with our babies in the night is not at all conducive to our modern lifestyles. I absolutely get it. And I have many clients and friends who have used sleep training methods, sometimes with very good results–hell, I’ve attempted a few of these methods myself with my first son out of sheer desperation (but wasn’t able to follow through with them). I am in no way judging the reasons why parents might turn to these methods, and I have nothing but empathy for the desperate exhaustion that makes these methods seem like the only answer. Getting more sleep is a positive thing for everyone involved, and allows us to be better parents, and in our bleary, sleep-deprived states figuring out how to get more sleep seems all-consuming and anything promising a quick fix seems like mana from heaven. But it’s important that we as parents do careful research and make informed decisions before deciding on a parenting course of action. Our media and society is saturated with messages about sleep and ways to “fix” it, and nearly all of these messages usually recommend some form of sleep training. That is one side of the debate. All of the articles I have posted here are the other side. It’s important to understand both sides before making an informed choice.

As a midwife, asking “Is your baby waking regularly and feeding regularly?” is a much more supportive and useful question for new parents instead of “Is your baby sleeping through the night?”. Most likely, a normal and healthy baby who’s feeding regularly and growing well will NOT be sleeping through the night, so rather than make parents feel like there’s something wrong, it’s much better to emphasise what’s absolutely right about this scenario. And then look for other ways to support exhausted parents to sneak a bit more sleep into their lives.

Sealing Birth

Sealing Birth

I’ve been finishing up the requirements for a Sacred Pregnancy Belly Bind and Sealing course which I started years ago, but was never able to complete thanks to the birth of my second son, which threw me for a bit of a loop. Two years later I’m finally coming back to it again, and have been enjoying it very much. At the heart of the course are the skills needed to do a bengkung belly bind (pictured below), but the course is about more than just the physical binding itself. It’s also about learning how to create a sealing ritual to honour the birth and provide closure for the woman, as well as supporting her through her postnatal journey–both of which are sorely lacking in our modern world!

Pregnancy and birth is all about opening, on so many levels: opening yourself physically, opening yourself spiritually and emotionally, opening yourself up to the vulnerability of a new and powerful love, and opening yourself mentally and psychologically to the needs of another human being (and being willing to put those needs first). Our western culture is fairly good at discussing the physical opening that takes place (just go to any childbirth class or antenatal prep class and it will be all about the stages of labour and dilation and what happens to your body), somewhat good at acknowledging the mental and psychological opening that takes place (but better at focusing on the baby’s needs than on the mother’s needs), and generally not so good at the emotional or spiritual opening that’s going on. Antenatally, there is the tradition of the Baby Shower (very popular in the US, much less so in the UK), which revolves around gift-giving and providing for the material needs of the baby but tends to gloss over the emotional or spiritual needs of the mom and the transition she’s undergoing. A Mother Blessing, based loosely on a Navajo tradition known as a Blessingway, is a newer tradition that’s been growing in popularity and does a better job of filling the emotional and spiritual void by honouring the mother and her journey and showering her with love and blessings from her community. However, this still pertains mostly to the antenatal time period, and is focused on the birth itself. Overall, in our modern society, very little attention is given to providing closure for women, helping them to ground and center themselves again after such a transformative experience, and acknowledging their new role as a mother. That’s where a sealing ceremony comes in.

After an opening, it makes sense that there should be a closing. A woman needs to be sealed, on so many levels. Physically, her womb and pelvis and pelvic floor need to contract again, after softening and expanding and dilating. Her abdomen has to knit together once more after the diastasis recti muscles have literally come unzipped.  Her blood volume shrinks and her blood pressure may rise again (slightly–this is normal, and has nothing to do with the stress of having a newborn!).  On a chi/ energy/ prana level, she has to re-balance herself and find her own, singular energy rhythms again, after having adjusted to holding her own chi as well as that of her growing baby.  Emotionally, she has to adjust to the sudden emptiness inside of her, after having grown used to sharing her body and feeling the baby’s movements inside her for months and months.  And even more importantly, she has to adjust to being the only occupant of her body again, reclaiming herself as a single entity, and feeling the wholeness of herself once more. Spiritually, she is going through perhaps one of the biggest transitions of her life, from maiden to mother, with all of the new uncertainties, vulnerabilities and identity upheaval that contains. It’s a very big deal–SO much is happening on so many levels, but in our western culture there is no formal way to acknowledge or honour this process.

Many traditional cultures around the world have sealing ceremonies and traditions which are an important part of the postnatal process. In China, new mums are encouraged to stay in bed for the first 30 days and are fed “warming” foods, often with lots of ginger and bone marrow in them to help . In India and traditional Hindu cultures, women remain home with their new baby for the first 40 days to help promote breastfeeding and avoid infection (interestingly enough, it takes about 6 weeks for a woman to fully establish her milk supply, which may be the underlying reason for this), allowing family and friends to care for her while she learns to care for her baby.  Bengkung binding traces its roots to Malaysia, where it’s part of the traditional postnatal care offered to women. But of course, in modern America and the UK, there’s often very little room made for the woman’s transition during the postnatal phase. The focus is very much on the baby. The early weeks of the postnatal period involve trips to the paediatrician (in the US) or home visits by midwives and health visitors in the UK, checking the baby’s weight gain before finally discharging the mother/baby dyad from care around Day 10. Well-intentioned family members and friends encourage the mom to “get her life back” or “get her body back”, set up feeding schedules and routines for the baby and attend baby classes and postnatal groups as a way of socialising, all of which require the mum to leave the house with her newborn at a time when she’s not fully confident in her new identity yet, and often still overwhelmed by the transition and the round-the-clock needs of her baby.

And of course, we’re getting it wrong again and again. For one thing, very few women are recovering from a peaceful or empowering birth in the first few weeks.  Most are having to process and contain experiences that ranged from disappointing to outright traumatic.  As a midwife and lactation consultant, part of my job is to listen to women’s birth stories. Often I’m visiting with women in the first few days or weeks after the birth, when the experience is still very raw and they’re still processing it. Asking them to share their story can sometimes open floodgates of emotion for them, particularly if the birth was traumatic to them. A big piece of my job is to give the woman time to tell her story, in her own words and at her own pace–not just to share the details of it for the purposes of collecting her medical history, but to give her a chance to debrief. Even if she’s already told all of her friends and family about her experience, there’s something different about the listening you do in the role of a birth worker. It’s important to give her space, without judgement, and to acknowledge her experience. Sometimes sharing her story will bring up questions about it that she didn’t even know she had, which I’m sometimes able to help answer (particularly if the question is about something technical), and sometimes not (but sometimes just being able to formulate a question for the first time is helpful). Other times she doesn’t have any questions, but will simply repeat something over and over again, usually until it’s acknowledged (and here, echoing the woman’s words back to her helps tremendously; she might say at 6 different points in the story that she hadn’t really wanted to be induced, and saying a statement like: “You really didn’t want to be induced” allows her to feel like she was heard). There are many counseling tips and tricks that you pick up along the way, such as active listening, asking open-ended questions, reflection, paraphrasing, summarising and clarifying etc. But the root of it, of course, is listening without judgement, and holding space for her to be or feel whatever is coming up for her. This is an important part of sealing a birth, and can be very healing for a woman.

Mothering is incredibly invisible and unappreciated in our society. In other cultures, mothers are respected and honoured on a fundamental level which we seem to be missing. So much of our identity comes from what we do professionally. Just think of a dinner party with new acquaintances where everyone is going around asking you about “what you do”. When I was not working professionally but rather staying home with my children, I would often respond to these types of questions with something like: “Oh, I’m just a mother right now” (JUST a mother…), or “Not much”.  Not much! As if the enormity of my daily work–caring for my children, nourishing them with my body when I was breastfeeding, preparing and cooking meals for them, running the household, doing laundry, cleaning, grocery shopping and a gazillion other domestic chores, but more than anything else teaching them *constantly* by my words and actions and attitudes–amounts to nothing much at all because at the end of the day I had very rarely achieved anything, at least anything that could be crossed off of a to-do list or recognized by the wider culture as important.  The work is repetitive, monotonous, lonely and under-valued, and in our culture it’s very low-status work. One has only to read a book like What Mothers Do by Naomi Stadlen to see the damage this lack of status inflicts on women on a daily basis. Here we are working our guts out, but the idea of a stay-at-home mother in our culture connotes the idea of not doing much of anything (but actually, this applies to any mother, because even working mums still have to come home from their paid job to begin their unpaid job of mothering, and are most likely only recognised for the work they do as part of paid employment). And we wonder why women are suffering from postnatal depression and anxiety in higher and higher numbers, or why modern women today are struggling as much as they are find their way.  The author of this article eloquently points out that perhaps feminism has let women down on this front. I agree with that, but I also think it’s part of a wider malaise in our society: raising children and parenting the future generation is not seen as important, meaningful work, and this is a problem.

Which brings us back to sealing birth…rather circuitously.  We need to get better and sealing birth for women. We can do this formally, through a ritual like the one Sacred Pregnancy has created (or something that we create on our own), or informally through birth debriefing, but at it’s very heart sealing a birth involves acknowledging the transition she’s been through, recognising the incredible work she has done and is currently doing–the work of giving birth, which is in itself a monumental achievement, but also the ongoing work of mothering–and honouring her for this. Sealing birth won’t elevate the status of motherhood overnight, or fix the many deficiencies in our culture, but it can definitely help to make a difference on an individual level to the woman herself. And every woman who feels supported, recognised and honoured as a mother will bring that confidence to her vital and incredibly important job of raising the next generation, and shaping our society in the process.

Looking back, I think that I was very lucky in that I was able to seal my first birth pretty well. While I never had a formal ceremony done, I was lucky to have had a very empowering birth experience (I’ll get my two birth stories posted soon) and I happily recounted my birth story over and over and over to whoever would listen. I felt like superwoman–I felt like I could do anything, after having given birth! There was something about repeating it again and again, something in the telling of the story, that helped make it real for me, and helped me gain closure on it. The telling of it and the closer helped to translate the confidence I felt about my birth into a growing confidence I felt about my new role of as a mother (Breastfeeding? Pshaw! OF COURSE I can breastfeed. I just gave birth after all–I can do anything!) I also had loads of support and help from friends and family in the first few weeks after my first birth, which made it a relatively smooth transition. With my second birth, this wasn’t the case. Even though the birth itself was wonderful, joyous and empowering, the postnatal period became incredibly stressful due to a medical emergency with my 5 day old son, which threw everything off kilter. Also, since it was the second time around, my expectation was that of course I would be able to manage it, just like I had with my first…but in reality, I found the transition from one child to two children incredibly difficult!  And perhaps not surprisingly, I suffered from postnatal depression with my second son (again, I’ll share the story on here sometime soon). I think sealing is crucially important part of the birth experience. Was your own birth sealed? And if so, how was this accomplished?

 

Bengkung belly binding

 

 

Breastfeeding News Roundup

Breastfeeding News Roundup

Breastfeeding has been in the news a lot the last few weeks. Here’s a quick roundup of some of the most interesting and exciting new articles regarding our first food, and why it’s so important.

First, a viral post about the microbiology research of a Vicky Green, a Biosciences student at South Devon College, who demonstrated the power of breastmilk by placing it in petri dishes cultured with some of the nastiest bugs around, including MRSA and E. coli. In the picture in the link, you can actually see clear rings surrounding each drop of breastmilk on the petri dish where the bacterial growth was halted by the breastmilk proteins. What’s even more remarkable is that she’s using the breastmilk from a mum nursing a 15 month old and a mum nursing a 3 year old, which just goes to show that breastfeeding DOES continue to play an important and vital role in nourishing our children and providing optimal health for them well past the first 6 months of life. Unfortunately, as an IBCLC, I hear all too often from clients that they were told by a (presumably well-meaning) GP or Health Visitor that there’s no benefit to nursing a baby past 6 months. Absolute nonsense, as this research so clearly demonstrates! And who knows, perhaps the protein in breastmilk will hold the key to defeating bacteria like MRSA in the future.

And speaking of nursing babies beyond infancy, Tamara Ecclestone recently posted a lovely photoshoot of herself nursing her 2 year old daughter Sophia and just about broke the internet in terms of controversial backlash, as people reacted so negatively to the photos that she was actually forced to defend her decision for posting the photos in the first place. Which honestly is just a very sad state of affairs. Also, the BBC article linked above doesn’t provide 100% accurate information. UK guidelines for breastfeeding are in line with WHO guidelines, and state that babies should be breastfed exclusively for six months and then continue to be breastfeed for a minimum of 2 years OR BEYOND, in addition to the food they’re eating. For the record, the right time to wean is whatever feels right for mom and baby, but the biological norm for our mammalian species is to breastfeed for anywhere from 2-3+ years, and as with all phases of growth or development, there’s a huge range of normal in terms of the right time to wean depending on the mother and baby dyad. It’s irresponsible to suggest that the UK guideline only encourages breastfeeding for the first 6 months. As for the controversy, unfortunately that’s nothing new. People are often outraged by the thought of breasts being used for purposes *other* than sexual, and sadly we hear of stories all the time of women being shamed for nursing in public, or told to use the toilet instead. And not surprisingly, most likely due in part to these cultural perceptions, the UK has one of the worst rates of extended breastfeeding of any developed nation in the world–even lower the the US’ rate of extended breastfeeding, which is quite surprising given that women in the UK routinely have 6 months of maternity leave (and often a year) compared to women in the US who often receive a scanty 6 weeks, if they’re lucky enough to receive anything at all. Clearly there’s still A LOT of room for improvement, and personally, as someone who’s still nursing her own two year old, I applaud Tamara Ecclestone’s decision to share her beautiful photos, which is an important part of how we can begin to normalize breastfeeding in the first place. The Milk Meg also has a wonderful article on this entitled: 9 Reasons my child is not “too old” to breastfeed.

And finally, this is a fascinating article by Kathleen Kendall-Tackett, IBCIC (who I saw at the LCGB conference last year, and is a fantastic speaker), discussing all of the ways that breastfeeding doesn’t just provide the optimal food for our babies, but also provides the best emotional and neurological foundation for their mental health. Breastfeeding encourages responsive parenting, promotes sleep (which in turn supports better parenting, as well as lowering the risk of postnatal depression–and breastfeeding is an independent factor for reducing maternal depression as well, regardless of sleep). Breastfeeding also promotes nurturance, attachment and bonding. As I often tell clients, breastfeeding is 10% about the FOOD we’re feeding our babies (and what incredible food it is!) and 90% about THE MANNER in which we’re feeding our babies, setting them up for healthy brain growth, emotional processing and psychological attachment in addition to optimal nutrition.

My First Week Away From Them

My First Week Away From Them

I just spent a week away from my boys–the longest time I’ve ever been away from them since my eldest son was born five years ago. I went skiing with some good friends, entirely on my own, while my partner held down the fort in my absence.

I think I’ve been dreaming about this week away for nearly five years now. In the early, bleary-eyed days of new motherhood, when I was certain the exhaustion would kill me, I dreamed about mere hours away.  A week was unimaginable, but I would fantasize about someone taking my son and holding him for three hours while I took a nap. And in all fairness, there are several occasions when I can remember exactly that happening. My in-laws would babysit every now and then, or my partner. Once two work colleagues took him for a walk for two hours while I slept on the couch, and once, in desperation, I went to a friend’s house 10 blocks away and slept in her bed for three hours, as I found it nearly impossible to sleep–really sleep, deep and undisturbed–if the baby was anywhere in the house with me. Even his slightest whimpers, faint snufflings in his sleep, would set me bolt upright, in those early days, so any chance of a real nap would have to be done away from him.

And then, as he grew older, I began to dream about entire days away, and even entire weekends. I would imagine how glorious it would be, how unfathomably luxurious, to have an entire day to myself. To do the things I used to do, the things I took for granted, before I had children. To sleep in late, have a lazy morning in bed reading the paper, showering for a full, uninterrupted 20 minutes, enjoying a leisurely brunch at a local restaurant, lingering over my coffee–hell, on some days even an uninterrupted 5 minutes on the toilet felt luxurious, the stuff of fantasies.  I couldn’t imagine an afternoon spent browsing through bookstores or watching a movie, cooking a complicated meal from a new recipe book, knitting while watching TV, drifting off to bed whenever I felt tired, rather than trying to sprint through the evening’s interminable to-do list with the bed at the finish line and the distance between us growing longer and longer.

My partner would leave, often for work but sometimes for pleasure, and I would think about how much easier it was for him to have a week or weekend away. He was less tethered, his life carrying on in many of the same ways that it had before children, whereas for me my post-kids life was unrecognizable to my pre-kids life. I was often unrecognizable to myself.  Some days I would cry bitter, jealous tears about this. Some days I felt like I was the default option, taken for granted. He could head off on stag-dos and weekends away because I was at home, maintaining the routine, ensuring that naps were had and noses were wiped, food was cooked and cleaned up and cooked and cleaned up again, bodies bathed, teeth brushed and bedtimes kept. Needs were met. That was partly where the bitterness came from; that needs came before wants for me now, and that there was never time or room or energy for my wants, whereas my partner could still occasionally fulfill some of his wants.

But little by little, I started to have opportunities to leave. First an evening out with girlfriends after putting the boys to bed, so that they never even knew I was gone, and then an afternoon here, a morning there. A day spent at a conference now and then. I started working again, one day a week as an IBCLC at a breastfeeding drop-in (strangely enough, my day spent “working” often felt like a holiday), and then I began working two days a week, and then three. An avid runner, I began to train for another marathon about a year after my second son was born. I spent hours away, running. And then, for the race itself, I left for an entire weekend away with my partner, while the grandparents watched our children. Brief glimpses of my former self, snatched here and there like an exhausted swimmer coming up for air.

But now, for the first time, with a five year old and a two year old, I am finally in a place where I can go for a week and not feel like my absence will be harmful to them. In fact, I feel quite the opposite–that it would be good for all of us.  Good for me to be away, good for them to realize that they can manage without me (for a little while, at least), good for my partner to be on his own, and understand what it feels like to be the one left behind, holding down the fort, and good for them to see their daddy not just helping me, but single-handedly doing all of the tasks I normally do.  Good to change the routine and remind ourselves that we’re all flexible, that we can adapt. And for the record, my partner is an incredibly capable and involved dad. Leaving him alone with the kids for a week is by no means beyond him, or even a stretch for him, and I had absolutely no qualms about it. They’re in good hands.

And so, here I am, on my own for a week…and it’s been WONDERFUL! But it’s also felt like I’ve had an arm chopped off. I keep feeling the phantom twinges of my family all around me, as if I’ve lost something really important and keep forgetting what it is. I walk into restaurants and start to ask for a high chair before remembering that it’s not needed.  During dinner, I keep feeling like I should be doing a gazillion different things besides just eating my meal and enjoying the conversation. I should be reminding the older one to use his cutlery, reminding the younger one to sit still or he’ll spill his water, trying to get both of them to have a few more bites or else there won’t be any pudding, snapping at both of them to stop harassing each other, refilling plates and making pointed reminders about using napkins, cutting meat and retrieving forks off of the floor etc. etc. It’s as if I’ve gotten used to juggling eight balls while also eating a meal, and now all of a sudden the balls have disappeared…but I still feel like I should be juggling.

And how strange it’s been to move through the world unencumbered again!  To only have to think about myself and my own needs. To be the one traveling light, to sail through airport security in a matter of minutes. To board a plane on my own, with a good book to read and no mental checklists involving emergency snacks and drinks, knowing exactly where various toys, books, games and Lovies have been stowed, checking the batteries on the iPad which is the inevitable emergency back-up to the games and books, and making sure that nappies have been changed and wees had before boarding. To just get on a plane, sit down, put on my seatbelt and be ready to go. How unbelievably decadent! I can roll out of bed and be ready to go 20 minutes later, whereas usually dressing, cleaning, feeding and preparing my children to leave the house is a 1.5 hour long endeavor. The freedom and ease is staggering!

Our culture is really good about focusing on the positives of motherhood and glossing over the negatives, but in truth, motherhood is usually always a mix, and it’s important to acknowledge the dark as much as the light. So much love you feel like you’ll burst (!!), on a daily basis, but also so much uncertainty, responsibility, tedium, loneliness and isolation (and in many cases, depression and anxiety as well). Lots of dark in addition to the light, and rarely a perfect balance of the two. And in those first few days and months, nothing can prepare you for how swift the bulldozing of your identity and former life can be! I feel like the process of becoming a mother razes your identity to the ground, and then, in the wreckage of your former life, you slowly begin to rebuild your identity from the ground up, trying to figure out how to reincorporate all the pieces of who you used to be into this new shape.  And bit by bit, over time, you remember the things you used to enjoy and do on your own before motherhood, and learn new ways to do them again. But this week has made it very clear to me that you never go back to being the person you were before you had kids, even when you do get to the point that you can leave them for a week. All of those months and years fantasizing about time away, so that I could be who I used to be, even for just a little while, is impossible.  That person is gone. Those things I used to love to do before children, I still enjoy, but now they don’t feel like they’re quite enough for me, on their own, because I guess it takes more to fill me up now.

And I miss my kids like crazy. This time away has been nourishing and vital, and very eye-opening, but I feel like what it’s done more than anything else is give me energy to plunge back into the fray of parenting again. And be a better mother for it, as well. I can’t wait to see them again!

The Wasted Hour

The Wasted Hour

We’re mammals. We like to ignore this most of the time, but when you attend births, it’s something which is impossible to forget. And like all mammals, we’ve been programmed to perform an elaborate bonding dance in the first hour after birth, often referred to as The Golden Hour*. During this time, babies are primed to respond to their mother’s voice, to look for her face, to root and nuzzle and find their mother’s nipple, to fix in their mind the image of their primary care-giver, and to breastfeed. Simultaneously, mothers are primed to fall in love with their babies. In fact, the hormonal cascade of labor is actually designed to change the brain chemistry of the woman who just gave birth, increasing her desire to nurture her newborn. Oxytocin, the hormone of love (and breastfeeding), peaks at its highest level immediately after the delivery, ensuring that motherly love—strong enough to move mountains, to fight like a tiger for your cub, to throw yourself in front of a moving bus to save your child without thinking twice—is cemented into place.

Bonding is crucial to survival; evolution has demonstrated this again and again. It’s well documented that in nature, if an animal fails to bond with her baby, that baby’s chances of surviving, let alone thriving, are pretty slim. With humans, it’s not as clear cut. Obviously strong bonds can form even without sharing the very first hour of life together, as adoption and chosen family (as opposed to biological family) demonstrates again and again, but it takes a lot more work. The beauty of the Golden Hour is that the wheels have been so perfectly greased—all you have to do is show up and be present, and falling in love is just about guaranteed.

Or was guaranteed, even just a few years ago. These days, it seems as if we’re almost willfully trying to shoot ourselves in the foot, having gotten way too meta about the entire experience. Since nothing has really actually happened until it’s been posted on Facebook, the very first thing new parents are doing these days is whipping out their phones to share the good news with the world. Gazing in wonder at the new human being who’s just entered their lives is often done through the lens of the smart-phone camera. It’s all about the stats—weight, height, name, time of birth—which is then texted to all the anxious relatives, ensuring that in addition to their parents’ voice, the very first thing the baby will hear is a barrage of beeps, vibrations or ring-tones heralding the arrival of each new text or tweet; their parents are often lost for 10-15 minutes at a time as they respond to the deluge of sms congratulations.

When I first started my career back in 2003, smart phones didn’t exist yet. Parents brought cameras with them to the hospital and maybe snapped a few photos before cuddling with their baby, but that was it. How refreshingly quaint that now seems! These days, I find myself frequently reminding parents to put their phones down. The updates can wait, the baby needs your attention now. Back in New York, when my husband and I tuned in to an episode of the American version of One Born Every Minute, we watched a well-intentioned new father accidentally drop his phone on his sleeping infant while trying to take a picture. Phones have become so ubiquitous now that no one in that delivery room even blinked—except the startled baby.

Right now we’re in the middle of giving birth to the first generation who will come into the world with smart phones as a given. My two year old son seems to think everyone has a phone the same way that everyone has a nose. He’s already quite adept at unlocking mine. The other day, in an unguarded moment, I caught him queuing up Winnie the Pooh on my Netflix app. While the American Academy of Pediatricians and Royal College of Paediatrics have warnings about this, recommending that television and other entertainment media be avoided for the first two years of life, it seems impossible to enforce. Media is everywhere we turn.

Evolution is a very slow process. Birth and bonding hasn’t changed that much in the last two thousand years, nor has our mammalian hard-wiring, while technology seems to move at the speed of light by comparison. Who knows what will happen to our species over time if we continue to squander the Golden Hour*? Put down the phone. Falling in love will never be this easy again.

*For the record, it’s not just a Golden Hour…it’s more like a Golden First Six Weeks! The many benefits of skin-to-skin contact–increased oxytocin release for both mum and baby, improved breastfeeding success, comfort, stable newborn core temperature, bonding etc.–can still occur well after the first hour of life. So even if the first hour wasn’t that golden (because you were separated from your baby, or under anesthesia, or in too much pain during a repair to be able to hold her) you can make up for it by putting your baby skin to skin as soon as possible. And for as much as you’d like to in the weeks to come!