Monday, January 16, 2012

The Case Against Swaddling

My very content un-swaddled newborn baby
When my son was born just over 2 years ago now, I remember being rather annoyed that every time the nurses brought my son back to me after tests and treatments (We were hospitalized for 5 days due to a placental infection not diagnosed until the birth) he was bound tightly in hospital issue receiving blankets. At the time I didn’t know why I was annoyed, it just seemed wrong that each time I would have to rescue my tiny grunting struggling son from his flannel burrito and spend the next 5-10 minutes calming him down enough to breastfeed.

‘Don’t un-wrap him’ one nurse told me. ‘They like it, it feels like the womb, he’ll settle.’

I looked down at my grunting, grimacing, rooting baby and then back up at her with disbelief. My son HATED the swaddle. In fact, my son hated anything that didn’t involve being skin to skin with a boob in his mouth. Yet each and every nurse would tell me how much babies like to be swaddled, about how it was comforting and would help him adjust to being on the outside. All of these praises made me feel kind of dumb, made me feel like there might be something wrong with my baby because he so obviously didn’t like their magical blankets one tiny bit. As I said before it was just kind of annoying.

When we finally got home and settled in I promptly forgot about the whole thing. Needless to say we never swaddled him again. Life went on.

More recently I found myself thinking about this again when I was watching a friend struggle to wrap her flailing infant as tightly as she could because ‘the nurses said it would help him settle’. I thought about how much my own baby hated it, and about how the more newborns I see swaddled the less I believe that any of them like it half as much as everyone says they do, and I started wondering where health care provider’s knowledge of it's wonderful benefits were coming from since every actual parent I’ve heard talk about it reports that their baby wasn’t really all that impressed by it.

So I did a little research. As it turns out there are, as far as I can see, far more reasons NOT to swaddle a newborn then there are reasons TOO do it.

Reasons to swaddle: Tightness is “womb-like” making baby feel content and keeping them from startling resulting in longer periods of sleep.

Reasons not to swaddle:

1) Keeps baby from startling – When we remember that the startle reflex is a survival mechanism which help infants to wake up and alert their parents if something is wrong. (Like falling out of a tree or forgetting to breath) Then logically it seems like a bad idea to intentionally subdue that reflex. As a parent the idea of it makes me really uncomfortable. Sure babies do sometimes startle when there is nothing wrong, but I will take a few false startles as a comfort that my baby will wake up if something is actually wrong. I should mention, however, that the scientific jury is still out on this one.

I have found two similar studies done on the effects of swaddling on the startle reflex here and here that come to two different conclusions. One recognizes the inhibition of startle reflex but asserts that this poses no risk for SIDS (This study used a swaddle method that did not limit mobility of the infant’s legs, which is interesting.), while the other shows a big difference in arousal responses of infants who are routinely swaddled vs those who are not and suggests that further study is needed on what this means for SIDS risk.

2) Not entirely all that womb-like – Aside from the snug fit, a swaddling blanket is nothing like the womb, it isn’t always the perfect temperature (see next point), it doesn’t have a heartbeat or comforting voice, it has no means of providing nutrients.

3) Possibility of overheating – Human infants are born quite helpless, we all know this. They cannot walk, feed themselves, or do their own (never ending) laundry. They also aren’t very good at regulating their own body temperature. When an infant becomes too hot, which could happen in a tight swaddle in thick blankets, they are at risk for apnea. The most natural way for an infant to maintain a proper temperature is through direct contact with a parent or caregiver. (see link in point 5)

4) Hip Dysplasia – The standard super tight burrito swaddle that the nurses at our hospital raved about can often result in an infant spending a lot of time with their legs incorrectly positioned causing problems in the hip joints not unlike the effects of improper babywearing. While no extensive large scale studies have been carried out on the effects of swaddling on hip joint development there is still evidence to show the correlation.

5) Limits tactile stimulation – Since an infant in a swaddle is so tightly wrapped in so many layers of fabric it limits the stimulation of a caregivers touch. Since physical contact is so important for bonding, breastfeeding, and for an infant to self regulate body heat, heart rate, and other biological systems, it may not be such a good idea for an infant to spend too much time wrapped up in this way.

6) Could potentially interfere with breastfeeding – In the early days a swaddled baby who enjoys being swaddled may rouse less often and therefore spend less time at the breast, this can lead to a higher incidence of jaundice and weight loss in newborns. A swaddle also prevents a newborn from displaying early signs of hunger like trying to get their hands in their mouth. In the very early days and weeks when learning cues and communication is still in progress limiting these early cues could potentially cause feeding problems. Limiting direct contact between mother and baby could also have an effect on milk supply.

7) Interferes with Elimination Communication - If you are planning to use natural infant hygiene with your infant, a tight swaddle will also limit your newborns ability to communicate elimination cues and your ability to acknowledge eliminations quickly.

There was, of course, no mention of any of this when my son was born and constantly being brought to me tied up in his flannel prison of sadness; only insistence that babies love to be swaddled when my baby so obviously did not. My instincts told me that the swaddle wasn’t right for us and I am happy I listened to them because knowing what I know now about it I would have been a lot more adamant that the hospital staff stop doing it.

I am, of course, not suggesting that no one should swaddle their infants ever. If your baby seems to enjoy playing cabbage roll then by all means don’t eliminate the practice from your repertoire completely. However I would say that the points above are very good reasons to limit the time an infant spends in a swaddle. All of the benefits of a tight swaddle can be achieved in other ways that do not pose the same potential risks. A good tummy to tummy hold in a sling or wrap for instance. So if you have the option to wear your baby, or have a family member spend some skin to skin time with your baby then why not do that instead when you can?

What I am saying is that swaddling really isn’t the magical cure all that many of us are led to believe and there is absolutely no harm in leaving it out of your life if that’s what you want to do. There is certainly nothing wrong with a baby who doesn’t enjoy it, so don’t feel bad when you quickly un-wrap your newborn the second a caregiver hands them to you.


Anonymous said... [Reply to comment]
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Tara said... [Reply to comment]

Thanks for this! My son HATED it too and everyone told us to. It drove me crazy, until I finally snapped and asked my midwife, who said it was for insecure or high need babies. My son LOVED his sling - that was where he got his "womb-like" experience. I also didn't understand the "womb-like" experience reasoning; both my children had their knees and elbows curled in. The woman who can carry her child bundled as if s/he was straight on a board? More power to her. Pfffftt. I say to Harvey Karp for making it so popular. It made my son hot and he burst out of the things (my daughter was born during the heat wave. It too hot for anything on her.)

Welcome said... [Reply to comment]

Not all babies enjoy being swaddled, and of course we should be careful to prevent over heating. If mom is breastfeeding, than baby is usually pretty settled and comfy anyway, so there wouldn't really be a need to swaddle while nursing, right? I think newborns should be fed unclothed, anyway. I'm a huge advocate of swaddling, and always suggest it to new moms, but I certainly don't think there is any harm in leaving it out, as long as everyone is happy and getting enough sleep. I'm also a huge advocate of baby wearing, though, and wouldn't recommend swaddling a baby just to keep him quiet, rather than wearing him, when that's an option. Personally, I never spent much time unattached to my babies (I baby wore and co slept), but there were times during the day they needed to sleep and I needed to, say, shower lol.

As for "popping out," there are a lot of bad swaddling blankets out there (think anything sold at Walmart). They aren't big enough, so they just don't work. You don't get the full swaddling benefit out of them. Personally I recommend the Miracle Blanket. It keeps baby very board like, without any risk of hip dysplasia (which I always associate with dogs, not with babies lol). It also has a "feet free" option.

I just don't think that there is enough research available to suggest that the risk is enough to stop swaddling babies altogether. It is a LIFESAVER for a lot of moms, especially moms who have babies with an "over active" startle reflex (mine, for example, could never sleep more than five minutes at a time without the startle reflex waking them). If I was wearing/holding them, they would settle right back in, but if they were free to flail, they'd end up wailing. It should be used as a tool, and not a "cure all."

Welcome said... [Reply to comment]

@Tara I really don't think it's fair to say all babies who enjoy swaddling are "high needs" or "insecure." I would have taken real issue with that comment had someone said it to me.

Stace said... [Reply to comment]

I agree with this post, especially because you were basing your opinion on how YOU and YOUR BABY felt about swaddling. More people need to consider their own voice and reading the behaviours of their baby instead of listening to a total hippy (and believing them just because) or a hospital nurse (and believing them just because).
My first, easy baby, born in a heat wave, loved being swaddled. It chilled her out and the startle reflex often woke her up with a start. The swaddle made her open her eyes during a startle then fall right back asleep.
My second difficult, high-needs baby fought the swaddle just as she fought everything else for the first 13 months of her life, and therefore, we literally threw in the towel after a few days. She needed to be back in the womb, not something that resembled the womb, and was angry with any substitutes! She's 2.5 now and I still think she's angry that I didn't come equipped with a marsupial pouch.

Kayce Pearson said... [Reply to comment]

Everyone tried to tell me to swaddle Glade because she would sleep so well! When in the NICU, they swaddled her to an extent, most times her arms were out, but her legs were wrapped tight, and she was too exhausted from trying to breathe to do anything about it, but once she had energy? She did not like to be wrapped up, one bit. I always felt there was something off about the swaddle, and I really didn't have a reason to hate it, but I did. I now know why, but it's mainly that I would much rather my baby be "swaddled" and held tightly against my chest in a wrap or sling than straight like a board away from me.

Great post, so excited you're back!!!!

Amy said... [Reply to comment]

We called my daughter Houdini because even if we tried swaddling her she would quickly undo it. Within a week we realized she hated it as well and never bothered again. I'm interested in the startle reflex portion of your post, because she did have an exaggerated Moro reflex, and at one point we had to have an EEG done because we thought she was having seizures (I grew up with epilepsy so we were overly cautious). She was not swaddled, and startled way too easily... hmmmmm Probably no connection whatsoever but I find it interesting!

Renee :) said... [Reply to comment]

Thank you! my daughter hated being swaddled as a baby, and I always wondered if I should have kept at it for longer. Now I'm very glad I didn't! Now as a three year old she still kicks off most of her blankets at night; I guess she's just a "don't fence me in" kind of girl :)

Judith said... [Reply to comment]

love this post especially because you were so tuned in to your baby. i am a hospital nurse and we teach parents lots about spending as much time as possible being skin to skin. i also tell parents to get to know their baby and see what they like. many things we do today like swaddling, we do because we were taught to do and now there is research and we are learning to do otherwise.

Liz said... [Reply to comment]

Good post. My son liked to be wrapped up. I never did it tight. It wasn't forced upon him at the hospital by the nurses either. We were there for 2 days after his birth and they let me do my own thing when it came to stuff like that. We also had a lot of skin on skin time as well. If a baby doesn't like to be wrapped then don't force it on them obviously, but if they do it doesn't have to done tight.

Bri!!! said... [Reply to comment]

I agree completely. We love the swaddle in our house. Both babes were sleeping mostly through the night their first week of life. I'm sure it helped I make a ton of milk, but I swear by the swaddle.

Bri!!! said... [Reply to comment]

My above comment was to "Welcome", not in regards to this post.

Busoni said... [Reply to comment]

My daughter was in the NIQU, and was always swaddled. I was recovering from an emergency c-section and pumped colostrum for her, yet they suplimented with formula. Between those two things, all she did was sleep and didn't react to much.

Thankfully I got her out of there before they messed her up too much. It took a week to bond with her and get her lively like the other babies her age. She HATES the swaddle now that she knows she can stretch out and cuddle! Now she is strictly breastfed and unswaddled, and already starting to roll at three weeks. :)

Mary said... [Reply to comment]

Love this! I have three (soon to be four) non swaddled kids. Everything about it felt wrong, physically and emotionally. It seemed to work against everything I wanted to encourage in my kids (exploring, moving, crawling, walking, rolling, frequent nursing, skin to skin, being positively attached to caregivers, bed sharing,etc.).

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