Monday, October 5, 2009
Monday, October 05, 2009
Sleeping With Baby: Breastfeeding, Night Waking & Protection from SIDS
Mothering, Issue 141
by Peggy O'Mara
One of the biggest crises of confidence that new mothers face has to do with sleep. Mothers feel responsible for their babies' sleep. Others ask mothers if their babies are sleeping through the night, as if this is something the mothers can control. Mothers lie to one another about whether or not their infants sleep through the night. And everyone lies about not bringing their babies into bed with them.
We lie because our society has unrealistic expectations of babies, and therefore we have unrealistic expectations of ourselves as mothers. Our expectations for babies' sleep simply do not coincide with babies' actual capabilities, or with the normal behavior of our species.
It is normal for human beings to wake during the night. We each awake several times a night, but don't remember that we have. It is normal for human infants, especially, to wake at night. During their early weeks, they sleep during the day and are awake for periods during the night. It takes about two months for their day-night cycle to regulate itself. From two to four months, infant sleep is more predictable, with longer stretches of night sleep. Parents are tempted during this time to say that their babies sleep through the night, and they fully expect that they should be. This is often false hope.
New brain activities—manifested in sitting up, standing, creeping, and crawling, as well as in the eruption of new teeth—conspire to make the period from five to nine months a time of increased night-waking. Baby becomes more aware of others during this time, and may have separation anxiety and nighttime fears.
The pattern of increased brain activity, new growth and stimulation, eruption of baby teeth, and the maturation of the immune system is mostly complete by two years of age. While many parents with one-year-olds who are not sleeping through the night think that their baby has a sleep problem, it is actually not until between two and three years of age that a child regularly sleeps through the night. This does not mean that the two-year-old wakes as much as the newborn, but only that sleep is a process as well as a state.
There is nothing we can do to change this, nothing we can do to make our babies sleep through the night. We sometimes think that introducing solid food will help our babies sleep, but starting solids too early can hurt them. One study found that feeding babies rice cereal before four months was a risk factor for the development of diabetes. The American Academy of Pediatrics recommends not starting solids before six months; the World Health Organization suggests waiting even longer.
Even if we wait to start solids, it is not a good idea to start with rice cereal, although it is very popular. Rice cereal doesn't make babies sleep through the night. In fact, it has a high glycemic index and may raise the baby's levels of blood sugar and insulin. It is not as rich in nutrients or flavor as other foods, such as vegetables and fruits. If food actually did make babies sleep, rice cereal would not be a good choice; as a starch, it is digested quickly. The cereal became popular decades ago to complement formula feeding because it could be more easily fortified with iron.
While we cannot make our babies sleep, we can provide them with regular bedtime routines. I always nursed my babies to sleep in a rocking chair. Baths, quiet time, reading stories, soft light, and a slow pace help prepare children—and adults, for that matter—for sleep. These routines help us to relax.
It is also important that older children have time during the day to run and play, as a lack of exercise can make them wakeful. On the other hand, children who are overstimulated can also take time getting to sleep. We all need a period of unwinding from a busy day, and the transition from waking to sleep requires sensitive pacing.
Most of us, though, can figure out the baths and the bedtime stories. It's the night waking when our children are babies that drives us wild. It drives us wild because we're up in the night and don't want to be. It also drives us wild because it's a dark secret to admit that our babies wake at night.
Over 30 years ago, I sat in a room with a bunch of other new moms and bemoaned the fact that my baby was waking up during the night. I thought I was weird. All of a sudden, it occurred to me to ask the other mothers how many of their babies were waking at night. Nearly all of them raised their hands. We all breathed a great collective sigh of relief. It was not our fault. It is just the way babies are.
After observing my four babies, it is clear to me that teething is a major culprit in night waking. My babies' night waking dramatically decreased after their two-year molars came in, often at about 18 months. There can be other reasons for night waking, and it's always helpful to try to figure out if there is anything out of the ordinary in the baby's life that might contribute to wakefulness. If not, one simply has to live with it.
We have set a cruelly unrealistic standard for infant sleep. We expect babies to conform to our adult world, and we justify coercing them when they don't.
I know it's been a long time since my children were babies, and I no longer feel in my bones the ache of missed sleep, but I found it easier to handle sleep interruptions once I came to accept night waking as normal. I recently received an e-mail advertising the services of a doctor who specializes in sleep training. "Sleep training" implies that we can, and therefore probably should, control our babies' sleep habits. But is sleep a "habit"? Good sleeping habits are one thing, and they do indeed help children sleep better—but sleep itself is a need, and therefore out of our control.
Yet we parents are not only expected to control our children's sleep, we are told where our babies are to sleep. Defying centuries of ancestral wisdom and common practice, today's medical experts raise doubts in young parents about the safety of sleeping with their babies. This advice flies in the face of the fact that most of the world's parents sleep with their babies and always have. It's the way of our species. The assumption that one needs a separate room and a separate bed to safely raise a baby is elitist. There's nothing inherently wrong with these things, but they don't have a monopoly on safe sleep.
Human babies are born helpless and have the longest period of dependency of any species. We are not comfortable with this because our culture equates dependency with weakness. It is, in fact, a healthy dependency that guarantees independence. I don't think I am the only mother who has observed that her most dependent babies turned into her most independent children. As with sleep, independence is not something we can teach our children. It is something they develop.
But what is a parent to do with all of the mixed messages regarding sleep and babies? One doctor recommends swaddling babies all night long. And yet, observation of babies self-attaching to the breast shows them using their arms to locate the breast and to move toward it. Babies also move their arms to lower their body temperature, which is important—overheating can be a contributing factor in SIDS.
Another doctor recommends that parents refuse to comfort a baby who wakes at night. He suggests standing outside the door of the baby's room to listen to her cry it out. I can't imagine any other circumstances in which one would be so deliberately unresponsive to a loved one's suffering. When the baby finally falls asleep out of exhaustion, it is not because she has learned how to sleep. It is because she has given up on others.
Convincing international research supports a parent's instinct to sleep with her baby. Cosleeping seems to have a corrective effect on the infant's respiration. The baby breathes more regularly when in skin contact with the mother. For this reason, too, cosleeping is protective against SIDS. One researcher even found that cosleeping was not only safe, it was twice as safe as not cosleeping.
And yet, the gold standard for infant sleep is an approved crib. According to controversial research conducted by the Consumer Product Safety Commission, each year 60 babies die in adult beds—but most of these babies are alone. On the other hand, 900 babies die each year in cribs, and in the last 25 years there have been 36 recalls of cribs. Does this mean that cribs are unsafe? No. It means that babies sometimes die at night.
It is cruel to suggest to parents that they could be lethal to their own children, and that the only solution is to buy a new crib, which many parents can't even afford. In fact, new products are recalled just as often as old ones. The fact that a product is new does not mean that it has been safety tested, because safety testing is not required. It may mean that it meets current mandatory standards, but if it is a new type of product, there may be no standards yet set for it. This is true even in the juvenile products market.
Common sense tells us that night waking is not a pathological abnormality but a temporary disturbance. It decreases as baby teeth come in and the immune system matures. Here are some ideas that can help:
Accept night waking as normal.
Sleep when the baby sleeps.
Don't turn on the light or change diapers when the baby wake at night to nurse.
Don't count how many times you're awake at night.
Don't look at the clock in the middle of the night.
Nap on weekends, or whenever you can get help with the baby.