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Maternal-Infant Sleep Study Rebuttal:Moms and Babies Deserve Better

2012 April 28

<img src="baby holding mother's finger" alt="cute sleeping baby holding mother's finger">
We’ve heard a lot about baby sleep and mothering recently in the media and chat forums. What triggered it all was a new study in the Journal of Child Development:  Maternal Depressive Symptoms, Dysfunctional Cognitions, and Infant Night Waking: The Role of Maternal Nighttime Behavior. The researchers,Teti and Crosby, concluded that depressed and anxiety-ridden moms were more apt to engage in night-time parental behaviors that disturbed their sleeping babies. The scientific team asserted that such maternal behaviors predisposed the studied infants to sleep deprivation and correlated health problems.

The mainstream press was instantly captivated. Time published an article titled “Never Wake a Sleeping Baby? Why Depressed Moms Don’t Follow that Advice.” A piece in the Daily Mail proclaimed, “It could be YOU that’s keeping baby awake: Babies are more likely to have sleep problems if mothers are depressed.”

Teti and Crosby postulated that frequent infant waking is a mother driven behavioral mechanism in mothers who are depressed and anxiety ridden. They argued that these mothers are more apt to engage in unnecessary and excessive parental actions in order to fulfill their own emotional needs or to avoid spousal relations.

They saw frequent night-time feedings, comfortings and check-ups as intrusive to the infant’s sleep requirements, since mothers would wake their babies or otherwise hinder them from being able to soothe themselves whenever they did wake up. According to Time:

” Teti has compiled preliminary data that shows that moms who have more problems in their marriage soon after giving birth are more likely to be bed-sharing and co-sleeping by the time their baby is six months old. For unhappy moms, sharing a bed with their baby — or rousing them in the middle of the night — may be a way for them to seek emotional comfort.”

But this study of infant sleep patterns — while seeking a broader understanding of the mother-baby relationship— has many fallacies. Its conclusions seem to attack responsible mothering and could make maternal depression and anxiety even worse, and possibly endanger infants. Thus a critique is in order to prevent the report’s doubtful conclusions from becoming part of parenting lore.

Questionable Relevancy

This limited study examined only 45 mother-infant relationships, with babies aged between one month and two years. The study was based on written recollections of mothers over a seven-night period, with only one of those seven nights being video-taped.

As well, the study relied on mothers, not pediatricians, to report on the wellbeing of their infants. This is relevant because some night-time sleep disturbances in infants could be linked to sleep apnea, reflux and allergic reactions, among other issues. Such undiagnosed conditions, with their associated discomfort, would warrant vigilant attention by mothers. Developmental phases such as crawling, walking, teething and talking might also disturb an infant’s sleep. Yet the study made no mention of any of these variables.

Then there were the so-called depressed mothers in this study. Not one of them had been independently evaluated by a mental health professional. Each had diagnosed her own depression as a result of completing a questionnaire. So they could have had transitory baby blues, clinical postpartum depression or simply a frustrating week. Then there was the authors’ lack of follow-up. Surprisingly, they never bothered to ask the mothers why they did what they did. Rather it seemed the authors were predisposed to see their actions as problematic, even though discerning questions might have revealed the mothers had good reason for them. The researchers chose, however, to interpret what they saw as odd, intrusive and dangerous.

Inherent Bias

The study failed to consider how maternal-infant relationships have survived and thrived throughout human history. Instead it reinforced the modern perception that parenting is a daunting and problematic task—with night-time duties creating huge dissatisfaction.

On the first home visit, mothers were asked to complete a questionnaire. Twenty questions were designed to ascertain how mothers perceived infant night behavior and associated waking. Unfortunately the questions displayed an inherent prejudice that discounted proactive parenting and made it seem abnormal. Here is a sampling:

* My child will feel abandoned if I don’t respond immediately to his/her cries at night.

* My child might go hungry if I don’t give him/her a feed at night.

* I should not allow my child to cry at night

* I should be getting up during the night to check that my child is still all right.

* If I try to resist my child’s demands at night, then he/she will get even more upset.

* If I say no to my child’s demands at night, it means I’m a bad mother.

* I should respond straightaway when my child wakes crying at night.

* I am able to resist my child’s demands when he/she wakes at night

* If I give up feeding at night, then he/she will never sleep.

If a mother answered yes to most of these questions, it seemed to prove to the researchers that she was anxiety-ridden. But it could be argued that such compassionate and involved mothering ensured the infant not only survived, but also thrived.

Dr. Mayim Bialik, author of Beyond the Sling: A Real-Life Guide to Raising Confident, Loving Children the Attachment Parenting Way, was interviewed by World Baby Report.

“If everything about the normal physiological patterns of babies is twisted and misinterpreted as some sort of abnormal manipulation,” she said, “then (one’s) entire framework for being a parent will be one of fighting that baby.”

She further stated that “to place on top of normal sleep deprivation this societal notion that there is something wrong with you, wrong with your baby, or at worst—which I have been accused of—that you are needy… leads to a really big societal problem.”

Bialik mentions high maternal-infant mortality rates and increasing social and psychiatric problems in children. It can be argued that such societal ills are not due to the failure of mothers to respond dutifully to their infants. But, that they are founded in forcible attempts to redirect those infants and mothers towards behaviors that are contrary to their innate, time-tested wiring

Biology Discounted

<img src="smiling mother with sleeping baby" alt="smiling mother face to face with sleeping baby">

Although mother-baby instinct is deeply rooted in human biology, the researchers elected to disregard the scientific trail of evidence.

In our interview, Dr. Bialik cited frequent night wakings and nursing sessions as indicators of “normal mammalian physiological sleep patterns.” She said mothers should securely understand that is “normal [behavior] to be concerned about the baby, so much that you want to be close to it. That’s the vigilance that leads to survival”

Human infants are born cerebrally premature. The bulk of their brain development is set to mature outside the womb. Such immaturity establishes a hard-wired biological need for infants to rely on their mothers for safety.

Dr. Nils Bergman, well known for his advocacy of skin-to-skin contact or “kangaroo care,” explained that such interdependence is linked to the inability of infants to walk at birth, unlike other animals. To protect the infant the mother had to carry it in our biological past. Moreover, the prematurity of the infant gut meant it had to be fed frequently with human milk which was low in fat and protein. So the human infant needed to remain close to its mother to survive. In the primal brain of the infant, separation signaled danger. For her part, the mother was flooded with hormones which directed her to maintain closeness.

“When mother is absent,” said Bergman, “the newborn brain feels unsafe. It perceives a danger and threat to life if its basic needs are not provided.”

He said the brain kicked in a powerful defense reaction, expressed first in a short burst of crying and then by a lowering of the heart rate and temperature, Then all activity was shut down, in an immobilization defense similar to that of frogs and reptiles.

“This looks like sleep!” Bergman said. “But it is not, and it is maintained by high levels of cortisol. This is not actually sleep, so the pathways are not established. Instead, when stress is prolonged, the cortisol disrupts brain architecture unless there is the buffering protection of adult support.”

In order for sleep to be biologically productive—for optimal physiological growth– the infant needed to feel safe. Physical contact with the mother reassured it of protection, and breastfeeding provided the best nutrition. The combination of both led to soothing sleep. So it was not only the quantity of sleep that was important, but also its quality.

Thus, mothers within the Teti Crosby study who responded positively to infant calls and cues to be comforted or fed were actually helping those infants to sleep better . Conversely, it is probable that infants who were left with unmet needs were left to voyage solo into a stressed sleep.

In Biological Psychiatry (2011) Barak E. Morgan, Alan R. Horn, and Nils J. Bergman further detailed the impact of sleep on these separations. They wrote:

” Maternal-neonate separation is associated with a dramatic increase in HRV power (heart rate variability) possibly indicative of central anxious autonomic arousal. Maternal-neonate separation also had a profoundly negative impact on quiet sleep duration.”

Hormones such as cortisol and somotostatin are released during stressed sleep states and disrupt physical and mental growth. Current theories even suggested such repeated states of infant stress predispose the matured body to obesity, heart attacks and strokes. So the lack of a timely response, at any hour of the day or night, to a crying infant, actually can cause the sleep disturbances and associated systemic health problems that Teti and Crosby sought to address. Thus, harbingers of illness, do not stem from vigilance but manifest instead in dismissing the biological needs of the infant by interpreting them as manipulative or unwarranted.

Infants learn to sleep as their biology matures. Sleep training or downright neglect of their needs might produce an infant who eventually sleeps, but today’s medical knowledge, including gains in neuroscience—now afford the knowledge that babies are merely triggering survival mechanisms.

Dr. Bergman explains that babies call to their mothers when separated. Cries and other manifestations of protest are enacted to draw the mother back to the baby—to effectively, rescue it. When the calls of the infant go unanswered, Bergman elaborates, “a deeper survival mechanism kicks in, based on the logic that the mother who does NOT pick up the baby is probably in greater danger herself … and so crying is endangering the mother and the baby, so baby stops crying”.

Bergman further describes a state of “freeze” the infant then enters characterized by a high arousal state with accompanying immobilization. This freeze state, as it lowers heart rate, can’t be maintained for long durations. A transitional stage is then entered, called “dissociation” where the baby disengages his awareness —tuning out of his environment. Maintenance of this state is easier for the infant to sustain until the mother returns. But it costs the infants, in the weakening of regulatory set points and furthering problems in self-regulation attempts.

How many adults would like to enter into these sleep states?

Dr. James McKenna, head of the Mother-Baby Behavioral Sleep Laboratory at Notre Dame, has also observed and documented the biological mechanisms between mother and child at night time. McKenna points out that bottle-feeding had revolutionized night time parenting. Once infants were given formula, they no longer had to exist in the same room as their caregiver. But the re-emergence of breast-feeding in western culture has reversed the logic of this trend.

Most women who chose to exclusively breastfeed their baby found that room sharing or bed sharing allowed them to respond better to frequent nigh time feeding needs, and facilitated the return of restful sleep for the nursing pair. So the recent historical tend of placing an infant in a room away from his parents became questioned. Parents began protesting this separation, both because it was inconvenient and because their instinct told them it was unnatural.

McKenna wrote, “Irrepressible (ancient) neurologically-based infant responses to maternal smells, movements and touch altogether reduce infant crying while positively regulating infant breathing, body temperature, absorption of calories, stress hormone levels, immune status, and oxygenation.” These faculties observed by McKenna in infants who co-slept with their mothers, led to increased infant sleep and more content babies.

Co-sleeping arrangements (a broad term relating to sharing a room or other sleeping surfaces with an infant) have even led to a 50 percent reduction in the rate of SIDS. The American Academy of Pediatrics, in acknowledging this statistic, affirmed safe co-sleeping practices after decades of advocating solo sleep environments. Teti and Crosby, take note! The AAP did not view co-sleeping practices as symptomatic of maternal psychosis.

Frequent breastfeeding at night is normal for infants. In fact, McKenna points out that frequent night feeds allow the transfer not only of vital nutrients but also of important antibodies. Sadly, one woman in the study was found to be aberrant in her mothering because she breastfed her infant nine times in one night. Individual metabolic rates, anticipated growth spurts, illness recovery and teething relief might necessitate more frequent feedings.

Of greater issue, however, is that each baby is a unique human being. One baby might need frequent feedings at night, while another might need fewer. My own children are frequent night feeders. And during my interview with Dr. Bialik she said her children were, too.

It is not correct to regulate the growth trajectory of our infants to adult clocks. Rather than question the hunger demands of an infant, we need to discover the rhythms of our infants and graciously comply.

Noted pediatrician Dr. William Sears, who coined the term “attachment parenting,” is supportive of co-sleeping arrangements. He became a believer after one of his infants often became distressed after being placed solo in a crib. He observed his wife and child sleeping side by side and noticed the mother acting almost as a “pacemaker” for her infant, regulating its breathing patterns. He watched a host of other non-verbal cues such as frequent touching and positioning. The pair acted in concert with one another—even experiencing timed arousals out of sleep states Both Sears and his wife, by working with the needs of their infant for closeness, experienced better sleep. They went on to have other children, some of whom they also slept with. And they are still married! So much for the marital discord Teti lamented that was supposedly caused by co-sleeping.

Societal Assault on Affirmations of Instinct

Besides personally noting the benefits of co-sleeping, Dr. Sears found his patients also experienced positive outcomes. His website includes such anecdotes. Many mothers felt their actions of co-sleeping with and vigilantly checking on their infants had life-saving results. Episodes of apnea and interludes of irregular breathing dotted the discourse. They shuddered to think what might have happened if they had resisted the voice in their head that alerted them to their babies’ dire need for attention.

Teti and Crosby would have described those mothers as having clinical psychological problems. They stated: “We suspect that mothers who worry excessively about their infants’ well-being at night may be motivated to seek out and intervene with their infants, regardless of whether the infants require intervention or not, in order to alleviate the mothers’ anxieties about whether their infants are hungry, thirsty, uncomfortable, and so on. … Mothers with elevated depressive symptoms may be motivated to spend time with their infants at night in order to satisfy [their own] emotional needs.”

Frustratingly, the authors made this bold leap without even asking the mothers directly about their actions. The study cited one mother who was video-taped picking up a baby (which resulted in the baby waking up) and carrying that baby back to her bed for the night. This was viewed as an act of lunacy and detrimental to the infant. Yet the mother was never asked why she felt such action was warranted. Perhaps she felt the need to be closer to the infant in order to protect it. This would have concerned her more than waking the baby. Who are we to question her instinct?

If depression or overt anxiety existed, it might be that the mothers in the study were displaying the emotional fall-out of a societal assault against them – a rejection of how they were biologically driven at their core to mother their babies. One could argue that the very vigilance they demonstrated sought to allay their psychological fatigue. This was not how Teti and Crosby saw it. But the women may have been attending to hormones and synapses that were directing them to be the best mothers they could be. Ignoring such biological impulses would have led to dismay rather than fulfillment.

<img src="mother with newborn baby" alt="smiling african american mother on bed with newborn baby">

Conclusions

We are in the midst of a baby craze in this country, with celebrity baby bumps making headline news. But as a society we are often unwilling to talk about the exhaustion of parenting and the sacrifices involved in embracing a new self and a new life. So new parents may have unrealistic expectations, and end up feeling like failures.

Dr. Bialik’s book, Beyond the Sling, attempts to bridge the gap between how parents expect life with a baby to be versus how it actually is. Bialik, a mother of two, is an advocate and practitioner of attachment parenting, and her approach is refreshing and honest.

First and foremost, she insists, believe you are the expert on your family. New parents need to incorporate this empowering premise into their thinking from the start. Accepting it will allow them to navigate through the flood of information (and misinformation) that they are besieged with, much of which contradicts how they intuitively wish to parent their child.

Bialik considers her book to be a “love letter” to attachment parents. She sees herself as “the public person who speaks out against things that many of us [attachment parents] are criticized for privately.” Beyond the Sling, was puposedfully designed to” appeal to people who may not have thought about attachment parenting or who may be thinking of parenting differently.” It doesn’t tell us how to parent, but it describes what this style of parenting looks like. It showcases –as Bialik describes – “the good, bad and ugly” of attachment parenting”.

The strains and sometimes isolation of motherhood can manifest themselves in clinical depression for some. If you are feeling depressed or simply overwhelmed by mothering —-at any stage of that journey—seek the help and support of a medical professional. Also reach out to family, friends and support groups such as La Leche League, Attachment Parenting International, local religious organizations and new mothering groups. Good people are out there willing to help, and there is no shame in your struggle.

As mothers we can help other parents who are doing the best they can by being less judgmental and more honest in sharing our triumphs and failures. None of us has it all figured out. But together we can form a common bond of understanding with which to push back studies like Teti’s that do a disservice to our efforts to mother lovingly.

We thank Dr Mayim Bialik for sharing her views on this study with our readers.

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