Pediatrician Clay Jones has a great piece today on The Scientific Parent, Recent Reports of Skin-to-Skin Benefits Fail to Mention Key Infant Safety Risks:
The Kangaroo Mother Care concept was introduced in the the late ’70s in developing countries as an alternative solution to incubators, where access to them and more complex healthcare for infants was limited…
…[Y]ou need to know that the reduced risk of death has really only been found in babies born with low birth weight…
Moreover:
[pullquote align=”right” cite=”” link=”” color=”#96712D” class=”” size=””]Practices beneficial for premature babies extended to term babies despite a lack of evidence? Where have we heard that before?[/pullquote]
There are risks. The media reports I saw had flawed conclusions, overlooking that these practices can put babies at risk of neurologic injury and even death.
Dr. Jones is talking about Sudden Unexpected Postnatal Collapse (SUPC):
This happens in the first week of life when a low-risk (healthy) newborn suddenly and unexpectedly has difficulty breathing, which can lead to their heart stopping. In the U.S. and Canada, we typically refer to this as early SIDS and sudden unexpected early neonatal death (SUEND). The outcome is frequently tragic, and half of the children affected die, with many of the remaining newborns are disabled in some fundamental way.
I’ve written about this problem before in association with the so called “Baby Friendly” Hospital Initiative designed to promote breastfeeding, in Is the Baby Friendly Hospital Initiative really the Baby Deadly Hospital Initiative? In it I discussed the paper Deaths and near deaths of healthy newborn infants while bed sharing on maternity wards published in 2014 in the Journal of Perinatology.
We know that bed sharing (co-sleeping) can be deadly for babies, and the risk is highest when mothers are impaired by drugs or alcohol
The author reported 15 deaths and 2 near deaths:
In eight cases, the mother fell asleep while breastfeeding. In four cases, the mother woke up from sleep but believed her infant to be sleeping when an attendant found the infant lifeless. One or more risk factors that are known or suspected (obesity and swaddling) to further increase the risk of bed sharing were present in all cases. These included … maternal sedating drugs in 7 cases; cases excessive of maternal fatigue, either stated or assumed if the event occurred within 24 h of birth in 12 cases; pillows and/or other soft bedding present in 9 cases; obesity in 2 cases; maternal smoking in 2 cases; and infant swaddled in 4 cases.
So the benefits of skin-to-skin are being completely oversold and the risks and downsides completely ignored.
That sounds familiar. Where have we heard about practices beneficial for premature babies extended to term babies despite a lack of evidence? Where have we heard about benefits being oversold and risks or downsides completely ignored?
I remember! The exact same thing has happened with breastfeeding and delayed cord clamping. All three share remarkably similarities.
1. A practice found to be beneficial for premature infants is extended to term infants in the absence of any scientific effort to support it.
As Dr. Jones notes, skin-to-skin care was found to be beneficial for premature infants who need help regulating body temperature. There were no studies that showed the same benefits for term infants who don’t have trouble regulating body temperature.
Breastfeeding has been found to prevent necrotizing enterocolitis (NEC), a deadly complication of prematurity, but has no similar life saving benefits for term infants.
Delayed cord clamping has been found to prevent anemia of prematurity, but does not prevent anemia in term infants.
2. The practice is promoted and popularized by allied health professionals like midwives and lactation consultants.
3. The practice is promoted in a dual effort to demonize conventional medical practice and promote alternative medical claims.
4. The practices are examples of unreflective defiance so prominent in midwifery theory.
The midwife who first promoted delayed cord clamping did so because she believed it prevented learning disabilities. That was obviously untrue but other midwives picked it up and made the rationale more plausible but still unsupported by scientific evidence.
5. The risks and the burdens are ignored.
This is especially true in the case of breastfeeding. Approximately 5% of mothers cannot make enough breastmilk to fully support a term infant. This can result in dehydration, brain damage and death. Nonetheless lactation consultants continue to promote the utter fiction that there is “no such thing” as not enough breastmilk.
Breastfeeding can be painful, inconvenient and burdensome for mothers … but who cares about mothers? Their needs are rendered invisible and considered meaningless.
6. Even deadly dangers are ignored.
We know that co-sleeping increases the risk of infant death. We know that prone sleeping also increases the risk of infant death. We know that the risk is higher when women have taken sedative medications. We know that soft bedding also increases the risk. Yet lactivists and lactation consultants encourage co-sleeping and prone sleeping next to or on top of sedated mothers enveloped in soft bedding to “promote” breastfeeding … and there’s no solid evidence that it has any impact on breastfeeding rates.
Has anyone ever said: “I stopped breastfeeding because if I had to get up anyway to put the baby back in the crib I might as well bottle feed”?
7. White hat bias
White hat bias is bias toward what are perceived to be righteous ends. Formula companies have committed egregious crimes in the developing world. White hat bias is bias against formula in a righteous effort to punish the manufacturer.
The desire to believe that “natural” is always better than technological is another form of white hat bias.
Midwives and lactation consultants have their own form of white hat bias. In an ongoing effort to demonize any technology that they cannot provide, they are heavily biased toward practices or procedures that they can provide.
In the final analysis, only careful scrutiny of scientific evidence should guide clinical recommendations … NOT intuition; NOT wishful thinking; NOT the desire to promote midwifery or lactation consultants; NOT a desire to promote breastfeeding; NOT white hat bias.
Women who pride themselves on taking a cynical view of doctors and industry products need to expand their cynicism to midwives and lactation consultants and their products.
Otherwise babies will continue to die completely preventable deaths because their mothers never received complete and honest information about minimal (or even non-existent) benefits or complete and honest information about deadly risks.
It’s nice to hear that skin-to-skin isn’t as crucial as the baby care class and hospital pamphlets implied since I couldn’t hold my baby until the fifth day and then we were both clothed. Why would you even give the skin-to-skin pamphlets to a mom whose baby can’t be held because he has a tube in his chest?
Carolyn, many mothers choose to bond immediately with their baby and have them in the same room. The hospitals still offer the mother the option for the nurses to take the baby so mom can rest. What a silly article
T, the article is about hospitals that follow the BFHI (“Baby Friendly Hospital Initiative”). Those hospitals do NOT have nurseries and they REQUIRE new mothers to room in with their babies, Literally all–even if the new mom just went through 20 hours of labor, an emergency c-section, a near-death experience and a blood transfusion. That’s what she’s talking about. You, in contrast, are talking about non-BFHI hospitals.
Some hospitals still have an infant nursery. We like those hospitals. But some do not. This article was about those that do not.
Dr Amy, I’m sure you already have articles about this, but I would love for you to write about “Baby Friendly” hospitals and the eradication of well babies nurseries. My 3rd baby was born in a hospital with a well baby nursery, and my recovery was 100% easier than when I had to room in with an infant after a difficult labor. It’s so absurd to me that hospitals expect women who have just been through a major medical trauma to also care for an infant with no assistance or rest.
Here’s one:
http://www.skepticalob.com/2014/09/is-the-baby-friendly-hospital-initiativ-really-the-baby-deadly-hospital-initiative.html
The problem, Carolyn, is that that was a benefit for YOU. And it’s very important that in order to be “Baby Friendly”, you can’t do things that might benefit mom. Even if it has no impact on the baby’s well-being, you can’t do things that might allow mom to do better.
Exactly. It sounds as if you weren’t suffering or martyring yourself in any way!
And make sure with all the uppity feminists around that these women remember what their place is!
My one time doing skin to skin in the NICU was very emotional because I had barely gotten to touch or hold him up to that point. Since I was sitting in a chair with monitors beeping all around me, lots of nurses, and my husband, and my baby was hooked up to multiple monitors, even if I had fallen asleep someone would have waked me up or an alarm would have gone off if his airway was compromised.
Not totally OT, in re: the “golden hour, “this article notes that it’s more like the “golden minute”–to get the baby to breathe: http://www.npr.org/sections/goatsandsoda/2016/01/07/461935008/so-heres-what-you-shouldnt-do-when-trying-to-revive-a-newborn?utm_medium=RSS&utm_campaign=news
Interesting article… I do have to say I have found being skin to skin with my baby to be a wonderful experience. It felt “right”. That being said, I never ever did so while I was sleepy or alone.
This is exactly what infuriated me about the CLSC nurses and their obsession with exclusive breastfeeding (CLSCs are health centres run by the province of Quebec). They do know that for many mothers breastfeeding causes major lack of sleep. And they promote all these breastfeeding positions that are frankly, quiet dangerous, so women can snooze while breastfeeding and don’t give up.
What I don’t understand is, what is wrong with combined feeding? Why do we have to be hooked up to machines around the clock and get milked if we have the supply but the baby is not latching ? (seriously, would men accept that??)
I do hope to have a second child and I hope to combine feed (I did switch to hypoallergenic formula for my sanity with my first after three months of breastfeeding ).
I have two questions for Dr. Amy and the community. 1)Is there a book/resource that gives good guidance on breastfeeding that doesn’t demonize formula (and preferably gives guidance on combined feeding). Cause I can’t count on the Clsc.
2) What can I do???? I am absolutely infuriated by the CLSC’s obsession with breastfeeding and the guilt culture. If pretty much evverryyyyone can breastfeed, why can’t I?? Do I have to see the La Leche League posters and photos of random women breastfeeding plastered all over the walls in the “breastfeeding” (not “feeding”) room while waiting for my baby’s vaccines? I thought of writing to the Minister of Health but doubt it will do anything. Perhaps I should just go and draw moustaches on the posters? 😛
In thinking it over I think I understand why the way this post is worded rubs me the wrong way. Are there risks to practicing skin to skin/kangaroo care improperly? Absolutely. But extrapolating that to say skin to skin is “risky” is not substantially different than when lactavists go on about how formula feeding is “risky” but then bring up practices that are obviously dangerous – improper hygiene, improper storage and handling, bottle propping, etc. Yes, not using basic hygiene (washing one’s hands, washing bottles and utensils), letting formula sit out too long, trying to use up bottles that babies started more than two hours ago, improper mixing of powder and concentrate, propping a bottle and leaving baby unattended can all make a baby very ill, or in extreme cases cause death, BUT that is not the fault of formula feeding and it is unfair and improper to speak of those as risks inherent to formula feeding. If proper safety measures are taken, formula feeding is very safe. Likewise, when practicing skin to skin, following some common sense safety measures is necessary. Babies are at risk during skin to skin if their airway is restricted, if they are allowed to sleep in a prone position, and if the mother/caregiver falls asleep themselves, BUT that is not the fault of skin to skin.
That said, the information about proper formula feeding is pretty well known and widely distributed. I never used formula with any of my children, but even I know the “rules”. With skin to skin you could make the argument that women aren’t being properly instructed as to how to do it safely, and certainly that needs to be remedied. But saying skin to skin is dangerous/risky is different (at least in my point of view) than saying that should a woman choose to engage in the practice, certain safety protocols must be followed. The former implies an inherent danger that would discourage the practice entirely, the latter actually instructs women in how they can do this safely. I find it an important distinction, just as I’m sure formula users would find it an important distinction as it applies to formula feeding. So, yeah, maybe this isn’t way off into tin foil hat land, but it is coming dangerously close. Using the kind of rhetoric and histrionics as lactavists is always loony, no matter what it applies to.
” I find it an important distinction”
I don’t actually. I don’t give a damn about how well something works out under “ideal” conditions. I care how it works out in real life.
For example, it doesn’t matter to me that the birth control pill is 99% effective if taken exactly as directed by a woman of ideal weight. Most of my patients aren’t of “ideal weight” and most forget at least a few pills per month. In my patient population, the birth control pill is only 80% effective.
Likewise with formula. The fact that formula can be mixed improperly is indeed one of the downsides of powdered formula. Deaths from this are quite rare in the developed world, but when they occur we cannot decide they “don’t count”. Likewise with breastfeeding. Babies who die from dehydration due to insufficient supply must be counted. Lactivists claim that if a woman was “doing it right” she would have made enough milk. But even if that is the case, so what? The fact that breastfeeding is so prone to glitches in the real world can’t be dismissed.
Likewise with smothering during skin-to-skin. It’s no consolation to a mother to be told that her baby would still be alive if she had only done it “ideally”.
Okay. So then what is the actual risk here? The article Dr. Amy linked to said that after adjusting for things like prematurity, illness, injury, etc, 75% of the cases of SUPC studied involved babies being in a prone position during skin to skin or initial attempts at breastfeeding. That doesn’t tell me a whole lot about the risk of skin to skin (or the risk of attempting to breastfeed, for that matter). I’d like to know what is the risk of SUPC of all babies in general (regardless of whether they are engaging in skin to skin), and what is the risk of SUPC of those whose mothers do engage in skin to skin (and of all babies whose mothers attempt to bfing) to find out what the actual risk is, and how the risks compare between groups. Put it this way – among very young neonates who become seriously ill or die from food born illness, what percentage of them were being formula fed, what percentage were fed pumped breast milk, and what percentage were breastfed at the breast? Honestly I’m not sure how to even find that out. Or if it really matters- it might be an interesting question, BUT for practical purposes the more important question is how many very young neonates die of food born illness in the first place, does formula (or bottle feeding in general) put them at greater risk and how much more risk are we talking, and how do we make bottle feeding safer (because simply telling women “it is risky so don’t do it” is stupid – people are going to use bottles, it is far more helpful to give people an idea of what the actual risks are and how best to reduce them). Just as your patients on bc deserve to know what the real world effectiveness rates of various methods are, how those rates stack up against using no bc, and how they can potentially maximize effectiveness of their chosen method, mothers deserve to know what the actual risk are, as well as the relative risk, and how to maximize safety when it comes to parenting decisions. Simply saying ” it’s risky, don’t do it” is kinda like preaching abstinence only to your patients because, hey, bc carries risk and doesn’t work perfectly anyway….
Never have I said “it’s risky, don’t do it”. If a woman wants to do skin-to-skin and there is no reason not to (e.g. baby unstable, mom very sedated), go ahead. She should be warned about the potential for suffocation and how to reduce that risk, of course. This can go right along with all of the education about suffocation/safe sleep that parents of newborns should be getting.
The point is not that we want to outlaw skin-to-skin. The point is that we should not be *promoting* it. There are no demonstrated benefits in term infants, and there are demonstrated (although rare) risks.
Touche! You are right, there is a marked difference between promoting something vs actively discouraging it and refusing to give info needed for informed decision making. I can understand ceasing the promotion of the practice in light of the potential risks, but at the same time instructing those who want to do it anyway what the risks are, as well as how to mitigate those risks (if possible).
I do wish the article had spelled out what the absolute risks of skin to skin are and the relative risks. The way the stat was worded is next to useless – if I told you 75% of people who died yesterday ate cold cereal for breakfast all you could ascertain from that is that cold cereal is a popular breakfast food. And the stat I mentioned is further confounded by lumping together prone position while skin to skin with prone position while initiating bfing. Why are we not warning women about the dangers of SUPC related to initiating bfing? It strikes me (and I could certainly be wrong, this is just my layperson hypothesis) that it’s not the initiating bfing, nor is it the skin to skin that is culpable in these deaths – it’s the prone position of the baby. I’d love to see stats on the risk of SUPC in babies who were skin to skin in a supine or side lying position vs those who were skin to skin in a prone position.
Sorry to ramble… just my musings on the article.
Is there any skin-to-skin protocol/guide/etc that has the baby facing away from the mom?
They can’t be *encouraged* to breastfeed if they are facing away from mom’s boobs…
I don’t know how anyone breast feeds with baby in a prone position to begin with! Side lying? Sure. Even supine is reasonably possible (though mom would obviously not be able to be reclined and I get a back ache just thinking about it). But prone? Maybe older babies who’ve good head and upper body control or toddlers (whose bfing acrobatics can be quite amusing), but a newborn, facedown on the boob? Yeah that seems not only like a really bad idea (how do they breath?), but also awkward as hell for the mother (I know I needed to see the baby’s mouth and my nipple in order to get a good latch, at least for the first few weeks, prone positions wouldn’t allow for that even if they didn’t risk suffocation of the child).
Prone position for BF is advised if mom has strong letdown reflex – lying on your back takes at least gravity out of play and baby should have easier times swallowing milk. How that would work in newborns I have no idea – I tried this when my baby was fussing at the breast and I figured out that it’s because of overabundance of milk when letdown kicked in – but it was around 2 months and he was holding his head without much effort.
Not that I’m aware of, but I don’t know what’s been attempted either. Can premature or otherwise compromised babies (the ones who actually do derive some established benefit from skin to skin) get the same benefit (or at least similar benefit) if mom holds that baby skin to skin in a cradle hold? I don’t know if that’s even been looked into. Certainly for term infants, for whom no discernible benefit has been established, it would make sense to instruct mothers to practice skin to skin time without putting baby in a prone position – they aren’t receiving established benefits anyway, so positioning really won’t matter in terms of benefit (assuming it even matters for premies), but it could reduce risk, perhaps dramatically so.
Just thought of an interesting thing… post section mom is hypothermic… this happens rarely. It becomes like putting baby on a cold waterbed. No never happened to me…
I was for my first. Loved the whole-body warming fan and the hot blankets. Daddy held baby in different room while I was in recovery room for 2+ hours.
That was my barracuda child. NO trouble breastfeeding, ever.
“It strikes me (and I could certainly be wrong, this is just my layperson hypothesis) that it’s not the initiating bfing, nor is it the skin to skin that is culpable in these deaths – it’s the prone position of the baby.”
It’s not the prone position per se, it’s that the baby’s face is smashed up against the soft tissue of mother’s chest. This can occur if mom is lying on her back and baby is prone on top of her, but can just as easily happen with a semi-reclined or sitting mother. And skin-to-skin, as it is currently practiced, involves mother and baby being placed naked chest-to-chest, in a position that is high risk for baby’s nose getting obstructed.
Lactation consultants say stupid stuff like “the baby needs to smell the breast milk” and “your baby needs to do ‘the crawl’ up to the breast. These obviously can’t be done with the baby facing away. The lactivist-approved “correct” way to breastfeed a baby is to to be 100% front-to-front. The long axis of the baby can be perpendicular (in the cradle hold and football holds) or parallel (if side lying) to the long axis of the mother, but in every case the baby “should” be facing straight inward, not turning its head at all.
Lactivists love to shame new breastfeeding mothers for “holding your baby as if you were feeding him a bottle rather than holding him securely against you with his whole body facing you”. But in reality, a more open “bottlefeeding position” is less of a smothering risk.
I was always told to turn DS completely towards me, tummy to tummy to BF when I was attempting to do so. It always looked awkward to me….that and the advice to “bring the baby into the breast, not take the breast to the baby”. It involved the LC smashing DS’s little face into my ample breasts trying for a successful latch.
But why encourage skin-to-skin at all? There’s no proven benefits in term babies and making it a safe practice can be challenging when you have a fatigued mom (try not falling asleep when you have a warm baby laying on your chest). It’s a practice with not much upside and a potentially deadly downside.
I really wasn’t trying to imply that it should be “encouraged”. More like, if it’s something the mother is interested in and/or is going to do anyway, she should have the info on how to make it as safe as possible.
I agree with you that information on safe skin-to-skin should be communicated to parents. What I object to is the fetishizing of S2S, overstating the potential benefit and encouraging demonstrably unsafe practices like bed-sharing to promote S2S.
And in overstating the benefits, it leads some to go too extremes, to the point of creating risks.
It’s like breastfeeding. By treating breastfeeding far more important than it is, you get women doing things like starving their babies to avoid formula, or stories like Dr Whackaloon avoiding sending a baby to the NICU because it might harm breastfeeding.
They aren’t “risks of breastfeeding” per se, but they are risks that result from overstating the benefits.
As per fiftyfifty, they are ‘risks of breastfeeding as currently practiced.’
Are you sure you know all there is to know about formula? Because it’s often made to sound simple, but there are, in fact, a lot of questions that come up. It annoys me to no end that we have lactation consultants rather than FEEDING consultants. What women really need is someone who is informed about ALL methods of feeding and can therefore support any dyad’s particular needs.
I don’t recall saying that I know “all there is to know” about formula, but I am acquainted with the safety measures, at least those outlined in every pregnancy/baby book, the discharge paperwork sent home with each of my kids, as well as the info widely available online (not to mention on the back of the sample cans I received). Obviously, if I were to need/want to use formula I would refresh my memory, and perhaps I would have questions that aren’t answered by those sources I mentioned. I would hope I could call my child’s doc and at least talk to one of the nurses who should be able to guide parents. If it were after hours, my insurance company has a “nurse advice line” and I’d think they could answer infant feeding questions. But, yes, lactation consultants should (whether they do or don’t, or have it and don’t dispense it is another issue) have that kind of info for new mothers. My only point in bringing that up was that the info on how to safely store and prepare formula is pretty widely available, so much so that someone who has never needed or wanted to use it is acquainted with at least the basics. The same cannot really be said about skin to skin safety protocols.
If you’re going by what’s in “every pregnancy/baby book” then you really don’t know much about it. It’s that attitude that prevents new moms from getting the information they need when they need it. No, it’s not all on the can, or in the books. If your pediatrician is pro-breastfeeding, they may not provide formula support either. Ditto for any sort of nurse call-in line you get.
I just find it pretty arrogant of you to say “I never formula fed, but I know all the rules” as if it’s that easy. It isn’t.
OT – have had an inquiry from a woman looking for cesarean by choice supportive OBs in the St. Paul / Minneapolis area – any suggestions would be appreciated.
I wish I could help, but I’m in NJ; however, as a soon-to-be-mom desiring an MRCS, I did want to thank you for sharing your story on your blog which I found through the SOB. You’ve given me the courage and the information to ask my OB for a CS at 39wks, and, after discussing the risks and benefits, she happily agreed. I feel like I can finally relax and enjoy the rest of my pregnancy now. Thank you for all your work on this issue!
I would suggest Dr. Jennifer Flynn at Metro OB/GYN. With my second, I was considering a C-section for no medical reason and she was very open to it. I always felt like she was treating me as a whole person with a past and future to consider when making medical decisions.
It’s a pretty liberal area in that regard. She could establish care with just about anyone, and if they didn’t do it, they would have no trouble referring her to someone who did.
Good luck to your friend! If she’s on Facebook, there’s a group called the Cesarean by Choice Awareness Network. And here’s a great book:
http://www.amazon.com/Choosing-Cesarean-Natural-Birth-Plan/dp/1616145110
The author runs some websites and may be able to point your friend (or others in her position in other cities) in the right direction:
http://cesareandebate.blogspot.com/p/about-me.html
http://www.electivecesarean.com/index.php
OT, but I just saw a post on Facebook that made me cringe–a mother posted a photo of her child’s chapped skin, and asked for recommendations. One poster suggested some kind of oil (can’t recall the name) and said that if she wanted breastmilk to pour over the affected skin, to let her know.
Edited to add that the post has now been edited, and I wonder if it didn’t get the reception she expected.
Confession time! When my daughter first started showing signs of eczema at two months old, every website I went to said to put breastmilk on it, that it would help moisturize and heal it, and that it had antibacterial, antiviral properties. I thought it couldn’t hurt and might help, so I put a drop on one cheek, figuring it was best to start with a small area before I fully gave in to what sounded kind of crazy. She scratched herself hard, broke the skin, developed impetigo, and had to take antibiotics for 10 days (which probably did more to destroy her intestinal flora than formula ever did). Of course, there’s no way to prove that the impetigo had anything to do with the breastmilk because eczema is itchy and her fingernails were like tiny razors, but I still feel guilty about it.
It seems totally unreasonable to put something sugar-rich on the skin (or in the eyes!) if there is some kind of infection. Treating pinkeye with breastmilk is wildly popular among crunchies, yet actual evidence is scarce and doesn’t apply to breastmilk, only colostrum http://scienceofmom.com/2011/11/08/can-breast-milk-cure-my-child%E2%80%99s-eye-infection/
We’re coping with eczema at the moment and the only “natural remedy” used is coconut oil (I don’t want to apply other creams on baby’s hands because he’s putting them in mouth), otherwise it’s Bioderma or Bepanthen all the way (seems that the worse is over, fingers crossed!)
I’ve struggled with eczema for years and coconut oil has been my best tool so far to keep it at bay. I was skeptical at the beginning because of the wooey-hype it has. But I have much less eczema outbreaks since I started using it on wet skin after every shower, mostly, I think, because it smells so good and is available everywhere, which makes it nice and easy to use it as often as possible, much more than most of the heavy, unscented eczema creams I used to use. In addition to this it is cheaper than most creams (I live in a very multi-ethnic neighborhood so coconut oil is a kitchen staple for many, who would probably laugh at the price it is sold in organic shops), and you can cook nice fish curries with it.
I started using coconut oil on my daughter’s eczema (and just for moisturizing after baths in general) because we have a lot of it lying around and I like the smell. I’ve found it to work really well too. Her eczema is mild though, just like mine was as a kid. I’m hoping she’ll grow out of it like I did (though I do seem to get it when pregnant).
Don’t be so hard on yourself! She was probably right at the point where she had been scratching hard enough to break the skin, and might have needed antibiotics even with topical steroid treatment. I doubt that the breast milk caused the infection.
Eczema sucks. I’ve had it my whole life. Topical steroids work until I quit using them, and I have just resigned myself to dealing with it as best as I can.
Funny, because I am currently battling yeasties in my little girl’s neck folds that I’m pretty sure live there due to the accidental breast milk spills. So have fun with that!
I don’t know; all this skin-on-skin business. I am almost certain that when I was born, they didn’t lay me naked on my mother’s bare chest or tummy. Despite that, I was bonded to her like no other human on the planet. I doubt she’d even heard of such an idea, anyway.
Now when my son was born, I was okay with the idea but I wasn’t about to strip off my shirt in the delivery room – for his first feed (from a bottle, agh!), he was snugly wrapped and I was fully dressed. In the privacy of my room, I did tend to open my shirt and put him inside to feed him – I don’t think I made him be naked, though – I certainly don’t remember doing that. And I certainly didn’t sleep with him! They had this lovely little thing that looks like an airline drinks cart so he was right next to me, but not in the bed with me. Perfect set-up! But lord knows, when he had a bout of jaundice the next week, he was in the blue light box for 48 hours, not skin-to-skin with me trying for some magical cure.
I had one of those newborns that just did NOT sleep. He was up every 45-90 minutes, very restless and fussy, and would absolutely not sleep in a crib or bassinet, or even a co sleeper right next to me. I did what many exhausted mothers do, and I brought him in bed with me. My husband hated it and was very against it, but we didn’t know what else to do. I remember once, he was only a few weeks old, and I woke up to find our heavy comforter over his head (he slept in the crook of my arm and I must’ve pulled the blanket up at some point during the night). The thought of what could’ve happened to him that night makes me nauseous. We ended up finding a combination of swaddling, pacifier, and swing on full speed (switching to formula helped a little bit as well) allowed us 2-3 hours of sleep sometimes, and the instant he turned 6 months we did CIO in the crib. I sincerely hope this next boy sleeps better, because now that I’m terrified of co-sleeping (and am logically aware that it is not safe) there aren’t always other options to get some rest.
We also did the tight swaddle, paci and swing with the addition of a white noise machine. It helped a lot. Good luck with the next one, it’s hell when your kid won’t sleep.
We had a setup that mimicked a car ride. It was a little motor thing that attached to the crib springs on the underside and a white noise speaker that attached to the side of the crib. When you turned it on, the crib vibrated and you had the white noise speaker cranking out the humming sound of a car in motion and the motor giving the feeling of a car in motion. It was a lifesaver.
Where does one get such an ingenious thing??
SleepTight Infant soother and I think this one can be covered by insurance if a doc gives an Rx for it. It also has a 30 day in-home trial & $ back guarantee.
There is a similar one, First Years Gentle Vibrations 3-in-1 that does the same sort of thing. Found it on Amazon.
Back when DS was a baby, I think the SleepTight was the only thing like it available. It was a bit pricey, as I remember, but I value my sleep and sanity.
Wow, thanks for this! I will definitely try it if this baby doesn’t sleep. We spent insane amounts of money on every type of swaddle, white noise machine, not to mention how many DD batteries we bought for the swing.
Thanks! I will definitely keep this in mind when current fetus arrives!!
This is brilliant! So many babies for as many generations have been around since cars were a thing in my family have only been soothed by a car ride. Driving while tired with a baby probably wasn’t the best idea but it was the only thing that worked.
It probably saves a small fortune in gas, too!
My NICU didn’t encourage kangaroo care, even. I don’t know if they have some new evidence that adequate incubators negates the effect or what, but all the videos that circulate about micropreemies getting kangaroo care made me a little sad that my almost-not-preemies and I couldn’t do it.
the hospitals goal is to get your preemies health stabilized, weight gained and out of the NICU ready to go home. And then parents spends lots of cuddle skin to skin time.
Right. But if kangaroo care has been proven to improve preemie outcomes, I just wonder why it wasn’t done in my hospital – not one patient there was receiving kangaroo care. I admit that I don’t know everything and perhaps there are new studies or new technologies that make it unnecessary. But all you ever hear about is how wonderful kangaroo care is for preemies.
And my secondary point was that if my NICU didn’t even recommend it for preemies, then it certainly can’t be necessary for full-term babies.
Thank you for writing about this. This whole skin to skin rooming in 24/7 thing is is taken way too far, and I agree, it’s dangerous.
NICHQ, (a government organization that works with Baby Friendly to “improve maternity’ care and increase BF rates) had an article about how to make more mothers want to room in.
Here was what one hospital did (the author thought the idea was great!!):
They put a self-proclaimed “scary” sign on the nursery door that reads: “Authorized Personnel Only. This space is reserved for flu isolation, MRSA isolation, urgent evaluation for sick newborns and procedures. Healthy newborns are assigned to rooms on the Family Beginnings unit. Please see your nurse for more information.” “Overnight the nursery became empty. I was astounded,” says Jennifer Hudson, MD, medical director for Newborn Services at Greenville. “Nurses said the sign really helped to define the space differently and made it look like a place people didn’t want to put their babies. It was the most effective intervention we had so far.” –
See more at: http://breastfeeding.nichq.org/stories/goodbye-nursery-hello-rooming-in#sthash.47dNTbpw.dpuf
That is sickening.
WTF? They think it’s ok to bring a baby into a room for a procedure where they are simultaneously isolating somebody with influenza?!
No, they obviously don’t. They would never do that. So they are intentionally lying.
It would be funny if it weren’t so disgustingly serious. Like Calvin putting a ‘no icky girls’ sign up.
Nice to see that the midwives suddenly like ‘interventions’ when it’s all about them bullying women. “It was the most effective intervention we had so far.” And nice to see them being so honest about their concept of ‘effective’ having nothing to do with the lives or well-being of babies.
What really would be funny is to snap a picture of the sign and sent it along with an infection risk complaint to the hospital inspection authorities.
If I saw that sign and believed it (and why wouldn’t I believe a sign at the hospital?) I probably would have opted my daughter out of all her procedures or asked them to do the procedures in our room. I wouldn’t want to risk her getting MRSA or the flu, and I probably would have complained that they wanted to take her into the infectious disease isolation area for routine procedures. I can’t believe nobody has reported it.
It’s also nice to see that they resort to lying to patients.
Hey, we can’t get them to do what we want, so let’s just lie to them! It’s for their own good!
(and then complain about the patriarchy of doctors)
The sad thing is–is this is a government program (National Institute of Children’s Healthcare Quality)–promoting these scare tactics. You would think that we could expect more… I wrote to the medical director and president (of NICHQ) after I saw this gem a few years back. Obviously they are all good with this…. because it is still there.
OK, so let’s lie to new parents and make them believe the nursery doesn’t exist or is unsafe. So then, when they are desperately tired and afraid of falling asleep while holding the baby, they believe they truly have no other option, thus creating an actual unsafe situation. Good job!
MRSA’s a hell of a lot scarier to me; that stuff lingers
Yeah, that makes no sense. They probably wouldn’t put flu patients near MRSA ones either–all three of those patient populations would be separate. And why would you put an area for highly infectious diseases on the same floor as L&D/baby? I guess they are banking on that the new parents will be too tired and intimidated to question this.
Imagine if a MRSA patient showed up at the door?
I fully agree that cosleeping in a hospital bed is a bad idea, plus for my kids the hospital time was blessed in that they could actually be put down in the bassinet. And I understand why AAP makes the recommendations they do. But you have to assess the risk of overall fatigue (someone may end up driving newborn around, especially if there are siblings) and find the best options for mom’s sleep. From day 3 to three months my kids would not nap on their own. My sleep deprivation with kid 1 trying to put her down was ridiculous. I was hallucinating. Loosening up with kid 2 and letting her nap on my chest made everyone saner and safer. Basically instead of dogma how about presenting the middle.
There is no middle. If you were suffering from maternal fatigue like 70% of women will then that was an additional risk factor on top of bedsharing ( unsafe sleep environment) and unsafe sleep position.
It is not dogma, and AAP recommendations are based on solid, detailed data gathered during infant sleep related death investigations
and expert review of all the evidence. They didn’t just pull those recommendations off the top of their crazy heads. I suggest that you read the full technical report and see for yourself: http://pediatrics.aappublications.org/content/pediatrics/early/2011/10/12/peds.2011-2285.full.pdf
But do AAP recommendations truly take in a full life cycle analysis? Added risk of fatigue while driving/living life.
And while I mention hallucinating I am serious. My overall fatigue level was far far less planning to nap with a baby (specifically staying away from bedding and pillows) than when holding a baby on the couch and passing out from exhaustion. I did in fact once pass out with my first kid with her airway covered. Fortunately she wiggled out and was able to breathe. And I am extremely lucky I didn’t get into a fatigue-induced car accident. I understand recommendations but you need the reasons behind the recommendations to evaluate what makes the most sense for your own family.
“But do AAP recommendations truly take in a full life cycle analysis?” Yes they do. Maternal fatigue is specifically addressed as additional risk factor that cannot be controlled in any bedsharing situation, thus reflecting all circumstances of bedsharing.
I can imagine that maternal fatigue would actually be a risk-factor for a bedsharing or co-sleeping arrangement, because mom will be so sound asleep she can’t respond properly.
I understand that there are risks of maternal fatigue that would make resolving that tiredness important, but co-sleeping with an extremely fatigued mom brings about another set of risks.
Anecdotal but my mom said that sometimes, she was so tired that she could not wake up even to us screaming our heads off and Dad heard us upon entering the flat. I cannot imagine that having a baby near or atop you in this state can bring anything good. In fact, it was probably safer for us to be screaming than being in the near vicinity of a mother who would not wake up.
A friend of mine used to make sure that her baby was fed, dry and safely in his cot before crashing into bed and passing out when she felt she’d pass out no matter what. I think that’s a far superior strategy than trying to soothe the baby OR cosleep. Both are just too dangerous to someone who can simply go to sleep any moment now.
Of course, both are risks. The question is, which is the greater risk in your household and with your combination of baby/mom sleep patterns. My children and I all sleep/slept very lightly during the day. A 45 minute – hour nap during the day (and dad giving first bottle at night) was a huge factor in preventing the level of sleep deprivation where I would crash and be more dangerous. (8 hours total with a 4 hour stretch of that being unbroken, vs 6 hours broken sleep with first kid.)
Yes! By the time baby number 4 came around I had it down to a science. I was of course exhausted after my time in the hospital (woke up at 7:30a Sunday, went into labor Sunday afternoon, tried to go to sleep when my husband did at 10 pm Sunday night, but that wasn’t happening, stayed up and labored most of the night, woke husband at 3:30 am to tell him it was time to go to the hospital; baby was born just before 6 am, day shift at a hospital is quite busy and I was looking to get early release for good behavior so there was a lot to take care of that day; my husband joined me for dinner that night, then left to take care of the older kiddos, baby 4, true to form, would not sleep in the fish tank so at 3 am Tuesday I sent her to the nursery for a couple hours, they brought her back at 5 am, and I was up until I went to bed Tuesday night at around 9 pm. So I got a grand total of two hours sleep in just over 60 hours). Wasn’t risking cosleeping that first night, so since dh was pretty well rested, he took the night shift the first night home, bringing her to me only for feedings. Then we started cosleeping after that, which, at least for me, prevents the maternal exhaustion that impacts 70% of mothers, as I can actually get some sleep. (All three of my older kids nearly drove me mad with sleep deprivation when trying to convince them to sleep by themselves for more than 20 minutes at a time; gave up and went to cosleeping earlier and earlier with each subsequent child and didn’t even bother trying with current baby; ironically the three oldest – 8, 6, and 3 – are now awesome sleepers, and have been since about 18 months – 2 years of age). It’s not perfect, but I cannot imagine trying to take care of the older kids (safely) and not baby or pass out in a chair with her, if I were running on no sleep because I was trying to get her to sleep in a crib.
Well then the AAP recommendations need to be more realistic about how to balance the risk of SIDS/suffocation with the mother’s need not to literally go crazy from sleep deprivation. One good place to start would be addressing practices that serve to exacerbate maternal fatigue (eg Baby Friendly Hospitals that refuse to take the baby to give the mother respite; breastfeeding practices that encourage constant feeding/pumping with no support for the mother.)
The essential problem is that you cannot make public health recommendations that ignore how people actually act. Extremely fatigued mothers are going to eventually chose something that lets them get a little sleep, and the more you push on one set of restrictions the more you are going to find unintended consequences. For example, the more you push “back to sleep” the more you end up with contraptions that keep the baby on their back and sleeping better (like the Nap Nanny) but have the side-effect of suffocating some babies. The more you push constant breastfeeding, the more you end up with fatigued mothers falling asleep with the baby in their bed.
I think maternal (and paternal) fatigue is really under-studied. We know it’s dangerous for truck drivers and air traffic controllers– is it really a stretch to consider the ramifications for parents of babies? Ideally, we want parents to be awake, alert, sane, and in a healthy frame of mind. Does it really make sense to focus so much on breastfeeding, etc. and then ignore sleep deprivation?
Best option for Mom’s sleep health for us – Dad feeds Baby a bottle (skipping one bf session) while mom sleeps 4-5 hours straight.
This brave mom is speaking out:
https://www.facebook.com/groups/123111634730506/permalink/136437096731293/
Oh my! This isn’t the first MD I see who is also a LC. Dr “I’ll Tell You What a Terrible Mother You Are If You Don’t BF” Becky is one as well. Perhaps it’s doing something to their brains. Conflicting goals and… loyalties.
Oh wow. That’s where I’m from, although I didn’t deliver at that hospital. I hear such good things about that hospital, too. I’m so glad her baby’s doing okay now.
The hospital was doing their best to do the right thing. The most horrendous part is when the baby had to be admitted to NICU after failing car seat test and the skin-to-skin/mom’s milk will cure everything enthusiast MD said that she wished the test could have been avoided.
Yeah, my shock was more at the doctor than the hospital itself, to be clear. The NICU sounds like they did an amazing job.
I wonder if this NICU has seen this happen too many times and knows how to get around the doctor’s orders.
Yep. It was subtle, but I was also aghast. Hey, ignore those problems and they will go away…
Yup. It’s like when CPMs don’t test for gestational diabetes or GBS. It’s the medical equivalent of holding your hands over your ears and saying LALALALA I CAN’T HEAR YOU!
So was this pediatrician a community pediatrician, or on the hospital staff? I cannot imagine a hospital allowing a pediatrician to remain on their staff after nearly allowing an infant to die from dehydration and hypoglycemia. Can hospitals ban particular community-based pediatricians from conducting well newborn exams? This is so unbelievably horrifying.
Here in California an MD popular with the woo crowd, Paul Fleiss, lost all of his hospital privileges after a little girl with AIDS died in his care. So yes, hospitals can ban doctors. Unfortunately, it takes a lot for that to happen
I read through the comments on the FB post and the mother confirmed that the doctor was a community pediatrician. They had started seeing her with their older child when she was 9 months old, and had not witnessed anything out of the ordinary (for example, ear infections were treated normally). This was not a family that was into woo, and it must have really shocked them to see this side of their pediatrician.
I found the doctor in question’s Facebook page, and yeeeeeesh is she spewing some ridiculous stuff on there… https://www.facebook.com/naturallyhealthykidsLauraWilwerding/
OMG, my heart was pounding while I read that. I was sure the baby was going to die. My God. That doctor needs to be sanctioned by the medical board. I hope the mom reports it to the Joint Commission too.
ETA: And she’s an IBCLC! Of course she is. Now my heart is pounding with anger.
I’m not on Facebook. Can you summarize?
Pediatrician thinks that skin-to-skin is the solution to all the babies woes, including dehydration and hypoglycemia. The prescription when the baby started showing symptoms was to not let the baby off the skin for a second, and spoon-feed expressed milk. Nurses at the hospital were concerned about the baby and did some things against the doctors orders and got shit for doing it. Fortunately (!), the baby failed the “carseat test” and was rushed to NICU and in the hands of the neurologists, recovered and is now an absolutely adorable 6 mo old. That is a really cute baby.
“My youngest daughter, Emma Jo, was delivered via planned repeat cesarean at 36 weeks gestation, at Methodist Women’s Hospital in Elkhorn, NE on Tuesday June 23, 2015 at 11:49 am. She was born early because my blood pressure was ever spiking despite attempts to control it via medication, and my providers were concerned I was heading toward preeclampsia. In addition, my daughter was considered small for gestational age for most of my pregnancy, for reasons unknown.
At birth, she weighed four pounds, twelve ounces, and was seventeen and a half inches long. Her Apgars were 8 and 9. NICU was present at her birth to check her out. They deemed her well enough to join me in my postpartum room, to our pleasant shock, as long as she remained doing ok.
Not long after birth, she was not holding her body temperature on her own. Her pediatrician, Laura Wilwerding, MD, IBCLC, ordered 24/7 skin-to-skin with us to keep her warm in lieu of a warmer. Per hospital policy for her gestation, Emma Jo received blood glucose checks every two hours, if I recall correctly, first by heel pricks and a handheld glucometer, then by larger heel slices to collect in vials and process in a lab (nurses explained the latter was more accurate) . This was to continue for the first 24 hours. Emma Jo was fed a bottle of donor milk after low readings, and this occurred a handful of times.
Nursing was going just ok. She’d latch and suckle, but quickly tired and released her latch, having to relatch again and again.
Nurses checked her temperature every 2-3 hours. With skin to skin, her temperature hovered around 98.0F, but sometimes dipped as low as 97.4. This was a concern to the nurses, but per pediatrician orders, they told us to keep her snuggled on us.
Dr. Wilwerding visited us for the first time on Wednesday June 24th around 10:00 am. She looked Emma Jo over carefully, and then talked to us at length about her expectations and the protocol she wanted us to follow. The following were her instructions for us and the nursing staff:
– continue 24/7 skin-to-skin with a warm blanket. She emphasized we should NOT PUT HER DOWN except for diaper changes, and something to the effect of “I don’t want to hear of her laying in that bed [the infant bed]”. She didn’t want her clothed, either. She referred to studies showing the benefits of skin-to-skin and cited that this is what other countries do instead of our NICU isolettes. Quote: “They call them isolettes for a REASON.” Paraphrase “Our NICU practices are far behind the current research.” Paraphrase, “More than anything, preemies just need their moms, and need to be held.” At one point, she described the NICU as “icky”, but then pulled back a bit and admitted that they do suit a purpose, but not for cases like Emma Jo’s. Edited to add: quote, “The NICU is a death sentence for breastfeeding.”
– stop all glucose checks. Despite the few lower readings, she deemed Emma Jo’s glucose ok on the whole, and believed the risks of stressing her out outweighed the benefits of the test.
– move to 8-hour intervals for temperature checks. The disruption to skin-to-skin and disturbing her (Emma Jo was easily agitated when moved) would disrupt her body regulation. Dr. Wilwerding adjusted the acceptable minimum temperature from 98.0F (hospital protocol) to 97.0.
– Avoid donor milk and especially formula. According to Dr. Wilwerding, the nutrition was sub-par because she wouldn’t be getting my milk. She believed very deeply /my/ milk would help Emma Jo more than anything. Dr. Wilwerding showed me how to hand express and feed Emma Jo by a spoon when a feeding by breast was not going well (her nursing sessions were recorded and self-reported by me). She believed donor milk was overused in the NICU, and used language that indicated she was very anti-formula.
– Also to note: she used language to express disapproval of the timing of Emma Jo’s birth. She said repeatedly she just wished we kept her baking for one more week. She didn’t acknowledge the risk:benefit analysis that factored into the timing of her birth, or my pregnancy health.
We continued with her directions, my mom, my husband, and I swapping off holding her on our naked chests. That afternoon, two nurses came in and said they’d like to do “an experiment” because they “read somewhere” that skin-to-skin care was only beneficial with the mother. We were asked if we’d allow them to take her temperature now, then take it again in (if I recall) 10-30 minutes. We were utterly perplexed by this, because it was against the pediatrician’s orders, and it was our very first indication that controversy over Dr. Wilwerding’s orders was brewing outside our door. We declined the “experiment” but we became vigilant about the truth of the matter. We were concerned that they were concerned.
That evening, after checking Emma Jo’s temperature and seeing that it was on the lower side of the 97s, my nurse asked if we’d like to put her in a warmer. We asked why (because the temp was still well within Dr. Wilwerding’s range), and the nurse replied “to get her nice and toasty”. We asked what that would do, and the nurse repeated again “get her nice and toasty”. Again, we were perplexed, and declined. Clearly the nurses did not like what Dr. Wilwerding ordered, and were very worried for our baby. I felt worried that they were worried, but also simultaneous loyalty to my baby’s doctor. I trusted her. We saw her for years for my older daughter, with satisfied results. Her protocol in this situation was unusual but I couldn’t tell as a layperson if it was safe or not. I couldn’t believe she would write orders that would put her in harm’s way.
Eventually, we hosted the charge nurse and my current nurse in my postpartum room for a heart to heart, inquiring into their odd behavior and the lack of direct communication. We needed to know, plainly, what was happening and what we should do. The charge nurse suggested, with the minced words of diplomacy, that we could get another pediatrician’s opinion. After this talk, we called Dr. Wilwerding to let her know that this was happening with the nursing staff. She asked to speak to the charge nurse, so we invited her back to our room. After speaking to Dr. Wilwerding via phone, the charge nurse apologized to us on behalf of her nursing staff, and said there will be no more issues with them. For the rest of the evening, the nursing staff was pleasant, but it was obvious they were stepping carefully around us.
In the middle of the night Emma Jo was weighed again (she lost some weight, but not quite 10% yet), and had her hearing test. She passed.
Very late into the night, I asked the nurse if she could take Emma Jo to the nursing so we could sleep. We swapped holding her so the three of us could rest, but by this time, no rest was possible because all three of us were too overcome with worry that the baby-holder would fall asleep accidentally. My husband and I were terrified of dropping her or of overlay. The nurse said they cannot do skin-to-skin, but she was sure she would stay warm enough if we dressed her and wrapped her in a blanket. So we did, knowing this was against Dr. Wilwerding’s instructions. The nurses said we should be able to get at least two hours. Our rest didn’t last that long, because about the 45-minute mark, the nurses wheeled her in, rather frantic, because her temperature had dropped too much in the nursery and she needed immediate skin-to-skin. Her temp came back up after snuggling on my chest, but we were worried. We were supposed to go home on Day 4 and this was the beginning of Day 3. How were we supposed to function with this issue at home?
Emma Jo nursed ok through the rest of the night, but morning she was pretty sleepy and didn’t nurse much. I gave her several spoonfuls of my milk, again pretty worried. I noticed her her soft spot had sunken in, and wondered if she was dehydrated.
Dr. Wilwerding came by for a short check up, I think, early afternoon. I asked about that day’s eating and sleeping, and the sunken soft spot. She peered into Emma Jo’s mouth and declared her well-hydrated. She said, paraphrased, that this was all normal for day 3. Reassured, we proceeded with the rest of the day. It flowed along much the same. Emma Jo slept for hours, and didn’t really care to nurse. I continued spoon-feeding her, replaying Dr. Wilwerding’s assessment in my head to combat the worry that was creeping up. She said this is normal. It’s normal.
I fed her via spoon at 8:30 pm, and around 9 we got a call from our nurse explaining that the car seat challenge would either have to be right now or first thing in the morning, because the neonatologist overseeing this needs to be present to interpret the results. Since she ate pretty recently, we relinquished Emma Jo to our nurse for the test. It was supposed to be 90 minutes long. 90 minutes came and went. Near the 2 hour mark, we inquired about Emma Jo to our nurse. She said that she is just now finishing up and would be back with us soon. I was relieved. She needed to eat.
A few minutes later, our phone rang. It was Dr. Wilwerding. Emma Jo failed her car seat test, and was being admitted to the NICU. Her oxygen saturation plummeted to 70% a few times during the test, which meant she couldn’t go home. She apologized to us and said, paraphrased, “I wish this (the car seat challenge) could’ve been avoided, but it’s out of my hands now”. The neonatologist was taking over. In a few moments, our nurse wheeled Emma Jo to our room, accompanied by the NICU nurse practitioner, two neonatal nurses, and I believe, the charge nurse of the mother-baby floor. We stood around our room and talked about what would be happening. The nurse practitioner explained that the reason there was such a delay talking to us was because Dr. Wilwerding kept her (the NP) on the phone for 45 minutes, and then insisted on calling us personally before Emma Jo was admitted to NICU.
Meanwhile, Emma Jo was just laying there, sleeping. She should be crying, I thought. She should be hungry. I asked why she was sleeping, thinking perhaps she had a bottle. No, her blood glucose is just extremely low, so low she’s near unconscious. At that point, I urged them to take her right then, realizing this is a very bad deal.
Once settled in the NICU we learned just how bad Emma Jo “crashed”. Her temperature registered at 93.somethingF. Her blood glucose was so low it couldn’t be read by a handheld glucometer (a nurse said this probably means it was <30). She was severely dehydrated, and her electrolytes were depleted, and/or out of balance. She weighed 4 pounds 3 ounces, if I recall correctly. That is a huge weight loss for such a little one.
Emma Jo spent the next 11 days starting from square one in the NICU. She needed to first gain weight, start regulating her body temperature, and then become strong enough to eat. While in the NICU she drank donor milk, and then my milk with fortifier via lavage, then learned to bottle feed her last week there. She went home on July 7th, 2015, a little over 5 pounds, and doing everything a newborn should be doing. We had a phenomenal NICU experience. I can't rave about her medical staff there enough. She's 6 months now, about 15 pounds, 24 inches, and babbling our ears off. She has been exclusively breastfed since she was about 7 weeks old, and is now taking in some solids.
I think Dr. Wilwerding's protocol was inappropriate, inadequate, and led to Emma Jo's decline. I had the sense that Dr. Wilwerding's bias in favor of breastfeeding clouded her reasoning and led her to prioritize Emma's Jo needs inappropriately. I do fear for her other patients now after having this experience, especially because she is extremely popular with the alternative crowd in my area.
The nursing staff at Methodist Women's Hospital did all that was in their power to do to prevent this and protect Emma Jo. The weirdness on their end was happening because they had to be creative and careful about their interference, due to their positions/professional hierarchy and hospital protocol. I felt frustrated that we were stuck between them and our pediatrician,, and at times I felt very defensive, but ultimately I believe they performed their jobs well and were looking out for our best interest, and I am grateful for that.
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I gotta hand it to the mother. That is probably the nicest way I have heard anyone say, “She was a whackaloon who almost killed my baby!”
I know I couldn’t have been so polite.
My jaw dropped when I read that account on SkOB’s FB page this morning. It’s just horrifying.
I mean – seeing how horribly ill the baby was at the car seat test, did the doctor – someone who went to the effort to get the fecking MD in their name – think that this was No Big Deal, or honestly think the baby was better off dead than in the NICU?
But the NICU is a death sentence for breastfeeding. See my earlier comment: Better dead than formula fed.
It would be nice to think that this mom’s story would get through to Dr Whackaloon and convince her that an NICU stay and a good BF relationship – if wanted and physically possible – are not incompatible. But to even be at the starting point of ‘NICU stays are the death of BF’ and therefore NICU stays must be avoided even if the baby is sick, Dr Whackaloon must be so divorced from reality that they’re living in different states and have finally hammered out visitation rights with the kids.
I thought the same thing. She was very nice in how she wrote it … it may have made it more powerful as you could just tell she was a very nice person.
Thanks.
And… Excuse my language, but holy fucking hell!! I don’t know what a car seat test is, and I haven’t had biology since 10th grade, but that so called doctor shouldn’t be allowed to touch a mouse, let alone have hospital privileges. How would skin to skin fix blood sugar issues? And those poor nurses. Horrifying.
A car seat test is where they stick the baby in the carseat, on monitors, and make sure he can breathe properly in that position. A lot of hospitals have them as a discharge condition for babies under whatever weight.
And yeah, that story made me sick.
Thanks. I don’t understand how it works in hospitals, despite having watched a lot of TV, but in situations like that with a whackaloon ped, is there someone else nurses can go to? A neonatalogist or head pediatrician or something?
They were advised to seek a second opinion, right? And Dr Whackaloon interfered with their attempt to do so.
I thought that was kind of a breech of ethics. As doctors, you don’t meddle in second opinions on your diagnoses (unless you are asked to)?
Yes, there is a “chain of command” so to speak. The RN would go to the charge nurse, then the house sup, and on up until s/he feels the patient safety issue is resolved. You can get the hospital’s legal department involved. It takes a lot of guts to go on up the chain but that’s the professional obligation.
Yeah, my 36 weeker had a car seat test too. Mine was also a bit small. But my hospital LCs were all “With late pre-terms, you should be supplementing with formula till you can pump 10 mL”. We did the “catheter of formula through a nipple shield” thing. Mine was better at holding her temperature, but when the nurses said “She’s a little cool, we’d like to take her to the incubator for a bit” my response was “Hooray! Take her and we’ll sleep for a couple of hours”. Our nurses were also quite clear…”if the baby is sleeping on you, you need to stay awake, if you need sleep, put the baby in the bassinet”. I was not super exhausted the day or so after, but the nurses taking her away maybe 3 times over the course of two days for a few hours really really helped.
Well, that gave me chills…
Long-time lurker here – I had my son at the same hospital last year. As a Dr Amy fan who wanted a MRCS and planned to formula feed, I was a little apprehensive about what to expect at the hospital, but I honestly cannot say enough wonderful things about every single staff member we encountered. Luckily the munchkin’s pediatrician is affiliated with the hospital and we absolutely love her. I do remember seeing this nut’s name on a flyer or something at my yoga class (good yoga; horrible woo). That was more than enough to put her out of contention. It looked like she might be antivax, but I never investigated more fully, so can’t be sure. Even so, wow.
What an intense story! Question for the MDs here: how does hopsital heirarchy work? Wasn’t there an MD who could overrule the pediatrician, or that the nurses could call themselves for a second opinion?
There was another post by medwife that explained it well. If a nurse thinks a patient is in danger it is her obligation to use her chain of command. It isn’t ok to just say “dr said so” and let a patient be hurt. You have to go up chain of command…can be charge nurse, supervisor, department head, director of nursing, administration… it’s all laid out.
Reading this story its hard to imagine this didn’t go to case review. You do have to wonder about some systemic problem in the hospital that instead of being direct the nurses appeared to be manipulating to get some action taken. This story as written looks like the mother is probably very accurate.. I tend to think this all really did happen, but sometimes the patient’s story can be very different from what happened. But taking it at face value I would think the hospital is at serious risk if it doesn’t take some steps to educate and encourage nurses to speak up and use chain of command.
A 36-weeker. The pediatric Dr – a darling of the local natcherels and a LC – was terrified that having the little girl in a warmer would DOOM BREASTFEEDING! Oh the woe! So she recommended skin to skin and constant nursing and didn’t budge when the baby started showing symptoms of dehydration and hypoglycemia. The nurses were uncomfortable with the “treatment” but the mother trusted her pediatrician, up until the moment the baby failed the carseat test and ended un in the NICU, at which point the doctor expressed regrets that the test had ever been done. Turned out, the doctor was well-known there and a preconceived opinion about parents who chose her was a fact.
Fortunately, the baby is fine now.
That story is terrifying, but this part in particular enrages me: “”The NICU is a death sentence for breastfeeding.”
My NICU twins were about the same gestational age and induced for the same reason as this woman. My daughter weight four pounds exactly, my son five. They went straight to the NICU. This WAS NOT a death sentence for breastfeeding. I pumped and they got breastmilk. The staff were informed to give formula if there wasn’t enough breast milk. They came home on pumped bottled and yeah, it was difficult to get the little one breastfeeding. She was too small to suck, and too week. My IBCLC knew this and supported us until she was big enough, and by six weeks both were breastfeeding 100% of the time.
So aside from the fact that proper NICU care is more important than breast at all cost anyway, as formula is healthy and fine, it’s also just untrue that NICU babies can’t breastfeed.
As opposed to NOT going to the NICU, which is a death sentence for the baby.
Sounds like this doctor’s motto is, “Better dead than formula fed.”
That motto rhymes, so it must be true. :/
This is sickening.
And then there’s the part where I *hate* being naked.
Not even in front of your husband?
🙂
https://www.youtube.com/watch?v=RFlCD5CYAcU
That’s for me to know…
Braille-reading pianists are good with their hands. 😉
No pianist jokes!
https://www.youtube.com/watch?v=QE5ThMiTowk
I’m glad to know I’m not the only one.
I hate it too, especially in the hospital where some staff member is coming in or out of my room every 15 minutes (housekeeping, dietary, nurse, LC, Doctor, etc.) let alone visitors.
My hospital did fairly immediate (I think it was a couple of minutes after my baby was born) skin-to-skin and the “sacred hour” with us, but afterwards she was mostly in her bassinet if she wasn’t being fed or held by someone. She even slept in the nursery at night, just brought in every couple of hours so that she could feed from me–and then the nurses came about a half hour later and took her back. (Which is good, because I do remember nearly falling asleep one of those times!) I don’t think there’s anything wrong with encouraging skin-to-skin in theory, but insisting that the baby has to be lying on Mommy’s bare chest the entire hospital stay (as the more extreme adherents seem to believe, from what I’m learning) is just ridiculous. I guess I’m just happy that the hospital I delivered in was reasonably middle of the road. They encouraged breastfeeding but gave us formula on our way out (and this was even before I’d officially thrown in the breastfeeding towel), encouraged rooming in but still offered to take her in the nursery overnight, etc etc.
OT but this is just infuriating. Henci Goer is not an idiot so she must have a cult-like belief in Natural Birth.
http://www.scienceandsensibility.org/homebirth-safety/
The very last paragraph is what finally made my head explode. I can’t even comment on the fb link that led me there because I just can’t even be civil. I KNOW several of the midwives that run the site! I’m disgusted!
You’ve got to be kidding me with this crap.
Her desperation is showing!
She’s edging a little closer all the time to admitting home birthing means smaller chance of c/s (which is highly unlikely to result in anybody’s injury or death) but a significantly higher chance of a dead or seriously brain damaged baby. That is what the choice boils down to. They admit it but then hurry to point out all this window dressing about how relaxing it is to birth at home and that you won’t get pain meds (even if you are literally screaming for it). Wow, big selling points.
Medwife, have you ever done any home births? Just curious if that was ever something that interested you. I appreciate your POV as a sane midwife.
Oh, thank you. IRL I often feel like a big party pooper when I acknowledge that maybe, just maybe, the studies that keep saying home birth has a higher rate of neonatal morbidity and mortality say it because that’s what the numbers actually mean. I never attended a homebirth as a provider but did observe a few before I started nursing school. I felt differently about it then and wanted to be a midwife who was actually well trained enough to be a safe home attendant, but as I gained more knowledge and responsibility I (shockingly!) felt differently about it. Now I can’t ever see doing home births, in any system let alone in the US’s. I will never feel that I am such a spectacular midwife I can go wing it at somebody’s home, basically by myself. I don’t know much but at least I’ve outgrown Dunning-Kruger!
Henci Goer is a danger to pregnant women. There are indeed some women who want big families, and I can understand their desire to avoid a primary c-section, but even then, most women privilege the life of the current baby over future fertility. For those of us only planning on 1-2 children, why take the gamble of a home birth? Many of us are also having kids much later in life, which means there’s no guarantee of getting pregnant again anyway. This callous disregard for the lives of these babies makes me sick to my stomach. I believe that the reason that most CNMs practice in hospitals or birth centers is precisely because they have seen enough births go bad to have a healthy respect for the process. We need all midwives to think and practice as you do, Medwife!
Well thanks, but… it should be a basic expectation that a CNM is educated and practices safely, in a way that respects the value of human life. That should not require a ticker tape parade.
That last paragraph doesn’t mention the baby.
Yes, because nobody is paying any attention to hospital safety.
Goer omits Oregon 2012 of 800% increase is homebirth death rate and doesn’t say that MANA data is only 25% of midwives.
Here is good resource about research of skin-to-skin practices and why their benefits are oversold http://scienceofmom.com/2013/10/02/the-magic-and-the-mystery-of-skin-to-skin/ Bottom line: for healthy term infants, mom and baby don’t have to be naked for the first snuggles, and mom doesn’t have to hold baby for hours or else they are doomed in regards of bonding and breastfeeding. Who could see that coming?
I got skin-to-skin immediately after delivering baby; basically midwife caught him, checked shortly and put on me for a few minutes, then his cord was clamped and after a while he was taken away, put into warmer box and stayed there while I got stitched up, had a light meal and had a bit of rest. Then midwife cleaned and dressed him and gave me for feeding. Before birth I was slightly grossed by the thought of having slimy, bloody baby put on me but in reality it was truly magical moment (and there had been enough gross factors during labor and delivery anyway and they didn’t bother in the slightest). Postpartum care was another story, I’m still furious about hospital policy which encourages exactly those risk factors mentioned in paper about newborn deaths.
Thanks for the link. I looked up a few studies a while ago, but everything I found was saturated in woo and/or had poor experimental design. Glad I gave up when I did.
Maternity ward beds and bassinets are not designed for safe co-sleeping and almost all the deaths occurred while following practices that are against the recommendations for safe co-sleeping. Co-sleeping and skin to skin are not one and the same anyways. I’ve also very skeptical of the claim that babies are being killed by their mother’s inability to breastfeed. As long as a baby is going to their wellness appointments it would seem impossible this would go unnoticed. Lactation consultants also recognize that not all people can lactate or produce enough milk for babies, but considering it’s only 5% of the population that means 95% of mother’s can biologically breastfeed.
“I don’t want to believe it, so it must not be true.”
Considering that women who are breastfeeding fine are less likely to need lactation consulting, LCs should be telling a lot more than 5% of their clients that they need to supplement. Do you really think that most LCs are telling 10-15% of the women they see “I’ve helped your biology all I can, it’s time to supplement”?
Where are you getting the 10-15% figure from?
At the hospital where I gave birth every breastfeeding mom is offered help from an LC when she first starts breastfeeding and again before she leaves the hospital. Many breastfeeding parents experience low supply because they started to supplement, not needed to supplement with formula because they had a low milk supply.
Citation needed, as current data shows that early supplementation promotes long-term breastfeeding. I’m not holding my breath for a citation from you, though.
You mean the study that is featured on Enfamil’s website? Yeah I’m sure that’s a credible study.
So you don’t have any citations, it’s just what you Want To Believe. I thought babbling Brookes were meant to be soothing, but this one is grating.
I don’t know anything about that Enfamil study, but if we’re throwing out studies that are featured on potentially biased websites, then any that show up on lactivist websites like Kellymom should be equally suspect.
Actually, I’d like to see the study where you got your 5% figure from. I vaguely know of it but I was under the impression that the 5% meant women who have complete primary lactation failure (meaning no milk at all). Can you cite the source you got the figure from?
From the article written above…
I see no citation above showing that only 5% of women can’t “biologically breastfeed.” You’ll have to be more specific.
Lol Brooke do you just go around and randomly slap value of 5% onto everything? Your ideal CS rate=5%. Number of women who can’t breastfeed = 5%. Your brain function compared to average = 5%.
I would like to see more research that actually looks at problems with supply. For all of this obsession with “breast being best,” you would think it would be helpful to determine how many women are actually affected by low supply and what causes it.
I would like to see this too. At least from my own personal experience with breastfeeding women and their babies, I’d say women with supply issues is closer to 15-20% of those I see. And since supply certainly can be influenced by other medical problems, eg PCOS, DM, etc and with more AMA mothers, I really don’t think a small study of breastfeeding women in Colorado in the 80’s is representative anymore. Truthfully, lactivists do not want to know if this number is higher because then they can’t just say “try harder.” And even if the number were 5%, that’s still 1 in 20, which is not that small. It would be nice if there were research to actually help these women if they want to breastfeed rather than just more and more confounded observational studies about purported benefits of breastfeeding.
I don’t have published statistics, but you really don’t think that population of women seeing lactation consultants, say a week after birth is enriched for women who aren’t making enough milk? You really think women with great supply are just as likely to go to an LC as women who aren’t making enough?
Well I personally like to drop $200 to see a medical professional when absolutely nothing is wrong.
I personally like to drop $200 to see a medical professional when nothing is wrong and a perfectly good alternative is available for 1/10 the cost and lasts longer than an hour.
The importance of feeding the baby comes second only to the sanctity of feeding your baby only breastmilk forever. It is well documented that starvation in newborns has no negative effects while combo feeding or supplementing will give your baby AIDS and make them ugly.
Inability to lactate or insufficient milk production is hardly the sole reason that a mother may be unable to breastfeed.
WTF is “biologically breastfeed”?
physically capable of breastfeeding, I presume, so long as mom can ignore the pain, mental or physical.
Oh I’m pretty sure that’s what she means, I’m just amused at the “biologically” thrown in there. Yay word salad.
I’m fairly sure she doesn’t consider babies ‘breastfed’ if they were fed breastmilk in a bottle.
The issue is that hospitals are moving toward policies that are supposedly baby-friendly, and in doing so they’re inadvertently creating other risks and harms.
I agree that maternity beds are not designed for co-sleeping, yet my hospital left me alone all night in a single bed with a newborn. My husband had to leave to be with our older child and knew I was exhausted, upset, bleeding, and in pain and specifically asked the nurses to take the baby for a bit so I could rest. They wouldn’t do it. I was exhausted and spent the night terrified that I’d fall asleep and drop my baby on the floor. It was really unkind and just flat out unsafe. Whatever the benefits of skin-to-skin may be, they don’t outweigh the risk of being accidentally dropped or suffocated by a sleep-deprived mother.
I agree that is terrible and dangerous but the baby friendly hospital initiative recommends rooming in, not co-sleeping or just abandoning the mother. The hospital I gave birth in won’t even let you do rooming in unless you gave birth naturally or have a person there that can assist you.
Is there a nursery they take the baby to? I babe birth in a baby friendly hospital that didn’t have a nursery other than a level 2 NICU. The policy of the hospital is that you have to have someone with you for your entire stay to help you. The problem is that there isn’t any kind of plan b for patients who don’t. The baby still has to stay in the room with the mom if she had a c-section and doesn’t have help.
That is so ridiculous. In what other area of the hospital do they make you have someone there with you the entire stay?
Especially considering baby is a hospital patient too. It’s just an excuse to cut back on staff. Thanks BFHI for making that acceptable.
Doubly ironic considering that forced rooming in is not baby friendly in any way…
The hospital I gave birth in doesn’t allow rooming in at night (no private rooms), and I was still treated like a horrible mother for even asking about giving formula at the point where I was so exhausted I was terrified of dropping my baby on his head.
Ok. Well the hospital I gave birth in had a policy of rooming in for everybody. I couldn’t lift my baby into the bassinet on day 1 due to my CS. So co-sleeping it was.
This was my experience as wel. My first went to the NICU, but my second went straight to the room with me. My husband had to go, and my hospital bed didn’t work (both the recline and lift functions were on the fritz). So it was really hard for me to reach into the bassinet from the bed, particularly while I still had the IV in. The nurses kept coming in to check the baby and then leaving him in the bassinet ACROSS THE ROOM. They never seemed to hear me ask them to bring him back, so that left me, less than 24 hours post op, climbing out of a non functioning bed (couldn’t even get the side rails down), dragging my IV pole across the room, then pushing the bassinet back to the bed (I figured it was safer than carrying him), then climbing back into bed, lifting onto my knees so I could reach high enough to grab him out of the bassinet. Yeah, he was in the bed with me as much as possible. Luckily that situation didn’t last long and as soon as I got the IV out and started on pain meds I was fine. Still, it was rough.
I agree that your experience happens and you aren’t alone. I also agree that as much as I hate the name of the Baby Friendly Initiative having read a lot of the guidelines it isn’t encouraging co-sleeping. Skin to skin is welcomed by the vast majority of new parents who are so excited to get to know their brand new baby. Its a much nicer experience than looking at baby under a radiant warmer. For that reason alone I have always been for it for the first hour or so and its always been a part of my practice… for almost 30 years … even before it was so widely adopted as some revolutionary way.. it is how I was taught. In the first few days, using skin to skin while mom is awake.. can help with breastfeeding problems, blood sugar or temp instability. The problem isn’t with the practice its with people not individualizing their care to unique situations, mother
s preferences or simply not thinking about why they are doing what they are doing. Sometimes too, I think hospitals like that couplet care means ( it shouldn’t mean this ) they can cut staffing. I hope that wasn’t what happened to you and I hope too it wasn’t some zealot skin to skin or else thing. It’s a shame that people experience what you did just as much as the days where moms and babies were separated for routine.
Skin-to-skin is nice, and you should do it if mother’s want and there is no reason not to.
But the physiological effects are clearly way over-stated, at least for term babies, and in those cases for sure, it shouldn’t be forced on anyone.
I keep hearing claims of “it’s important.” No, it’s not. It’s NICE, sure, but important? Nah, just another way to guilt mothers who didn’t do it.
I didn’t have any immediate skin-to-skin contact with my babies—not until several hours later when I tried to breastfeed them. And the babies were down to diapers only because they were too sleepy and the nurses said that undressing them could wake them up enough to eat. And of course it made sense for me to be half naked, trying to feed one baby on each side. So the skin-to-skin was sort of incidental.
Meanwhile, my children are psychotic arsonists who can’t bond with other people even with superglue. Oh wait, no, they are normal children who have loving relationships with lots of people. So I guess it didn’t matter too much.
Right. And I say again, sure, it would have been nice to do it, probably. But important? Nope.
I really wish they would take that approach – “it’s nice to do, so let them do it if they want to and there is no reason not to.”
But instead, they have to over-state things by claiming how important it is.
“. I also agree that as much as I hate the name of the Baby Friendly Initiative having read a lot of the guidelines it isn’t encouraging co-sleeping”
They may not say they are encouraging it, but their policies frequently leave no other option. I was s/p C-section, but even so, “Baby Friendly” hospital policy was rooming in. My husband was home with the toddler, so I had nobody to help me, and I couldn’t transfer the baby into the bassinet on my own. Ringing for the nurse was an exercise in futility….so co-sleeping it was.
“Maternity ward beds and bassinets are not designed for safe co-sleepin.”
There is no adult bed that is designed to be safe for bedsharing, because all bedsharing is unsafe.
I think if your bed is flat, hard, and blanketless and you are a still, light sleeper then cosleeping with a newborn isn’t too unsafe, but that describes so few people that it is almost not worth mentioning.
As a person with a soft bed, a bajillion pillows, the fluffiest comforter that Ikea could provide and a tendency to thrash in the night cosleeping is right out. I would even say that a sidecar would be too dangerous given the number of times I have woken up with my pillow over the edge.
“I think if your bed is flat, hard, and blanketless and you are a still, light sleeper then cosleeping with a newborn isn’t too unsafe, but that describes so few people that it is almost not worth mentioning.”
You can never be a light enough sleeper ( it is humanly impossible to function without several cycles of deep sleep each night on regular basis). As far as the bed you are describing goes – no, that is not a safe bed for bedsharing, even according to the owrld’s biggest bedsharing peddler dr McKenna:
“Dr.
James McKenna, 2007, a recognized advocate for bedsharing (which he terms “cosleeping”), describes the “proper way to cosleep” as involving
“parents (who) do not smoke, are sober, have chosen to bedshare and are breastfeeding their baby.The bed frame (is) completely removed and the mattress, placed at the centre of the room away from walls and furniture.Light blankets and firm, square pillows are used.No older children, pets or stuffed animals are allowed in the bed.”(p. 90).” http://www.pssg.gov.bc.ca/coroners/shareddocs/sudden-infant-death-cdru-report.pdf
Basically he is describing a bedsharing unicorn because no one bedshares IRL like that. The quote is taken from one of many detailed reports on sleep-related infant deaths in which just like in all of them bedsharing was either the direct cause or contributing factor in half or more all SUID deaths:
“None of the 51 infants who were bedsharing at the time of death were in a situation such as Dr. McKenna advocates.”
This report also covers the second most commonly repeated bedsharing myth how it is only unsafe in the presence of additional risk factors:
“Furthermore: ” “Safe Bedsharing”
Three of the most common risk factors discussed in safe sleep risk reduction are
1. bedsharers who are smokers or
2. under the influence of drugs or
3. alcohol.
If these three factors are considered for the 51 infants – twenty two had NONE of the risk factors. ”
http://www.pssg.gov.bc.ca/coroners/shareddocs/sudden-infant-death-cdru-report.pdf
There are hundreds of recent, detailed, full reports and reviews that show one after another that bedsharing by itself is the single biggest infant sleep death risk factor, even in absence of all other risks. That is why AAP guidelines are clear when they say that there is no safe bedsharing.
Just look it up on the internet. There are multiple stories of mother who saw their baby lose weight to dangerous levels and were still told by LC or other people to just keep breastfeeding more. It shouldn’t happen, obviously, but it does because some people out there think BM is liquid gold and that one drop of formula is going to destroy your baby’s future.
As for the only 5% of mother not being able to breastfeed. That’s also not the actually truth. Sure, in theory 95% of women have enough milk. But do they have working nipples? does this milk flows well or does it take 3 hours for all the milk to get out? is the baby actually able to suck properly to feed himself?
So, even with proper supply, a lot more than 5% of women will find themself physically unable to breastfeed.
Then, even when it works, you also have to all the the things that can still go wrong. You could get mastitis, breasfeeding could be ridiculously painfull, maybe your baby doesn’t eat much and require feedings practivally ever hour, or just anything else that could go wrong.
Then you add the mental health of the mother. Which can be affected depending on how many times a day and night she has to feed the baby and how well those feedings are going. Being stuck at home all the time because your baby need to be breasfed every hour while your nipples are on fire is probably not very good for yourself. Sure, you are breasfeeding, but is that really something you should be doing to yourself?
Telling mothers that 95% of women can breasfeed is nothing more than a lie. Spreading this misinformation is hurting women who are having trouble breasfeeding. Breasfeeding can be hard and mother’s should be told that it can be. If they have problems, of course they should be able to get help. But they should also be properly advised about their baby’s health and the option of formula feeding or combo feeding.
So, what benefit does co-sleeping have?
I don’t know Dr. A, I would be careful not to veer off into tinfoil hat land. My experience with a Baby Friendly Hospital was that we were given a “golden hour” of skin to skin while a nurse stayed in the room but out of the way. It’s hard for me to imagine why that would be dangerous or lead to the kind of complications you reference in this post.
That said, I still hated the golden hour. I had been in labor for 24 h that finished with a c-section, and I was shaking, vomiting, paralyzed from the stomach down, and in unbearable pain. Asking me to hold and nurse a newborn was completely unreasonable.
I would have enjoyed my “sacred hour” with my newborn better if I hadn’t been getting stitches from an episiotomy, and my epidural had apparently worn off by then. The most painful part of my childbirth was after the baby was already out, and the baby was lying on my chest crying that whole time. I mean, once the stitches were done and the baby had calmed down a bit, it was nice, but for me it was more like a “sacred half-hour”. It’s one of those ideas that’s nice in theory, but real-world complications can really throw things for a loop.
Epidurals frequently don’t numb the perineum well. If there’s a next time, demand local for the stitching up. I was given lidocaine injections, if I remember correctly.
Huh, I didn’t know that. Thanks for letting me know! Still haven’t decided if another baby’s in our future or if I’m “one and done”, but if we do have another I’ll try to remember that (although hopefully I won’t need stitches next time…)
I don’t get why more providers don’t offer. We KNOW epidurals don’t always cover the perineum. I don’t care how fast you are, if you’re putting a needle and thread through my vagina and labia, you are going to numb me first, as much as you can. In fact that is when I would want nitrous, not during labor.
GAHHH! Sorry, description of needle, vagina and labia are just GAHHH!
My Christina is the only piercing I’ve had where I felt any substantial pain, and it was enough that I couldn’t help yelling out loud in the moment. Noticing the gaggle of teenage girls in the waiting room with their moms/older female caregivers as we were exiting, I said to my husband, very loudly, “Wow, that ear piercing hurt more than I expected!”
I can’t imagine being stoked at being stabbed even closer to the happy bits without any analgesic.
I had lignocaine for repair after my eldest (labial tear) but since I’m really resistant it did nothing. I had been awake for 3 days at that point and sleep was the highest priority, so I left it instead of saying something because I was just that exhausted.
Now that is some real fatigue.
I hear ya! With my first two babies skin to skin wasn’t offered to me, and it wasn’t as much of a “thing” back then anyway. I had skin to skin with baby number 3 (it was something the hospital offered) as I didn’t need a repair, but with the number 4 I was glad to hand her over during the repair of the tear – me and lidocaine are not good friends (and even with my first when I had the epidural I still felt the repair, even after the lidocaine was used on top of the epidural – I’m just lucky that way). I knew at some point I’d be jumping off the table and I didn’t want to be holding my daughter while I did it. I felt every bit of those last two stitches (had four in total), and I don’t know that I could have held it together as well if I had been holding my baby at the same time. And even with the baby I did have skin to skin with – it wasn’t an hour…. more like 35 minutes. Then I had to pee…. I guess to be a “good mommy” I should have just wet the bed… I’m sure the nurses would have LOVED that, lol.
Oh yes. I wish I’d had the presence of mind to ask someone to hold my first as I was being repaired. The numbing didn’t “take” very well and I felt terrible at the time that some of the first words my baby was hearing from me were of the 4 letter variety (not ‘love’).
It’s not tinfoil hat land, it’s the truth. Skin-to-skin has been sold as something vital not to miss. The fact that it is now called the “golden hour” or the “sacred hour” is proof in itself.
“Sacred” has the very specific overtone of ‘cannot be questioned, paramount in importance over all other considerations.’ It’s not a word that has any place in health care, IMO.
I don’t think it’s helpful to imply that an hour of skin to skin after birth is going to kill babies, which this post does even if it never explicitly connects the dots.
I like this blog because the goal is to be evidence-based, but this is one of the rare posts that goes off the rails in the interest of fighting back against bullshit. There is a lot of bullshit to fight back against, using evidence, and no need to fight back against bullshit by creating more bullshit. Skin to skin as it is generally practiced is not going to kill babies. Forcing them to do it for 24 h+ or forcing babies to room in is the danger and I think it is worth drawing a distinction between THOSE practices vs. 1 hour of supervised skin to skin after birth.
That first “golden/sacred hour” is the gateway to major woo-land. Some can do the hour skin-to-skin and then not be fussed with it again. Others, on the other hand, take that first sip of the kool-aid and that starts them off on the skin-to-skin, breastfeeding at all costs, rooming in with no option for a nursery repreive roller coaster.
If things are presented to you as a “not a choice” scenario, you aren’t likely to try and buck the trend. And just because it (whatever *it* is: formula, night nursery, well-baby nursery, warmers, pacifiers, etc) is available/an option, does NOT guarantee that the mother’s request/demand/frantic pleading for *it* will be heeded and honored.
“I don’t think it’s helpful to imply that an hour of skin to skin after birth is going to kill babies”
Well the proof is in the pudding. It *has* killed babies. Read the case reports above. And yes, some of those cases were in the first hour and they were done as it is actually practiced.
Sure, it’s not common. It’s super rare. But when it does happen, it’s tragic. We are telling women that skin-to-skin is vital, and are not telling them about any risks. Why are we promoting something that is needed only for preemies in countries where they lack incubators? Why are we telling women there is a “golden hour”, a “sacred hour”? Why not tell women the truth: If you want to do it, you can. Just be sure to keep baby’s nose free the entire time.
Please show me which of the cases mentioned in this post, or anywhere, involved babies dying during skin to skin in the first hour after birth. I have read the linked manuscript above and cannot find any evidence showing that to be the case.
The linked manuscript above reports the first victim being found at 1.15 hours of age. It’s possible that the baby could have been fine for the first 60 minutes and then only smothered at 61+ minutes, so technically you are correct. But I hardly find that comforting, and I doubt the mother does either.
Another citation is Herlenius and Kuhn 2013. They found that SUPC was more common than previously thought and that the first 2 hours of life were actually the *most* risky time for SUPC of any time period during the first week. That’s when 1/3 of the cases occur:
“Estimated incidence of the SUPC of a presumably healthy infant after birth differs widely, ranging from 2.6 cases to 133 cases/100,000..[…]…When a defined time for the SUPC event is described, approximately one third of reported events occur during the first 2 h, between 2 and 24 h and between 1 and 7 days after birth, respectively.”
Again, they don’t specify how many of those events were in the first 60 minutes verses 61-120 minutes, but I hardly think it matters. The burden of proof is on us if we want to keep promoting “the sacred hour” as somehow immune from smothering, when it is clear that the first 2 hours are at highest risk.
The original post is more clear that he is talking about extended skin to skin, aka kangaroo care. Not one immediate hour after birth.
Interesting that they just assume that the mother has excessive fatigue in the first 24 hours.
When I was doing Dad’s Boot Camp, one of my main messages was to remind the dads to remember that she has just been through a long process, and typically without any sleep (just think of the stories of “…I was in labor for 30 hours” and remember there’s not a lot of sleep in that time (although epidurals can help that)). I’m glad that this issue is medically recognized as pretty much a given.
And that’s not counting if they have Mom on magnesium, which can make a person very loopy. My doc wanted me to stay on it for 24 hours after delivery.
I noticed that, too – there’s a sense in the article that both mom and baby went through the ringer and are going to be just wrecked for a little while. Again, the AP idea that the mom should be the sole caregiver for a newborn goes against biology and history.
Of course if it was a long labor and the partner did not sleep during it either , they may not be awake enough, nor coherent enough to judge whether the baby is breathing normally.
I didn’t have a long labor but the end was difficult and scary. After I delivered I had the shakes for hours, it was a weekday and I went into labor at six at night so my husband had worked all day. After the initial hour or two of holding and feeding our daughter my husband went with the nurses when they took her to the nursery for observation while I attempted (and failed) to sleep. I sent my husband home after a while because he was exhausted too.
Once I got a few hours sleep the nurse brought my daughter back in and we got to know each other. Sorta modified rooming in.
having a newborn in a hospital bed with an exhausted mother seems like a recipe for disaster.
In boot camp, it’s not about judging whether they are breathing normally. It’s about what to expect mom to be able to do, and what dads need to expect to do.
One of the benefits of a planned repeat C-section at 7:00 am. Well rested and able to enjoy the first day with your newborn!
7 am? Try noon.
We had to be to the hospital by 10 am.
An elective RCS is looking better and better to me…
Loved mine!
I’m a little confused–is Dr. Jones saying that skin-to-skin causes SUPC/SIDS? Are there other risks of skin-to-skin?
From his article:
“For infants who die in the first week of life in this manner, studies have shown that when complications like prematurity, illness, injury, etc were ruled out, it’s typically the result of being in prone position (face down) in a skin-to-skin situation, something that pediatricians have universally recommended against since 1994. In fact, during a review of the literature, the authors of this study found that 75% of all SUPC cases happened during in this position during skin to skin contact and initial attempts at breastfeeding.”
Oh I see (I missed the link to the article). Does that also apply to babies in a sling or carrier? I imagine if they aren’t properly placed, they could be at risk of SUPC or suffocating.
I have heard reports of infants dying in slings due to poor positioning and airway compromise.
There are some types of slings/soft carriers which are NOT suitable for newborns because their default positioning there is poor; good babywearing consultants will advise not to use them but it doesn’t stop manufacturers from promoting their products (because there are no safety standards for slings whatsoever) http://www.sleepingbaby.net/safety.php
Agree. In particular, the pouch type slings are the worst as far as I know. I did use a ring sling for my newborn but she was always upright, airway clear and I was always awake and constantly supervising her breathing.
U.S. Consumer Product Safety Commission warning about slings, including right and wrong ways to use.
http://cpsc.gov/en/newsroom/news-releases/2010/infant-deaths-prompt-cpsc-warning-about-sling-carriers-for-babies/
A tragic case in Britain raises concerns:
http://www.dailymail.co.uk/news/article-2596584/Baby-died-mums-sling-Christmas-Eve-stroll-Infant-10-minute-walk-calm-down.html
We’re the mother awake or asleep? Were there other attendants around? I just fail to see how having skin to skin time after delivery (assuming both mother and baby are healthy enough and the mother is interested) would increase the risk of SIDS, assuming the mother is awake and there are doctors/CNMs and/or nurses (not to mention fathers/significant others/whathaveyou) to make sure she doesn’t fall asleep and to check on the baby periodically. Blaming skin to skin makes no sense- would the babies have survived if only they had a onesie on?
They are talking about the practice of extended skin to skin- where the baby never leaves moms chest in the first week or longer of life- it’s often recommended to mothers to improve breastfeeding. Leaves moms exhausted and babies sleeping in unsafe conditions as a result. Doesn’t have anything to do with the skin to skin time right after a delivery.
Okay… That clarifies it! I did skin to skin immediately after delivery with my third child (it was offered; I think that’s just what that particular hospital was doing at that time) and we were both awake the whole time (she was prone on my chest for about 15 minutes, started rooting around at which point I shifted her into a nursing position and fed her for about 15-20 minutes, at which time I handed her off to the nursing staff because I needed to pee and wanted to clean up a bit). Seems it’s not the mere fact of being skin to skin then – it’s allowing baby to fall asleep in a prone position (which is a well established risk factor for sids) or the caregiver falling asleep while holding baby (another well established risk factor) or a combo of the two – the presence or absence of clothing has nothing to do with it. So it’s not “overselling the benefits and ignoring the risks of skin to skin” it’s “ignoring the risk of a tired mom letting a baby fall asleep on her chest and/or falling asleep herself, regardless of state of dress”. Or “overselling the benefits and ignoring the risks of well established unsafe cosleeping practices”. Skin to skin doesn’t have much to do with it, as mothers (or fathers, or anyone else caring for baby for that matter) can just as easily fall asleep with baby on their chest whether they are donning a shirt or not.
I think the issue is that skin to skin, as currently practiced, involves those risks. You mitigated them by limiting the duration of skin to skin, and doing it in the presence of medical supervision, which is, IMO, a very good mitigation strategy. Not using such a mitigation strategy is, IMO, ignoring the risks.
Again, as mentioned – “In fact, during a review of the literature, the authors of this study found that 75% of all SUPC cases happened during in this position during skin to skin contact and initial attempts at breastfeeding.”
“Skin to skin doesn’t have much to do with it, as mothers (or fathers, or anyone else caring for baby for that matter) can just as easily fall asleep with baby on their chest whether they are donning a shirt or not.”
But nobody is promoting the idea that shirted mothers and fathers should hold their newborn in a close, prone position to promote bonding and breastfeeding; actually, those promoting kangaroo care and skin to skin (as per the name) say you need to have the bare skin contact present to get the benefits.
Okay, I see what you’re saying, and I agree. But at the same time – I don’t see anyone promoting the idea that mothers should fall asleep while practicing kangaroo care and skin to skin, or that they should let the baby fall asleep (or stay in that position if they do fall asleep). If it’s about “bonding and breastfeeding”, wouldn’t it be best to do it while everyone involved is awake?
That makes very reasonable sense, but in practice when lactation consultants / “natural” parenting blogs / etc. start giving advice on breastfeeding, it’s something like “Get in bed with your baby and stay there all day! Do lots of skin-to-skin!” There’s a not-always-directly-stated assumption that of course you’ll be co-sleeping.
Ah. I’ve never taken that advice literally and didn’t think anyone would (how does one stay in bed all day, baby or no baby?), so I guess I wasn’t thinking in those terms. I always took that advice more as – nurse as often as possible, rest as much as possible, stay skin to skin as much as possible. Not to literally nap all day naked in the bed with the baby… I think I’d go crazy if I had to stay in bed literally all day, lol. (I mean unless I was very very sick, or injured)
“nurse as often as possible, rest as much as possible, stay skin to skin as much as possible”
And I think that’s problematic advice – it seems like it can lead to a mom unintentionally falling asleep with her baby, or a baby falling asleep in a suffocating position without the mom noticing.
“I don’t see anyone promoting the idea that mothers should fall asleep while practicing kangaroo care and skin to skin, or that they should let the baby fall asleep (or stay in that position if they do fall asleep). ”
But they’re promoting skin to skin without warning of the risks, and/or promoting mitigation strategies. Just ‘do skin to skin and everything will be sunshine’ (or, more often, ‘good mothers do skin to skin.’) And co-sleeping usually is advised as a good way to promote extensive skin to skin and EBF. The idea that you can fall asleep despite your best intentions, especially in the exhausted post-delivery time, isn’t part of the narrative. Regular checks on the kid’s breathing isn’t part of the narrative.
It’s like having a party with a lot of alcohol and nobody collecting keys/offering to call taxis/serving as the designated driver. Sure, they’re not actively promoting drinking and driving, but they’re promoting a space where it’s likely to occur if the possibility isn’t addressed and mitigation strategies aren’t part of the narrative.
This is just my experience, but I was left alone with my baby in a single hospital bed all night. My husband couldn’t be with me, they got rid of the nursery, and the nurses wouldn’t take the baby at all. I was dead tired and struggling to stay awake so I wouldn’t drop him. Terribly unsafe. The hcps and administrators apparently were more concerned with making sure baby and mother are never separated than ensuring baby doesn’t fall out of bed or get smothered.
I had similar experience; we had bassinets – higher than beds so it was really hard to soothe baby without getting up and many moms ended up bed-sharing out of desperation – but bed-sharing was encouraged despite narrow beds, pillows and blankets in them and total lack of safety instructions. Taking baby to nursery was not even offered; I know that it happens if mom is flat out unconscious after birth or CS but no luck for us “normal” ones. Huge factor in this is lack of resources (not enough nurses during night shifts) but ideology plays a big role too.
Same here, vaginal delivery and my husband had to go home to watch our son. No nursery and the nurses said they couldn’t watch the baby. Also with my first the nurses said I should do skin to skin since he wasn’t interesting in breastfeeding. She called it “softing” being skin to skin for 15 minutes then attempting to breastfeed. She said, “imagine you’re in a bakery, you need to smell the delicious breads before you want to eat them.” Also I had to work on frequency of feeding since he wasn’t eating I was half naked with my son for what seemed like an eternity.
That’s actually a pretty sweet way of putting it, though ugh on the half-naked business.
I don’t find it very sweet. It seems like a bunch of made-up bullshit to me.
I’m trying to be positive. New Years resolution. 😉
I remember feeling unpleasantly bovine about the whole thing — a bakery analogy might have been preferable.
No, I DO mean that the benefits of skin to skin are oversold and the risks are ignored.
The first part I agree with – the benefits (at least for full term babies and for premature babies who have access to incubators) are oversold. But skin to skin as an independent risk factor for sids? How does clothing protect a baby from falling asleep prone on moms chest? How does clothing prevent mothers from falling asleep while holding their babies? Not being snarky here, I just fail to see by what mechanism clothing would be protective, all else equal. IOW – if mom-baby dyad 1 are “skin to skin” with baby in prone position on mom’s chest and they both fall asleep, are they are greater risk than mom-baby dyad 2 who are fully clothed with in baby prone position on mom’s chest, who also fall asleep, and why would that be? If the risk between those two situations would be the same, then it isn’t anything inherent in being “skin to skin” that is risky.
I don’t think it’s the skin part that’s the issue; it’s more that people think that the physical contact is so important that they encourage it at the expense of safety or in unsafe circumstances.
Then why bash “skin to skin”? Why not talk about safety and how important it is not to let baby remain chest to chest with a caregiver once the baby is asleep and how critical it is for caregivers to never fall asleep while holding the baby? I don’t think women should be discouraged from having skin to skin time after delivery, which, while certainly not necessary or even particularly beneficial can be a pretty wonderful experience, assuming mom and baby are up to it. Make sure parents know that even when baby is sleeping in your arms he needs to be on his back, and make sure that parents know that falling asleep while holding baby is a big risk factor for sids, and impress upon hcps and fathers/sos that mothers will be exhausted in the days following delivery and they need to take care not to let mom fall asleep while holding baby, regardless of state of dress.
I’m not sure anyone is bashing skin-to-skin, just saying the benefits are oversold. I think it can be great — just find it a problem when it is promoted without also thinking about safety.
I get what you’re saying. I wasn’t meaning to be a PITA or obtuse in this thread – I guess I always thought (and I could be wrong here too) that the benefits of skin to skin (the actual ones, not the over-inflated ones) are attributable to the actual skin to skin contact; not simply holding the baby, or even holding the baby in a certain position, but the actual skin on skin contact. So when someone speaks of the “risks” of skin to skin it leaves me head-scratching – unless mom/dad has some contagion that is transmittable through skin to skin contact, how is there risk in being skin to skin, kwim? So the first place my mind went was ‘what is the mechanism by which clothing protects babies from SIDS?’ I hope that clarifies my initial reaction.
And of course, I was thinking with some actual logic (a dangerous thing when talking about the practices of NCB advocates and lactavists, I know). Leave it to these people to take something that is nice (if you are willing and able) and pervert it to the point where it becomes dangerous…. imagine that. That’s why I never realized that people are literally spending all day skin to skin in their beds with their babies. Nurse often to boost supply? Sure. Spend some time skin to skin before each feeding to encourage baby? Sure, if you want to. Get rest and take it easy (sleep when the baby sleeps, take it easy on the housework -now is not the time to re-grout the bathroom tile or re-insulate the attic, get help with older children)? Absolutely – exhaustion can negatively impact supply. And maybe those things will help boost supply…. maybe. But if you have to spend days laying about doing nothing but nursing, maybe bfing isn’t working out so hot? So yeah, I understand where you all are coming from now… sorry, sometimes I can be thick, lol.
Yeah. Enjoy your DVT! There’s a difference between taking it easy and being stuck in your bed all day and night. Most people would go nuts.
Oh, no, not at all. It’s good to clarify things. Skin to skin is fine, nice even, but just within the bounds of common sense. It isn’t so important you compromise the baby’s safety in order to do it.
I’ve literally never heard of skin to skin for a week or longer most of the studies are referring to skin to skin immediately after birth followed by skin to skin contact while nursing, babywearing etc
I’m not the expert, I’d ask Jones on Twitter – he’s very responsive. The article does allude to relatives missing the signs of compromised breathing in the baby, and recommends having a HCP regularly checking on mom + baby, rather than relying on the family…
“would the babies have survived if only they had a onesie on?”
I think they’re talking about skin to skin as a practice vs keeping the baby in a bassinet/crib, which is Child Abuse for the AP set.
” I just fail to see how having skin to skin time after delivery (assuming both mother and baby are healthy enough and the mother is interested) would increase the risk of SIDS,”
Because it’s the skin-to-skin contact which is being promoted as vital. Mothers are told that they and the baby need to be naked and chest-to-chest. It’s the standad kangaroo-care position. And she’s also told she needs to put the baby right to the breast. Since mother is often exhausted, and semi-reclined, it can be a recipe for disaster. The baby can easily end up basically lying prone with its face positioned right on mother’s smothering breast.
I am wondering if part of it is that often when you do skin to skin for the entire time, the baby ends up sleeping on its stomach on your chest. I just remember the nurses tucking the baby in with me and he ended up that way.