Yesterday, the New York Times published an op-ed about a pediatric practice in New York that recommends - and in some cases insists - that most babies should be sleep trained around 8 weeks old. For this practice of doctors, known as Tribeca Pediatrics, sleep training at 8 weeks involves a twelve hour period (e.g. 7 pm - 7 am) where the baby is put down awake and left until the morning. In this time the baby is supposed to figure out how to put itself to sleep. Since babies have few skills on their own at this age except for crying, this form of sleep training is called "cry it out" or CIO. Nursing, changing, comforting, or physically being in the room are not allowed in this this doctor's version of extinction cry it out.
The op-ed's title states that it takes "guts" to sleep train. I disagree with that word choice and I'll explain more later. But I will say it took guts to write this article for me. It takes guts to wade into the sleep training vs. co-sleeping dichotomy, just as it would take guts to take a side in the breast vs. formula wars.
Ultimately, I know that every baby and every parent and every family are different. And when it comes to sleeping, as a doula, I believe the same thing that I do with feeding your child: you have to do what you feel is best as a parent for your baby and for you - within reason.
However, that "within reason" is a big caveat. Just as it is not reasonable for you to feed your child something that their system can't handle or spend 24 hours hooked to a pump or not feed them because you can't feed them the way you want to, there are things related to sleep expectations that are not reasonable. As a parent, who has read a lot about sleep and as a trained doula who has studied extensively developmental milestones of babies and emotional and physical needs of mothers, I disagree with extinction CIO at 8 weeks old.
We are taught to rarely put stakes in the ground as a doula, but I am doing it here. I don't believe that you should demand sleep patterns that the vast majority of babies' brains and bodies don't process naturally or healthily.
Providing healthy sleep habits and strong sleep cues can start on day one. And sleep training that involves some tears may have to happen at some point for some parents. But 8 weeks according to most credible evidence and common experience is far too early for babies -- and for parents.
Your instinct to respond to your baby's cries is bred into you from years of evolution. We respond out of concern, empathy, safety, and intelligence. We nurse and change and connect with our babies because 8 hours, days, weeks or even months is not a long time to be in this world. And certainly not a long time to understand it.
Moms are still learning their babies and babies are still learning the world at this newborn stage of life. Responding to them is natural, normal, and healthy. And yes, fussing or crying is also natural, normal, and healthy. But a lack of response is not standard, not natural (a reason many mothers cannot be home when their children are being sleep trained).
I personally know moms who have sleep trained at 8 weeks at the recommendation of Tribeca. And they are loving, brilliant, kind, connected moms. And I am sure that they did what they thought was best for their family at the time. And I know it was hard - both from hearing their stories and from experiencing some parts of it myself.
I know this pediatric practice well, because we were patients there when our son was born. With branches all over the city, convenient hours, sleek online portals, and a restrained approach to antibiotics, it felt like a fine place to start. We left after two months - because of lack of breastfeeding support and because of sleep recommendations and because no one ever knew our names.
Full disclosure: our guy is a challenged sleeper. Still at 16 months we rarely get a full night's sleep. Fuller disclosure: We have tried almost everything to get him to settle for one of those 12 hour stretches promised by Tribeca. And yes, we even tried to sleep train using Ferber twice at 7.5 and 10 months - including a night of extinction at the recommendation of our new pediatrician. Neither episode worked for us and ultimately we decided that we were OK with a family bed and with a wake-up or two. I am sure Dr. Cohen would say that we didn't do it early enough, long enough or hardcore enough. That perhaps, we didn't have the guts. Luckily, I am fine with that.
Because as far as I am concerned, sleep training isn't about guts. It is about desperation. When you are more tired than you've ever been in your life and less certain of yourself as a person, we do all sorts of things we never thought we would. I have been that mom so tired and tightly wound, uncertain of how to go about my life, and unsteady without enough support. It didn't take guts for me to try Ferber. It took desperation. It didn't take guts to sit in my living room and sob listening to my baby crying. It took sheer and utter desperation.
What would take guts in this country is creating better postpartum support for our moms. What would take guts is demanding companies provide paid family leave. What would take guts is not expecting exhausted and physically depleted moms to go back to work 6 weeks after having their baby - often still bleeding and usually still learning how to breastfeed and pump effectively. What would take guts is to own your decisions without fear or regard for their reactions - "We cosleep." "I work." "I stay home." "We still breastfeed at 2." We supplement." What would take guts is to stop telling moms how to mother and dads how to father and let them be vulnerable and awesome as they follow their instincts and learn their baby. It is no ones instinct to leave their baby to cry alone for 10 minutes let alone for hours.
And Instincts are very rarely wrong when it comes to your children.
There are many sleep methods out there and very strong opinions on all sides. 'Cosleepers are freaks.' Or 'Sleep trainers are monsters.' And like with formula or vaccines, everyone has an article that they reference or a straw that they grasp on to. Here is an article based on an evidence review that debunks many cry-it-out claims. And yes, there are babies that take to early and aggressive sleep training early and are perfectly fine, loving children. But there are other babies and parents that are not fine with it. We put these extremes out there forgetting that very few of us live on the edge. In fact, most of us live in the middle.
So, Here Goes...
I am going to try to offer some sanity and moderation to this sleep debate.
First, in early days, sleep when the baby sleeps. Yes that means stay in your pajamas until you get 8 hours of sleep. If that means you nap from 10-12 and the laundry doesn't get folded so be it. And get help. Have a family member, good friend, postpartum doula, or night nurse come to help you get some sleep (day or night!) even just once or twice a week makes a difference.
Second, build sleep cues and healthy sleep habits. The Happiest Baby on the Block is a great resource for guidance on the how to's here. Assuming baby is warm, dry and fed, general wisdom stresses routine, white noise, movement, dark, and swaddling to achieve optimal results.
Third, as with everything progress happens slowly. Not all at once. Your baby will start sleeping more. And more. And then less. And then more. And then maybe less again. But eventually they sleep. I've yet to hear of a 16 year old who likes to get up at 5, 7 or even 9 a.m.
Fourth, about the sleeping less thing...yes, sometimes it happens. Little ones are dealing with a lot of things. Massive growth spurts both physical and developmental, teething, colds, awareness levels, travel, caregivers changing and the list goes on. It is important to note that sleep training isn't just a one and done experience. Most every parent I have every talked to who has sleep trained has had to retrain throughout the first two years when those life events happen.
Fifth, sleep training. As with everything some babies just get it and others need help. But start slow and be steady. Know that things take time and just as you wouldn't expect your 7 month old to feed herself her dinner, you shouldn't expect her to get this new reality right away. Always try the gentle techniques first. Two great resources are the Sleep Lady's Good Night Sleep Tight or Elizabeth Pantley's No-Cry Sleep Solution. Many people have had great success with them. If they don't work for you, move on to something gradual like the Ferber method before going for "extinction" as advocated by Tribeca.
Sixth, some babies just don't sleep well for a while. Some for a long while. If that is the case, get help when you can. Sleep in shifts. Bring in your parents or inlaws or a babysitter. Take a night away a month. Nap. Let go of the things that you don't need. Replace them with rest.
Lastly, whether getting 12 hours of sleep or having 12 wake-ups a night, it goes by so fast. Your baby will need you for a short and fast period of time in the grand scheme of things. Ultimately, try to determine what YOU need and don't be afraid to go after it in a way that makes you and your baby feel whole, happy, safe, and sane. The less tears for baby, mom, and dad the better!
Love + (Night) Light,
Ali