The recent issue of Time that taunted parents with its headline of “Are You Mom Enough” alongside a provocative picture of a larger-than-average three-year-old nursing while standing on a chair has unleashed a firestorm of debate, criticism, and defensiveness. Interestingly, I see a lot of parents that I know to practice many of the tenets of Attachment Parenting (AP) minimizing the importance of those practices in favor of assuring everyone that we’re all doing the best we can and all choices are valid choices—that there are many ways to raise healthy, happy children. And this is true. We are all doing the best we can. But many of us have made a decision to practice AP—an unpopular and scrutinized choice. We did this intentionally. We did this because our instincts led us here, and we did it because research supports it. There are certain practices that are backed-up by evidence, and some of us chose those practices on purpose. We are so worried, though, about making others feel bad (with our words and our choices) that we are minimizing our own conscientious decision-making. But remember: we are not trying to guilt-trip anyone. That was what Time doing that with its divisive, disingenuous headline meant to stir up more fuel for the Mommy Wars fire.
What does that mean that something is backed-up by evidence? Well, evidence-based practice is a term used by medical professionals that takes research (as well-designed as possible given the tricky ethics of studying humans) and combines that with clinical experience and patient values to guide decision-making. As a midwife, I am challenged to support any recommendations I make or information I present with evidence—anecdotal information and “old midwives tales” just aren’t going to cut it anymore.
Why, then, as a parent, would we make decisions based on what our mothers did, who made their decisions based on what their mothers did? Some of that might be the experience piece of evidence-based decision making. But that is only one piece of three and they may be giving advice based on a foundation of outdated information. In many cases we have been exposed to the message of something (i.e, “Breast is best”) but haven’t really delved deeper into understanding why or in what ways one particular practice might be supported by evidence. We may know something on one hand, but know the opposite on another (i.e., “I was raised on formula and am just fine”) and make an emotional or quick decision based on the anecdotal evidence rather than the researched evidence. My fifteen years of parenting has at least taught me that theory and practice do not always walk hand-in-hand. Most often, we like the idea of something but aren’t fully informed about or supported in its implementation. My desire here is to highlight the evidence-based nature of AP practices. It is not to convince one to practice them. I suppose it is to explain why we do what we do, because I think there can be very unfair characterizations of AP parents.
What about AP?
So, AP is a general parenting behavior, or set of behaviors, that places priority on meeting the child’s needs. It is meant to be responsive parenting. It is, unfortunately, distilled down to several behaviors as recommended by Dr. William Sears in The Baby Book. I say “unfortunately” because it is more than these behaviors and less than these behaviors. You can be an attachment parent and not practice all recommendations, or you can practice each and every one and not be an attachment parent. For me, I know that it was easy for me to practice all behaviors (and then some), but still struggle with the responsive connection that practicing AP strives for. Still, as a pragmatic approach to this discussion, let’s look at the some of the quintessential practices of AP. (Note: there is recognition by me and other proponents of AP that all of these practices are not possible all the time—interventions are required for a multitude of reasons. That doesn’t mean the behaviors are unimportant, though, even when they are not possible.)
|Rhys's first nursing after a peaceful homebirth |
and uninterrupted immediate postpartum.
Dr. Sears recommends preserving the immediate connection that moms and babies will have in the immediate postpartum if undisturbed. The incredible body of work by Nils Bergman confirms this. Not only is this bond after birth an important connection, it protects the baby from blood sugar dysregulation, temperature instability, and promotes an optimum initiation of breastfeeding. There is no research that supports immediate separation of mother and baby (and, by the way, keeping baby in the room, but not in physical contact with mom is still separation—as far as that baby knows his mother is in
Birth practices are also important for successful breastfeeding initiation. To read more about this, I wrote an article on this topic (page 4) and highly recommend Linda Smith’s Impact of Birth Practices on Breastfeeding
|Rhys, 26 months, nursing after breaking his leg. |
Nothing gives comfort like mama's milk.
It is far beyond the scope of this article to explain the myriad reasons why breastfeeding is important. That is fodder for volumes, not a paragraph. But it is undisputed. I think, though, that the focus on this issue is particularly surrounding the idea of nursing past infancy. That, too, is supported by evidence. The World Health Organization recommends breastfeeding for at least two years, the first six months of which are meant to be exclusive (meaning no complementary food or other baby milks during that time). Indeed, there is no health organization that does not recommend breastfeeding for at least a year. Most recommend at least two years. This doesn’t mean that you cut them off cold at two. It means that you continue past two “for as long as mutually desired by mother and child.” (Thanks to the
of Pediatrics for that phrase.) American Academy
Kathy Dettwyler is an anthropologist who explains the issue of toddler/preschooler nursing, and the ages of biological weaning, better than anyone. In short, it is normative behavior to nurse well past infancy.
Again, evidence for early weaning is non-existent. Evidence for nursing well past infancy abounds.
Perhaps of all the AP tenets this is the least researched. I know that my decision to babywear was greatly informed by the late Jean Liedloff’s book, The Continuum Concept. This book is an anthropological look at how other cultures keep their children close. Though we do not have the same body of evidence here as we do for breastfeeding, we can take an anthropological look at this issue, and we can also look at risks to not carrying our babies much of the time. For example, we know that excessive car seat use (using the infant car seats as baby carriers) has been implicated in cranial asymmetry.
It is a common anthem of parents that “my baby is happy until I put him down.” Humans are “carry mammals” rather than “cache mammals.” That is—we are designed to have our babies with us, rather than leaving them in the den or nest as do other animals. It is an instinctive need for a baby to be in physical contact with his mother. Because of this, infants are often distressed when left alone, and reducing infant distress is probably one of the most important motivations behind AP practices. Babywearing just makes holding your baby more manageable.
This issue may be the one where there is evidence on both sides of the debate. Make no mistake, sleeping at least in the same room as your baby is a universal recommendation. Sleeping in a room apart from your baby is highly associated with SIDS deaths. However, the American Academyof Pediatrics does not recommend co-sleeping in the same bed (bed sharing) as your infant, though many, many AP parents do so.
We know that bedsharing facilitates breastfeeding. We know that breastfeeding also significantly reduces the rate of SIDS deaths. I also feel that there is more research to be done here, as these figures may not reflect the practice of exclusive breastfeeding, which could potentially even show a greater protective effect.
We also know that many, many women will bedshare despite the AAP’s recommendations. It is very difficult to get up and get the baby in the middle of the night, compared to readjusting and helping him latch on right there. Kathleen Kendall-Tackett reports that mothers who co-sleep, though they do not have the long stretches of deep sleep, report less pain (which can contribute to postpartum mood disorders) than mothers who do not. I maintain that it is therefore important to inform women of the risk factors for bedsharing related deaths, so that they can make an informed decision for themselves. I highly recommend reading the work of James McKenna to learn about safe bedsharing practices.
This topic, then, is one where part of the decision-making incorporates the values preference of the parents. Though “patient values” is an important aspect to all evidence-based decision-making, in other areas there is no contradictory evidence. Here, where there are contradictions, it must necessarily play a larger role.
All of this is simply to say that attachment parents have made conscientious, rational decisions based not only on experience and instinct, but also on a factual understanding of a baby’s needs, and an understanding that those needs don’t magically change at one year of age.
|Margaret and I nursing our toddlers--my son Liam was |
2 years and 8 months here, her son Torin was 17 months.
There are many myths associated with AP and its practices: the child won’t learn independence, you can’t nurse a baby with teeth, you’ll never have sex again, etc. I would ask you to consider each myth that you believe to be true and do a small amount of research before perpetuating it. What you find will likely surprise you. After all, don’t people make assumptions and perpetuate myths about your vocation? (Is there a lawyer in the house?) Let’s not vilify a mother, any mother, for making the choices she has. Because, truly, we do not know what road she has traveled—there may be many reasons why she is parenting in the way she is. Indeed, I did not employ every AP practice with each of my kids due to misinformation and a lack of support. But my message for AP moms is this: let’s not downplay the choices we have made. We made them with intention and love. Please own them so that the world can see what AP (and extended breastfeeding and cosleeping and natural birth, etc., etc., etc.,) really look like. That is not judging others. That is simply being true to ourselves.
And finally, I would like to applaud Jamie Lynne Grumet for being brave enough to stand at the forefront of the firestorm. I feel proud that you represented us so well. Personally, I think that photo rocks.