Recently, in three separate lactation consultations, mothers told stories of their experience that contained sad elements and that touched on ACEs. In this blog, we share a number of aspects.

One mother was unsure about whether the latch of her 7½ week old baby was going well and whether she should change things in the way she handled feeding during the day. “I really want to keep feeding. My sister really enjoyed it, too, and I don’t want to stop just yet, especially because I am self-employed and my job thus allows me to fit feeding into my day, but I keep wondering if I’m doing it right. My baby is a super fanatic drinker, said the maternity nurse, a real piranha!” I felt triggered by these two labels; are they suitable for a baby that has just come into the world…? How do they form the parents’ image of their newborn child…? I asked what made her feel insecure and where the doubts were. She told about her birth experience, in which she had wanted to stay at home, but ended up in the hospital, was placed on her back, had had medication for labour augmentation and in her opinion had to give up control. “I have experienced a strong urge among the care providers to be in control of it all; the care was not holistic and I really wanted to get out of there as soon as possible so we could do it our own way at home. All kinds of things have happened that I specifically did not want, such as an electrode on the head of our unborn baby and it was said that he would not feel anything. I felt there was a hierarchy and my baby and I were not at the top of it. They were talking *about* us, not *with* us. I didn’t want an epidural, but I did get a pitocin drip nevertheless and eventually a cut had to be made. In short… a lot has happened and I now feel that I still have to find my way at home.” We discussed everything extensively and I could confirm that she was completely right with her intuition and that she did not have to imitate the compulsion she had seen to control everything, but could rely on her child and their mutual relationship. What a reassurance that was for her… the sheer relief brought tears and she nodded vigorously at the things I described as good for her baby: cuddling, feeding abundantly, not letting them cry… That was exactly what she wanted and actually deep down also already knew.

During another consultation we had to go over some things which I normally have already taken from the intake form beforehand. This consultation was scheduled so quickly, however, that I had not had time for it. Mother said she gave birth in hospital. I usually ask whether that was also the plan or whether it arose during the birthing process. While talking it turned out that she had had a caesarean section, because various things had gone differently than hoped for. She said she was at peace with that. I looked at her and allowed for a long silence, during which I saw tears welling up in her eyes. “It’s totally okay if you’re sad about what happened. Even if you’re glad the essential things went well, you have every right to mourn what you missed and what you hoped for…” I put a hand on her arm, and the crying grew more intense. The sense of ‘being at peace with it’ was there intellectually, but emotionally it was a completely different matter. Father had also experienced the birth as intense; all sorts of things had happened that he had felt he had no control over and that had affected them both. We went through everything and I encouraged both parents to create lots of hugs and skin-to-skin contact with their baby and thus bathe all three of them in the oxytocin hormone, which is not only good for the breastfeeding relationship, but also has a healing effect.

At a subsequent consultation, feeding was still a bit difficult because the baby of about a week old was restless at the breast and did not latch too well yet, so that mother had sore nipples. Together, we went through how she could support and steer her baby when latching on, so that a larger amount of breast tissue would go into baby’s mouth and the nipple would be further back and not get damaged. That went very well during the consultation and the little bumblebee fell into a deep sleep, satisfied in mom’s arms. Mother felt better this time than when the eldest was born. She was born by caesarean section after all kinds of things had happened that the mother had experienced as traumatic: the doula was not allowed to join them in the delivery room, strangers were constantly walking in and out, disrupting concentration, and mother did not feel ‘in control’. After initially having contractions, she was not allowed to push when she was 9½ cm dilated.

When the nurses said it couldn’t go on for more than half an hour because baby was having a hard time and that a caesarean section would follow, an emergency arose in another delivery room. Everyone disappeared, father saw the half hour pass and was concerned about the baby, but no one had told the parents that medication to slow down labour had been administered and that therefore waiting longer was not a risk. All in all, the whole process had been stressful – hugely different from the experience in the birthing pool this time, well prepared, again in the hospital, but in a different town).

What is touching about these three stories is that the circumstances that the parents are sad and disappointed about and that they mourn, were not inherently related to the natural course. The pain, sadness and disappointment are mainly about communication, about the way in which their wishes were not heard or honoured, about the fact that insufficient attention was paid to the importance of privacy and gentleness. For an undisturbed and stress-free course of labour and birth, it is necessary to guarantee a safe, warm, embracing environment. The birthing woman and the baby are together the centre of that small, enclosed universe and everyone should be subservient to the great transition they make together. Labour and being born are crucial, transformative events in the lives of the parent and the child respectively. They deserve to be surrounded with the greatest respect, so that they are engraved as an anchor and a radiant experience in the mental and physical memory of (especially) mother and child.

We know that ACEs, Adverse Childhood Experiences, can occur very early in life and therefore deserve prevention. We also know that a good birth is a powerful start for the baby and that a beautiful labour experience can heal a lot of old pain for the mother. When she experiences that her body can do something she has never done before, it gives her enormous strength. She takes this strength with her in her parenting role and it helps to build the foundation for the child. Properly guiding the delivery and birth is therefore not only an emotional and spiritual responsibility. It is also simply a matter of salutogenetic, preventive health care. Let’s work together to ensure that more and more attention is paid to this!

Last week, we shared a first part about communication towards new parents, following an article by Ouders van Nu. Today we discuss the second half of that contribution.

The article also discusses sleep rhythm: it speaks about a ‘normal’ sleep rhythm. In line with previous questions: what is the definition of ‘normal’? Whose standard are we talking about in this context? English has two beautiful words that are often used: ‘normal’ and ‘common’. Many things that are ‘common’ are in fact not biologically ‘normal’ (according to the biological norm). It is important to make a conscious distinction in this regard. What we refer to as a ‘normal’ sleep rhythm is different for every culture. In many countries they take a siesta; in the Netherlands we don’t do that. Is it ‘normal’ to take an afternoon nap or is it normal to only sleep at night?

Every adult human being is different; every baby is different too. All patterns added together form an average (perhaps referred to as ‘normal’). Even if not one baby sleeps according to the average pattern, it can still be the average (this is math: add everything up, divide by the number of elements). You can try and steer this a bit, but you cannot force it. Some children are very active and curious and energetic (and therefore awake a lot) from an early age and other children love to sleep a lot. Either way, they all need a sense of security to confidently surrender to sleep. That safety lies mainly in your presence as a parent, in your ability to co-regulate your child, to be sensitive and responsive and to satisfy your child’s needs as best as possible. If you succeed in that, sleeping will usually not cause too many problems. And if your baby is awake a lot and needs you, that shows something important: it might not be such a good idea that parents are often expected to combine taking care of their child with all kinds of other urgent obligations. It may help us to realise that it may be time to reshape this (socially constructed, culturally coloured) pattern of care for newborn babies.

Always looking at the baby monitor as a problem: good point, to focus on your baby and not on technology.

etting your baby sleep with you for too long: all the aforementioned points apply again here. What is  ‘too long’? According to whose opinion? On what basis can someone say it is ‘too long’? What objections can be raised against it? It is, as stated, certainly useful to have your baby close when you are breastfeeding, but that is partly defined from the perspective of the adult (namely the mother who is breastfeeding). What would happen if we gave all advice about babies and how to deal with them from *their* perspective, from the question of what *they* experience as nice or important or useful or reassuring or comforting? How can we estimate the importance of parental proximity and hearing them to *every* baby, not just the breastfed one? Who decided that at some point a baby *must* go to sleep in its own room? Who says so? For what reason? And why should that coincide with the parent’s return to work (with ‘taking care of a family’ seemingly not being defined as ‘work’)? When a (breastfeeding) mother picks up her work outside the home and the baby goes to daycare, the baby’s need for proximity to mom is often extra great at night. That is exactly for the reason mentioned in the article: babies feel safe when they know mom (and dad) are close. At night, they try to compensate for the separation during daytime. There are babies who then switch to ‘reverse cycling’: they drink little during the day, sleep a lot at daycare, and then make up for contact with their mother’s body during the night. Again, if we look at this from the baby’s perspective, this is completely logical behaviour. Your baby feels best close to you and will therefore try to realise this as much as possible. After all, your child is not focused on a career or other economic matters; your child just wants to be with you.

As a family, as parents you choose a certain nighttime sleep constellation. It is certainly true that children who enjoy this will probably try to maintain it. There’s nothing wrong with that and it makes perfect sense (as adults, we also do our best to keep what we like). However, there may come a time when one or more sleepers in the bed no longer like the situation. Then it is time to come to a different approach in good consultation and with gentle persuasion. Depending on everyone’s wishes, this will lead to a different solution. What parents choose will depend on the value they attach to nighttime contact, how much it disrupts or promotes their sleep, how heavily they weigh their child’s perception of safety, how easily the child can surrender to sleep, how much room there is in the house to do things differently, how the other children react to it… and whatever else you can think of.

In short: every family is unique. Every baby is unique too, but all over the world babies share the need to be close to their primary attachment figures, especially at night (mom, dad, grandparents, sibblings – all partly dependent on what the cultural habits are like). In the interests of baby’s needs, it seems desirable to take a broad perspective and to not persist in approaches that may be considered culturally ‘normal’, but about which science has gained new insights, in line with what we intuitively and instinctively already knew. We do not need to follow the advice of some experts without questioning it; after all, that little child, who wants to feel safe and thus lays a good foundation for a happy adult life, is not their child. It therefore does not make much sense and it is counterproductive to polarise between parent(s) and child in all kinds of media publications. That is also framing: picturing the child in such a way that it seems as if that child is a nuisance that you as a parent have to keep a little (a lot) under control, because otherwise you will guaranteed be in for trouble. Just as a fish cannot see the water in which it swims, we as humans often cannot see the strange habits of our culture. We grew up with it, were brought it up and are then stuck with it, sometimes from one generation to the next. If you’ve always believed that the people who told you certain things were right and you’ve built your own worldview around it, it can be a disturbing idea to step away from that image and say: “Hmmm… yes, now that I understand how that works with a baby or young child’s perception of safety, I can see that a lot of advice is not really useful or even harmful. Let’s approach it differently from now on!” That is often not easy, but it is a mature way of dealing with advanced insight: “I did not know it and I now see that it could be done better.” Especially people in a position with a large general audience bear a great responsibility in this regard. It is to be hoped that as a society we will have the courage to bravely shoulder that responsibility for the sake of our babies, so that they can grow up securely attached and healthy!

No mistakes, but a shared quest

Recently we received a message via someone’s Facebook page about an article by Ouders van Nu. A discussion arose among the readers of the message about, among other things, whether it was written for parents of ‘now’, or more for parents of ‘the past’. Several people also found the tone patronising and had difficulty with the resoluteness of certain formulations, starting with the word ‘mistakes’ in the title (‘7 ‘mistakes that many new parents make around the issue of their baby’s sleep’).
The text of the article is not super recent, but from 2021. Nevertheless, around this time last year, the insights were already such that some comments can be made about the message to young parents. They deserve honest information and support in their completely new search, not a negative judgment about their choices. We would therefore like to discuss some aspects that can influence the perception of security of both the child and the parent in the parental role. This perception of security has a major influence on how we develop as humans and therefore also on our total health.

Indeed, let’s start with the title: mistakes. That’s a tricky opening. What does it mean for new parents to read that choices they make are ‘wrong’ choices…? On a more fundamental level: who determines what is ‘right’ or ‘wrong’…? Is there an unequivocal answer to that? How does our culture influence ideas about this? How do those kinds of ideas relate to norms and values ​​and visions of parents’ responsibility towards their baby? How do we view the task you have as parents? In it we can imagine a whole continuum, from a difficult, gruelling task that you have to work through until your children finally stand on their own two feet… to an honourable, joyful task in which you can lead a totally dependent person into adulthood… and all degrees of experience in between. More questions: what does the science say about children’s needs and how do we feel about that? What about children’s rights to have their evolutionarily imprinted needs satisfied? How well-known are those needs in society as a whole? The answers to these questions determine how we want to interact with these little creatures as long as they are completely dependent on us as adults for their survival and well-being.

Sleep: many think that sleep is something a baby needs to learn, but of course it isn’t. Babies already do that in the womb. This means they can already sleep before they are born. What we may often do is give them an experience of our world that makes it harder for them to confidently surrender to that sleep. When do we ourselves dread the night? When are we ourselves unable to fall asleep or do we keep waking up, looking for comfort and reassurance in the middle of the night? And when we need it… what do we do? How does what we as adults can do to regulate ourselves and go back to sleep compare to what a baby can initiate on their own? What is the definition of an ‘easy sleeper’? Who should it be ‘easy’ for? What is the definition of ‘good sleep’? What is the definition of ‘sleeping through the night’? Do we always sleep ‘through’, without waking up even once? And if not, where does that come from and what do we do about it (or against it)?

Crybaby, lottery, roar, terror: many words are used that create a certain atmosphere. In another word, this is called ‘framing’: you convey something in a certain way to realise a vision. You want to propagate a certain opinion and try to convince the reader or listener of this by choosing words that convey that specific atmosphere. How helpful is it to ‘frame’ the expressions of totally dependent babies with negative terms, while they rely for everything they need on their caregivers’ willingness to make things right? If a baby cannot sleep well… who is it worst for? If a baby cannot surrender to sleep… how can we explain the restlessness of that little child? Who is able to change which things about it? What is meant by the admonition not to worry about your baby’s sleeping behaviour?

Falling asleep on the couch with your baby in your arms is said to be one of the best things in the world. That in itself is a nice statement. However, it continues with the remark that this is dangerous, just like ‘bedsharing’ (letting your baby sleep in your bed). Firstly, the latter is not true, provided you have worked on a number of conditions beforehand. Second, why do parents fall asleep on the couch with their baby rather than in a safe setting in bed? This is often because parents are constantly being terrified by healthcare providers and policy makers and media outlets about bedsharing, although humanity has been cosleeping with its own children for millennia. Next thing, parents then sit on a sofa or chair while parent and child are both tired, because taking the baby to bed is ‘forbidden’. However, sharing the sleeping place is the norm for mammals, and therefore also for humans. The fact that we put babies to sleep separately, sometimes in another room, is very ‘weird’ from a socio-cultural and anthropological point of view and occurs mainly in WEIRD countries (Western, Educated, Industrialised, Rich, Democratic). It is an historic novelty, a departure from what we have always done as humans. Given the enormous numbers of people who can only sleep with the help of sleep medication, it seems a good idea to ask ourselves more often whether all those sleeping problems may have a cultural cause. Could they have their origins in childhood? Could they be related to what parents are advised and sometimes forced to do regarding sleep behaviour…? These may be uncomfortable, but nevertheless important questions to ask and investigate.

Sleeping in a car seat: that is indeed not a very good idea. Sleeping in a sling, on the other hand, is wonderful for a baby. If the cloth is properly knotted and the baby is worn in en ergonomically responsible way, this is in all respects a very beneficial place to sleep for a young child and for the parent it is often a very practical way to have their hands free while baby sleeps.

A bed surround: the risk of SIDS is mentioned here. It is indeed important to make a baby’s sleeping place safe. This applies to both a cot (where instructions for distance between the bars and mattress thickness and what not are considered very normal and are even bound by legal regulations) and an adult bed where the child sleeps together with the parents (a setting usually described as extremely risky, despite the extensive research to the contrary). It is interesting, by the way, that this phenomenon is called ‘cot death’. It names the place where the child dies. Maybe that crib is not as safe as is often claimed…? Whatever the case… cots are not forbidden. And in the tragic cases where a child dies in the parental bed… was the condition of the parents checked? Had they been drinking, smoking, taking medication? In other words: was it the sleeping place or the condition the parents were in? Here also, negative framing is often involved.

Next week, we will look at another couple of aspects.