Dear Nikki,

First, as you will see when you read my book, I have never suggested that mother's should do 50-100 nursings/day.  As you pointed out, we adapt our expectations to fit our culture.

But, when you say "how can a THB practitioner say that this method promotes breastfeeding?" I am afraid you are missing the forest for the trees..

I am sure we both have the same simple goal - to help parents (moms and dads) feel successful in meeting their child's needs (including calming crying efficiently, promoting successful nursing, and facilitating sleeping behavior). But, despite all the great information that is available to all parents about nursing, the information about baby calming and sleep have been very poor and misleading.

I released my DVD and book in 2002, because there is a REAL problem in our culture that was not being addressed. It had to do with parents feeling incompetent and because of an inability to adequately calm their baby. 

At least 25% of babies in our culture cry/fuss more than 2 hours/day!  These are RARELY hungry babies. As we know, feeding is usually the first thing a parent tries when her baby is fussy. These are also babies who are not helped by skin-to-skin or who are helped by it, but then cry again as soon as they are put down. 

This is a real problem…and occasionally it is tragic.  Infant crying can provoke PPD, SIDS, SBS, marital stress, poor bonding... AND breastfeeding failure.  

It is well known that breastfeeding moms of fussy babies are often recommended to go on a very restrictive diet...to stop nursing for a several days...or to stop completely. This may well play a significant role in the attrition in breastfeeding rates that are routinely reported between birth and 4 months of age.

If you can help a mom calm her baby easily (and get some well deserved rest) you will prevent many from ever reaching the point of frustration, demoralization, guilt, depression and feelings of failure (not to mention, loss of family support for nursing) that are SO undermining of her successful nursing.  And, as a giant bonus, feeling competent to calm a baby who is not  (to say nothing of other positive engagement with her baby).

And remember, this is still ongoing despite a very extensive decades long education campaign by the pro-lactation educators. 

And, these are not all “colicky” babies.  Even a baby who cries just 1 hour a day may be difficult for a family to deal with if they are struggling with other challenges (illness, fussy toddlers, single parents, twins, financial stress, marital difficulties, depression, prematurity, ill grandparents, recovery from C-section, etc, etc).  This is why it is so important to teach the 5 S’s to ALL parents, not just those who get up the courage to call the doctor after weeks of suffering at home with a screaming child.

Crying can undermine breastfeeding success for several reasons.  1) It can be difficult to latch a baby onto the breast who is crying and flailing (or they may get latched on hurriedly and incorrectly); 2) the crying can lead to extreme stress and fatigue, which can lead to reduced milk production or difficulty letting down the milk that is there; 3) mothers of crying babies (and their husbands, doctors, and family members) may lose confidence in the quality or quantity of their milk pressuring them to stop altogether. So, when you ask “how can a THB practitioner say that this method promotes breastfeeding?" This is how! 

I totally understand your concerns about missing early feeding cues.  In fact, your point  makes the argument for all parents taking a class to learn the 5 S’s….which is the goal of our THB educator’s program. That is because parents who are taught the 5 S’s are always encouraged to 1) swaddle only during sleep and fussy periods 2) that inside the womb babies are held, rocked and shushed 24/7…so having your baby in your arms for 18 hours/day may seem like a lot to you, but from your baby’s POV it is a dramatic reduction in calming, loving stimulation 3) feed the baby first when the baby cries and 4) wake a baby for 8-12 nursings a day until the breastfeeding is well established. 

When these are done, there is no concern about the mom missing early feeding cues during the night.  She is picking them up frequently during the day, and occasionally, she is anticipating them…even before they occur. We know that the !Kung babies nurse 50-100 times a day, so it is obvious that waiting for “early feeding cues” is not necessary for a mom to decide to offer the breast…and for a baby to take it.

I reiterate to you that the 5 S’s are NOT new…but teaching parents how to do them optimally IS new….and that is the critical difference between success and failure for many parents. (This is very similar to teaching successful nursing techniques.  But, while there are many excellent texts teaching the specifics of nursing technique, THBOB DVD/book is the FIRST parenting guide to teach the specific techniques of infant calming.)  


You are certainly free to ignore the 5 S’s. But, I beg you to read the book AND watch the DVD before you make further attempts at criticizing my work.  On the DVD you will see baby after baby going from crying to quiet alert…in seconds! This sudden, predictable response to a specific stimulus are many of the characteristics that define a “primitive reflex”. I look forward to your feedback about this response after you see it.  It may not be a reflex, but as a pediatrician and child developmentalist for 30 years (with special areas of interest in early infant development) I find this the most reasonable explanation for this wonderful response.

Just like breastfeeding, the 5 S’s are techniques that are not 100% intuitive…that our culture has forgotten or devalued over the past 200 years…and that parents desperately want and need.


Warmly,

H


>Date:    Fri, 16 Feb 2007 13:17:26 EST
>From:    Nikki Lee <[log in to unmask]>
>Subject: Dr. Karp's reply
>
>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.
>
>
>
>Dear Friends:
>    No one, anywhere is asking women to nurse 50-100  times a day. 
>    In cultures where people don't wear clothes and the  baby is carried all 
>the time, nursing rates are very high. Like the Kung San!  that feed 60+ 
>times/24 hours.
>    However, those of us that live in temperature or  colder climates can't 
>do that.
>    We are asking mothers to pay attention to feeding  cues, and nurse at 
>least 8 times in 24 hours.  Dr. Karp says: "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."
>    How then, can a THBOB practitioner say that this  method promotes 
>breastfeeding?
>    warmly,
> 
>Nikki Lee RN, MS, Mother of 2, IBCLC, CCE
>Lactation Consultant,  Philadephia Department of Public Health
>Maternal-Child Adjunct Faculty, Union  Institute and University
>Film Reviews Editor, Journal of Human  Lactation
>www.breastfeedingalwaysbest.com

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