I left the office in tears, feeling unsupported, feeling as if I had no workable options, and mostly feeling as if I was somehow wrong, that I was a bad mother.
To many mothers, my story is simply another drop in the bucket of ways our health-care system abandons mothers. Babies receive at least six well-visits with their pediatricians in the first year of life. The mothers of those babies, whose bodies and emotional lives have been entirely upended, receive one well-visit.
I was lucky enough to be able to turn to my postpartum doula after that demoralizing appointment, and together, we had a nuanced conversation about how to attend to my son’s sleep safety while also prioritizing my own sleep needs so I could show up for my family and feel like myself.
But far too many mothers are left unsupported and exhausted, desperate for sleep.
How can we keep our babies safe and healthy while also acknowledging that a mother cannot keep her baby safe and healthy without getting sleep herself?
Alexandra Sacks, a reproductive psychiatrist and host of the Motherhood Sessions podcast, explains that sleep deprivation “affects everything in terms of your personhood: bodies, moods, cognition, stress hormones, cortisol levels, appetite.”
She says that sleep deprivation can tip some mothers into a postpartum anxiety or depression episode and that some women find that their intense distress subsides after getting a good chunk of rest. (This is, of course, not the case for all women dealing with a perinatal mood disorder. Whenever in doubt, call your doctor, or reach out to Postpartum Support International, or PSI, whose mission is to help mothers and fathers find local support.)
Ann Smith, PSI board president, says that misinformation, stigma and shame are still huge factors that prevent mothers from both seeking and finding help.
Culturally, we take for granted that a mother’s sleep is no longer a priority once a newborn arrives. This is not the case in many other countries. Sacks cites China’s “sitting the month,” for example, during which the community (including, sometimes, trained nurses!) help care for a new baby so the mother can rest and heal. And many European countries offer paid maternal and paternal leave, which prioritizes not just newborn sleep, but also family sleep.
Emily Oster, economist and best-selling author of “Cribsheet” and “Expecting Better,” notes that in America, “official sleep advice is very stringent and rigid.” (The AAP advises placing infants on their backs in an empty crib. No bed-sharing, swings or products designed to mimic the cozy womb.)
While the American Academy of Pediatrics’ safe-sleep guidelines have been hugely instrumental in preventing infant deaths, she worries that if the guidelines don’t work, and the baby screams instead of sleeps, parents can feel “a little trapped” and might make “unhealthy decisions.”
Alexis Dubief, author of “Precious Little Sleep,” points out that this risk can be made worse “because many parents … have zero paid leave and can’t afford unpaid leave, so they’re returning to work a mere weeks after giving birth.” Even a “good” paid-leave policy in the United States (which isn’t federally mandated) “is six weeks, which puts you square in the middle of the newborn no-sleep forest. And if you want parents to adhere to safe-sleep guidelines, they need to actually sleep because when parents are exhausted, the safe-sleep guidelines are going to go out the window.”
One way to prevent parents from making unhealthy choices out of exhaustion and desperation, Oster says, would be to employ “the second best” approach, which could outline the safest possible sleep situation for baby, while also giving parents “next best alternatives.”
This is exactly what my doula did with me, and there’s been recent movement in the United States toward this approach on a policy level. Rachel Moon, who chaired the AAP Task Force on SIDS and was lead author on the AAP 2016 policy statement, says a few SIDS researchers are working on a “risk calculator,” which would outline the safest sleep scenario and also provide next-best solutions to prevent parents from troubleshooting on their own and ultimately making unsafe choices.
For example, a calculator might rate sleeping in a crib crowded with stuffed animals as high risk, sleeping strapped into a MaMaRoo infant seat within sight of parents as low risk, and sleeping flat on back in a crib as even lower risk.
But Moon cautions such a risk calculator could never be 100 percent resistant to failure, because “there are an infinite number of combinations, and when you have combinations of risk factors that you’re comparing, the number of cases that you can compare becomes very small, and it becomes statistically impossible to do.”
And this is where we face a common hurdle when it comes to studying pregnancy and infant-care: There is a vast multiplicity of variables and factors and contexts, making controlled studies incredibly difficult.
There are several things everyone I spoke with agreed on: First, that a baby’s health is directly linked to a mother’s health. Second, our health-care system needs to do a better job reflecting this reality. Third, one of the biggest game-changers would be mandated paid parental leave.
It bears repeating (over and over) that we are the only developed country that does not have mandated paid parental leave. This lack of leave is directly tied to a mother’s struggle with safe sleep choices, because she’s forced to go back to work so soon after her baby is born.
Mothers also face the problem of America’s obsession with idealized motherhood. Rashmi Kudesia, of fertility clinic CCRM Houston, says this can leave many new moms blindsided by the harsh realities of early parenthood. “Our culture promotes the myth of an Instagram-worthy pregnancy with smiling bump shots and a postpartum course where mom bounces back quickly and returns to work soon after delivery,” she says. “Countries that promote parental leaves of 12 or more months, and a less medicalized, more collaborative version of pregnancy and childbirth, generally create a more supportive atmosphere around maternity care.”
For the many mothers who, like me, have sat holding their infants while sobbing because of exhaustion or sat watching their baby sleep strapped into a swing while sobbing because of the shame of “doing it wrong,” we are not alone.
“From the moment we find out we’re pregnant, we’re told about limiting behavior — don’t do this, this is wrong … don’t trust yourself,” says Angela Garbes, author of “Like a Mother: A Feminist Journey Through the Science and Culture of Pregnancy.” “All of a sudden, the person you were for decades, you’re supposed to suspend that, and we really encourage the sublimation of the mother from the very beginning.”
Garbes argues that sharing our stories can be a way forward. By simply saying, “This is what I know to be true,” we can slowly make our voices heard in a health-care system where “mothers are really only of value insofar as gestating and creating the next generation of consumers and workers.”
As Garbes says, “We don’t value women, and therefore we don’t value female reproductive health or female health in general, so most laws, rules, institutions, have been written by cis white men, and they are built to support, sustain and perpetuate white supremacy — it’s baked into our institutions, and it’s important to find ways to work within that or find ways to make our own community and seek out our own information for ourselves.”
Oster echoes this sentiment, suggesting moms avoid “being at the whim of whatever culture you live in, and actually look at the evidence and think about how it works for you.”
Not all hope is lost, however.
The think tank Zero to Three is one of many organizations advocating paid parental leave. Last year, the American College of Obstetricians and Gynecologists released a study stating the importance of looking at postpartum health more holistically and increasing care and support during the harrowing “fourth trimester.” More and more women are running for, and winning, office, bringing us closer to a country whose elected officials resemble the people they serve.
Until America catches up with us, mothers have a right to own our experience, our knowledge, our gut instincts, our expertise when it comes to advocating for our children and ourselves.
And if we want to keep fighting, we’ve gotta get some sleep.
Sara Petersen writes about feminism and motherhood and lives in New Hampshire. She’s working on a book about how the Victorian “angel of the house” lives on in idealized perceptions of the modern American mother.