Monday, November 28, 2011

Spirit-Led Parenting : The Upside of Up-All-Night

Megan is here today to continue our series on infant sleep! If you are in need of a positive focus during the sleepy days of nights of life with a newborn, here is one to think on.

I loved Laura's post last week on what we wish we had known about infant sleep with our first babies. In our culture, there is so much emphasis on when baby sleeps through the night that the importance of understanding how infant sleep is different from the sleep of a fully-grown, fully-matured, and fully-developed adult can often be overlooked. I think what she touched on in terms of differences in sleep preferences from person to person is so vital to this conversation as well.

"How is she sleeping for you?"

"You getting any sleep at night?"

"So, if she's three months old, she should be sleeping through the night for you now, right?"

These questions are all so common to the early months of parenting. Our culture places a high premium on sleep, and for good reason. Night after night of broken sleep for an adult results in long, bleary-eyed days. It can be so discouraging when you are in the midst of just trying to survive those days to begin to think that there is something wrong with your baby (or with you as a parent) if that gold standard for parenting success has not been achieved.

But what if we really stopped and thought about the biological benefits of all those nighttime wake-ups?

We talked last week about infant sleep patterns. For those of us who believe (as Laura and I do) that we are created according to God's perfect design, we can ask ourselves why would God design babies to have such different sleep patterns than we do? Well, just look at the multitude of differences between a new baby and his parents. He relies mostly on crying to communicate, his diet may consist solely of breastmilk which is digested quickly, he can't tell you if his nose is stuffy or if he is in pain from digestive problems, he can't tell you he is too hot or too cold to get comfortable ...

Nighttime can be an extremely vulnerable time for a baby, and we tend to think it's part of God's design for these littlest ones that they are so sensitive to their environments and what is happening in their little bodies that they are able to awaken easily to alert parents to a need that needs to be met. We don't think it's any coincidence at all that the phase of life when a baby's physiological (digestive, cardiopulmonary, etc) systems are the most immature and underdeveloped is also the phase of life when sleep is most filled with light (REM) sleep. Cycling more frequently into light sleep allows a baby to be more aware of his needs throughout the night.

Now certainly, there are babies who just sleep through the night early all on their own. Maybe you have one of those, and if so, you surely count yourself fortunate. As we look at our older children or our peers, it's easy to be aware of how different people are more sensitive to some things than others. My oldest daughter, Dacey, can go for hours and hours after waking up before she realizes she needs to eat. In fact, last Wednesday when she was out of school for the day, she didn't eat breakfast until 11 AM. Aliza Joy, our younger daughter, likes to have something to eat as soon as she wakes up. I absolutely have to sleep buried under blankets while my husband prefers just a sheet. My sister can't sleep at all if her nose is stopped up but it doesn't seem to bother me a bit. And so there will be babies who just aren't as sensitive to physiological needs throughout the night and there are babies who need a parent to help them meet a need and get back to sleep in the night.

So what is the upside in all of this up-at-night nighttime parenting? I think it helps to take comfort in knowing when baby is up at night, she is doing what babies are designed to do - growing, developing, and maturing. Though it is exhausting at the time, it's also kind of amazing to think about the way God builds in these survival mechanisms that are obvious even from birth. This is also why when it comes to discussions about sleep training, Laura and I are both very cautious about any training that takes place before a baby is six months old. The research indicates there is just so much going on with a baby developmentally in those first six months to take a chance on not attending to baby's cries. You might be wondering if we think cry-it-out sleep training is ever appropriate. You'll have to come back next week for our thoughts on that!

Have you ever considered nighttime wakings to be part of God's design for babies? Does this concept make a difference in how you view nighttime parenting?

* * *

image source: nanagyei

Monday, November 21, 2011

Spirit-Led Parenting : What we wish we'd known about infant sleep

Thanks so much to all who have read and participated in our series of discussion posts on infant feeding! We're beginning a new series today, on the other BIG TOPIC on the minds of new parents: Sleep. (Zzzzzzzzzzzzzzz...)

As Megan and I shared in our introduction stories (here and here), we each experienced deep struggles with our first children in the area of sleep. We had each been thoroughly primed with the "right" methods for ensuring early success with our babies' sleep habits. Techniques that work very well in many households. Yet we found that these methods led to massive feelings of guilt and failure in our lives, eventually discovering through much heartache that they were an incredibly wrong fit for our families.

Looking back, we have often commented to each other that one thing severely compounding our difficulties during those early months was our complete lack of understanding of three major facets of infant sleep.

1. What is normal

• Medical professionals consider “sleeping through the night” to be a five hour stretch,generally from midnight to 5 AM.

• Breastmilk is digested by a baby’s body in two hours or less

• According to one longitudinal study, at the age of six months, only 16% of babies were sleeping ten or more hours without waking at night

• Another study reported that at twelve months, 50% of children still woke at least once per night

• Even children who have been sleeping five or more hours per night at a time may relapse into frequent nighttime wakings due to teething, illness, gastric reflux or other gastrointestinal issues, or preparing to reach a new developmental milestone.

This is data that we wish we had known while rocking our babies through the nights, hearts aching because our daughters weren't "normal". From everything we had read and heard, we were completely under the impression that we should be expecting 10-12 hour stretches of sleep by the time they were a few months old. And that anything different indicated an abnormality or behavioral issue in need of intervention.

2. Infant Sleep Patterns

Babies' developing systems cause them to cycle through sleep phases differently than we do as adults. It takes them significantly longer to settle into deep sleep, and they cycle between deep and lighter (REM) sleep phases more often throughout the night - averaging between 50-60 minutes between the two, as opposed to the 90-minute average for their parents.

We will discuss in next week's post some of the biological benefits of babies' night-waking, and God's design for their development in those critical first few months. But even without the knowledge of why they wake so often, just knowing that those habits are physiological would have been so comforting to us during interrupted nights.

3. Every baby is different

At the heart of our message in Spirit-Led Parenting is the reminder that we are each a unique creation of our Father God. And our individuality is clearly present from birth. Some infants are "good sleepers" from day one, waking less frequently than others and preferring to self-soothe to sleep at naps and bedtime. Others just naturally require more parental help in the form of rocking or other methods of soothing.

The same differences exist in adulthood, really. I spent a night this past weekend at a retreat with sixteen other women from church. Some headed to bed by 11:00, while others sat up hours later. Some burrowed under thick quilts and others wanted just a light sheet. Many drifted immediately off to sleep, while a few spent time reading to settle down. There were ear plugs and eye masks and I downloaded a white noise app to my iPod at 3:00 AM. Anyone attempting to implement one across-the-board sleep environment for the whole group would have made a good percentage of us completely miserable. We simply have different needs when it comes to sleep.

Megan and I each spent a great deal of time fretting over why our babies just wouldn't fit the mold outlined in the manuals. We wish we could have had the perspective then that pursuing the same mold for every baby - while convenient and desirable - just might be neither realistic nor intended.

Would it have totally eased the bleary-eyed haze of the baby days to have known all of these things as we entered parenthood? Not so much. But an awareness that our daughters were behaving in developmentally appropriate ways would have helped us to respond in peace and confidence to the way that the Holy Spirit was guiding us away from the mainstream model that we were trying to emulate, toward the methods of nighttime parenting that were right for our homes.

Have you ever wrestled with misconceptions about infant sleep? Are any of these three areas as comforting or fascinating to you as they were to us? What else are we missing? If you have more than one child, what differences have you noticed in their sleep habits or needs?

* * *

Image: Jomphong

Wednesday, November 16, 2011

The Holiday Inn Express thanks you to wear your undergarments while dining.

So, over fall break, our family road-tripped to the lovely land of Oklahoma to spend some long-overdue time with Megan and her family. We had a wonderful weekend, and I've tried for awhile now to come up with the perfect post to report on all of the memories contained in those eventful few days.

I could tell you about how thankful we were that our kids traveled so well, and the debt of gratitude we owe to the inventor of the dual-screen portable DVD player.

I could tell you about how fascinated we were by our introduction to the unfamiliar Oklahoman landscape, with its signs indicating the boundaries of tribal nations and others warning us repeatedly, "Do Not Drive Into Smoke". (We obeyed, although one of the first questions we posed to Megan upon our arrival was what this mysterious smoke was and why Oklahoma was so adamant that we not drive into it.)

I could tell you about how Megan is just as kind and thoughtful and lovely and fun as you would imagine (more so, even); and how it instantly felt as though we had grown up on the same street as life-long friends. About how I treasure our friendship even more now, and have thought many times since we've been home about how I would love to be sitting at her kitchen island again with a mug of coffee, talking about kids and life and God and food and whatever else comes to mind.

I could tell you about how Kyle is a man of many talents - fixing us fabulous meals of his own invention, plus teaching a Sunday School lesson out of 1 Samuel that I'll remember for a very long time.

I could tell you about how I enchanted we all were with Dacey and Aliza Joy, beautiful girls with spunk and spirit whose uniquely charming personalities completely captured my heart.

I could talk about how well our kids played together and about trips to the museum and church and about incredibly refreshing time spent in face-to-face brainstorming and talking through the work of our book.

I could tell you about all of that, and it would be true.

But really, what I'm very much wanting share with you today are these two pictures:

The first, taken with Mark's phone in the breakfast room of one of our hotels on the way home. Please note that this is the cinnamon roll station, and observe the printed sign below the counter.

And now, the close-up:

"In the interest of hygiene, please do not remove briefs when trying on garment. When satisfied with fit, protective polythene can then be removed."

Wise words for the morning meal, my friends. Wise words.

You will all be relieved to know that we left our briefs securely in place during breakfast. And a hygienic cinnamon roll was enjoyed by each of us.


Monday, November 14, 2011

Spirit-Led Parenting : Milk Production and Scheduled Feedings

Thank you so much for your patience and understanding as chatter has turned to crickets around here lately with a major lack of posting. We are just about 2 1/2 weeks away from the deadline for our manuscript draft, so most all writing time and energy has been directed that way these days.

is back to share today some valuable information about milk production as we wind down our series on infant feeding. Very soon, we'll jump into another topic. Will it be sleep? Marriage? Sex? Your guess is as good as ours at this point, but we are excited to continue these discussions in the coming months!

* * *
Image source: ODHD

As you might remember, we've been talking through some issues on infant feeding in our Spirit-Led Parenting series. One of the central issues that comes up frequently in discussions about infant feeding is whether or not babies should be fed on a schedule. Today, I want to talk about some concerns for breastfeeding mothers when it comes to scheduling.

I have to clarify from the very beginning that I breastfed Dacey on a schedule starting at about four weeks or so. This was during the time I was trying very hard to follow both Babywise and The Baby Whisperer. Dacey was a big (!) newborn - she arrived weighing nearly ten pounds and she continued to be completely off the top of the charts in weight and length throughout her first year. I continued to nurse Dacey on a schedule throughout her first year, even after I made the philosophical mind-set change from Babywise to a more AP-centered approach. She nursed until she was newly two and I got pregnant with AJ and lost my milk supply.

I say all of that from the start because I am not writing today to bash scheduled feeding OR to say that all women who breastfeed on a schedule will have supply issues. Clearly, it is completely workable to breastfeed on a schedule with no milk production problems at all.

The concern comes, however, when we begin to notice a trend in moms who have breastfed on a schedule from birth and then begin to have supply issues after baby hits the four month mark. To understand why this happens, we need to look at the science of breastfeeding and the system God designed that controls how our breasts make milk.

If you have time, reading this article at Kellymom explains some of the most important information we can find on milk production. Here is what I want to discuss in terms of scheduled feeding:

Milk production doesn’t start out as a supply and demand process. During pregnancy and the first few days postpartum, milk supply is hormonally driven – this is called the endocrine control system. Essentially, as long as the proper hormones are in place, mom will start making colostrum about halfway through pregnancy (Lactogenesis I) and her milk will increase in volume (Lactogenesis II) around 30-40 hours after birth.

Under normal circumstances, a woman's body creates milk under the direction of the endocrine control system in the first three months. Something extremely important happens within those first few weeks.

The hormone prolactin must be present for milk synthesis to occur. On the walls of the lactocytes (milk-producing cells of the alveoli) are prolactin receptor sites that allow the prolactin in the blood stream to move into the lactocytes and stimulate the synthesis of breastmilk components. When the alveolus is full of milk, the walls expand/stretch and alter the shape of prolactin receptors so that prolactin cannot enter via those receptor sites – thus rate of milk synthesis decreases. As milk empties from the alveolus, increasing numbers of prolactin receptors return to their normal shape and allow prolactin to pass through - thus rate of milk synthesis increases. The prolactin receptor theory suggests that frequent milk removal in the early weeks will increase the number of receptor sites. More receptor sites means that more prolactin can pass into the lactocytes and thus milk production capability would be increased.

Now, I realize that's a lot of science-y stuff. I've bolded what is most important for us to understand. In the first few weeks after giving birth, it is frequent nursing that actually puts a system in place to give mother and child the best possible start of long-lasting milk production. It is our belief that this is why newborns seem to want to nurse around the clock - God designed babies this way to stimulate milk production not just in those early weeks, but the system of production that will guide the milk supply for the months to come.

So, let's go back to the hormonal systems that control milk production. We know the endocrine system controls milk production for the first three months or so. What happens after that point? From three or four months onward, it is the autocrine system that governs milk supply.

Consider this from "Examining the Evidence for Cue Feeding" by Lisa Marasco, BA, IBCLC and Jan Barger, MA, RN, IBCLC

Endocrine control seems to be primary for approximately the first three months or so, until prolactin levels diminish. It is now believed, partly due again to Dr. Hartmann's work, that another process referred to as autocrine (local) control takes over at about this time. Under the theory of autocrine control, the body continues milk production at a more local level that has been set during the early period. What appears to affect successful long term lactation is the proper development of adequate prolactin receptors during the endocrine control period, which in turn appears to be correlated with frequency of feedings: the more frequent the feeds, the greater the stimulation of receptor development.

So when the body moves from endocrine to autocrine control of milk production at about the three or four month mark, there may be a drop-off in supply if prolactin receptors were not adequately developed in the earliest weeks of nursing.

Now, again, this will not affect every nursing mother. For women like me who had overabundant milk supply issues, the four month mark was a wonderful relief. I could finally stop wearing (and soaking through) nursing pads around the clock and I didn't have to swaddle myself with burp rags to catch the copious amounts of milk that were just everywhere each time I nursed one of my babies. For women whose bodies will have abundant milk supply no matter what approach to feeding is taken, this switch from endocrine to autocrine control will probably go unnoticed.

However, for some women who by nature do not have an abundant milk supply, there will be a noticeable difference in milk production, and some women will completely lose their supply between four-to-six months.

So what is the take-away here?

1) If you want to breastfeed, please don't view a new baby who wants to nurse all the time as an indication that you have milk supply issues. On the contrary, your baby is doing exactly what God designed for him to do: helping you build your milk supply for the present time and the months to come!

2) If you think that scheduled feedings would work best for your temperament and for your family's unique circumstances and if you would like to be able to breastfeed throughout the first year, please consider not implementing scheduled feedings until after the first month. I found that with Aliza Joy, my baby who I fed on demand from birth, she very naturally fell into a predicable feeding schedule at about two months or so. I didn't have to watch the clock but I did notice that around that time she wanted to nurse every few hours instead of throughout the day. I mention that because if the idea of demand-feeding is not something that appeals to you, you might find that idea of not implementing a schedule from the start to be unsettling. Babies often find their way to predictable routines, and it is a lot easier to stretch time between feedings for a baby who is a couple of months old to move them toward a schedule.

Several books that encourage scheduled feeding advise a two-and-a-half to three hour feeding schedule from birth through the first eight weeks. Given what we know about the science of milk production, this is not developmentally appropriate and may set women up for, at best, disappointing breastfeeding experiences and, at works, failure to thrive in babies that occurs in the four to seven month range when mother's milk supply begins to drop but early introduction of solids may mask the issue.

We would love to hear your thoughts today! Were you aware of the hormonal changes that govern milk supply? What do you think about breastfeeding and schedules? Feel free to tell us your story in the comments!