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.
  • Carry on.
  • RELATED ARTICLE: COSLEEPING TWICE AS SAFE

25 comments:

  1. I remember reading this in a MOthering magazine years ago when Grace was just a baby and saying, YES. Even though I already knew most of that instinctively and didn't feel sleep pressure I felt like sharing it with all my other mom friends so they could LAY OFF their babies. :)

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  2. 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."

    People told me I was putting my baby in danger, but my instincts SCREAMED when I left her alone in a bassinet the first night or two. I got no sleep until I brought her to bed with us. She was happy, I was happy, and we both slept better.

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  3. no other mammal on this planet leaves their infant defenseless, alone during sleep - its totally counter-intuitive to the mothering instinct and just plain wrong.

    Co-sleeping gives our infants/children a connection and bond to another human that offers them not only physical, but emotional stability.

    I wish there was a way to go through our prison systems and determine how many of those people were breast fed/ co-slept. Hmmm

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  4. it just never crosses my mind to ask if a baby sleeps through. they sleep when they need to sleep. so strange to judge how a mom/baby is doing by how they are sleeping...

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  5. After my first never was in his crib, I never even bought one for my next two babies. Moms in other countries say moms in America put our babies in cages. I couldn't sleep without my baby next to me- it freaked me out!

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  6. I wish there was a way to go through our prison systems and determine how many of those people were breast fed/ co-slept. Hmmm ??"
    I love that Jessica! The number of times I have thought of that...

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  7. Great article!!!! I'm sharing! :)

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  8. Thank you! It is wonderful to hear the reassurance that it is normal and that I am correct in following my instincts. I am surrounded my other mothers whose babies sleep through the night and have used sleep training techniques. It is so refreshing to hear this.

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  9. Wonderful article. My baby doesn't sleep through the night-and I never have as an adult! Cosleeping is the best answer for both of us.

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  10. Thank you! Just in time. I appreciate having my instincts validated and the helpful hints. I was way to focused on keeping track of how much sleep I was losing!!! I got to put it to work last night - and it was a very wakeful night, but I feel so much better! Thanks again! ;-)

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  11. This is a great article! When my son was about 3 months old I gave up on sleeping through the night and (finally!) started to listen to my common sense...I believe that babies grow and learn, and their sleep patterns develop along with them! Co-sleeping and side-nursing saved us...those first months when I grabbed my son from the co-sleeper every time he cried, and sat up in bed to nurse every time were sheer hell. When I finally gave in to my mommy instinct and began co-sleeping in bed, and when he had learned to nurse well enough so we could side-nurse was when we really started feeling more rested.

    My son is now 2 years old, and independent as they come. :) He sleeps in a big bed, and yes, I am still coming in some nights to snuggle with him and help him back to sleep...but he does sleep through most nights by himself. But, if he needs me at night, I'm there for him. Plus, the snuggles are so sweet! :D

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  12. I never intended to cosleep, I was one of those moms whose kids would sleep through the night from birth. And then I had a baby. The tune changed right away. It felt wrong for my baby to be away from me. From night one they slept in bed with me. My 2 year old still joins us in bed occasionally, but the 4 year old goes to bed on his own and sleeps all night and likes it! My children have a healthy approach to sleep and I believe that it all goes back to cosleeping and being attentive to them 24/7. Great article and definately shared with all the moms I know!

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  13. I was afraid of my first baby sleeping with us in our bed. But I loved to side-by-side nurse in bed. He slept in a pack-n-paly next to our bed for the first month. Then because of external pressure (namely my MIL and also my DH protesting by sleeping on the couch) DS moved into his room. With baby #2 I was exhausted from working 40 hrs/wk (and having DD there with me so she could nurse - awesome woman boss!) and having 2.5 yr old DS, I would fall asleep with DD nursing. We had the PNP in our room, but most nights she just slept right next to me or between us. DH was very open to this and she slept in our bed for 4 months. It got to be cold and we needed blankets, so DD slept in the PNP and hardly woke at night to nurse anymore. She was gradually moved into her own room and is a great sleeper. I miss her being in our bed. I miss feeling her nursing at night. I look forward to happy early morning snuggles in our bed with either DS or DD. I just hope it happens! They both sleep well! Neither of my kids have ever had to CIO - ever. How could you do that to a person you love with all your heart and soul?

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  14. What a beautiful blog you have. I agree with every word of this post. I have dealt with unsolicited advice for everyday my son has been alive. I have stuck to my guns though. I love the photos of babies co-sleeping. My 9 month old loves taking naps on mommy and daddies chests and sleeping all snuggled up with his boobies. He is the happiest little boy I know(and smart too!) I work full time and I don't know how I would live without co-sleeping and baby wearing. I would feel so detached from him. Thank you for your amazing words. They keep someone like me going. I live in a western culture where everyone does what their moms did and I just couldn't be like that. I follow my mothers intuition and my mammal instincts.

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  15. I just stumbled across this article after searching about breastfed babies waking several times at night. I have an 8 month old and although I've been, for the most part, confident in my practices of co-sleeping and nursing to sleep, every now and then I feel like I should expect my son to sleep through the night. Although 18 months feels like a long way off it is a relief to know that it might take that long for him to sleep through. For now I will continue to be content with nursing him when he wakes. Thanks for the boost!

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  16. When I first came home from the hospital with my son, I was exhausted but I couldn't sleep myself unless I was touching my son. Even if someone else was holding him, I couldn't relax. I was the one with separation anxiety. Now I know that it was a normal feeling for me to have and my instincts to have my baby close are right.

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  17. Much like a previous post, it is unnatural to leave a baby alone at night. Imagine a cave woman with her new baby--would she put her baby far away from her, leaving the helpless creature to fend for itself if a hungry animal came wandering in? Especially if mommy is sleeping? Or does it make more evolutionary sense to keep the baby close by, not only for ease of feeding but to protect the baby and act quickly in its defense? All moms I know who cosleep are happier and better rested than non cosleepers.

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  18. I just happened to come across this blog, & it has given me a breath of fresh air. My son is 5 1/2 weeks old, & I've been stressed out to get him to sleep through the night. It feels good to know I shouldn't expect him to be sleeping through the night. I also feel validated that I have been co-sleeping with him and ro k ow it's the right & healthy thing for me to do.

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  19. So great to see all these positive articles about co-sleeping. We had initially intended for our son to sleep next to us in a basinette by our bed. The first night we brought him home and I set him down in there and he looked so tiny and helpless and unhappy in there my husband and I both instinctively knew that wasn't where he was supposed to be. We looked at each other, I scooped him up and snuggled him down between us he's spent the night there happily ever since (he's now very happy, healthy one year old). It's amazing though how many people are shocked when you tell them about the sleeping arrangement, we've had a number of 'concerned talks' from co-workers, acquaintances and a doctor (we switched doctors after that to a lovely lady who thinks it's great and advised us on safety precautions like bedding etc and we did our own research too ). Sad that something so natural is so misunderstood, I hope websites like this one can help spread the word and make for happy babies everywhere.

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  20. My sentiments exactly! I love the collage of photos at the end.

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  21. hmm I recently have changed my mind about bed sharing as my four month old is starting to teeth. I noticed since he's been sleeping next to me we're both more rested and my breasts don't get as full at night since he can help himself when he's hungry. It just seems like the right thing to do and I don't think I'll be purchasing a crib for my next child. I too thought that babies were to sleep through the night on their own.

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  22. I slept with my baby in the hospital for the two nights we were there. I did this despite nurses coming in and telling me I had to put her in the plastic bassinet on wheels. They told me that babies can and do die from sleeping with their parents. One nurse even told me of a mother who had given birth there the month before to her second baby and that her first baby had died sleeping next to her. She didn't give a name but I actually knew the mother she was referring to and I know that the mother had suffocated her baby in the night (two month old baby sleeping on a soft mattress between two parents that collectively weigh over six hundred pounds). I knew that in that hospital bed with the alertness and excitement I felt that there was no way I would hurt my baby so I did it anyway. Then we went home with a ton of pamphlets and they all spoke of the dangers of cosleeping. Everyone I knew said I had to put her in the crib that had been bought for us. I did this for six weeks against my better instincts which caused a lot of heartache and sleepiness for me. I hated the fact that she had to cry to wake me up. I went to the library around six weeks (when I finally healed from C-section) and read Nighttime Parenting by William Sears. Baby has been in my bed ever since. Dad sleeps on the couch because he is a heavy sleeper and he fears rolling over on her in our small bed. My mattress is directly on the floor and is very firm. I use my arm as my pillow and a light blanket or sheet only as high as baby's waist. I sleep with no shirt on and she sleeps with only a cloth diaper on. Most of the time I wake up in the morning with empty breasts and don't even remember her latching on in the night. She is happy and I am happy. There is nothing like waking up in the morning to your sweet happy baby. She is now 8 mos. old and all smiles every day.

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  23. Forgot to add about my previous comment (8 month old that still sleeps with me) that I have been telling doctors, friends, and family since she was six weeks old that she does sleep through the night. If they ask, "Really???" or even if they don't say anything further I say "Of course! She still feeds several times a night but goes right back to sleep afterward." I get the funniest looks sometimes and "Oh..." I try to tell everyone I can that this is completely normal and that part of being a mother is sacrificing to take care of someone that can't take care of themself and that needs a ton of love. I still get people telling me that if I would just let her get herself back to sleep without eating then it would only take about three days and she would stop waking in the night. Can't understand letting my sweet love cry for even one night. For even a full minute!!! And for those that need more of a reason than that I say that since I have been breastfeeding all day and several times a night I still don't have a period!!! How's that for incentive? :)

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    Replies
    1. I love that respond to the question about STTN! :) Going to have to try it in the future... I always just said I didn't know 'how well he slept' because he was snoozing next to me all night and grabbing milk when he needed it... hard to know when you never have to get up out of bed. :)

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  24. If I didnt co sleep my 2nd baby girl would be dead. She had jaundice when we came home from the hospital. I noticed she had slept WAY too long and was very cold to the touch. Turns out her liver was overloaded from the jaundice and she was slipping away. I had been trying to get her to sleep in a crib next to the bed since my spouse was not comfortable sleeping with the baby. I was comfortable since I had co slept with my 5yo but tryed his way out of respect. The 1 night I put the baby in bed saved her life. She hated being in the crib and desperate for sleep I brought her in with us.If she had been in the crib that night she may have died without me ever noticing.

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