For several years I have worked as an infant sleep consultant, supporting families to help their young children to sleep well and guiding them to move away from unsustainable sleep situations. Parenting dynamics can be complex, and every family is unique. I walk a fine line at times. Parents are sleep deprived and feelings can run high. The conflicting advice that parents receive when it comes to their baby’s sleep is a common thread that is frequently undermining parents’ confidence and causing psychological distress. I am no stranger to the conflicting opinions on baby sleep, but last week the chasm between the opposing and polarised views was highlighted through a few particular events.
The first was a discussion that I had with a mother who, for 8 months had held her baby for naps and slept beside her baby in the same bed at night. 8 months in and she needed things to change but she was unsure whether any separation would be damaging to her baby’s development. The source of this worry were particular social media accounts that insist that a healthy attachment involves literally being attached to your baby, and that in order for a baby’s brain to develop optimally, this closeness in proximity should be maintained until at least 3 years of age. Some experts, from neuroscientists to psychologists, will advise an approach of “attachment parenting” where the baby spends most of their time with their primary attachment figure, sleeping with them or on them. They will insist that a young child has no ability to soothe themselves to sleep and that they need this close proximity to feel safe.
In my experience, this attachment figure is usually the baby’s mother, and this approach is often linked with breastfeeding, so the mother is also responsible for most, if not all of the feeding also. A couple of weeks previously I had similar discussions with a mother of a baby of the same age. The baby was sleeping incredibly poorly. Naps during the day often lasted no longer than 30 minutes, and the baby was waking overnight every 45 minutes or so to latch onto her mother’s breast in order to resettle. Mother and baby were co-sleeping. A 2-hour stretch of sleep was the most that this mother got, and that was rare. Both mother and baby were incredibly sleep deprived. Yet, the thought of allowing her partner to spend time settling the baby at bedtime or overnight brought this mother to tears. “I am so afraid that she will be upset and will feel that I have abandoned her. It might damage her attachment to me”, she sobbed down the phone to me.
Then there was an online discussion amongst sleep professionals with regards to guidance that a postpartum doula was being given by a superior. The doula was looking after a 2-week-old baby at night and was being advised not to feed the baby more than twice during the course of a night. This tiny baby was expected to sleep for long stretches in a crib overnight. If she woke up in between the designated feeding times, the doula was being advised to let the baby cry. This is a disturbing example of a very hardline approach taken with the goal of getting a young baby into a strict nighttime routine, eliminating night feeds and hence removing the need for the parents to have to tend to the baby overnight. The majority of experts advising a strict routine-based approach will not advise anything so harsh, but it does illustrate just how far some parents and childcare providers are willing to go to achieve a full night’s sleep as quickly as possible.
Now imagine that you are a new mother, striving to parent in the best possible way, but parenting in a time when there is very little social and emotional support for mothers - yet also when there is huge financial pressure to engage in paid work, and mountains of psychological and societal pressure to get our parenting right from the outset by establishing the right kind of feeding, hitting milestones on time, weaning, engagement, play, clothing and education… the list is endless. Then there is the matter of baby sleep. Unique and important because of the unavoidable truth that a baby’s sleep – its quality, duration, timing and location – directly impacts not only a parent’s sleep but also the quality of their day, due to the requirement for naps. “Nap trapped” is a phrase used for the common situation of being stuck holding a sleeping baby, unable to move for fear of waking them up.
The advice for new parents is inevitably being sourced through social media, where are thousands and thousands of parenting accounts. They are littered with catchy short reels, shouty reminders, informative videos, schedules, weaning ideas, to name a few. The algorithm picks up on the fact that you are pregnant or have a new baby very quickly, and new parents are flooded with advice on what ALWAYS to do and what NEVER to do.
And so, this is where mothers find themselves, in the toxic space between two highly polarised approaches to baby sleep. The first, as mentioned above is an “attachment parenting” approach. Loosely based on attachment theory, this has been distilled and focussed into a highly intensive approach to sleep where your baby should essentially be with you at all times, and baby wearing and co-sleeping are encouraged. Cots can be dismissed as prisons, family floor beds are recommended and there is often an assumption that you will be breastfeeding. Some “experts” go as far as saying that swaddling and placing a baby down in a cot is depriving them of sensory input, which may affect their brain development. This is worth a moment’s pause - exhausted mothers are being told that if they put their baby down to sleep, then their baby’s brain may not develop properly. My observation is that - thanks to ‘advice’ such as this - often maternal mental health is an afterthought or lip service, at most.
There is a suggestion that you should want to parent in this way anyway; that it is easier and more natural, that our ancestors parented this way, and that you should lean in and rest with, or under, your baby as they sleep. The fact that you may have other children (or other commitments in general) is not really considered, neither is the fact that some mother’s don’t sleep well beside a baby and some babies don’t sleep well beside a parent. Chronic sleep deprivation is often normalised, and parents are reassured that the days and nights are long but the years are short and that this time will pass. Parents often bring up the fact that they are worried about how their baby will cope in childcare when they go back to work. The usual advice is that childcare professionals will do what they need to do, and a baby will adapt. Dr William Sears, who first suggested an approach of attachment parenting, initially advised against mothers going back to work, but has since changed his stance because of course such a view wouldn’t be tolerated by today’s standards.
Still, it is at this point that the whole thing jars most with me and the hypocrisy becomes clear. Hold your baby 24/7, until you need to go out and make money again, then just make it work. We must also be realistic here that while many fathers are supportive and engaged, the vast majority of the overnight parenting and parenting in general through the early months at least is done by the mother. Online parenting groups are predominantly run by mothers for mothers and a quick scan of the comments sections on parenting social media accounts will tell you that the contributors are almost exclusively mothers. There is some good old-fashioned misogyny lurking around in the undercurrents. I have yet to witness a father being told that he should be able to tolerate constant hourly waking overnight before getting up and doing a 12-hour shift. As a friend and fellow sleep consultant once said to me – it’s almost like attachment parenting is attaching mothers to the kitchen sink again, but repackaged and rebranded.
Then, there is the second, almost polar opposite approach: avoid “bad” habits, establish a strict schedule of feeding and sleeping, and sleep train early to establish your baby’s independence. The American Association of Paediatrics advises against co-sleeping, insisting that baby’s should always sleep in their own cot or crib. Popular books declare in their titles that you can get your baby to “sleep through” by a certain age. Many well-meaning paediatricians and family doctors will advise parents just to “cry it out” in order to get more sleep. Someone handed me a particular book after I had my twins which promised me contented and settled babies. A quick flick through the pages told me that I would be picking up baby 1 at a set time, feeding a set amount, picking up baby 2 to feed them a set amount and then putting both babies to sleep for naps at a set time for a prescribed duration. Thankfully, that particular book gathered dust at the back of the bookcase. Studies have found that set routines don’t often work well for young babies, often causing more anxiety for parents when they find that their baby won’t behave robotically (Harries & Brown 2019).
When it comes to sleep training, which is an umbrella term for helping a baby to learn to sleep more independently but is often associated with a cry-it-out approach, the term “ferberising” has become everyday parenting speak for a strict method of sleep training, particularly in the US. Methods like this are usually associated with crying. You will find passionate supporters who treat it as a sort of rite of passage and others who dismiss it as a form of abuse. It is understandable that the US is fertile ground for debates on sleep training, with mothers being expected to return to paid work before their C-section wound has healed and post-birth bleeding stopped. Social media sleep training accounts will often advise strict schedules and will show videos of mothers placing their baby at set times in their cots in the dark, neatly swaddled and asleep in minutes to the sound of white noise as the calm and well-rested looking mother goes about her well-organised day.
And so, it would seem that many mothers find themselves in the horns of a sleep dilemma. Should they do what many experts say is best for their baby – attachment, contact and co-sleeping, even if they themselves get little to no rest or sleep? Or, should they establish a strict schedule and independent sleep for their child, even if it involves some tears, because it will afford them more sleep at night and more freedom during the day? Could any upset involved actually damage their baby long term? Add in the fact that mothers are navigating this dilemma as they deal with swinging hormones, sleep deprivation and enormous adjustments to the realities of life as a parent and you have a situation that can become highly emotional and fraught.
I completed my nursing degree right when the discipline of nursing was swinging away from the doctor’s handmaiden paradigm towards it being a proud profession in its own right – being “evidence based” was the name of the game. Surely some sound, research-based inform us what the right approach to sleep should be. Sadly not. It is hard to think of an area that would be more difficult to study scientifically and objectively; the number of variables is almost infinite. Many studies are small and rely on parent reporting when measuring wake ups and sleep durations. After working with parents for many years, I know that even something as simple as what constitutes a wake up will vary hugely from parent to parent. Some parents will count brief sounds and movements in the night as wake-ups. Others won’t count having to get out of bed briefly to replace a baby’s soother. The Flinders study (2016) and more recent studies by Kahn et al (2023) will be cited by those in favour of sleep training as they appear to demonstrate improved sleep without any negative impact on the baby. However, those against such interventions dismiss such studies as fundamentally flawed in their methodology. Certainly, there is good quality information available from large studies that tell us what is normal when it comes to amounts and durations of baby sleep and how that tends to evolve over time. Reliable studies show us that it is normal for babies to wake and for them to wake less as they get older. Some babies wake more, some babies wake less, and lots of factors can affect this. Reliable sources of information do tell us that a stable family environment and a parent that is engaged, responsive, loving and attuned to their baby’s needs is more likely to raise a well-balanced, happy and healthy child. This makes sense - so surely maternal mental health should be our priority.
This area is nuanced, complex and sensitive but very important. I frequently feel upset, worried and angry when I talk to fellow mothers who are struggling under the weight of conflicting advice. This is affecting women when they are at their most vulnerable. The area does not lend itself to being black or white and there is no “right” way for a baby to sleep. Maternal mental health is hugely important, and it is suffering. The MAMMI study in Ireland (carried out between 2012 and 2018) found that significant numbers of mothers experience mental health difficulties during the first year post-partum. In the absence of reliable research on baby sleep, then perhaps it makes the most sense to prioritise the mental health of our mothers and to encourage mothers to do what is right for them as the real expert on themselves and their own child. For some mothers, that will involve happily co-sleeping and contact napping. For others they will need their baby to learn to sleep more independently in order to get the rest that they need themselves and to avoid anxiety about a messy house or other children or tasks that demand their attention. For some it will be a messy middle of a bit of both - and let’s face it, lots of parenting is somewhere in the messy middle. Confidence is really important. If a mother feels confident, then she is likely to trust her instincts and babies thrive on a calm, intuitive energy.
I find myself referring to Winnicott’s “good enough mother” model often. British Paediatrician Donald Winnicott wrote about the good enough mother as a loving, empathetic and attuned parent who very naturally leans into her newborn baby’s every need. He argued that as the baby grows, a mother will naturally allow her baby to allow small levels of frustration before attending to his needs, not responding to every cry immediately while simultaneously remaining loving and not allowing long periods of upset. She isn’t perfect because perfection doesn’t exist, and the baby learns to naturally wait a little and realise that every need may not be met immediately. He argued that this developing dynamic is healthy for both baby and mother, as she will sacrifice all of her own needs initially (including the need for sleep) before gradually reclaiming them as her baby grows and develops. He warned that you cannot teach a mother to mother and that too much information or advice from an external source can interfere with her natural instincts to read and align with her child’s needs. As someone who supports parents on a daily basis, this makes perfect sense to me and is part of the reason that so much advice via social media ends up doing much more harm than good for many mothers.
This area is likely to remain a contentious one, but common sense would dictate to me that it is not the location of a baby’s sleep that matters, but more that the baby feels safe, secure and loved, regardless of the location. Sleeping habits simply need to be workable and sustainable, whatever that may look like for each family. Babies need to be held and nurtured but can learn to sleep more independently if they are coaxed and taught by a parent who feels confident to do so. Sleep deprivation doesn’t benefit anybody, and a mother who is well rested is far more likely to respond and tune in to her baby’s needs and to enjoy time spent engaging with her child. The world of parenting is not black and white - it is too messy for that. It is many shades of grey and colour, and everything in between. Mothers are important. If maternal mental health is our priority, then everything else will fall into place.
References:
Harries V, Brown A. The association between baby care books that promote strict care routines and infant feeding, night-time care, and maternal–infant interactions. Matern Child Nutr. 2019; 15:e12858.
Gradisar M, Jackson K, Spurrier NJ, Gibson J, Whitham J, Williams AS, Dolby R, Kennaway DJ. Behavioral Interventions for Infant Sleep Problems: A Randomized Controlled Trial. Pediatrics. 2016 Jun;137(6):e20151486. doi: 10.1542/peds.2015-1486. PMID: 27221288.
Kahn M, Barnett N, Gradisar M. Implementation of Behavioral Interventions for Infant Sleep Problems in Real-World Settings. J Pediatr. 2023 Apr;255:137-146.e2. doi: 10.1016/j.jpeds.2022.10.038. Epub 2022 Nov 12. PMID: 36375604.
Hannon S, Gartland D, Higgins A, Brown SJ, Carroll M, Begley C, Daly D. Maternal mental health in the first year postpartum in a large Irish population cohort: the MAMMI study. Arch Womens Ment Health. 2022 Jun;25(3):641-653. doi: 10.1007/s00737-022-01231-x. Epub 2022 Apr 29. PMID: 35488067; PMCID: PMC9072451.
D. W. Winnicott, The Child, the Family, and the Outside World (Penguin 1973) p. 173
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