Tag Archives: infant

The Importance of Skin-to-Skin Contact

By Jack Newman, MD, & Teresa Pitman

Editor Rita Brhel doing Kangaroo Care with her premature daughterWe now have a multitude of studies that show mothers and babies should be together, skin-to-skin (baby naked, not wrapped in a blanket), the baby’s neck extended slightly so his head is in “sniffing position,” immediately after birth – and they should spend as much time together skin-to-skin as possible in the days that follow. The baby is happier, the baby’s temperature is more stable and more normal, the baby’s heart and breathing rates are more stable and normal, and the baby’s blood sugar levels are better.

Not only that – skin-to-skin contact immediately after birth allows the baby to be colonized by the same bacteria as the mother. This, plus breastfeeding, are thought to be important in the prevention of allergic diseases. When a baby is put into an incubator, his skin and gut are often colonized by bacteria different from his mother’s and studies show that the baby is much more likely to adjust to his new world, metabolically speaking, when he is skin-to-skin with the mother than if he is in that incubator.

We now know that this is true not only for the baby born at term and in good health but also for the premature baby. Skin-to-skin contact and Kangaroo Mother Care can contribute much to the care of the premature baby. Even babies on oxygen can be cared for skin-to-skin, and this helps reduce their need for oxygen and keeps them more stable in other ways as well.

From the point of view of breastfeeding, babies who are kept skin-to-skin with the mother immediately after birth for at least an hour are more likely to latch on without any help, and they are more likely to latch on well, especially if the mother did not receive medication during labor or birth. Putting mother and baby skin-to-skin can also be a valuable first step in solving any breastfeeding difficulties they are having.

There is no reason that the vast majority of babies cannot be skin-to-skin with the mother immediately after birth for at least an hour. Hospital routines, such as weighing the baby, should not take precedence. Of course, there is also no reason a baby cannot be back skin-to-skin with the mother immediately after the hospital routines are done.

The baby should be dried off and put on the mother. Nobody should be pushing the baby to do anything; nobody should be trying to help the baby latch on during this time. The mother, of course, may make some attempts to help the baby, usually in response to the baby’s behaviors showing some interest in going to the breast, and this should not be discouraged. The mother and baby should just be left in peace to enjoy each other’s company. The mother and baby should not be left alone, however, especially if the mother has received medication. It is important that not only the mother’s partner but also a nurse, midwife, doula, or physician stay with them – occasionally, some babies do need medical help and someone qualified should be there “just in case.”

The eye drops and the injection of vitamin K can wait a couple of hours. By the way, immediate skin-to-skin contact can also be done after Cesarean section, even while the mother is getting stitched up, unless there are medical reasons that prevent it.

Studies have shown that even premature babies as small as 1200 grams (2 pounds 10 ounces) are more stable metabolically, including the level of their blood sugars, and breathe better if they are skin-to-skin immediately after birth. The need for an intravenous infusion, oxygen therapy, or a nasogastric tube, for example, or all the preceding, does not preclude skin-to-skin contact. Skin-to-skin contact is quite compatible with other measures taken to keep the baby healthy.

Of course, if the baby is quite sick, the baby’s health must not be compromised, but any premature baby who is not suffering from respiratory distress syndrome can be skin-to-skin with the mother immediately after birth. Indeed, in the premature baby, as in the full-term baby, skin-to-skin contact may decrease rapid breathing into the normal range.

Even if the baby does not latch on during the first hour or two, skin-to-skin contact is still good and important for the baby and the mother for all the other reasons mentioned.

I have heard of a few cases where a mother had planned not to breastfeed but was still urged by hospital staff to hold her baby skin-to-skin. After doing this for a short period of time and seeing her baby gravitate to her breast, these mothers decided to breastfeed after all. The effects of this simple technique are powerful! In fact, one could say that skin-to-skin contact is even more important if the mother does not breastfeed so that the mother and baby have this special opportunity to “fall in love with each other.”

The Case for Skin-to-Skin Contact Between Mother and Baby, Whether Full-term or Premature
In summary, skin-to-skin contact immediately after birth that lasts for at least an hour has the several positive effects. These babies:

  • Are more likely to latch on, and to latch on well.
  • Have more stable and normal skin temperatures.
  • Have more stable and normal heart rates and blood pressures.
  • Have high blood sugars.
  • Are less likely to cry.
  • Are more likely to breastfeed exclusively longer.

Excerpted from The Latch and Other Keys to Breastfeeding Success by Newman, J., and Pitman, T. (2006) Amarillo, TX: Hale Publishing. (pp. 9-12) www.ibreastfeeding.com

Length of Postpartum Depression Determines Mother-Baby Attachment Difficulties

From API’s Publications Team

depressionAccording to an article on Guadian.co.uk, “Postnatal Depression and Your Baby,” the length of a new mother’s postpartum depression has a strong tie with the difficulties she’ll experience in establishing a close attachment with her baby.

Women who recover from their depression by the time their baby is six months old relate better to the baby than women whose depression lasts longer, according to a study published in a 1995 issue of Developmental Psychology, “Depression in First-Time Mothers: Mother-Infant Interaction and Depression Chronicity.” Treatment of postpartum depression is essential for the mother-infant relationship, as well as the infant’s development.

According to “Postpartum Depression Beyond the Early Postpartum Period,” a study published in a 2004 issue of Journal of Obstetric, Gynecologic and Neonatal Nursing, children of mothers with long-time or recurrent depression tend to have behavioral problems, such as crying a lot and being excessively demanding or withdrawn.

Mothers with postpartum depression encourage these infant behaviors through certain behaviors, including:

  • Stopping breastfeeding before the baby is ready;
  • Not interacting socially with the baby, such as playing and showing books or toys;
  • Not following care routines.

The Role of Attachment in Healing Infant Depression

By Rita Brhel, managing editor and attachment parenting resource leader (API)

HeartDepression — a mental illness marked by unrelenting sadness and hopelessness that permeates the lives of an estimated one in 18 people — is among the most prevalent medical disorders in today’s world, affecting 12 percent of women, 7 percent of men, and 4 percent of adolescents in a given year. Eight percent of adults will develop depression sometime in their life, and women are most prone — their lifetime risk is 20 percent.

Depression is a devastating illness. In its mildest form, it drains the happiness out of a person’s life. In its most severe form, depression kills. It can lead to suicide or, in cases where depression symptoms manifest as anger and rage, as assault or worse.

Treatment of depression, overall, is usually complicated. There are many severities of depression, from mild but chronic to seasonal affective disorder to anxiety to major depressive episodes. Chemical imbalances in the brain often contribute to the development of depression, but that is rarely the only cause. Additional contributing factors may include recent events such as a death in the family or a job loss; a traumatic upbringing, such as a childhood marred by abuse; low self esteem; major life changes, such as a new baby or moving to a new city; natural disasters; physical illness; and others. Therefore, treatment often includes not only medication but also long-term counseling; very severe forms of depression can also lead to hospitalization. Continue reading The Role of Attachment in Healing Infant Depression

Rates of Unnecessary Childbirth Interventions is Alarming

From Lamaze International

BirthDespite best evidence, health care providers continue to perform routine procedures during labor and birth that often are unnecessary and can have harmful results for mothers and babies.

The Centers for Disease Control and Prevention’s (CDC) most recent release of birth statistics reveals that the rate of Cesarean surgery, for example, is on the rise to 31.1 percent of all births — 50 percent greater than data from 1996. This information comes on the heels of The Milbank Report’s Evidence-Based Maternity Care, which confirms that beneficial, evidence-based maternity care practices are underused in the U.S. health care system.

What the Research Says

Research indicates that routinely used procedures — such as continuous electronic fetal monitoring, labor induction for low-risk women, and Cesarean surgery — have not improved health outcomes for women and, in fact, can cause harm. In contrast, care practices that support a healthy labor and birth are unavailable to or underused with the majority of women in the United States.

Suggested Labor and Delivery Practices

Beneficial care practices outlined by Evidence-Based Maternity Care, a report produced by a collaboration of Childbirth Connection, the Reforming States Group, and the Milbank Memorial Fund, could have a positive impact on the quality of maternity care if widely implemented throughout the United States. Suggested practices include to:

  • Let labor begin on its own.
  • Walk, move around, and change positions throughout labor.
  • Bring a loved one, friend, or doula to support you.
  • Avoid interventions that are not medically necessary.
  • Choose the most comfortable position to give birth and follow your body’s urges to push.
  • Keep your baby with you — it’s best for you, your baby and breastfeeding.

“Lamaze is alarmed by the current rate of Cesarean surgery, and furthermore, by the overall poor adherence to the beneficial practices outlined above in much of the maternity care systems in the United States,” said Pam Spry, president of Lamaze International, www.lamaze.org. “We are continuing to work to provide women and care providers with evidence-based information to improve the quality of care.”

Lamaze International has developed six care practice papers that are supported by research studies and represent “gold-standard” maternity care. When adopted, these care practices have a profound effect –instilling confidence in the mother, and facilitating a natural process that results in an active, healthy baby. Each one of the Lamaze care practices is cited in the Evidence-Based Maternity Care report as being underused in the U.S. maternity care system.

A Need for Balance

“As with any drug, we need to be sure that women and their babies receive the right dose of medical interventions. In the United States we are giving too high a dose of Cesarean sections and other medical interventions, which are causing harm to women and their babies. Yet, there are many countries where life-saving medical interventions are under dosed, which can also cause harm,” said Debra Bingham, chair of the Lamaze International Institute for Normal Birth. “Every woman and her baby needs and deserves the right dose of medical interventions during childbirth.”

The research is clear, when medically necessary, interventions, such as Cesarean surgery, can be life-saving procedures for both mother and baby, and worth the risks involved. However, in recent years, the rate of Cesarean surgeries cause more risks than benefits for mothers and babies.

The Danger of Cesarean Sections

Cesarean surgery is a major abdominal surgery, and carries both short-term risks, such as blood loss, clotting, infection and severe pain, and poses future risks, such as infertility and complications during future pregnancies such as percreta and accreta, which can lead to excessive bleeding, bladder injury, a hysterectomy, and maternal death.

Cesarean surgery also increases harm to babies including women giving birth prior to full brain development, breathing problems, surgical injury and difficulties with breastfeeding.

About Lamaze International

Since its founding in 1960, Lamaze International has worked to promote, support and protect normal birth through education and advocacy through the dedicated efforts of professional childbirth educators, providers and parents. An international organization with regional, state and area networks, its members and volunteer leaders include childbirth educators, nurses, midwives, doulas, lactation consultants, physicians, students and consumers. For more information about Lamaze International and the Lamaze Institute for Normal Birth, visit www.lamaze.org.

Chaos Theory: The Search for Personal Balance Amidst Parenthood

By Lu Hanessian, author of Let the Baby Drive and member of API’s Board of Directors

**Originally published in the Winter 2006-07 Balance issue of The Journal of API

Lu
Lu

A while back, I hosted a travel show on television. It was a crazy, chaotic time in my life. Traveled so much that I once reached for my seatbelt in a movie theater. Anchored live TV wearing an earpiece in which I could hear the director screaming to producers in the control room when they lost the live satellite feed while I conducted an interview in the studio. Witnessed an industry of smoke and mirrors where the carrot at the end of the stick was designed to be permanently out of reach.

Still, on a good day, I thought I had things pretty much under control.

Then I had a baby – a deeply tender and wise boy who stared long at me the moment he was born as if to say, “Work with me, Ma.” Popular opinion wasn’t popular with him. He urged me to redefine everything I knew. Little did I know, this was a good thing. Continue reading Chaos Theory: The Search for Personal Balance Amidst Parenthood

Dear New Moms

By Pam Stone, co-leader of API of Merrimack Valley, New Hampshire

**Originally published in the Spring 2007 annual New Baby issue of The Journal of API

New MomWelcome to Motherhood!

Many times people will tell you to enjoy these times, because they go by so fast. It may be hard to imagine, as you struggle to function through exhaustion and frustration, that you will look back at this time as warm and beautiful. But you will.

When your daughter wakes you for the fifth time tonight to nurse, gaze into her eyes and remember that sleepy, milky grin. When your arms ache from carrying her for hours, but she wakes at the slightest hint that you may sit down, marvel at her precious innocence and her relaxed body, so tiny that she snuggles comfortably in the nook of your arm. Continue reading Dear New Moms

Decoding Tantrums

By Stephanie Petters, leader of API of North Fulton, Georgia

**Originally published in the Spring 2007 annual New Baby issue of The Journal of API

TantrumWhen a parent utters the word tantrum to another parent, the reaction is either a supportive smile or a grimace of dread; I have yet to see or hear another parent respond with glee. And really, who blames her? Until recently, tantrums were considered manipulation by the child to control the parent.

Times are changing, and the subject of childhood tantrums has new meaning and insight for parents. We now understand the reasons and/or causes of tantrums, how to effectively manage them while remaining connected to our children, and how to take preventive action for the tantrums that you can control.

What is a Tantrum?

According to the Merriam-Webster dictionary, a tantrum is a fit of a bad temper. Connection Parenting, by Pam Leo, defines a temper tantrum as a spillover of emotions, while the tantrum is the release of the accumulated hurts not seen by the parents. In Elizabeth Pantley’s Gentle Baby Care, a baby tantrum is defined as an abrupt and sudden loss of emotional control. Continue reading Decoding Tantrums

AP from a Preemie Mom’s Perspective

By Rita Brhel, managing editor and attachment parenting resource leader (API)

**Originally published in the Spring 2007 annual New Baby issue of The Journal of API

Rita doing Kangaroo Care with Rachel
Rita doing Kangaroo Care with Rachel

It was a big day for me, my husband, and my daughter. In mid-January, seven months after Rachel was born, when she had reached 18 1/2 pounds and 26 inches long, her pulmonologist told us she was ready to come off the cardio/respirations apnea monitor that had been a constant part of her life since she left the hospital five months earlier. I was nervous, but her doctor told me that it was OK – in all his many years of practice, he had never seen a healthier looking preemie than Rachel.

It was a great compliment. My daughter was born in June at 30 weeks gestation, due to a significant placental abruption, a serious pregnancy complication in which the placenta prematurely separates from the uterus. Weighing three and one-half pounds and measuring 16 inches long, Rachel was nearly three months early.

A Traumatic Start

I had been planning a drug-free childbirth, but what I got was anything but easy, natural, and beautiful. It was traumatic for me, both emotionally and physically. I had been in the hospital for four days after hemorrhaging, and I was being treated with several anti-labor drugs, one of which (magnesium sulfate) left me so weak that I required oxygen. I was given an epidural in case I needed a C-section, and I had an episiotomy that became a fourth-degree tear and later acquired an infection. This was not the childbirth of my birth plan. Continue reading AP from a Preemie Mom’s Perspective

Dear Editor: Confused By Crying Article

Dear Editor,

Crying & Comforting articleThe article “Crying and Comforting” from The Journal of API, Summer 2008 AP in a Non-AP World issue, states: “Two commonly prescribed approaches include: ignore the crying and encourage the crying,” and it offers API’s stance on responding to our crying babies by saying, “Fortunately for parents and babies alike, there is a warm and compassionate middle ground between ignoring and encouraging crying. The AP approach…involves recognizing and empathizing with a baby’s emotions and patiently working with him to uncover the unmet need causing the tears.”

I would like to offer the perspective that there are various gentle approaches for comforting a crying baby, each of which is unique – as unique as every loving and attuned mother-child relationship.

It is common for mothers who are highly attuned to their babies to know when their babies simply need to cry – and when they are crying because of an unmet need. A mother might use additional soothing behaviors for her in-arms baby, or she might not. She might continue to search for causes for the crying, or perhaps not. If she feels like bouncing her crying baby, then she does. If she feels like holding her baby in stillness, then she will. When she opens her heart and follows her baby’s cues, she knows best what to do.

About the prevalence of approaches that encourages crying: I could not find any advice on the internet that promotes the encouragement of crying in babies and children. In my experience talking with many parents, I have not known anyone who encourages their babies and children to cry. Is this truly a commonly prescribed and followed approach?

Those parents I know who have learned about the stress-release crying approach do not decide to encourage their babies to cry. Rather, they interpret the approach as saying that it’s important not to discourage their babies from crying.

To illustrate this interpretation, I’ll share a friend’s story: Her two-year-old daughter was in an accident and was seriously burned. Weeks after the accident, her daughter sometimes needed to “cry and release her fears and tensions of what she had been through.” My friend explained that when her daughter didn’t want the breast, “I’d hold her but not attempt to stop her [from crying]. Some small thing would have her in floods of tears, and I could just tell that it wasn’t about the small thing, but about the accident.”

The Benefits of In-Arms Comforting of Crying Babies

I was confused about the following statements made about the stress-release crying approach in the Journal article:

  • “The parent is unable to identify the need using her mental checklist, so she holds the baby without comforting behaviors;” and
  • “Parents are to hold their infants and let them cry, and not try to calm the baby with distractions such as toys or pacifiers. While API agrees that the parent should recognize and empathize with the crying child, we also believe parents should be available emotionally and physically to help soothe the distressed child.”

Tender holding of one’s crying baby is itself one of the most soothing, comforting maternal behaviors available to any mothers. Mother can stand, sit, or lie down with baby in her arms. The simple act of holding one’s baby includes movement, sounds, smells, and touch, as well as other comforting sensations and feelings that defy description. Baby experiences the warmth of mother’s arms and body; soothing, rhythmic bodily sounds, such as mother’s breathing and heartbeat; comforting, rhythmic movements, like the rise and fall of mother’s chest and the whoosh of air from mother’s lungs as she exhales, and the rise and fall of his own chest against hers; the familiar smells of her body; and the comforting awareness that his mother – the source of all things good and wonderful – is there with him.

A message of unconditional love is offered, and received. Baby may sometimes be able to focus better on all of these most basic comforts, some of which are reminders of the womb environment, when mother holds him in stillness and silence, without rocking, bouncing, jiggling, rocking, singing, humming, etc.

I’m guessing most mothers would not want to restrict themselves from using any key comforting behaviors along with holding. Moreover, we would want to use them in any combination that feels “right” to us in the moment. For me, that might sometimes mean holding my baby without the use of other comforting behaviors and sometimes without endeavouring to find causes for the crying. I would not want to restrict myself from simply holding my baby, because sometimes it was exactly what my baby and I needed. This still holds true for my children (now 6 and 4) and me.

The tender holding of one’s baby or young child without other comforting behaviors does not need to be associated only with the stress-release crying approach. For me, to discard the option to hold my crying baby in stillness is to throw my baby out with his tears.

Are We Generally Accepting or Unaccepting of Crying?

There are at least two powerful influences that may be – but do not need to be – affecting our responses to our babies’ crying: Our upbringing and our culture. It may be helpful for parents to be mindful of these influences and start shifting their perspective, if necessary:

  • If we were raised by parents who let us cry-it-out alone as babies and/or who discouraged our crying, then quite possibly our own reactions to our babies’ crying are exaggerated by our own unresolved childhood hurts. How did my parents handle my crying? What feelings are aroused in me by my baby’s crying?
  • Crying is a behavior that is not embraced and accepted much in our society. What messages am I hearing about crying from doctors, friends, family, television, books, etc.? How much am I influenced by societal views about crying?

If a parent tends to be unaccepting of crying, she may lean towards either extreme of ignoring, or actively discouraging, her baby’s crying. I wonder, though, if it is common for parents to express their lack of acceptance in more subtle ways?

It seems to me that there is a fine line between discouraging crying and using soothing responses while searching for causes for the crying. How does my baby or child interpret my continuing efforts to search out reasons for his crying? Does he continue to sense my unconditional love for him? And what is the impact on me?

If a solution-focused mother is unable to pacify her baby, his crying may increase, which in turn may cause the mother to intensify her search for a solution. If she still isn’t able to discover the unmet need, she may understandably start becoming anxious (and mothers’ anxiety is often exacerbated when they are sleep deprived). The baby senses his mother’s growing anxiety and may become more distressed. It can become a vicious spiral.

Mother has lost touch with the moment. She isn’t paying attention to her baby’s evolving cues. Desirous of a settled baby (which isn’t the baby she has in her arms!), she may forget just how much she loves the one who is crying in her arms. She may forget to listen to him. To really listen to him. With stress levels rising, she might end up either blaming her baby or herself: “There is something wrong with my baby because he continues to cry. He’s not a good baby.” Or, “There is something wrong with me. I am failing my child because I can’t stop his crying. I’m a bad mother.” Of course, no one is to blame.

I would like to take a closer look at the toe-and-sock example given in the article: “Imagine that a baby is trying to communicate, ‘The seam on my sock is irritating my toe.’ The parent is unable to identify the need using her mental checklist, so she holds the baby without comforting behaviors.” The situation described sounds to me like a type of unobvious irritation that would likely go undiscovered by many mothers, no matter how they view their baby’s crying, whether or not they use soothing behaviors in addition to holding and whether or not they continue searching for solutions. So, in this type of situation, is it possible that the parent might find herself in a vicious spiral as she strives to find out what is causing the crying?

I also wonder whether it might be possible for any additional soothing behaviors, such as rocking, swinging, jiggling, and bouncing, to aggravate the irritation of baby’s toe? Furthermore, the parent might be in solution-oriented mode and eventually happen to take off the sock that is irritating baby’s toe, but perhaps her intuition might more readily lead her to do that when she has not been jiggling, rocking, singing to the baby, and not in search of reasons for the crying?

About the stress-release crying approach, the article states: “If the close contact alone is not enough to soothe the child…there will be further release of potentially damaging cortisol in the child’s brain and there will be no release of calming opioids. The child’s emotions may spiral out of control, leading to feelings of anger and rage and potentially toxic brain chemistry.” In light of the advice: “The AP approach…involves recognizing and empathizing with a baby’s emotions and patiently working with him to uncover the unmet need causing the tears,” I feel concerned about the impact of this statement on mothers, especially those new to mothering, and worry that this information punctuates the overall message about the importance of being solution-oriented.

The Benefits of Acceptance

It seems to me that a gentle approach to crying need not always be solution-oriented. In our busy, solution-driven society, we are admonished – or admonish ourselves – “Don’t just stand there. Do something!” Sometimes, especially in stressful situations, I find it helpful to remind myself of Buddha’s words, “Don’t do something. Just stand there!” Don’t do. Be. Be present. Be mindful. Be centered in my love for myself and my baby.

In order to provide calm and loving support to my crying in-arms baby, I found (and still find) it helpful to center myself in peaceful acceptance of the situation; to be still in my body, mind, and spirit; and not jump instantly into fix-it mode. However, that’s not always easy to do, especially when I’m tired, and given my tendency to be unaccepting of crying! So, I give myself the following reminders:

  • Focus on my breathing: Breathe slowly and deeply.
  • Bathe my thoughts in the gratitude I feel for the simplest of things: Being alive, having arms and hands to hold, touch and feel, eyes to see, ears to hear. Celebrating these most basic pleasures gives me strength to deal with the challenges of this moment.
  • Connect with my love for myself and my child. I love my child so much. I love myself.
  • Answers will arrive to me when I flow with the situation, rather than resist it.
  • I am being the loving parent I wish to be.
  • My in-arms child knows that I love him just as he is now, tears and all. He knows my love for him is unconditional.
  • My child senses my inner peace, and this positive energy is soothing to him.
  • My child will not continue to cry forever. He will stop crying.

When I was attuned to my baby’s state, I was (as any attuned mother is) able to distinguish whether he was meeting a need by crying or his crying was a request for help in meeting a need. If, for instance, he wanted to breastfeed, I knew his signals and responded accordingly by offering my breast. However, on occasion I was not able to figure out what the need was. And, as far as I’m concerned, that was OK! I’m not a perfect mother! In my imperfect moments, holding my baby close to my heart, and just breathing deeply, eyes closed, was sometimes exactly what he – and I – needed.

With the conscious intention to remain present and highly attuned to my children, and aware of how my upbringing and culture influence me, I simply wish to respond lovingly to my child’s feelings and needs, be mindful and accepting of what each moment brings, and not be too anxious to bounce or sing away my child’s every tear.

~ Tamara Parnay, The Netherlands

RESPONSE

Thank you, Tamara, for your letter. API’s intention in publishing the article was to warn parents against advice regarding comforting baby’s cries that works against the parent-child bond. API agrees with you that comforting the crying should be focused on meeting the need of the child. If a baby is comforted by being held still, that would certainly be more responsive and sensitive than to try rocking or jiggling.

The caution is against refusing to soothe a child who could be soothed by noises, repetitive motion, etc. because this particular child would cry longer and harder without these soothing techniques and that this is supposed to be a good thing for the child. API does not agree with this stance on encouraging crying.

There is a difference between soothing during an emotional outpouring and trying to stifle the crying. A parent can encourage a complete release of emotion while also comforting and soothing, and if the child prefers not to be soothed, then this is the better choice for the parents to make in order to respond sensitively.

Lastly, as you pointed out, it is important that the parent stays calm while soothing and comforting, even when unable to determine the cause of the crying. The important point is that the parent continues to seek ways to soothe the child, rather than giving up.

Thanks again for your letter, as it helps API to clarify our stance and helps to answer similar questions from other AP parents.

~ Rita Brhel, editor of The Journal of API

When It’s OK to Induce Labor, and When It’s Not

By Rita Brhel, managing editor and attachment parenting resource leader (API)

One in five pregnant women will have her labor induced, for varying reasons. Some of these reasons are valid; others are not. Catherine Beier of www.givingbirthnaturally.com weighs in.

When it’s OK to induce labor:

  • Pre-existing medical conditions in the mother – These may include heart disease, a seizure disorder, hypertension, cancer, or another serious health issue, although many women with these disorders can still give birth vaginally.
  • Pre-existing medical conditions in the baby – If the baby is known to have a congenital or other medical condition that requires intervention or intensive care immediately after birth, induction may be the safest way to ensure the baby gets the care that’s needed.

And when it’s not OK to induce labor:

  • Overdue pregnancy – While the American College of Obstetricians and Gynecologists warn against induction before 39 weeks, the average pregnancy worldwide lasts 42 weeks. For medical doctors who don’t want to wait that long, they should consider accuracy of a woman’s due date, which is calculated on a 28-day menstrual cycle with ovulation on day 14; for women with long or irregular cycles or late ovulation, this due date can be significantly inaccurate. For these women, a reliable estimate of the due date, within one day, can be obtained with a transvaginal ultrasound at eight to ten weeks of gestation. As the pregnancy progresses, ultrasound becomes a less reliable predictor of the due date, as the weight estimate can be off by as much as two pounds.
  • The baby is too big – The vast majority of women are able to give birth vaginally to their babies, even those who are larger. Because hormones during labor relaxes and stretches the hips and pelvis, for those very few whose pelvis is too narrow to birth a full-term baby, it’s impossible to know until the time of childbirth.
  • The mother is too tired or uncomfortable – Remember, it’s called labor for a reason. Labor can be rather long and hard with the first baby especially, but it is normal.
  • It’s more convenient to know when the baby will be born – Whether induction on a certain day is better for the baby’s family or the medical provider, this does not take the baby into account and not a true reason.