Written for the New Zealand College of Midwives ‘Midwifery News’ Magazine, March 2013
Babywearing Best Practice (unedited version)
The phrase ‘Babywearing’ “…simply refers to carrying your baby in a soft carrier close to your body…” (Blois, M. 2005). Dr William Sears and his wife Martha carried their 6th baby around in bed sheet material. Martha’s comment, “As long as I wear him he’s content” lead them to the phrase ‘babywearing’. (Blois, M. 2005)
Jean Leidloff’s book ‘The Continuum Concept,” written in 1975, followed by the Sears family’s advocacy and manufacturing of ‘The Original Babysling’ triggered modern day babywearing in the West. “In regions where non-Western cultures prevail, it has been common practice for centuries to carry children in a variety of ways.” (van Hout, I.C. 1993)
In New Zealand today, many parents are choosing to ‘wear’ their babies in commercial baby carriers. Babywearing has many benefits. A study of Canadian mothers and their infants showed that babies who were carried more, 4.4 hours per day compared to 2.7 hours per day, cried for a significantly shorter amount of time “- a 43 percent difference.” (Barr, R.G. 1991). Recently, it has been discovered that there is ideal and not so ideal babywearing.
A midwife has the ability to recognize when a baby is being carried in a less than ideal carrier or position by knowing some basic principles for safe babywearing. Positioning for an open airway is essential. The most ideal position for a baby is inward facing, upright, firm especially around the upper back, high on the wearer’s body and in the ‘straddle squat position.’ The UK Sling Manufacturer and Retailers Consortium came up with the TICKS acronym for safe babywearing of a newborn up to 6 months (longer if the baby was premature or is unwell):
Tight – the baby’s chest must be firm against the wearer.
In view at all times
Close enough to kiss
Keep chin off the chest – harder to achieve in the cradle carry position.
Supported back and Straddle squat position
The bag sling is dangerous for a young baby. At least 14 babies have died in this style of sling, from either suffocation or positional asphyxiation, the latter being a position where the chin falls onto the chest restricting the airway. Consumer New Zealand (March, 2010) has issued a warning about this type of sling explaining “The curved position can cause a baby’s head to flop forward, restricting its ability to breathe.” http://www.consumer.org.nz/news/view/baby-sling-warning
They suggest a front pack rather than a sling. This type of carrier is also problematic and many slings, such as the ring sling, pouch and wrap around slings, are very safe when used correctly.
Front packs have a narrow crotch and differ from soft structured carriers (SSC) that have a wide crotch/base. The narrow crutch is less than ideal for the angle and pressure it puts on a baby’s developing hips and spine.
This position [Figure 1] may contribute to developmental dysplasia of the hips (DDH) and arthritis later in life. The not-for-profit International Hip Dysplasia Institute (IHDI) explain that, “The most unhealthy position for the hips during infancy is when the legs are held in extension with the hips and knees straight and the legs brought together, which is the opposite of the fetal position.” http://www.hipdysplasia.org/developmental-dysplasia-of-the-hip/prevention/baby-carriers-seats-and-other-equipment/
In a front pack the pubic and sitting bones are supporting all of the baby’s weight with the pressure transferring up through the immature spine.
Ideally the carrier should support the full length of the baby’s thighs and bottom, as the SSC does. The pelvis is tilted back allowing for a natural curve of the lower spine. The lower leg should be hanging vertically and free to move. [Figure 2] “If the legs are bent more than 90° (about 100 – 110°) and spread approximately 90° … the femur head fits ideally in the hip socket. Thus favors its healthy development.” (IHDI)
Forward facing out (FFO) is a position used most commonly with a Front Pack, though it can be done with many carriers. Parents believe that by 4 months their babies want to see more of the world. Along with the vertically hanging legs, the tilting forward of the baby’s pelvis puts all their weight onto their crotch and arches their spine. There is also a high potential for overstimulation. The wearer may experience back pain from having to compensate for the baby’s weight pulling away from them. A hip or back carry using an appropriate carrier is an ideal alternative to FFO.
The cradle carry is a position that mimics the baby being cradled in someone’s arms. The baby is semi-reclined, with their bottom at the lowest point of the sling and their back well supported. This can be tricky to achieve and not doing so can lead to the baby slumping, their chin dropping to their chest and at worst positional asphyxiation. The main problem with the cradle carry is that even when done correctly the baby’s legs are forced together, potentially damaging their hip joints. See Figure 1.
Benefits of Babywearing
A baby who is ‘worn’ is benefiting more than one who is not. Benefits are the same as those for ‘kangaroo care,’ including regulating heart rate, breathing, temperature and nervous system, stimulating growth and enhancing the breastfeeding relationship. Other benefits include: baby’s signals can be responded to quickly; baby cries less and falls asleep easily; the upright position supports the immature digestive system. When held in the ideal position a baby’s musculoskeletal system strengthens quickly and correctly. Babies feel secure, relaxed and confident in-arms – “their rightful place.” (Leidloff, J. 1975). A parent can continue their work both in and out of the house, hands free knowing their baby is safe and well.
The bag style sling is dangerous. The front pack, FFO and cradle carry positions still have more benefits than a car seat or pram, they are just not ‘ideal.’ New parents need to know which baby carriers and positions are ideal. Midwives can continue to encourage them to wear their baby safely and refer them to their local Babywearing group. Dunedin Babywearing is one such group, http://dunedinbabywearinglibrary.wordpress.com/. Run by passionate and experienced babywearing mothers, it has a babywearing library where parents can loan a carrier for a nominal fee and receive safety advice, instruction and ongoing support. The New Zealand babywearing website www.slingbabies.co.nz is a not for profit, educational babywearing resource and group. You can find links to all the established babywearing groups throughout New Zealand at http://www.slingbabies.co.nz/Site/Group_Info/Other_groups.ashx
Anna Hughes is the Co-Director of “Wearing Your Baby: Techniques for Holding Your Baby Close and Living Life” a babywearing instructional video due for release in 2014. www.wearingyourbaby.co.nz She was a Midwifery Standards Reviewer and she is a mother of two boys.
Barr, R.G., Bakeman, R., Konner, M. et al. (1991). Crying in Kung infants: a test of the cultural specificity hypothesis. In Developmental Medicine and Child Neurology 33 pp. 601-10.
Blois, Maria. MD. (2005). Babywearing. The Benefits and Beauty of This Ancient Tradition. Pharmasoft Publishing, Texas, USA.
Consumer NZ. Making Decision easy. (2010). http://www.consumer.org.nz/news/view/baby-sling-warning
International Hip Dysplasia Institute (IHDI). http://www.hipdysplasia.org/developmental-dysplasia-of-the-hip/prevention/baby-carriers-seats-and-other-equipment/
Kirkilionis, E. Dr. (2006). Carrying babies facing away from the parents body – is this truly positive for baby? In Mothering Magazine, July/August 2006, No. 136
Leidloff, J. (1975). The Continuum Concept. In Search of Happiness Lost. Da Capo Press.
van Hout, I.C. (1993). Beloved Burden. Baby-wearing around the world. Amsterdam: Royal Tropical Institute.