Dear Nikki and fellow-lacnetters,

I have read with great interest the exchanges about THBOB posted
over the past month. I thank you all (especially Micky) for sharing
your experiences and I thank the listmothers for allowing me the
opportunity of responding to some of the very valid issues being
raised.

I have to admit, specifically, I was finally prompted to respond by
Nikki Lee's posts (see a sample below) because I feel responsible
for answering the several excellent questions she raises (and
because I don't want her to want to "smack me"). I care very much
what you all think, so I have spent several hours compiling this
response. I hope to convince you that I am your ally in the very
important work of encouraging women to breast feed and helping them
to succeed.

But, if you don't mind, let me share a bit of my background: I have
long been a part of the lactation support community. When I
entered pediatric practice, my two associates were LLLI medical
advisors Paul Fleiss and Jay Gordon.  For 10 years, I shared an
office with a midwifery practice and I attended many home births
and non-physician birth center births.  I was medical consultant to
the UCLA Lactation Training Program and have given many lectures on
breastfeeding to doctors.

When THBOB first came out, I made a personal trip to Schaumberg, IL
to introduce myself to the officers at LLLI and solicit their
feedback.  They supported my DVD and placed it on the LLLI
webstore (they chose not to promote my book, in part because of the
references to pacifiers). SInce that time, my baby calming work has
been enthusiastically endorsed by Jim McKenna, Sandra Steffes (US
Breastfeeding Task Force), Elisabeth Bing (co-founder of Lamaze),
Penny Simkin (co-founder of DONA), Kathleen Huggins (Nursing
Mother's Companion), Ann Grauer (past president DONA), and
Attachment Parenting International.  My work has been accepted for
presentation at several regional breastfeeding conferences, ILCA,
and LLLI national conference.  Most recently, the State of
Pennsylvania has adopted THBOB as an important part of their
breastfeeding promotion initiative and will be teaching it in
lactation centers across the state.

In other words, THBOB is a tool to help improve breastfeeding
success rates.  As you all know, many women struggle with nursing
because of stress and fatigue associated with prolonged  infant
crying.  Crying can lead to difficulty latching on, decreased
lactogenesis and let down, loss of confidence, onerous diets, false
perception of child illness, loss of support of father and family,
increased depression, etc. ALL of these stack the deck against
nursing success!

Questions:
What's new about THBOB? Aren't you teaching (and taking credit for)
what has been know for thousands of years?

THBOB is new in 3 critical areas - 1) the importance of the idea of
"the missing 4th trimester", 2)the existence of a calming reflex,
3) instruction on how to do each of the 5 S's optimally

1) I did not originate the idea of the 4th Trimester...it was
discussed by many in the past (besides Ashley Montague...I refer
you to an excellent book that was entirely devoted to this subject
-  The Continuum Concept  Jean Leidlhoff 1986).  However, THBOB is
the first common parenting guide to stress this concept.  In fact,
most book sstress stimulating and teaching babies...which has lead
to  the whole Babywise idea that you have to dominate your baby
from the first days of life.  My philosophy is not at all what you
state "technology versus heart." My work strives to enlighten
parents on the richness of the sensory world of the fetus and how
important it is to spend a large part of the day replicating that
for their babies.

2) While we have known about swaddling, shushing and rocking for
millenia...my idea of the calming reflex is a revolutionary new
idea that has never been advanced before.

3) While swaddling, shushing, rocking have been know for millennia,
it turns out that there is an optimal way to do them for
success...especially with colicky babies.   The 5 S's are like the
ingredients to baking a cake.  If I told you to mix flour, eggs,
sugar and milk...you probably wouldn't end up with a very good
cake.  You need to know how much of each, how to mix them, how long
in the oven, what temperature.  The same is true with the 5
S's...there are specific ways to do them that are much more
effective. This is especially important with colicky babies...but
the 5 S's make even calm babies calmer (of course a major S's to
keeping babies calm is suckling at the breast).

As I describe in the book and video, this is NOT a one size fits
all...some babies prefer 1 or another S...some need several.
Parents have to try them and see what works best for their child.
But, having said that, reflexes are predictable...there are a few
specific things to do that  stimulate a rooting reflex...if you
touch the cheek too close to the ear it may not work...if you
touch both cheeks at the same time the baby may not know where to
turn and get frustrated and cry more.  Similarly, there are optimal
ways to do the 5 S's and when they are not done optimally they may
not work...or even make the baby cry more!

Is infant crying such a big deal?  Isn't breastfeeding all babies
need to be calm?

Persistent crying is a huge deal to parents/  It leads to
significant monetary and human costs.  Besides breastfeeding
failure, persistent infant crying causes:

Increased calls/visits to MD's with screaming, sleepless babies.
  Increased  ER visits and follow up doctor visits.
  Increased  diagnostic tests for sepsis and reflux and Increased
unnecessary prescriptions of drugs.
  Increased incidence of postpartum depression...with resultant
reduced missed work, doctor visits, medication, suicide, etc. (A
prime trigger for PPD has been shown to be fatigue on day 14 post
partum...this is directly helped by parents learning the 5 S's -
Corwin,E, et al, The Impact of Fatigue on the Development of
Postpartum Depression. Journal of Ob Gyn and NN Nursing 2005;
34:577-86)
  Increased  incidence of Shaken Baby Syndrome...with resultant
reduced hospital and rehab care, legal costs, etc. (In 95% of SBS
episodes, teh attach is precipitated by infant crying...the average
age is 3.5 months. The monetary value of saving a single child from
brain injury from SBS is estimated to be between $1-2 million.
Enough to pay for this type of program for a county for a year! )
  Increased incidence of SIDS! (More on SIDS below)
  Increased marital stress and improved parent sleep and work ability
  Potential Increased in rate of childhood obesity (via decreased
overfeeding)

And of course there is significant benefit to teaching parents to
be competent baby calmers to improving parental bonding and the
overall psychological health of the family unit.
  Suckling at the breast is wonderful, but unfortunately studies
show that nursing babies have the same 10-15% incidence of colic
(crying/fussing more than 3 hours a day) as formula fed babies.

Why doesn't THBOB encourage baby wearing and skin-to-skin?

Nikki is only partially correct when she states that other
cultures are successful at soothing crying because the respond so
quickly or practice baby wearing. Moms of a colicky baby respond
quickly (with rocking, feeding, "wearing" whatever they can think
of), obviously if these worked...there would be no such thing as
colicky crying. Ron Barr showed infant carrying lessed crying in
non-colicky babies, but made no difference in colicky babies.

Baby wearing is very important.  I had a short essay on in in the
book, but it was cut by the editor. Carrying is not specifically an
"S", but it automatically gives babies several "S's" simultaneously
and it is recommended several times in THBOB. Also, recommended  in
THBOB is infant massage (4 pgs of THBOB are dedicated to the
benefits to babies, and parents, of infant massage.)

If a baby is swaddled and white noise is playing, will you miss
early feeding cues?

When swaddling and white noise CD are used all night long, the baby
usually will sleep an extra 1-2 hours at a stretch.  I am not
looking for babies to sleep 8 hours at a time...or even 6, but I am
trying to give parents a 4-5 hour stretch of sleep.  This leads to
the obvious question, won't swaddling and white noise obscure the
hand to mouth cues or mild fussing that signal early hunger?  Yes,
they will.  But, in all honesty, very few women in our culture
suckle their babies the 50-100 times a day that humans are supposed
to receive.

I would hope to persuade you that babies who sleep a little more at
night can easily get the 8-12 feeds/24 hours that are routinely
recommended by waking them every two hours  during the day.  Babies
easily adapt to that schedule...and if they get more than a little
hungry during the night and begin to fuss, naturally they need to
be nursed.

(During the first 2 weeks of life, it is very important for parents
to be taught to wake their baby up out of sleep after a few hours
to make sure the baby is getting at least 8-12 feeds so the feeding
can be established and the baby does not get dehydrated.)

What proof is there that the 5 S's are effective?

There is a robust body of research supporting my observations and
recommendations (over 50 peer reviewed references that I am happy
to send to anyone who wishes).  They can be divided into 3 pillars
of evidence:
1) Numerous peer reviewed studies demonstrating efficacy of
swaddling, white noise, rhythmic motion, and sucking on diminishing
infant crying (including the additive effect of multiple
   modalities used simultaneously)
2) Field studies of aboriginal parenting and "proximal parenting"
techniques in our culture that significantly diminish excessive crying
3) The Happiest Baby video (essentially a video multiple case study)

Several studies are underway/planned to further validate the 5 S's
approach.  An NIH-funded study began this summer at Penn State
using THB educators with healthy primips.  Researchers are
examining infant parameters (sleep, cry, weight gain to see if
obesity risk can be lowered) and parental parameters (depression,
feelings of competence, sleep, etc).  Researchers plan to replicate
this study at UNC.  Other studies are being developed in Boston
(with PCA America and Harvard School of Pub Health and WIC
parents), in New Haven with the CT dept of children and families,
and perhaps at Riley Children's Hospital in Indianapolis.

             ***********************************************

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