Surviving the First Year: Two books to help you understand baby’s sleep

For most new parents, sleep becomes an obsession, their most precious commodity. They will happily trade exercise, sex, and time with friends for just a shot at catching some Z’s–kind of like how a rat with ad libitum access to cocaine will happily forgo food.

Continue reading Surviving the First Year: Two books to help you understand baby’s sleep

An early beta hCG test is a good predictor of an ongoing pregnancy

That first glimpse of two pink lines–is it real?–and your heart start to pound with excitement. You’re pregnant!

But after a few minutes of celebration, you descend back to earth. Okay, you’re pregnant, but for how long? Will this pregnancy stick? This is a new, more hopeful limbo than the much bemoaned two-week wait, but it is still not picnic.

These kinds of worries are inevitable. Miscarriage is very common, especially early in pregnancy. And for most women, good info about viability does not come until the first ultrasound usually performed at 8-10 weeks.

Fortunately, women undergoing fertility treatments receive information about their chances a bit earlier with a “beta”–that is, a blood test of their beta hCG (Human Chorionic Gonadotropin) levels.

What is HCG (Human Chorionic Gonadotropin)?

The embryo produces hCG as it burrows into your uterine lining. HCG passes into your bloodstream and helps to maintain the uterine lining and keep progesterone levels high in early pregnancy.

During the first trimester, blood levels of HCG rises quickly, normally doubling every 48 hours in early pregnancy, until reaching a peak around 20 weeks, after which they begin a slow decline.

Predicting ongoing pregnancy with HCG

The level of hCG in your blood predicts your chances of an ongoing pregnancy–which researchers usually define as one that lasts through the first 8-12 weeks.

The table below summarizes findings from several IVF clinic-based studies which tracked pregnancy outcomes by hCG levels. These numbers apply to singleton pregnancies. Twin pregnancies tend to have higher hCG levels.

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When comparing your test results, pay close attention to the post-retrieval or post-transfer date listed in the Day tested column. Some studies report by day from egg retrieval (post retrieval). Others report from day after blastocyst or embryo transfer (post transfer). HCG rises rapidly in early pregnancy, so whether a specific beta is a positive or negative signs depends on precisely when hCG was measured.

The hCG threshold for likely viability rises with each day. As one research team that examined hCG levels on different days post-retrieval reported “hCG samples … were taken on day 14, 15 or 16 after oocyte retrieval in 204 patients undergoing IVF or ICSI were analyzed… optimal cut-off levels to discriminate between viable and non-viable pregnancies… were found at 76, 142 and 223 IU/L for day 14, 15 and 16, respectively”

Interpreting your betas

If your betas are above the numbers listed in the table above, congratulations! Your pregnancy has a very high chance of continuing through the first trimester.

Note, however, that HCG is not as good of an indicator of a live birth as it is of avoiding a first trimester miscarriage–so you’re not completely off the worry hook yet. Your first ultrasound will provide better information than your beta about your chances of a live birth.

What if your hCG is below those in the above table? Don’t panic. In all of these studies about 40-60% of the pregnancies with values below the stated thresholds were ongoing. In other words, hCG was better at predicting a good outcome than it was at predicting  a bad outcome. Because hCG levels vary a lot from pregnancy to pregnancy, there is no strict cutoff for determining viability.

HCG Levels during the first trimester

Normal HCG levels range widely in early pregnancy.

Below are the ranges of beta hCG by week following your Last Menstrual Period (LMP), according to the American Pregnancy Association.

  • 3 weeks LMP: 5 – 50 mIU/mL
  • 4 weeks LMP: 5 – 426 mIU/mL
  • 5 weeks LMP: 18 – 7,340 mIU/mL
  • 6 weeks LMP: 1,080 – 56,500 mIU/mL
  • 7 – 8 weeks LMP: 7, 650 – 229,000 mIU/mL
  • 9 – 12 weeks LMP: 25,700 – 288,000 mIU/mL
  • 13 – 16 weeks LMP: 13,300 – 254,000 mIU/mL
  • 17 – 24 weeks LMP: 4,060 – 165,400 mIU/mL
  • 25 – 40 weeks LMP: 3,640 – 117,000 mIU/mL

Serial hCG measurements

What does often indicate an impending miscarriage, however, are hCG levels that fail to double every 48 hours or that drop over time. This nearly always indicates a failing pregnancy. It can also indicate an ectopic pregnancy–an pregnancy that has implanted somewhere other than the uterus.

One final caveat: All of the above studies involved women undergoing IVF. We cannot say whether these numbers apply to women undergoing IUI or who conceived naturally.

Special case: Frozen embryo transfers

Some but not all studies find that HCG levels are lower and less predictive of miscarriage after frozen (as opposed to fresh) embryo transfers.

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In Xue’s 2014 study, nearly 100% of pregnancies that made it past 12 weeks had day 12 hCG levels about 50 IU/L, as shown in the table below. But many miscarriages also had hCG levels above this threshold; 50 IU/L did not discriminate well between ongoing pregnancies and miscarriages.

A higher threshold of 135-147 IU/L performed better. Nearly 94% of pregnancies with hCG levels above this threshold were ongoing.

Have you had a beta? What was it and how did your pregnancy turn out?

(If you have had a first trimester ultrasound, you may wish to check out my post on miscarriage risk by week, by fetal heart rate, and by other risk factors like your age.)

References

Porat S, E. al. Early serum beta-human chorionic gonadotropin in pregnancies after in vitro fertilization: contribution of treatment variables and prediction of long-term pregnancy outcome. https://www.ncbi.nlm.nih.gov/pubmed/17307176

Kim, J. H. et al. Serum biomarkers for predicting pregnancy outcome in women undergoing IVF: human chorionic gonadotropin, progesterone, and inhibin A level at 11 days post-ET. Clin. Exp. Reprod. Med. 39, 28 (2012).

Kim, Y. J. et al. Predictive value of serum progesterone level on β-hCG check day in women with previous repeated miscarriages after in vitro fertilization. PLoS One 12, (2017).

Kumbak B, E. al. Serum oestradiol and beta-HCG measurements after day 3 or 5 embryo transfers in interpreting pregnancy outcome. https://www.ncbi.nlm.nih.gov/pubmed/17007661

Papageorgiou TC, E. al. Human chorionic gonadotropin levels after blastocyst transfer are highly predictive of pregnancy outcome. https://www.ncbi.nlm.nih.gov/pubmed/11704121

Xue Y, E. al. Effect of vitrification versus slow freezing of human day 3 embryos on β-hCG levels. https://www.ncbi.nlm.nih.gov/pubmed/24880883

Ochsenkühn R, E. al. Predictive value of early serum beta-hCG levels after single blastocyst transfer. https://www.ncbi.nlm.nih.gov/pubmed/19878087

Lambers MJ, E. al. Optimizing hCG cut-off values: a single determination on day 14 or 15 is sufficient for a reliable prediction of pregnancy outcome. https://www.ncbi.nlm.nih.gov/pubmed/16466846

Sung N, Kwak-Kim J, Koo HS, Yang KM. Serum hCG-β levels of postovulatory day 12 and 14 with the sequential application of hCG-β fold change significantly increased predictability of pregnancy outcome after IVF-ET cycle. Journal of Assisted Reproduction and Genetics. 2016;33(9):1185-1194. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5010803/

Back sleeping and stillbirth revisited: A reason for caution, or a few extra pillows

As longtime readers of my blog know, in 2011, carrying my first child, I became obsessed with the question of whether pregnant women could lie on their backs–either for short periods of time, such as during a yoga class, or while asleep at night.

Several OBs told me to avoid lying on my back. But their justifications were murky, and their advice conflicting. Not a one could point to a single published study backing this advice up. And when asked at what point in pregnancy I needed to start avoiding back sleeping, their answers were all over the place. One told me it was verboten from 4 months on, another from 5 months on, and the third claimed I should worry only in the last month or so.

Sleeping with a bowling ball-sized stomach is challenging, to say the least. At the same time, groundless sleep prohibitions with vague but terrifying warnings that you might harm your baby are immensely frustrating, and yet almost impossible to disregard.

But while in 2011, these dire warnings sounded like a yet another pregnancy prohibition in search of a reason (no Brie, not a drop of alcohol, keep your heart rate below 140 while exercising, etc., etc.), several studies (one from Australia, two from New Zealand, one from Ghana, and the latest, from the UK) have since found that back sleep may indeed be linked to what is termed late stillbirth, or pregnancy loss after 28 weeks.

The science of back sleeping and stillbirth

Continue reading Back sleeping and stillbirth revisited: A reason for caution, or a few extra pillows

Why is the American Academy of Pediatrics exaggerating the benefits of breastfeeding?

The AAP doubled down on the long-term benefits of breastfeeding, just as the evidence for those benefits was crumbling underneath their feet.

In their most recent statement on breastfeeding, issued in 2012, the American Academy of Pediatrics (AAP) reaffirmed their earlier guidelines recommending 6 months of exclusive breastfeeding. They justified this recommendation by citing “the health outcomes of exclusively breastfed infants and infants who never or only partially breastfed”.

In effect, the AAP doubled down on the idea breastfeeding confers massive, lifelong benefits to babies–benefits so profound, they say, that the decision to breastfeed should not be considered a “lifestyle” choice but in “investment” in your child’s future–just as recent, large, and better-designed studies have overwhelmingly shown that the benefits of breastfeeding in the developed world are trivial.

Continue reading Why is the American Academy of Pediatrics exaggerating the benefits of breastfeeding?

Sign away mamas: Formula consent forms are based on unscientific fearmongering

As part of their “baby-friendly” initiatives, some hospitals now require women to sign consent forms before receiving formula. These forms purport to list the “harms” associated with “a single bottle” of formula, and ask that parents signify their understanding that formula should not be given unless medically necessary.

On its face, asking parents to sign a waiver to receive formula, a long-used and widely available way of feeding babies, seems astoundingly paternalistic. But what I find most shocking are the allegedly “scientific” claims these forms make about supplementing with formula.

Continue reading Sign away mamas: Formula consent forms are based on unscientific fearmongering

What’s the deal with the infant microbiome?

The human microbiome is one of the hottest topic in medical research today, and with good reason.

This collection of trillions of microscopic inhabitants–bacteria, viruses, and fungi—cover nearly every interior and exterior surface of the human body, and many scientists now believe that these unseen co-passengers, far from being incidental hangers-on, are instead actively cultivated by our bodies and play a critical role in our immune and metabolic health.

Over the last decade, studies have linked the composition of our microbiomes the to a panoply of modern ailments: obesity, asthma, allergies, acne, C difficile induced diarrhea, and autoimmune diseases like Crohn’s and Type 1 Diabetes.

Our microbiome may matter most in early infancy.

Continue reading What’s the deal with the infant microbiome?

Overwhelmed by prenatal genetic testing options? Download my ebook!

Who needs prenatal testing for genetic disorders? How much does your risk of carrying a baby with a genetic disorder increase with your age? Which prenatal test or screen is right for you?

These are among the questions my amazing co-author Molly Dickens (and fellow pregnant scientist blogger/partner-in-crime) and I tackle in our new ebook on prenatal testing. We provide a quick “cheat sheet” on how these tests compare, and then dig into the nitty-gritty details of each as well as the history of prenatal testing and how to estimate your personal risk of carrying a baby with a genetic disorder.

Continue reading Overwhelmed by prenatal genetic testing options? Download my ebook!

Prenatal Testing: Download my ebook (free)!

Who needs prenatal testing for genetic disorders? How much does your risk of carrying a baby with a genetic disorder increase with your age? Which prenatal test or screen is right for you?

These are among the questions my amazing co-author Molly Dickens (and fellow pregnant scientist blogger/partner-in-crime) and I tackle in our new ebook on prenatal testing. We provide a quick “cheat sheet” on how these tests compare, and then dig into the nitty-gritty details of each as well as the history of prenatal testing and how to estimate your personal risk of carrying a baby with a genetic disorder.

Even having gone through prenatal testing twice before, I was still surprised to learn while researching this book that…

  1. Testing only women over 35, as was the case in the 80s and early 90s, misses around 70% of the cases of Down’s Syndrome.
  2. The risk of miscarriage from amnio and CVS is around 1 in 1000–far, far lower than the still commonly cited but outdated 1 in 100 estimate.
  3. Until you are 38 years old, you are more likely to carry a baby with a chromosomal disorders involving tiny pieces of chromosomes than carry a baby with disorder involving missing or extra whole chromosomes–but these disorders are not well detected by any prenatal screens. This is a huge problem, because younger women are often advised to get screens over diagnostic testing.
  4. How women under 35 are more than twice as likely to get a false alarms on prenatal screens as women over 35.

And so much more that I am excited to share.

We all need to up-to-date, evidence-based information to make the best decisions for us and our families. But with prenatal testing rapidly evolving, sometimes doctors and other healthcare professionals are woefully behind or outright misinformed on the latest developments. So please download and share with fellow parents-to-be!

Download the pdf here: Prenatal Testing ebook.

How much iron does my baby need?

Too little iron in infancy can cause irreversible cognitive deficits. And iron deficiency can have no symptoms. It’s scary.

Yet the advice parents get on meeting your baby’s iron needs is complex, conflicting, and incredibly confusing.

Continue reading How much iron does my baby need?

Breast may be best, but why isn’t it better?

In honor of World Breastfeeding Week (yes, yes, I know–it ended yesterday), we need to talk about a widely overlooked aspect of breastfeeding, its recipients!

Nope, I am not talking about our babies. (After all, who could overlook them?) I am talking about our babies’ gut bacteria.

Breast milk contains carbohydrates (known as HMOs, for Human Milk Oligosaccharides) specially designed to nourish specific gut bacteria, particularly Bifidobacteria. Bifidobacteria contain genes designed to metabolize HMOs–implying they have co-evolved with us for a long time.

This process of seeding your baby’s gut begins not with breastfeeding, though, but before birth. During pregnancy, women’s bodies cultivate these bacteria while pruning out others, seemingly in preparation to pass them onto our babies during birth.

Why does this matter? Health benefits.

Breastfeeding may benefit health indirectly–by cultivating the right gut bacteria. Scientists now believe that having the right balance of gut bacteria helps to calibrate your baby’s immune system and metabolism, possibly with lifelong effects.

I dig into the latest research on this breastfeeding-gut-health axis in my latest post for BloomLife. Check it out!

https://preg-u.bloomlife.com/breast-may-be-best-but-why-isn…

Drinking While Nursing: 7 Things to Know

While over half of mothers in the U.S. drink alcohol while breastfeeding, many of us are foggy on how this does (or does not) affect our babies.

Can you drink a glass of wine while breastfeeding your baby? Or do you need you wait 2-3 hours for the alcohol to clear? And exactly how much alcohol is too much alcohol to nurse?

Doctors and trusted sources like KellyMom and Babycenter give wildly conflicting advice on these points.

Continue reading Drinking While Nursing: 7 Things to Know

A quick update and where to check out some of my latest writing elsewhere on the web

As you may have noticed, it has been a while since I have posted on this blog. Rest assured, I have a ton of great content in the works.

But what has been keeping me too busy to post and up at night? Well, Baby #3 for starters. (Now 8 months! How time flies… or with a new baby, how it passes in slow motion and sudden leaps.)

And in my stolen moments (read:naps) I have been writing content for a company called BloomLife. BloomLife makes a contraction tracker, just like those used in a hospital but for at home use. It syncs with your phone and lets you know if you are experiencing contractions, how strong they are, and how long they last.

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Baby #3 and her big sister. None of us were quite ready to wake up the morning this picture was taken. Yet there we were, up.

Many of my posts for Bloom will be of interest to my readers, so I wanted to share them with you here. Hop on over and check them out!

  • Prenatal Genetic Testing and Screening. My take on the new kid on the prenatal genetic screening block, Non-Invasive Prenatal Testing (NIPT) and why it needs to be offered to all women, not just women over 35.
  • Stalled Labor. My first labor was going gangbusters until I arrived at the hospital, where it swiftly ground to a halt. This is a common birthing experience. At the time, I blamed the slowdown on stress, but another unexpected culprit may have been to blame: those glaring florescent hospital lights. Here’s more on how humans evolved to labor at night, and why laboring women would be wise to dim those darn lights!
  • Exercise during pregnancy. Should you avoid starting a new exercise program while pregnant? Do you need to keep your heart rate below 140? Will lifting weights prompt preterm labor? Contrary to what you may have heard, the answer to all of these questions is an emphatic NO. I discuss the all these exercise myths here, and talk about the latest research and recommendations on exercise for pregnant women.
  • Natural Remedies for Group B Strep. Anywhere from quarter to a third of pregnant women test positive for Group B Strep (GBS) in their third trimester. In the U.S., this means receiving IV antibiotics during labor, to prevent early-onset Group B Strep, a serious but rare infection that occurs when a newborn contracts GBS during birth. But nobody wants to receive antibiotics if they can avoid it, especially during birth, when mom needs to pass her microbiome–a diverse collection of healthy bacteria and other microbes–to her baby. So, is there anything you can do to avoid testing positive? I talk about the research on vinegar rinses, yogurt squatting, and probiotics here.

What I’ve Been Doing the Last Few Weeks

It’s been awhile since I’ve posted on this blog, so I wanted to give my readers a bit of an update on what I’ve been up to these past couple of months.

Mostly I’ve been away because of some good news: I’m expecting our third child, a girl, coming sometime in October!

Continue reading What I’ve Been Doing the Last Few Weeks

The Middlemiss Study Tells Us Nothing About Sleep Training, Cry-It-Out, or Infant Stress

Last week, I wrote a post about sleep training and stress, in which I argued that everything we know about stress suggests that sleep training is not harmful.

In response, some people objected that sleep trained babies continue to experience elevated cortisol and significant distress, even after they have stopped crying. In their view, sleep training teaches babies that crying does not help. They haven’t learned to self-soothe or to fall asleep on their own, they’ve simply given up.

What a heartbreaking thought. And one that surely strikes fear in the heart of many parents.

So it’s important to realize that this claim comes from a single small and deeply flawed study of 25 babies, led by Wendy Middlemiss, a researcher at the University of North Texas’s College of Education.

Continue reading The Middlemiss Study Tells Us Nothing About Sleep Training, Cry-It-Out, or Infant Stress

Critics of Cry-It-Out Fundamentally Misunderstand How Stress Affects the Brain

Because whether or not to sleep train can be such a fraught decision for new parents, I wanted to share my sleep training story, and to explain why, given everything we know about stress, the argument that sleep training causes long-term harm doesn’t hold water.

Sleep Training My Son

When my son was 4.5 months old, I decided to sleep train him. Even by baby standards, my son was not much of a sleeper. He’d snooze for at most 4 or 5 hours, and then wake up every hour like clockwork, wanting to nurse but not wanting milk, popping on and off my breast and screaming in frustration.

I had gone back to work a month earlier, so napping to catch up on sleep was out of the question. Worse, I was commuting an hour to the office each way.

By then, I had reached the end of my sleep deprivation rope. I was so tired I could barely string two thoughts together. I had to coach myself through even mundane tasks like checking out at the grocery store. Say hello to the cashier. Take out your credit card. Pick up the grocery bags. Leave.

I was terrified every time I got into my car to head to work that I would nod off at the wheel and kill someone, quite possibly myself. I joked with coworkers that driver’s licenses should be temporarily suspended for new parents, but the situation really wasn’t funny.

So there I was the first night of sleep training, dripping sweat as I listened to my son’s cries. Minutes ticked by, each seeming longer than the last. I pondered whether the Ferber method included soothing every five minutes just so that you would realize only five minutes had passed.

But I was determined to stick this out, to get it done. Doing it halfway was worse than not doing it at all, I reminded myself over and over. If I were to give in, I could teach my son that crying for 30 minutes was what it took to get mommy to pick him up.

That night, he woke two more times, but never again cried more than 15 minutes. The next night, he cried for 10 minutes at bedtime, conked out, and slept until morning. That morning we greeted each other with a smile, and for the first time since his birth, I really felt like smiling at his freshly woken little face.

Although by all appearances, sleep training went well for us, some critics of cry-it-out methods would contend that I was an inadequate parent who had permanently harmed my son by leaving him alone to cry.

The Cry-It-Out Controversy

“An emotionally available parent would probably not let their baby cry it out,” claims Dr. Teti, a researcher at Penn State.

Dr. Narvaez writes in Psychology Today:

“Letting babies get distressed is a practice that can damage children and their relational capacities in many ways for the long term. We know now that leaving babies to cry is a good way to make a less intelligent, less healthy but more anxious, uncooperative and alienated persons.”

When someone tells you that you have permanently damaged your child, it’s hard to shake off, no matter how much happier you and your baby seem once you start getting some solid rest.

Thankfully, as someone who has studied the effects of chronic stress in animals and in people, I knew that claims like Dr. Narvaez’s are not supported by data and instead rest on a fundamental misreading of stress research.

Studies on Cry-It-Out

Studies involving cry-it-out methods find no ill long-term effects for babies, and big benefits for parents. In one study, rates of depression in mothers dropped from 70% to 10% after sleep training.

Critics of cry-it-out methods argue that these studies are flawed–they don’t have the right measures of harm, they fail to determine whether the parents actually used cry-it-out methods to sleep train their babies, and they rely on parents’ reports instead of observation.

Admittedly, some of these criticisms of sleep training research are fair. Sleep training research is hard to do, especially since researchers can’t exactly force parents to sleep train little Johnny, or prevent parents from doing so.

That said, there’s no evidence in humans–none–to support the view that sleep training is harmful. If there were, we’d have heard about it.

So what the critics of cry-it-out argue, really, boils down to this: They know that sleep training is harmful, because they know stress is harmful to babies.

The problem with that argument? All stress is not created equal. We were designed to handle short-term stress. Where we humans, and other animals, run into trouble is when stress becomes chronic.

Short-Term Versus Chronic Stress

In terms of their effects, the difference between short-term and chronic stress is one not of degree, but of kind. Short-term stress enhances memory; chronic stress impairs it. Short-term stress boosts the immune system; chronic stress weakens it.

(Seeing short-term and chronic stress as fundamentally different is not just my own heterodox personal take. This is the view of people who study stress for a living, including the renowned stress neuroscientist and primatologist Robert Sapolsky, professor of Neurology at Stanford University, who writes extensively about this key distinction in his excellent book, Why Zebras Don’t Get Ulcers. The American Academy of Pediatrics emphasizes this distinction in its statement on early life stress. And the Harvard statement on child development, cited by Dr. Narvaez herself in her Psychology Today piece, makes a point of distinguishing between short-term and long-term stress.)

The Effects of Stress in Early Life

Short-term stress mobilizes us for action–the classic fight-or-flight response. Adrenaline and cortisol pump through our veins; our bodies brim with energy; and mentally we become hyper-focused.

But these short-term adaptations are harmful when switched on for too long, especially when we are young. Scores of animal and human studies show that early life stress, such as severe early social deprivation, leads to long-term changes in the brain, cognitive and social problems, and heightened susceptibility to anxiety, depression, and drug abuse in adulthood. Chronic stress is toxic.

But from this can we conclude that all early stress, even short-term stress, is harmful?

No. Absolutely not. In studies of short-term stress early in life, occurring within the larger context of a close caregiver-infant relationship, none of these ill effects are observed.

In fact, young monkeys exposed to early short bouts of stress, such as brief periods of separation from their mothers, become more resilient to future stresses. They are less anxious and have less extreme physiological reactions to stress later in life. This phenomenon is so consistent that researchers have labelled it stress inoculation.

My Take

So where does that leave us? A little stress, even in infancy, is fine, if not beneficial, but too much for too long is very, very bad.

Do we know exactly where sleep training fits in this spectrum? Just how much stress does a baby experience during cry-it-out?

The short answer is that we don’t know for certain. Everything we do know, however, suggests that this amount of stress, in the context of a warm, loving family, is just fine.

To see why, let’s return for a second to the American Academy of Pediatrics statement on early life stress, which provides examples of the types of stress children can withstand, provided they occur within a broader context of loving, supportive relationships. These include “the death of a family member, a serious illness or injury, a contentious divorce, a natural disaster, or an act of terrorism”. By comparison, sleep training seems pretty mild.

But I would go further. I believe that sleep training is not only not harmful, it is beneficial. Successful sleep training can decrease depression and chronic stress in the parents, and this benefits parents and their babies. Unlike sleep training, having a depressed mother during early childhood has been shown, repeatedly, to be linked with worse long-term outcomes for children.

Which brings me to what I find most troubling about the claims of sleep training opponents: Their zero-sum take on parenting. Worrying about your own sleep needs is selfish, they not so subtly imply. Any time you fail to put your baby’s needs before your own, you are potentially doing him harm.

What a narrow, cramped view of parenthood.

No one would ever dispute that parenthood entails enormous sacrifices, especially when your children are young and their need for you feels so endless and all-consuming.

But I think that because parenthood, and motherhood in particular, is so often judged in terms of self-sacrifice, we tend to forget that a primary job for parents is to be strategic.

As parents, we must weigh short-term costs against long-term harms, because our children cannot. We have to consider the risk of a few nights of stress and unmet needs against the risk of a car accident or job loss, and against the serious physical and emotional toll of chronic sleep deprivation on the entire family.

We can forget, too, that the parent-child relationship is one not only of sacrifice but also of profound mutual benefit. You being a whole, fulfilled individual with a solid relationship with your partner, meaningful social ties, and a sense of purpose enriches your world and your child’s world. You being a well-rested, healthy, and happy parent is good for you and good for your child.

References

Ashokan A, Sivasubramanian M, Mitra R. Seeding Stress Resilience through Inoculation. Neural Plasticity. 2016;2016:4928081. doi:10.1155/2016/4928081.

Center on the Developing Child (2010). The Foundations of Lifelong Health Are Built in Early Childhood. Retrieved from www.developingchild.harvard.edu.

Crofton EJ, Zhang Y, Green TA. Inoculation Stress Hypothesis of Environmental Enrichment. Neuroscience and biobehavioral reviews. 2015;0:19-31. doi:10.1016/j.neubiorev.2014.11.017.

Darcia Narvaez. Dangers of “Cry-It-Out”: Damaging children and their relationships for the longterm. Psychology Today. 2011.

Fenoglio KA, Brunson KL, Baram TZ. Hippocampal neuroplasticity induced by early-life stress: Functional and molecular aspects. Frontiers in neuroendocrinology. 2006;27(2):180-192. doi:10.1016/j.yfrne.2006.02.001.

Gunnar M. Reactivity of the Hypothalamic-Pituitary-Adrenocortical System to Stressors in Normal Infants and Children. Pediatrics. September 2, 1992;90(3):491.

Hsiao YM, Tsai TC, Lin YT, Chen CC, Huang CC, Hsu KS. Early life stress dampens stress responsiveness in adolescence: Evaluation of neuroendocrine reactivity and coping behavior.Psychoneuroendocrinology. 2016 May;67:86-99.

Lyons DM, Parker KJ, Schatzberg AF. Animal Models of Early Life Stress: Implications for Understanding Resilience. Developmental psychobiology. 2010;52(5):402-410. doi:10.1002/dev.20429.

Mindell JA, Kuhn B, Lewin DS, Meltzer LJ, Sadeh A; American Academy of Sleep Medicine. Behavioral treatment of bedtime problems and night wakings in infants and young children. Sleep. 2006 Oct;29(10):1263-76.

Parker KJ, Buckmaster CL, Sundlass K, Schatzberg AF, Lyons DM. Maternal mediation, stress inoculation, and the development of neuroendocrine stress resistance in primates.Proceedings of the National Academy of Sciences of the United States of America. 2006;103(8):3000-3005. doi:10.1073/pnas.0506571103.

Sánchez MM, Ladd CO, Plotsky PM. Early adverse experience as a developmental risk factor for later psychopathology: evidence from rodent and primate models. Dev Psychopathol. 2001 Summer;13(3):419-49.

Sanchez MM, McCormack KM, Howell BR. Social Buffering of Stress Responses in Nonhuman Primates: Maternal Regulation of the Development of Emotional Regulatory Brain Circuits. Social neuroscience. 2015;10(5):512-526. doi:10.1080/17470919.2015.1087426.

Evidence-based info for the thinking parent

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