Interesting Letter from a pediatrician

I know most of the users of this forum are just looking to make it through another day breastfeeding twins. Now that I've experienced feeding one, I've gotten a lot more interested in the politics of breastfeeding and I know that there are some others into that here as well. So I thought I'd share this letter to the Journal of the American Academy of Pediatrics in response to an article about sleep training. This anthropologist, Dr. James J. McKenna--who is a cosleeping advocate, wrote a very well written letter that bring up a lot of important ideas.

My synopsis--our culture has placed a very high priority on getting infants to sleep through the night as early as possible. This is not a global goal--just a goal of "western" (Mainly US, Canada, UK and other English speaking countries) cultures. But sleeping through the night at a young age make successful breastfeeding more difficult.

Here is the letter if you are interested
http://pediatrics.aappublications.org/cgi/eletters/126/5/e1081#50784

I never set a goal for STTN for my children, but the older two learned to do it on their own. I imagine the younger one--who is currently 9 months old--will do it to.

 

I've been thinking about this a lot with the birth of my 3rd child. My sleep experience with the boys was awful, and I didn't want to repeat that, but I also ask myself how have humans evolved over thousands of years. I'm pretty sure cave women weren't sleeping far away from their kids--they'd be worried about wild animals getting them or they may have other concerns about the difficulty of feeding them when they are farther away.

It seems completely logical to me that it would not be "normal" under the conditions that most human's lived in for thousands of years to sleep away from a baby and to go that long without nursing a baby. I even wonder if day time nursing was more of a hinderance because it could slow down the group or keep the mother from getting work done.

To me the biggest shift is with capitalism. In capitalist societies, we have much more rigid notions of time, and people live in conditions that allow them to sleep far away from their baby, yet know the baby won't succumb to danger. We also expect people to live and work in those time frames. Middle of the day naps are not widely culturally accepted in capitalist societies and it interferes with "productivity."

Another related factor is the decline of the extended family and a communal society, which also encourages early sleep consolidation. When you have little to no help in raising your child or the help you have is paid for, it encourages forced sleep consolidation.

I can definitely say that lack of extended family and general social support and being part of the labor force both contributed to a strong desire in me to consolidate my kids sleep. After about 8 months, I no longer felt safe driving to work because I was so tired and exhausted. To me this is part what encourages the STTN ideology so prominent in contemporary Western societies. You also add to excessive fear that we plant in mothers about co-sleeping, particularly the idea that it is dangerous.

 

Thanks for the response Rachel, we haven't seen much of you lately.

I'm lucky in that I'm a very light sleeper who falls back to sleep easily. I think that makes me the perfect cosleeping mama. I can hear my baby stirring, position him for a feed and be back to sleep in less than a minute.
I've never got the fear factor. I've even gotten into it with people on here who refuse to believe that it is simply NOT dangerous to sleep with their baby.

Like you mentioned daytime feed could slow a mother down and it still can today. I now work outside of the home 8 hours a day and I still breast feed my baby, infact he only gets 4 onces of formula a day. He gets three good solid feeds, and I breastfeed him upon waking in the morning, between 2 and 3 pm, and as much as he wants overnight. I also still haven't gotten my period, nor do I expect to soon. With my twins it came back at 14 months. Research has shown that it is more the lack of night feedings that signal to your hormones to resume your cycles than it is lack of day feedings.

 

Very interesting!

I think another huge problem is that a lot of people see dropping feeds almost as a developmental milestone, something to work toward and be proud of. "Yay, my 3 mo old only drinks 4 (giant) bottles a day!" Um, yeah, like that sets the groundwork for healthy eating habits??? And I have seen moms force their BF babies down to 4 feeds a day way too early, and then they don't gain any weight for a month, and the mom can't fathom what's wrong and will try literally anything short of actually feeding them, bc after all the book says to make them do that... Just as the whole sleep thing sets up an adversarial relationship, the goal of feeding as little as possible sets up an adversarial relationship: if you feed the babies when they're hungry, you're "caving" or spoiling them or creating bad habits or creating "snackers." In other words, your babies are out to GET YOU. I wonder how much the obesity epidemic could be slowed down if it were more common for parents to understand and respond to their infants' hunger cues: feeding when babies are hungry and allowing them to stop when full (ie not trying to get as much of that bottle into them as possible so you don't waste formula $$$), instead of forcing them to eat by the clock, and setting up conditions where they learn to gorge themselves at a feeding, since they're going to have to wait a long time until the next one. I mean, if we all just automatically ate when we were hungry and stopped as soon as we were full, how many of us would be overweight? And of the overweight, how many would actually be obese?

 

Great points Holly!

On the weekends when I'm home all day, I'm actually the one constantly trying to get my baby to nurse. I offer to nurse him like every 30 minutes! One because I love spending time with him. But also because both my girls have had coughs and sniffles nonstop for over a month, so I want him to have as much breastmilk in him as possible.

 

Thanks for posting this! I love to read about things like this.

As you all know, i tried so, so hard to nurse my twins. The discussion of co-sleeping and feeding on demand is really an interesting one to me from both a bfing and a bonding perspective.

We never pushed STTN, and we co-sleep. I didn't expect to become such an advocate for co-sleeping, but, for our family, it has been one of the best parenting decisions I've made. While we were not able to maintain the bfing relationship after about 6 months, we were able to continue co-sleeping, and I feel this natural rhythm between mom and babies is so hugely important and spills over into our relationship as a whole. Rather than see it as a negative thing or a "dependent" thing, I love that my boys are able to reach over and touch me and fall right back asleep. Knowing they have this security at night makes me feel very peaceful.

Holly---I agree so much with what you are saying about the whole idea that so often discussions are framed as if the baby is out to get you. When we remove that assumption I think something magical really happens.

Anyway, sorry, bit of a tangent I guess. I know if we have another child we will co-sleep for the bfing benefits and for the general all around closeness it brings.

 

What I love about that Dr's letter is the fact that it takes cultural ideology into account, and it accounts form cultural variation over time and place. So much of our contemporary medical literature doesn't do that. I think about this in relation to so many of our discussions here on TS. For example, I wonder how much culture influences postpartum depression. I know many people in our modern society believe it is purely biology, but I'm convinced that our contemporary cultural practice of isolating new Moms is a huge contributor to this problem. We are so far from how we evolved, and while I have no personal desire to go back into caves, huts, or nomadic clans, I think we do have to ask ourselves to what extent is our cultural ideology clashing with our biology and to what extent are our cultural norms causing strain and conflict because they are so unrealistic (socially, emotionally, and biologically).

I felt that way with my boys, and I'm definitely starting to feel that way with Lena.

It's so frustrating. I slept with all three on my kids in a crib right next to me for the first 5 months, and when they got hungry I put them in bed with me and let them nurse. Sometimes I fell asleep with them there. I did it until I couldn't take it anymore. Like Melissa, I'm a light sleeper, but I can't easily fall back to sleep, and that gets worse with each passing month of sleep deprivation. I definitely think I was less sleep deprived in the first couple months, but what has frustrated me is that my kids don't seem to progress. In fact, Lena's slept a 4-5 hour stretch as a newborn, and now wakes every 2-3 hours, which is what makes me feel like I'm doing something to encourage the waking. (I'm feeling a little jaded today about this because I was up 6 times last night, and only 4 of them were with Lena, and the night before was the same.)

I've really had to reckon with myself and ask what is reasonable for my sanity and what will fit with our modern day society. I also have to ask myself what I really believe. It was actually talking with my parents that starting my rethinking. My parents co-slept or slept nearby us for a long time, and my Dad swears it's the normal thing to do until kids are like 3-4 years old. I wasn't much of a believer in co-sleeping before I had kids, but I set two cribs up right next to me when the boys were born. LOL! With Lena I even let her stay in bed with me, and she loved it. However, I didn't like it. I didn't like it with the boys because I was trying to get up early and go to work after being up all night, and with Lena, I have to get up early to take care of the boys. If I lived with a nomadic clan or in an early agricultural society, I wouldn't be "going away" to work, and I'd probably have some older women in the clan taking care of my children.

So to me I think it really is a balance between 1) what is biologically necessary for the mother and child feeding dyad to operate in an optimal way (mother has a few problems as possible and child eats and grows), and 2)what is culturally acceptable and 3) what is feasible given the socio-cultural conditions that we find ourselves in.

We haven't even mentioned how the lack of adequate family and maternity leave plays into all of this. I can tell you that the formula industry makes billions off of inadequate family leave, and inadequate working conditions for mothers who want to breastfeed. Even if we had just a little more flex time or flex place, parents would be less inclined to try to force sleep on babies.

 

I know; I don't have as much time as I did. I'm glad to see you back

 

So true. I especially like they way you articulated the sentence I bolded.

 

Melissa,
one of the things we teach in our monthly breastfeeding class is " a good baby is not a baby that sleeps through the night, a good baby, is a baby who wakes up several times to eat" We try to teach mothers that its a GOOD thing that their baby wants to nurse all night! and one of the positions we show is side lying. We try to emphasize to learn to nurse laying down early on and mothers will get much more rest Thanks for sharing the article!

 

Jess, here is another one to share with your class

Infant Feeding Methods and Maternal Sleep and Daytime Functioning

Rachel,
Maternity leave is such a big part of it. I have a friend and coworker with a baby who just turned a year (so he's 3 months older than mine). She was not able to take additional time off after then end of her leave. Leave here is 12 weeks--but it HAS to be 6 before your due date and 6 after! :umm: When she came back to work at six weeks, she tried to pump at work. But it was really hard for her to fit it in, and get much pumped. (She had a pump her sister sent her from the US) So she started supplementing and the baby took to the bottle and she stopped feeding him by about 12 weeks. She just wasn't able to work and feed. In my case finicially I as able to swing taking six months off after my leave so I came back to work when my baby was 7 and a half months old. Breastfeeding was WELL established, and I've had no problem continuing to feed him when I'm home without pumping at work. She and I are a lot alike in terms of being into "natural" things and she wishes she could have been able to feed him longer. I blame it entirely on having to come back to work full time when her baby was only 6 weeks old.

 

I love my boys and would walk through fire for them, however. The side-lying position makes me kind of angry. Because you really can't tandem side-lying. So every time I was able to do it, I felt resentful that it wasn't as much of an option as it usually is for a nursing mother. My night-time nursing experience consisted of getting up, putting on the ez2 nurse, grabbing our iPod touch and going on TS at 2am. I am lucky that I do fall asleep pretty easily, but it still could have been much, much better.

 

We dont get many mothers pregnant with twins in the class, but when we do the position I like to show them individually that I feel like promotes the most comfort/sleep is the "laid back" position with both babies kinda ontop and along side a leg. Lots of pillows. I realize side lying doesnt work for some, but you would be suprised at the amount of people that dont think of that position early on, or if they do are "stumped" on how to get that to work.

I know some moms with twins (me) would side lying nurse but I fed them individually. We co-slept so I would nurse/sleep with one baby till the next baby woke up then Id roll over and nurse/sleep with that one so I basically rolled from one side to the other throughout the evening. :lazy:

 

Yeah, I'd need a bigger bed for that, I think!

 

I have not read the article yet but plan to so Thanks! I not only nurse my children on demand but also allowed them to nurse to pacify. I could tell when they were sucking to feed or sucking to pacify. None of my kids took a pacifier and learned just fine to fall asleep on their own and pacify and entertain themselves eventually. I allowed them to also wean on their own (the longest was just over 2 years) I did not co sleep exclusively but kept the baby close with me. Our 3 yr old still comes to sleep with us in the morning. When she was born she was colicky and would not sleep in the hospital and I brought her to bed with me and she slept. The nurse came in and said "we discourage sleeping with the baby" I said "I know" I went back to sleep! Not sure how nursing twins will be but we will find out!!

 

Rachel, I'd give you all my points for that if I could!

 

That's exactly what I did. When the twins were babies, We bought two twin beds--that they use now--and one of those things that connects the two to make a king size bed.
What was hard for me was with this baby, for the first 10 weeks bfing hurt so much that I couldn't side lie to feed him. For some reason that position was particularly painful. And I had a hard time staying awake long enough to sit up and give one of those long new born feeds--we don't have a recliner or anything like that.

Momof6--at the hospital where my son was born babies HAVE TO sleep with their mothers, there are no basinettes for healthy babies. If the baby is not in the special care nursery then he's in your bed. This is done to promote breastfeeding.

 

Wow! That is awesome, I have never heard of that before.

 

So I was getting all sentimental about this thread, trying to figure out why Lena's night wakings are even more common than they were in the first three months, and then, wham I woke up today and I got aunt Flo. LOL! No wonder she was nursing a lot.

It kind of interesting because I got AF at 7.5 months with the boys, and I was still nursing babies about 3-4 times a night. And with Lena she pretty much doesn't go more than 3 hours without eating, so I guess I'm the exception. Night time feedings do not seem to be correlated to Aunt Flo for me.

I also had a very difficult time pumping in months 9-11.5 when my boys stopped nursing. I'm fairly certainly that I could not exclusively pump for more than the first 5 or 6 months. I was drying up with each AF, and towards the end I was pumping 3-4 times a day and getting like 6-10 ounces.

Anyways I just thought that was interesting...

 

Not for me either, Blake wakes up to nurse probably 3-6 x's a night if not more and I got AF at 6.5 months!

 

Rachel, do you know about the magnesium/calcium supplement?

 

Nope, tell me about it.

 

I am curious - what is the maternity leave in the States? In Canada we get a year - maternity and parental leave combined. I can't believe the leave in Mexico though...back to work after 6 weeks. That is hardly enough time to bond with your child/ren.

 

i think the US is similar - i think some places offer 8 weeks if you've had a c-birth. i'm sure one of our lovely American gals will fill us in though.

 

If you are lucky enough to have job where you get paid maternity it is usually only 6 weeks. Other jobs don't offer it but I believe do to the family leave act must give you 6 weeks off un paid... I think the policy here in the States sucks regarding this. My best friend lives in Spain and it is 4 months or something like that. I am blessed to satay at home so I don't have to worry about this!

 

Rachel, read the section that talks about Low milk supply associated with menstruation Kellymom.
ive recommended this to a few moms now and all have had a noticeable difference