The dreaded and quite controversial topic of... INFANT SLEEP (Part 1)
If you are a new parent or a parent to be, you're probably familiar with this refrain-- or some version thereof:
"How is the baby sleeping?"
"Dare I even ask: how much sleep are you getting?"
"How do you plan to handle sleep?"
"Prepare to not sleep again for the next 18 years..."
Etc. etc.
Honestly, these comments/questions, while usually not intentionally invasive, can be grating on the nerves of a parent who is doing their best. In my case, from day 1 through about the end of month 4, I really navigated it in a "trial by fire" manner.
But let me back up. Before I had my baby, I was CONVINCED I would not be "one of those parents" who let the baby/child sleep in the bed with me. I was sure that it was important to start enforcing healthy boundaries early and often, with my own personal space in the bed being a top priority. This probably isn't true to every parent, but I'm just speaking from my own experience here, and looking back at the things my 38-week pregnant self was saying about our sleep plan is pretty comical now.
So here's what went down in our household: (this story covers day one through about four months old)
I had a 25 hour labor ending in a vaginal delivery with a second degree perineal tear. I felt like I got hit by a truck afterword. We spent one night in the hospital, then it felt like we were rushed home. (I didn't realize at the time that we had the option of staying a second night- I thought it was a "one and done situation" until the visiting lactation consultant told us on our way out that most people stay a second night). Then when we got home I had trouble getting a deep enough latch while breast feeding. My nipples became scabbed and extremely sore within 48 hours. Baby was struggling to gain weight and suckling at the breast pretty much around the clock without getting enough milk out, plus she had a tongue-tie (which we later decided to have clipped). I got help with breastfeeding from a lactation consultant, and the latch improved, but then within two weeks, I got a clogged milk duct, which quickly turned to mastitis, and went on 10 days of heavy antibiotics. In the chaos and without any good nutritional counseling or advice, I was eating a lot of sugar at that time (I was craving toast with butter and jam and sweetened granola bars and cookies like a mother fucker) and I didn't think to take any probiotics. This situation yielded a severe yeast overgrowth, manifesting in itchy uncomfortable rashes all over my breasts for several weeks, which I was told put me at risk for getting yeast in the milk ducts and thrush in the baby's mouth. This supposedly would feel like glass churning in my breasts every time we nursed if I let it progress to that point without taking swift action to prevent the spread of yeast. And I am allergic to many of the pharmaceutical remedies for yeast so I had to go hard on the anti-candida diet, natural anti-fungals (grapefruit seed extract) and a quality oral probiotic. (With this trifecta, I was able to ward off the infection in my milk ducts, luckily!)
So the postpartum period, while it could have been worse, was tough. The fourth trimester, as they say, was a period of survival mode for me.
In the midst of all this, here's where we landed with our sleeping situation:
Our baby would cry and fuss if we tried to lay her down in her own bed at night (re: we had a Pack 'n Play set up in our room). At night, for some reason, the Pack 'n Play was like lava- a toe would touch it and she'd erupt into fussing. While in survival mode, after having (somewhat) successfully nursed the baby, calmed her, gotten her to nod off, it felt like an emergency to have the baby erupt into fussing and have to do it all over again when I'd try to lay her down. (**I will say that for probably 60% of the nap times during the day I was able to successfully lay the baby down in a device called the SnuggleMe and she'd sleep well in a crib, bed, or Pack 'n Play. This only seemed to last for the first six weeks, then the crib was lava all the time, which continued for several months.)
All of this is context to explain that for the first three months postpartum and then into month four, I really just did whatever I had to do to get the baby to take long, healthy naps and sleep well at night. This manifested in the following routines that developed over the course of the first three months:
1) Before the timing became routine, I really just nursed on demand and the baby slept whenever wherever. This was the case for about the first four weeks.
2) Around week five or six, baby seemed to wake up a bit and we went through about two weeks of intense fussing because I wasn't yet paying attention to sleepy cues. Coincidentally, I also started trying to integrate a bedtime routine at this time, with bath/massage/pjs/rocking around 6:30pm. It didn't really work, meaning that baby would just fuss hard from about 6:30- 9:30pm for those two weeks (or some of those days, she would fuss for longer). I came to understand later that she probably was not developmentally ready for sleep routines, was probably becoming more awake from the bath, was not yet tired for the night, and was going through a six week sleep regression. So after experimenting with this routine for two weeks, I called it a failure just decided to go with the flow and let her natural patterns guide her to sleep, and decided it was my job was to make her comfortable in rocked/moving or dark places when she started to exhibit tired cues.
Now, that pretty much brings us up to present- we are at four months old and in the last week I just started trying to get serious about sleep training. This was brought on by a handful of factors:
This manifested in an approach in which I was sort of trying to enact a version of cry it out, Ferber, and "drowsy but awake" whereby we'd do a sleep routine (enter dark room, turn on sound machine, read a story, do some shushing, rock the baby, plug in pacifier, then lay her down in the Pack 'n Play), then leave and close the door to let her cry for six minutes, then return and depending on how worked up she was, either pat her on the chest and tell her it's alright or pick her up to comfort her for a few minutes, then leave again for another 6-10 minutes. At this point, my baby was just escalating her screams to the point where she was gasping for air, turning purple, and getting hoarse. It was heartbreaking and very clear that she was stressed! I know a ton of moms who have felt the same and couldn't get past this part.
To me, allowing her to cry in that way felt like I was going against all my biological intuition to comfort her and help her relax. So after between 15- 30 minutes of repeating these patterns (allowing baby to scream for intermittent intervals then entering to soothe, then leaving again), she would either fall asleep (maybe 30% of the time?) or continue escalating and I'd give in and pick her up, nurse her, and not put her back in the crib. The times she would fall asleep, she was staying asleep for very short durations, between 20- 45 minutes before waking at an escalated scream and would not go back to sleep no matter what I tried. Because she wasn't sleeping longer durations, she then was proceeding to get more and more overtired throughout the day, eyes getting red and purple around the edges, yawning continually, rubbing eyes and getting more fussy. All in all, this approach just wasn't working for us.
Which led to me both evaluate why I was doing this (really dig in to the motivation) and appeal for help on social media to all the moms I knew. What I discovered was that I actually had been pretty happy with the routines we'd had in place before if I let go of the perceived judgment from others. In our old routine, baby was getting plenty of sleep, was happy and healthy, and we were both enjoying our days. It was only because of outside pressures that I felt I need to make drastic, immediate and expedited change. Which, when I dug deep, wasn't a good enough reason to go against my intuition.
When I read through the responses from about 25 friends on Instagram after my plea for help to all the moms I knew, I also noted that only three had successfully employed a cry-it-out (CIO) method (one employed "extinction", two employed Ferber) and the rest either tried CIO and gave up because they didn't like it, or employed a gentler method from the get-go. Three people straight up voiced their opinions to me that I should not do CIO because it was damaging to the child (this is a widely held opinion within the child-sleep debate) and three people voiced their opinions that they thought I hadn't given the CIO method enough time to work (another widely held opinion within the child-sleep debate). My mom, my husband, and mother-in-law all expressed the perspective that they thought the baby was using her powers of manipulation by knowing that her cries would make me pick her up. While my dad, and the teacher of our birthing class agreed with my perspective that babies at four months of age don't have the cognition to manipulate you and just cry because they're uncomfortable and it's the mom's natural biological response to go to them when they cry. My sister, along with several others, didn't express any opinion either way about what I should do, but firmly told me that I shouldn't worry about what anyone else thought or was doing and should just do what worked and felt right for me and that there are no rules or right ways of doing things.
Additional responses I got from my plea on social media was that baby is likely going through a four month sleep regression and this is not a good time to sleep train. Another mom (wisely, I thought) pointed out that going back to work is a stressful enough life change and it might be better to tackle that one first, before introducing a second major change (sleep transition). Of the folks who employed "no cry" methods to get their babies to sleep in cribs, most said they would soothe baby to sleep by whatever means necessary, and gradually practice putting them down in their crib while calm/drowsy/asleep. This method was said to take time and prove exhausting for parents, but also used by people who could not stand to let the baby cry it out. A few folks (maybe three different moms) shared with me that they never quite figured out how to get their baby in their own bed, so 2-4 year olds were still sleeping in bed with their parents.
So, all of this is to say: figuring out a sleep method is hard! It's emotional, complicated, and varied. But my take away, after searching my heart for how I really felt about all this, is four fold:
"How is the baby sleeping?"
"Dare I even ask: how much sleep are you getting?"
"How do you plan to handle sleep?"
"Prepare to not sleep again for the next 18 years..."
Etc. etc.
Honestly, these comments/questions, while usually not intentionally invasive, can be grating on the nerves of a parent who is doing their best. In my case, from day 1 through about the end of month 4, I really navigated it in a "trial by fire" manner.
But let me back up. Before I had my baby, I was CONVINCED I would not be "one of those parents" who let the baby/child sleep in the bed with me. I was sure that it was important to start enforcing healthy boundaries early and often, with my own personal space in the bed being a top priority. This probably isn't true to every parent, but I'm just speaking from my own experience here, and looking back at the things my 38-week pregnant self was saying about our sleep plan is pretty comical now.
So here's what went down in our household: (this story covers day one through about four months old)
I had a 25 hour labor ending in a vaginal delivery with a second degree perineal tear. I felt like I got hit by a truck afterword. We spent one night in the hospital, then it felt like we were rushed home. (I didn't realize at the time that we had the option of staying a second night- I thought it was a "one and done situation" until the visiting lactation consultant told us on our way out that most people stay a second night). Then when we got home I had trouble getting a deep enough latch while breast feeding. My nipples became scabbed and extremely sore within 48 hours. Baby was struggling to gain weight and suckling at the breast pretty much around the clock without getting enough milk out, plus she had a tongue-tie (which we later decided to have clipped). I got help with breastfeeding from a lactation consultant, and the latch improved, but then within two weeks, I got a clogged milk duct, which quickly turned to mastitis, and went on 10 days of heavy antibiotics. In the chaos and without any good nutritional counseling or advice, I was eating a lot of sugar at that time (I was craving toast with butter and jam and sweetened granola bars and cookies like a mother fucker) and I didn't think to take any probiotics. This situation yielded a severe yeast overgrowth, manifesting in itchy uncomfortable rashes all over my breasts for several weeks, which I was told put me at risk for getting yeast in the milk ducts and thrush in the baby's mouth. This supposedly would feel like glass churning in my breasts every time we nursed if I let it progress to that point without taking swift action to prevent the spread of yeast. And I am allergic to many of the pharmaceutical remedies for yeast so I had to go hard on the anti-candida diet, natural anti-fungals (grapefruit seed extract) and a quality oral probiotic. (With this trifecta, I was able to ward off the infection in my milk ducts, luckily!)
So the postpartum period, while it could have been worse, was tough. The fourth trimester, as they say, was a period of survival mode for me.
In the midst of all this, here's where we landed with our sleeping situation:
Our baby would cry and fuss if we tried to lay her down in her own bed at night (re: we had a Pack 'n Play set up in our room). At night, for some reason, the Pack 'n Play was like lava- a toe would touch it and she'd erupt into fussing. While in survival mode, after having (somewhat) successfully nursed the baby, calmed her, gotten her to nod off, it felt like an emergency to have the baby erupt into fussing and have to do it all over again when I'd try to lay her down. (**I will say that for probably 60% of the nap times during the day I was able to successfully lay the baby down in a device called the SnuggleMe and she'd sleep well in a crib, bed, or Pack 'n Play. This only seemed to last for the first six weeks, then the crib was lava all the time, which continued for several months.)
All of this is context to explain that for the first three months postpartum and then into month four, I really just did whatever I had to do to get the baby to take long, healthy naps and sleep well at night. This manifested in the following routines that developed over the course of the first three months:
- Night times- At first, we would hold the baby all night, then around week three I moved the baby with me into the guest room and practiced safe bed-sharing. I really ended up enjoying bed-sharing, with all the sweet cuddles and coos and time I would otherwise have missed connecting with my baby. I also think we both slept incredibly well with this strategy and that we both got more sleep than we would have otherwise- primarily because when she was hungry in the middle of the night, baby would just find my boob in the side lying position, nurse, then go back to sleep without crying. Our awake periods at night were quite uneventful, rapid, and easy to handle. She was consistently getting 12-15 hours summative hours at night, while I was consistently getting 8+. I followed La Leche League's Guide for The Safe Sleep Seven. Here is a great summary of the guide for safe bed-sharing:
- (to the tune of “Row, Row, Row Your Boat”)
- No smoke, sober mom
- Baby at your breast
- Healthy baby on his back
- Keep him lightly dressed.
- Not too soft a bed
- Watch the cords and gaps
- Keep the covers off his head
- For your nights and naps.
- First morning nap- around 3 months the baby started waking around 6:30am and then would stay up for an hour talking to herself and making faces at me, then would get sleepy and start yawning and rubbing eyes after about an hour. At the sleepy point, we were typically still in bed so I'd just nurse her again and she doze off next to me in bed. We'd both get another hour to hour and a half of sleep before getting up for the day, which was usually around 8:30am. I stayed in bed after the first wake-up primarily because I was still tired and needed more sleep.
- Second morning nap- Around 7- 8:30am, baby would wake again and then stay awake for 1-2 hours. At this time, we'd get up for the day and typically nurse/play/laugh/change clothes/change diaper. In month three, we started adding in tummy time and baby workouts to that mix. Then I'd put baby into her swing around 9am-ish. Baby would typically swing awake for 30 minutes to an hour and then fall asleep for about 2 hours, until maybe 11am.
- Third nap- Around 1pm, baby would start getting tired again (displaying sleepy cues like staring off into space, yawning and eye rubbing) and most days I'd either go for a walk with baby in the stroller or go for a drive/run errands. She would almost always fall asleep in the car seat for as long as we were out (maybe an hour, sometimes longer?)
- Fourth nap- For late afternoon, around 4 or 5pm, a final nap was hit or miss and generally pretty short in duration, maybe 30- 45 minutes. For this one, baby would usually nurse and fall asleep in my lap at the breast or if we hadn't already done a walk, she'd sleep in the stroller or baby carrier strapped to me.
1) Before the timing became routine, I really just nursed on demand and the baby slept whenever wherever. This was the case for about the first four weeks.
2) Around week five or six, baby seemed to wake up a bit and we went through about two weeks of intense fussing because I wasn't yet paying attention to sleepy cues. Coincidentally, I also started trying to integrate a bedtime routine at this time, with bath/massage/pjs/rocking around 6:30pm. It didn't really work, meaning that baby would just fuss hard from about 6:30- 9:30pm for those two weeks (or some of those days, she would fuss for longer). I came to understand later that she probably was not developmentally ready for sleep routines, was probably becoming more awake from the bath, was not yet tired for the night, and was going through a six week sleep regression. So after experimenting with this routine for two weeks, I called it a failure just decided to go with the flow and let her natural patterns guide her to sleep, and decided it was my job was to make her comfortable in rocked/moving or dark places when she started to exhibit tired cues.
Now, that pretty much brings us up to present- we are at four months old and in the last week I just started trying to get serious about sleep training. This was brought on by a handful of factors:
- I'm returning to work part time next week and had been prompted by my mom (who will be the primary child care giver while I'm away) to start practicing "good" sleep habits such as making baby sleep in her own crib for naps.
- Some experts agree that sleep training finally becomes appropriate around the four month mark when baby has started to establish some waking/sleeping routines. (Some also think this is still too early for rigorous sleep training).
- Based primarily on a book my mom was reading, I was under the impression that in order to have a healthy baby, it was my responsibility to teach her to self-soothe around this time, by having her to sleep on a stationary surface by herself at routine and consistent times everyday (re: get rid of swing sleeping, car sleeping, stroller sleeping, and sleeping on people).
This manifested in an approach in which I was sort of trying to enact a version of cry it out, Ferber, and "drowsy but awake" whereby we'd do a sleep routine (enter dark room, turn on sound machine, read a story, do some shushing, rock the baby, plug in pacifier, then lay her down in the Pack 'n Play), then leave and close the door to let her cry for six minutes, then return and depending on how worked up she was, either pat her on the chest and tell her it's alright or pick her up to comfort her for a few minutes, then leave again for another 6-10 minutes. At this point, my baby was just escalating her screams to the point where she was gasping for air, turning purple, and getting hoarse. It was heartbreaking and very clear that she was stressed! I know a ton of moms who have felt the same and couldn't get past this part.
To me, allowing her to cry in that way felt like I was going against all my biological intuition to comfort her and help her relax. So after between 15- 30 minutes of repeating these patterns (allowing baby to scream for intermittent intervals then entering to soothe, then leaving again), she would either fall asleep (maybe 30% of the time?) or continue escalating and I'd give in and pick her up, nurse her, and not put her back in the crib. The times she would fall asleep, she was staying asleep for very short durations, between 20- 45 minutes before waking at an escalated scream and would not go back to sleep no matter what I tried. Because she wasn't sleeping longer durations, she then was proceeding to get more and more overtired throughout the day, eyes getting red and purple around the edges, yawning continually, rubbing eyes and getting more fussy. All in all, this approach just wasn't working for us.
Which led to me both evaluate why I was doing this (really dig in to the motivation) and appeal for help on social media to all the moms I knew. What I discovered was that I actually had been pretty happy with the routines we'd had in place before if I let go of the perceived judgment from others. In our old routine, baby was getting plenty of sleep, was happy and healthy, and we were both enjoying our days. It was only because of outside pressures that I felt I need to make drastic, immediate and expedited change. Which, when I dug deep, wasn't a good enough reason to go against my intuition.
When I read through the responses from about 25 friends on Instagram after my plea for help to all the moms I knew, I also noted that only three had successfully employed a cry-it-out (CIO) method (one employed "extinction", two employed Ferber) and the rest either tried CIO and gave up because they didn't like it, or employed a gentler method from the get-go. Three people straight up voiced their opinions to me that I should not do CIO because it was damaging to the child (this is a widely held opinion within the child-sleep debate) and three people voiced their opinions that they thought I hadn't given the CIO method enough time to work (another widely held opinion within the child-sleep debate). My mom, my husband, and mother-in-law all expressed the perspective that they thought the baby was using her powers of manipulation by knowing that her cries would make me pick her up. While my dad, and the teacher of our birthing class agreed with my perspective that babies at four months of age don't have the cognition to manipulate you and just cry because they're uncomfortable and it's the mom's natural biological response to go to them when they cry. My sister, along with several others, didn't express any opinion either way about what I should do, but firmly told me that I shouldn't worry about what anyone else thought or was doing and should just do what worked and felt right for me and that there are no rules or right ways of doing things.
Additional responses I got from my plea on social media was that baby is likely going through a four month sleep regression and this is not a good time to sleep train. Another mom (wisely, I thought) pointed out that going back to work is a stressful enough life change and it might be better to tackle that one first, before introducing a second major change (sleep transition). Of the folks who employed "no cry" methods to get their babies to sleep in cribs, most said they would soothe baby to sleep by whatever means necessary, and gradually practice putting them down in their crib while calm/drowsy/asleep. This method was said to take time and prove exhausting for parents, but also used by people who could not stand to let the baby cry it out. A few folks (maybe three different moms) shared with me that they never quite figured out how to get their baby in their own bed, so 2-4 year olds were still sleeping in bed with their parents.
So, all of this is to say: figuring out a sleep method is hard! It's emotional, complicated, and varied. But my take away, after searching my heart for how I really felt about all this, is four fold:
- I am the mom and I have intuition for a reason. It's my job to listen to it and not give in to pressures from society, friends, family, or anyone else. I generally know what's best for baby and for me, specifically because I'm currently the most physically connected to my child (having grown her in my belly, birthed her, nursed her, and spent the most amount of hours with her thus far).
- The most important thing to me is that baby gets a significant amount of sleep everyday to stay healthy. For us, at this age (four months), it's not as important to me to take away her sleep crutches, like the swing or the car seat, as long as she's continuing to get good sleep and is rested and happy. In my cost/benefit analysis, the risk and negative effects of getting overtired are wayyyy worse than the potential payoff of having her immediately learn to self-soothe in her own crib.
- The stress of crying it out was frazzling my nerves (and seemingly baby's too) and causing more pain than it was worth.
- I actually don't need to hurry to get immediate results-- I'm comfortable taking a longer term approach to gradually placing her in the crib while she's calm and picking her up and soothing her when it doesn't work (for now). My mom agreed that she's ok with taking a gentler approach than I originally thought she was planning to use, by letting her only cry for short stints and comforting her as needed while gradually trying to place her down in a crib here and there. She's confident she can get baby to take naps at her house without causing too much distress.
So in an effort to share resources, here are a few that were passed on to me that I plan on weeding through carefully in the next few months so that when/if I decide we need to try something else, I'll be prepared.
- Healthy Sleep Habits, Healthy Child- this is the book my mom was working from. It essentially calls for watching the baby carefully for drowsy signals, then placing baby down in crib at the exact right time. Author preaches that if you get this timing right, baby will not cry. I was successful with this so far maybe twice, out of probably 30 attempts? So it's not too realistic for me. But power to the folks that can make it work.
- Extinction Cry It Out Method- this method dictates that the care taker does not tend to the baby for consoling no matter how long they cry. I couldn't do this one, and there is significant criticism of the technique but alternately, some parents swear by it. For folks wanting to try this, my friend pointed me toward a description of the types of cry, that can prove helpful once you can distinguish differences in their wails and know you're past the "peak cry" point. Read about the different types of crying while extinction sleep training here.
- Ferber Method (graduated Cry It Out)- this method was first published in Ferber's book Solve Your Child's Sleep Problems and calls for the care taker to put baby to bed, leave the room even if baby is crying, then return at graduated intervals to soothe, while never picking the baby up. Here's a good summary of the method with a bit more detail.
- Cara Babies- this is a blogger mom who has all types of information and advice on sleep. Follow @takingcarababies on Instagram. In my brief review of the site, looks like she's got all kinds of helpful tips, including how to handle short naps, bedtimes, etc. This was recommended by two mommas.
- Baby Massage- one friend recommended IAIM.net to find certified infant massage instructors near me and that massage would help baby get drowsy and relaxed enough to put down in her crib. She also recommended Infant Massage: A Handbook for Loving Parents by Vimala McClure as a guide. Related, another mom shared that she used a lavender scented massage oil for a massage before bed and that the sleep association her twins got was so strong it worked wonders for their family.
- Eat/Wake/Sleep- another mom recommended the book On Becoming Babywise, which I assume is where she got her practice of nursing baby upon waking, and then never nursing before sleep so that they could sleep without that crutch. Here's a quick summary of the method. She also recommended using pacifier and lovey/blankie that smells like mom for nap times.
- Utilize good sleep routines with white/pink noise machines, bath, consistent schedules, swaddles
- Place baby in SnuggleMe or Dock-a-tot; while not recommended for unsupervised sleep, some parents have cited that they do so and our pediatrician told us this was the original intent of these devices
- Pick them up anytime they cry, comfort them, and just keep putting them back down in crib over and over, even if it takes 100 tries
- Rock or soothe baby to sleep then very carefully place them in crib. Attend to them (feel free to pick up if needed) when they cry.
- While baby is face up in crib, place one hand below (on their back) and one hand on top (on their chest) and gently rock until they are calm or sleeping. Gradually fade your presence.
- Transition baby to cosleeper (from bed-sharing), then to crib, slowly over time.
- Place baby in crib, but stay nearby with hand on chest if needed to keep baby calm. Gradually fade your presence, from hand on baby to just sitting next to baby, to moving chair farther from baby, to standing outside door, to finally removing your presence altogether.
- Put baby to sleep on a mattress or matt on the floor from day one. Nurse in this location, and practice leaving the baby there on their own after they've fallen asleep. This method means you start them in their own bed from day one, but are gently there with them as needed, and you never have to make any transitions or changes to which bed they are sleeping in.
Hope this helps all the new moms and parents out there! Remember: you got this, you know best, and it's all good no matter what you do as long as you love your baby!
-katiekos
-katiekos
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