Elimination communication from birth

Did you know?

Do you know that you can start putting your baby on the potty from birth?

Do you know that babies are born with strong instincts not to soil themselves?

Have you ever been welcomed by a fountain of wee as you open your newborn baby´s nappy? 

Or noticed that your 9 month old baby floads his/her nappy as he/she wakes up in the morning? 

These are opportunities to help your baby stay dry and help him/her associate his/her elimination needs with the appropriate receptacles.

What is Elimination Communication (EC)?

Elimination Communication, or early infant potty training, or infant potty learning is the process by which caregivers tune into their babies´s cues and signs of needing to eliminate and help them do it in a culturally appropriate way (such as a potty, toilet, sink, garden). It is nothing new. It has been the way humans have approached dealing with babies´waste before disposable or cloth nappies existed. It is still practiced in developing countries. Ask yourself, how did hunter gatherers survived being pooed or weed on constantly? Imagine how you would keep your baby clean and dry with no disposable nappies or no running water to be washing 10 cloth nappies a day? Simple, mothers would tune into their babies cues, move them away from their bodies and signal them to eliminate with a sound such as “pssss”. These practices have been documented by Laurie Boucke in her book “Infant Potty Training” which explores how tribal communities “potty train” their young. Andrea Olson also has stories and resources on her website.

Elimination communication with an independent midwife

Why do this now?

You might think that elimination communication is backwards, that there is no need to go back to this in the same way that we now have running water, kitchen appliances, sofas and carpets making live easier for everyone and much harder to deal with the occasional pee miss. However, modern society has other concerns such as the fact that not a single nappy that has been thrown into landfield has decomposed (and will not for 500 years), that the plastic over consumption is not sustainable, that cloth nappies do still utilise lots of resources and that currently the age of potty training in the UK is 36 months. This is a stricking difference with babies being potty trained at 18 months back in the 50s before disposable nappies where introduced.

So, what is the most ecological and cheapest alternative to disposable and cloth nappies? Well, not to use nappies at all! Or to use them as little as possible and as a backup to when we miss the communication, rather than as a toilet to be carried around.

How do you do it?

It is as simple as holding your newborn baby over a small potty, a plastic container or your sink. You can hold him/her by his thighs with his/her back against your belly (like shown in the video). Then you offer the potty /sink when you know he/she is likely to wee. These are pottytunities as we call them, such as after waking up or after being in the car seat/pram/high chair. Every time your baby wees or poos you do a sound that they start associating with eliminating and soon he/she will eliminate on cue (if they need to go!). Every few weeks we do some nappy free observation and figure out how often he/she wees or poos. 

How did it go for us?

Elimination communication can be started at any age up to 18 months and as a family we have been practicing it since my son was 2 weeks old. We have currently trying to remove him from his nappies (except for outings) at 14 months as he is mastering his walking and we are using the next few months to wrap it up. It has not been a straightforward journey, there is no linear progress in EC, there is always a back and forth with any childhood matter, and it requires adjusting our expectations and let go of goals and putting pressure on our children. It is a beautiful practice of respecting and trusting our young.

I got so immersed in it during my maternity leave that of course I had to start supporting my clients with this from birth! If you hire any postnatal care I can show you the basics if you ask me to. If you hire a 4-6 week care package I will provide you with your own top hat potty as part of my goody bag that also includes a sling, cloth nappies (as they are a better alternative to disposables and they help babies not disassociate elimination with wetness) and co sleeping advice.


Elimination communication in home birth packages

Let me help you!

From an experience mama to you mama, I cannot wait to share with you all I have learnt over the last year of bringing up my baby using the potty. And the inmense pleasure I have gained from it.
If you would like your midwife to help you in this crucial moment of your life get on to a right start, check out my packages of care or book a discovery call.

Resources For Fetal Heart Monitoring

1.When did we start monitoring babies in labour?

For more high quality evidence around fetal monitoring please visit Kirsten website here, an obstetrician with a PHD in CTGs. https://birthsmalltalk.com/

In this post she discusses intermittent auscultation: https://birthsmalltalk.com/2023/08/23/what-is-intermittent-auscultation/

Hear her talk about the lack of evidence behind CTGs in this podcast: https://open.spotify.com/episode/1eXZY973Oxbs1ducavpSAk?si=872f8c4077be4ba5

Post on the history of fetal heart monitoring: https://birthsmalltalk.com/2023/08/09/listening-to-the-fetus-the-history-of-fetal-heart-rate-monitoring/

Cochrane review comparing CTG to intermittent ausculation (CTG increases interventions
): https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD006066.pub3/full

Does CTG use improve outcomes for high risk women? https://birthsmalltalk.com/2024/10/16/the-story-behind-our-paper/

2. How should we use intermittent auscultation in labour?

These are the NICE guidelines for fetal monitoring in labour: https://www.nice.org.uk/guidance/ng229/chapter/Recommendations

Midwife researcher and lecturer Rachel Reed has a brilliant article and podcast about this where she unpicks the evidence around the recommendations for intermittent auscultation protocols here https://www.rachelreed.website/blog/listening-to-baby-during-labour

and podcast here: https://open.spotify.com/episode/3sJeIR3xUOr20EBRGilHxl?si=818537594dd04457

The WHO recommendations for intrapartum care: https://iris.who.int/bitstream/handle/10665/260178/9789241550215-eng.pdf?sequence=1

3. How does intermittent auscultation detect fetal distress?

For more on normal and abnormal heart rate monitoring watch this explanatory video: https://www.youtube.com/watch?v=Ni48bbtiZgs

4. What happens if there are concerns with the fetal heart rate at a homebirth?

NICE guidelines for fetal monitoring in labour: https://www.nice.org.uk/guidance/ng229/chapter/Recommendations

5.What is better for fetal monitoring in labour: a Doppler or a Pinard/fetoscope?

To read about the research and the experiences of midwives using a fetoscope/pinard antenatally and in labour check these links out.

Short facebook comments compiled in this magazine here: https://www.midwiferytoday.com/mt-articles/wisdom-of-the-midwives-issue-131/

Midwives perceptions of fetoscope vrs Doppler Tanzania https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-018-1736-y

Midwives experiences of Pinard use Norway https://www.sciencedirect.com/science/article/pii/S0266613822000407

Defense of fetoscope article by American midwives

https://hearthandhomemidwifery.com/blog/fetoscope-a-tool-of-the-midwifery-trade#:~:text=Fetoscope%20uses%20go%20beyond%20just,birthing%20person%20and%20the%20baby.

A Cochrane review that compares Doppler and Pinard use in low income countries: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD008680.pub2/full

For a compilation of research that compares the use of Doppler to Pinard check this link: https://www.cochranelibrary.com/content?templateType=related&urlTitle=%2Fcentral%2Fdoi%2F10.1002%2Fcentral%2FCN-01110791&doi=10.1002%2Fcentral%2FCN-01110791&p_p_id=scolariscontentdisplay_WAR_scolariscontentdisplay&_scolariscontentdisplay_WAR_scolariscontentdisplay_action=related-content&p_p_lifecycle=0&p_p_mode=view&type=central&contentLanguage=

6. What if you decline some or all fetal auscultations?

Is fetal monitoring essential?: https://birthsmalltalk.com/2024/11/06/myth-busting-3-fetal-monitoring-is-essential/

7. What to bear in mind about intermittent auscultation in labour?

Examples of womens experiences of fetal auscultation in labour: https://www.sciencedirect.com/science/article/pii/S1871519224002658#bib14