By Kittie Frantz
Issue 132, September/October 2005
When I became a grandmother, I considered myself lucky. I was a practicing pediatric nurse-practitioner and teaching in a university; as new studies came along that suggested making changes in the way people parented, I could understand and accept them from a medical point of view without feeling invalidated as a mother. The trend that most disturbs me is the notion that it is unnecessary, almost wrong, to soothe your baby by breastfeeding. I am puzzled when I hear the advice to never breastfeed your baby to sleep. Mothers are advised to breastfeed ?babies only for nourishment, and to put babies down in the bassinet awake so that they learn to go to sleep by themselves. The rationale—the fear—is that if you don't, you will condition your baby that only mother can put him to bed.
Funny—on PTA night, my husband had no trouble putting our baby to sleep. My friends who breastfed their babies until they fell asleep didn't complain of problems. Have you ever fallen blissfully asleep in someone's arms? As a baby, wouldn't you love to fall asleep in your mother's arms? True, some babies fall asleep with ease in anyone's arms, and some seem to sleep only when mother nurses them. But to make your baby conform to another's opinion of what a baby should or shouldn't be doing seems to punish the baby for not being like all the other babies you may be currently reading about. Advocates might tell you to "train your baby to put himself to sleep." However, the "training" part means you are changing or "correcting" a healthy natural behavior.
Then there are the advocates of "the self-calmed baby." Somehow, your baby must learn to calm himself. Why? Is he doing something wrong? Is vocally expressing his needs such a bad thing? Erik Erikson, a classic researcher of child development, labels the first year of an infant's life "Trust vs. Mistrust" and describes it as the development of the ego. If the infant's needs are met, the infant feels worthy and develops into a confident, independent person. Roberta Winter, RN, a mentor of mine at William Carey International University, felt that trusting your parent to meet your needs in the first year is the basis of how we learn to trust God. Ah, but Roberta was my age.
One advocate of the "scheduled babies" ideal feels that the marriage is more important than the baby, and that the baby needs to learn his "place" in the family. When the infant is left to cry at night, to calm herself to sleep without the breast, what message does she receive? Are you telling your baby that vocalizing her needs will not get her any peace, relief, help, love? Crying signals need and is the beginning of language.
Some people describe "sleep-training" the baby and proudly state that their infant sleeps all night. But how do you know the baby is asleep all night? My opinion, shared by University of Notre Dame infant sleep researcher James McKenna, PhD, is that babies wake many times during the night. The "sleep-?trainers" should call it "training the child to know you're not there" instead of fooling parents into thinking the baby has learned to happily sleep all night. The baby is indeed waking; she just knows you're not coming. What if she is teething? Books with titles that include such phrases as "Help Your Baby Sleep Longer" lead parents to believe that there is something wrong with a baby who does not sleep for a specified amount of time. Even Dr. Richard Ferber recanted his stand on this in The New Yorker.
Advocates of scheduling a baby's feedings have been around for the last three generations, and come and go with the tides. My opinion is that some people can't help but be controlling. They try a technique that seems to work for them, think that everyone should learn this technique, then write a book about it. Often, the best thing about babies is how they teach us things such as patience, flexibility, and unconditional love. When you're a tired new parent, it is very seductive to think that you can "manage" your erratically and often frequently feeding infant by putting her on a schedule—especially if you're a first-time parent and had time before the birth to read, imagine, and, unfortunately, plan how things would be once the baby was born. It's not surprising that books on infant sleep are top moneymakers for publishers—in early infancy, every baby wakes in the night, so every parent will want such books. But the one thing such books and the erroneous advice they give do not seem to take into account is the baby. What works for one baby may not work for another. What works for a toddler won't work for an infant. Here are the facts. Because babies grow in spurts, their needs will change throughout the day, the week, and the months to come. And because of this, their schedules change. A lot. The composition of breastmilk also changes throughout the day, week by week and month by month, to match the baby's needs. This process of making different kinds of milk at different times may be initiated by changes in the way the infant suckles. Why mess up this symbiotic process by putting the baby on a schedule? Can you imagine being hungry because your body is signaling a change, and someone says you can't eat now because she, not you, has decided it isn't the "right time" to eat? The baby's job is to double her birth weight in the first four to six months after birth. Restricting breastfeedings may make this task seriously difficult.
It is interesting that research by Arthur Parmalee, of UCLA, revealed that babies need to feed around the clock, and do not sleep for a consecutive six hours until they are 8 to 12 weeks old (just before they have almost finished the task of doubling their weight). He calls a six-hour sleep "sleeping through the night," though this label should not be confused with some parents' definition of the phrase as meaning 8 to 10 hours (which doesn't come till much later in the first year). Research with similar findings was published by M. Shimada in the October 1999 issue of Brain Development. The American Academy of Pediatrics (AAP) says that newborns should feed 8 to 12 times within each 24-hour period. Note that it did not say "every two to three hours," which is how some interpret this recommendation. The AAP phrases it this way because research has shown that babies ?vary their schedules to accommodate their needs.
Marshall Klaus found that during each 24-hour period, newborns have at least one "cluster feed"—several breastfeedings close together. Most experienced breastfeeding women know this and roll with it. How long a baby stays at the breast is related to how well she suckles. Slow sucklers need longer feeds; when schedulers restrict this time, the slower-feeding baby is out of luck. Renowned breastfeeding expert Chloe Fisher of Oxford, England, says to "finish the first breast first"—that is, let the baby feed until she lets go, signaling that she is finished.
I tell parents that a simple way to sort out conflicting advice is to see which basket it fits into: the good-for-the-parent basket or the good-for-the-baby basket. For example, into which basket would you put "You should put that baby on a feeding schedule"? This process will help you decide which advice feels best for you. Trust your gut—your first instinct. Don't talk yourself out of it by believing that some advice you read must be good because it was in a book, or the person giving the advice has five kids, or was a nurse.
In my day, the support I wanted was someone to cook, do laundry, answer the phone, shop for food, run a vacuum cleaner, and take my toddler to the park so I could take a nap. I ask new parents, "Do you like your cleaning lady? Does she nurture your household? Hire her for more days and nurse the baby at night—your body produces the most prolactin, the milk-making hormone, between 1 and 5 a.m." Babies nurse more at night in the first three weeks and tend to sleep more in the daytime.
The AAP's statement on breastfeeding recommends that pacifiers be avoided until breastfeeding is "well established." The AAP doesn't define "well established," but many feel that it takes at least the first six weeks. Still, what will Dad's success with a pacifier, swaddling, loud shushing, and jiggling the baby away from his chest and onto his thighs do to the breastfeeding?
In my practice, when fathers were successful in calming their babies, I found that their infants fed only six of the needed minimum eight times in each 24 hours. This resulted in lower weight gain for the baby, more initial breast engorgement for the mother, and a slow start for the milk supply. The infant was missing at least two needed feedings. Patricia Franco published a study in the May 2005 issue of Pediatrics that shows that swaddling caused infants to spontaneously awaken less often. I often have to scramble to convince parents to hold off on the calming until after the breastfeeding. My generation didn't have to calm our babies after feeding; we nursed them to sleep, which takes less time than bouncing, wrapping, shushing, and pacifying.
If the baby has true colic, Dad's help is welcome when the baby is older than two weeks and is going through a fussy time, and especially when Mom has had it. In my day, we called this period a growth spurt—a time when the baby would begin to grow suddenly, therefore needed more food, and so nursed more often. We just nursed the baby a lot to get him or her through the rough spot. All that additional nursing of babies two to six weeks old—who are normally fussy in any case—really boosted and set the milk supply. The breast worked best to calm these fussy, more frequently feeding babies. We used to call this time of day, whenever baby was fussy and nursed a lot, Grandma's Hour—this was when Grandma shone, taking care of dinner and the other kids' baths while mom nursed. The baby loved it. Many think that pumping breastmilk is just as good a stimulus to lactation and the milk supply as a nursing baby. Perhaps. But most lactation specialists concede that a breast pump does not give the same signal to the breast that a baby does: to create an ongoing supply of milk. They also suspect that most breast pumps can't get as much milk from a breast as a baby gets from direct nursing. Women pumping solely for hospitalized premature babies tell us that their supply dwindles after only six weeks of pumping, but zooms back up when the baby is put to the breast. Remember that lactation seems to be established in the first six weeks of breastfeeding. Why interfere with milk establishment in the first six weeks at all? Let baby do it!
In my day, the breast worked. Dr. Nils Bergman of South Africa has recently studied the infant's response and the mother's response to Kangaroo Mother Care—skin to skin on the breast, and breastfeeding. Mother and baby symbiotically adjust to each other in many ways to get exactly what they need: body temperature, heart rate, and breathing and hormone levels settle into a calm state of low energy consumption. When modern laypeople and books brag about how they can calm the baby, they can get the baby to sleep longer, they can get the infant on a schedule, they can feed the baby mother's milk instead of the actual mother, I wonder if any of them think that the human breast even works anymore. Today, dads and hired folk can take care of this brave new baby. Yes, dads, grandmas, and baby nurses or doulas need to be supportive of and help the mother—but not to the detriment of the breastfeeding process. I, for one, know that the breast still works to meet all of a baby's needs, including the need to be calmed. Remember: You're not managing an inconvenience, you're raising a human being.
See http://www.mothering.com/articles/new_baby/breastfeeding/breast-work-notes.html or call our resource editor at 505.984.6292 for the bibliography for this article.
Kittie Frantz is the director of lactation services at the Los Angeles County University of Southern California Medical Center, and ?instructor in pediatrics for the Keck School of Medicine, University of Southern California, Los Angeles. This article relates the opinions of Kittie Frantz, and not necessarily those of her employers. See www.babysperspective.com for more information.