Welcome to my latest blog. One of the points of difference with The Babysleep Doctor strategy is that I work with women from 36 weeks’ pregnancy to provide knowledge and strategies to apply from day one of the baby’s life. The aim is to prevent feeding and sleeping problems ever arising.
I recommend that women see me for one visit at about 36 weeks. If they are having twins or multiples I will see the mother between 32 and 34 weeks’ gestation.
The reason for this single visit during pregnancy is to convey knowledge and to develop appropriate expectations. It is my experience that this can be very helpful particularly when there is so much conflicting advice for mothers.
There are two main elements of my teaching at this pregnancy visit.
Firstly there is teaching of my basic six points on sleep:
- Sleep is cyclical with short arousals. In babies these cycles are about 45 minutes long
- Achieving sleep is usually considered as being driven by a combination of tiredness and external cues of sleep
- Cues of sleep are learned, can be altered, and relearned
- Sleep is usefully regarded as a learned skill
- Because sleep functions as a learned skill, like all human skills, if we become overtired the ability to perform the skill decreases. Over-tiredness is the enemy of sleep in babies.
- Cues of sleep which are parent independent are the most useful for a baby.
The second part of my antenatal teaching is to provide guidance on the first few days after birth.
There is increasing evidence that the baby’s nutrition during pregnancy, the first few days, the first weeks and possibly months have significant impact upon fundamental physiological settings. Good nutrition for the baby in the first few days and weeks is important and can lead to lifetime health benefits.
The primary objectives of my care for a baby under three months of age are optimal feeding, excellent sleep and the best possible growth. A baby will not sleep successfully unless they are being well fed and meeting their body’s genetic requirements for optimum growth. The best possible growth rate for a baby varies from child to child and relates to both their sex and their final adult height. Boys in particular are quite intolerant about being hungry.
A problem for parents is that philosophies of care in the first few days and weeks of life vary dramatically. Particularly for first-time mothers, the pressure that can be put on them to achieve a particular style of feeding and a recommended model of care can be quite intense. This pressure is exacerbated by the variety of advice given. Many mothers report inconsistency in advice and subsequent confusion as a major problem in these early days and weeks.
My position in the baby’s first few weeks is that I will support the mother in her decisions unless they are clearly dangerous. My role, as I see it, is to teach important basic knowledge, to advise the mother on her range of feeding options and care choices and to simply guide her ‘through the woods’ of the first few weeks and months of her child’s life, so that she can proceed with confidence.
In these last few weeks of pregnancy and while preparing for hospital and delivery I also give advice on infant feeding.
I am a strong advocate of top-up bottles of formula in the first few days of life while waiting for a mother’s milk supply to arrive. Bottles and formula may not be available in some hospitals and expectant parents should check with their hospital or simply make sure that they have them available for that first couple of days when the baby can be quite hungry while only receiving colostrum.
Unfortunately, this advice about top-up bottles is not universally approved of. In fact in some quarters it is implied that offering bottles to a newborn baby is dangerous. There is no evidence that this is the case and the key point that I can make is, that in my experience over many years, that to support a mother’s feeding in the first few days and to avoid the distress of a hungry baby significantly improves a mother’s ability to breastfeed successfully. My research and research which has been recently published in the USA has shown that supporting lactation with top-up bottles in the first few days can increase breastfeeding success rates at 12 weeks by about 50%.
For mothers who have decided that they need to exclusively breastfeed, I offer the following advice: simply take my advice on bottles as an idea and put it into the back of your mind. Once the baby is born, if you find that there are days where, in your opinion, the baby may be hungry and tearful, it gives you a backup option.
TIPS
I offer the final few tips to help mothers and new children get the very best start in life:
- After the delivery, if it is possible offer the baby a breast feed (this feed may be quite short – 3-4-5 minutes per side). Then put the infant down before he or she becomes tired. We want to avoid the baby being overtired within the first 60 minutes of life.
- From the first feed, offer the breast anywhere between two to four hourly – on demand – followed by a top-up of formula from a bottle. We are avoiding hunger while waiting for your milk to come in. Milk often comes in about day 3 after giving birth.
- The length of breast feeds increases by about two to three minutes per feed per day. Aim to feed something like 10 minutes per breast by day 3 or 4. Most babies can empty a breast in about 10 minutes and prolonged feeds will increase the risk of both an overtired baby and sore nipples.
- Once your breast milk arrives the baby will have less interest in the bottle. This technique protects the baby from hunger and INCREASES breast feeding success rates (while protecting your nipples from trauma and pain).
All the very best to you and your baby or babies.
I invite you to provide feedback on this topic or on topics you would like me to discuss in future posts.
Dr Brian Symon
The Babysleep Doctor
