What the flip? Part Two: How to create a close shoulder flip.

In my recent What the flip? article I discussed the reasons why shoulder flips can be useful when using a number of different slings. It considered the reasons for and against closed and open shoulder flips. In this piece I am going to look at two different methods of achieving a closed shoulder flip. A closed shoulder flip is a secure flip. It helps create a clear space around baby, can make a sling more comfortable by spreading weight over a wider area, help support knee by creating a vertical line and supporting the back with a horizontal line. Learning how to achieve them is a skill that can add an extra set of tools to a sling users toolkit.

There are two methods to achieving a closed shoulder flip. There is a large level of personal preference in which method will choose to use. Neither is the right way. It is up to you. The first involves allowing the fabric to fall from your shoulder before lifting the bottom rail up to your neck. The second requires you to guide the top rail underneath the sling until it has taken the place of the bottom rail. Both work equally well, both are secure closed flips.

 Method 1 – fall and fold.

Decide which carry you wish to do and why you need to achieve a shoulder flip. I am doing a front double hammock. I have switched which wrap I use for teaching purposes during the slide show.

In this method you allow the wrap to fall gently from your shoulder slightly, creating enough space for you to fold the bottom rail up so that it is closest to your neck, creating the vertical line to support the babies knee. When you have completed this, gently gather the slack on your shoulder so you are left with a small capped sleeve, rather than the full width of wrap down your arm.

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 Method 2 – up and under.

Here you can see the method  of reaching underneath and working top rail out. Choose which carry you are wishing to create. I was opting for a Front Double Hammock here. Supporting babies weight with one hand reach up and underneath the fabric to grab the top rail. With this wrap this is the pink stripe. Gentle work this underneath the fabric until it is out in the place of the bottom rail. As you can see here the purple bottom rail is now closest to my neck and the pink stripe is now on outside furthest away from me. This pink top rail is helping to support babies back and provide tension to the carry. The purple stripe is creating a vertical line from babies knee and helping to support this it.

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Once achieved closed shoulder flips are extremely comfortable and secure. Why not have a go too? Why do you like a shoulder flip? Do you opt for open or closed?

 

 

  

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Gideon’s Story

This piece is the third installment of our series looking at how babywearing and carrying is more than just being about the sling and how it can help families who have babies and children with additional needs. It is written by Rae, a Mum of Three. I have ‘known’ Rae for the majority of my own carrying journey as we are both members of the Natural Mamas forum and we shared our own pregnancy journey’s on its pregnancy sub forum. Here Rae will explain how using a sling helped her care for and bond with her third son. When Gideon was born he was diagnosed with Prader-Willi Syndrome or (PWS). 

At birth babies with PWS are usually very floppy (hypotonia) and this means they often cannot suck properly, have a weak cry and often do not have a full range of movement. It is a genetic disorder that is typically not diagnosed until baby has been born, although lack of movement in utero can be associated with the condition. There have been research studies undertaken to investigate if fetal ultrasound scanning can be used to help diagnose the condition but currently 99% of cases are diagnosed via genetic testing.

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Professional courtesy and sticking to what you are trained to teach.

I am extremely proud of my profession. I am a teacher by training and practice. Although I no longer teach in a classroom teaching teenagers I do spend my days teaching new parents how to carry their children comfortably and safely. I am a Babywearing Consultant. I have spent several thousand pounds training, I attend regular continuous professional development, I have insurance costs and pay subscriptions to our voluntary professional body. I know my area of expertise is slings and carriers, baby handling and sling safety. I know where to draw the line. I know I am not a doctor. I do not give medical advice. Despite being a breastfeeding mum and breastfeeding peer supporter I know I cannot diagnose feeding issues. I know when to refer to those who do know more than me. I know my professional boundaries.

When I see posts dismissing what I and many others do it is extremely hard not to be offended. Unfortunately, a recent social media post, and then subsequent dismissive comments, by a well-known breastfeeding expert has caused upset to my profession. 

If you are going to share material that is not within your area of expertise it is only correct that those of us who do work in that area identify flaws and sign post to sources of help. How many of us would start a reply with the words “Oh Please”? Does it seem respectful? Non-judgmental or professional? I think most of us would agree it doesn’t. It appears rude and disparaging; especially when you are commenting on something you only have your own experience of doing (and when you have openly criticized the role of peer support in your industry). I was especially taken aback by this. It was certainly not the way I thought a respected International Board Certified Lactation Consultant (IBCLC) would start a reply.

IBCLC are in a highly privileged position; their title is a protected one. This means you cannot simply start calling yourself one. It takes years of training and recertification every 5 years. However, IBCLC have not always existed. They began after a loan from La Leche League International in 1985 in a move to professionalize the industry. The Lactation Consultants of Great Britain has an even newer history forming in 1994. Nobody would say a IBCLC has less importance than a Midwife, or Physiotherapist or any health care professional – but each would agree that they all have their own area of expertise. It is not necessary to see an IBCLC to breastfeed, but if having difficulties then it has benefits. IBCLC are trained to assess a feed in detail; for example, look at the structure of the mouth, transfer of milk, tongue function, suck and swallow of the baby.  In same way that a midwife is trained to care for a mother in the antenatal period, and to help deliver her baby and care for the mother and newborn in first few weeks postnatally. Their professional expertise though does not stretch to caring for a 2 or 3-year-old. Here, a health visitor would be qualified to help. Knowing where our professional boundaries and personal experiences lie, is crucial.

Babywearing Consultants do not have the luxury of a protected title. Currently, anybody can choose to call themselves one. It is only in the last few years that there has been a growth in our number and an increase in training opportunities. We are experts in our field.  There are moves to create national and international standards and a regulation of our industry. A move I wholeheartedly applaud.babi-logo-transparent It is why I already subscribe to the British Association of Babywearing Consultants (BABI). Babywearing Consultants are attempting to professionalize our industry in the same way IBCLC did in 1985. Just because we are still in the process of doing so does not mean our knowledge or expertise is any more or less needed than that of IBCLCs: we simply have different areas of expertise.

Babywearing is a millennia old activity. For as long as humans have needed to move, we have needed to carry our young. Our babies are born helpless; unable to care for themselves and completely dependent on their parent or care giver to meet every need. By carrying our young we are able to respond quickly and efficiently to their ever changing needs. All cultures have a tradition of carrying their young; although the methods vary widely. This tradition though has disappeared in the western world.  Skills traditionally passed from mother to daughter have disappeared. It is only in the comparatively recent past that there has been a resurgence in its popularity. Babywearing, like breastfeeding, became unfashionable. It has taken the growth in breastfeeding support: from peer to peer support through to IBCLC, and international laws around infant formula marketing to help increase breastfeeding rates. The growth of sling libraries and Babywearing consultants in the last 4 years is unprecedented. The increasing understanding of ergonomic baby carriers and availability on the high street is making it much accessible.

Newborn and small babies, and those with underlying health conditions, are particularly at risk when being worn in a sling when it is worn incorrectly. This is why the TICKS guidelines were developed in 2010. They have become widely accepted as best practice for safe Babywearing. Unfortunately, if not followed (or supplied) there is a risk of a baby suffering from positional asphyxia. Any internet search about safe Babywearing will bring up stories of where things have gone wrong. As a Babywearing Consultant it is my job to help teach parents how to minimize those risks.  I work step by step, in detail, focusing on the small things which make a big difference: tightening, safety, positioning, comfort. DSCF2830This is why Babywearing consultants suggested that if you are going to back carry a small baby (something that can be achieved safely if you know what you are doing), that you do seek support, especially if you have limited knowledge of carrying your children in a sling. To suggest we are not necessary is to oversimplify the issue. No, it is not necessary to always have a consultation but there are times and places where it is advantageous. I have helped parents carry babies born extremely prematurely, with Development Dysplasia of the Hip (DDH), Talipes, multiple births, breathing difficulties, congenital heart defects, genetic disorders and hyper mobility to name just a few. As well as parents who just want some 1:1 support to get it right first time. 

 

Dismissing the role, myself, and other Babywearing Consultants, has the potential to be fatal. Please, give us some common courtesy as well as professional respect. We will stick to teaching how to carry babies safely, and will point out if there are weaknesses with technique that could be dangerous. Let other professionals stick to their specialisms. This way we can work together to support new parents for the benefit of them and their babies.

How slings and carriers can be used to promote attachment with adoptive and foster families.

“The single most important child rearing practice to be adopted for the development of emotional and socially healthy infants and children is to carry the infant on the body of the care giver all day long”.


In 1996 James Prescott in his piece “The Origins of Human Love and Violence” stated that “the single most important child rearing practice to be adopted for the development of emotional and socially healthy infants and children is to carry the infant on the body of the care giver all day long”. This statement has stuck with me since the first time I read it and is integral in explaining why slings and carriers can be an important tool for foster and adoptive families.

The act of carrying our young is not a new concept, carrying is in fact normal. It is one of the few universal things which unite nations and cultures (although we each have our own carrying methods and histories), as babies and small children want and need to be held. Observe a newborn and you will see how they turn their feet inwards to cling to their mother, their hands grasp to hold on and they bring their knees above their bottom into a fetal position once more. These primitive reflexes have survived our evolution and remain evidence of their need to be carried. For biological mothers and fathers it can be completely natural for them to want to pick their children up, to hold them to kiss them and to carry them and in doing so continue to develop the strong attachments between baby and parent that began when baby was in utero.

Attachments are deep and enduring emotional bonds that connects one person to another, they are the foundations on which we can grow. As demonstrated by Maslow’s Hierarchy of Needs simply providing a child  with food and shelter is not enough for them to prosper. Safety, security and love are also needed.

Typically children will seek their attachment figure when they are upset or threatened (Bowlby, 1969) or when they feel unwell – there is therefore no spoiling baby by picking them up: it is meeting their basic need for love and reassurance. By choosing to use a sling parents are able to keep their baby close in order to be responsive and reactive to their needs. Neuroscientists Megan Gunnar and Bonny Donzella summed it up nicely when they wrote “the effect of sensitive, responsive, attentive caregiving is that it allows children to express and experience distress, communicate those emotions without stimulating increases in glucocorticoids.” As small babies and children have very few ways in which they can communicate; by keeping them close parents are able to pick up quickly and easily on non-vocal cues as well as respond to the more vocal.

Children who have been separated from their care giver have also been shown to elicit a cortisol response and prolonged and extreme levels of cortisol negatively affect the developing brain. This stress hormone for example was shown to rise in one study in 1992 when securely attached 9 month old infants were separated for 30 minutes from their mother and left with a babysitter who although ensured the child was safe, did not respond to their needs. It is also known that cortisol increases in babies without secure attachments, so by adopting methods which can help increase attachment we can go some way to reduce cortisol levels in infants. Children unable to manage toxic prolonged stress by themselves and need the help of caring adults to support them (Middlebrooks and Audage, 2008). If this is not available and toxic stress is prolonged infant brain growth is effected (National Scientific Council on the Developing Child, 2005).

Unfortunately not all babies or small children have the benefit of a loving or safe home, with strong and secure attachment figures. As such they will not receive support from an adult capable of responding sensitively or appropriately to their needs. Bowlby’s early work into attachment theory led us to understand the need for strong attachments and he described these as a “lasting psychological connectedness between human beings”. Typically between a primary care giver (usually the mother) and a child and that this relationship had a strong effect on the child’s social, emotional and cognitive development. Children who are unable to form this strong bonds in early childhood are at a disadvantage; as securely attached children and adults live happier, less conflict ridden lives (Whitborne, 2005).  Foster and adoptive families have an immense role in helping to form strong attachment bonds with the children they look after and to help those children who do not have strong attachment bonds to begin to form them.

Carrying adopted and foster children can help promote attachments with their adoptive/foster parents and ease transition to their new life. This does not mean immediately a child is placed with a family putting them in a sling but it is a useful tool that should not be discounted. Baronel and Lionetti in 2012 stated that adoption is “an intervention that assures the adoptive child the opportunity to catch up on emotional development and to partially resolve prior traumatic attachment experiences”. As using a sling has been shown to promote secure attachments between mother and child, primarily because of the speed by which mother could respond, we can therefore hypothesise that carrying an adopted child in a carrier could have the same benefits for attachment and this appears to be the case from case studies I found and from my own experiences.

There are several reasons why carrying a child in a sling can be helpful. These can typically be broken into health reasons and practical reasons. Using a sling or carrier has been shown to enhance growth and weight gain (Charpak, 2005), stabilize baby’s heart rate, resulting in lower cases of bradycardia and tachycardia (McCain, 2005), and even ease the symptoms of reflux (Tasker, 2002) to name just a few. While also simply giving the wearer their hands back, especially important if you have older children to care for, or for those days where baby simply doesn’t want to be put down. But the majority of research has been done between child and biological parents, primarily the mother. However, anybody can sling: parents, grandparents, child minders and nursery nurses, older siblings etc. Therefore carrying your child could be as important to adoptive parents as it is to biological parents, maybe even more so. This is one of the why for example The UP Project, a UK community interest company which provides free carriers to disadvantaged families, includes foster and adoptive families in the category of families they can help.

In 2009 Bick and Dozier found that when mothers engaged with biological and non-biological children, oxytocin production was higher after the interactions with the non-biological children. Oxytocin or ‘the love hormone’ has been associated with “attachment related thoughts” and there is a “general consensus that oxytocin has positive effects on human social behaviour” and a “secure attachment in infancy is important for normal psychological development…from which the infant explores the world beyond” (Campbell, 2010). Therefore the way in which close contact can help boost oxytocin production, and as a result attachment, can be seen as an important reason for adoptive and foster parents to carry the children in their care. This was supported by research conducted in 2007 which concluded that by replicating earlier missed experiences, such as close physical contact via the use of a sling, and being responsive to child’s needs, the caregiver would help the emotional development of child and promote attachment (Gribble, 2007). Gribble in this study began with the hypothesis that those physiological practices which help post-partum attachments should and could be applied to adopted children, and this seems to be the case from working with lots of families at sling library sessions.

For example, on one busy Saturday afternoon drop in session I had a visit from a Mum and Dad and their three children (two girls 3 and 2, and a baby boy of 9 months). A completely normal experience in my work. It was not until their 2nd visit that I discovered they were an adoptive family and they had come to find a sling: firstly for the practical reasons of getting their hands back but also to help with bonding. When I asked Mum why she chose to use the sling library she said that using slings had helped promote attachment with her baby and that “there does not exist the same closeness with our oldest child, who most people would have said at 3 and a half was too old to be carried”. Amazed that she could carry her older children Mummy A is now allowing her older children the opportunity to be carried to give them “the experience they never had as a youngster”.

“there does not exist the same closeness with our oldest child, who most people would have said at 3 and a half was too old to be carried”.

There are several different kinds of sling available and there are slings suitable for tiny premature babies through to pre-school and beyond, there is a carrier for all situations. One family who came to visit was Baby girl L and her mummy. With a dog that needing walking and a caravan they needed a sling. On this occasion Baby L had been placed with her parents from birth with them acting as foster parents while they went through the adoption process to avoid her having to be placed in temporary foster care. Born prematurely she was a tiny 5lb 1oz when she came to visit for the first time. After hiring a sling for 4 weeks Mum J told me that she want to try a sling “after a few people told me it was the next best thing to being pregnant”. Later on she was able to say that it has “most definitely helped with the attachment we have with Baby L”.

“after a few people told me it was the next best thing to being pregnant….most definitely helped with the attachment we have with Baby L”

IMG_2074Sling library’s and babywearing consultants exist across the country and they want to help parents to find the carrier that works for them. It isn’t a one size fits all world. My own sling library has carriers that can comfortably carry up to 24kg thus allowing even older children to be carried close to their adopted parent as possible. An appropriately chosen sling or carrier for age and development of child should mean that the weight is distributed evenly and make it comfortable for the wearer. Babywearing is like any form of exercise, take it slowly and build up. Then the only limit on how long you carry your child is how you both feel about it. It will take your body a little time to adjust to the extra weight, but this gets easier the more you do it, so little and often is the key when starting to carry older children.IMG_1836

With so many different types of sling available it can be daunting where to start. Babies under 3 months have indiscriminate attachments, predisposed from birth to form an attachment to any care giver, for them stretchy wraps and carriers such as the Close Caboo™ offer a relatively easy and affordable entry into the sling world. Small babies are the most likely to want to be carried and this can make the transition to a sling easier for them. As with everything, it is important to ensure you follow all safety guidelines, especially the TICKS guidelines and manufacturers instructions.

Still image of dis-allowed goal. (226)

For older babies and toddlers who may not have had the same experiences of close contact it may take more time for them to adjust. A hip carrier, such as the Scootababy™, does not enclose them to the same degree as a wrap based carrier. It is possible with older to children to find carriers with patterns or pictures that they like, making it “their sling”, giving them some autonomy and choice in the process of selecting the carrier can make it easier for them to become adjusted to it. Choosing a sling with a variety of carrying positions is also helpful and building up how long you use the sling. For some children they may not want to be looking at the adults face but may prefer to be on their back, close but not too close, while others seek the security of their carers face.1270200_10152359721119473_5123666437256962842_o

There is no one size fits all solution. Take time to see what works for both carer and child. One family visited me and hired a carrier for their newly adopted 15 month old who had only just begun to walk. They hoped that the sling would allow them to get out and about but she was hesitant to go in the sling to start with and after a month coped with small periods only. They show that we cannot expect miracles straight away, we should always move only at the baby’s pace.

My final case study is a story of international adoption. Thank you D, her husband A and baby R for letting me share. In the spring of this year they adopted an 1.5 year old little boy from China. They took with them a carrier with them and I want to finish with her description of using the carrier: “it was particularly useful on the internal and international flights and trips. It was such a brilliant way to bond with my new son, keeping each other cosy. R accepted the carrier without complaint, in fact he accepted everything about his new life with good humor and curiosity, and trusted us from the start. He is amazing. We are so lucky to be his parents, and I love being his Momma”. R demonstrates the resilience of children. The freedom and joy that the carrier gave them is the same freedom and joy biological parents, grandparents and aunties and uncles feel when they use a sling, let us make it the norm for adoptive and foster families too, after all Carrying is normal.

“It was such a brilliant way to bond with my new son, keeping each other cosy. R accepted the carrier without complaint, in fact he accepted everything about his new life with good humor and curiosity, and trusted us from the start.”

Finally I am going to leave you with a few words of wisdom from the first foster mum who got me interested in the benefits of sling use for adoptive and foster families, I feel she speaks the clearest of any of us.

“Part of the reason it can help is children that may have attachment issues when they are adopted, and need security, a feeling of safety and above all else to be claimed.  Using the sling as one means of promoting that close contact and parental availability all assists in the vital settling in and bonding period. Added to this the practicality of a sling as an excellent means of transport can be invaluable to a parent learning the job.”


Background

This  blog was originally published in 2014 as part of my Slingababy consultancy community project. The original blog can be viewed here. I was then approached by the organisers of the 2015 Northern Sling Exhibition to present a seminar on the topic. This blog is a reworking of original piece and includes more on attachment . Case studies are anonymous to protect the families involved.

References

Anisfeld E, Casper V, Nozyce M, Cunningham N. (1990) Does Infant Carrying Promote Attachment? An Experimental Study of the Effects of Increased Physical Contact on the Development of Attachment. Child Development 61:1617-1627.

Baronel L and Lionetti F, ‘Attachment and emotional understanding: a study of late adopted pre-schoolers and their parents’, Child Care Health Development, 2012 Sept 38 (5)

Bick J and Dozier M, ‘Mothers and children’s concentrations of oxytocin following close, physical interactions with biological and non-biological children’, Psychobiology 52: 100-1007, 2009

Bowlby J. (1969). Attachment. Attachment and loss: Vol. 1. Loss. New York: Basic Books.

Campbell A, ‘Oxytocin and Human Social Behaviours’, Personality and Social Psychology Review, April 2010, p. 281-296

Charpak, N., “Kangaroo Mother Care: 25 Years After,” Acta Paediatric 94 2005: 5, 514-522.

Gribble, K.D, ‘A model for caregiving of adopted children after institutionalization’, Journal of Child and Adolesent Psychiatric Nursing, Feb 2007, Vol 20:1, p.14-26

Gunnar MR, Donzella B. Social regulation of the cortisol levels in early human development. Psychoneuroendocrinology 2002; 27: 199-220

Middlebrooks JS, Audage NC. The Effects of Childhood Stress on Health Across the Lifespan. Atlanta (GA): Centers for Disease Control and Prevention, National Center for Injury Prevention and Control; 2008.

McCain, G et al. “Heart Rate Variability Responses of a Preterm Infant to Kangaroo Care,” 2005 Journal of Obstetrics,

National Scientific Council on the Developing Child (2005). Excessive Stress Disrupts the Architecture of the Developing Brain: Working Paper No. 3. Retrieved from http://www.developingchild.harvard.edu

Prescott, J. ‘The Origins of Human Love and Violence’, Pre and perinatal psychology Journal, Spring 1996, Vol 10;3 p. 155

Tasker, A., Dettmar, P. W., Panetti, M., Koufman, J. A., Birchall, J. P., and Pearson, J. P. (2002). Is gastric reflux a cause of Otitis media with effusion in children? The Laryngoscope, 112:1930–1934

Whitborne, S,K. “The 4 Principles of Attachment Parenting and Why They Work” in Psychology Today 2013, July

 

Photo Tutorial – Short Cross Carry with a sling ring

The Short Cross Carry with a sling ring (sometimes referred to as a Front Cross Carry with a ring) was my go to carry with a shorter wrap with Isaac from around 3-8 months. I liked that it was a “poppable” carry and can be achieved with a shorter wrap. The sling ring acts as a lock so carry is a knotless one too. I wanted to write this blog as a photo tutorial. There are hundreds of wrapping videos but I know that videos do not work for everyone.

Stage One – Preparing the wrap

Thread the sling ring over one end of the wrap until it is in the middle of the wrap. When the sling ring is in the middle take time to pleat the fabric through the rings to neaten the fabric. This will help prevent the wrap from twisting and help ensure a neat looking carry.

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Next, loop the fabric over your shoulders so that the ring is placed in the centre of your back. Again, tidy the wrap by gathering and then cross tails.

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Holding the sling ring to keep it flat use the other hand to take first wrap pass and take it over the top of sling ring before going through and pull down towards the floor so that you have a 90o angle. Before repeating this with the second pass. This takes some practise to get the ring to stay flat. If you don’t achieve it the carry will not be knotless as wrap will move freely in ring.

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Once again tidy both passes so they are smooth and not twisted. Tighten your bottom rail. The bottom rail is the part of the sling which is in the middle as it comes out of rings.

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Find the positon where you are most comfortable in having the sling ring by lifting the fabric from shoulders and moving it up and down.

Create slack and space for baby by pulling fabric back through ring. Be careful not to introduce too much slack. You want just enough space to put baby in. Thread excess slack back over shoulders and through ring. Use praying hands to double check you have enough space for your baby.

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Stage Two – Putting baby in the wrap

Pick up your baby and place on the shoulder of the top pass so that first underneath pass is visible and accessible.

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From the bottom of underneath pass, reach up and find babies foot and bring this through the pass. Ensure the fabric is in their knee pit.

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Lean forward slightly and move baby to other shoulder and swap supporting hands. Then bring babies foot through as per last step. Let the wrap take babies weight with them sitting on the cross passes to allow their bottom to drop lower than their knees.

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Supporting baby underneath their bottom using the hand of the top pass, use free hand to spread the bottom pass until your supporting hand is covered. Place free hand on babies bottom and then slide covered hand out from under the fabric and complete pulling across babies back.

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Remove excess slack by supporting babies weight and working strand by strand across width of wrap. When slack has been gathered up feed this towards ring by leaning forwards (while supporting baby) to pull slack through the ring. As this is a carry with a cross pass the slack goes under the opposite leg to the shoulder it came over initially. Then pull the slack through ring by pulling on the tails.

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Supporting baby underneath their bottom using the hand of the bottom pass, use free hand to spread the top pass until your supporting hand is covered. Place free hand on babies bottom and then slide covered hand out from under the fabric and complete pulling across babies back.

Finally tighten strand by strand and work to rings. The carry is now completed.

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At this point our final checks are that their airway is clear (you can flip shoulder to keep them visible), that they hands are up near their mouth, fabric is in knee pits and their pelvis is tilted. Check that fabric is smooth on their spine and that you are comfortable too.

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Stage Three – Removing baby from the wrap

Remove shoulder flip if you have included one, then un peel the top pass and then the bottom pass so that baby is sat on (and still supported by) the cross pass. Supporting babies back when the wrap is not covering them gently lift them out of wrap.