When it comes to baby hygiene, many parents primarily know two paths: disposable diapers or cloth diapers. Both can be useful. But there is another option that can be a relieving addition to family life: elimination communication.
Elimination communication means that parents offer their baby the opportunity to relieve themselves outside the diaper at appropriate moments – for example, over a potty, sink, or bowl. The diaper can still be used. It is not a sign of failure, but often simply a backup.
For midwives, this knowledge is particularly valuable. Especially during the postpartum period, parents ask many practical questions: Why is my baby restless? Why does he cry during diaper changes? Are there alternatives to classic diaper use? Do I have to choose between disposable diapers and cloth diapers?
The answer is: No. There is a third option.
Elimination communication doesn't have to be perfect. It doesn't have to be practiced completely. And it doesn't have to be dogmatic.
Elimination Communication Briefly Explained
With elimination communication, parents respond to their baby's potential elimination needs. They hold the baby in a safe, supported position over a suitable receptacle and give them the opportunity to urinate or defecate outside the diaper.
This can happen after certain situations, for example, immediately after waking up, during diaper changes, after breastfeeding or bottle feeding, or when restless, if other needs have already been checked.
The clear distinction is important: elimination communication is not early potty training.
Classic potty training usually involves a child increasingly going to the toilet independently. Elimination communication, however, is about accompanying a baby. The responsibility lies with the adults. The baby doesn't have to perform, control anything, or "do it right."
A simple explanation for parents:
Elimination communication means: You offer your baby the opportunity to relieve themselves outside the diaper at appropriate moments. If something comes out, great. If not, that's fine too.
"Diaper-free" does not mean: without a diaper
The term "diaper-free" is well-known but misleading. Many parents first think of a baby who doesn't wear any diaper at all. This can quickly create pressure.
In practice, however, diaper-free often does not mean that a baby is always without a diaper. Many families still use diapers as a backup. Some only do EC in the morning. Others only during diaper changes. Still others use EC primarily for bowel movements, for diaper rash, or in specific everyday situations.
For midwifery, therefore, the term part-time elimination communication is often more helpful than "diaper-free." It takes the pressure off and makes it clear: It's not about perfection. It's about perception, offering, and connection.
Elimination Communication: the more technical term
Another term is elimination communication. Internationally, it is often referred to as EC.
The American Academy of Pediatrics describes elimination communication as a practice in which caregivers use a baby's natural timings and cues to recognize elimination needs and allow the baby to eliminate outside the diaper.
Source: American Academy of Pediatrics: Elimination Communication: Diaper-Free in America
Possible signs can be:
- Restlessness
- Crying without an apparent cause
- Latching and unlatching during breastfeeding
- Pushing or straining
- Tense posture
- Sudden pause
- Fidgeting
- Discomfort in a carrier, bouncer, or on the arm
At the same time, it is important: Not every baby signals clearly. And not all parents recognize signals immediately.
Relieving advice:
You don't have to be able to read every signal. You can also simply offer something in typical situations.
Why midwives play a key role in elimination communication
Midwives accompany families during a phase of life when parents are particularly open to guidance. They see daily life, experience uncertainties firsthand, and can translate information into the specific family situation.
The German Midwives Association describes midwives as specialists who accompany families from the beginning of pregnancy until the end of breastfeeding, providing medical and psychosocial care. Gesund.bund.de also describes midwives as important points of contact for questions regarding mother, child, health, breastfeeding, nutrition, and practical care after birth.
Sources: Deutscher Hebammenverband: How do midwives work? and gesund.bund.de: Support for families after birth
Precisely for this reason, midwives can make such a difference when it comes to elimination communication. They don't have to actively recommend it. But they can objectively inform parents that this option exists.
A possible formulation:
Besides disposable diapers and cloth diapers, there is also elimination communication. You can do it completely, but you don't have to. Many families just try it during diaper changes or after sleeping.
The most common misconceptions about elimination communication
1. "Elimination communication means the baby is not allowed to wear a diaper."
No. Many families continue to use diapers. The diaper remains a backup.
2. "Parents have to constantly pay attention to every signal."
No. Elimination communication can also work through typical situations: after sleeping, during diaper changes, or after feeding.
3. "Elimination communication is early potty training."
No. Elimination communication is not about the baby becoming potty-trained independently. It's about an offering from the caregiver.
4. "That puts additional pressure on parents."
This can happen if elimination communication is presented as an obligation, ideal, or performance goal. However, it can be relieving if explained in a low-threshold way.
5. "Diaper-free is only for very alternative families."
No. Elimination communication can be very pragmatic. Many families don't use it out of ideology, but because it makes individual everyday situations easier.
What does the professional literature say?
Elimination communication is also discussed internationally under the term Assisted Infant Toilet Training.
An open-access review published in 2025 in the Maternal and Child Health Journal describes Assisted Infant Toilet Training as a practice in which caregivers respond to a baby's cues and natural elimination timings. The review concludes that potential benefits for bladder and bowel health are discussed, but the evidence needs to be further strengthened. Importantly, no increased rate of dysfunction compared to later toilet training was observed in the review.
For midwifery advice, this means: Elimination communication should not be explained with exaggerated promises. It is not a guaranteed path to early dryness. It is not a medical therapy. And it is not suitable for every family.
Serious classification:
Elimination communication can be a helpful, relationship-oriented, and everyday-compatible addition to diapers for some families. Voluntariness, relaxation, and realistic expectations are crucial.
When is elimination communication useful in the postpartum period?
In the postpartum period, elimination communication should not be presented as an additional task. Parents have enough to do: settling in, breastfeeding or feeding, sleep deprivation, postpartum recovery, healing, siblings, and emotional adjustment.
Therefore, elimination communication is particularly suitable when it connects to existing routines. The simplest situation is usually diaper changing.
The baby is undressed anyway. The diaper is open. Parents can briefly offer to hold the baby over a potty, sink, or bowl.
If something comes out: good. If nothing comes out: also good.
It requires no analysis, no plan, and no perfection.
The 5 best starting moments for parents
1. During diaper changes
This is the lowest-threshold entry. The baby is already without a diaper. Parents can briefly hold the baby for elimination and then change the diaper as usual.
2. Immediately after waking up
Many babies need to eliminate after sleeping. This moment is often easier to recognize than individual cues.
3. After breastfeeding or bottle feeding
For some babies, drinking and digestive activity stimulate bowel movements. For some families, this time is therefore well-suited.
4. In case of restlessness without an apparent cause
If hunger, closeness, temperature, fatigue, and other needs have been checked, elimination pressure can be a possible reason for restlessness.
5. Before carrying or lying down for a longer period
Some babies relax better in a carrier or on a blanket if they have been able to eliminate beforehand.
Which elimination communication positions are suitable?
For newborns and small babies, stability is crucial. Head, back, and legs must be securely supported.
A commonly used position is the classic elimination communication hold: The baby lies with its back against the caregiver's body, the thighs are gently held so that the baby can eliminate in a squatting position over a potty, sink, or bowl.
Important for parent counseling:
- The baby is never forced.
- The hold must be stable and secure.
- The baby can be taken out at any time.
- Elimination communication should happen calmly and not hectically.
- If the baby clearly resists, stop.
A good phrase for parents:
You offer. Your baby decides if it's suitable.
For which families can elimination communication be particularly helpful?
Elimination communication can be particularly interesting for families who:
- are curious about natural baby care
- use cloth diapers or want to reduce diaper consumption
- observe recurrent diaper rash on their baby
- notice their baby becomes restless before bowel movements or urination
- carry their baby a lot
- want to promote good body awareness in everyday life
- are open to small, everyday rituals
- are not looking for a complete solution, but an addition
It remains important: Elimination communication should never be presented as a standard for good parenting. A family that doesn't practice elimination communication is not doing anything wrong.
When should midwives be cautious?
Elimination communication does not fit into every postpartum situation.
Restraint is advisable when:
- Parents are very exhausted or overwhelmed
- Breastfeeding or feeding is currently very stressful
- Birth experience, C-section, or postpartum recovery require a lot of attention
- Parents tend towards perfectionism
- One parent is already highly anxious about elimination, sleep, or weight
- The baby shows significant stress
- Medical issues are paramount
In such situations, it may be enough to mention elimination communication as a later possibility:
This doesn't have to be an issue now. If you're curious later, you can simply try it during diaper changes.
This way, the information is retained without creating pressure.
How midwives can explain elimination communication in 60 seconds
A possible formulation:
Besides disposable diapers and cloth diapers, there is a third option: elimination communication. This means that you offer your baby the opportunity to relieve themselves outside the diaper at appropriate moments – for example, during diaper changes or after waking up. You don't have to live completely diaper-free for this. The diaper can simply remain a backup. If something comes out, great. If not, it's just as okay.
This explanation is short, professionally sound, and relieving. It contains all the important points: third option, appropriate moments, no obligation, diaper as backup, and no pressure to succeed.
Which language relieves parents
The language used determines whether elimination communication is perceived as helpful or overwhelming.
Better not to say:
- "You have to recognize your baby's signals."
- "Babies don't want to mess their diapers."
- "With diaper-free, your child will be potty-trained earlier."
- "If you're attentive, it will work."
- "This is more natural than diapers."
Better to say:
- "You can just try it during diaper changes."
- "The diaper can remain a backup."
- "It doesn't have to work every time."
- "Many families only do part-time elimination communication."
- "If it stresses you out, you can stop."
- "It's an option, not an obligation."
This language is crucial because many parents in the postpartum period don't need another ideal. They need permission to try things imperfectly.
Elimination communication and diaper rash
Many parents become interested in elimination communication if their baby repeatedly has diaper rash. This is understandable: if individual eliminations occur outside the diaper, contact with urine and stool in daily life can be reduced.
Nevertheless, elimination communication should not be presented as a medical cure. For severe, persistent, or unusual rash, a professional assessment is always needed, as usual.
Serious phrasing:
If your baby frequently has diaper rash, offering individual eliminations outside the diaper can be helpful for some families. However, this does not replace a clarification if the skin is severely irritated or does not improve.
Elimination communication and sustainability
Another reason why parents ask about elimination communication is sustainability. Those who regularly practice EC can potentially reduce diapers, waste, or washing efforts.
But here too, the rule applies: don't overstate it. Not every family will significantly reduce diaper consumption through elimination communication. Some only do EC occasionally. Others continue to use full-time diapers. That's fine too.
The stronger message is: Elimination communication creates room for maneuver.
Parents are not limited to "either disposable diapers or cloth diapers." They can experiment, combine, and find the path that suits their family.
What midwives can specifically tell parents
For many parents, the initial thought alone is relieving: elimination communication doesn't have to be all or nothing. It can start small.
A simple recommendation for getting started is:
Try it once during diaper changes. If your baby is undressed anyway, you can briefly hold them over a potty, sink, or bowl. If something comes out, great. If not, just continue with the diaper change.
This turns elimination communication into an offering – not a new task.
Parents usually don't need extensive theory at the beginning. Three thoughts are particularly helpful:
1. The diaper can stay
Elimination communication does not mean that a baby has to be without a diaper. Many families continue to use the diaper as a backup.
2. It doesn't have to work every time
If nothing comes out, nothing went wrong. The baby may not have had a need at that moment, or the timing wasn't right.
3. Standard situations are enough to start
Parents don't have to immediately recognize all their baby's signals. They can start with simple moments: during diaper changes, after waking up, or after feeding.
This keeps elimination communication low-threshold. It is not presented as an additional ideal, but as an opportunity that parents can try out – without pressure and without demanding perfection.
FAQ for Midwives
Is elimination communication the same as diaper-free?
Not quite. "Diaper-free" is a well-known term, but often misunderstood. Elimination communication describes the specific action: parents offer the baby to eliminate outside the diaper. Many families still use diapers.
At what age can you start elimination communication with a baby?
Some families start in the first weeks of life. Others start later. For counseling, what's more important than the exact age is that it remains relaxed and suits the family.
Do parents have to recognize their baby's signals?
No. That can help, but it's not a prerequisite. Parents can also start with standard situations, for example during diaper changes or after waking up.
Is EC early potty training?
No. EC is not about the baby becoming potty trained independently. It's about an offering from the caregiver. The baby doesn't have to perform.
What if nothing comes?
Then nothing happens. The baby is changed again and daily life continues.
Can EC overwhelm parents?
Yes, if it's presented as an obligation or ideal. That's why an undogmatic explanation is so important.
Does a midwife have to recommend EC?
No. But she can neutrally inform parents that this option exists.
Conclusion: Midwives don't have to evangelize EC – but they should be able to explain it
EC is not an obligation, an ideology, or a competition. It's an additional way to support babies in everyday life.
For some families, it will become an important part of their daily routine. For others, it remains an occasional attempt during diaper changes. Still others choose against it. All of that is perfectly fine.
This is precisely why midwives are so important.
They can turn a misleading term into relaxed information. They can protect parents from pressure. And they can show that baby hygiene doesn't just have to consist of disposable or cloth diapers.
The most important sentence for counseling:
You don't have to live diaper-free. You can simply offer your baby the opportunity to relieve themselves outside the diaper at appropriate moments. The diaper can remain a backup.
When parents hear this sentence, they often understand EC correctly for the first time.
And that's where change begins: not with pressure, but with knowledge.
Sources and further information
- German Midwives Association: How Midwives Work?
- gesund.bund.de: Support for families after birth
- Austrian Midwifery Board: Midwife care in the postpartum period
- Swiss Federation of Midwives: The Midwifery Profession
- American Academy of Pediatrics: Elimination Communication: Diaper-Free in America
- Hindmarsh, Davis & Atchan: Assisted Infant Toilet Training and Bladder and Bowel Health: A Global Integrative Review
