The good, the bad and the ugly of Parenting Information

EVERYONE has advice for new parents.

Every person who has become a parent has learned a lot from their own experience and many want to share their wisdom by providing verbal or written advice for others they encounter. Expectant and new parents need to be prepared to receive advice even when they didn’t ask for it, and to be discerning about what they take on board, and what they ignore.

It’s a minefield out there in “parentland”.

Relatives, neighbours, the lady in the checkout queue – all have something to say about babies when they see them, and most of it is well intentioned and probably fairly benign. Occasionally someone WILL say something to a new parent which will be surprising, shocking or even very offensive. New parents are sensitive beings and “wrong” comments can be really upsetting, and their confidence can be easily shaken – because EVERY parent wants to do everything right, which no one can, of course.

We live in a world of information overload.  Parenting magazines and movies depict a glossy wonder world of perfectly groomed mothers with smiling babies in tidy homes (usually sitting on white couches) and Facebook pages can be just as misleading about the reality of new parents’ lives.  When challenges arise, which they always will, there are so many options when seeking guidance that parents can find themselves in real turmoil trying to make sense of often-times conflicting information received from various sources.  Unfortunately this can be the case even when trusted health professionals – GPs, Midwives and Child Health Nurses – are providing the information.

A “mummy blogger” described this situation very well – As a new mother, you will be faced with a great many challenges as you find your feet and one of the biggest hurdles is working out who you can trust to give you advice.  Not just small scale advice, like knowing if your baby needs socks on or how often to trim their fingernails, but large scale advice that can impact not only on your mothering experience but also on the way you and your baby experience each other. Advice on breastfeeding, sleep and settling, weight gain, health and development – the big ticket items, who can you trust to offer their advice? Who actually has the evidence to back what they are saying? Who is up to date and who is just feeding the same tired advice of years before? Has this person ever actually trained in this specific area they are advising on?

As her blog progresses, she discloses that in hindsight she would have questioned the HPs she saw  far more about the evidence which supports the advice given,  and discovered that more often than she wished to admit, they gave incorrect, inaccurate, incomplete or simply out of date advice.  “They gave it sincerely, with, I have no doubt, the very best of intentions but, the ramifications for my baby and I were significant. https://grubbymummyblog.wordpress.com/2017/04/30/the-question-all-mothers-should-not-be-afraid-to-ask-can-you-provide-the-evidence-to-back-your-advice/

So the message here is – parents DO need to do their research about whatever concerns they are hoping to address and seek out health professionals who are up to date with evidence and research.

How do you do that? Many GP clinics have websites with profile information about their resident doctors – check them out first rather than taking pot luck. Sometimes the more recently qualified practitioners – GPs and midwives – are the most up to date and well informed.

Ask other mothers in your area about the local Child Health Nurses, and if breastfeeding is on the discussion list, ask to see a Lactation Consultant.  If an LC is not available consider seeing one privately. This could be the best money you will ever invest in your breastfeeding journey.  To find an LC go to the LCANZ website http://www.lcanz.org/find-a-lactation-consultant/

What about other resources – Books, Blogs, Facebook pages?

Again, parents need to be very discerning.  And I need to be very careful how I comment on some of the rubbish that is out there, on bookshelves especially.

THE BAD – Parents need to understand that anyone can write a book. And even a book filled with nonsensical advice which has no sound evidence base can become a best seller.

I am referring to a book which appeals to desperately tired new parents, offering them a strict regime which will deliver order and sanity to their lives. In reality, this is impossible but parents still crave it especially when they are exhausted.  My deep concern about this book is because it was written by a person with NO health professional qualifications at all, and I have seen a number of babies who have required admission to hospital as a consequence of the very rigid feeding and sleep routines which are prescribed for babies, even newborns.   Because this author is not a health professional she is not accountable to any registration body for the potentially dangerous advice provided. The only accounting done in this case is a bursting bank balance.

But wait, it gets worse.  Another book which is also front and centre on bookshop shelves is written by a midwife, who provides infant feeding advice which contradicts and contravenes World Health Authority feeding guidelines.  So including a health professional qualification in the title does not guarantee up to date or evidence based advice. No wonder parents are often confused and misled.

THE GOOD –  And  there are good books. Authors such as Pinky McKay, Howard Chiltern, and Sarah Buckley provide evidence based information for expectant and new parents and any of their books will be welcome residents on new parents’ bedside tables.

I created my own resources “New Baby 101 – A Midwife’s Guide for New Parents” book, app, eBook and videos to address the real need for concise, relevant and reliable information which is easy to read and to access.  Part of the Foreword written by Pinky McKay states “you will be able to relax knowing that everything here is evidence based, written by a highly qualified health professional who cares deeply for new parents and babies…whose recommendations are kind and respectful to you and your baby and will empower you to be the parents you want to be”.

In addition there are many very good “mummy blogs” available on line which provide relevant and up to date information, often serving a particular location and demographic.  Facebook pages can also provide information about particular topics which interest new parents such as Cloth nappies, Breastfeeding Advocacy and Support, and mothers’ group meetings and so on.

However, caution needs to be exercised when participating in Facebook groups which are not moderated, and debates sometimes become very heated when people are passionate about certain topics. Things are often written on line, anonymously, that would never be spoken face to face. Parents can become enmeshed in Facebook communities which can be helpful, but also harmful.

WHICH LEADS ME TO THE UGLY  Again, parents need to be discerning about which information they accept, and which they discard.  One of the hottest topics among parents and health professionals at present is “ties” – referring to the incidence of tongue-ties in babies’ mouths, and other proposed oral restrictions and the exponential increase in their diagnosis and treatment. This topic has become an example of extreme focus, mostly on-line, and I will tackle this story in its entirety another day.

Coming back to the Mummy Blogger I mentioned earlier – here is an example of poor advice which confounded her parenting journey –  “I had one particular piece of advice that was given repeatedly to me as the mother of an extremely wakeful baby that illustrates this issue- That I needed to adopt a Feed-Play-Sleep routine. This was given to me in an extremely matter of fact manner on numerous occasions over the course of my baby’s first 12 months”

She wisely goes on by referring to the evidence based work of Dr Pamela Douglas and Koa Whittingham in their advice about  “Feed, Play Sleep” “it is still suggested because we live in a society where we need to ‘fix’, ‘mould’ and ‘conquer’ anything we see as problematic or abnormal. In our fixer-upper world, a baby who doesn’t fit the sleepy ideal needs ‘fixing’ and as sleep is prioritised above all else, we have come to making recommendations of techniques and strategies that focus solely on this desire without much critical thought into the impact of these techniques and strategies.

Douglas and Whittingham conducted a systematic review of  the literature about behavioural infant sleep interventions, sleep regulation and sleep disturbance (2014) and made findings about the Feed-Play-Sleep routine that are actually quite concerning-

“Basically, falling asleep after feeding  is the biologically normal way for a baby to fall asleep and is present from birth, not something that is taught/ conditioned by a parent after. It is also plays a part in a baby’s the normal development of their parasympathetic nervous system and a healthy breastfeeding relationship. By decoupling feeding from sleeping, there are concerns raised about potential unintended outcomes as well as the increased stress it places on the parent- infant relationship unnecessarily. Feed Play Sleep “may actually cause sleep problems it supposedly aims to solve and may jeopardise the mother and baby’s breastfeeding relationship”.

I have provided a link to my own article from New Baby 101 Facebook page about Feed, Play, Sleep http://www.newbaby101.com.au/feed-play-sleep-no/ , and have included an excerpt from the systematic review at the end of this discussion for those who want to explore this further.

Concluding this discussion about the potential for new parents to become caught up in the information whirlwind, I offer these words of advice –

“If something you have been told to do doesn’t feel right, it probably isn’t right. Seek evidence-based information but ultimately, you already know your baby better than anyone else, because it is YOUR baby. Trust your instincts.”

DOUGLAS AND WHITTINGHAM RESEARCH:

‘Feed–play–sleep cycles are thought to bring sleep under the regulation of other learned stimulus cues such as bedtime routines, which are deemed to be more appropriate. However, we argue that post- prandial somnolence, a tendency to fall asleep after feeding, is not learned through operant conditioning. In fact, it is present at birth. Postprandial somnolence is an innate neurobehavior resulting from the effects of parasympathetic nervous system activation, elevated oxytocin, and elevated plasma cholecystokinin. The decoupling of innate neurobehavioral patterns may have unintended outcomes within the complex system for some mother–infant dyads, such as premature cessation of breast-feeding or frequent high levels of arousal of the sympathetic nervous system and the HPA system (Douglas & Hill, 2013).

Feed–play–sleep cycles not only decouple the innate neurobehavioral link between feeds, bodily contact, and downregulation but also the appropriate stimulus of felt sleep pressure from sleep. In addition, feed–play–sleep cycles may have consequences for the parents, as the promotion of feed–play–sleep cycles falsely suggests to parents that their baby’s postprandial somnolence was either created by their actions as parents or is not a legitimate cue. This places unnecessary stress on the parent–infant relationship, including on the breast-feeding relationship, at a vulnerable time. (Whittingham, K & Douglas, P. 2014, Optimizing Parent Infant Sleep in the first 6 months: a new paradigm, INFANT MENTAL HEALTH JOURNAL, Vol. 35(6), 614–623 )

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02 May 2017| no comments.