by Kel Whittaker, Certified Maternity & Child Sleep Consultant
There is an internal self-struggle for many women as mothers. The mother instinctively wants to do everything right for her child and devote all her energy into that. However, the woman’s sense of self can suffer. This internal conflict of guilt can manifest to behavioural sleep issues, as the woman is desperate for a good night’s sleep, yet as a mother she knows she must put the needs of her child ahead of her own.
Maternal stress or depression is not just about the wellbeing of the mother, it affects the child and their relationship. In an Australian study in 2012 by Symon et al, it is reported that maternal depression can have serious and long-term detrimental effects on family well-being and upon the cognitive and emotional development of the child.
When working with mothers sensitive to stress, as sleep professionals, it is our role to recognize this conflict, whilst serving the best interest of the child, protecting their bond and working with the family to make changes that will work from a behavioural point of view.
In the longest post intervention follow up, peer-reviewed study in Australia, it was reported secondary benefits included better parent sleep, mental health, and child parent relationships (Symon, et al, 2012). Despite concern that behavioural sleep techniques hindered the child parent relationship, they actually improved it.
|“Improving sleep of mothers suffering from prenatal depression has a positive effect on their relationship with their infants”|
In a further study that supports this, the findings suggest that improving sleep of mothers who suffered from prenatal depression may have a positive effect on mothers’ self-reported relationship with their infants. (Tikotzky, L. et al, 2014).
By the time a parent reaches out for help, they may already be at breaking point. Tensions are running high in their household and many parents find using traditional sleep training challenging to their internal self-struggle and parenting style. As a double-edged sword, this stressful tension is also adding to the sleep problem.
|“By the time a parent reaches out for help, they may already be at breaking point”|
In a case in November 2014 in Brisbane, a very anxious mother sought professional guidance for settling her 9-week old infant daughter. The mother was so anxious and filled of her own self doubt in her abilities as a mother, the child was certainly picking up on the maternal stress.
Research shows that mothers with post natal depression are less likely to pick up on baby’s cues and if they do, they may not respond exactly the way that baby requires (Stein, et al, 1991). The mother was picking the baby up to feed every time she stirred during the night, even before she woke or made a noise.
On the day of the consultation, the mother was observed trying to settle her baby to sleep; several means were used, cuddling, rocking, bouncing and then putting baby in the crib with patting. After it appeared the baby was still distressed, the mother was asked to take a tea break outside for a moment. The baby calmed and after 10 to 15 minutes was asleep. With further emotional support, being taught to repeat positive self statements and encouragement, the mother became more at ease, and the baby more settled.
Is traditional sleep training required?
Traditional sleep training such as controlled crying and camping out certainly have their place, and see results. In the same study by Symon et al, three weeks after implementing sleep training, the average night awakenings dropped from 5 to 0.5. The proportion of mothers assessed as having any degree of depression decreased by 85%.
However, what is apparently lacking from many professionals is a heart-felt approach in consideration to how the mother feels, and is coping, and her fears of how her bond with her child may be compromised for the sake of feeling more rested.
In a recent co-sleeping case in Northern Territory Australia, the client is a co-sleeping mother with a two year old boy still enjoying their breastfeeding bond, even in the shower. However, he wakes six times a night and always fed to sleep with patting. The mother is nervous about sleep training and certainly not up for crying. She was unsure anyone could help. Within three days of purely focusing on the foundations and emotional wellbeing work, the child was down to 3 wake ups. One week later of coaching through a tailored approach that still considered their attachment (and not giving up the breastfeeding bond) and the child is sleeping all through the night, in bed with his mother. The mother was so pleased with the outcome, and relieved the approach was so different to what she feared. In this case example, the mother was guided to a solution born out of understanding.
Tips to guide your client to finding an appropriate solution:
- Listen to their story with active listening skills to get them to expand on details “so talk to me about how you feel when…” This can help you to walk a mile in their shoes. Find out what is important to them. What are they not willing to sacrifice for the sake of their goals?
- Empathise with them and praise their ability.
- Coping strategies for stress. Incorporate bonding opportunities surrounding the sleep routine with child.
- Look at the mother-child relationship. Does the mother recognize baby’s cues/language and respond suitably?
- Foster a relationship of trust and understanding with your client.
- Validate and explore all their concerns for why they feel an approach may not work for them. Get creative with adapting a method to work for them.
Stein, A., Gath, D.H., Bucher, J., Bond, A., Day, A.& Cooper, P.J. (1991). The relationship between post-natal depression and mother-child interaction. The British Journal of Psychiatry. 158:46-52
Symon, B., Bammann, M., Crichton G,et al. (2012). Reducing postnatal depression, anxiety and stress using an infant sleep intervention. BMJ Open
Price, A.M.H., Wake, M., & Hiscock, H. (2012). Five-year follow-up of harms and benefits of behavioral infant sleep intervention: randomized trial. American Academy of Pediatrics.
Case examples provided by Kel Whittaker, client names remain confidential and property of Kel Whittaker.
About Kel Whittaker
Kel Whittaker is a Certified Maternity & Child Sleep Consultant, Certified Happiest Baby on the Block Educator with a background in Psychological Science and trained in crisis counselling. All correspondence to firstname.lastname@example.org or www.sleepmumma.com
Disclaimer: The views and opinions expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the International Maternity and Parenting Institute.
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