The Misconceptions of Attachment Parenting

by Holly Keich

As the leader of a the Harrisburg Attachment Parenting Group, I’m often approached with requests to join the group followed by a list of reasons the applicant considers themselves to be an attachment parent. Often I’m left wondering how it is that each person has come to identify specific attributes to this particular parenting style. Breastfeeding, babywearing, cloth diapering, co-sleeping, home schooling stay-at-home moms who slather their babies in coconut oil, make all their own baby food, choose to leave their baby boys intact, are vaccine hesitant and buy amber necklaces in bulk…This has become the attachment parenting stereotype.

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Let’s take a step back and look with fresh eyes to see where it all started. Attachment Parenting; a phrase coined by Dr. William Sears in and his wife Martha, a registered nurse, in 1982; was discovered by Dr. Sears when reading Jean Liedloff’s book The Continuum Concept. (1) This ground breaking book published in 1975 took a look at the Ye’kuana people of Venzuela. Through her research, Liedloff proposes that the modern Western ways of giving birth and raising children, with bottle feeding, cribs and baby carriages, does not meet the evolutionary needs of children and therefore they develop a sense of wrongness and shame about themselves and their desires. (2)

Attachment Parenting owes it’s roots to many philosophic predecessors beyond just Liedloff. The first of which is the father of attachment theory, John Bowlby and subsequently his research assistant, Mary Ainsworth who is most notably known for the “Strange Situation” which investigated how attachments might vary between children. With Attachment Theory burgeoning in the world of research after World War II, many responsive parenting styles began to become more mainstream. Most notably Dr. Spock’s best selling book “Baby and Child Care” was published in 1946 where he advised mothers to raise their infants according to common sense and plenty of physical contact. (3) In the 1990’s T. Berry Brazelton also contributed to this discussion with new research about the capacity of newborn infants to express themselves and their emotions and for parents to become sensitized to their babies needs and to follow their own judgment. (4) And there are countless others in between the two as research began to hone in on how babies attach and what that looks like in varying family situations.

The Baby BookIn 1993, the Sears’ published the first edition of “The Baby Book”, the first publication that guided parents in the tenants of “attachment parenting”. (5) This is where the 5 Baby B’s where introduced, which later became the 7 Baby B’s in 2001 with the introduction of “The Attachment Parenting Book”. (6)

  • Birth bonding
  • Breastfeeding
  • Baby wearing
  • Bedding close to baby
  • Belief in the language value of your baby’s cry
  • Beware of baby trainers
  • Balance

As we look at the 7 Baby B’s we begin to see where some of these stereotypes surrounding attachment parenting might have originated.   And even though the Sears’ discuss that attachment parenting is a responsive approach to parenting that it doesn’t have a strict set of rules, many choose to dig in and identify with the above concepts as guideposts to being the perfect parent, myself included in the early days of parenting. Have you found yourself using the guideposts as a checklist rather than a potential strategy that could be weighed in determining what works best for your family?

In 1994, with the blessing of Dr. Sears, Attachment Parenting International was founded by two educators and mothers, Barbara Nicholson and Lysa Parker in Nashville, Tennessee. (7) Both were teachers who noticed a growing need among their students for, greater family security and caregiver availability. (8) API has expanded on the 7 Baby B’s and Dr. Sears’ work and now promotes the 8 Principles of Attachment Parenting. (9)

  • Prepare for Pregnancy, Birth and Parenting
  • Feed with Love and Respect
  • Respond with Sensitivity
  • Use Nurturing Touch
  • Ensure Safe Sleep, Physically and Emotionally
  • Provide Consistent and Loving Care
  • Practice Positive Discipline
  • Strive for Balance in Your Personal and Family Life

While the intent is the same, the principles expand on the Sears’ premise by including Positive Discipline and allowing a broader definition for each category, further defining and refining the core concepts of attachment. While the Sears’ 7 Baby B’s are geared primarily for children 5 and under, the 8 principles are expansive enough to guide you through the ages and stages of parenting up until the teen years (and beyond).

Although it’s been around for nearly 35 years, with roots dating back to World War II, Attachment Parenting is viewed as a fad. Even though the tenants of parenting that are proposed are as old as time and secure attachment remains as basic and beneficial as it ever was to human development, there are critics of Attachment Parenting. Often, this criticism is muddled, confusing attachment parenting with permissive parenting, helicopter parenting, and natural parenting. But if we go back to the principles, you won’t find these attributes on the list. Positive Discipline utilizes strategies that are empathetic, loving, and respectful while strengthening the connection between parent and child. The strategies are kind yet firm. The ultimate goal of discipline is to help children develop self-control and self-discipline. (10) And even though many of the tenants are instinctual, responsive and therefore may come “naturally”, the use of coconut oil, cloth diapers, and natural remedies as espoused by natural parenting is nowhere on the list.

Despite the broader definitions, Attachment Parenting is still mistakenly viewed by many as an intensive parenting style that requires you give up yourself completely to care for your child. Visions of babywearing until they are in middle school are conjured up in people’s minds and written about in articles. And this stereotype may made even more true by those adhering to what they believe are the attachment parenting principles, forgetting that one of those principles is to Strive for Balance. Taking time for yourself is one of the key elements of being an attached parent. If you run yourself ragged meeting your baby’s needs and everyone else comes before you, you’ll soon find yourself struggling to hold on without realizing that you’re the one leading the circus. You’re the one spinning more and more plates striving for perfection and applause. That is, until they come crashing down to the ground and the tent falls in.

Before you loose yourself, take a step back, take a deep breath and realign yourself with the principles that speak to you and work in your life. Use them as tools rather than steps that help you achieve the broader over-arching goal of raising a compassionate, loving and responsible human being. Look at the principles as objectives in reaching that goal. Realize that babywearing is a tool, one of many that can help you meet the objective of using Nurturing Touch, as are infant massage, bathing, hugs, and snuggles. Move through each principle and reassess. There is no one right way to be an attachment parent, but there are a million ways to attach with your child. As is embedded in the philosophy itself, listen to your intuition and let it guide you. You are the best parent for your baby. You know what is best for you and your family. If you are able to quiet your mind enough to listen, to stop the plates from spinning, you can hear that inner voice guiding you. Sit with that voice. Learn to trust that voice.

Celebrate Attachment Parenting Month with a deep connection to peace, love and trust in your own heart so that inner light can shine out brightly for others.

  1. https://en.wikipedia.org/wiki/Attachment_parenting
  2. https://en.wikipedia.org/wiki/Attachment_parenting
  3. https://en.wikipedia.org/wiki/Attachment_parenting
  4. https://en.wikipedia.org/wiki/Attachment_parenting
  5. https://en.wikipedia.org/wiki/Attachment_parenting
  6. https://en.wikipedia.org/wiki/Attachment_parenting
  7. https://en.wikipedia.org/wiki/Attachment_parenting
  8. http://www.attachmentparenting.org/WhatIsAP.php
  9. http://www.attachmentparenting.org/principles/principles.php
  10. http://www.attachmentparenting.org/principles/discipline

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Holly Keich is the owner of Om Baby Pregnancy & Parenting Center in Camp Hill.  She is a Licensed Social Worker, Yoga Instructor, Certified Infant Massage Instructor, Parent, Wife and adamant learner in the school of life.

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Food Before One Should be Nourishing and Fun

Food before one should be nourishing and fun

by Erin Donley

Have you ever heard the term, “Food before one is just for fun?” I call that baloney. Have you ever thought of the most nutrient dense foods you eat? Some may say baked salmon, fruits, vegetables and coconut oil. Yes! All of those foods are very nutrient dense. They have awesome fats for the nervous system (helps the brain work well!), vitamins and minerals for beautiful skin and energy, and coconut oil is very satisfying and can even help your metabolism.

So, now think about those first foods infants are usually fed…rice cereal, packaged fruits & vegetables, infant cookies & crackers (puffs) and maybe some fresh fruits. Rice Cereal is not that nutrient dense compared to salmon or coconut oil. Children prior to the age of 18 months actually cannot digest grains such as wheat, barley, oats and rice. They don’t have the digestive enzymes and their systems have not matured enough to break them down.  So what is there to feed baby then?

Letting baby lead the process of starting solids is the best way to encourage healthy eating behaviors. Some babies will start as early as 5 months or so or up to 10 months for their first foods.

There are many soft and easy to mash up foods that are perfect for children up to age 2. For instance, the Weston A Price Foundation, a group that advocates nourishing traditional foods based on the work the dentist Weston A Price, suggests baby’s first foods should be egg yolks, liver, bone broth, butter, avocados, fish eggs, and fermented cod liver oil. These foods are easy to swallow and are chocked full of protein, fats, vitamins and minerals. These foods can be introduced at around 6 months old. Just lightly cook a whole egg in a skillet and grate some grass fed frozen liver into the egg yolk. Then just put some on a little baby spoon. You may be quite surprised how much your baby loves this food! Babies also love to eat mashed banana and avocado.

At around 10 months or so, babies can be fed a variety of meats, fish, fruits, fermented dairy (if tolerated) and vegetables. Don’t forget to include healthy fats such as grass fed butter, coconut oil, olive oil, and other grass fed fats when cooking for baby.

My son, now almost 3, had many digestive issues as an infant. After trying every commercial formula, we researched and found the infant formula recipe in the cookbook, Nourishing Traditions by Sally Fallon. We started giving it to him when he was about 5 months old. He loved it. Then at around 6 months we started with the liver and egg yolk. Some of his digestive issues started to return so we stopped the eggs in recommendations of his physician. However, we continued to feed him soft cooked sweet potatoes and other root vegetables blended with bone broth. He would practice feeding himself avocado, banana, soft pears, and even beef stew meat. His skin was beautiful and his sleep was finally settling out better at night. Honestly, I was surprised how easy it was to feed him a whole foods based diet. I saved a ton of time using my crockpot frequently to cook down many types of animal meats.

By feeding your baby nutrient dense foods prior to age 1, you will encourage him to enjoy nutrient dense foods and develop a palate for vegetables and fruits. Plus, the whole family benefits from eating a whole foods based diet together. Remember that the main source of baby’s nutrition should come from breastmilk or formula before 1.


Erin headshotErin Donley M.Ed NTP is a Nutritional Therapist in private practice in Mechanicsburg PA. She has a passion for working with young families transitioning to a whole foods based diet, working with couples trying to achieve pregnancy, and running the RESTART group program for those looking for solid nutrition education and a sugar detox. Find more information on Facebook @ Faithandhopewellnessassociates and at www.faithandhopewellness.com.

 

It’s All Normal: A Story of Extended Breastfeeding in American Culture

20526275_10155428980056257_533579188615686729_n“How long did you breastfeed?” she’d asked as I started engaging in small talk at my husband’s friend’s New Year’s Eve party. She had seen me still breastfeeding my youngest earlier in her living room. I’m stumped by her question. This is the first time I’ve ever been asked point blank about the length of time I breastfed my oldest child.  I searched quickly for a non-answer and couldn’t find one. So rather than engage in awkward silence, I answered tentatively that he’s still nursing. She was astounded. “I mean don’t you want your body back?” She continued saying that she’d weaned at one because she needed to have her body back. It was her story, many women’s story, and another story that let me know I was different. This interaction left me feeling exposed, sure she would share my secret that my son was still breastfeeding at age 6.

“You know what they say? If you breastfeed past two it’s just for you.”  A co-worker who loves to instigate throws this quip at me after learning that I am still breastfeeding my then 2 year old son.  The implication is that I get sexual pleasure from the experience. It’s said in a tone that meant ‘not me of course, but that’s a belief that’s out there.’ It’s an offensive thought, but a small part of me feels the shame of society and looks inside as I defiantly defend myself and my sons need to keep nursing beyond what is socially understood or accepted in our ‘me first’ culture.

Up until age 2 I had an easy, pre-prepared come back; “The AAP recommend breastfeeding until one and the WHO recommends continuing to breastfeed until at least two years old.”  Even that gap between one and two years old felt tenuous when I said it. American pediatricians at least agreed that breastmilk was important enough for a child under one, but beyond that those WHO recommendations were really just for those living in 3rd world countries. For those living where it was less safe to mix formula for their child due to water conditions. Where disease was more prevalent and dangerous and breastmilk beyond one would help their survival rate. It really wasn’t for the modern mom living in western suburbia and headed to work every day.

So I developed a new story; “I planned to nurse to 2 years old, but my child had a different plan.” I used attachment parenting and the adage to follow your child’s lead to guide me through the years after two. But I became acutely more aware of the moments when he wanted to nurse in public, being extra sure to be discreet without actually leaving the room to hide my ‘shameful breastfeeding’ away. I wanted to normalize it, but had my own tenuous feelings of wanting to hide in those years after his 2nd birthday.

My son is 3 and perusing the food table stealing snacks and treats out of my view at a party. Eventually as day turns into night, he comes to me and wants the comfort of nursing or maybe it’s that he fell and bumped his knee, I can’t quite recall.  He wanted the comfort of being held close in his mama’s lap and the familiar rhythm of nursing. I don’t know these people, I think. I don’t feel safe to nurse here, so I steal away to a quiet, dark corner and sit at the bottom of an open stairway to nurse. This is the first time I remember feeling shame while nursing. I am more worried about who could see us than my son’s need to nourish himself, be it emotionally based rather than nutritional.

Before he was born I wasn’t certain how I felt about breastfeeding in public. It’s not something I had seen often and I’m not an exhibitionist who feels free with her body to expose it.  I mean whenever I was in a situation in college where everyone went skinny-dipping, I was the one sitting on the dock, fully clothed wondering what fresh freedom these people had found. It wasn’t that I was ashamed of my body, but that it was private and there was shame in sharing it publicly. How would these thoughts transition to breastfeeding my child? What I found is that my newborn’s needs trumped my concerns about what other people thought or saw. I mean which would they rather have, a crying, hungry baby or a possible nip slip sighting? I felt justified in those early days. And I’m pretty sure the hormones of birth and early parenting had a lot to do with that fierceness that allowed me to take care of my child regardless of setting. After all, this is what nature intended.

The cultural norm in countries where breastfeeding continues to term unhindered by these judgmental labels, what’s considered ‘extended breastfeeding’ in our culture (as if anything beyond 1 is abnormal), is 4-7 years old. Good, good. I’m within the cultural, biologically normal group. There’s nothing wrong with this, nothing wrong. We’re not an enmeshed family dyad where my needs depend on him needing me.

As the days and years pass, I tell myself he won’t nurse forever. He won’t need me forever. It’s as if I’ve resigned myself to his needs as I’ve always done since he was born, without considering me in the equation.  After all, what is motherhood but selfless service to another? I don’t need him to nurse to give my life value. His very existence as my child brings value to my life. He was a ‘wanted’ child that we conceived after two years of trying and many procedures poking and prodding my ovaries to work properly. Is it in my effort to prove to myself and the world that we aren’t enmeshed that I begin to push him away and resent his need of me? Is it what I feel or what society has laid on me?

In breastfeeding groups over the past ten years I’ve seen more women speaking out about how long they’ve breastfed. Proud of their 3.5 years, 4 years, 5.5 years. But you don’t hear much beyond that. Is there still shame in nursing to the upper limits of ‘normal’ even amongst breastfeeders? Portrayals of women who continue this connection beyond even the extended breastfeeders norm are considered freaks. The mother who has the bravery to share her story on TV is shown holding her child with their lanky legs dangling off her lap, certainly too old for breastfeeding. A story of someone who once knew a woman who nursed her son until he was 8, until her family had an intervention to say enough is enough.

My son lay next to me in his bed, our typical bedtime ritual in progress, reading a book, then lights out and nurse to sleep. It’s the only time my son nurses anymore. It’s the last of his security he’s had since he’s arrived on earth. As we turn out the lights and he drifts off to sleep sucking on my breast,  I hear my mother-in-law walking back the hallway to tell me she’s leaving. I quickly unlatch and we lay side by side as she comes in to say goodbye.

It should come as no surprise then when my son asked to nurse on another day in another time and knows that I’m scanning the room to see if I feel safe enough to indulge right then and there. I’ve taught him that it’s not safe to expose yourself, to be vulnerable even in the name of love. You must hide to feel safe.

Screams and cries as my son hits the floor in the lobby of the Farm Show building. It’s only been a few weeks since his little sister arrived in the world. We’re trying our best to keep his world the same and show our love for him by doing things. Nothing says love like the smell of a barnyard and petting a fluffy bunny.  As I carry his sister in the Moby Wrap, I assume he has tripped behind us and fallen to the ground. Nothing worse than the screams of a 4 year old in a massively crowded public setting. I scoot us to the side, out of the way of the moving crowd and know that he’ll want to nurse to calm down. I pass my daughter to my husband and I huddle up my son in my lap and enshroud us in my giant babywearing coat and hide in plain view of everyone entering and exiting the Farm Show. I comfort him. I meet his needs. And I send a clear message that what we are doing isn’t to be seen by others.

I often wonder how those messages were received. I continue to nurse to meet his needs, but if I’m ashamed of it what story does that implant in his brain. How will it display itself when he’s older?  Curiosity sparks me to continue nursing to term to see what is his norm, regardless of my discomfort which is more cultural than personal.

Despite my fears, I realize he still looks at it as a loving normal connection as I ask him if it’s OK if I share a story of our breastfeeding journey. He pauses for a second and looks confused as to why it would be important enough to write a story about it. It’s all normal. It’s the expression of the life giving love and power of motherhood…
regardless of the age of your child.

How to Be a Good Friend to a Postpartum Goddess

Ideally her house is clean, her sheets and pj’s smell yummy, there is plenty of comforting foods and fresh fruits in the fridge…

Any good visitors that come over should bring her food, visit a short while, and clean something.

Folding laundry, or playing with her other kids is fine too..

Everyone that passes new-mama-goddess on the couch or bed should ask her if she needs anything.

If she says no, just go get her some water.
If she’s crabby or acts weird, just know:

  • She’s really busy adjusting to her new role as mother (of 1, 2, 3, or 4 etc. children)
  • She’s more concerned with figuring out how her baby feels constantly..(hungry, tired, cold, scared, comfortable, etc.)
  • Her hormones are wacking out..
  • She needs help and doesn’t want to ask you (or yell at you, or cry while she’s talking)

She’ll need a little time to touch her belly, alone…the new postpartum body is kind of shocking. Someone should offer to hold down the fort while she takes a shower.Her boobs are taking up alot of space. (in her mind, in her baby’s mind, in her husband’s mind, in the bed, in her bra)…maybe ask, “how are the girls?” Can you offer breastfeeding help? Get someone who can, if she needs this…

While feeding baby, she’ll feel a little more in control (in her new out-of-control world)by doing a few pelvic squeezes, even if they are weak. This will help speed up the healing process of her perineal chakra..which holds her chi…lifeforce.

The squeezing movement  gives a sense of power back to her, that can ease her sense of any trauma that she may have endured..(This is true for all women, mothers or not,  BTW) Maybe do some with her and giggle over “Kegel Faces”.

Deeper Kegels will come with time, as she can trust in the process of taking this area of her body back (from the birth process). Ask her if she needs a nap..or a shower..again.
You are such a good friend, Goddess…

Please tell her to check out:
The Mama Goddess Experience for pregnant and postpartum women, a special summer workshop at OM Baby on August 5, 2017.
More details here

Mama Goddess Experience 2

The Dark Side of Fatherhood

by Holly Keich

There’s a secret in our culture and it’s not about how strong women are in birth, it’s that men experience postpartum depression. Every day 1,000 new dads in the United States become depressed. 1 And some studies indicate that this is a low estimate and that it could be as high as 25% of new dads that experience paternal postpartum depression (PPPD).2 What these statistics tell us is that postpartum depression in men is common. But if it’s so common, then why haven’t we heard about it before now?

IMG_7324bwTraditionally, men have been conditioned to be the strong one, the provider for their new family. In fact, I recently came across a quote by Sigmond Freud that states, “I cannot think of any need in childhood as strong as the need for a father’s protection.” Because of this societal pressure, men tend to hide their depression and withdraw from others. There can be a disconnect as well between how men feel and how they think they should be feeling after baby arrives. Depression in men may also look different. Withdrawal may mean working more and spending more hours away from home. In fact, research tells us the men often experience depression in ways that are different than women. Men sometimes cope with their symptoms in different ways too. This may be why even trained mental health professionals may misdiagnose men’s depression.

It’s helpful to first look at the classic symptoms of depression which may also be present in men postpartum. 3

  • Depressed, sad mood
  • Loss of interest or pleasure
  • Significant weight loss or gain
  • Trouble sleeping or over-sleeping
  • Restless feelings and inability to sit still or slow down
  • Fatigue, loss of energy, or tired all the time
  • Worthless or guilty feelings
  • Impaired concentration and difficulty making decisions
  • Recurrent thoughts of death or suicide

Typically a person would need to exhibit 5 or more of these symptoms over a 2-week period to be diagnosed with a depressed mood.

But as mentioned, there’s more to paternal postpartum depression in men. One thing that researchers are finding is that men don’t often acknowledge feelings of sadness, hopelessness, or guilt.4 They tend to have additional symptoms that are unique to men.

Symptoms of Men’s Depression 5

  • Increased anger and conflict with others
  • Increased use of alcohol or other drugs
  • Frustration or irritability
  • Violent behavior
  • Losing weight without trying
  • Isolation from family and friends
  • Being easily stressed
  • Impulsiveness and taking risks, like reckless driving and extramarital sex
  • Feeling discouraged
  • Increases in complaints about physical problems
  • Ongoing physical symptoms, like headaches, digestion problems or pain
  • Problems with concentration and motivation
  • Loss of interest in work, hobbies and sex
  • Working constantly
  • Frustration or irritability
  • Misuse of prescription medication
  • Increased concerns about productivity and functioning at school or work
  • Fatigue
  • Experiencing conflict between how you think you should be as a man and how you actually are
  • Thoughts of suicide

The number of symptoms may vary as may the severity between individuals. While the list may seem daunting, the important thing to know is that depression is treatable. You can recover.

Because research on paternal postpartum depression is in its infancy, we know little about what exactly are the risk factors. What research is beginning to show is that many of the risk factors are similar to that of women. 6,7

  • A lack of good sleep
  • Changes in hormones
  • A personal or family history of depression and/or anxiety
  • Poor relationship with spouse
  • Poor relationship with one or both parents
  • Relationship stress – with a partner or with in-laws
  • Excessive stress about becoming a parent or father
  • Nonstandard family (such as being unmarried or a stepfather)
  • Poor social functioning
  • A lack of support from others
  • Economic problems or limited resources
  • A sense of being excluded from the connection between the mother and baby
  • A personal history or alcohol or drug abuse
  • A major life event such as a loss, house move or job loss
  • Being a father of multiples or a baby with special needs

One risk factor that may have caught you by surprise was hormonal changes. We’ve all heard how fluctuations in hormones during pregnancy and after birth can affect women, but may not know that men have hormonal fluctuations during pregnancy and postpartum as well. Studies show that a man’s hormones also shift during pregnancy and after birth, for reasons that are still unknown. Testosterone levels drop; estrogen, prolactin, and cortisol go up. Some men even develop symptoms such as nausea and weight gain.8 According to Dr. Courtenay, a psychotherapist who specializes in men’s depression and host of postpartummen.com, one of the few websites devoted to the issue, “Evolutionary biologists suspect that the hormone fluctuation is nature’s way of making sure that fathers stick around and bond with their baby.”9

Another risk factor that may be surprising is that if your partner is depressed, there’s a good chance that you are too. Up to half of men whose partners have postpartum depression are depressed themselves.10 So it’s important that it’s not just the mother that gets assessed for PPD after baby, but their partner’s should too. The same tool can be used, the Edinburgh Postnatal Depression Scale – or the EPDS, for short. It is the most widely used assessment for postpartum depression and anxiety. It has been tested and found effective with men. You can find the PPPD assessment here.

*The instructions for completing the EPDS are different for women and men. If you are a woman and concerned that you have postpartum depression please use the following EPDS assessment from the postpartumstress.com.

According to the Journal of Parent & Family Health, fathers are most likely to experience the first onset of paternal postpartum depression in the first 3 – 6 months after the birth of their baby.11 This isn’t just a coincidence. It’s around this time that women in the U.S. end their maternity leave and head back to work, adding more stress to what is already a major life transition. As if figuring out how to parent isn’t complicated enough, returning to work adds one more thing to balance on an already teetering plate.

If you identify with the risk factors and are not yet pregnant, there’s time for preventative measures. Consult a mental health professional if you have a history of depression to prepare should you have a recurrence. If you have relationship issues or poor communication in your relationship, seeking help before the child is born can help you learn new skills which can lessen the stress and reduce your risk of PPPD. If there are economic concerns, it’s time to address them and set up a budget. Setting aside time to think through the logistics of postpartum can also be helpful. Postpartum Support Virginia offers an excellent, detailed plan for adjusting to life with a new baby.

If you’ve identified yourself or your partner in the symptoms for PPPD, then it’s important to get help. Depression is a very treatable condition, but if left untreated can result in damaging, long-term consequences for you, your kids, your marriage, your career, and your finances. Finding a therapist that is skilled in working with men is key in order to get an accurate diagnosis and appropriate treatment. You can ask your doctor or pediatrician for a referral. Be sure to ask when making an appointment if they have experience in treating paternal mental health. Therapy can also help you with stress management, juggling home and work responsibilities and relationship issues that can often come up when you and your partner are transitioning to parenthood.

There are other coping strategies as well that can be useful in conjunction with therapy:
Medication may also be suggested as a strategy and can be used short term to help to recover.

Tackle Isolation by reaching out to others. Talk with your partner or friends about the challenges of parenthood. This isn’t just a problem that effects you, it’s a family problem and sharing your feelings is a step to reaching out to develop a support network in your journey toward healing. If talking to those you know is too difficult, utilize online resources. postpartummen.com has a forum where men can share their feelings anonymously.

Take Care of Yourself physically and emotionally. Exercise, eating well, journaling, yoga, meditation, acupuncture – anything that reduces stress should be on every new parent’s to do-list.

Get Rest. Yes, we mean sleep.  We know it’s at a premium these days, but figuring out a plan that works for both parents is imperative.  Mood disorders can happen to anyone who is sleep deprived.  Alternate nights taking care of the baby, hire a postpartum doula for a few nights or ask a family member to help so you can get some sleep.  Allow yourself a break. Many men do double duty by going to work and then taking over childcare as soon as they get home. Discuss how you can share childcare and chores so you can have some down time.

Despite the secretive nature of PPPD it’s still a very treatable condition.  Seeking help is imperative not only for your health, but also the well-being of your marriage and child(ren).  If left untreated, research shows it can cause a negative impact on the emotional and behavioral development of your children years later.12   So the best thing you can do to provide for your children’s future is to get help for yourself today.

1 http://postpartummen.com/

2 http://postpartummen.com/

3 http://drsarahallen.com/paternal-depression/

4 http://postpartummen.com/mens-depression/

5  http://postpartummen.com/postpartum-depression/

6  http://drsarahallen.com/paternal-depression/

7 http://postpartummen.com/postpartum-depression/

8  http://www.parents.com/parenting/dads/sad-dads/

9 http://www.parents.com/parenting/dads/sad-dads/

10 http://postpartummen.com/postpartum-depression/

11 http://drsarahallen.com/paternal-depression/

12 http://postpartummen.com/get-help/

 


Holly Keich, LSW supports family connections through Om Baby Pregnancy & Parenting Center in Camp Hill, PA since 2008.

Folate vs Folic Acid in Pregnancy

Pregnancy often makes us take a closer look at our nutrition. Even if we weren’t taking vitamins in the past, we’re likely to start. At the first appointment with our prenatal care provider, likely we discuss some of the recommended requirements or possibly for those of us that are Type A personalities, we’ve already thoroughly researched the topic because we want to be on top of everything by the time we meet our provider.  I recall hearing from a variety of sources that Folic Acid was one of the key important nutrients and to be sure to make sure you were getting enough.  But what is enough and is a multi-vitamin the best source of this important nutrient?  We’ll take a look at recent research to find out how much is enough, is there such a thing as too much of a good thing, and what are the best sources of folic acid or it’s more natural form, folate.

Folic acid and folate are members of the B vitamin family.  Their names come from folium, the Latin word for leaf. (1) It is not a surprise that leafy vegetables are by far the best sources of folate. This nutrient is found naturally in various leafy vegetables such as spinach, cabbage, turnip greens, collard greens, and romaine lettuce. (18) Often the terms folic acid and folate are used interchangeably as in this excerpt from the Baby Center, “If you’re pregnant or might become pregnant, it’s critically important to get enough folic acid, the synthetic form of vitamin B9, also known as folate.” (3)  But in fact, folate refers to various tetrahydrofolate derivatives naturally occurring in foods. (6) Folic acid, on the other hand, is the fully oxidized synthetic compound (pteroylmonoglutamic acid) used in dietary supplements and in food fortification. (6)

Human exposure to folic acid was non-existent until its chemical synthesis in 1943. (4) In January 1998, the U.S. Food and Drug Administration (FDA) began requiring manufacturers to add folic acid to enriched breads, cereals, flours, cornmeals, pastas, rice, and other grain products. (13) The overwhelming evidence that folic acid supplementation before conception and during early pregnancy prevents neural tube defects (NTD) in newborns is what led to the FDA requirement. Food fortification rather than supplementation was deemed necessary because NTD’s could occur during early pregnancy, before a women knows she is pregnant.

The neural tube is the part of the embryo from which your baby’s spine and brain develop. If something goes wrong in their development, the result is called a neural tube defect. These are birth defects of the spinal cord (such as spina bifida) and the brain (such as anencephaly). (3) A baby’s neural tube is formed and closed in the first four to six weeks of pregnancy. (10) By the time most women know or suspect they are pregnant, the time for the developing fetus to benefit from extra folate has passed. NTDs affect about 3,000 pregnancies a year in the United States. (3) The Centers for Disease Control and Prevention (CDC) reports that women who take the recommended daily dose of folic acid starting at least one month before conception and during the first trimester of pregnancy reduce their baby’s risk of neural tube defects by up to 70 percent. (3)

Beyond protecting against NTD, folate is a key player in essential cell functions. It helps make, protect, and repair DNA (15), aids the complete development of red blood cells that carry oxygen from your lungs to all parts of your body (and to your baby) (14), and helps convert some amino acids (the building blocks of proteins) into others (15). During pregnancy, women’s requirements increase as baby grows in the womb.  The rapid cell growth that takes place in the placenta and as your baby grows makes getting additional amounts of folate important. Some research suggests that folate can also reduce your baby’s risk of cleft lip, cleft palate, congenital heart defects, reduces low infant birth weight, preterm delivery and fetal growth retardation. (3, 13) Not only can this  important nutrient protect your baby, there can be benefits for the mother also.  It may also reduce your risk of preeclampsia, a serious blood pressure disorder that affects about 5 percent of pregnant women. (3)

Folate is found naturally in a wide variety of foods, including vegetables, fruits and fruit juices, nuts, beans, peas , dairy products, poultry and meat, eggs, seafood and grains. (13) Spinach, liver, yeast, asparagus, and Brussel sprouts are among the foods with the highest levels of folate. (13) For a more detailed list, check out the U.S. Department of Agriculture’s Nutrient Database Web site which lists the nutrient content of many foods and provides a comprehensive list of foods containing folate arranged by nutrient content and by food name.

The federal government’s 2015-2020 Dietary Guidelines for Americans notes that “Nutritional needs should be met primarily from foods (13) and folate is no different. Folic acid was once thought to absorb better in the body than natural folate, but studies have found that a whole foods, folate-rich diet is just as effective. (18) Based on a 2007 study published in the American Journal of Clinical Nutrition, the aggregate bioavailability (the degree to which a substance becomes available to the target tissue) of folates from fruit, vegetables, and liver is approximately 80% of that of folic acid. (16) Therefore, it was decided that the consumption of a diet rich in folate from foods can actually improve the folate status of the population more efficiently that was assumed just a few years ago. In part, this may be because although the body may absorb folic acid faster than it absorbs folate, it must then convert it into folate before it can get to work. (15)

Another consideration is that when getting your folate intake through unfortified food, it comes with a whole host of other vitamins, minerals and as-yet undiscovered phytonutrients that work synergistically in the body.  In fortified foods and single supplements, it may be working alone.  Therefore, it’s best to get your nutrients from food. (15)

During pregnancy though, due to the increased demands of the fetus, it is difficult to obtain a therapeutic dose strictly through diet and may be best to supplement to ensure that you are getting appropriate amounts.   Fortified foods can help correct deficiencies, but they can overdo one nutrient. This may prove to be more detrimental that beneficial.  For example, some fortified breakfast cereals contain 100 percent of the recommended daily amount. (3) And some breakfast cereals, nutrition bars, and other fortified foods deliver up to 800 micrograms of folic acid, and that’s about double the recommended daily dose. Studies have more recently emerged which raise concern about the safety of chronic intake of high levels of folic acid from fortified foods, beverages and dietary supplements. It has been shown that many ready-to-eat foods are actually over-fortified with folic acid and that the projected daily folic acid intake from fortified food has been greatly exceeded. (2) In fact, the fortification program was projected to increase folic acid intakes by approximately 100 mcg/day, but the program actually increased mean folic acid intakes in the United States by about 190 mcg/day.(13) Considering this may be in conjunction with a daily prenatal vitamin in pregnancy which typically provides 400 mcg or more, we see how this may exceed the Recommended Daily Allowance.

Let’s take a look at what the recommendations actually are for folic acid.  The Recommended Daily Allowance (RDA) is the average daily level of intake sufficient to meet the nutrient requirements of nearly all (97%–98%) healthy individuals. (13)  The intake recommendations for folate and other nutrients are provided in the Dietary Reference Intakes (DRIs) developed by the Food and Nutrition Board (FNB) at the Institute of Medicine (IOM) of the National Academies.(13). It states that women of childbearing age should get 400 mcg of natural folate daily. It is recommended that women get 600 mcg during pregnancy, and lactating women get 500 mcg of folate each day. (18)  In table 1 below taken from the National Institute of Health, you’ll see that folate is listed as micrograms (mcg) of dietary folate equivalents (DFE’s). This term was developed to reflect the higher bioavailability (the amount of a nutrient that reaches the body’s tissues after it is eaten or the amount that your body absorbs)  of folic acid than that of food folate. This chart assumes that at least 85% of folic acid is estimated to be bioavailable when taken with food and that only about 50% of folate naturally present in food is bioavailable.

Table 1: Recommended Dietary Allowances (RDAs) for Folate*

Age Male Female Pregnant Lactating
Birth to 6 months* 65 mcg DFE* 65 mcg DFE*    
7–12 months* 80 mcg DFE* 80 mcg DFE*    
1–3 years 150 mcg DFE 150 mcg DFE    
4–8 years 200 mcg DFE 200 mcg DFE    
9–13 years 300 mcg DFE 300 mcg DFE    
14–18 years 400 mcg DFE 400 mcg DFE 600 mcg DFE 500 mcg DFE
19+ years 400 mcg DFE 400 mcg DFE 600 mcg DFE 500 mcg DFE

*chart from National Institutes of Health (13)

As discussed previously, while there is no agreement on the extent of difference between folic acid and folate bioavailability, folate bioavailability is more efficient than this chart assumes. So, the concern might be that you are consuming too much folate, but rest assured, you can’t get too much from foods that naturally contain folate. (12) It comes naturally packaged in balance with other micronutrients, and the body regulates its absorption. It is possible, however; to get too much folic acid from man-made products such as multivitamins and fortified foods, such as breakfast cereals.

While low levels of folate present many health concerns, new research is showing that excess levels may be a concern as well.  The Institute of Medicine advises not to take more than 1,000 mcg per day of folic acid unless advised by your healthcare provider. (15)  Certain situations that may require a higher dosage are:  (3)

  • Women who are obese appear to be more likely to have a baby with a nueral tube defect.
  • Previously pregnant with a baby with a neural tube defect (have a 3-5% chance of having another pregnancy complicated by an NTD.
  • Carrying twins
  • Methylenetetrahydrofolate reductase (MTHFR) mutation – that makes it more difficult to process folate and folic acid (about 50% of women in the U.S. are unable to methylate or fully convert folic acid to folate because of one of more defects in their MTHFR gene (19) )
  • Diabetic or taking certain antiseizure medications

Studies show that the body can’t properly process a high intake of folic acid into folate. It is possible that unconverted folic acid circulating in the bloodstream could elbow aside folate for spots inside binding enzymes, carrier proteins, and binding proteins. (16) In theory, this could decrease the amount of folate carried into brain and other tissues—like dying of starvation in a land of plenty. In practice, though, whether this is a real problem is not clear yet. (16)

Looking more specifically at MTHFR issues, this mutation makes it more difficult for the body to detoxify. During pregnancy this is especially concerning because the build up of unusable folic acid (from fortified food and certain prenatal vitamins) can cause toxicity and folate deficiency because it blocks absorption of naturally occurring folate. (20)

Multiple studies have been released in the past few years expressing health concerns about excess folic acid consumption. One of those studies presented preliminary findings in 2016 and suggests that excessive amounts of folate (vitamin B9) and vitamin B12 in a mother’s body might increase a baby’s risk of developing an autism spectrum disorder. (9) The researchers found that if a new mother has a very high level of folate right after giving birth – more than four times what is considered adequate – the risk that her child will develop an autism spectrum disorder doubles. (9)  Very high vitamin B12 levels in new moms are also potentially harmful, tripling the risk that her offspring will develop an autism spectrum disorder. If both levels are extremely high, the risk that a child develops the disorder increases 17.6 times. (9)

While this may spark concern in new mothers, it’s important to view the new findings with perspective.  M. Daniele Fallen, PhD, director of the Bloomberg School’s Wendy Klag Center for Autism and Developmental Disabilities and the study’s senior author urges us to remember that “Adequate supplementation is protective: That’s still the story with folic acid.” (9)  She feels that this study tells us “that excessive amounts (of folic acid) may also cause harm. We must aim for optimal levels of this important nutrient.” (9)  In other words, more research needs to be done.  It still needs determined just how much folic acid a woman should consume during pregnancy to provide optimal blood folate levels for the best outcome for her baby.

Additional studies point to other concerns of excess folic acid during pregnancy.  A 2015 Portugese study published in the Journal of Edocrinology expresses a concern that excessive amounts of folic acid during pregnancy may predispose their daughters to diabetes and obesity later in life. (11)  This study also calls for a need to establish a safe upper limit of folic acid intake for pregnant women.

A few studies have also suggested that excess folic acid may be associated with increased risk for colorectal, breast, and prostate cancers. (15)  While these studies are limited, they sound an additional warning about getting too much folic acid and confirms that this topic certainly deserves further investigation.

Despite mounting studies about the concerns of excess folic acid and statistics from the CDC that indicate on the other end of the spectrum that one in four women of reproductive age in the U.S. have insufficient folate levels (8), it’s surprising that levels are not routinely monitored during pregnancy. Likely testing was previously thought not to be needed once food fortification requirements were put into place to raise levels of folic acid in women of childbearing age. Since conventional belief is that B vitamins are water soluble it was thought that any excess would be flushed out. Until recently, there wasn’t a concern about high levels in the body.

As discussed previously, most folic acid cannot be converted into the active folate 5-MTHF, and instead it is converted in the liver, or other tissues in the body. (18) While both folate and folic acid need to be converted into the bioactive MTHF for the body to use, it’s easier to convert when it comes from food. (19)  The process of converting folic acid is very slow and has been shown to be even worse when fortified foods and folic acid supplements are consumed together. (18) When this happens, it can lead to unmetabolized folic acid in the bloodstream. (18) Possibly as more studies are done to find a safe upper limit of folic acid regular testing will be included in a future prenatal panel checklist to ensure optimum levels.  Keep in mind though that by the time you know you are pregnant, it may be too late, so it may be better to be proactive and get testing beforehand if you want to know for sure.

It’s clear that the science is not settled on this issue, so what’s an expecting mama to do regarding folate intake?  T.H. Chan of the Harvard School of Public Health recommends to continue taking your standard (prenatal) multivitamin, but to stay away from heavily fortified foods that deliver a full day’s dose – or sometimes more – of folic acid. (15) If eating fortified foods, Chan recommends avoiding foods fortified with more than 100-200 micrograms of folic acid (25% to 50% of the % Daily Value). (15) While no supplement can replace the synergistic effects of whole foods, it’s a great insurance policy, especially when trying to conceive, during pregnancy and lactation.  There are now high quality prenatals that contain folate – the natural methylated form, 5-methyltetrahydrofolate (5-MTHF) on the market.

Seeking Health, Optimal Prenatal

MTHFR-Seeking-Health-Optimal-Prenatal

Thorne Research

Thorne-Research-prenatal-supplement-facts

Zahler Prenatal + DHA

Zahler-Prenatal-DHA-prenatal-supplement-facts

You can get more info about nutrient profiles of prenatals in this blog post by Mama Natural.

Prenatal vitamins containing l-methylfolate have been compared with ones containing folic acid during pregnancy and the results are mixed.  Some experts say that new research will eventually change the guidelines for women, while others say there’s not a compelling case to do so. The choice is yours until more clear information is provided, but as always, be sure to check with your doctor or midwife before making any changes.  Let us know what you decide in the comments.

References/Sources

  1. https://www.hsph.harvard.edu/nutritionsource/folic-acid/
  2. http://blog.designsforhealth.com/blog/bid/115121/Folic-Acid-vs-Folate-Part-I
  3. https://www.babycenter.com/0_folic-acid-why-you-need-it-before-and-during-pregnancy_476.bc
  4. https://www.ncbi.nlm.nih.gov/pubmed/18038944
  5. https://chriskresser.com/folate-vs-folic-acid/
  6. http://blog.designsforhealth.com/blog/bid/115121/Folic-Acid-vs-Folate-Part-I
  7. http://healthybabycode.com/5-myths-about-pregnancy-nutrition-5-folic-acid-supplements-are-safe
  8. https://consumer.healthday.com/cognitive-health-information-26/autism-news-51/too-much-folic-acid-in-pregnancy-tied-to-raised-autism-risk-in-study-710859.html
  9. http://www.jhsph.edu/news/news-releases/2016/too-much-folate-in-pregnant-women-increases-risk-for-autism-study-suggests.html
  10. https://www.betterhealth.vic.gov.au/health/healthyliving/folate-for-pregnant-women
  11. https://www.sciencedaily.com/releases/2015/02/150210083651.htm
  12. https://www.womenshealth.gov/a-z-topics/folic-acid
  13. https://ods.od.nih.gov/factsheets/Folate-HealthProfessional/
  14. http://www.marchofdimes.org/pregnancy/folic-acid.aspx#
  15. https://www.hsph.harvard.edu/nutritionsource/folic-acid/
  16. https://www.ncbi.nlm.nih.gov/pubmed/17284745
  17. https://www.ncbi.nlm.nih.gov/pubmed/20608755
  18. http://www.doctorshealthpress.com/general-health-articles/folate-vs-folic-acid
  19. http://www.foxnews.com/health/2014/07/27/should-skip-prenatal-vitamins-with-folic-acid.html
  20. https://www.mamanatural.com/best-prenatal-vitamins/

Holly Keich, LSW is the owner of Om Baby Pregnancy & Parenting Center in Camp Hill, PA.  When she became pregnant with her first child she began teaching prenatal yoga classes that impart not only the wisdom of poses for the childbearing year, but also knowledge of the spiritual and emotional process of becoming a parent. Holly has attended pre and postnatal yoga teacher trainings with Stephanie Keach and Mindful Mamas. She has also attended Baby Om Yoga training in NYC and is a Certified ChildLight Yoga Instructor, including Baby & Toddler Yoga as well as a Certified Infant Massage Instructor. She supports mother, child & family connections through the opening of Om Baby in 2008.

Share the Love

by Kelly Bolt

Have you heard of the Share the Love program? You probably haven’t, and I’m hoping to change that!  I’m Kelly. I’m a new site host with the Share the Love program.

GCDC2015-Share the Love Optimized
Share the Love is a unique program sponsored by CottonBabies. This program offers assistance to families in need of help diapering their child(ren) we provide a loan of cloth diapers, and inform parents how to use and care for them. These diapers are on loan until the child’s 3rd Birthday or until the family’s need is no longer there.  There are currently over 150 sites across the United States. Each site host is a volunteer, and we donate our time to helping families in need.
We all know that WIC helps cover the cost of food and formula for families. Food stamps helps supplement the grocery budget. But there is not a government assistance program designed to help families meet the (expensive) cost of diapering a child. That’s where Jennifer Labit, CEO and founder of CottonBabies, wanted to step in.
Jennifer knows what it’s like to have to choose between diapering your baby and buying food for the week. This is what motivated her to create STL! She didn’t want anyone else to struggle that way. She knows that the inability to afford diapers can lead to reusing disposables, stretching the use of each diaper by leaving it on too long, and other ways to “recycle” disposables. This can lead to baby getting severe rashes, which causes a need to see the doctor, leading to another bill and another stress on the family. Share the Love is here to help alleviate the stress and strains that come with struggling to diaper your baby.
I decided to get involved with volunteering to become a site host because I want to help others. I saw that there wasn’t a local host, and I knew that the need was here in York, Dauphin, and Lancaster counties. We currently accept donations of new and gently used cloth diapers, wet bags, pail liners, and other cloth diaper accessories. You can drop off any donations at Om Baby, and we will have a special bin set up at the Great Cloth Diaper Change on 4/22/17
If you are in need, or know someone in need, you (or they) can fill out an application at www.cottonbabieslove.com
If you feel it in your heart to become a site host, and help others in your community, you can submit an application at www.cottonbabieslove.com/join-in/