Sleep training from baby's point of view

This is from one of my lists:

Sleep Training...

OK, here's my situation. My Mommy has had me for
almost 7 months. The first few months were great--
I cried, she picked me up and fed me,
anytime, day or night. Then something happened.
Over the last few weeks, she has been trying to
STTN (sleep through the night).
At first, I thought it was just a phase, but it is only
getting worse. I've talked to other babies, and it seems like it's
pretty common after Mommies have had us for around 6 months.

Here's the thing: these Mommies don't really need
to sleep. It's just a habit. Many of them have had some 30 years to
sleep--they just don't need it anymore. So I am implementing a
plan. I call it the Crybaby Shuffle.

It goes like this:

Night 1--cry every 3 hours until you get fed.
I know, it's hard. It's hard to see your Mommy upset over your
crying.
Just keep reminding yourself, it's for her own good.

Night 2--cry every 2 hours until you get fed.

Night 3--every hour.

Most Mommies will start to respond more quickly
after about 3 nights.
Some Mommies are more alert, and may resist the
change longer. These Mommies may stand in your doorway for hours,
shhhh-ing. Don't give in. I cannot stress this enough: CONSISTENCY IS
KEY!!
If you let her STTN (sleep through the night), just once, she
will expect it every night. I KNOW IT'S HARD! But she really does not
need the sleep, she is just resisting the change.

If you have an especially alert Mommy, you can
stop crying for about 10 minutes,
just long enough for her to go back
to bed and start to fall asleep.
Then cry again. It WILL eventually
work. My Mommy once stayed awake for 10 hours straight,
so I know she can do it.

Last night, I cried every hour. You just have to
decide to stick to it and just go for it.
BE CONSISTENT! I cried for any
reason I could come up with. My sleep sack tickled my foot. I
felt a wrinkle under
the sheet. My mobile made a shadow on the wall. I
burped, and it tasted like pears.
I hadn't eaten pears since lunch,
what's up with that?
The cat said "meow". I should know. My
Mommy reminds me of this about 20 times a day. LOL.
Once I cried just because I liked how it
sounded when it echoed on the monitor in the
other room. Too hot, too
cold, just right--doesn' t matter! Keep crying!!

It took awhile, but it worked. She fed me at 4am.
Tomorrow night, my goal is 3:30am.
You need to slowly shorten the
interval between feedings in order to reset your Mommies' internal
clocks.

P.S. Don't let those rubber things fool you, no
matter how long you suck on them, no milk will come out. Trust me.

One session with a lactation consultant improves your chances of success!

January 8, 2007 — A single antenatal counseling session with educational materials improved breastfeeding practices up to 3 months after delivery, according to the results of a randomized trial reported in the January issue of Obstetrics and Gynecology.
More here.

"Both the World Health Organization and the American Academy of Pediatrics recommend exclusive breast-feeding for the first 6 months, followed by the introduction of suitable complementary foods and continued breastfeeding up to 2 years of age. Despite increasing clinician awareness of the many advantages of breastfeeding, many mothers in the United States and worldwide do not maintain exclusive breastfeeding for the first 6 months."

A US survey in 2001 revealed that at 6 months' postpartum, only 27% of mothers were still breastfeeding, and only 7.9% were exclusively breastfeeding, which means without any additional formula or food or drink. In Singapore, the National Breastfeeding Survey 2001 showed that only 21.1% of mothers continued to breastfeed at 6 months, and that fewer than 5% were breast-feeding exclusively.

"The challenge therefore remains to implement programs that can effectively improve rates of exclusive and predominant breastfeeding both in the short and long term. In these surveys, significant factors affecting the decision not to breastfeed included a lack of support from healthcare professionals (reported by more than 10% of Singapore mothers) and a lack of knowledge about breastfeeding.

Although programs aimed at promoting breastfeeding through patient education and caregiver encouragement have yielded mixed results, systematic reviews conclude that educational programs are more effective at improving breastfeeding practice than are informative pamphlets dispensed without accompanying educational intervention. Seeing a lactation counselor before delivery establishes contact with someone who can continue to provide postnatal care and support. Breastfeeding counseling should be part of a broader program aimed at educating pregnant women for motherhood."

If you are in Tokyo, once a month classes with a Lactation Consultant are available here.

Private consultations are also available on request.

Once a month La Leche League meetings are held in Tokyo at 2 locations. Meeting the group Leaders and the other mothers can also help you establish the network of support you need.

The mystery of mother's milk

Happy New Year!
If you are here because you saw us in the January 2007 edition of Tokyo Families magazine, welcome! For people outside Tokyo, my article from their latest edition, the Mystery of Mother's Milk can be read online. This blog and my classes are also listed, along with other post-natal resources.

"Nothing prepares you"

"Nothing prepares you" is the title of one of the chapters in the new book "What Mothers Do, especially when it looks like nothing" by Naomi Stadlen.
This is the phrase she most often hears from new mothers when they discuss how they feel about becoming a mother. They often say that it was " a shock" to find out what mothering really entailed. Another article called "The reality of motherhood: What Nobody Tells you discusses how we usually underestimate how much our lives will change when the baby arrives. We have read the books, taken the classes, watched the videos, yet there is an underlying feeling that perhaps there was something missing in our preparations...surely it wasn't meant to be quite like this???

Recently Setagaya ward's volunteer bureau in Tokyo held a seminar where the speakers discussed their experiences of being mothers in a foreign country. Many of the Japanese women in the audience reported similar experiences when their families were posted overseas. The consensus was that in addition to culture shock, there should be a whole separate category called "new mother shock". Compounded with some degree of pre-existing culture shock, it can leave a new (foreign) mother feeling quite overwhelmed. Even if you expected your baby to bring some degree of change to your life, the extent of the real impact of baby's arrival on your life and your emotions can far outstrip what you anticipated. You may indeed feel that "nothing prepares you".

The first newborn baby you ever held may have been your own baby. Few of us have spent time with newborn babies, so we may not know instinctively what is normal. We may not have family or friends nearby to support us. So that is when we turn to the books or the internet to get some perspective. There is a huge market in writing for new parents, because everyone is worried, and lots of unqualified "experts" are cashing in on these vulnerabilities, telling us that they have the answers, their methods are the secret to unlocking the mysteries of parenthood.

How do you know your baby is doing OK? Is it normal to have a baby feeding frequently every evening? How can it be normal to poop so much? When is spitting up too much? What will I do if there is an emergency? Will I even recognise there is actually an emergency? What if I don't speak Japanese well (or at all)? Where can I find the help I need? How long before life returns to "normal" and I can "get things done" again? Why am I so forgetful now, even though before the baby arrived I was a highly competent and organised business professional? These are just a some of the things that might run through your mind.

And to top it off, all this occurs while you are recovering physically, emotionally and mentally from your birth, possibly replaying the experience over and over in your mind, adjusting to living with interrupted sleep and hormones that are in flux, and being totally responsible for this new little person, 24/7. Learning to breastfeed, learning to recognise your baby's signals, getting to know your baby's needs and how to satisfy them, dealing with the nights, coordinating feeding, changing, sleeping, eating meals yourself, maintaining yourself, your relationship with your partner, your home...this intense on-the-job training happens when you may feel at your most vulnerable, and at times it is hard to pick out the exact bit of information you need from all the things you have heard, read and stored for future reference.

If we were all parenting our new babies in extended communities, we would probably have been exposed to little babies and the things they do while we were growing up. We might have some inner sense of "this is what babies do". In an extended family or community, other women may
be able to share their wisdom and experience when our babies are born, help us out with the myriad of tasks we are learning, and support us in a positive way as we learn to become mothers. But being in Japan, you may find yourself more isolated than if you were in your home country.

During pregnancy, most first-time mothers are focussed on the birth. It can be so all-consuming that we tend not to think about what comes after: we trust the next part will all come naturally, and look after itself. Compared to the birth, how hard could it be???

Before the baby arrives, many women say they are determined to keep some sense of routine and order after the baby is born (which explains the appeal of those books with carefully planned daily schedules). They start from the premise that being in control is essential to being a parent. "No baby is going to run my life!" Having a baby is the beginning of a life-long relationship. What other relationship in your life is based on "control"? Each baby is an individual, each wired differently, and a control-based one-size-fits-all approach to parenting can make life very stressful for a new mum. It is easy to think that because your baby doesn't do everything that the book says, or doesn't respond to the methods in a particular book, there is something wrong with your baby. Maybe there is something wrong with the book???

By not anticipating and preparing for the reality of life with a newborn and the changes that will arrive in your life, new motherhood can come as a massive shock. Before your baby arrives, read some books on gentle parenting, attend La Leche League meetings or join a new mothers group in your area where you can see mothers and babies in action and hear their stories, join online discussion forums where you can have your questions answered sensitively. Do this at a time when you are still able to think straight, and be open to different suggestions...you never know what might work for you in the future! These links are just somewhere to start to help lessen the new mother shock, and then after the birth these same places may be able to offer you support as you adjust to your new life as a mother.

Our babies truly benefit from us being flexible, spontaneous and open to new ideas as we learn to be their parents. If we listen to our babies, and watch them, and grow and learn with them, our lives can be so enriched, and sometimes just a little less stressful!

Making milk is easy!

Download the flyer "Making milk is easy! 10 steps to make plenty of milk " from the Massachusetts Breastfeeding Coalition - available in English, Spanish, Portuguese, Italian & French.

Breastfeeding in Japan photos!!

Would you like to share your breastfeeding photos? Babycafe Japan is going to start a gallery of breastfeeding photos on our blog. You don't need to have your name included, nor your face if you don't want to, but we know that if everyone can see more babies breastfeeding, it makes everyone more comfortable that breastfeeding is the normal way to feed your baby. You could send us your picture of breastfeeding in the park, on the subway, in a restaurant, visiting a shrine, while hiking in the countryside, at the pool, while wearing your baby in a sling: happy breastfeeding babies ...anytime... anywhere!

Send photos here, and include any story you'd like to share about breastfeeding...maybe we can put them all together in another format. Just one thing to note: the photos must be owned by you.

Epidurals and breastfeeding

There is more and more evidence that breastfeeding is affected by birth practices, particularly the epidurals mothers receive during labor.

Epidural use is not all that common in Japanese hospitals, but if there was a survey done on the non-Japanese mothers' use of epidurals, the rates would definitely be higher than for the local mothers.

This video gives an interesting discussion of the situation being seen in North American hospitals where epidural use is much more common. The doctor describes how babies born to mothers who have had epidurals during labor are having more difficulties getting breastfeeding started. Their behaviour is affected by the medications. They are usually sleepier, may have disorganised sucking patterns and are often subject to other kinds of interventions, as are their mothers.

One thing to note is that the comments she makes about the medications passing into the mother's colostrum are not supported by the evidence. Dr Thomas Hale who specialises in pharmacology and lactation, reports that the fentanyl transfer from epidural anesthesia during labor into mother's milk is poor and probably clinically unimportant. The milk is not the concern: more important is the effect of the epidural on the baby during labor, and the different breastfeeding behaviours being observed when compared with babies whose mothers had unmedicated births.

I think what this all means is that all mothers should be informed of the potential risks of epidurals and other birth interventions, and if possible you should take childbirth classes here or in your local area to learn about resources for coping with labor. Read some good birth books and ask lots of questions.

Ideally, staff in the hospital or clinic should be well versed in how to help mothers and babies get breastfeeding off to the best possible start...lots of skin to skin contact with baby on mum's chest, keep mother and baby together at all times, give baby time to come to the breast, if baby is having trouble, you might need to express some of your colostrum and feed it by syringe or spoon, very sleepy babies may need to be woken for feeds and gently encouraged to continue feeding for long enough and so on. Unfortunately, we cannot control what level of skill the staff have, nor how supportive the hospital or clinic will be of breastfeeding.

The best idea then, is to learn as much as possible about breastfeeding during pregnancy. Mothers-to-be can attend La Leche League meetings, both parents can take classes here if they are available in your area, so everyone knows what to expect with normal breastfeeding, and can recognise if things are going well or not after your baby arrives.

For a more technical review of epidurals and breastfeeding see here where the author states "There is evidence to show that epidural anesthesia probably does diminish the neonate's early ability to suckle. " A recent breastfeeding journal article concludes "women and their clinicians may feel that sufficient evidence has accumulated to justify offering extra support to establish breastfeeding if women have received high doses of analgesics in labour."

Make sure you get the support you and your baby need.