Monthly Archives: May 2010

And now the end is near

All of a sudden, I seem to have an alarmingly small number of days left to work in my current job.  Not only is June 7th approaching with haste, but I also had a bunch of annual leave owing that I was going to have to use now or lose, so I've ended up just booking it wherever it could be fitted in.  This means I've been off last week and the beginning of this week, I'll be back for Thursday and Friday, then off for five days (Bank Holiday weekend plus my usual Tuesday off plus annual leave on Wednesday), then back for Thursday, Friday, and Monday… and then finito.  (Technically, Tuesday 8th will be my last day, but since I don't work on that day it's a bit of a moot point.)  It was something of a shock to realise, at the end of the week before last, that although I still had just over three weeks to go in my job by the calendar (which, of course, is an eternity and nothing to get too worked up about) I only had five days of actual work during that time.  Gulp.

I can't actually remember the last time I took this much annual leave in one go.  My usual practice is to try to spread it out as much as possible, partly through inclination and partly as a response to the practicalities of having two different lots of family in two different distant locations to visit – we can do that more often if I take a lot of long weekends.  I have to say, there is something particularly relaxing about knowing that not only do I have the whole week off but I also have an extra few days after that.  Instead of spending last week knowing that all this relaxation was all very well but next week it would be back to business as usual with a full working week, I got to spend it knowing that I would still be off for the first three days of the week, and that I'd then only have two days back before being off again for several more days.  This is a near-unheard of luxury in my life, and I cherished it.

So, with all this time off, what I've been doing with it has been going back into work.  Only on a couple of days, of course.  The rest of the time I've been toilet-training Katie (a project that I was putting off until after the wedding and thus now have to actually get on and do), and alternately catching up on other stuff I've been meaning to do and relaxing.  But I have the usual enormous stack of things in the general category of Put Aside To Deal With Later, and, now that I'm rapidly running out of later, I need to catch up.  Hence, last Friday and this Monday, after dropping Jamie off at school, I went in to work and devoted a few hours to clearing both my virtual and physical inboxes.  This is not nearly as bad a way to spend your holiday as it sounds, because it's darned good just to have the chance to sit down in the knowledge that you will remain absolutely uninterrupted by other responsibilities for the next few hours and actually crack on with all that stuff that is, admittedly, hellishly boring to deal with but isn't all that great to have looming over your head as undone work either.  Being able to focus on clearing a load of it out of the way was damned good. 

This has worked pretty effectively.  While there are still a few items that for various reasons didn't get sorted out on those days, not to mention just over two years' worth of clutter on my desk awaiting clearing (I can date the duration with precision, since I last cleared my desk just before going off on maternity leave and hence do at least know that the current clutter has all accumulated since I returned), it is now looking at least somewhat feasible that I will have everything done and dusted by June 7th and be able to walk out at a not-desperately-unreasonable hour that evening with a clear desk, inbox, and conscience.  Whereupon, of course, I will start my new job with a new leaf thoroughly turned over and spend the rest of my life being super-organised and getting everything done when I'm supposed to (pausing only to dodge the flying pigs).

So, the goal of getting caught up on work is going fairly successfully.  So indeed is the goal of getting Katie toilet-trained (without wishing to burden you with too much detail, I am pleased to say that just over a week into the process we are getting more successes than failures and she clearly has a good general grasp of the whole issue).  So is the goal of relaxing.  Last Wednesday, Jamie's school were offering parents of children in the Reception classes the chance to come in and join the children for lunch, so I did that and stayed for the rest of the lunch break.  Which meant  that, after a quick flashback to the school dinner halls of my childhood, I got to spend a glorious half-hour running around with three five-year-olds, practicing handstands,
rolling down a hill, and jumping into a former sandpit.  I didn't have nearly this much fun when I was five.

I have also been ordering research articles.  And ordering research articles and ordering research articles and ordering research articles.  What, you thought all those articles I report back on in my efforts to provide evidence-based posts on parenting controversies were just lying around waiting for me to pick them up?  They are obtained for me by the wonderful staff at the library of our local hospital, who have, over the past five years, ordered dozens of articles on breastfeeding and sleep training and cortisol levels in children and all sorts of things of equally limited relevance to general practice, all without batting an eyelid at my requests.  I'll technically have the option of doing the same in my new job, but, of course, there's no guarantee that the librarians I'll be dealing with will be quite as happy as the ones at this hospital to order large numbers of articles on whatever I might happen to be arguing about on the Internet with no questions asked as to what all of this actually has to do with my clinical practice.  I'm working on the basis that if there are any studies I really want to read, I'd better order them now.  Since the number of studies that could potentially fit that description is almost unbelievably vast, I have been spending whatever spare minutes I can get on poring over review papers and meta-analyses and scribbling out request forms by the score.  Give it another few years, and I may even get around to reading them all.

The other thing I've done is something I've been meaning to do for the entire almost-five years I've been working in my current job; I finally got round to hanging the sunflower picture in my room at work. I am not kidding about this.  Five years of meaning to get a job done, and, with only five days to go, I finally do it.  I bring new levels of meaning to the term 'better late than never'.  Well, either that or to the term 'completely bloody mental'.  I'm not oblivious to the fact that the sensible thing to have done at this stage would have been to leave it and save myself the trouble, and for a while I planned to do just that.  But that little room has been my domain for the past five years and, while it may be small and crowded and awkward and a complete nightmare to get a wheelchair or pushchair into, it's still mine, and I've been feeling sad at the realisation of how little I ever did to mark it out as my individual little bit of space.  This was my last chance to do so, and, in the end, I didn't want to miss it.  So I took down the Edwardian-style picture of children playing blind man's buff that I never ever liked, and hung my giant framed Anne Worthington sunflower print in its place.  For the five final days that I work in that room, the patients will have something to look at that's beautiful, eye-catching, and a statement of my individuality.  For my five final days in that room, I'll know that it's properly marked as mine.



Filed under Here Be Offspring, I think this line's mostly filler, The doctor is OUT. To lunch.

To my sister, with love

At my wedding, my sister braved stage fright and laryngitis to stand up and surprise me with a beautiful speech, thanking me for what I'd done for her as a sister.  I always thought I'd return the compliment at her own wedding, but my sister and her new husband decided to limit the speeches to one each for the two of them plus one very brief welcome from my mother at the beginning of the meal.  I can't deny I was relieved not to have to write a speech and deliver it in public, but it does seem pretty obvious that my sister got the short end of the stick here; two weddings at which she gave a speech in which I was thanked and praised, none at which I did the same for her.  So this, instead, is my thank you to her.

Ruth, thank you for all the times you've fought my corner.  Thank you for all the times you've been there for me.  Thank you for being the strong-minded, caring, funny, determined, wonderful person you are, and thank you for being my sister.  It was a privilege and a joy to see your wedding day today and be a part of it, and I wish you and Neil every happiness for all the years to come.


Filed under Uncategorized

Why I don’t believe that sleep training is incompatible with children’s rights

Mothers for Women's Lib regularly host a Carnival of Feminist Parenting.  Every month (recently reduced to every two months) they post links to a selection of posts about various diverse topics on the general themes of feminism, sexism, and other forms of discrimination, and about how parenting is affected by these issues (both by discrimination and by the need to fight against it).

A few months ago, one of the featured posts was an anti-sleep training polemic.  Just Let Her Cry started out with a fictional first-person tale of an ill and depressed woman shut in her room by her husband every evening when it suited him regardless of whether she was hungry, in pain, or just not tired.  The author then drew her analogy between this and controlled crying or other forms of cry-it-out (CIO) sleep training, which she referred to as 'neglect with a different name'.  She claimed, inaccurately but ominously, that scientists everywhere knew the short and long-term consequences of CIO to be 'vast', and was scathing in her condemnation of parents who've tried sleep training: 'They aren't setting out to harm a
child, but that doesn't change the fact that they are.  Argue with me
all you want.  Say "I let my baby cry it out, and he/she is fine".  I
don't believe you.  I believe you broke your child like an animal.  I
believe they gave up.  They didn't magically learn to "self-soothe",
they just figured out that you suck at being a parent at night time.'  This wasn't a discussion of feminist parenting; this was a no-holds-barred shot in the Mommy Wars.

I enquired as to the appropriateness of this post as a carnival submission.  One of the site's authors replied 'We are advocates of children’s rights as well as women’s rights and
believe the two are very much intertwined.'  So be it; their Carnival, their choice as to what they consider appropriate, and I wouldn't even want to go down the road of telling people what views they can or can't express.  But I disagree with the implication that a belief in children's rights automatically means a belief that controlled crying is always wrong, and I think it would be a shame if that particular post was the only view a site supposedly for anyone interested in feminism and parenting had on the matter.  So this is my explanation of why I do not agree with that poster's analogy, and why I do not agree that a belief in children's rights is incompatible with a belief that sleep training may be a perfectly reasonable option for a parent to consider.

First off, some background explanation of what sleep training actually is, what it's not, and what purpose it serves:

A little-known fact that's important for understanding sleep training is that all babies wake up multiple times each night.  I'm not talking just about the sleep pattern of very young babies or about occasional bad nights in older babies (although it's important to recognise those as facts of parenting life as well); I'm talking about what happens in every baby, every night, including all the ones whose parents think of them as sleeping through the night.  The parents of those babies aren't lying; the key is not that those babies don't wake up, but that they get back to sleep again right away when they do wake up.  If, on the other hand, the only way a baby can get to sleep is by being rocked or nursed or what-have-you by someone else, then the someone else is going to have to wake up several times every night to do this; and that's where it becomes a problem.

One way of dealing with this is simply to have the baby in bed with you, thereby meaning that you can cuddle or nurse them or whatever without waking up.  As long as the parents are also happy with this and have taken proper safety precautions, this can be a perfectly good solution.  However, there are various reasons why this is not a universal solution for every situation, and so the other option is to teach the baby to go back to sleep alone.  (Older babies, that is; babies in their early months still need to feed every few hours and so trying to get them to sleep through an entire night can actually put them at dangerous risk of dehydration.  For this, among other reasons, sleep training methods are not recommended for babies in the early months.)  Sleep training is the term used for the various methods used to do this. 

Sleep training is not meant for use in situations where the problem is actually that the baby still needs night feedings, or isn't well, or has had a nightmare, or some other need for help or comfort.  (I'm not trying to claim, here, that nobody has ever ignored a baby in such situations and mistakenly referred to that as sleep training; I'm pointing out that
this is not why sleep training methods were designed or how they are
appropriately used.  From what the author said in this post and others
on her blog, it is absolutely clear that she was not merely warning against
misuse of sleep training – in which case I'd have agreed with her – but
was lumping all sleep training in under that description and condemning
it wholesale.)  Sleep training is for teaching the baby to be able to get back to sleep in situations where nothing's actually wrong.

The method usually recommended a few decades back was simply to leave the baby crying for however long it took to fall asleep alone, cold turkey style, but this method was pretty distressing for everyone (including the neighbours), and hence a variety of modifications were introduced.  The first of these was the advice to come in at regular intervals to comfort the baby briefly before going out again, extending the length of the intervals as time went on; this is the infamous controlled crying method, also referred to as Ferberisation after its inventor, Richard Ferber.  He advocated a fairly rigid schedule for going back in and very limited
time in the room/interaction with the baby.  Most of the other suggested methods are just variations on this initial method with different advice about intervals for which the baby is left and/or the amount of time spent comforting the baby.  There are a couple of others which don't involve leaving the baby alone at all; Ferber had an alternative which I think of as Ferber-lite, in which the parent stays in the same room but moves further and further away from the baby's cot, and Tracy Hogg of Baby Whisperer fame had a version to which I personally am very partial called PU/PD, standing for Pick Up/Put Down and referring to doing precisely that with the crying baby until it gives up and falls asleep.  (By the way, if you go looking for that last then a) the full description is in this book, not this one which is a near-complete waste of time, and b) be prepared to grit your teeth, because she was one of the most annoyingly patronising baby experts on the market.  But I still think the method's a good one.) 

The plethora of methods can seem fairly bewildering, but makes a lot more sense when you think of them all as just being different ways of getting from point A (baby needs cuddling or rocking or whatever to get back to sleep) to
point B (baby gets back to sleep without any sort of requirement for
parental help).  The trick, as with an awful lot else in parenthood, is in finding a method that's not unduly harsh yet is firm enough to get the message across.  I don't think there's any such thing as a 'best' method because it will depend on the baby and the situation and what-all else; in any case, most methods will work perfectly well for most babies at the end of the day.  But the point of all of them is not to neglect babies who are hungry or wet or frightened, but to teach babies how to get themselves back to sleep after normal night wakings where there aren't any other problems.  Penelope Leach nicely summed up the principle behind sleep training when she said that the idea was to show the baby that you were
always available but after bedtime you were very boring. 
As the delightful Libby Purves comments, it is possible to get very
boring indeed by three in the morning.

So, if the neglected-wife analogy in this post was rewritten to reflect the way in which sleep training is actually supposed to be used, how would it look?  Something like this:

There was a time, not so long ago in my life, when I had some major problems with getting to sleep.  The only way I could get to sleep was to have somebody hug me and rock my body back and forth in their arms, which would relax me enough to drop off.  As well as needing this at bedtime, I was waking up several times a night and needing the same thing each time.  Everything else in my life was going fine – I was happy, healthy, and had no other problems.  I just couldn't get to sleep by myself, that was all.

Fortunately, this wasn't a problem for me, as my husband was there to help.  Whenever I woke up during the night, I just woke him as well to rock me back to sleep (or, if he hadn't gone to bed yet and was trying to do something else, I'd just interrupt whatever he was doing and call him up to the bedroom to rock me).  That, as far as I was concerned, was the problem sorted out.  Oh, sometimes the disturbed sleep made me grumpy and grouchy during the daytime, but my husband could handle that.  And I didn't see a problem with calling on him at any hour of the night that I wanted to, every night.  After all, he loved me and was very attentive to my needs by daytime; I didn't see any problem with expecting the same intensity of service during the night-time hours.

It seemed not everyone saw it the same way.  At one point I heard my mother-in-law talking to my husband about the situation.  "You have to put your foot down.  You can't go on like this.  You haven't had a decent night's sleep for months!  You're going to make yourself ill with exhaustion – and for what?  She doesn't really need anything.  She should learn to get back to sleep by herself."  I didn't understand what she was talking about, and, even though my husband was looking haggard and was also becoming a lot more snappy during the daytime, I didn't see what that had to do with anything I was doing.  Even though I love my husband more than anything in the world, I didn't really see him as a person with his own needs.  I'd never seen any reason why I shouldn't expect him just to give me everything I want when I want it, or how this could have any sort of impact on him.  This wasn't my fault – I certainly wasn't intentionally being selfish.  It's just that, at that stage of my life, I wasn't yet mature enough to be able to think that way.  I wanted my husband's help to get back to sleep every time I woke up, so I called out expecting to get it.

But things changed.  My husband told me it was time for me to learn how to get back to sleep on my own.  I wasn't happy about this in the slightest, and burst into tears when he walked out leaving me alone to get back to sleep, but he stood firm.  He didn't leave me alone for long at a time – every so often he would come back to comfort me, check I was all right, and speak reassuringly to me – but he absolutely refused to stay in the room for long enough to help me to get back to sleep in the way I was now used to.  I was bewildered, upset, and furious at being left awake and alone, and at first I would lie awake for long periods of time, crying with frustration and upset that my husband had stopped doing things the way I wanted. 

Fortunately, it didn't last long – I found that, eventually, sheer tiredness was enough to overcome my difficulty in falling asleep, and, the more often I fell asleep without my husband there, the easier it got.  Within less than a week of this starting, I found I had reached the stage of being able to get back to sleep easily when I woke up without needing to call out for help.  If ever anything was genuinely wrong, my husband was quick to help out; but on most nights I could now get by without him.  He was as attentive as ever during the day – in fact, if anything, he seemed more attentive and less snappy than when I was waking him up multiple times at night – and it wasn't long before the new night-time pattern had taken over as the norm in our house. 

Does that still sound like an appalling story of a cruelly neglectful husband?

Also, do bear in mind that a baby may cry at bedtime simply out of annoyance that it is bedtime.  Babies are as capable of adults of wanting to stay up and have fun rather than putting everything on hold for the night to get some sleep, and rather less capable than adults of recognising the possible ramifications of this.  Have you ever had a friend wanting you to stay up and boogie the night away with her when you had to work the next day and knew that you – and, for that matter, she – would end up regretting it if you did?  If you said no, was that a shockingly neglectful act on your part that was likely to traumatise your friend so deeply that she would never be able to trust you as a friend again and would possibly suffer lifelong psychological damage into the bargain?

Babies cry when they need something.  But they also cry when they want something, and it is a really big mistake to assume that if a baby is crying for something this must mean that they need it to the point of risking psychological damage if denied it.  (One obvious reason why this is a really big mistake is because it would rapidly lead to you giving your baby sharp knives and live electrical circuits to play with.  Babies are totally capable of crying for things that they very much need not to be allowed to have, thankyouverymuch.)  I don't believe that setting limits on the extent to which you can meet a person's wants violates that person's rights in any way, regardless of their age.

One other point worthy of mention here, which is technically not sleep training but is very frequently mistaken for it, is that some babies actually need to cry for a few uninterrupted minutes as part of their wind-down into sleep, and attempts to soothe and settle them can backfire and keep them awake.  My daughter was like this; I've heard of other babies who are.  If your baby is one of these and you're locked into a rigid dogma of never leaving a crying baby alone, you're in for some problems, because all your efforts are actually going to be keeping your baby awake rather than settling them and what they really need is for you to back off and leave them alone while they go through the wind-down process.  In which situation, leaving your baby alone to cry is meeting his or her needs.

I wish I didn't even have to make the next point, because it seems so obvious to me, but… absolutely none of this is meant to try to persuade any parent that they should use CIO.  Believe it or not, I'm all in favour of avoiding CIO methods wherever feasible; not because I think CIO violates children's rights or damages their psyches, but because it's simple common sense that if you have a choice between equally effective ways of solving a problem it's good to go for the one that doesn't cause upset to anyone.  And I'm all in favour of minimising the amount of crying involved where crying does have to be involved, for the same reason.  I believe that parents should set limits gently, sympathetically, with full regard for age-appropriate behaviour, and with careful consideration of what limits really need to be set in that particular household and what limits don't actually matter.  I don't, however, think it a good idea to confuse any of that with the notion that we can get by without ever setting limits or
ever causing at least some upset to others by doing so.

So, if you've found an alternative method of dealing with the sleep situation in your household that seems to be working out all round, more power to you and go for it.  If you've found that that doesn't work and that, for whatever reason, your baby does have to be left alone for a bit as part of the process of getting them to sleep, then do that.  Either way, don't assume that whatever it is you're doing would work for every other family as well, and don't resort to scaremongering, guilt-tripping, or poorly-informed parent bashing to try to get others to fall into line.  I'm not trying to replace the anti-CIO polemic with a pro-CIO polemic;
I'm trying to replace it with an anti-Mommy Wars polemic.

Instead of the Mommy Wars, I'd like to see a widespread willingness to trust parents.  To trust that parents, if given information about different options (which is not code for 'scare stories about the options we don't like), are actually pretty good at making decent choices for their children.  To trust that even if a parenting choice isn't what you would choose/what would work for your child, it doesn't automatically follow that that parent did something terribly wrong and harmful to their child.  To trust that parents know their own children and that if a parent has done something that happens to go against your particular dogma but they genuinely believe their child is doing fine then it might just be that it's your dogma and not the parent's knowledge of their child that's wrong.  A feminist parenting site strikes me as a very good place to eschew the Mommy Wars and promote that kind of trust.


Filed under Don't let the bedbugs bite, Grr, argh, Sacred hamburger