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Free Injoy Webinar: Secrets of a Postpartum Doula: Newborn Care and Soothing Techniques

November 14th, 2012 by avatar

 

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evilpeacock/3285516649/

Injoy Birth and Parenting Education is offering a free webinar titled “Secrets of a Postpartum Doula: Newborn Care and Soothing Techniques” taught by  Kimberly Bepler, IBCLC.

This webinar is scheduled for December 6, 2012, 1:30 pm (EST).  Some of the objectives of this webinar are to present:

  • The latest evidence in newborn care
  • Tips on teaching parents how to keep their babies happy and fulfill their innate needs
  • Ways educators can become more baby-friendly and promote breastfeeding, while still supporting parents and giving them the competence (and confidence) to do their best
  • New options for the care of infants

If you are a professional who works with expecting and new parents and their newborns in the classroom, or one on one, you may want to consider registering for this webinar event.  Learning effective methods of presenting evidence based information and interesting learning techniques is something that we all can brush oup on, no matter how long we have been working with new families.

Please consider joining the webinar and hearing what Kimberly will be sharing.

Click to to register and for more information. Please contact Injoy for all questions about this webinar.  Thank you.

Babies, Childbirth Education, Continuing Education, Infant Attachment, Newborns, Parenting an Infant, Webinars , , , , ,

“Don’t Sleep with Big Knives”; Interesting (and Promising) Developments in the Mother-Infant Sleep Debate

      In November 9, 2011, amid much fanfare and media attention, the city of Milwaukee unveiled their latest campaign to promote safe infant sleep.

The City of Milwaukee launches their most-recent infant sleep campaign.

 

The images are disturbing to say the least—they were designed that way. “Co-sleeping deaths are the most preventable form of infant death in this community,” Barrett said.  “Is it shocking? Is it provocative?” asked Baker, the health commissioner. “Yes. But what is even more shocking and provocative is that 30 developed and underdeveloped countries have better (infant death) rates than Milwaukee.”  A campaign such as this has a noble goal: to prevent infants from dying. But does this type of campaign keep infants safe?  The tragic answer is “no.” In less than two months after this campaign was launched, two more infants had died in Milwaukee in what the press described as “cosleeping deaths.” http://www.jsonline.com/news/milwaukee/ad-campaign-unveiled-as-another-cosleeping-death-is-announced-s030073-133552808.html

On January 3, 2012, WITI-TV, the affiliate Fox News in Milwaukee reported this:

One-Month-Old Infant Dies in Co-Sleeping Incident

Medical Examiner’s Report Says Baby Was Sleeping On Floor with Three Other Children

     The second death was of a 10-day-old infant who had died while sleeping with three other children on an adult bed. http://www.fox6now.com/news/witi-20111118-sleep-message,0,4692090.story  Neither of these infant sleep locations was safe and should not be classified as “bedsharing deaths.” The sad take-away we can learn from these cases is that “simple messages,” may be headline-grabbing. But in the end, they do not communicate what parents need to know to keep their infants safe while sleeping.

 In the same month as the Milwaukee campaign was launched, the American Academy of Pediatrics issued their new policy statement and follow-up technical report (American Academy of Pediatrics & Task Force on Sudden Infant Death Syndrome, 2011a, 2011b) on infant sleep-related deaths. In their press release, they stated that they were “expanding [the AAP guidelines] on safe sleep for babies, with additional information for parents on creating a safe environment for their babies to sleep.” http://aappolicy.aappublications.org/cgi/content/full/pediatrics;105/3/650

Poster from the Milwaukee campaign designed to warn against the dangers of bedsharing.

When I first read through this statement, it didn’t seem to differ all that much from previous statements, particularly on the issue many of us are interested in—namely, their recommendations regarding bedsharing. That recommendation did not really change. But in reading the full statement, there were some interesting, and dare I say hopeful, developments.

   The AAP Policy Statement (2011a) lists their Levels A, B, and C recommendations. A-Level recommendations are those with the strongest evidence. Number 3 of their Level-A Recommendations is that parents and infants room share, but not bedshare (p. 1031). They based their recommendation on the results of a new meta-analysis of 11 studies comparing 2,404 cases where infants died (28.8% of whom bedshared) with 6,495 healthy controls (13.3% of whom bedshared). They calculated the odds ratio and found that it was 2.89 (95% CI, 1,99-4.18).1  Based on their calculation, bedsharing increased the risk of SIDS by almost three times. But wait…..The authors noted that there was “some heterogeneity in the analysis” (p. 45). The heterogeneity in question referred to the fact that several of the studies included infant deaths that took place on a chair or couch (a situation that greatly increases the risk of infant death), not just those that took place in an adult bed with a non-smoking, non-impaired parent.

     This issue has, of course, dogged the bedsharing debate for more than a decade. The authors themselves acknowledged that this was a difficulty (Vennemann et al., 2012).

Only recent studies have disentangled infants sleeping with adults in a parental bed from infants sleeping with an adult on a sofa. This is certainly a limitation of the individual studies and hence of the meta-analysis (p. 47).

Poster from the Milwaukee campaign designed to warn against the dangers of bedsharing.

 But hopeful sign number 1: the AAP statement specifically differentiates between bedsharing and the broader term, “cosleeping,” which often includes all deaths that take place outside of a crib. I hope that this distinction will trickle down into future research studies.

 And there’s more. Vennemann et al. (2012) noted that bedsharing was much more hazardous with a smoking mother (OR=6.27; 95% CI, 3.94-9.99) than a non-smoking mother (OR=1.66; 95% CI, 0.91-3.01).  So there was still some increased risk if an infant slept with a non-smoking mother. But remember that this analysis included studies where babies died on couches and chairs. The next analysis was by age of infant. For infants <12 weeks, the odds ratio was 10.37 (95% CI, 4.44-24.21). But for older infants, 1.02 (95% CI, 0.49-2.12),  i.e., no increased risk.  Another analysis looked at whether bedsharing was routine. They found that if bedsharing was routine, the odds ratio was 1.42 (95% CI, 0.85-2.38). If bedsharing was not routine, but happened on the last night, the odds ratio was 2.18 (95% CI, 1.45-2.38). The authors noted that the risk was NOT significantly elevated in the routine-bedsharing group (although I note that there does seem to be some elevation in risk, probably due to the studies that included couch sharing).

     The next interesting issue is regarding their recommendations on chair or couch sharing with an infant. This has been a long-standing concern of mine due to the massively increased risk of infant death if parents fall asleep with infants on these surfaces. In fact, I have spoken with quite a few parents who routinely do this because they want to avoid bedsharing. Here’s what AAP says.

Because of the extremely high risk of SIDS and suffocation on couches and armchairs, infants should not be fed on a couch or armchair when there is a high risk that the parent might fall asleep (AAP, 2011a, p. 1033).

Further, they acknowledge—and seem to affirm—feeding babies in bed, but putting them in their own cribs for sleep.

Therefore, if the infant is brought into the bed for feeding, comforting, and bonding, the infant should be returned to the crib when the parent is ready for sleep (AAP, 2011a, p. 1033).  

     Unfortunately, this statement does not acknowledge that it’s quite easy to fall asleep in bed: 70% of mothers in our study who fed their babies in bed said that they fall asleep there (Kendall-Tackett, Cong, & Hale, 2010). And many a new parent would argue that that is precisely the point. There needs to be some recognition of, and planning for, that contingency.  But other than that, I am happy to see this recommendation included.

     The final point that I would like discuss is the role of breastfeeding in SIDS prevention, and how bedsharing has a role in sustaining breastfeeding. For example, Helen Ball (2007) found, in her longitudinal study of 97 initially breastfed infants, that breastfeeding for at least a month was significantly associated with regular bedsharing.

     We, in the breastfeeding world, have been saying this for a very long time (Academy of Breastfeeding Medicine, 2008; McKenna & McDade, 2005; McKenna & Volpe, 2007). But now the SIDS researchers are saying it too. For example, Vennemann et al. (2009) found that breastfeeding reduced the risk of SIDS by 50%. (Yes, this is the same Vennemann whose meta-analysis was cited above.) Regarding breastfeeding, Vennemann et al. (2009) said the following.

We recommend including the advice to breastfeed through 6 months of age in sudden infant death syndrome risk-reduction messages (p. e406).

     Peter Blair and colleagues (Blair, Heron, & Fleming, 2010) went further and highlighted the role of bedsharing in maintaining breastfeeding. (Peter Blair is also a co-author on Vennemann et al., 2012.)

Advice on whether bed sharing should be discouraged needs to take into account the important relationship with breastfeeding (p. 1119).

     So I am hopeful that we may be reaching a possible accord on this issue. While the AAP will probably never come straight out and recommend bedsharing, it would be helpful if they acknowledged that it will likely continue, and that our role is to help all parents sleep as safely as possible–either with or near their infants. Such a statement is possible. I’d like to close with the words from the Canadian Paediatric Society (Canadian Paediatric Society & Committee, 2004/2011).

Based on the available scientific evidence, the Canadian Paediatric Society recommends that for the first year of life, the safest place for babies to sleep is in their own crib, and in the parent’s room for the first six month. However, the Canadian Paediatric Society also acknowledges that some parents will, nonetheless, choose to share a bed with their child…..

The recommended practice of independent sleeping will likely continue to be the preferred sleeping arrangement for infants in Canada, but a significant proportion of families will still elect to sleep together…….

The risk of suffocation and entrapment in adult beds or unsafe cribs will need to be addressed for both practices to achieve any reduction in this devastating adverse event (emphasis added).

Do you talk about safe sleep in your classes? How do you address the risks and benefits of bedsharing?  Have new parents come to you after birth expressing concern about where their newborn is sleeping?  Share your experiences with talking to new parents about parenting a sleeping newborn, always a big discussion topic in the first weeks and months. – SM

 _____________________

[1]An odds ratio of 1.0 indicates no increased risk. Above 1.0 means increased risk. The higher the number, the worse the risk.

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References

Academy of Breastfeeding Medicine. (2008). ABM clinical protocol #6: Guideline on co-sleeping and breastfeeding. Breastfeeding Medicine, 3(1), 38-43.

American Academy of Pediatrics, & Task Force on Sudden Infant Death Syndrome. (2011a). Policy Statement: SIDS and other sleep-related deaths: Expansion of recommendations for a safe infant sleeping environment. Pediatrics, 128(5), 1030-1039.

American Academy of Pediatrics, & Task Force on Sudden Infant Death Syndrome. (2011b). Technical Report: SIDSand other sleep-related deaths: Expansion of recommendations for a safe infant sleeping environment. Pediatrics, 128(5), e1-e27.

Ball, H. L. (2007). Bed-sharing practices of initially breastfed infants in the first 6 months of life. Infant & Child Development, 16, 387-401.

Blair, P. S., Heron, J., & Fleming, P. J. (2010). Relationship between bed sharing and breastfeeding: Longitudinal, population-based analysis. Pediatrics, 126(5), e1119-e1126.

Canadian Paediatric Society, & Committee, C. P. (2004/2011). Recommendations for safe sleeping environments for infants and children. Retrieved from http://www.cps.ca/english/statements/cp/cp04-02.htm#Recommendations

Kendall-Tackett, K. A., Cong, Z., & Hale, T. W. (2010). Mother-infant sleep locations and nighttime feeding behavior: U.S. data from the Survey of Mothers’ Sleep and Fatigue. Clinical Lactation, 1(1), 27-30.

McKenna, J. J., & McDade, T. W. (2005). Why babies should never sleep alone: A review of the co-sleeping controversy in relation to SIDS, bedsharing, and breastfeeding. Paediatric Respiratory Reviews, 6, 134-152.

McKenna, J. J., & Volpe, L. E. (2007). Sleeping with baby: An internet-based sampling of parental experiences, choices, perceptions, and interpretations in a Western Industrialized context. Infant & Child Development, 16, 359-386.

Vennemann, M. M., Bajanowski, T., Brinkmann, B., Jorch, G., Yucesan, K., Sauerland, C., . . . the GeSID Study Group. (2009). Does breastfeeding reduce the risk of sudden infant death syndrome. Pediatrics, 123, e406-e410.

Vennemann, M. M., Hense, H.-W., Bajanowski, T., Blair, P. S., Complojer, C., Moon, R. Y., & Kiechl-Kohlendorfer, U. (2012). Bedsharing and the risk of sudden infant death syndrome: Can we resolve the debate? Journal of Pediatrics, 160, 44-48.

 About Kathleen Kendall-Tackett

Kathleen Kendall-Tackett, Ph.D., IBCLC, RLC, FAPA is a health psychologist, IBCLC, and Fellow of the American Psychological Association. Dr. Kendall-Tackett is Editor-in-Chief of Clinical Lactation, President-elect of the American Psychological Association’s Division of Trauma Psychology, clinical associate professor of pediatrics at Texas Tech University Health Sciences Center, and owner of Praeclarus Press. More information on the mother-infant sleep debate can be found at http://praeclaruspress.com/sense-sensibility.html

Babies, Breastfeeding, Childbirth Education, Guest Posts, Infant Attachment, Newborns, Parenting an Infant , , , , , ,

Celebrating Mother’s Day: Part Two: Infant Attachment

May 10th, 2012 by avatar

this is a guest post by Jessica Zucker, Ph.D.

Part Two: Fortifying Parenthood: Know Yourself

Part Two is about the importance of knowing yourself as a step towards developing healthy parenting practices.

Q: How can I prepare to become a parent who offers my child(ren) a different experience than I had growing up?

Awareness is essential. Having a reflective stance and carving out time to consider your attachment relationship history can have far-reaching effects on your future parenting patterns.

Research has found that their baby’s emergent attachment security is more likely when parents have been honest with themselves about the realities of their own childhood experiences. This means we need not have experienced perfect, flawless childhoods ourselves in order to ensure our future offspring with secure relationships.

What is vital, however, is having a curiosity about the realities of how you were raised, your formative relationships, and how you were impacted by your experiences- the good, the bad, and everything in between.

Reviewing our lives through a raw and honest lens will allow us to more deeply understand why we are who we are. This type of reflection is a natural springboard for cultivating additional insight, mourning difficulties in childhood relationships, and honing aspects of your person-hood that may create a more harmonious babyhood for your children.

Cultivating a sense of reciprocal intimacy in the ever-changing relationship relies, in part, on how you navigate the many feelings that arise each day. It is not a danger to the budding relationship with your child to experience complex feelings. It is what you do with these poignant moments, how you understand the feelings, and the way you react to them that matters most.

There is no more powerful a way to invoke the memory of your childhood than to become a parent yourself. And the opposite of this is true as well.

Getting a taste of what you didn’t get from your parents while parenting your newborn can stir enigmatic feelings that viscerally catch us off guard, leaving us potentially panic-stricken.

Our childhood histories don’t simply fade into the background upon becoming a parent. In fact, entering the maze of motherhood often stimulates memories seemingly long forgotten. Though they might not be consciously remembered, early experiences get stored deep in the crevices of our psyches and in the muscle memory of our bodies.

A potentially daunting task, swimming in the complicated pools of our past ensures a smoother childhood for our offspring. Research states that “experiences that are not fully processed may create unresolved and leftover issues that influence how we react to our children” (Siegel & Hartzell, 2003).

Attempting to make connections between the ways in which the past impacts the present awards us a freedom and flexibility of being with ourselves and with our children. Invariably, when we model for our children an embodiment of authentic reflexivity we provide them with opportunities for deepening connection. Developing a clearer sense of how we have been shaped by the parenting we received fosters a more conscientious parenting path.

Consistency builds healthy attachment. Predictability yields trust. Bonding strengthens connection.

Engendering these experiences in your child might require you to dig deep–to excavate your own childhood experiences with the aim of being the best parent you can be.

Book References:

Siegel, D. J. & Hartzell, M. (2003). Parenting from the inside out: How a deeper understanding can help you raise children who thrive. New York: Penguin Books.

Siegel, D. & Payne Bryson, T. (2011). The whole-brain child. New York: Random House.

Perinatal and Postpartum Mood Disorders: Perspectives and Treatment Guide for the Health Care Practitioner (2008). S. D. Stone and A. E. Menkin (Eds).

 New York: Springer Publications.

Wallin,D. (2007). Attachment in psychotherapy. New York: The Guilford Press.

Wiegartz, P. (2009). The pregnancy and postpartum anxiety workbook. Oakland, California: New Harbinger Publications.

Web Reference:

Early Moments Matter: PBS Toolkit

http://www.earlymomentsmatter.org/

Dr. Jessica Zucker is a clinical psychologist in Los Angeles specializing in women’s reproductive and maternal mental health with a focus on transitions in motherhood, perinatal and postpartum mood disorders, and parent-child attachment. Jessica studied at Harvard University and New York University. She is an award-winning writer and a contributor to The Huffington Post and PBS This Emotional Life. Dr. Zucker is currently writing her first book about mother-daughter relationships and issues surrounding the body (Routledge). Jessica consults on numerous projects pertaining to the motherhood continuum.

Web: www.drjessicazucker.com
Twitter: @DrZucker

Authoritative Knowledge, Babies, Guest Posts, Infant Attachment, Maternal Mental Health, Parenting an Infant, Uncategorized , , ,