Thursday, September 17, 2009

Why do I...

...parent my babies to sleep? Why do I not "sleep train" them? (I imagine this will also cover some of "Why do I sleep with my babies")

The short answer: Because I couldn't stand leaving them crying alone!

The long answer...

Really, the short answer says a lot of it if I delve into it more deeply. A lot of the arguments against leaving babies to "cry it out" (CIO) claim that there is scientific evidence to support the potential for attachment problems and even neurological damage resulting from CIO. This is based on the fact that prolonged, unattended crying in babies and young children (and really, in any age) raises cortisol levels, which is stressful and could impact the young child's rapidly-developing brain, which is so busy forming neurological connections in the first two to three years.

Then there are the arguments for letting the baby CIO, saying that there is no scientific evidence that CIO sleep training methods cause any problems later in life.

Okay, so it would appear that science has neither definitively proven nor disproven that leaving a baby to CIO will harm him. I am not going to claim here that I won't leave my babies to CIO because I know that it would damage them emotionally or neurologically to do so. I do not know that as a scientific fact. Nor do I know that they are guaranteed to suffer no ill-effects if I were to use CIO sleep training on them.

So many other discussions of this issue go straight for the "science." So, science aside...

I parent my babies to sleep because it feels right instinctually. I am their mother, and they were growing inside me all those months and know nothing different. They cry for a reason - God gave them the ability to cry in order to signal distress. They are very immature developmentally, and they don't come to us knowing how to sleep "well" (as we define this for adults). I do not expect my baby or my young child to sleep like an adult sleeps. Even if I did, adults don't always sleep through the night... we wake up to use the bathroom, get a drink of water, or just because... and we are typically mature and developed enough that we can understand how to go back to sleep, that there is not something out to get us in the dark, that our other loved ones still exist even though they are not there in the bed with us.

Let me backtrack a minute for those who may be unfamiliar with CIO sleep training: the basics are that, usually once a baby is about six months old, books about sleep training advise the parents to put the baby in a crib awake at bedtime. He will probably cry. The parents are supposed to leave him for some time period... each book varies a bit on this. Some say to leave for five minutes and then come back to check on the baby, some say to check every 15 minutes, some say to increase the intervals between your checks... some say you may not pick up the baby but you may give him a hug or pat his back, others say you may not touch the baby but may reassure him briefly with your voice, you may clean him up if he vomits on himself from the crying but do so matter-of-factly and put him right back in bed, etc. Rules. It is about following rules in a training regimen. The intended result is that the baby will gradually cry less and less, and then he will learn to put himself to sleep and will do so without crying - and will sleep through the night for 8 or 10 or 12 hours straight.

I do not feel comfortable with this approach for several reasons. First, these plans from books are not tailor-made for my baby. They often appear to be very rigid (although I am sure that some parents vary the rules up when using them on their babies). Also, this goes against what I said above - that babies cry for a reason. They are not just trying to be obnoxious. They are not trying to be "manipulative" in the sense that "manipulative" has a negative connotation. And finally, I feel that the means don't justify the ends. The end result is a sleeping baby who will put himself to sleep and eventually sleep all night, or at least not wake his parents when he wakes. The books on sleep training show their "success" based on the fact that most babies will indeed sleep all night after a few nights or weeks of CIO. But the approach bothers me... the means to this "independence" in sleep was brought about not because the baby learned how to sleep "better" (more on that later) but because he learned that his cries did not elicit a response. There was no cause and effect type of a reaction, so he has really just learned that his crying is in vain, and he eventually gives up. I am not personally comfortable with training my babies to give up on getting my attention.

About that "better" sleep... most people seem to assume that long, deep periods of uninterrupted sleep are healthier for everyone. For babies, there is actually a protective purpose to frequent waking and remaining in lighter sleep states more frequently (which they do naturally, when they are not trained to do otherwise). Babies have immature breathing, and this peaks at 2-4 months of age... the time when SIDS is most prevalent. Their frequent waking may actually be self-preserving in that they can rouse themselves easily. Falling into too deep of a sleep when you have irregular breathing patterns can spell disaster. Babies actually wake frequently as a survival mechanism! Dr. James McKenna at Notre Dame has done some very interesting research on this.

Babies eventually start to develop more adult-like sleeping patterns... even if not prodded to do so. They will gradually decrease in their wakings, usually with several periods of backsliding due to developmental progress, teething, illness, vacation, or other issues (which often causes regressions in babies who CIO as well). Many people seem to think that if a baby is not sleep-trained, he will never develop healthy independent sleep habits. They seem to think that if a child still needs his parents to help him fall asleep at age two, then he will be needing it at age 18 (and will have to take mommy to college with him!).

So... back to the "science aside" thoughts. Regardless of any proof one way or the other of sleep training's effects on children, it doesn't feel right to leave my baby crying. It doesn't feel right to leave my 18 month old crying, either. It doesn't feel right to leave my four year old alone to cry herself to sleep (but of course, I can reason better with my four year old and she can accept and understand things better than my one year old... it does get easier sleep-wise as they get older). I go back to the thought that these children are not really mine - they are on loan to us from God. How would He want me to respond to my children? Would he want me to leave them alone and sobbing in order to teach them how to do something that is a natural part of life that they will naturally mature into if given time? I would not leave my babies sobbing with any other developmental task... in a high chair with a fork in order to teach them how to eat, on the floor with a stacking toy in order to teach them how to make it work, on the toilet alone in a bathroom in order to teach them how to use it. The difference is that it appears that one can force independent sleep because the baby will do it if left crying long enough. I could leave a four month old in a high chair for months with a fork and he still might not learn how to use it to get food into his mouth. But sleep is something the baby does from birth... just not sleeping through the night. Sleep is also a reaction to stress or trauma for infants. They will often go into a deeper sleep after a traumatic experience as a means of "escaping." So the sleep does happen with CIO, but for what reason? For me, I want the means to be more important than the ends. Many parents have the goal of a sleeping baby - and that is the goal. My goal, after examining this more closely as my first child grew and even more once my second came along, is not for my babies to sleep long stretches as early as possible, but for them to learn that I am there for them to help them learn all the new skills in life, including sleep.

Another goal is for them to get enough sleep. Babies and children need more sleep than adults. Adults also need a decent amount of sleep. Many people say this is why they used CIO sleep training. Makes sense, if that is the only way to get sleep. But is it the only way?

This is where I feel for the parents who were told by their pediatricians that they *had* to sleep train their babies. It seems that the trend is changing some now - a few generations ago, it seems like all parents used CIO because this is just "what was done." Pediatricians had recently become "parenting experts" rather than doctors whose purpose was to treat childhood illnesses. This was the age of Dr. Spock, and it became the norm to go to the pediatrician for advice on matters such as discipline - matters in which the doc had no formal training. Maybe this was in part due to families being more spread out - grown children didn't always have their extended family around for support and therefore went to the pediatrician. Whatever the reasons, CIO became seen as a doctor-endorsed part of baby care. And so many parents did it because their doctor said they should.

I hate that people feel guilty about it. Especially for parents who really thought it was the only option and it had to be done for the baby's well-being... we do the best we can with the information we have at the time, and with the circumstances we faced at the time. Nobody should feel guilty about doing what they honestly thought was the only way to do something, and hopefully they do not. It seems that people also claim that others who don't use CIO "make them feel guilty." I don't think anyone can make another person feel guilty - they can try - but true guilt comes from within, when we feel like we have not made the right choice. All parents feel guilt about one thing or another. The guilt I feel about some parenting mistakes is my own - and it makes me want to improve and do things differently in the future (knowing that I will still continue to make mistakes despite my desire to do better). There are no perfect parents, although I think God had a plan when he decided what type of children with which to bless their parents. He knows what He is doing, even if we don't have a clue!

And on the topic of parenting... maybe a change of viewpoint on the issue would be refreshing. Perhaps we could look at children learning to sleep not as a parenting issue but as a relationship issue. When we characterize night wakings as a "problem," then we tend to see it as something that we as parents must control, must train, must affect. If we see wakings as being normal, then we can use them to benefit our relationships with our children. We can use our relationship with our children to teach them, gently, as opposed to forcing them.

Yes, but what if the waking *is* a problem, in that the baby or parents are not getting enough sleep, as I mentioned a few paragraphs back? Of course that is problematic, but so is the assumption that the only way to increase the amount of sleep for everyone is by using CIO. There are other options. The one that I personally have found to be most effective is co-sleeping. My baby is in bed with me, and I can breastfeed lying down, even in my sleep, and I do not have to get up out of bed in order to attend to my baby's needs. I also am teaching my baby through example that nighttime is for sleeping, something that many parents say is important to them and a reason for using CIO.

Most people around the world co-sleep, and have been doing so for thousands of years. This has not bred centuries of insecure people who never learn to sleep without their mommies, though! It has instead led to moms getting more rest while baby gets his nighttime needs acknowledged and met. Win-win, in my opinion. Not only that, but it would appear that we are biologically made to sleep this way. For instance, mothers have been shown to rouse just a few seconds before their co-sleeping infants do and to then be able to begin nursing them without either one having to fully wake. Mothers have been observed to adjust the covers and adjust the baby as needed while asleep - as in, they don't recall doing this later. James McKenna, who I mentioned already, has also found that the mother's breathing and presence help to regulate the infant's breathing... the mother's mature system acts as a protective mechanism against SIDS. Sudden Infant Death Syndrome is also known as "cot death" (cot meaning crib) in many places, because it happens so much more frequently when a baby sleeps alone in a crib as opposed to near his mother. In countries where co-sleeping is the norm, SIDS deaths are virtually unheard of. Dr. McKenna even goes so far as to say that a baby under six months of age should never be left alone to sleep. This is information that most parents do not know, and I think it is very important to get out there. I am so glad that I found this information on co-sleeping's relationship to preventing SIDS, because I found it to be more information that could empower me to make decisions that could affect my young baby. I do not share this info in order to scare people or guilt-trip them... but I share it as a concerned mother who assumes other mothers might have some of the same concerns I had.

Well, some people say, co-sleeping just isn't for me. I can understand that, because it is such a foreign concept to most of us in our culture. Engrained views can be hindrance to successful co-sleeping. For me, though, the alternative being to get up with my baby all night long... I chose to change my views about co-sleeping and gradually began to not only accept it, but embrace it. I can see that a parent who has to physically get out of bed eight times a night might feel that CIO is the only answer! I would go nuts with sleep deprivation if I had to get up from bed and stay awake to nurse as well.

I think that in order for co-sleeping to succeed, there has to be a certain attitude about it. If somebody says, "Oh, co-sleeping would never work for me" without trying it at all, then of course it won't work... because what you don't try cannot work! Personally, I thought it would be uncomfortable to sleep with a baby in my bed. And what about the fear of rolling over on the baby that is so widespread? I had to educate myself on all of this in order to feel most comfortable, and I had to actually try co-sleeping to find that it did indeed give me much more sleep! I don't think you can understand how easily one can fall asleep nursing in bed in those exhausting early weeks until you've done it. Co-sleeping with a squirmy, bigger toddler can be another issue altogether... but co-sleeping with a tiny infant works extremely well, and rightly so, since our bodies were designed for it.

My advice to those who would consider co-sleeping: acceptance, acceptance, acceptance. Accept that this is normal, this is not wrong, this is not letting your baby manipulate you, and this is not unsafe so long as you take some basic precautionary steps. I love the phrase "this too shall pass," because it is so true. A baby may be in your bed for years, but it *will* pass. It will end one day. People don't end up with their 25 year old children climbing into bed with them. A few years may seem like an eternity when you are in the midst of it... especially for a first-time parent (I seriously had days where I thought my first child would never be able to communicate with me, would never be able to sleep alone, or learn to do anything for herself, even though this was completely irrational!). But in the long run, when you look back, the baby and toddler years are quite short comparatively. The years of cuddling a sweet sleepy little one will be gone forever one day. I'd also say to not "psyche yourself out" by setting yourself up for failure ahead of time - like becoming overly anxious about the baby's sleep before the birth, or thinking about how crazy you'll be with the baby sleeping next to you, or about how you'll never get to sleep with somebody else *touching* you, much less your breast! Of course these can be valid concerns, but I would advise not getting worked up over them... mind over matter here. Which can be very tough, I know! It can be really hard to overcome these thoughts, given the cultural perception of co-sleeping. Seek out support, read helpful and reassuring information - I loved the book Three in a Bed.

The whole topic of CIO seems to be so controversial from some things I have read online - I almost hesitated to post about it. But co-sleeping is an important issue that many parents don't even know is possible, and it is also one that gets the most raised eyebrows and disapproval from family and friends when they learn you are doing it. Therefore, co-sleeping parents need support for what they are doing. It is more common for somebody to critique a parent's choice to co-sleep than it is for them to critique the CIO method, which is often advised to co-sleeping parents by well-meaning friends and family, or by pediatricians. So, my purpose in this post was to provide an explanation of why I do it this way, and to give other co-sleeping parents reassurance and confidence in what they are doing. I will also add the disclaimer that my support for nighttime parenting/co-sleeping does not mean I think people who use CIO are "bad parents." I have seen that come up in some online discussions, where one person's support for co-sleeping is taken to mean that they think parents letting a baby CIO do it because they are mean or bad. Sleep-deprived, maybe, but not mean. And if a parent is absolutely certain that there is no other option besides CIO, that they will have a nervous breakdown and snap otherwise, then it may be better if that is really the case. I just wish that our culture was more accepting of the norms of infant sleep in a way that we all grow up understanding this, and having the support around us that helps us to deal with nightwakings. I think much of our perceived need to "do things" to our children stem from our societal structure and our support around us... because it is *hard* to be a parent no matter what, and even harder when you don't have people around you to help you, be models for you, and just experience life with you! And when you are swimming against the cultural tide, it is even more helpful to have support, to see that there are some others out there doing what you are doing, and to get a reassuring smile or pat on the back.

Some other resources:
PhD in Parenting (also try the CIO and co-sleeping tags on this blog)
Dr. Sears Sleep Resources
Natural Child Project sleep articles (with several good ones by Dr. McKenna... can you tell he's one of my heroes?!?)
And a post I wrote myself about co-sleeping


Carrie said...

I did not know the info about the sleeping patterns being immature! GREAT info!
We co-slept with Katie until she was about 12-14 months old and sleeping through the night without bfeeding. I was also pregnant with Noah and getting pretty big and not sleeping well so it was incentive to get her into another bed/room before he was in there needing me! lol.
Noah slept with us until he did not wake at night anymore either. We didn't do it after that point just because it wasn't a need for us and we ALL slept better otherwise.
SO, you CAN definitely co-sleep for the first year and still end up with independent sleeping happy kids who don't still sleep with their parents! ha ha!
I love reading these posts!

Kris said...

Great post. I had to share my experience, because I have done both CIO and co-sleeping. With our first baby, I did not co-sleep at all when he was a baby and he was our WORST sleeper. As a toddler, he routinely woke up every night and came down and spent the rest of the night in our bed, wiggling around. Eventually, I was VERY pregnant with our 2nd and we did two nights of CIO with the oldest, just to get him to sleep through the night. It "achieved" the purpose and he did not come down any more. With our 2nd, I had a pretty severe ankle injury when he was just a couple of weeks old, so I was forced into co-sleeping, because my husband didn't want me going up and down the stairs in the night with him to nurse. What a difference!!! We have since co-slept with all our infants (4). What worked for us was to being total co-sleeping when we arrived home from the hospital. As the baby gradually got bigger and was nursing less, we would start putting them in the crib for some naps (soemtimes I was lucky enough to get a nap with them, in which case it was co-sleeping) and also putting them in the crib to start the night out. As soon as they would wake the first time, we would bring them in our bed. This gradual process worked well for us for two reasons - it gave me a few hours at night where I was getting full sleep, but it did not take away from the baby's need for me in the night. All of our children slept through the night alone by the time they were one, for the most part. My youngest seems to need a little more attachment, and at 4 1/2, he occasionally spends part of the night in our bed. What I love about co-sleeping is that you can totally tailor it to meet your needs and your baby's needs. It doesn't have to mean baby is always in the bed, for years, unless that's what is best for your family. With CIO - you're restricted (as you said!) to a set of "rules". Co sleeping lets you make the rules for your own family, and for each individual child, as every child's needs are different. Thanks again for posting this - for the legions of us that co-sleep, but don't talk about it with each other, or with our pediatrician!!

Tiny Actions said...

Great post and excellent references. Keep blogging Erin.

Just to add another point about the whole CIO...What does it show the other siblings about how to take care of babies? That's a frightening thought and perhaps that could be why so many people think of children as a burden and not as a gift.


Ecodea said...

Great post! Initially when our son was born we would put him in the crib and I would get up everytime he needed to breastfeed. I felt tired all the time so after about 8 weeks I instinctively put him in bed to sleep with us and when he needed to breastfeed I was just there. It felt so right and suddenly I could get all the sleep I needed. Months later I read "Our babies, ourselves", a great book by an anthropologist who talks about several childcare related issues in cultures around the world and saw that my instincts were completely right! Now my son is 5 and sleeps in a low bed beside ours; he usually climbs in around dawn. Our relatives do not like it and keep telling him he has to sleep in his own room, but I really don't care. I know it's not going to be forever and for now it feels just perfect.

Erin said...

I loved the book Our Babies, Ourselves... I would highly recommend it to anyone!