Why all doulas should have a sling!

This piece, by Sophie Messager, was first published in The Doula magazine.

As a doula I wouldn’t be without my sling! I find it invaluable to be able to help parents choose a carrier for their baby, to see the joy on their faces when their baby contentedly falls asleep in the sling and they can meet their baby’s needs effortlessly whilst still being able to look after themselves. Postnatally, I am usually found with a sleeping baby tucked inside a stretchy wrap whilst mama is enjoying a nap or a long, uninterrupted bath. I can then get on with a bit of tidying up/folding some laundry etc, and I often end up sitting down with a cup of coffee and a piece of chocolate, safe in the knowledge that mama and baby are both cared for and happy.

A bit of background

Humans are primates. Primates carry their young with them at all times-they do not leave them in a nest or a burrow. British anthropologist Timothy Taylor explains that slings were invented over 2 million years ago, and were instrumental in allowing our species to achieve its current brain growth, as it allowed us to carry our immature offspring and carry on with daily tasks. Until very recently in human history (since the invention of the pram about 200 years ago), babies were carried as a matter of course, including in the West. They are still carried in many parts of the world today, and the Western population is rediscovering this ancient tradition. Human babies are “clinging youngs”- they are designed to be carried. They crave close contact with their parents, and display reflexes associated with carrying- they instinctively flex and spread their legs when picked up which helps them cling to the adult body.

Benefits for babies

• Emotional development
  • Close to your heartbeat, breathing, smell, voice, touch and warmth –”womb with a view”
  • Helps develop a sense of security and trust
  • Cries less as cues are responded to quicker
  • Stronger attachment
  • Increased breastfeeding.
• Mental development
  • More time in a “quiet, alert state” – ideal for learning
  • Baby sees more of the world than from a buggy and learns social skills and communication faster.
• Physical development
  • Regulates temperature, breathing, and heartbeat
  • Stimulates balance and muscular strength
  • Counts as “tummy time”which helps avoid flat head syndrome.

Benefits for parents

• Sheer convenience
  • Hands free!
  • Get on with the things you want to do.
  • Easier to get around in busy places, country paths, holidays and public transports (no need to carry a car seat, or pushchair into your car, or up stairs).
  • Gentler for your back than carrying with hands (or than carrying a car seat).
• Emotions
  • Helps bonding.
  • Less crying.
  • Get to know baby faster and better (read cues).
  • Helps with breastfeeding.
  • Helps with postnatal depression.
  • Helps siblings adjust to new baby.

How to carry your baby comfortably and ergonomically

At birth, a baby’s spine and hips are still immature. The spine is naturally rounded, in a c-shape, and not designed to be straight. The spine and the hip joints are still cartilaginous, and therefore fairly soft and flexible.

To support and protect a baby’s developing spine and hips, it is important that the carrier supports the baby’s hips, back and neck.

To support the hips, the carrier should allow the baby to assume a position known as spread squat, or M position as shown on the picture below – where the baby’s bottom sits lower than her knees, and the fabric should support the baby’s legs from knee pit to knee pit . This allows for the balls of the hips to sit adequately in their sockets. Rosie Knowles, a GP and babywearing consultant, has written an excellent article on the topic, with very good graphics.

To support the back, the carrier needs to allow the baby’s back in its natural rounded position, and the fabric should be snug enough so that the baby doesn’t slump in a slouched position (see more about this in the safety paragraph).

Finally, the fabric should be high and snug enough to support the back of the baby’s head and be adjustable so it comes no higher than this. This is especially important in newborn babies.

For the reasons highlighted above, it is not recommended to carry your baby facing out in a sling as it forces the baby’s back straight against the wearer’s chest.This does not allow the baby to assume the spread squat M shape as it causes the legs to dangle in a harness like position.

Finally, for the comfort of the parent wearing the baby, it is important that the carrier is high and tight on the parent’s body, to avoid causing back strain and displacing the wearer’s centre of gravity. As a rule of thumb, the baby should be placed close enough for the wearer to be able to kiss the baby’s head.

Issues with most brands of high street “front-pack” style baby carriers

Unfortunately, few of the major carrier brands sold on the high street meet the ergonomics criteria highlighted above. These carriers put a baby in a dangling position, much like sitting in a harness, with all of the baby’s weight resting on her crotch rather than being spread from her bottom and her thighs. The baby’s back is also forced into a straight position. This type of sling also places the baby too low, with the baby’s head at mid chest level. The design of this type of carrier and the low position of the baby are not ergonomically effective for the adult and carrying a heavy baby can quickly become uncomfortable.

Different types of slings

There is a plethora of baby carriers available. The range of baby carriers available in the UK falls under four categories: Wraps, Mei-tais, soft structured carriers, and ring slings & pouches

Wraps

Wraps are long pieces of cloth (4 to 5 metres long) that are tied around the baby and parent .

Stretchy wraps are made of soft t-shirt like material. One of their advantages (especially if the fabric contains elastane rather than just plain cotton, this is known as a two-way stretchy wrap) is that they can be left on all day, which allows the wearer to pop the baby in and out easily and is very convenient with newborns. Due to the nature of the fabric, many parents find that stretchy wraps are not supportive enough for older babies (6 months onwards).

Woven wraps are diagonally woven cloths, which gives the fabric the ideal amount of stretch and support. They are the most versatile form of carrier available, as they automatically adjust to the size of the carried child. They can be used from birth to toddlerhood and beyond, and can be worn on the front, hip and back and tied in many different ways.

Mei-tais

Mei-tais are Asian style carriers which consist of a shaped piece of fabric (usually a square or a rectangle) with 4 straps. One set of straps is tied around your waist and the other around your shoulders, the fabric then forming a pocket where the baby is held. They can be worn on the front, hip and back. The size of the rectangle of fabric determines what age range each mei-tai is suitable for, for example a small mei-tai can be used for young babies, and a bigger one for toddlers.

Soft Structured carriers

Soft structured carriers have a body similar to a mei-tai however the waist and shoulder straps fasten with buckles and clips, much like a rucksack. Because of their structured shape and size, most of them need a padded insert to be used with a newborn baby, up to 3 to 4 months of age. They can be worn on the front, hip and back and come in baby, toddler, and even preschooler sizes.

Ring slings and pouches

A ring sling is a piece of cloth with 2 rings sewn at one end. The free end is looped through the rings, forming a pouch for the baby, with the tail of the fabric hanging down. They are worn over one shoulder and are quick to put on but require rigorous learning to get the adjustment right. The rings offer more adjustability than a pouch. Unpadded ring slings are easier to adjust, and ones made out of woven wrap material are comfiest to wear.

 

Pouches are also worn over one shoulder. They are made of one folded up length of material which forms a pocket for the baby and is worn over the body like a sash. Unless they are adjustable, they need to be sized for the wearer so the same pouch cannot be used for two parents of very different sizes.

 

A note about fitting

Slings are very much like jeans or shoes – one style does not fit all. Different body shapes and sizes means that one person’s dream sling might be the next person’s nightmare. It is always a good idea to try before you buy (see: how to learn to use slings).

If you would like to read more about the topic of different types of slings, start here.

Sling safety

These guidelines are downloadable as a PDF here.

Due to these guidelines, babywearing instructors usually recommend that the safest position for a baby to be carried is in an upright position. Lying down “cradle” type positions are best avoided with newborns, as it can be difficult to ensure the position is safe with no chin to chest posture. Upright positions are also more respectful for the baby’s developing hips and spine.

Avoid bag style slings

Bags slings are unsafe for small babies as they put them in a dangerous position (chin to chest) and cover their faces with fabric-both of which carry a risk of positional asphyxiation. The Infantino brand was recalled in 2010 due to deaths in the US, however similar shaped brands are still sold in the UK.  You can read more about sling safety here.

Breastfeeding in a sling

Is it possible to breastfeed in a sling and this is something many mums enquire about, especially second time mums so they can look after their older child whilst nursing their new baby.

Breastfeeding whilst babywearing is not a hands free option as one hand is needed to support baby’s neck like you would without a sling. However it can help with mobile breastfeeding and can take weight away from a mother’s arms.

Breastfeeding is a skill, as is babywearing, so please ensure you master both skills separately before attempting to breastfeed in a sling. If breastfeeding in a sling, be particularly aware of the risk of positional asphyxia at all times: avoid the chin to chest position and make sure that the baby’s face is not pushed into the breast. It is probably safer and easier to wait until the baby is a few weeks/months old and can hold his head steady prior to attempting to breastfeed in a sling (for examples of breastfeeding in a sling videos, see this site.

How to learn to use slings

As explained in this article there are three options for practitioners and parents who want to learn how to use a sling: they can teach themselves, attend a free drop-in like a slingmeet or sling library, attend a small group workshop or have a consultation with a qualified sling consultant.

If you prefer to teach yourself how to use a sling, there are many good video tutorials on the internet, such as this one.

You can find an extensive map and list of both drop-ins and consultants here.

Dr Rosie Knowles, a GP and babywearing consultant, has an excellent website, with many great articles about slings.

You may decide to train yourself as a peer supporter or babywearing consultant. Peer supporter courses are available from Born to Carry and the School of Babywearing. Consultant courses are available from three different babywearing schools in the UK: Slingababy, Trageschule UK , and The School of Babywearing.

This article explains how to choose the right school  for you (which is very much like choosing the right doula for you!

Where to buy slings

Few high street retailers stock slings that meet the ergonomics criteria highlighted above (although this is slowly changing and options are increasing with time). There are many online stores selling carriers, most of which tend to be small “cottage industry” type businesses, which provide excellent customer services. They are listed on the slingpages website. Beware of eBay and non approved online retailers, as there are many fake, poor quality copies of well known brands such as Ergo, Freehand and Moby circulating on the internet. Here is a list of resources to buy second hand slings from.

 

A biology research scientist by training, Sophie’s passion shifted towards supporting parents in the journey through parenthood following the birth of her first child in 2006. She is a birth and postnatal doula, babywearing instructor and tutor, and birth and parenting educator. She has run a local slingmeet group and worked as a babywearing consultant since 2010 and has also been offering babywearing peer supporter courses since 2012. She has helped over 1000 families to choose and use a sling, and has trained over 100 babywearing peer supporters. (http://sophiemessager.com/peer-supporter-courses/)