To Swaddle or Not to Swaddle? That is the Question.

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If there is one issue that seems to divide many doulas, midwives, lactation consultants, and paediatricians, it the question of swaddling. In its most basic form, swaddle is a technique of snuggly wrapping a baby in a light blanket. The purpose of swaddling, says its proponents, is to help babies sleep better and longer.

There are so many advocates of swaddling, most notably these days Dr Harvey Karp, author of Happiest Baby on the Block. Of his now famous '5 S' techniques, swaddling is generally the first one most parents use to calm a fussy infant. What has been very beneficial about Dr Karp's book and subsequent fame is the confidence it has given parents to swaddle their babies correctly. Studies have linked correct swaddling to lower SIDS rate, when the baby is placed on his or her back. It's very important that swaddled babies are never left on their stomachs, and that as soon as your baby is able to turn from back to front, you no longer swaddle her, as it risks suffocation.

But for those early days, when your baby is adjusting to life outside of the womb, there is quite a body of evidence to back up Dr Karp and others' belief that swaddling can soothe your baby. As a doula, I'm not entirely sold on its premise of replicating the womb - we know that babies, even large ones at the end of gestation, are able to move within the womb. Furthermore, the cushioning of amniotic fluid is very different from the muslin or flannel blankets we use for swaddling. However, we can see even anecdotally that most babies are comforted when placed in a well-done swaddle.

So who's against swaddling?

The earliest professionals against swaddling were doctors who began seeing a rise of hip dysplasia, a relatively uncommon condition, in children who were swaddled. This was more than forty years ago, and thanks to public awareness on how to swaddle babies correctly, this issue has largely gone away. The important difference from earlier forms of swaddling is to allow your baby enough room for his legs to kick and move within the blanket. Another way of mitigating this problem is to put a second diaper over the first, which puts your baby's hip at a better angle to prevent the rare condition of dysplasia.

The group that remains against swaddling today are mainly breastfeeding advocates, who point to a disconnect between nursing your baby, and swaddling. This is not to say that one can't be a advocate for breastfeeding and swaddling - but those who advise against swaddling base their argument like this: swaddling causes your baby to sleep longer, and deeper, than she otherwise might if left unswaddled. This may be beneficial for sleep-deprived parents, but it risks both you and her missing what we call 'early hunger cues,' the signs that she is ready to nurse that come before crying. Once she reaches a state of hunger that is strong enough to wake her up, she may cry to the point of not being able to latch on correctly. This can be extremely frustrating for both of you, and even distressing if it lasts more than a few minutes. A lactation consultant I know also points to the problem of such long, uninterrupted sleep for mothers: even if the idea of sleeping for four hours sounds extremely appealing, a nursing mother generally cannot go that long without feeding, or risks the pain of engorgement and a potential blocked duct. You need to nurse as much as your baby needs to!

Where does this leave us? From my role as a postnatal doula AND a breastfeeding advocate, I would say that there shouldn't be an imperative to swaddle your baby, if you feel rested enough and that your baby is comforted by being held, suckling, or any other combination of techniques. If you find that your baby isn't sleeping for stretches of at least forty five minutes without waking herself up, either by scratching herself, because of her startle reflex, or simply because she dislikes being put down, swaddling may be a help. If your milk hasn't yet come in, I wouldn't recommend it, as it's a time that your baby will want to be at the breast, cluster feeding in order to ramp up your milk supply. Likewise, there are times when similar cluster feeds will happen, and no amount of swaddling will pacify your baby. This generally occurs at two weeks after birth, and again at six weeks.

If you do choose to swaddle, there are many products on the market that offer different ways of wrapping your baby. From simple muslin cloths to Velco straps, you  can find the one that works best for you and your baby. Remember though, to be mindful of those early hunger cues, and wake your baby up to feed if he's slept soundly for a couple of hours. Undressing him and doing skin-to-skin is the best way of waking a sleepy baby.

The final word on swaddling goes to Ina May Gaskin, whose advice is always practical and imbued with her usual common sense approach: "I use swaddling mainly to help a jittery or fussy baby take her mother's breast without frustration. Swaddling is not a good idea if your baby is gaining slowly as it prevents the skin-to-skin contact that will help your baby stimulate a greater milk supply." (Ina May's Guide to Breastfeeing)

So while there's no hard and fast rule when it comes to swaddling, I hope that the benefits and issues surrounding the topic can help you decide what to do with your own baby. Perhaps we'll leave it by saying this: swaddle if necessary, but not necessarily swaddling.