How to Get Your Baby to Sleep Through the Night

Wednesday, September 29, 2021

How to Get Your Baby to Sleep Through the Night with Eva Klein

(Taken from The Birth Lounge Podcast with Eva Klein, Certified Sleep Consultant)

So I am a certified infant and child sleep consultant. I help exhausted moms get their little ones consistently sleeping through the night so that they can be functioning humans again. And I got into this business because of my middle child. So, um, I'm a wife and a mom of three. I live in Toronto, Canada and I, my kids are 10, almost eight and almost three. Um, and so it was my middle child that got me into this business because interestingly, I'm actually a lawyer by training. So my previous lifetime, um, which wasn't, which was you about 10 years ago now I was working as a lawyer. I basically finished law school, had my first baby. Um, that first baby was like this unicorn baby that made me look amazing and was just so easy and happy all the time and you know, slept amazingly. And then a couple of years later when I was done law school and got called to the bar and I was working, I had, I gave birth to my second daughter who unlike her older sister, you know, this baby was a very high needs, very difficult. 

I could tell from the second that she was born. When I say the second, I literally mean maybe 20 minutes after she was born. I could just tell that this baby was different. That her temperament was different. She was, you know, fussier. She was crankier. I have this image of my husband. It was probably four o'clock in the morning and he's walking around the postpartum ward, holding this baby, trying to get her to calm down. And, uh, that was never the case with my older one. And so naturally she did not sleep. She was waking me every 90 minutes all night long. You know, when she was four or five minutes old, I was so exhausted. I literally felt like I was going to die. I was not functioning. I could barely cope with life. And I should just mention that I was on maternity leave. 

I mean, I don't mean to rub this in the faces, any of your American listeners, but I mean, here in Canada, we get 12 months of maternity leave. Actually. Now it's technically you can take up to 18 months. Um, so I really, I hate mentioning this on an American broadcast because they feel so terrible. My sister lives in New York. I should just manage it. And she had her first baby about three months ago and she's going back to work soon and she's literally beside herself. So I, I know how hard it is, but it's relevant to the story here and that I was on maternity leave. I was dying from the exhaustion. I had no choice, but to open up the sleep books and figure out what to do. And I managed to make the situation a little bit better on my own, which gave me some clarity. 

What does 'sleeping through the night' REALLY mean?

For my purposes, I do like to use one definition of sleeping through the night and that is baby sleeping 11 to 12 hours uninterrupted. Now, when is a healthy baby able to consistently do that? In my experience, definitely by eight months, but I've definitely seen babies younger than the eight month period be able to pull that off. However, there are just as many babies in that four to seven month mark that might still need that one feed around, let's say 3:00-4:00 AM. So it's definitely a little baby dependent, but I would say for the most part, if a mom comes to me with a five month old baby who is waking her up multiple times a night to eat, we can absolutely get that baby sleeping significantly better than the way that baby is right now. I can tell you for a fact that when you get a baby who is waking up four times a night down to one night waking, it is a game changer when it comes to mom's mental health and ability to function on a day to day basis. 

The number one thing you want to make sure is that your little one is never over-tired.  Over tiredness is a massive sleep stealer when it comes to babies of all ages, right? It's going to cause them to fight sleep, fight bedtime, wake up more  unnecessarily at night, and give you short naps. It can also cause early rising as well. So from day one, I suggest making sure that your baby isn't up for too long throughout the day. That's really the key here is to be looking at their periods of wakefulness. 

How long can your little one be up for before they need to go back to sleep for newborns? The answer is not very long.  It is really important to stay on top of the appropriate wake windows for their age.  Most importantly, understanding that what goes on during the day directly impacts what happens at night is really, really crucial. 

As the day goes on, naps tend to get trickier and trickier for these babies because external homeostatic sleep pressure gets weaker. Basically there is this external force that basically just describes this buildup of sleep that helps babies fall asleep when they need to fall asleep. But as the day goes on, when that external sleep pressure gets weaker, that means that the baby is going to rely more and more on you to help them fall asleep. And that's okay because they're really little- and they may need your help here.  That may mean your last nap of the day before bed time is on a parent, in a stroller, or in a carrier.

Sleep Regression

So let's chat about the four month regression...one tip that I have for parents starts back in the early newborn days: to try to get your little baby down sort of awake half awake, drowsy, but awake. In other words, not completely asleep, maybe once a day. The reason for that is because it's a very important skillset that your little one is going to take with them throughout the next months and years when they are learning how to sleep like a champ.  When babies reach the 'regression' stage, what happens is that their sleep cycles undergo a permanent neurological change where they are now cycling in and out of deep and light sleep similar to the way that adults do.  

Now, the reason why I don't like calling it a regression is because the term regression implies that it's this temporary phase, that baby is going through and that all you have to do is just wait it out.  Your baby is not going back to being a newborn. Your baby's not going back to sleeping like a newborn. And they are now sleeping like an infant, which resembles that of an adult. So the solution at that age, if the baby relies very heavily on something like feeding or rocking to fall asleep, then we need to begin teaching that baby how to put themselves to sleep on their own without any help. By putting babies to bed drowsy but awake from day one you may be able to avoid being hit hard by this 'regression'.

It's definitely multi-faceted in that part of the solution needs to involve teaching that baby, how to sleep independently, right? Sleep, training, sleep, coaching, etc. There are many different approaches here. This doesn't just have to involve cry it out. If cry it out is outside your comfort zone, where you know you put the baby in the crib and you leave and you don't go back in- you don't have to do that. There are many other approaches that you can use, but part of the solution does need to involve teaching that baby to sleep so that they can connect their sleep cycles. 

At the same time, the sleep training is not going to work if that baby is overtired or under-tired. The daytime has to have proper structure that is biologically appropriate. We have to make sure that we've got those puzzle pieces in place first. And so that's why in my signature method that I use to help these moms get their little one sleeping, it's a four stage process for sleep training. A lot of parents don't even know that there is stage one or stage two.  These stage involves looking at the sleep environment, routines, schedule, the nap times the daytime, etc. That all has to be down pat first in order for stage three- the sleep training to work well. Check out my free masterclass for more information about these stages:

How to Get Your Little One CONSISTENTLY Sleeping 11-12 Hours at Night so You Can Be a Functioning Human!

Want to connect with Eva? Check out her website here! Or her Instagram here!

Five Impactful Tools for Your C-Section Recovery

Wednesday, September 22, 2021

Cesarean Recovery

Written by: Sarah Everly

No matter how we bring our children into this world, our bodies will have some healing to do. Bringing a baby earthside is physically taxing, and involves so many different systems of the human body. In the case of cesarean delivery, there are a few more steps added to the recovery process. We tend to neglect these steps when leaving the hospital, but it’s important to know what tools are available in your recovery toolbox. Here are the five most impactful tools that ensure a faster and more complete recovery. 

  1. 1. Walking- After surgery your epidural or spinal will be removed and over the next few hours the numbness will begin fading away. While you may leave the OR expecting to take it as easy as possible, you will quickly find that the first task on your “to-do list” is getting up and taking a walk through the hospital corridor. While this can be painful and feel like it adds insult to injury, ambulation is imperative to proper recovery. Why? Because it is the action of walking that jumpstarts our body’s routine functionalities. Walking as soon as possible after surgery, and continuing to take several short walks around your home each day encourages proper blood circulation, decreases the risk of blood clots, disperses any built up gas and the pain that it may be causing, has been shown to lower the need for narcotic pain relief, shorten hospital stay length, and ensures that the muscle movements of your digestive tract begin working as soon as possible which will lead to less constipation and discomfort throughout the coming weeks. 
  2. 2. Proper Nutrition- Several studies have tested the efficacy of enhanced recovery after surgery pathways (ERAS). These pathways include measures such as decreasing the amount of time patients go without food and drink, encouraging early mobility as we covered above, providing regional anesthesia, etc… One pathway found to be very helpful is not only a proper nutritious diet both before and after surgery, but also ensuring limited interruptions to that diet during the pre and postoperative periods. Keeping fasting to a minimum has shown to have many benefits. These benefits include reducing pain levels, stabilizing blood sugar, and reducing tissue hypoxia. Because of these benefits the American College of Gynecology (ACOG) has encouraged providers to use this pathway. It is now recommended that liquids in moderation should be encouraged up until 2 hours prior to surgery, and instead of no food by mouth policies starting 12 hours prior to surgery it has been decreased to 6 hours. Food and drink is encouraged between two and four hours postoperative. 
  3. 3. Abdominal Binders- Abdominal binders are one of the most underutilized recovery tools in the post cesarean (post birth) toolbox. While not widely studied, there are small randomized case studies on their benefits. In a study of 89 patients, all with similar hemoglobin and hematocrit levels, it was found that the group of participants that were given abdominal binders not only had better hemoglobin and hematocrit levels at 36 hours post surgery, but they reported lower pain levels as well. Binders are also instrumental in supporting the return of postpartum abdominal muscles to their original placements. While all mothers will experience some degree of Diastasis Recti, binders can prevent this muscle separation from advancing, and help close the gap overall. 
  4. 4. Pain Management- Unfortunately cesarean recovery can come with a great deal of pain. Bending, standing, walking, and even turning over in bed can become difficult tasks even with pain medications, let alone without. Because of this, pain management is one of the most important parts of a proper recovery plan. Not only does adequate pain management keep the patient in a certain level of comfort, It will reduce the overall length of opioid usage, shorten the length of hospital stays, aid in returning to normal functionality, lead to a higher level of maternal satisfaction, which in turn effects breastfeeding, bonding, and postpartum mood. While opioid usage is still the most effective and most common form of pain management, there are local anesthesia options being used in select hospitals that can deliver lidocaine or marcaine directly into the incision. One form of this is known as the ON-Q pump. This small pump delivers numbing medication to the incision site through a small catheter placed within it. These pumps will be sent home with you, and will last an average of three to five days post-op. Afterwards it can be gently pulled out of the incision. While this sounds scary, I assure you from my personal experience that it does not hurt, and in fact is hardly even felt. This mode of pain management is not available at all hospitals and it may be worth inquiring about prior to settling on a birth location. These pain management options may not entirely cut out the use of opioid pain relief, but it is likely to decrease the amount needed and the length of use.
  5. 5. Birth Processing- In many cases, a mother may have arrived on the OR table after a scary or confusing turn of events. The fear of getting to the OR and the fear of Being in the OR can bring about a trauma response, and this may affect her overall feelings about her birth even after that fear has passed. The mental health aspect of birth is overlooked across the board, not just with cesareans, but we commonly see trauma based mental health issues arise after traumatic births. Having access to proper therapies and a support system in place is vital to the postpartum experience. Without these we may see this trauma develop into a myriad of postpartum mood disorders which can leave long lasting impacts in the life of mom, baby, and family. Without mental health, there can be no physical health. 

Post Written By: Sarah Everly, Tranquility by HeHe Team Member


Check out more about Sarah here!

Resources:

Things that F*ck Up your Birth Plan, A Series

Wednesday, September 8, 2021

Things that F*ck Up your Birth Plan


LATE PREGNANCY ULTRASOUNDS

Ultrasounds are a ‘normal’ part of pregnancy if you ask any American woman—BUT if we look at the science behind them, you might be surprised at what you find…

While you may enjoy seeing your baby, it’s worth discussing the risks before saying ‘yes’ to any and all ultrasounds and scans. Pregnant people routinely go through a number of ultrasounds during pregnancy. 

Most commonly:
  • - 11-14 weeks to confirm pregnancy
  • - 18-22 weeks to confirm anatomy is looking normal
  • - 35-38 weeks which is known as the growth scan (we check the ‘size of baby’ and baby’s position)
I put ’size of baby’ in quotations because the accuracy of ultrasounds is so laughable that it’s ridiculous to lead anyone to ever believe we could accurately predict the size of a baby that way. Ultrasounds also get less and less accurate as the baby grows. However, there are risks with late-pregnancy ultrasounds and some are severe like misdiagnosis, unnecessary inductions, and unnecessary c-sections. There is a fine line between intervening and monitoring—sometimes, checking in actually hinders the process

The Science

This 2015 Cochrane Review of Late Pregnancy Ultrasounds (after 24-weeks) found, ‘there were no differences between groups in the rates of women having additional scans, antenatal admissions, preterm delivery, induction of labour, or instrumental deliveries although the rate of caesarean section increased slightly with screening. For babies, birthweight, condition at birth, interventions such as resuscitation, and admission to special care were similar between groups. Infant survival, with or without congenital abnormalities, was no different with and without routine screening, and childhood development at eight to nine years was similar in the three trials that measured it. None of the trials reported on psychological effects for mothers of routine ultrasound in late pregnancy.’ You can also find the 2008 original version of this paper here.

During the 1970’s a few major key players in maternity care changed —for better or worse (feels like worse). First, Electronic Fetal Monitoring was introduced and promised to reduce infant mortality which it has not done, but it has increased c-sections and maternal complications astronomically. Coincidentally, this is also the time that we saw c-section rates go from 5% (1970) to nearly 25% by 1988! 

The Benefit

There are other functions of this third trimester ultrasound like checking for baby’s position, placenta position, evaluates (not with great accuracy) amniotic fluid levels, and can detect any late term abnormalities (cardiac complications, abnormalitites in kidneys or urinary systems or central nervous systems). Isabel Monier, a French Researcher, has long said, ‘Neonatal outcomes were not better for SGA infants if FGR was suspected.’

The F*ck Up 

The Global View You know I love looking at other countries and this 2013 Journal of Obstetrics and Gynecology Canada article shares, “In women without risk factors for intrauterine growth restriction, comprehensive third trimester ultrasound examination including biophysical profile, fetal biometry, amniotic fluid volume, and umbilical artery Doppler studies is not recommended. (II-2D).” Based on existing evidence, routine late pregnancy ultrasound in low risk or unselected populations does not confer benefit on mother or baby. There is no evidence that it should be recommended routinely in late pregnancy, yet this is the standard practice across the United States.

The Small Baby There is ‘the difficulty in distinguishing between those SGA that truly have an FGR problem and those constitutional SGA which entails a high false positive rate.’ Another study found that even with risk factors identified, it was still challenging to get accurate results. The artihttps://pubmed.ncbi.nlm.nih.gov/26488771/cle states, ‘However, despite the presence of these factors, 60% of SGA and 40% of severely SGA infants, respectively, were not suspected of FGR.’

The Provider Bias Your provider’s bias can be more influential than the actual screening results! Customizing fetal size for maternal height, weight and ethnicity, has been shown to improve the identification of babies who are small because of FGR, rather than constitutional reasons.

The Manipulation The issue with constant monitoring —besides how inaccurate the results are— is that it opens up the conversation for scary, fear-based manipulation. Expecting every body and every baby to do exactly the same exact thing is unrealistic. Obstetricians, and some midwives, will give care from a place of ‘looking for a problem’ rather than ‘responding to whatever the body shares.’ Looking for a problem says ‘go for a ‘just in case scan’ even though you’re not yet in the range that I’d be concerned,’ whereas responding says ‘you’re in the normal range but let’s watch it.’

The Gender Bias There is also one last bias that we should all expect at this point—but female gendered fetuses are more likely to be suspected of FGR. https://pubmed.ncbi.nlm.nih.gov/26488771/

So since this routine practice doesn’t improve outcomes and leads to higher rates of stress and unnecessary worry for pregnant people—why are we still recommending this across the board? 

Late pregnancy ultrasounds should be something you have to ‘risk’ into meaning that we don’t give them to everyone as the current US medical system does. Only folks who have risk factors or individual factors that lead us to believe they may have increased risk that we may be able to mitigate if we catch it via a 3rd trimester ultrasound. But, these complications are so rare and that’s why not everyone needs them. 

The Risk

Unless you need one, they are unnecessary interventions that have the major potential to disrupt your birth plan by causing unnecessary drama or courses of action. Consenting to extra ultrasounds after 24-weeks should be a very calculated decision in which you understand the risk of just how inaccurate the results can be plus the risk of opening the door to pressure and manipulation from medical staff. If you understand the risk and feel comfortable navigating that — I support you.

Are there risks to having Small For Gestational Age babies?

Yes, there are risks to everything. This article shares clearly the risks associated with small for gestational age. One thing that people always forget to look at are your own genetics.
  • - What did you weight at birth?
  • - What about the baby’s other parent?
  • - How big of a human are you now?
  • - What about the baby’s other parent?
If this baby is made by two relatively small people, why would we expect your body to grow a 11lb baby! I am a very petite person at 5’4” and 100lbs. My partner is not a large guy, either with a height of just 5’6”. We have no reason to believe the two of us would make a ginormous baby. So genetics matter. Small people make small babies and that’s okay. It almost feels like that’s how nature intended it to be. 

More so than the risks to your baby, thisis about making sure that you need the initial scans in the first place. When we intervene (with anything—even as little and seemingly harmless as an ultrasound), we must understand the risks associated with it and not just the physical ones! We must also think about the rate of false-positives (where you believe you or your baby has something bad, but you/they don’t) and false-negatives (where you falsely believe you and your baby are safe/in the clear and you are not). This is one stat that providers fail to mention with almost ALL care—with how much certainty can they give you this answer? With ultrasounds—it’s not very certain!

You can see how using a notoriously inaccurate tool, like ultrasound, to diagnose such a hard thing to distinguish to begin with (SGA vs FGR) can lead to a few twists and turns in your labor story. 

The Birth Lounge will help prepare you for all of those twists and turns so you know exactly what your options are at each step of the way. You’ll also learn the pro’s and con’s plus the appropriate timing of each intervention and how they might interact with other interventions along the way!

All of the content is accessible via an app that conveniently goes into the birth room with you so you can have lounge support from start to finish!

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