Rethinking Swaddling

It seems that every time you see a "birth" on TV the baby is immediately mummified in blankets and hats and handed to the fully clothed mother to smile and coo at.  Wrapping babies up tightly in a blanket is known as "Swaddling", and until recently was considered the normal way to keep babies warm after birth and it is still the generally accepted practice in most hospitals.

While considered the norm, many doctors are speaking out against swaddling and studies are proving over and over that swaddling is not only NOT helpful in warming the baby, it also negatively effects the baby's ability to breastfeed naturally and properly, and can increase risks of SIDs.

Babies are meant to be with their mothers, and the best way of nurturing a baby is to maintain skin-to-skin contact between the baby and it's mother.  This is known as "Kangaroo Care" . The baby, wearing only a diaper, is held upright against the parent’s bare chest. The term kangaroo care is used because the method is similar to how a baby kangaroo is nurtured by its mother - from the safe environment of the womb to the safe environment of the pouch where further maturation of the baby occurs. Skin-to-skin contact promotes more consistent heart and respiratory rates; it stabilizes oxygen needs; it aids in stabilizing blood sugar levels; it regulates body temperature; and improves weight gain and helps increase breast milk supply.

Dr. Nils Bergman, the father of modern "Kangaroo Care"  developed and implemented Kangaroo Mother Care (KMC) for premature infants right from birth. This resulted in a five-fold improvement in survival of Very Low Birth Weight babies raising the survival rate of these tiny preterm infants from 10% to 50%.

But Kangaroo Care isn't just for preemies. Skin to Skin contact is vitally important for all infants.

"The very best environment for a baby to grow and thrive, is the mother's body," says Dr Nils Bergman, "When placed skin-to-skin on the mother's chest, the baby receives warmth, protection and food, and its brain can develop optimally. Not feeding the baby often enough and leaving it to sleep alone after a feed can result in the baby getting colic", he adds. "The mother's skin is the baby's natural environment, and both physically and emotionally the healthiest place for the baby to be".

Dr. Jack Newman of the Newman Breastfeeding Clinic & Institute in Toronto is a huge supporter of mother & baby skin to skin contact and strongly promotes it in his clinic and when training and working with medical professionals in the birthing industry.

"To appreciate the importance of keeping mother and baby skin to skin for as long as possible in these first few weeks of life (not just at feedings) it might help to understand that a human baby, like any mammal, has a natural habitat: in close contact with the mother (or father). When a baby or any mammal is taken out of this natural habitat, it shows all the physiologic signs of being under significant stress. A baby not in close contact with his mother (or father) by distance (under a heat lamp or in an incubator) or swaddled in a blanket, may become too sleepy or lethargic or becomes disassociated altogether or cry and protest in despair. When a baby is swaddled it cannot interact with his mother, the way nature intended. With skin to skin contact, the mother and the baby exchange sensory information that stimulates and elicits “baby” behaviour: rooting and searching the breast, staying calm, breathing more naturally, staying warm, maintaining his body temperature and maintaining his blood sugar."

Nancy Mohrbacher in her blog  writes an excellent article that outlines the many reasons why the tradition of Swaddling babies is dangerous and needs to come to an end:

Rethinking Swaddling

There’s no doubt that babies seem calmer and sleep more when swaddled.  But is this a positive or a negative?  The research provides some surprising answers, starting with the first days after birth.
Swaddled babies arouse less and sleep longer.¹ That may sound good, but in the early hours and days after birth this can lead to less breastfeeding, which is associated with greater weight loss, more jaundice, and a delay in milk production.²
Swaddling delays the first breastfeeding and leads to less effective suckling.  In a study of 21 babies after a vaginal birth,³ researchers divided them into two groups.  One group was laid skin-to-skin on mother’s body, examined briefly, then returned to skin-to-skin contact for two hours.  The other group was shown to the mother, examined, and swaddled with hands free and then returned to mother.  The swaddled group showed delayed feeding behaviors, suckled less competently at their first breastfeeding, and established effective breastfeeding later.

But what about after hospital discharge?  Once a baby is breastfeeding well, is there any reason to avoid swaddling?  While swaddling may be helpful when used occasionally, routine swaddling during the first months associated with greater risk of:

• Respiratory illness¹⁰ 
• Hip dysplasia¹¹
• SIDS in prone sleeping positions¹²
• Overheating¹³

Evidence is also growing that babies’ hand movements aid them in finding the breast and latching. ¹⁴ Swaddling during breastfeeding to restrict babies’ hands may contribute to breastfeeding problems.
After reading the research, my own opinion of swaddling has changed.  In most cases a mother’s body is her newborn’s best “baby warmer.”  When babies get fussy, it may be best to limit swaddling and suggest instead parents consider alternatives, such as skin-to-skin contact and baby carriers.

 HERE to read Nancy's entire article

For more information about swaddling please read my article "In the Pouch"

CBC Radio portrays co-sleeping as dangerous

It would seem that not a year can go by without the media running their anti co-sleeping campaign.  It starts with one report and snowballs from there.  Unfortunately the media seldom does their homework nor do they seem capable of  analysing the statistics: any way you slice it, co-sleeping is SAFER for baby!!!! Yes there are safety guidelines that you need to follow to co-sleep safely with your baby, but that is the same with everything in life, isn't it?  All you need to do is to look at societies where sharing a family bed is the normal way of life and analyse their statistics on SIDs (Sudden Infant Death).  In Japan where co-sleeping and breastfeeding (in the absence of maternal smoking) is the cultural norm, rates of the sudden infant death syndrome are the lowest in the world!!  Dr. James Mckenna writes a brilliant article that outlines the vital necessity for babies to sleep next to their mothers in Cosleeping and Biological Imperatives: Why Human Babies Do Not and Should Not Sleep Alone

Many times when the topic of bed sharing or co-sleeping enters conversations someone will undoubtedly bring up "The Study".... the Study that has caused several media storms of negative articles about co-sleeping and the irresponsibility of parents who sleep with their babies.  This is a perfect example of how the media is unable to read a study and analyse it correctly, without letting their own personal bias come into play when they publish the report to the public.

This research study I am talking about came out in 1999 from the U.S. Consumer Product Safety Commission that showed 515 cases of accidental infant deaths occurred in an adult bed over an 8-year period between 1990 and 1997.  The media jumped on this (and has jumped on it again and again), using fear mongering  and sensationalism to proclaim loudly that sleep sharing and co-sleeping is unsafe.  But anyone with the ability to read facts and use logic would be able to see through the gigantic holes in this study and be capable of concluding that not only is the study flawed, but that the conclusions drawn from it are highly illogical.

Dr. William Sears discusses the glaringly illogical conclusions of this study, and more importantly brings to light a huge conflict of interest on his website.

SLEEPING SAFELY WITH YOUR BABY

the U.S. Consumer Product Safety Commission that showed 515 cases of accidental infant deaths occurred in an adult bed over an 8-year period between 1990 and 1997. That's about 65 deaths per year. These deaths were not classified as Sudden Infant Death Syndrome (SIDS), where the cause of death is undetermined. There were actual causes that were verified upon review of the scene and autopsy. Such causes included accidental smothering by an adult, getting trapped between the mattress and headboard or other furniture, and suffocation on a soft waterbed mattress.
The conclusion that the researchers drew from this study was that sleeping with an infant in an adult bed is dangerous and should never be done. This sounds like a reasonable conclusion, until you consider the epidemic of SIDS as a whole. During the 8-year period of this study, about 34,000 total cases of SIDS occurred in the U.S. (around 4250 per year). If 65 cases of non-SIDS accidental death occurred each year in a bed, and about 4250 cases of actual SIDS occurred overall each year, then the number of accidental deaths in an adult bed is only 1.5% of the total cases of SIDS.
There are two pieces of critical data that are missing that would allow us to determine the risk of SIDS or any cause of death in a bed versus a crib.

• How many cases of actual SIDS occur in an adult bed versus in a crib?
• How many babies sleep with their parents in the U.S., and how many sleep in cribs?

The data on the first question is available, but has anyone examined it? In fact, one independent researcher examined the CPSC's data and came to the opposite conclusion than did the CPSC - this data supports the conclusion that sleeping with your baby is actually SAFER than not sleeping with your baby (see Mothering Magazine Sept/Oct 2002). As for the second question, many people may think that very few babies sleep with their parents, but we shouldn't be too quick to assume this. The number of parents that bring their babies into their bed at 4 am is probably quite high. Some studies have shown that over half of parents bring their baby into bed with them at least part of the night. And the number that sleep with their infants the whole night is probably considerable as well. In fact, in most countries around the world sleeping with your baby is the norm, not the exception. And what is the incidence of SIDS in these countries? During the 1990s, in Japan the rate was only one tenth of the U.S. rate, and in Hong Kong, it was only 3% of the U.S. rate. These are just two examples. Some countries do have a higher rate of SIDS, depending on how SIDS is defined.
Until a legitimate survey is done to determine how many babies sleep with their parents, and this is factored into the rate of SIDS in a bed versus a crib, it is unwarranted to state that sleeping in a crib is safer than a bed....

...A conflict of interest? Who is behind this new national campaign to warn parents not to sleep with their babies? In addition to the USCPSC, the Juvenile Products Manufacturers Association (JPMA) is co-sponsoring this campaign. The JPMA? An association of crib manufacturers. This is a huge conflict of interest. Actually, this campaign is exactly in the interest of the JPMA.

HERE to read the entire article

 So the next time someone tries to tell you that you are endangering the physical and emotional well being of your baby by cuddling up next to him all night, give them the facts!!!

Co-sleeping Unsafe?? Letter writing opportunity to CBC Radio: The Current!

by Gina Merlin on Thursday, 25 November 2010 at 13:51

This morning The Current ran an interview (Letters section, Nov. 25, 2010) that portrayed co-sleeping as dangerous and a practice that results in baby deaths. The one woman interviewed, Miranda Halladay, was responding to a story that aired last week on co-sleeping policy in PQ (I didn't catch that story). Mrs. Halladay shared her personal story of tragedy in the hospital, but the message was to extrapolate from this one experience to say co-sleeping is an unsafe choice, that mothers can choose whatever but they should know that their choice will lead to baby deaths. Her baby was born "textbook delivery" at hospital. The next day, she was very groggy with pain killers at the hospital. She was left alone to figure out breastfeeding. She nodded off. When she awoke the baby had been "smothered by my breast." They were able to revive the baby but he never recovered and died in 2002.

This woman's point of view was clearly biased by her personal tragedy, and her message was based on fear, not based on all the available information. In fact, I don't think this baby's death technically even describes co-sleeping or SIDS death, but rather there are many factors at play, not least of which must be the heavy sleep-inducing drugs this woman was on. In the context that this message will ill inform The Current's listeners, and may scare new parents or well-meaning friends and family unnecessarily out of becoming informed and making their own choice, as is their duty, I called to set the record straight. I believe parents should be supported in in becoming informed of factual info and making the *right* decision for themselves in each particular situation.

Additionally, as this woman's story indicates, many of these reported co-sleeping deaths are actually NOT co-sleeping according to anyone's guidelines ~ for example, deaths on couches. This evidence is confounding, and context is important. What we know is that co-sleeping CAN be safe, and certainly does have some benefits, especially for breastfeeding mothers-babies. Co-sleeping doesn't by definition even have to mean the baby is IN your bed (bedsharing), but rather is in the room and at arms reach. Co-sleeping encourages mother-baby awareness and as such the mother is aware of the sleep-wake state of her baby and is able to attend to the baby's immediate needs at any time. Further, for as many stories as you'll find against co-sleeping, you'll have as many co-sleeping parents report waking up to notice their baby is having a problem (unrelated to co-sleeping), and being able to respond right away and possibly save the child's life. Other factors at play include the stability and suitability of the sleeping surface, as well as not overwhelming the baby with blankets, pillows and stuff in the sleeping space (true also of crib-sleeping).  Another point, since bedsharing in hospital with newborn babies is a policy now encouraged on hospital birth and postpartum wards, this tells me this instance although tragic has not changed hospital policy against co-sleeping ... this policy is more prevelant, not less, since this baby's death in 2002.

It is my opinion that to not include these aspects of the decision making processes in this coverage of this parenting choice, and to indicate that co-sleeping is dangerous because of this woman's very sad and complicated anecdote, is not supportive of informed and empowered parenting and is not fair to the intelligent and capable listeners of this program. I expected better of this radio program, one I normally enjoy.


If you have an opinion, I hope you'll share it with The Current, or if you'd like to encourage a revisit of the topic from a more unbiased point of view ...
PLEASE WRITE to Anna Maria Tremonti at:
Contact Us:  http://www.cbc.ca/thecurrent/contact/
Telephone:  Feedback line (877) 287-3700
Fax: (416) 205-6461
Twitter: @TheCurrentCBC
Facebook: http://www.facebook.com/pages/CBC-Radio-The-Current/107919209244845?ref=ts

Thanks all, I thought you'd want to know about this opportunity to express some facts!

Cheers,
Gina

Listen to the Podcast: http://www.cbc.ca/thecurrent/episode/2010/11/25/nov-2510---pt-3-letters/
Co-Sleeping: Quebec is grappling with the deaths of three infants ... each of whom were sleeping in their parents' beds. Last week on The Current, we weighed the risks and benefits of this practice. We heard some of your thoughts last week in the mail but there were a couple more letters we wanted to share.
We also received a letter from Miranda Halladay. Her son Rex died in 2002 as a result of co-sleeping. We reached her in Naramata, BC this morning. We always appreciate you hearing from you, contact us with you stories.

Breastfeeding reduces risk of SIDs by 50%

American Academy of Paediatrics  recommends marketing breastfeeding to reduce the risk of SIDs..... how about they throw in reducing the risks of certain cancers, obesity, juvenile diabetes,  asthma and allergies, ear infections and digestive disorders.... to name but a few.  How about they market breastfeeding as the NORMAL way to feed your baby?  Even better, how about they just tell the truth about the risks of infant formulas?

...or better yet, how about they push to have the WHO code put into law and protect the lives of babies from unethical marketing and the propaganda from infant formula companies?

Well, I guess it's a start.  Baby steps forward are better than giant steps backwards.

 

Does Breastfeeding Reduce the Risk of Sudden Infant Death Syndrome? 

BACKGROUND. In the last 20 years, the prevention campaigns to reduce the risk of sudden infant death syndrome were very successful. In some countries the advice to breastfeed is included in the campaigns' messages, but in other countries it is not.

OBJECTIVE. To examine the association between type of infant feeding and sudden infant death syndrome.
METHODS. The German Study of Sudden Infant Death is a case-control study of 333 infants who died of sudden infant death syndrome and 998 age-matched controls.
RESULTS. A total of 49.6% of cases and 82.9% of controls were breastfed at 2 weeks of age. Exclusive breastfeeding at 1 month of age halved the risk, partial breastfeeding at the age of 1 month also reduced the risk of sudden infant death syndrome, but after adjustment this risk was not significant. Being exclusively breastfed in the last month of life/before the interview reduced the risk, as did being partially breastfed. Breastfeeding survival curves showed that both partial breastfeeding and exclusive breastfeeding were associated with a reduced risk of sudden infant death syndrome.
CONCLUSIONS. This study shows that breastfeeding reduced the risk of sudden infant death syndrome by 50% at all ages throughout infancy. We recommend including the advice to breastfeed through 6 months of age in sudden infant death syndrome risk-reduction messages.

 HERE to read the original article

 

"Settling the Cosleeping Controversy" LIVE Teleseminar!

Here at Platypus Media, we want to make sure you have the most current information about sleep and your baby. This teleseminar is an excellent way to keep up with current information on safe infant sleep.

API LIVE! Teleseminar

Monday, June 28, 9 pm EST/6 pm PST - Register Now

"SETTLING THE COSLEEPING CONTROVERSY"

Get the Facts About Cosleeping, SIDS, Bedsharing and Breastfeeding with special guest Dr. James McKenna, author of Sleeping with Your Baby: A Parent's Guide to Cosleeping

Register for this call to hear hosts Lu Hanessian and Lysa Parker talk with Dr. McKenna about: Why the cosleeping debate? What if the baby won't transition out of our bed? Can we put the baby in the middle? Can't there be siblings near the baby? Until what age are the guidelines relevant? Can I nurse lying down? How? And answer your questions--email them to APILive@AttachmentParenting.org

Order a copy of Sleeping with Your Baby: A Parent's Guide to Cosleeping from Platypus Media.

Visit www. PlatypusMedia.com to order!

"Brilliant! This information is vital to all who care about infants, parenting issues, public health concerns...and our society in general."
-Chele Marmet, M.A., I.B.C.L.C.

"Cosleeping is one of the most delicious experiences in parenting, and Dr. McKenna's carefully researched and thoughtful advice separates the myths from the marvelous reality."
-Harvey Karp, M.D.

"Back to Sleep"

By now just about everyone has heard the hard core recommendations "Put baby to sleep on their back". Studies are quoted saying that babies sleeping on their back have a reduced chance of dying of SIDs.

http://www.nichd.nih.gov/sids/

http://www.hc-sc.gc.ca/ahc-asc/activit/marketsoc/camp/sids-eng.php

Now, for the record, I'm not questioning the validity of this Campaign, nor the importance of sharing the information with new mothers....

...But I have some questions. When these studies were done, showing that sleeping on their backs reduces the incidents of SIDs in babies, what were the criteria that was used? For example, were groups divided according to whether a baby was exclusively breastfed? Did the babies sleep by themselves in a crib? Or in the Family Bed? Was the crib in another room? Or beside the parents bed? When they studied the incidents of SIDs deaths that happened to babies who slept on their stomachs, were details such as where the baby was sleeping, what type of bedding, were there other factors involved (ie: stuffed toys in the crib, pillows, bumper pads...)?

The reason I'm asking these questions is because I seem to have ANOTHER tummy sleeper on my hands.

I posted about Kael's love of tummy/snooze time on my Facebook status and was surprised at the amount of responses I've received from other moms who've had/have babies that prefer sleeping on their tummies. Both of my youngest sons were much happier sleeping on their stomachs. logan started flipping over to his tummy at 2 months. After fighting with him to get him to sleep on his back (like all the studies say) I finally gave up and just put him on his tummy. I made sure he was on a firm surface and that there was absolutely nothing around him to get entangled with or to interfere with his breathing..... and I checked on him constantly, even if he was in a bassinet right beside me. Now Kael has decided that he'd much prefer to sleep on his tummy too!! I put him down on his belly for some tummy time....and he falls asleep!! and for the past 3 days he has not been napping well on his back- often waking up within 15 minutes (and being miserable because of it).

I have to wonder about the back to sleep campaign and whether it applies to us? KWIM? My children are exclusively breastfed, they sleep either with me in bed (under safe shared sleep conditions), or sleep in a bassinet beside me in the livingroom- on a firm surface with nothing to get entangled with and under constant supervision. Is it really that risky to tummy sleep under these conditions? To be honest, I worry a lot more about Kael choking (he's a puker, and has choked several times while sleeping) while on his back, than I do about SIDs. Like I said, I'm not advocating that we all ignore the recommendations... but I still wonder if they take into consideration all the factors.

What do you think?

Discussions?

"Why babies should never sleep alone:.."

Why babies should never sleep alone: A review
of the co-sleeping controversy in relation to SIDS,
bedsharing and breast feeding

James J. McKenna* and Thomas McDade
University of Notre Dame, Notre Dame, Indiana, IN 46556, USA
PAEDIATRIC RESPIRATORY REVIEWS (2005)

"Summary
There has been much controversy over whether infants should co-sleep or
bedshare with an adult caregiver and over whether such practises increase the risk of
SIDS or fatal accident. However, despite opposition from medical authorities or the
police, many western parents are increasingly adopting night-time infant caregiving
patterns that include some co-sleeping, especially by those mothers who choose to
breast feed. This review will show that the relationships between infant sleep patterns,
infant sleeping arrangements and development both in the short and long term, whether
having positive or negative outcomes, is anything but simple and the traditional habit of
labelling one sleeping arrangement as being superior to another without an awareness of
family, social and ethnic context is not only wrong but possibly harmful. We will show that
there are many good reasons to insist that the definitions of different types of co-sleeping
and bedsharing be recognised and distinguished. We will examine the conceptual issues
related to the biological functions of mother–infant co-sleeping, bedsharing and what
relationship each has to SIDS. At very least, we hope that the studies and data described
in this paper, which show that co-sleeping at least in the form of roomsharing especially
with an actively breast feeding mother saves lives, is a powerful reason why the simplistic,
scientifically inaccurate and misleading statement ‘never sleep with your baby’ needs to
be rescinded, wherever and whenever it is published."

HERE to read the entire PDF article

Cosleeping and Biological Imperatives: Why Human Babies Do Not and Should Not Sleep Alone

By James J. McKenna Ph.D.
Edmund P. Joyce C.S.C. Chair in Anthropology
Director, Mother-Baby Behavioral Sleep Laboratory
University of Notre Dame

"

In Japan where co-sleeping and breastfeeding (in the absence of maternal smoking) is the cultural norm, rates of the sudden infant death syndrome are the lowest in the world. For breastfeeding mothers, bedsharing makes breastfeeding much easier to manage and practically doubles the amount of breastfeeding sessions while permitting both mothers and infants to spend more time asleep. The increased exposure to mother’s antibodies which comes with more frequent nighttime breastfeeding can potentially, per any given infant, reduce infant illness. And because co-sleeping in the form of bedsharing makes breastfeeding easier for mothers, it encourages them to breastfeed for a greater number of months, according to Dr. Helen Ball’s studies at the University of Durham, therein potentially reducing the mothers chances of breast cancer. Indeed, the benefits of cosleeping helps explain why simply telling parents never to sleep with baby is like suggesting that nobody should eat fats and sugars since excessive fats and sugars lead to obesity and/or death from heart disease, diabetes or cancer. Obviously, there’s a whole lot more to the story.

As regards bedsharing, an expanded version of its function and effects on the infant’s biology helps us to understand not only why the bedsharing debate refuses to go away, but why the overwhelming majority of parents in the United States (over 50% according to the most recent national survey) now sleep in bed for part or all of the night with their babies.

That the highest rates of bedsharing worldwide occur alongside the lowest rates of infant mortality, including Sudden Infant Death Syndrome (SIDS) rates, is a point worth returning to. It is an important beginning point for understanding the complexities involved in explaining why outcomes related to bedsharing (recall, one of many types of cosleeping) vary between being protective for some populations and dangerous for others. It suggests that whether or not babies should bedshare and what the outcome will be may depend on who is involved, under what condition it occurs, how it is practiced, and the quality of the relationship brought to the bed to share. This is not the answer some medical authorities are looking for, but it certainly resonates with parents, and it is substantiated by scores of studies..."

Here for the full article