I took a vacation from blogging. I've been getting treatment for my neck injury, and now I'm finishing up my e-book. I plan to up and running in the fall, but blogging is not my centerpiece business, it is an off-shoot business, my counseling practice is how I make my living. I need to run to work as I am writing this.

But I felt compelled to blog today. In Psychology Today, Darcia Narvaez, Ph. D. Published a blog post titled “Did You Get Last Week's Message? Pushing* Formula Is Evil.” And, understandably, there's a big backlash around the web about this.

I think that Dr. Narvaez meant well, but didn't go about it in the right way. In her comments, she apologized for being brusque. She also took people's criticisms and changed her blog post to read differently.

I mean, the information about attachment, or bonding, was inaccurate. But I notice she changed her information. That's good.

The fact is that human attachment occurs over a long period of time and is not dependent on the feeding method. But there is a sensitive period right after birth when nature tries to set up a time for mother-baby to bond strongly. Just as in the 1950's when Bowlby discovered the importance of child-parent for wellness in the 1950's and hospital policies changed, so have birth practices have been modified over time to respectfully accommodate this sensitive period for mother-baby, whereas hospitals used to just ignore it.

Now I said nature tries, right?

If, for other reasons, such as illness, trauma emotional upsets, etc, mom and baby don't get to be together during this sensitive period right after birth, then it does not mean that attachment will not occur or the mother is not a good mother. Secure attachment still takes place over a period of time.

Then again, Dr. Narvaez admitted she wasn't a psychologist, but a researcher, and an advocate for public policy for children.

Her perspective is different than a therapist focused on woman-baby issues and perinatal mood disorders. But I think her perspective was widened by the reaction in the blogosphere. Which is a good thing.

The issues of breast-feeding and formula feeding operate on different levels.  The concerns of individuals, of clinicians and individual mothers, are going to be different than the concerns of public-health officials working on a global level. The two levels intersect, and both need consideration.

On a global level, formula feeding is responsible for death of infants every single day.

Every day, formula companies advertise to women around the globe. The result of this is women who are too poor to be able to buy enough formula to feed their babies long-term, begin using the free formula they get at the hospital. The women do not initiate breast-feeding. The free formula runs out, they don't have money to buy more formula, and they don't have any milk. So their baby starves to death. Another scenario is the water supply is tainted so when it is mixed with formula and fed to the baby, the baby dies.

I think that Dr. Narvaez meant to publish a blog post that was supportive of children's health and family from a public health point of view, addressing the global issues above.

Unfortunately, her tone came across as harsh and as condemning individual women who choose to or had to, formula feed for personal reasons.

So, okay, so she deserved the backlash. She needed to consider the clinical issues of individual women who are dealing with their very real perinatal mood disorders and feelings/realities about breast-feeding and formula feeding.

To her credit, she listened to the responses, and modified her approach.

However, let's face it, her information is valid and reliable.

Now I'm not trying to take away a woman's right to choose, that is a personal issue.

AND there are numerous valid and reliable studies that show that breast milk has superior nutritional value for infants, attenuating effects on human physiology, contributes to psychosocial protective factors against stress, and other another positive outcomes that improve quality of life. And many formulas have corn syrup in them, which all nutritionists who don't work for the corny syrup lobby, agree is junk food. 

Some of the studies are listed here and here and here.

Of course there are the large long-term issues of genetics and environment. If a child is brought up in an abusive home, after having been breast-fed, breast-feeding is not going to protect him from the effects of abuse. And if there isn't adequate nutrition available later on in life, breast-feeding can protect the child from that, either.

It's just not a simple issue.

But to say that formula and breast-milk are equally nutritious is not scientifically valid.

Women are pretty DARN AMAZING!  Our bodies have a wondrous capacity to carry a baby, give birth, and feed that baby!  Hooray for us!  We are amazing! 

AND those statements aren't meant to invalidate an individual woman's right to choose.

AND I also believe that women are intelligent enough to be able to understand the facts. Every choice we make has pros and cons. Every choice we make opens some doors and closes some other doors. And every choice doesn't need to be perfect.

AND women are pretty darn amazing.

None of us are perfect or should feel pressured to be perfect.

But women are smart enough to be able to understand the information. And formula companies have been hurting women and families for a long time. There have been 22 recalls of formula in 20 years. Formula has been known to have deficiencies, which companies are correcting over time. But at the expense of public health, in the form of infants.

AND on an individual level, there are healthy formula fed babies and healthy breast-fed babies.

AND breast-feeding versus formula feeding does not operate on just an individualized level.

It is a global issue.

How long can formula companies keep taking advantage of women and children all around the globe every day? The worldwide protest has been going on for years, for decades even.

And hey, I'm not saying that a woman who suffering from postpartum depression postpartum anxiety postpartum psychosis, any of the perinatal mood disorders, should be trying to get involved in a social cause.

When they are well, perhaps part of the healing might be getting involved in a larger community of women and families in their town, in their county, in this state, in their country, or may be looking at communities around the world.

I just want to state the following disclaimers below about how I practice as well. Read them if you feel like you have some extra time in your day.

When a client comes in to see me, I don't press my opinions or personal choices upon him or her. I'm too well trained for that. In addition I took an ethical oath, which I take very seriously. It would be unethical to make any statements that would sway a person to change their personal choices, as long as they are in the range of legality and safety, to suit my purposes. I want to add that as a Licensed Professional Counselor who specializes in Maternal Mental Health and in helping developing families, I consider myself an advocate for women and families. I also advocate for US social climate to change so it is easier for women and families.

And let me also say that I attempt to the best of my ability to work in an evidence-based manner. What I mean by this is that I don't give people information that’s basically just my personal opinion. I use techniques and information that are validated by replicated studies.

This is number four in my review of the seemingly endless books on Infant Sleep Methods currently out there. I'm demystifying the field of infant sleep for new moms, to make it a bit easier. I mean, who can read a two hundred page book

when you are trying to get some shut-eye with your newborn in the middle of the night?

The take-home messages from Dr. Karp are: become educated about the fourth trimester, the discovery of the Calming Reflex, learn the Five “S”s of infant sleep, all of which he adapted from studying the intersection of modern research and observation of baby care in tribal societies.

Dr. Karp first educates people about the reality of the fourth trimester, asking parents to adjust their expectations and understand the true nature of newborns. He opens the discussion about fourth trimester with a quote from Dr. Arthur H. Parmalee (1977). Dr. Parmalee (1977) says that most parents dream about receiving a baby that resembles a smiling, social, four- month-old! But what they, of course, instead receive is a fussy, fetus-like newborn!

Think about the profound developmental changes that occur in the first three months of life. A four month old baby is very different than a newborn! And then think about how parental expectations are powerfully shaped by modern advertising! In ads, the babies are usually sitting up and smiling, if not walking. The thing is, the babies in ads are not newborns, but are usually at least four months old.

Dr. Karp suggests human physiology causes our babies to

be born in an immature state. He stresses that there are huge physiological and psychological difference between a four day old newborn and a four month old baby and a lot of those differences have to do with nervous system and brain maturation and size.

Dr. Karp considers a newborn to be very much like a fetus. In fact, he wistfully wishes that humans had pouches like kangaroos! But because we don't have pouches, we need to learn behaviors that imitate the uterine environment in order to keep our newborn fetuses happy! Hence, Dr. Karp believes the first three months of a baby's life is actually a fourth trimester where a lot more maturation takes place. He suggests we need to re-learn how to parent babies in the fourth trimester.

Think about this: a newborn's brain is 20% smaller than a four-month-old baby's brain. Because of this more mature brain, a four-month-old baby has more mature

capabilities than a newborn. Some such capabilities are: processing sensory input faster than a newborn can, smile and interact with her parents, focus on objects across the room, and has more mature control of body movements, such as being able to roll over and move her head.

In contrast, a newborn has behaviors that are largely driven by survival reflexes, such as the Moro reflex and the well-known Crying Reflex. And from the study of tribal societies, Dr. Karp has rediscovered the Calming Reflex.

Dr. Karp believes the Calming Reflex evolved from conditions created in the uterus. He also posits ancient mothers needed to know how to calm their babies quickly in order to quiet them and keep the entire family group safe from predators. The Calming Reflex works quickly. The Calming Reflex depends on mimicking conditions within the womb. Dr. Karp calls these conditions the five “S”s. The five “S”s are: swaddling, side or stomach lying (but not for all night sleep), a loud SHUUSSHHIIN

NGG sound, swinging and sucking.

Initiation of the remarkable Calming Reflex can be watched on Dr. Karp's DVD, “Happiest Baby on the Block.” It is truly remarkable to watch Dr. Karp teach parents the Calming Reflex and to see how quickly and easily a baby falls asleep when enacting the natural human Calming Reflex. Anyone who has cared for an infant will be awestruck by the footage on the DVD!

One other message Dr. Karp has for parents is that colic usually fades around the four-month mark. Dr. Karp believes colicky babies are babies who are are more sensitive to being born early than other babies. Dr. Karp believes the “cure” for a colicky baby is

the use of the Calming Reflex.

Dr. Karp's Calming Reflex works so well that he is now partnering with various agencies across the nation in order to design and implement interventions intended to reduce the sad abuse called Shaken Baby Syndrome.

What do I take away from this method

For the other methods I reviewed I said, “If you are a mom who is not having any trouble with your baby's sleep, and are managing ok, then don't bother reading any of these books (unless you are helping a relative or a friend out!). “ I don't feel this way about Dr. Karp's book.

I think that Dr. Karp's methods are so easy and natural to use and so caring of babies and families that everyone interested in parenting a baby should read this book. I think the fourth trimester and the Calming reflex are major discoveries and contribute hugely to parenting literature.

As a therapist who sees new parents and depressed moms, I will definitely incorporate some of Dr. Karp's messages and methods into my work. He has natural, practical, and easy ways to help parents understand newborns and manage manage infant sleep. Parents in need of sleep can easily learn his methods and get the sleep they need to be emotionally healthy for themselves and their family.

I'm so impressed with his methods that I am planning on becoming a Happy Baby educator. And I have sworn for many years I would never get certified in anything again! So it's that good!

Okay, the next and last infant sleep method I am reviewing will be Dr. Sears. After that review, I plan to put together a consolidated overview of the current thinking on Infant Sleep. Thanks for going through this process with me!

Please let me know what you think!

Good Enough Night-time Parenting Styles

Hey everyone! Back after a long blogging break! If you visit my Twitter and Facebook feeds, you know that in February, I fell on the New Jersey ice and got a mild concussion. I was trying to work at my usual pace, but the doc suggested I pretty much stop reading and writing to allow my brain to rest! Tough order! But it sure helped alot! It's April and I'm coming back slowly!

To continue my review of current infant sleep methods, today I take a look at Marc Weissbluth, MD’s book, Healthy Sleep Habits, Happy Child. Dr. Weissbluth is a practicing pediatrician based in Chicago, Illinois. He is also the founder of the Sleep Disorders Center at Children's Memorial Hospital in Chicago. Dr. Weissbluth believes that by creating reasonable sleep patterns early on in infants, then a family can prevent the development of a sleep disorder which can persist into toddler-hood, early childhood and beyond. He has a family-systems and preventative approach.

Well, all I can say is if you want an overview on the research about the negative effects of sleep deficit (on infants, adolescents and adults), you've come to the right place. Dr. W states lack of sleep is a global health issue (just to add something else to this list!). He describes our overworked, over-scheduled, stressed-out, chronically tired and guilt-ridden society and its negative effects on infants, children & families!

General Dr. Weissbluth Messages:

The negative effects of sleep deprivation and

there is more than one path to positive night-time parenting

I see two messages standing out in his work. His main message is that sleep-deprivation in our children is bad for their physical and emotional health and this in turn creates stress in parents and families. He culls information from his wide and varied roles as researcher, scholar, pediatrician/practitioner, and father/grandfather. His mantra is: small but consistent sleep deficits wreak havoc on the brain, resulting in problems in growth, and behavioral and emotional instability.

A second message coming across is that there are three ways to approach being a good parent regarding night-time parenting: no-cry, some cry (graduated extinction) and let cry (extinction). Also that night-time parenting should be tailored to the individual baby and family's needs. Dr. Weissbluth believes families should use different flexible methods regarding baby/child sleep management, and free themselves from the guilt and rigors of attachment parenting. He is an advocate of flexible and good-enough parenting, as different parenting (albeit loving) practices can produce securely attached and emotionally secure babies/children/adults people just as well.

A Few Dr. Weissbluth General Sleep Facts:

Research indicates not getting enough sleep:

• negatively impacts the optimal waking state

• inhibits the development of concentration

• produces a mindbody state mimicking jet-lag syndrome (overall fatigue, general grumpiness, cognitive disorientation)

• causes fatigue-induced tantrums

• results in diminished brain growth

• results in higher cortisol levels, in turn increasing the occurrence of obesity

• in teenagers, results in more drug & alcohol use and daytime sleepiness

• in mothers, causes or exacerbates postpartum depression

A Few Baby-Specific Dr. Weissbluth Sleep Facts:

• Babies have high sleep needs

• Sleep behaviors developed in infancy can carry over to toddler-hood, childhood, adolescence and adulthood

• Do NOT sleep-train infant under the age of 4 months. As their brains are not yet developed

• From one – two weeks old, through six weeks, newborns go through a developmental phase whereby they have several hour periods of fussy, gassy behavior. This is normal and is generally not a result of maternal anxiety, poor parenting, or lack of breast milk. It is from newborns having an undeveloped nervous system. It passes as the brain matures.

• 80% of babies have common fussiness, 20% have extreme fussiness

  • Of the 20%, 56% of these are at risk to have difficult temperaments

  • Families with babies with extreme fussiness plus a difficult temperament are at highest risk for sleep problems after four months

    • This small percentage (post-colic babies) have the most persistent sleep problems & lots of family stress

• Usually, even colicky babies settle down around the four month mark

• Hunger does not affect infant sleep patterns; even babies who are hooked up to continuous feed IVs have wake & sleep cycles.

• Rather, a complex interplay of sleep rhythm is established in sync with cycling levels of body temperature, melatonin and cortisol

• Melatonin, which induces drowsiness and relaxes the muscles around the gut, begins to be manufactured in the maturing brain at about 3 -4 months. This is when day/night confusion and colic begin to disappear.

• Body temperature rhythms mature about 12 – 16 weeks as well, this contributes to sleep consistency.

• Add in cortisol rhythms, established between 4 and 6 months, peaking in the early morning and lowest at night to sleep patterning.

• Adults fall asleep for longest periods of time at peak (or just after peak) of temperature cycle.

• Sleep begets sleep, meaning that naps help create more and better nighttime sleep, so naps are an integral part of physical & mental health

• From 4 months on, infant/child sleep schedules are impacted more by external factors (parental scheduling, guilt, etc) than by internal factors (biology, temperament, etc)

A Few Dr. Weissbluth Infant Sleep Method Guidelines:

• Preserve the sleep, to preserve emotional and physical health

• Tailor your approach to your individual baby's fussiness level & temperament type and to your parenting style

• There are three approaches, no-cry (attachment parenting), some-cry (graduated extinction), let-cry (extinction)

• No-cry may be tiring, but if it works for you & your family, so be it, but do not judge others; it's not the only way to be a good parent

• Some-cry may take longer to achieve goal of baby self-soothing to sleep than let-cry

• Let-cry might be necessary in extreme cases to help mom get some sleep, to prevent postpartum depression and to prevent health problems in baby

• Use small shaping behaviors to move slowly towards & achieve sleep consistency

• Practice consistency in parental approach and sleep times

• Establish a sleep schedule based on baby's sleep cues

  • Sleep cues are subtle, a lull in activity, staring off, rubbing eyes

  • Don't wait until the baby/child is overtired, as it will be harder for the baby/child to fall asleep easily or fall asleep at all

• Develop and maintain a consistent soothing-to-sleep routine, using such cues as gentle infant massage, darkening the room, rocking, swaddling, nursing, pacifier, holding, etc

• Letting the baby/child practice falling asleep makes it effortless over a period of time

• The entire family is impacted by lack of sleep if one person does not sleep

• Working parents should not expect their schedules to impact their child's schedule

• Cut back on activities as too much over-scheduling impacts the family's health

• In some cases, recommends letting baby/child vomit and also putting a lock on the door

What do I take away from this method

If you are a mom who is not having any trouble with your baby's sleep, and are managing ok, then don't bother reading any of these books (unless you are helping a relative or a friend out!).

As a therapist who sees new parents and depressed moms, I can definitely incorporate some of Dr. Weissbluth's messages and methods into my work. His well-researched information about the natural patterns of infant development, the nature of infant fussiness and the statistics and description of infant fussiness and temperament is an invaluable source when working with new parents. I would recommend this book to people wanting solid information about the nature of infant development.

I think that over-tired and depressed parents would have trouble reading such technical material and could use some help, such as a pediatrician, a postpartum doula, a grandmother in implementing a sleep change.

There is so much pressure for parents! They feel like they are not good-enough! I also commend Dr. Weissbluth for suggesting there are many ways to be a good parent and that infants thrive and develop secure attachments under many (of course, loving) conditions. He indicates the well-being of the entire family should be considered and cites the mother's emotional state as important to her own and family functioning.

The thing that really bothers me is the letting the child vomit and the locking of the doors. I cannot recommend these methods at all to anyone as I feel they are dangerous and extreme. I want to believe Dr. Weissbluth is a good man and has a lot of experience with very difficult families and situations, but this part of his method seems dangerous and extreme to me and I would not be able to recommend this to parents in my practice.

But I do think it is good practical advice for moms to know that there are several ways to be a good-enough parent. Depression is fed by lack of sleep, so it is a good thing to put Mom's needs into the mom-baby equation. Be kind to Mom, help her practice self-care.

All in all, I was prepared to dislike Dr. Weissbluth. But after meeting him in his book, I do not. He comes across as a balanced family man, advocating for babies by presenting solid information about their true nature, advocating for breastfeeding, but inclusive of all parents because, as a pediatrician, he does serve a broad population.

I just don't understand the vomiting and locking the door thing. Not for me,.

At the end of the series, I plan to put together a consolidated overview of the current thinking on Infant Sleep. Thanks for going through this process with me!

Please let me know what you think!

References

Babson, K. A. et al (2010). A test of the effects of acute sleep deprivation on general and specific self-reported anxiety and depressive symptoms: an experimental extension. Journal of Behavior Therapy and Experimental Psychiatry, 2010;41(3):297-303). Retrieved March 5, 2011 from Academic Search Premier Databases.

Weissbluth, M. (2005). Healthy sleep habits, happy child. New York: McGraw-Hill.

Sohr-Preston, S.L. & Scaramella, S. (2006). Implications of timing maternal depressive symptoms for early cognitive and language development. Clinical Child and Family Psychology Review, 2006,;9(1), 66-83. Retrieved February 15, 2011 from Academic Search Premier Databases.

Yes, a mother's mental health influences the mental health of her baby. Depression in mothers affects their babies. Also, depression is fed by lack of sleep.

“Well, maybe she gets up all the time because of all that breastfeeding.”

      “If you let her cry, she will grow up to feel unloved and insecure.”

      “If you always pick her up, you will spoil her and she will never be independent!”

      “You have to feed on demand, around the clock, in order to breastfeed.”

      “If you bed-share, be careful, the baby can suffocate!”

      “If the baby sleeps in a crib away from you, she will feel abandoned.”

      “Breastfeeding can be a cause of postpartum depression, you know.”

      “Bottle-feeding is a way to separate moms from their babies, and you can get postpartum                     depression  from being separated.”

      “In order for the baby to feel secure, you must be available at all times, so she doesn't cry.”

      “Letting a baby cry is ok, even if she vomits.”

      Do these contradictory things sound confusing? I personally heard every one of these things when I became a mom. It's hard to describe how overwhelming it was to process all of this stuff, in real time, at the time I needed help sixteen years ago.

       Today, in my counseling practice, I see new moms struggling with postpartum depression every week, women who are exhausted and feeling bad about themselves. They are new parents, learning so many new things, feeling sort of insecure, trying to develop a new identity as a parent.

      I get a lot of infant sleep questions, and there really isn't any professional training out there about this subject, so a lot of advice given out in practice is personal opinion. So, I decided to get more clear about this subject by reviewing the current infant sleep authors and hitting the research libraries to develop a balanced approach to infant sleep that serves the needs of both mother and baby.

Elizabeth Pantley's No-Cry Sleep Solution

      After reading a few of the books, I decided to start with a review of Elizabeth Pantley's “The No-Cry Sleep Solution.” Well, I thought, as I read this book, so there IS a middle ground. Her method is a balance between the polarized cry-it-out camp and the attachment parenting nurse-to-sleep camp. Mrs. Pantley feels the emotional needs of both mother and baby are met with a solution balanced between the stress of all night, no-sleep parenting and the stress of cry-a-thons.

Balancing Parents' Needs with Babies Needs

     On one hand, Mr. & Mrs. Pantley believe the current experts who support cry-it-out sleep methods are ignoring the emotional needs of babies. They wish to support parents in sensitive parenting. They compare crying-it-out to ignoring, day after day, a child's request to play ball, or missing a child's musicals at school. Sure, the child gets used to it, but the need for sensitive and responsive parenting has been brushed off at an early age, and this pattern of insensitivity is a pattern of parenting to which the Pantleys do not subscribe.

      On the other hand, Mrs. Pantley, the mother of four children, says she could not continue with the emotional and physical fatigue of all-night (and day) attachment parenting. Mrs. Pantley's personal experience with her four children showed her that some children easily sleep through the night and others emotional temperament did not allow that.

Understanding age-appropriate sleep behaviors

     Mrs. Pantley emphasizes that it is natural for a baby to want to suckle to sleep, and in different cultures, practicing attachment parenting is not as difficult as it might be in our modern culture, where mothers are often the only caregiver available all day long. In our culture, being an isolated caregiver, coping with the demands of multiple children, working outside the home, and being a caregiver to an older relative place are just some of the things modern moms are juggling.

      Mrs. Pantley includes information about appropriate expectations about infant sleep. She notes that a baby's sleep consolidation is dependent on biological considerations, as the infant brain is not mature at birth. Thus, the sleep consolidation schedule does not mature until about the fortieth week of life. She says that it is normal for babies to awaken about three times per night until around the fortieth week.

From multiple night wakings to a full night's sleep in 60 days

      Mrs. Pantley developed a no-cry method for her baby that took him from multiple night wakings to a full night's sleep in sixty days. She tested her method with sixty real-life mothers who were exhausted from continuous nighttime parenting and had a 92% success rate in sixty days.

     The first step is to assess your home for infant sleep safety. In prevention of SIDS, she advocates putting the baby on her back to sleep, and if you choose to co-sleep, to take the necessary precautions to safely do so.

     The next step is realistically assessing your lifestyle (breastfeeding, bottle-feeding, sleep-sharing, not sleep-sharing) and your current night-time patterns. She provides forms to help you with this assessment.

In addition, she asks the mom to consider her own emotional readiness for changing their sleep patterns. In other words, examine your own feelings about separating from your baby at night. This could be a part of your assessment.

     When you have done the initial lifestyle assessment, use this information to , begin to make some changes that are right for you and your family. In general, the gentle techniques she advocates are understanding why your baby is waking, introducing new routines and associations for sleep and then gradually change the patterns. Mrs. Pantley also advocates for a nap schedule and early bedtimes to increase sleep and avoid a sleep deficit. She urges us to be cognizant that it is our modern hectic life-style and lack of social support that is driving our need to teach a baby to sleep. However, sleep is necessary for a mom to function.

An overview of some of her methods

• To manage breastfeeding, if it is age-appropriate, respond less quickly with the breast to your baby's stirring, to see if she is really needing to nurse or is really awakening or is just stirring

• Don't allow the baby to fall asleep at the breast every single time, instead allow her to nurse to sleepiness, then put her down to fall asleep, so she will have other associations for sleep besides nursing

• Incorporate the Pantley Gentle Removal Plan into your nursing practice. Know that babies have a need to suck, allow baby to fall asleep at the breast, pacifier, or bottle, then slowly detach the baby and gently hold her lips closed or press her chin. Repeat patiently until the baby's sleep behavior slowly changes

• If baby is used to falling completely asleep on you, slowly shift that routine to letting the baby almost fall asleep on you, and then move her to her sleep area to completely fall asleep. This would need to be done multiple times.

• Create good associations around sleep area, read a favorite book to your child while she is in her sleep area

• Create and use the same sleep cues every time, such as saying “Time for night-night,”, use the same bedtime music

• If bedtime is too late, modify to an earlier bedtime in increments of 15 minutes every evening.

• Watch for signs of sleepiness and create a nap schedule around this

• To lengthen her nap, when baby awakes, use the sleep cues to help her fall back asleep, such as nursing, pacifier, bottle. This should help lengthen the nap after about a week.

What I take away from this method

      If you are a mom who is not having any trouble with your baby's sleep, and things are going well, don't bother reading any of these books (unless you are helping a relative or a friend out!).

      As a therapist who sees depressed moms, I can definitely incorporate some of Mrs. Pantley's methods into my work. Her methods are a nice balance between baby's needs and mom's needs.

      I think that a depressed mother may have some trouble focusing and sorting through her feelings and doing the written lifestyle assessment by herself. But it could be done with help from a trusted friend, a relative, a postpartum doula, her partner (if s/he is on board), her pediatrician, or her therapist. Also, an overtired or depressed mom may not be capable of sticking to the methods, gentle though they are, or of taking the time needed for the behavioral adjustment. So, she may need practical outside help, such as a postpartum doula, to get through the first few weeks.

      I think it is good practical advice for moms who practice attachment parenting and breastfeeding to be aware of the use of sleep associations and to sometimes allow the baby to almost fall asleep at the breast and to also sometimes put her down gently before she completely falls asleep. This sets up the scenario for falling and staying sleeping without mommy, so mommy can get some rest. I really like the Pantley Gentle Removal Plan; she gives a mom a gentle how-to here. Depression is fed by lack of sleep, so it is a good thing to put Mom's needs into the mom-baby equation. Be kind to Mom, help her practice self-care.

      I think she is kind to both parents and babies and uses research and experience to support her methods. No mention of locking doors or letting the baby vomit. Good show.

     All in all, I am glad I met Mrs. Pantley; she seems kind and balanced.

     Next week I am going to discuss Dr. Harvey Karp's methods.

     At the end of the series, I plan to put together a consolidated overview of the current thinking on Infant Sleep. Thanks for going through this process with me!

     Please let me know what you think!

References

Babson, K. A. et al (2010). A test of the effects of acute sleep deprivation on general and specific self-reported anxiety and depressive symptoms: an experimental extension. Journal of Behavior Therapy and Experimental Psychiatry, 2010;41(3):297-303). Retrieved March 5, 2011 from Academic Search Premier Databases.

Pantley, E. (2002). The no-cry sleep solution: Gentle ways to help your baby sleep through the night. New York: McGraw-Hill.

Sohr-Preston, S.L. & Scaramella, S. (2006). Implications of timing maternal depressive symptoms for early cognitive and language development. Clinical Child and Family Psychology Review, 2006,;9(1), 66-83. Retrieved February 15, 2011 from Academic Search Premier Databases.

    

You are a new parent!  Your baby doesn't seem to have the same sleep needs as you. Little did you know that in America, because of our hectic lifestyle, there is a huge industry built around infant sleep. In traditional cultures, people don't fuss so much about infant sleep, family life has a slower, natural rhythm.

      You were used to doing pretty much what you wanted, working, staying up late. Maybe you have a nice career that you've nurtured over the years. You took certain steps, and the career path responded, expanding accordingly.

      But your baby is not responding in this structured manner. It's just not what you thought it would be. You feel exhausted, confused, happy and angry all at once. You wonder if you are a bad parent. Why won't he sleep? Why do my partner and I bicker? What you'd really like is for someone to come over and hold the baby while you take a shower, or to bring over a casserole for dinner.

      Everyone in the world seems to be zooming in on you and giving advice. While they **are** well-meaning, the advice comes in dribs and drabs, and is contradictory, and maybe it just doesn't feel quite right for you.

      People are commenting, “Oh, my baby slept through the night the first week she was home!” Do they all do that, you wonder? You're just not sure. There are so many books out there about infant sleep. So many opinions! So you can have an overview of what's out there, for the next few weeks, I'm writing a blog series on the leading infant sleep methods. Then, you can pick and choose which you'd like to incorporate into your parenting style.

      My first blog post in this series is about infant sleep safety. Infant sleep safety is a large topic. Crib-sleeping, co-sleeping, and bed-sharing all have safety issues associated with them.

                           

                                        Sudden Infant Death Syndrome (SIDS)

      Learn the precautions against Sudden Infant Death Syndrome (SIDS). The good news is that SIDS is at an all-time low. American SIDS Institute says its occurrence has dropped significantly since 1983. The National Institute of Health says SIDS has dropped 50% since since 1992, when the parents were first told to put babies to sleep on their back. SIDS is most likely to occur between ages 2 -4 months, 90% occurs before six months and January is a peak month.

      Research from the American Academy of Pediatrics (AAP) lists the risk factors for SIDS as smoking, sleep position, illicit drug use, alcohol use, prematurity, overheating, teenage motherhood, being male, being a multiple, poor prenatal care, soft bedding, poverty, sleeping on a couch or recliner with a caregiver, co-sleeping with a parent, and spacing of less than one year between pregnancies.

Infant sleep safety includes:

• Put the baby to sleep on his back

• Do NOT smoke in the house or car or near the baby

• Do NOT over-heat the baby with clothing or room heat

• Do NOT use soft bedding in the crib

• USE a tightly-fitting sheet in the crib

• Do NOT use comforters or large, thick blankets with an infant

• Do NOT put anything else in the crib

• Do room-share. That is, keep the baby's crib in the bedroom until the baby is six months old. The AAP believes that infants are safest when near their mother.

• The AAP says that babies should NOT sleep in the same bed as their parents

• The Academy of Breastfeeding Medicine has found that exclusive breastfeeding is a protective factor for SIDS

• The AAP has found competing evidence that breastfeeding is protective of SIDS, but not enough to recommend it

• Using a pacifier may be protective of SIDS

Bed-Sharing vs. Co-Sleeping                                  

The issue of bed-sharing has become controversial. Bed-sharing is practiced worldwide and as the United States becomes a breastfeeding culture, bed-sharing is more widespread. As noted above, the AAP conducted research around SIDS. The AAP concludes that co-sleeping is a risky behavior and recommends room sharing instead of co-sleeping on a population-wide level.

However, the Academy of Breastfeeding Medical Professionals has made a distinction between bed-sharing and co-sleeping. The ABMP analyzed the AAP study and found a significant lack of scientific rigor in distinguishing infant cause of death.

The ABMP has made a distinction between bed-sharing as a safe behavior and co-sleeping as a risky behavior.

The ABMP defines bed-sharing as a safe practice between a breastfeeding mother-infant dyad, as distinct from co-sleeping which is a risky behavior.

      James McKenna, PhD, is a researcher in the field of co-sleeping and the mother-infant dyad across the world. Dr. McKenna believes the AAP's unqualified recommendation against co-sleeping aimed at a population-wide level, is not scientifically valid. Dr. McKenna feels that co-sleeping is a normative human behavior, objects the AAP has medicalized this normal human behavior, and believes the AAP has disregarded research regarding the benefits of human touch in their conclusions.

      In his research, he says there are distinctions between unsafe co-sleeping and bed-sharing, which is safe co-sleeping. He feels that bed-sharing is a complex behavior, and is not a good fit for all persons. However, Dr. McKenna thinks the US is a breast-feeding culture and bed-sharing is beneficial for the breastfeeding mother-infant dyad, as long as it is done responsibly.

      McKenna says, like the AAP, unsafe co-sleeping occurs on a recliner, couch, with overheating and soft blankets, in bed with with adults who smoke, drink alcohol, or take drugs (illicit or medication that causes drowsiness), bottle-feed and that other children should not be permitted to sleep with an infant. Ideal co-sleeping conditions are between a mother-infant dyad who are breastfeeding.

      McKenna believes that the physiological attunement which occurs between the breastfeeding mother-infant dyad helps infant development, and the positive benefits of touch facilitate infant growth and development.

      Dr William Sears offers some more information. He also believes that AAP did not do a legitimate job of distinguishing between co-sleeping and bed-sharing. He adds that the benefits of bed-sharing protect against SIDS, as the physiology of the nearby parent help regulate the physiology of the infant.

      He recommends another alternative to the infant sleeping in the bed would be a safe arms-reach arrangement whereby the infant sleeps in her own bassinet but close to the mother in bed.

                                                                Crib Safety

      Crib and bassinet safety is important. The Consumer Product Safety Commission (CPSC) says there have been 18 recalls of cribs totaling nine million units. The CPSC recommends:

• Use a bassinet for a baby six months or younger (recall list here)

• Drop-side cribs are NOT safe

• The crib should be less than ten years old

• Check that your crib has not been recalled on the CPSC website

• Cribs with a gap larger than two fingers between the mattress and slats are unsafe. Check this regularly, as hardware can loosen with use.

• Slats should be less than 2 1/8” inches wide

      So, there you have it, the complex world of modern American infant sleep safety!

     Kind of makes you wish you were a !Kung mother, where things aren't so complicated by time schedules and such! LOL!

      So, let me know where you weigh in on such things, if you have anything to comment or add!

Happy Conscious Parenting !

References

American Academy of Pediatrics. (2005). Task Force on SIDS Policy Statement. aappolicy.aappublications.org/cgi/reprint/pediatrics;116/5/1245.pdf

American Academy of Breastfeeding Medicine (2008). Guideline on Co-sleeping & Breastfeeding. http://www.bfmed.org/Media/Files/Protocols/Protocol_6.pdf

Consumer Product Safety Commission (2011). http://www.cpsc.gov/onsafety/2010/06/watch-and-share-check-your-crib-for-safety/

McKenna, W. (2011). Co-sleeping and Bed-sharing Behaviors. www.nd.edu/~jmckenn1/lab/interview.html

Sears, William (2011). Sleeping Safely with Your Baby. www.askdrsears.com/html/10/t102200.asp

I won the Stylish Blogger Award!

Thank you Carol & Stacy!

I am honored to have won the Stylish Blogger Award from Carol & Stacy, the creators and writers of Intentional Conscious Parenting !!

This is a pay it forward award.

There are 4 duties to perform when you receive this award:


1. Thank and link back to the person who awarded you this award!

You can just use the copy in this blog to help you out with this work!


2. Share 7 things about yourself:


1. I am a Licensed Professional Counselor in Wayne, New Jersey.
2. My business name is BirthTouch® Counseling & Training.
3. My specialty is Couples Counseling and the Emotions of Pregnancy & Birth.
4. I love to work with Expressive Art, using visual journaling to express emotions.
5. I owned Appaloosa horses for 12 years.
6. I love to ski, although I am not so good at it!
7. I love to scrapbook!


3. Award 15 recently discovered (by me anyway) great bloggers!

I have to say this was a very hard choice. I follow so many great blogs, there's so much new talent out there! Here are the blogs I whittled my choices down to:

1. Jodie's It's All Good in the Mommyhood!

2. Kristi's Live and Love Out Loud

3. Leleana's Writer's Den

4. Stacey at Write to Make a Living

5. LT at Single Life

6. Nicole at Bottle's Up

7. Jenny at The Bloggess

8. Maggie at Fireworks.Sparkle.Rainbow

9. Lori at A Day in Mommyhood

10. Katherine at Katherine's Corner

11. Mama at I Thought I Knew Mama

12. Jamie at Happy House Happy Home

13. Sherry ay City Chic On a Farm

14. Edina at The Writing Hustler

15. Joan at Bad Marriage is Fattening

Help manage postnatal emotions!

Infant massage

You get two for the price of one! Care for yourself and that cute baby!

      Are you a new mom wanting to enhance your relationship with your new baby? Do you wish you could help both your mood and your baby's mood at the same time?

      Your baby is finally here; you are learning every day what it is to be a parent. Perhaps you are experiencing emotional highs and lows you have never felt before. Perhaps extreme exhaustion from lack of sleep. Perhaps you had infertility treatments and are coping with the myriad of feelings accompanying those treatments. Perhaps you had a previous miscarriage or abortion and feelings from this experience intrude on your daily life with your baby. Maybe you had an idea of how you thought the birth of your child might take place, but it did not go as you had planned. So, you are grappling with re-framing your understanding of what was possible at that point in time.

      Whatever your individual situation, you could be feeling extreme love, peppered with depression and anger. Maybe you are feeling mostly depressed, anxious and angry. In this case, you need to give yourself the gift of self-care and see a local doctor and therapist.

      In all of these emotions, perhaps you are concerned that you are not bonding with your infant. Some people have the mistaken impression that human bonding occurs all at once, with sort of a single, initial, imprinting. This is not the case, LOL, we are not ducks! Human bonding (or attachment) develops as a result of a reciprocal, interactive process on a daily basis over time. Human bonding develops in the context of daily accessibility to a responsive primary caregiver over time. And it not a virtual experience! It is a body-based, biological and emotional experience involving touching, seeing, smelling the primary caregiver on a consistent basis.

      You might be experiencing some depression, feeling this physical and emotional care-giving is a large responsibility! And it is!

      Did you know that pre-and-post-natal massage has been validated as a treatment to help ease pre and postpartum depression in mothers? See this article from Massachusetts General Hospital and also Dr. Tiffany Fields' studies for a thorough discussion of the clinical evidence. So give yourself permission to get some massages.

      Did you know that infants can be depressed? And that infant massage can help a mom regulate an infant's emotions and increase bonding behaviors?

      So infant massage is good for both mom & baby's mood. Here is the link to some studies about infant emotional development and the positive effects of massage.

      There are many opportunities for classes in Infant Massage near you. Classes are usually held at local hospitals, midwifery offices, yoga studios, and massage schools. Make the effort to connect with one of these places, get out to a class, use this opportunity to inexpensively and consistently use the power of safe touch to help yours and your baby's mood at the same time!

                                         Here's to happier mothering!

Marriage Therapies Explained

Perhaps you and your spouse or significant other have been having problems for quite some time. Perhaps you are discovering the person you thought you wanted to live with for the rest of your life is not who you thought he or she is. Perhaps you are confronting and dealing with infidelity or extreme anger issues. Perhaps there is emotional and or verbal abuse, continual sarcasm that you have been trying to deflect or manage, but you are finding that is not working out so well. If there is physical abuse in your relationship, you need to find a safe house as soon as possible and take haven there. Go to a relative's house, a friend's house, or a shelter if you need to hide from your abuser. Help is available.

If you are in a situation that is safe, and you have decided to pursue couples therapy, then the next step is to look for a licensed therapist and sort through the different personalities and therapies in which they have training. There are so many types of couple therapy out there, with differing names. It can be confusing to choose!

The goal of relationship therapy is to modify anger, helplessness and criticality in a relationship to assertion, feelings of self-efficacy and action, and affection. Sometimes there can be an identified mental illness, such as major depression, post-traumatic stress disorder, generalized anxiety that is interfering with the couples ability to relate.

In your internet searches in your area, three of the methods that you will probably find many couples/marriage counselors are trained in are Gottman Couples Therapy, Imago Relationship Therapy and Emotion Focused Therapy. Many therapists are trained in several methods, but have not chosen to get fully certified in any one method, as it is very expensive and time-consuming to go through the hoops, and then one's practice is tied to a copyrighted method.

What are the differences between these methods? I will give you a hint, there are more similarities than differences, and therapists generally have a broad range of additional training to support their work with you. 

The Gottman Method is based on 30 years of research in which John Gottman, PhD. D., is actually one of the principal researchers. Dr. Gottman and his colleagues studied hundreds of real-life couples in minute detail, recording behaviors and emotions. Gottman discovered that the prevalence of four emotions/behaviors predict divorce. The fours emotions/behaviors, which he calls the Four Horsemen, are Criticism,. Defensiveness, Contempt, and Stonewalling. In the therapy, the therapist and couple work to identify strengths and areas of improvement in the relationship, and identify exercised to reduce/eliminate the Four Horsemen. Communication and relationship skills are taught.

The Imago Relationship Therapy is based on the idea that we unconsciously choose our partners as a way to repair the hurts we experienced as children, and to fill in emotional gaps. For instance, we long to feel bliss and connection, so in the rush of romantic love, we feel deeply loved and cherished by our partner. Our partner may also be outgoing where we are more reserved, so we also unconsciously choose a partner who has qualities we do not have. As the relationship evolves, we find that our partner cannot meet all our unmet needs, and we begin to negotiate, cry, manipulate for what we want. Disillusion and anger sets in. Imago therapy is based on learning the Imago Dialog, a method to experience deep listening, sharing and understanding.

Sue Johnson, PhD. D, developed Emotion Focused Therapy. EFT is based on 20 years of empirical research regarding marriage relationships and adult love or attachment. The therapy uses exercises based on client-centered techniques and family systems work in order to restore the attachment bond between the partners.

The best way to know if a therapist is a good fit for you is to call up and ask for a 15 minute consultation over the phone. Couch shop. Ask some questions about their experience, how they practice, what methods they use. Therapists are trained to quickly establish rapport with a client. That is their job. If you do not feel comfortable talking with the therapist on the phone, then find someone with whom you do feel comfortable. Try to choose someone close to your home or work. If the office location is not convenient, you won't be able to make the sessions. Remember you are allowed to couch shop, but don't use the selection process as a way to procrastinate. Narrow down the phone choices to three or so. Chances are you will find someone pretty quickly. If you are in a densely populated area, there are usually quite a few therapy offices near you. Often the best referrals are from a friend or relative.

Let me know if you have any questions or comments, I'm glad to help out!

The Carnival of Managed Care:

Who Determines if You Really Need to Talk to a Professional Counselor?

LOL. Do you think it is YOU? Think again. LOL.

Do you think that, after months (maybe years) of hemming and hawing about the time and cost and need of going and finally deciding to actually give yourself the gift of self-care and receive professional care, do you think it is YOU who decides if you can go and use the insurance that YOU PAY FOR?

I could be blogging about steps to help overcome depression, postpartum depression, generalized anxiety, obsessive-compulsive disorder, any number of mental health diagnoses in which I have been trained. But I have decided to blog about managed healthcare insurance a few times, just so you have an understanding of what goes on behind the scenes.

Do you know who determines if you are allowed see a mental health professional? For the first few sessions, well, I need to ask permission to see you from the clerical staff at managed care who completes authorizations. You can get a whole six, yes count 'em, six sessions to start with.

Your husband is abusive? Sexual or age discrimination at your workplace? Well, you get six sessions. You feel depressed from a convergence of a multitude of issues? Perhaps past abuse? Rape? Gang rape? Post-traumatic stress disorder from a shooting? PTSD from multiple medical procedures (even if warranted and life-saving, this is common). Your child has leukemia?

Well, you get six sessions. TAKE 'EM OR LEAVE 'EM.

What's the matter? You need to talk more? You need more treatment? MORE??

Sounds Dickensian...you want some more OF THE SERVICES YOU PAY FOR!!

Well, okay, then there is the continual authorization renewal process.

I want to let you know what this is like. I need to take time during my clinical hours to hold on the phone for usually about 30 minutes, sometime less, ofter more, to wait for the honor of speaking to a Care Manager.

During this conversation, the Care Manager ask me invasive questions about YOUR LIFE and then judges me on my clinical expertise.

Then, the Care Manager judges me on how well I have been trained like a dancing bear to play their game. The managed care insurance company sets up rules where a certain type of treatment MIGHT be acceptable. And others are not. Did you know there are course on how to give managed care the answers they want? I won't take one of these courses. I won't spend my hard-earned money on this nonsensical game.

If I say the right thing, DING! Like at a carnival, DING! You get more sessions (MAYBE).

If DING, I say the WRONG thing, DING! You are denied.

(LOL -No sessions for you, says the insurance Nazi ..like Seinfeld's Soup Nazi...this is a joke)

But, let's face it, after a few authorizations, not even the right words help.

So, DING the case gets escalated to a managed-care psychiatrist. And then I need to make an appointment during my clinical hours to speak to this disembodied person on the phone, who again asks MORE invasive questions about a client that he has never met and never will. And then I am judged again.

Is this the way other people get paid? Are your paychecks held back unless you answer the questions correctly EVEN AFTER YOU'VE DONE YOUR JOB????

But you know, you, the client, are the loser in this game.

Oh, well, guess you'd better go to a relationship coach about your marriage. You can't continue to see your therapist, with whom you have a therapeutic bond that has developed over a long period of time.

What to do? The response of the therapeutic industry has been to become more facile and to offer programs outside of insurance. Stay tuned to this blog for new programs. Thanks!