Solids

There seem to be two recommendations of when to start solids:

1. start your baby between 4-6 months when they show interest and willingness in taking food off a spoon; and
2. do not start your baby on solids before 6 months.

Needless to say, you can't follow both these recommendations.  So why does the advice conflict and which is correct?

The short answer:

As far as I can work out, the answer is that if you live in a developed country and practice appropriate hygiene in the preparation of food, the risks in introducing solids after 4 months are negligible.  There is nothing wrong with exclusive breastfeeding until 6 months either - and if you are breastfeeding, continuing to breastfeed through the period you are introducing solids is highly recommended.  Even after you introduce solids, most of your baby's nutritional needs will be met by breast milk or formula until at least 12 months of age.

Personally, I reckon that now my baby is at an age where she is putting everything in her mouth and gumming the floor, the risk of her picking up extra bugs from hygienically prepared solids is minimal.

Here's the evidence:

It was previously thought that exclusive breastfeeding until 6 months and delaying the introduction of allergenic foods such as eggs could reduce the development of allergies in children.  The current state of the research is that there is no clear evidence that delaying solids until 6 months makes the development of allergies more or less likely.  The Australasian Society of Clinical Immunology and Allergy (ASCIA) summarises its position based on research into allergies as follows:

Do not:

• introduce solids before 4 months

What can help prevent allergies: 

• breastfeeding up to and during the period of introduction of solid foods
• if breastfeeding is not possible, there is some evidence that hydrolysed formula can help prevent allergies (fully hydrolysed formula is only available by prescription - partially hydrolysed formula is sold as HA formula) 

What probably makes no difference: 

• excluding foods from the breastfeeding mother's diet

• delaying the introduction of solid foods for longer than six months 

• delaying introducing potentially allergenic foods such as egg, nuts, wheat, cow's milk and fish - if the child's going to develop an allergy, they will probably develop it anyway

The tricky part is that the ASCIA also states:

• "more research is needed to determine the optimal time to start complementary solid foods.  Based on the currently available evidence, many experts across Europe, Australia and North America recommend introducing complementary solid foods from around 4-6 months."
• "There have been some suggestions that delaying the introduction of foods may actually increase (rather than decrease) allergy, however at this stage this is not proven." 

This part of the advice is a bit vague for me.  Which experts?  Why do they say 4-6 months is optimal?  And what is meant by 'delaying the introduction of foods'?  Till 4 months?  6 months?  A year?

And no wonder it is vague, when joint position paper of the European and North American Societies for Paediatric, Gastroenterology, Hepatology and Nutrition actually says:

"Exclusive or full breast-feeding for about 6 months is a desirable goal. Complementary feeding (ie, solid foods and liquids other than breast milk or infant formula and follow-on formula) should not be introduced before 17 weeks and not later than 26 weeks."

A quick bit of maths reveals that this advice tells you to exclusively breastfeed (no solids) for 6 months, but to introduce solids before 6 months.  Nice.  In one breath, two major leading health organisations give you a recommendation that is basically impossible to follow.

The reason solids are not introduced before 17 weeks is due to the infant gut not being mature, leading to risks of allergies, infections etc, as well as failure to thrive issues from the infant taking less milk.  As to what time after this is appropriate:

"With respect to neurodevelopment, it is likely that, as with any motor skill, there will be a range of ages in infant populations for the attainment of most milestones. For example, by around 6 months, most infants can sit with support and can ‘‘sweep a spoon’’ with their upper lip, rather than merely suck semisolid food off the spoon. By around 8 months they have developed sufficient tongue flexibility to enable them to chew and swallow more solid lumpier foods in larger portions. From 9 to 12 months, most infants have the manual skills to feed themselves, drink from a standard cup using both hands, and eat food prepared for the rest of the family, with only minor adaptations (cut into bite-sized portions and eaten from a spoon, or as finger foods). An important consideration is that there may be a critical window for introducing lumpy solid foods, and if these are not introduced by around 10 months of age, it may increase the risk of feeding difficulties later on (15). It is therefore important for both developmental and nutritional reasons to give age-appropriate foods of the correct consistency and by the correct method.

The Committee considers that gastrointestinal and renal functions are sufficiently mature by around 4 months of age to enable term infants to process some complementary foods, and that there is a range of ages at which infants attain the necessary motor skills to cope safely with complementary feedings." (taken from the joint position paper cited above)

A look at the detail of the paper reveals no clear reason why there is such a strong recommendation to introduce solids before 26 weeks.  There are some studies that suggest iron deficiency can occur if babies are exclusively breastfed to 6 months, but this probably depends on the amount of iron the baby obtained in utero, which in turn depends on the mother's diet and whether the baby was full term (premmie babies may not have enough iron in their bodies).  The 2002 World Health Organisation (WHO) report on the Nutrient adequacy of exclusive breastfeeding for the term infant during the first six months of life found that breast milk did not provide all the infant iron needs, but for the first six months the infant drew on iron reserves already in his or her body.  After 6 months, complementary feeding was necessary to ensure adequate iron.

The Australian National Health and Medical Research Council states that:

"A number of observational studies and two randomised trials have not identified any benefits from the introduction of solid foods before the age of 6 months."

But when you actually look at the studies they are referring to, both were conducted in the developing Honduras.  It is therefore unclear how applicable these studies are to developed countries like Australia.

The World Health Organisation (WHO) is best associated with the position that babies should be breastfed exclusively until 6 months of age.  But when I looked at the evidence provided by the WHO website, particularly the 2001 The Optimal Duration of Exclusive Breastfeeding: A Systematic Review, the evidence really only supports delaying solids in developing countries or in households with other risk factors - such as smoking, low socio-economic status etc.  There may be a small elevated risk of gastrointestinal infection when starting solids early (as evidenced from a large study in Belarus, but not demonstrated in a smaller Australian study), but such infections are extremely unlikely to result in infant deaths in a developed country.  What the review set out to establish and could basically support was that there was no harm in exclusive breastfeeding for at least 6 months.

When the evidence is this way, why is exclusive breastfeeding until 6 months advocated so strongly in developed countries?  In part, this may be a public policy decision (see the ANHMRC paper p47)  - as it is feared that when parents are given the 4-6 month range, mothers who feel their babies are advanced try to introduce solids before 4 months (17 weeks) where statistically most babies' guts are not ready, and there are higher risks.

Methods for starting solids:


There are two basic methods for starting solids - using purees and spoon feeding, or starting later with finger-foods using 'baby led weaning'.

Purees and spoon feeding allow you to start feeding your baby solids before they can sit up and before they develop the motor skills to do anything other than suck on objects placed in their mouth.  Harder food is a choking hazard for babies without these skills, which typically develop around 6 months, although the age can vary greatly from baby to baby.  For information on how to do this method, including recipes etc, you can find advice on Annabel Karmel's homepage.

Baby led weaning involves waiting until the baby is older and then essentially starting them straight on finger foods.  BLW advocates like that this means less work than a long period of pureeing food etc (although this may be more true for breastfeeding mums than mums doing formula).  Other possible benefits is that the baby learns that food is for chewing not sucking from the outset, so potentially less risk of choking, and that babies develop a positive relationship with food by feeding themselves the quantities they need, not being force-fed.  For more information on how to do this method, see advice from Gill Rapley or for more detailed information this blog.

Three Generations of Mothers

On Monday, Bethany and I visited Ballarat's famous historic town theme park, Sovereign Hill.  Bethany's Aunt Steph works there as an Education Officer, which was handy because not only was there free entry, but we got a personalised behind-the-scenes tour with lots of cute photo ops:

Aunt Steph teaches Bethany her name in ladylike handwriting

Early left-wing tendencies

Mmm... tasty!

Rare 19th century colour portrait of Bethany and I

It was entirely too much fun.

And now for a clumsy segue from historic photos to a bit of real family history.  We are actually visiting Melbourne for Bethany's Great Nanna Rose's 90th birthday.  She is Bethany's mother's, mother's, mother, and it is pretty cool that we all have this opportunity to get together.

Me, Bethany, Nanna 'Rain, and Great Nanna Rose

I thought it would be a nice idea to ask my mum and nanna about their memories of early motherhood to see what's changed.  The answers were eye-opening and made me appreciate how easily I have it now.

My mum had me when she was 29, the same age I had Bethany.  Both she and my dad had only just finished uni, so they didn't have a lot of money.  My mum used terry cloth towelling nappies with safety pins, and she had to scrub them clean in the laundry sink before putting them in the washing machine.  They had a tiny one-bedroom house so there was really no question of where the baby would sleep.  Unfortunately for my mother, I was a difficult baby with breathing problems, and woke at least five times a night crying and distressed from when I was several months old, until about two and a half, when the problem was finally identified (overlarge adenoids) and I had surgery to remove it.  She remembers being desperately tired.

A baby me and my mum on the right.

From the moment I was born my mum did odd consultancy jobs researching historic buildings.  It wasn't so much a question of needing the money, as needing a chance to have some adult time, and the work bought her a chance to pay a babysitter to take me (and then my sister) for some time each week.  She had just moved to Geelong when she had me and didn't really know anyone apart from my father, so her experience of being a young mother was that it was very isolated.

My nanna, Rose, was born in 1920 and grew up during the depression.  Her mother died when she was  eight and Rose was raised by her oldest sister.  By the time she was 14, she had left school to work.  She walked 2 miles to the train station each morning then caught a train for an hour's journey to Richmond to work at a factory, then back home each day.  She met my grandfather just before the war, and was engaged to him when he was posted to Rottnest Island.  Their first child, Barbara, was born a couple of years after the war ended.  

Barbara, Cecil, Margaret, and Rose

When I asked my nanna about her memories of being a new mother, she laughs and says she doesn't remember a lot now.  But she does remember living in the front room of a small house provided by the army when she was pregnant, and sitting out on the porch and knitting and knitting so she would have enough baby clothes.  It was far too expensive to buy clothes.  Apparently, she did so much knitting that the army turned off the electricity to the porch light because they deemed her electricity consumption excessive.

She was also able to borrow a sewing machine to make nappies out of flannelette material.  When she had the babies she was lucky enough to be living with her husband's parents who had a 'copper' which you could light a fire under, so she had hot water each day to wash the nappies.  She breastfed all her children, but 'oh, the sore nipples!'  She had watched her older sister breastfeed her children, but 'each baby was different and it depended how they moved their mouths'.  With the first baby, they couldn't afford a pram so they just carried the baby everywhere.  With the second child they bought a motorbike with a sidecar to get around.

She found it challenging living with her mother in law, who would get upset at her if she hadn't cleaned out the fireplace each morning, but if Rose cleaned out the fireplace instead of tending to her babies, her mother in law would take offence at that too.  Her husband eventually agreed that they would borrow a caravan and move onto the block where they were building a house in Highett (total mortgage: £2000).

Margaret and Barbara outside the caravan on their block.

There was no telephone and no sewerage connected - the nightman came to take the sewerage once or twice a week and they used old telephone books for toilet paper.  (My mum recalls 'they weren't that absorbent'.)  It was an event of some significance a few years later when one of the houses in the street got a 'party telephone' connected that you could walk down to in order to make calls.  From when the house was completed, the children slept in cots in a separate room, and they had old orange crates as dressers.

My mum (Lorraine), Margaret, and Barbara

She was able to stay home with her children until the fourth was three or four years old, then she got work in a knitting factory, making little sweaters to sell for Coles.  She took the youngest with her and he had to sleep or play on a mattress on the floor nearby.  From then on she worked full time and did all the housework or delegated it to her children.

What I found interesting about my nanna's story was that she was raising her children during the now-idealised 1940s and 1950s, which some people believe was a time when mothers stayed home so they could look after their children.  But even setting aside a feminist critique of this image, that is a very rosy, middle-class view of how things were.  My nanna worked for a pittance doing basically sweatshop labour as well as took care of all the kids.  Apart from with the first child, she had very little time to enjoy or bond with her children.  Babies had to be left to cry till they gave up because there was too much to do and one person simply couldn't do everything.  

And even before she worked she was so busy with the time-consuming domestic labour that she had far less time than we do today to be taking care of the children.  Paid child care centres did not exist.   Rather, it the children (particularly the girls) were required to do far more of the household labour than most children would do today.  

This was just the way things were and my mum thought this was normal at the time but it was later something she tried to change with her own parenting.  My mother worked hard to put herself through night school and then university part-time over many years so that she would be able to have the money to give her own children the opportunities she never had.

It is a testament to both their efforts that I grew up oblivious to all the difficulties they had encountered.  I just thought the opportunities and the time and affection I got from them were normal.

It's a long way from our life today.  I am able to keep in touch with my family on Skype, we have all the mod-cons.  As for my nanna, she's still kicking on strong.  She enjoys playing billiards and surfing facebook on her ipad so she can check out what we're all up to.  The next time you see a post by Roseemma Huddle on my profile, you'll know that's my nan - an extremely impressive woman!

Sick

I think it is traditional for your baby to get sick and stay that way for most of their first big trip away, and Bethany has decided she is a traditionalist.  She is a sick, snotty baby.

She could have picked it up anywhere.  Her dad was sick just before we left, we've been travelling on an aeroplane, she gets cuddles from everyone, and she keeps getting chances to gum other kids' toys.  I've just let her go for it and given in to the inevitable.

On the plus side, as a sick baby she's pretty good.  She sleeps better for starters.  Just the other night she did a massive 10 hour sleep.  Given that her previous record was 7 hours, and that was some time in the distant past, I was particularly impressed.  Even better, I slept for 9 of those 10 hours.

Treatment has been breastfeeding, flushing out her nose with a little saline solution, and sleeping her in her car capsule, which keeps her semi-upright.

Fortunately, I've only had traces of the cold.  It's a funny thing, before having the baby, I used to get sick all the time.  Since having the baby, I have not had a cold, despite all the bodily stress and sleep deprivation, and despite that my baby and husband have had two.  I barely seem to get the first symptoms before I'm better.

I have wondered whether this is somehow related to breastfeeding, because if I'm producing all these extra antibodies for her, then perhaps my immune system generally is more effective.  An article from the International Breastfeeding Journal suggests there is some evidence that the mother's immunity is improved by breastfeeding:

A study of 43 breastfeeding women found that both breastfeeding and holding their babies without breastfeeding significantly decreased ACTH, plasma cortisol, and salivary free cortisol [51]. In response to an induced stressor, cortisol responses were attenuated in breastfeeding women for a short time after feeding their babies. The authors concluded that suckling, but not breastfeeding in general, provided a short-term suppression of the stress-related cortisol response and HPA axis response to mental stress [51]. They argued that this short-term suppression provided several evolutionary and biological advantages. It isolated the mother from distracting stimuli, facilitated the women's immune system, protected the babies from high cortisol in the milk and prevented stress-related inhibition of lactation. Based on their review, Groër, Davis and Hemphill drew similar conclusions [9]. They noted that the neuroendocrinology of breastfeeding women possibly down-regulated the stress response. This down-regulation protects the breastfeeding mother and directed her toward milk production, conservation of energy, and nurturing behaviors.

Exclusive breastfeeding also increases the effectiveness of the mothers' immune system [50,51]. In a study of 181 women at 4 – 6 weeks postpartum, perceived stress, depression, anxiety, anger and negative life events were related to decreased immune competence for the formula-feeding mothers [52]. This relationship was not present in the breastfeeding mothers who were protected from the harmful effects of stress on immunity [52].

So maybe.  Or maybe there's a placebo effect because I feel strongly that I just don't have time to get sick?

Destination Melbourne

Yesterday, Bethany and I embarked on our first great expedition together, flying the 3000 or so kilometres from Darwin to Melbourne, just the two of us.

I used to think our first great expedition was when I forced myself to get into my car with her for the first time and drove a terrifying 10 minutes to the Nightcliff Health Centre. Or possibly when I walked with her in the pram to Woollies through the blazing tropical sun. Those trips had been like horror movies, at least insofar as my heart was in my mouth and there was a lot of screaming.

And if they were that bad, what would this plane trip be like, I wondered? The last flight I had taken was when I had been 5 months pregnant, and that time I had been seated next to an alcoholic with a personal hygiene problem, and the smell of stale sweat and VB almost combined to bring back my morning sickness. Would I have him again? Or maybe the woman who sued Qantas because a three year old child cried on the flight and ruptured her eardrum?  My anxious imagination generated all kinds of scenarios:

Bethany fell asleep in my husband's arms as we waited at the airport, but then woke up just after he gave her back to me, as we boarded the plane.

Not what I wanted.  She tends to whinge if I sit with her in one place for too long.

But judging by the smiles, waking up to find herself on an aeroplane was the Best Fun Ever!

I kept waiting for it to all go haywire, but it never did.  I fed her on the way up: she fell asleep and didn't wake until we were disembarking (onto the tarmac - it was 9 degrees - her little eyes shot open as soon as she felt it).  It was nowhere near as difficult as those early trips in the car and pram.  It made me realise how far Bethany and I have come since those early days.  All you new mums, take heart - it gets easier!

Of course, it helped that the two empty seats on the plane were next to me.  (Very wise, Virgin Blue, very wise.)

The only issue I had was with the stupid baby seatbelt.  Airlines supply you with a strap that goes around the baby's waist and hooks into your own seatbelt.  I hate to break it to you, Virgin, but in the event of an emergency, that seatbelt is not going to protect the baby.  There is a reason that baby carseats have five point harnesses and face backwards.

The baby seatbelt appears to be one of those annoying gestures of safety that have been bureaucratically put in place without regard for common sense by some bright spark who has never looked after a baby.

You can't bring a capsule on to secure your baby more safely, presumably even if you pay for an additional seat.  JetCrapstar is apparently a bit more open to using a range of restraints, but even they object to using a Baby Bjorn or Ergo or similar to help hold your baby during the flight.  Apparently this is a 'safety issue'.  Why is a mystery.  They're obviously better secured in an Ergo than they are by that baby seatbelt, and are less likely to suffer major spinal or brain damage from whiplash in the event of sudden turbulence.  A friend and I have speculated that maybe if the aeroplane goes down, and you are unconscious, it is easier for the cabin crew to rescue your baby than it would be to extract her from an Ergo.  You are probably unconscious in this scenario because you have headbutted the seat in front of you because that is the only way to do the advised 'brace position' while holding a baby on your lap.  Personally, I think in the extremely unlikely event that the plane goes down, we've all got bigger problems.

The only function of the baby seatbelt provided I have observed is that it is one more thing to sort out when you are trying to juggle your luggage and settle your baby in a confined space.  And that's what airlines should aim for, I reckon, making it more difficult for parents to settle their crying babies on planes.

But that issue aside, the cabin crew were fantastic.  Very attentive.  And when we arrived, they carried all my cabin baggage for me across the tarmac, up the stairs, and into the terminal, so I could just focus on Bethany.  Other mums from my mothers group have also given rave reviews of travelling Virgin with a new baby.  I'll be using Crapstar on the way back so we'll see if that's as good.

Honesty

A few days ago I posted Guilty New Mum Bingo!, a fun list of difficult moments in early motherhood, on which I can bingo myself several times over. The feedback I have got from other mums is that it's reassuring cause it's all too true, and that's something they don't hear enough.

Here is a sample of the kind of response I have been getting:

It's so lovely to read a mothers honesty after all this time. It makes me so cranky when all those mums out there make out like its all roses. Yes there are plenty of rosy moments with babies but there are more than your fair share of poopy, insane teary moments.

Why is it like this? Why are so many mothers not willing to talk about the lows as well as the highs of motherhood?

I found one answer to this question a couple of days ago when a concerned friend rang me to see if I was ok. She had been reading the Bingo post and had been startled to find that one of the moments to tick off was 'wished had never had baby'. What was going on in my head that I could write such a thing, she wondered? I said that I was ok and was doing fine, but I don't think she really believed me.

It made me wonder whether I should have included that box in the Bingo game at all. My blog is public - was this something I wanted anyone and everyone to know I had written? How open was it to misinterpretation?

My first thought was, yes. I think writing these kind of honest posts does more good than harm. Is it really so outrageous or unusual to have a moment where you wished you never had the baby? Really? I'm going to go out on a limb here and say that I reckon most mums have at least one moment in those first few months where she thinks: Oh god, what have I done? I'm not cut out for this. I made the wrong choice. After all, if one in seven women have these kind of negative thoughts so regularly that they are diagnosed with post-natal depression, it seems logical to suppose that many more women have negative thoughts occasionally.

But then I had another thought: One day my baby daughter is going to be old enough to find and read this blog for herself. Maybe she will think I don't really love her.

This was much harder. These posts might do mothers some good, but what if they do my daughter harm?

After much thought, I have decided I was right to publish my Bingo post, but that I owe my little girl an explanation. So there are no misunderstandings when the day comes that she reads this blog, here is the explanation she will find:


Dear Bethany,

If you're old enough to read this you're old enough to know that parents are not perfect.

I get grumpy, I say and do stupid things, and I don't have all the answers. But one thing I know for certain is that I am madly in love with you.

I loved you before I met you, before I could even feel you kicking inside me. When I was pregnant, nothing scared me more than the thought I might lose you. When you were born and they put you on my chest, you looked up at me with wide, curious eyes and I thought you were the most beautiful thing I had ever seen. There have been times where you have kept me awake so often that my head aches and the room spins with nausea, but then you smile at me and I feel ok.

I still love you when you are difficult. When you cry, I try to help you. And when I can't make the pain go away, I will stay with you so you feel strong enough to face it until the day you tell me you are strong enough to face it on your own.

I want you to figure out the kind of person you want to be, and whoever that is, I want you to be happy. I hope you will be kind. Yes, your Dad and I will have rules, and no, you won't always like them. You won't always like us. Perhaps sometimes you will even hate us. But even in those darkest moments, deep down there will be a part of you that loves us. Imagine that part times a hundred, and that is much I love you.

I have never wished you harm. The very thought of you coming to harm makes me sick. But there have been moments when I wished I didn't have a baby - or where I could pass off the baby phase to someone else and have you back when you were a little older. I'm not afraid to be honest and own up to the fact I have had these thoughts, because I know what they mean.

Babies are hard work. It's not you in particular - all babies are like this. And when you first arrived in my life I was overwhelmed by just how much work it was, and I was scared I would not be able to handle it. In those moments, I thought I had done the wrong thing by becoming a mother.

But what I have realised is that it's not the fact that I have these thoughts that matters. It's the fact that I love you so much that I will do everything I can to keep caring for you even when things get so tough that I question my choice to have a baby at all.

I am glad that the dark moments for me are few and far between, but even if they weren't, that wouldn't mean I don't love you. It would mean you would know just how much I love you, because you would see that I will be there in the darkness as well as the light.

One day when you have a baby, maybe you'll have thoughts like these of your own, and if you do, you'll know that they do not mean that you love your baby any less. They're just one of the guilty secrets of normal mothers.

All my love,
Mum

Relation Ships

Today I received a message from someone who had been reading this blog, and part of that message was:

I'm really interested on your take of what having a baby does to a relationship. No matter how strong it was before hand.  The reason I ask is my relationship with [partner's name] was a very strong one but since [baby's name] it has really gone down hill and having a baby has really taken a toll on us.

What I found striking about the message was that once the names were removed, that message could have been written by almost any new parent that I know.

About two weeks ago, my husband and I were fighting about priorities, feeling unappreciated, and how much time and effort we were each contributing etc.  I was at my wit's end.  Luckily, a mutual friend gave me a big hug, sat me down with a cup of coffee, and told me that she had been through exactly the same thing, as had every couple she knew.  It wasn't that I was in a doomed relationship.  This was normal, and most couples work their way through it.

A baby, for better or worse, changes everything. 

I think it must be particularly hard for those in romantic do-everything-together type relationships - the relationships that might appear 'stronger'.  It's hard because a baby gives you a lot less time with your partner, at least once Dad goes back to work, and your share-everything life is probably what you conceptualise as the heart of your relationship.

In some ways I was lucky, because before the baby, my husband and I had plenty of different hobbies and different friends, and our definition of romance was pizza and a video.  We'd eat together, chat together, watch TV together, go to family events and some occasions together - but we spent more time doing our own thing.  I prefer to go to the movies, catch up with friends for coffee, study and read books.  He likes to go fishing or shooting, play PS3, or go out to the pub with his mates.  But even for us, it was a big change.  I reached a point after the baby was born where I felt we were nothing more than two ships passing in the night.

Two particularly tired, grumpy ships.

In addition to the time issue, there is the way parenting puts you into such different places.  When you are the woman, you are shoved into motherhood whether you like it or not.  You have to go through labour (or have major abdominal surgery), and you feel no choice but to look after the baby (for hormonal and cultural reasons).  But for many blokes, the arrival of fatherhood has a more optional quality.  The woman has no choice but to get up and keep running the marathon, the man has to motivate himself to do it.  As a mum, I sometimes feel I'm doing an endurance test, but for my husband I think it's different - it's about having the willpower to do the right thing all the time.  

What follows from this, and I know I'm generalising here, but this seems to be true for many couples: the man thinks of his free time as an entitlement that he sacrifices in an effort to do the right thing by the woman and baby, whereas the woman thinks of free time as a luxury she could maybe organise for herself if she found someone to care for the baby.  I think it grates on mums that many dads accidentally or deliberately take advantage of this perceptual difference by simply going out of the house when they feel like it.  (For their part, the dads just notice all the times they felt like leaving but dutifully stayed in the house and helped, and cannot understand that their partners are objecting to such a small time away.)

Then there is perception by some fathers that mothering is just not that hard.  I mean, you just do laundry, and feed and play with the baby, and that's about it - isn't it?  And to be fair to the blokes, it is almost impossible for anyone to imagine what it's like to be a new mum until they do it for themselves.  They don't know what it's like to have your whole body out of your control, to feel perpetually hungover with sleep deprivation, to have hormones switch on this avalanche of fear and worry for the baby, to feel the baby's crying inside your skull, and to have even the simplest tasks (taking a shower, going to the supermarket) become major strategic missions that take ten times as long as they used to and which you often have to abandon part way through.

The mums are so overwhelmed by dealing with all these changes that they have no energy to recognise or support the adjustments the dads are making.  Instead of being able to come home and unwind from work, a dad now has an exhausted, emotional partner who expects their attention, support, and assistance.  Instead of being your first love, they have been shunted out of the way by your new love.  

It is annoying for mums when they go out somewhere and their partner holds the baby for a mere 10 minutes and people say, "Oh look, what a great dad."  But the flipside is that when mums work, they are considered supermums, but when dads work, everyone thinks... so?  And whereas mums can vent and generally be given hugs and coffee - if dads dare to have a whinge, everyone thinks they are indescribably selfish bastards who need to man up and knuckle down.

Happily for my marriage, we have been able to work things out.  We did this by setting really clear expectations.  And when I say we made them clear, we wrote them down and negotiated and redrafted until we were happy.  Topics we considered included: our roles and primary duties for the household and as parents, what 'family time' meant and how we were expected to spend it, how much 'free time' we each had per week, any particular times we expected each other to be home, and what communication was expected.  We could then see the whole picture, what needed to be done, and what was a fair division of labour.  We also considered how to build some flexibility into the arrangement.  

Writing it all down might sound strangely over the top and legalistic, but we needed to make a big shift in how we were doing things, and that required careful thought and commitment. Writing it down made us be thorough, and helped us stop getting bogged down in emotions and accusations, and turned the situation into a problem that we were going to solve together.  Instead of: "I want you to do x." we were saying things like: "Well, if I'm doing x, who's going to do y?" and "What's a fair way to break this down?".

No, there's still not much romance.  Yes, we're still challenged and sleep-deprived by parenthood.  But now we are working as a team and thinking together about how we're going to live as a family.  

I guess what I've learned is that when you have a baby, you may turn into tired, grumpy ships, but you probably won't be the Titanic.

Guilty New Mum Bingo!

I knew the first month as a new parent would be hard.  I had no illusions.  But I wish I had known that the particular failures and incompetencies I had were all too common.

Finally, here is something you can give new mums so they know they are not alone in their moments of parental ineptitude.  That's right - what could be more fun than Guilty New Mum Bingo!  Tick off those craptacular, joyous, and guilt-inducing moments as you have them.

Hand out at the hospital or take to mother's group.  Suitable for approximately the first two months post-partum.

Download the full size version to print here.

Save Our Baby... From Tizzie Hall

New parents talk endlessly about sleep. There is a huge industry built around providing advice to sleep deprived parents, from self-help books and consultants, to 'sleep schools'. People often ask me, “Is she a good baby? Does she sleep well?” in one breath, as though the two questions are synonymous.

What makes the topic particularly difficult for new parents is that many sleep 'experts' are particularly forceful in pushing their particular method, making unrestrained claims about its success (if it fails, you're just not doing it right), and fear-mongering about other methods (other methods will make your child stupid / obese / spoilt etc.) These forceful opinions are usually expressed without citing any evidence, as though the facts are self-evident – sometimes with vague or selective references to 'studies', but no serious analysis or exploration of the research that is actually available. Mostly, these opinions are supported by de-identified anecdotes that may or may not even have occurred, selective testimonials, and sentences that begin 'in my experience' – there is nary a footnote in sight.

Tizzie Hall... helping parents put their babies to sleep or making a f*ckload of money by giving parents a guilt complex? Perhaps both?

Some sleep gurus, like Tizzie Hall, who has no qualifications to speak of, have webpages which provide some 'tastes' of advice in order to try and induce you to spend ridiculous amounts of money on them. She will sell you a .pdf with some 100 pages or so of general advice for $38, and for no less than $350, Tizzie will personally... wait for it... reply to an email from you!

Buy! Buy! Buy! (Tizzie's homepage with advertising highlighted.)

But while I find Tizzie's exploitative marketing a bit vomitous, I have to admit that I know a number of people who swear by her advice – stating that Save Our Sleep saved their sanity. I should also admit that Tizzie Hall went from being vaguely not for me to Someone I Hate because someone recommended her to my husband in the early days, and then for the first two months every time the baby did anything difficult, he'd say, “You wouldn't have this problem if you just used Save Our Sleep.”

We were out of sync because before we had the baby we both agreed that routines and consistency were crucial for children, but what we hadn't discussed is our views on letting babies cry. This was because I didn't really have a view on crying before I had the baby. Then when I had a sleepy newborn, I didn't need to think about it because she only cried if she needed feeding or changing, basically – so I always just responded. But then at 3 weeks when she became more awake and developed grizzling and a witching hour (or 5 hours), I didn't know what to do. I asked a child health nurse and she told me that the baby was just overtired and I had to let her cry to sleep – that she would just be crying because she was tired, not because she was really unhappy. She said babies would reach a peak in crying then drift off. She showed me how to settle her in her pram by patting and shushing her while she cried for about 10 minutes until she fell asleep. It was horrible – she really screamed - but it worked.

Feeling newly empowered, I attempted her method the next time she needed to sleep. She cried, and cried, and cried – no matter how much I patted and shushed. Eventually, I picked her up and settled her, but thereafter whenever placed in her pram, even when happy and awake, she would become instantly distressed and start to cry. If I put her down asleep then her eyelids would flutter open five minutes later and if she found she was in her pram, she screamed. I was up and down with her that night as I tried to get her to sleep in the pram, she did not sleep for more than 5 minutes at a time, just kept waking and crying until she crashed out exhausted at 3am. It was such an astonishing change in behaviour, from a baby who had always been happy to be put in the pram unless she just didn't want to be put down at all, to a baby who always hated it, that it was hard not to see a link.

I wondered if she had just developed a fussiness with being put down to sleep (rather than the pram in particular), so I tried to put her in her cot – she was happy to be put in there awake, and if rocked to sleep in my arms, she would do several sleep cycles happily in the cot as well (except at witching hour, when she would not sleep anywhere very well).

It was at that point I decided that I was not going to do any method that involved letting her cry. I couldn't know for certain, but it seemed that the crying had 'trained' her to understand that her pram was a nasty, nasty place. My husband thought I was jumping to conclusions. Maybe so, but it had been a horrible night and I was not about to chance her developing a phobia of her cot as well.

Fortuitously (or, because I am such a nerd that when pregnant I had spent many a happy hour reading reviews on Amazon and purchasing books I thought might be useful), I had a copy of Elizabeth Pantley's The No-Cry Sleep Solution, which I was able to put forward as a legitimate alternative approach.

The No-Cry Sleep Solution or the No Sleep Cry Solution? Views differ, but I found it useful.

Pantley, I suppose, is also a 'sleep expert'. But her book comes from a different perspective. She wrote it as a mother who found that letting her baby cry was too distressing, so she started to look for alternative methods that could work. The only thing Pantley sells is her books, and on her website she offers most of her advice in summary form for free.

The other alternative source of advice comes from Pinky McKay's Sleeping Like a Baby. Pinky provides lots of vigorous pep-talky articles on her website for those who are resisting the advice to cry. I feel a bit uncomfortable that she runs it like a business, but at least her rates are a lot more reasonable ($295 for a 2 hour visit to your home, plus a book and DVD, plus follow-up phone consultation – and she will advise on breastfeeding and baby massage, both of which she is qualified to advise on, as well as sleep).

But like crying didn't work for me, the No-Cry Sleep Solution and Pinky McKay don't work for everyone either. Like I said, Tizzie's advice does work for some people.

But before you hand over your hard-earned dough to Tizzie, consider the following:

Does a schedule suit you?

Which best describes you?

a) I like to roll out of bed at 6am pronto every morning and hit the gym, eat a precise (perhaps calorie controlled) breakfast, get to work at time x etc. If someone or something disrupts my routine, I feel lousy and out of control.

b) I suppose I have some patterns and some favourite things, but I'm not strict. I sometimes like to be spontaneous. Following a strict schedule would make me feel tied down and miserable.

If you strongly align with answer 'a', then you are probably going to warm to a Tizzie Hall-style 'sleep expert' approach. But you don't need to pay Tizzie Hall for them. Jo Ryan (BabyBliss) has a bunch of baby sleep routines similar to Tizzie's freely available on her website (http://babybliss.com.au/services/babybliss-routines/).

If you strongly align with answer 'b', even if you can get Save Our Sleep to work for you, you may hate it. Putting your baby on a schedule means putting you on a schedule too, and it may make it impossible for your baby to sleep anywhere except in his or her cot at home – which can be awful if you need or want to go somewhere else. Remember that a schedule is different from a routine (even though some experts call their schedules 'routines'). A routine is where you have a sequence of activities leading up to a sleep (eg. feed, play, feed, sleep. Or bath, massage, feed, cuddle, bed.)

Are you exclusively breastfeeding?

You can only follow a schedule-based approach if you do at least some bottle feeding. Breastfeeding requires you to feed on demand, so breastfeeding to a schedule does not work. Your baby goes through growth spurts and needs to feed more to trigger you to make more milk etc. If you have amazing milk supply you may be able to express enough for all your bottle feeds to be expressed milk, but beware that most women are unable to express as much milk as their baby can extract, because babies are naturally better at it. I never could express as much as my baby needed, and even to get most of a feed took about an hour and a half.

Even Tizzie Hall is explicit that unless you can express as much as she suggests, you should not follow her routines. Nevertheless, she and many other sleep experts give advice on breastfeeding such as 'feed for x minutes from left breast' etc. This is rubbish breastfeeding advice and can lead to supply issues and mastitis.

When do you plan to go back to work?

A number of women I know who like Save Our Sleep or its equivalents had to go back to work pretty early in their baby's life – and so did not have the time to do a more baby-led approach.  But if you are not going back to work so quickly, maybe you don't need to.  When considering timing, remember most sleep experts reckon their methods work within a couple of days to a couple of weeks.

What is your view on crying?

a) You have to be tough. If you always respond to the baby, you'll teach them you come running every time you cry.

b) Well, I don't think crying's a good thing, but quite frankly, I don't have the energy, patience, or time to be helping them every single sleep. I need them to learn to do it themselves. And if that takes a little bit of crying I can tolerate it.

c) I won't let the baby cry if I can possibly help it. End of story.

If you align with view (a), then you should probably be aware that even the majority of sleep experts would disagree with you. Before you go down this track, you should read about some of the arguments against letting your baby cry it out. In particular, you should read the Australian Association for Infant Mental Health's position papers on the issue: http://www.aaimhi.org/policies.php. Some other website you might look at are the collection of articles on this blog: http://bawlingbabies.blogspot.com/2006/07/comfort-babies-rather-than-let-them.html, and this website dedicated to discussing some of the problems with Gary Ezzo's strict approach in On Becoming Babywise: http://www.ezzo.info/. If, after reading this material, your views haven't changed, then rather than just leaving your baby to cry for hours, you could try the controlled crying technique suggested by the paediatrician Richard Ferber – described here (http://baby.about.com/od/sleep/ht/How-To-Help-Baby-Sleep-Using-Ferberization.htm)

If you align with view (b), then advice from routine-based sleep experts may be helpful. Aside from Tizzie Hall, you could look at:

• Sheyne Rowley (Dream Baby Guide. Australian. Flexible routines, some limited crying but if crying try for no longer than a few days. Rowley's focus on communication eg. Role-playing routines before trying them, are probably best suited to an older baby http://www.australianbabywhisperer.com.au/html/methodology.html)
• Jo Ryan (Babybliss. Australian. flexible routines, some limited crying but crying for no longer than a few minutes) (http://www.babybliss.com.au/)
• Nicole Johnson (American. Advocates a range of non-crying and crying methods. Most advice freely available online. http://www.babysleepsite.com/)
• Gina Ford (The Contented Little Baby Book. British. But, like Tizzie, charges for any information at all – and doesn't give any advice you can't get from the others.)

Before you embark on these programs, it is worth pointing out that routines and crying methods are not necessarily quick fixes. Some babies adapt to them well. Others fight and fight them, and then just as soon as you have them cooperating, you have to start again with every growth spurt, every cold, every trip away etc. But these authors have a large range of ideas for settling and guides for routines and sleeping that may help you.

If you align with view (c), know that this is not a view just advocated by mums like me who are too wussy to let their babies cry. It is supported by infant mental health bodies on the basis of research into attachment, because it is thought that regular unresponsiveness to your baby's crying disrupts the process of attachment, which leads to lower self-confidence and a more clingy, needy child as your baby gets older, followed by a less empathetic and more rebellious teen. You should consider Elizabeth Pantley, Pinky McKay, and Nicole Johnson, all of whom are already mentioned above.

How old is your baby?

a) Is your baby younger than about 4 months?

If yes – relax and stop worrying about 'bad habits'. Babies don't begin to develop their understanding of cause and effect until about 4-6 months (see this entry in Cornell University Medical School's Child Health Library). Before this, your baby, as far as he or she is aware, lives only in the present. Your baby may be developing memories (although how well they can store and retrieve memories is debatable), but no sense that time is directional or that events can be purposeful. For this reason, it is unlikely that a baby could learn that crying makes you come running in the first few months of life, because that would require your baby to grasp cause and effect. This doesn't mean that your baby can't form associations. So, if you always wrap and rock your baby to sleep, your baby may start to associate rocking and wrapping with sleepiness, and rocking and wrapping may induce sleep. But this is quite a different thing from a baby learning a sequence of events leads to sleep (knowledge which requires an understanding of causality and time). So rock and wrap and feed and your baby to sleep to your heart's content. You can try and put your baby down sleepy but awake if you want to, and maybe they will drift off to sleep, but even if they do, they probably aren't learning to drift off to sleep unassisted, they just happen to be doing it. As you approach 4 months, they become more alert and their sleeping patterns change, so you will probably find it all goes haywire anyway.

Rather than worry about bad habits, focus on getting your baby to relax in order to get to sleep. If you are having trouble, a good place to start is the 5 S's method advocated by paediatrician Harvey Karp in his book, The Happiest Baby on the Block, summarised here (http://www.colichelp.com/shop/happiestbabyontheblock.html) – or explained by Karp here in this freely available video. I found it was useful to see exactly what Karp meant by the 'Swinging', since what worked for us was the gentle jiggling he advocated, but which I would never have thought to do because I would have been worried it was too close to shaking a baby.

If your baby is an escape artist, here is another swaddle. As Karp points out, babies don't usually like initially being swaddled so many parents give up on the swaddling before giving it a chance, but once they are swaddled, using one or more of the other 5 S's frequently calms them. It is a bizarre thing that they resist the swaddle and then calm right down with the other S's, but doesn't calm if you do the other S's on their own. I found I needed a wrap that was at least 120cm x 120cm to do a proper swaddle. One of the nice things about Karp's techniques is that all 5 S's are things fathers as well as mothers can do.

The only disadvantage of settling to sleep in your arms prior to about 4 months is that the baby goes to sleep one way, and at the end of their sleep cycle (usually 40 minutes) wakes to find up to find himself somewhere else, which can freak him out. If your baby wakes up every 40 minutes through the night, every night, then this might be what is happening, and you'll need to find a way to get your baby to sleep in the cot. Alternatively, you could try co-sleeping.

b) Is your baby about 4 months or older?

While every baby is different, around 4 months babies can and do start developing notions of time, causality, and their role as a causal agent. This means they can start to not only be relaxed by warm baths and baby massages, but start to know that such events lead up to bed time. So it can be helpful to start doing a wind-down routine at this stage.

If you still have lots of night wakings and still don't want to try crying, then yes, you may create certain sleep associations on which your baby becomes dependent, but remember that it's not a problem until it's a problem for you – and your baby can always unlearn these habits if that becomes necessary. See this great article by Nicole Johnson (http://www.babysleepsite.com/baby-sleep-support/baby-wont-sleep-your-fault/).  Some time between 12 months and 5 years, your baby should naturally outgrow these needs, or reach an age where you can teach them a new way to fall asleep by talking, role-playing, and using their pride in being all 'grown up'.

It may help to remember that a baby has growth spurts and developmental leaps. For $2.49 you can get the Wonder Weeks app for an iPhone (http://itunes.apple.com/au/app/the-wonder-weeks/id342152206?mt=8), which helps you appreciate when your baby is likely to be more fussy and difficult and when they will be calmer and easier to settle. If nothing else, this can help remind you that even with the best routines, there are other factors involved.

Do you need more intensive / personalised help?

If so, you can look into sleep schools or consultations.

• Karitane (http://www.karitane.com.au) in NSW offers a sleep school for babies older than 6 months, and settling assistance for babies younger than this and has a phone line for advice: 1300 227 464.
• Tresillian (http://www.tresillian.net/) in NSW offers sleep schools, consultations, and phone advice. Freecall: 1800 637 357
• North Park Sleep School in Melbourne and Pinky McKay offer personalised help that does not involve crying methods.
• Nicole Johnson will do an email consult for $29.95 USD, or unlimited emails for a month for $239 USD.