by Sarah J Buckley MD
Excerpted from Gentle Birth, Gentle Mothering: The wisdom and science of gentle choices in pregnancy, birth, and parenting by Sarah J Buckley MD www.sarahjbuckley.com
Is it really possible to raise a baby without diapers? Can our babies actually communicate their elimination needs?
Well, how do you know when your baby needs to breastfeed?
Perhaps you recognise a certain gesture or cry. Perhaps your baby is restless, fist or finger sucking, or has a newborn's blind rooting behaviour. Maybe you also consider when your baby last fed, and whether they might have a special need for the breast because of tiredness, teething or being in an unfamiliar environment. As well, you might think about your infant's activity level; the weather; his or her routine; your routine; and many other factors that you instinctively take into account when you interpret your baby's signals.
And when you offer your breast, you usually get a "Yes" from your baby, but sometimes they will decline, or be only half interested, whether or not you are reading the signals correctly.
However, gradually and gently, you and your baby learn to fit together, communicating with each other and having a mutually satisfying nursing relationship — not to mention saving on all the cost and activity that formula feeding can imply.
Now imagine the same process, but with a focus on what your baby produces, rather than what they take in. This is elimination communication (EC) — also known as elimination timing (ET), natural infant hygiene (NIH), and infant potty training (IPT), among other names — in which we learn to communicate with our babies about their elimination: peeing and pooping.
Just as our babies know their own bodies, and their needs for food and breast, they also know the bodily sensations that go with the need to pee and poop, and they can, and usually do, communicate these needs. They tell us through body language, noises (from the bottom end as well as the top), fussiness, and also by the subtler, psychic communications that result from the intimate sharing of body space between mother and baby.
And if we pick up these signals, we can process them just as we do with breastfeeding, taking into account other factors and arriving at our interpretation of whether baby needs to eliminate. Then we have the opportunity to respond and offer a solution matched exactly to this baby's need. We can hold our babies in a position, and in a place, that facilitates their act of elimination. We can also feel, as with nursing, the satisfaction of consciously fulfilling our babies' needs from our own resources.
Sometimes we will misinterpret the signals, or may not be getting a clear message, just as with breastfeeding. And our babies will sometimes generously allow us to feed them — and toilet them — according to our needs, if we are going out, going to sleep, etc.
Like breastfeeding, EC has a powerful impact on our relationship with our babies, opening up new levels of communication and understanding, as well as keeping us finely tuned to our baby's their wavelength. EC highlights the mutuality that is, I believe, what our babies most need from us as mothers, and which can be lost or diluted in modern child-rearing practices.
This is not a method of toilet training, as some have misinterpreted. Rather it is an enlightening process for baby and mother (and possibly other carers) that makes conventional toilet training unnecessary, because our babies have never learned to ignore their body's signals. Neither is EC a way of making babies control their bladder or bowels prematurely, coercively, or traumatically. It does, however, dissolve the illusion that children have no control over elimination until the toddler years.
EC is also what the global majority of mothers and babies regard as normal. Very few women worldwide have the resources, facilities, or need for diapers. EC parallels the activities of other mammalian mothers, and seems to be as close to our genetic imprint as we can get.
Why elimination communication?
I came to choose EC with Maia Rose, my fourth baby, after learning about the possibility through several sources. I had read a letter to Mothering magazine in 1998 written by Rosie Wilde (who set up the first EC website) describing her positive experiences using elimination timing with her son.1 Elsewhere, I had read that African women cue their babies by making a "psss" noise when they pee, and I started doing this with Maia when she was newborn. A friend pointed me towards the website when Maia was three months, and, inspired, I held her over the laundry tub for the first time. I made the familiar "psss" noise, and, to my amazement, she peed straight away.
In my daily practice of EC, I had a lot of support from Emma (then ten), Zoe (seven) and Jacob (five) who told me how much they disliked sitting in wet or soiled diapers as babies. Some believe that we set up our society for sexual problems by encouraging our babies to dissociate, or switch off, from unpleasant sensations in their genital areas.
EC has also made a beautiful contribution to my experience of mindfulness in my mothering. Like nursing, EC has kept me close to my baby, physically and psychologically; ensuring that I remained present to my baby's needs; and providing very immediate and practical feedback when I was not tuned in!
As well as these advantages, EC has given us less washing and less waste, and a better time for Mother Earth. And it's been fun! After three babies in diapers, I have been constantly delighted at Maia's ability to communicate her needs, and to keep telling me until I understood. I was also blessed with more of her skin to stroke, especially at sleep time, and of course — no diaper rash.
How does it work?
I've come to the conclusion that probably all babies signal their elimination needs from an early age, but because we're not listening for it, we can misinterpret it as tiredness, needing to feed, or just crankiness — especially if our baby is in a diaper, and we don't observe the connection with eliminating.
In the first few months, I learnt Maia's signals by carrying her around bare-bottomed (usually with a cloth under her), and observing her closely. This was fairly easy for me, as it was summer and she was very much in arms in her early months. I discovered that she would squirm and become unsettled when she needed to go, sometimes with low-level crying, especially if it took me a while to "get it".
At other times, it was more psychic, and I found myself heading for the laundry sink, where she usually eliminated, without really thinking. When I was distracted, or delayed acting on my hunch, I sometimes got peed on. (However, she almost never peed on me when I carried her in a sling.) Her signal for poop was usually noisy wind, and sometimes she'd pull off the breast as a means of signalling that she needed to go. She didn't want to sit in her own poop!
Learning Maia's daily pattern was also useful. She usually pooped first thing in the morning, and, as a baby, tended to pee frequently (about every 10 minutes) in the first few hours after arising. (Nicholas found this really tricky when he was caring for her in the morning.) I noticed that she would also pee about ten minutes (that's mama minutes, not clock minutes) after breastfeeding or drinking. She would almost always pee on awaking, which seems true of older children too; I think it is the need to eliminate that actually wakened her.
In her first year, we used the laundry sink by preference. I'd hold her upright by her thighs, with her back resting on my belly. A small plastic bucket with a conveniently concave lip was also useful from the early days2; I'd sit down and hold it between my thighs, holding Maia above it. The "blue bucket" — now a family icon — has been very well travelled, and was also invaluable for nighttime eliminating in the later months. As she got older and heavier, I found that sitting her on the toilet in front of me worked well — sometimes we'd have a "double pee", which was always successful if nothing else worked! Along with the position, I cued her with my "psss" noise; and sometimes at the tub, when I thought she had a need but was slow to start, I'd run some water as well.
After three months or so of doing this, I became more certain of my interpretation and I would sometimes gently persist, even when she seemed reluctant. Usually I was on track, but it's a fine line; with EC it's vital to have cooperation, and not a battle of wills, which can sometimes develop around toileting issues. EC is more a dance of togetherness that develops, as with breastfeeding, from love and respect for each other.
On a practical level
I used cloth diapers when we were out and about, and peed her as much as I could. Mostly the diapers stayed dry, but I didn't expect to be perfect in these, or any, circumstances. We used toilets or took the bucket (or another plastic container with a tight lid) in the car. When we missed a pee, my reaction was, "Oh well, missed that one." On hot days, I just laid a diaper on the car seat; if it wasn't convenient to stop, I'd say to her, "Sorry Maia, you'll have to pee on the diaper, and I'll change it as soon as we stop."
Maia didn't like to be disturbed at night in the early months, so I'd lay her on a thick cotton blanket and just let her pee. I changed this whenever I woke up. Or I'd wrap a cloth diaper loosely around her bottom and change it when wet. I found that, as with naps, she usually peed on awaking and then would want to nurse.
Around six to seven months, Maia went "on strike" (a well-recognised phenomenon in EC) coinciding with teething and beginning to crawl. She stopped signalling clearly and at times actively resisted being peed. I took it gently; offering opportunities to eliminate when it felt right and not getting upset even when, after refusing to go in the laundry tub, she peed on the floor. Even on bad days, though, we still had most poops in the bucket or the toilet.
At nearly ten months, we were back on track. I noticed that as she became more independent and engrossed in her activity, she was not keen to be removed to eliminate, so I started to bring a receptacle to her. She preferred a bowl or bucket on my lap, and later we began to use a potty: I initially held her while she used it. At nighttime, I started sitting her on the blue bucket (and attached to my breast at the same time — tricky to lie down afterwards and not spill the bucket!). When I was less alert, she peed on a diaper or blanket underneath her.
There was a marked shift soon after she began walking at 12 months, and by 14 months, to my amazement, Maia was out of diapers (diapers) completely. She now was able to communicate her needs very clearly, both verbally and non-verbally, and her ability to hold on was also enhanced. When she needed to eliminate, she said, "wee" (that's Australian for "pee") or headed for the potty — we had several around the house.
Nicholas was so delighted when she first did this that he clapped, and so she would stand up and applaud herself afterwards. She began to be very interested in the fate of her body products, and joined me as we tipped it onto the garden or into the toilet. She even began to get a cloth and wipe up after herself!
With this change, I stopped using diapers altogether, and switched to trainer pants for going out.2 Dresses are great too, for outings with bare-bottomed girls in warm summer months. By around 16 months, Maia was totally autonomous in her daytime elimination. She could tell us her needs in plenty of time to get to the toilet, or could take herself to the potty.
I did find that when we were out of our usual situation — for example, visiting my family overseas — that she needed more help with her elimination, and it felt good to be able to use EC to tune in more deeply with each other. I also found that I was more alert to her needs when we were travelling, so our flight (about four hours from Australia to New Zealand) involved many trips to the toilet, but we arrived with a dry diaper!
Nights continued to be busy through Maia's second year, with lots of feeding and peeing but, unless she was unwell or I was very tired, we had very few misses, and sitting up at night to pee her seemed to me a small effort in return for the benefits we were reaping.
I used a hot-washed (and therefore shrunken and felted) woollen blanket with a towel on top under the sheets to protect the mattress, and if we had a mishap, I just covered the wet patch with a cotton blanket until the morning. Some EC mothers report that their babies stop peeing at night, even in the first year, or have a predictable pattern (for example not peeing after midnight). Knowing that this was around the corner for us was heartening. Some EC babies are happy to be in diapers at night, but this wasn't right for Maia and me.
When Maia turned two, I began to wean her from night nursing, and so her overnight peeing diminished significantly. By two and a half, we would get through most nights without the blue bucket. Diaper-free days were very easy, and it was delightful to see her peeing her dollies with the "psss" noise!
Throughout my EC time with Maia, I learned a lot from talking with other mothers, from the EC email list and from reading and re-reading the beautiful book Diaper Free! The Gentle Wisdom of Natural Infant Hygiene by Ingrid Bauer.3 It seems that our 14-month shift is a usual pattern, and that at some time in the second year, things fall into place and the baby becomes fully continent, although with possible lapses now and again due to changes, illnesses etc.
Ingrid Bauer writes of four tools that we can use to practise EC (a term she coined) with our babies. The first is timing — that is, guessing when your baby needs to pee or poop according to feeding, sleeping, interval since last pee, their usual routine etc. Second, we can learn our baby's signals, noises, and body language, realising also that whatever signal we respond to will be reinforced, thus creating a unique language for each mother and baby pair.
Third, we can be open and trusting of our intuition and our psychic connection to our baby. EC is a particularly beautiful way to tune into, and develop trust in, this level of communication, and our babies will respond happily when we follow our intuition. Alternatively, when we fail to act on our hunches, we can get very tangible consequences! Fourth — and this was the point I learned about first — we can cue our baby through position, sound, and movement so that our baby learns to release their pee and poop in the appropriate place — bucket, sink, toilet, diaper, garden etc. Different cultures use some or all of these cues; we used a "psss" noise and a supported squat.
I have also learned from Diaper Free some of the physiology of EC, which is totally counter to what I was taught at medical school, where it was asserted that babies do not have sphincter control until close to the second birthday. Obviously the pediatricians didn't consult the global majority of mothers and babies! What interests me is that with EC, which must be our evolutionary norm, babies begin with releasing their bladder and bowel before they learn to hold on. This makes EC very convenient because, when co-operative, a baby can empty even a small amount from their bladder and, for example, I could know that we were starting a car-trip with minimal chance of Maia needing to pee for at least half an hour or so.
I wonder also about the mind-body implications of this subtle difference to conventional toilet training. I have witnessed the ease with which Maia can let go of her pee and poop, and I feel that this process may help her in letting go on an emotional level as well. I can also feel, in my mothering, the beauty of supporting her in her eliminative functions, which many of us feel shameful about and would prefer to deny — hence diapers, which hide the eliminating act itself.
For me, the beauty of elimination communication has been in the process, not in the outcome, however remarkable or convenient. (Although it's been great to do less than a full load of washing each day for a family of six!) Using EC has taught me that mothers and babies are connected very deeply — at a gut level — and that babies (and mothers) are much more capable and smart than our society credits.
I have experienced EC with only one baby, starting at a young age. Many women in many places have done it differently; starting from birth or with an older baby; making less or more use of diapers; taking a long time or a short time to catch on; doing EC part-time or full-time; having their babies naked or wearing snow-suits; and some women have even begun work outside the home and trained their baby's caregivers in EC. (This is actually not so radical; in many cultures the baby's grandmother teaches EC, as part of caring for the baby while the mother works.)
If you feel drawn to EC, I encourage you to have a go. Look on the Internet — it's all I needed to get started, and is also a great source of ongoing support. Consider also Ingrid Bauer's comprehensive book, as well as talking to other mothers, especially women from countries such as India and China. Laurie Boucke's excellent book, Infant Potty Training,4 has an extensive section on EC-type practices in other cultures. Although it can be more complex for older babies, some of whom may have already learned to ignore their body's signals, others may welcome the chance to communicate their elimination needs.
In our society, mothering is often seen as a chore — a time in our lives when we are unintellectual, and unproductive. Dealing with our children's elimination products is perceived as particularly onerous, and big business has capitalised on this, making millions of dollars and tonnes of waste, by manufacturing disposable diapers. These attitudes sadden me — how awful for our children to be seen as the cause of bad feelings and unsanitary waste.
There is, however, a radically different point of view, shared by many in other cultures, that sees mothering as a women's spiritual practice, and our babies as our teachers. We have the opportunity in mothering, as never before, to practise devotion, awareness, selflessness, and unconditional love through our daily mothering tasks. Our intellectual capacities may (or may not) be diminished, but our hearts and instincts can bloom, and we can practise the mindfulness that allows us to be totally in the present — in love with our babies and children — which is where they are.
Blessed be the babies.
Previous versions of this article have been published in Byron Child No 4, Dec 2003, pp 23—5; The Mother (UK) Issue 3, Autumn 2002, pp 32—3; and Natural Parenting No 1, Summer 2002, p 20—22. This version updated May 2005 for www.mothering.com.
1. Wilde R. Cloth Diapers (letter). Mothering, 1998:11—12.
2. For small EC receptacles and Australian brand Bright Bots trainer pants, which come in small sizes, see www.theecstore.com
3. Bauer I. Diaper Free! The Gentle Wisdom of Natural Infant Hygiene. Salt Spring Island BC: Natural Wisdom Press, 2001.
4. Boucke L. Infant Potty Training — A gentle and primeval method adapted to modern living. 2nd ed. Lafayette: White-Boucke Publishing, 2002.
More EC Resources
Diaper free! Elimination awareness explained and explored - Video made in Australia and available from www.natureschild.com.au
Elimination Communication Yahoo group
Diaper free baby — local groups, resources and links
You will also find EC discussions at the following forums:
Mothering Magazine's MotheringDotCommune
Ingrid Bauer's Natural Infant Hygiene site and book, plus links: http://www.natural-wisdom.com
Laurie Boucke's site, books and the Infant Potty Training Webring: http://www.timl.com/ipt/
Natec's Elimination Timing article, excerpt from her original booklet: http://www.timl.com/natec_1.htm