Thinking beyond sleep training as a sole treatment for Postpartum Depression
Postpartum depression (PPD) and anxiety (PPA) can be both terrifying and ground shaking for any parent. Not only has the world as we know it been flipped upside down overnight with the arrival of our new baby, but throwing PPD or PPA into the equation can make it one of the hardest times of many parents’ lives. The statistics of how many of us it will affect are astonishingly high - 1 in 5 mums and 1 in 10 dads will at some point experience PPD or PPA (PANDA, 2022).
In a society whose mental health care system is overburdened and overflowing, finding the right help and support for our mental health while raising babies with such intense needs can be somewhat elusive. What often happens within healthcare and online communities is that the focus gets shifted from the mother and her feelings, to one of adjusting the baby to help relieve the mother’s depression/anxiety. It is as though the infant is the root cause of all these deep feelings and experiences in every single mother or father. No consideration is given to the parents and their inner world until first we try to change the infants sleep through training of some sort or another. In some instances this can be the thing they need, but for others it can push them further down the spiral.
What is coming up is one of the most sensitive topics I work with in this parenting sphere. It is so nuanced and almost impossible to pin down a cause and effect for each and every experience of PPD. The journey of parenthood, never mind PPD or PPA, is so very different for everyone. I want to discuss the zeitgeist of pushing sleep training as the answer to all things maternal and paternal mental health and how it is failing a lot of parents, who so desperately need more support. It is leaving those who choose to respond to their child at night adrift and afloat in the times we most need a hand to hold. I want to highlight how deeper societal, familial and relational issues are ignored and can be the cause for these parents depression and therefore they never get access to the help they really need.
Imagine just having had a baby and the cocktail of hormones and exhaustion of birth, feeding, and waking to this child overnight has rocked the internal architecture of your being. You being to feel adrift and lost, and unable to find yourself. You want nothing more than to be the mother you hoped you would be, but instead, you are racked with dark feelings of worry and hopelessness. Feelings that in the dark of the night, alone with your child, really scare you. You live in a society where family and friends now live hundreds if not thousands of miles away, but even if they were close you don’t even know how to explain the feelings you currently feel. You are ashamed and embarrassed to admit that you aren’t enjoying this new you, aren’t enjoying being a mother. You struggle to leave the house, to get changed, to pick up the phone. You are so determined to care for and love your baby that you become hyper-vigilant over every sneeze or cry and your nervous system is in a constant state of alert. For those who haven’t experienced depression or anxiety before these feelings can hit you like a train in the back out of nowhere. For those familiar with the dark emotional spaces that come along with mental health challenges the emergence of such feelings at times when someone so vulnerable needs you so much can be petrifying, when you know where they have led you before.
Imagine that these feelings don’t lift, that every day you feel like you are walking through a dense forest and cannot find the light. You still want to respond to your baby to be there day and night as this is the choice you made and the path you want to follow. You manage to bundle yourself and your child into the car and head to your G.P where, through tears, you try to explain how much you love your child yet you still have these feelings. Imagine then that instead of telling you they hear you, that this must be hard, or offering support they instead ask “how is your baby sleeping?” Here the zeitgeist begins……
While there is no denying that the sleep deprivation that comes along with being a parent can affect our mental well-being deeply and can be one of the driving factors of PPD. We also cannot deny that mothers and fathers need more support to raise their children and get more sleep to abate the effects of sleeplessness and wakeful nights without compromising on their responsive choices. I cannot deny that for some parents when they do find more sleep, they are better able to manage those deep internal feelings that are rocking their worlds. What is hard to conclude is that this is the only or main reason for us experiencing PPD and PPA. What is unfair in today’s society is biologically normal infant sleep is pinned as the overriding cause of what is going on for us at this time. I think this narrative needs to change. I argue that the provision of better community care to parents of young babies and infants would have far-reaching effects on the wellbeing of all parents and infants despite how they choose to parent. If we take a holistic stance on understanding the origins and reasons why 1 in 5 mothers are struggling then perhaps we can start holding their hands in a way that is so vitally needed. We can stop adding fuel to the fire by disconnecting a mother, who wants to respond to her child, from that infant in a bid to improve her well-being.
Mental illness doesn’t discriminate, it doesn’t take a mother who has chosen a strict schedule and sleep plan and spare her the worries and concerns of those who don’t. Sleep training may provide parents with more sleep and therefore more resources to find ways to help with depression or anxiety but does it get to the true cause of the feelings everytime though? Depression and anxiety doesn’t discriminate between cultures or location in the world, we still see a predominance of PPD and PPA in both countries where the proportion of babies sleep trained is high and equally in cultures and societies where it is not even a consideration or known about. This begs the question that mental health struggles can’t always be down to sleep and this is too simplistic a way to view this topic. This thought process is doing such a disservice to so many mothers and infants who would choose to night time parent responsively otherwise. What is interesting to note in a study by Bluden et al (2022) is that reported levels of stress within mothers was significantly less in those who chose responsive settling over those who had chosen extinction practices, and so too was their symptoms of depression despite little to no difference in the amount their children woke. This speaks to the fact that offering choices of sleep interventions rather than a one size fits all technique, from a relational and maternal mental health perspective could potentially avert the stress and anxiety we feel around infant sleep.
If we consider that there are both parents who find relief in using self soothing or cry it out techniques for their child to get uninterrupted adult sleep, then why can’t we also consider that there are parents who find relief in easier feeding practices, co-sleeping and considering both the infant and the adult at the same time. This discussion isn’t about one being right over the other, it is a discussion that the mainstream advice is favouring the former and therefore pushing the families who chose the latter further into depression and anxiety. It so often happens that medical systems forget those mothers who choose an infant-led approach to caregiving and give them no other options but to sleep train.
There are countless stories of parents who try to sleep train with good intentions but tell of how overriding their intuition exacerbated their anxiety and depression. The reasons are two fold, the feel like they are failing their baby by not responding, and they feel like they are failing because their baby is not responding as they should i.e. sleeping through the night. These parents often describe how when these interventions fail to work they become more isolated from the healthcare providers and support they so vitally need and are given no other support or options. This is the crux of this debate. How effective is sleep training and manipulating our babies' needs in favour of our own at helping every single case of postpartum depression and anxiety. If we aren’t at the same time helping mother to discover the deep internal cause of where these feelings came from are we even setting our mothers up for full recovery?
There is still a lot to understand about postpartum depression and anxiety in the scientific and wider community. It is still an illness whose origins are unclear. As it stands PPD and PPA are thought to be a combination of physical, emotional, genetic, and social factors. It is these we are disregarding in our one size fits all sleep school and training advice. Our society is so poorly set up to support new mothers and the enormity of what motherhood involves, it seems no wonder 1 in 5 of us is suffering with our mental health. What if instead, we had a system whereby mothers were given community support such as food, household chores, mother care, and companionship, I wonder then what this statistic would look like. What if birth trauma was treated with the seriousness it deserves and mothers were provided with the correct support to overcome the often devastating impacts of birth on their physical and mental well-being? What if instead of pushing our babies to sleep more we educated a generation of parents, their wider families and support systems on exactly what biologically normal infant sleep looks like so we can prepare the support we need ahead of when we need it? Then perhaps we could start addressing the depression and anxiety on all levels (emotional, genetic, social, physical).
We are failing to address the influences beyond sleep that affect our moods and wellbeing. By touting sleep-training as the only answer we are missing so much. There are parents who become triggered themselves when moving into parenthood because of their own childhood trauma. We pay little respect to unconscious feelings and memories than can be reignited as we try to raise our little people. Society is overlooking mothers who have to do and be it all. Family histories of depression are rarely discussed nor have we considered a generation of parents who have had to parent in isolation through a worldwide pandemic. The system isn’t big enough or wide enough to encompass all of this into the understanding and origins of PPD and PPA. What is handed out is a generic ticket to a local sleep school to fix the child.
“The child can be protected tremendously if the environment around the mother is supportive and protective and can compensate and can allow her to connect to the baby and all that..
.. the problem is, that depression tends to happen in people who lack that support in the first place. Not uniformly. The problem is things tend to be multigenerational and where there is depression in a woman that usually is not just the novel response to the birth of a child it’s also a trigger of childhood stuff that began with her family so in other words it’s multigenerational.”
GABOR MATE
When we stop fighting and pitting one against the other in terms of our choices of how to parent we might be able to invite in surrender and acceptance of the changes involved with infants and their sleep. These two states, anyone who has come to recover or manage their depression or anxiety will tell you, are vital. If we educated parents antenatally about all sleep choices including safe co-sleeping practices we could start building them up for success instead of fear. If there were more discussion around options and individual choice and supporting both of these could we help our mothers more?
This topic is so vast, and cannot be dissected fully in a blog post. What I hope has been presented here is a starting point as to how and why we need other options for our parents, particularly those who are traversing mental health problems while also raising their babies. This topic is why I offer the support I do, because it is rarely available for parents who choose a responsive pathway. All parents despite their choices should be able to access the support they need when they need it, without having to choose between their own well being and responding to their child.
If you or someone you know is experiencing Postpartum depression or anxiety here are a few service below that I recommend:
SAMANTHA - Our very own in house perinatal mental health social worker, she has worked in the therapeutic space with mothers and families for over seven years. As an Accredited Mental Health Social Worker she has additional knowledge and training in infant and parent mental health and attachment, and early intervention parenting support. She has availability NOW hop over to the website to book in HERE
PANDA – Perinatal Anxiety & Depression Australia – supports the mental health of parents and families during pregnancy and in their first year of parenthood, you can access their website and support HERE
FOR WHEN - Mental health support for new and expecting parents. They connect parents that are struggling to navigate the complex waters of pregnancy and new parenthood to the critical mental health services you might need most, access their website HERE
References:
Blunden, S., Osborne, J., & King, Y. (2022). Do responsive sleep interventions impact mental health in mother/infant dyads compared to extinction interventions? A pilot study. Archives of Women’s Mental Health, 25(3), 621–631. https://doi.org/10.1007/s00737-022-01224-w
PANDA | Support that’s always there, for you and your family. (n.d.). https://panda.org.au/
