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foundation of outdated information.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.)
Birth Practices
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| 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 Alaska ).
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
Breastfeeding
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| 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 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.
Babywearing
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.
Sleep Sharing
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.
So?
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.
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| 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.
