I was involved in a discussion on Twitter the other day, reminiscing about the old days when babies were taken into the nursery at night and cared for by the staff on the maternity unit whilst mum was able to take advantage of the opportunity to catch up on some much needed sleep. Within seconds I was questioned (rather accusingly) as to whether I supported the concept of ‘separating mums and babies’!
Actually nothing could be further from the truth. I think the mother-baby dyad should be supported and nurtured whenever possible when that is what the mother wants but establishing a secure attachment goes much deeper than just rooming in and promoting skin to skin.
Sleep deprivation is known to exacerbate mental health issues, occasionally with very severe consequences. Fit, healthy males have been known to suffer from hallucinations whilst undertaking the Royal Marine Commando Course whilst undergoing enforced periods of sleep deprivation to test endurance, and many fail. The very fact that we would treat something which is just generally expected of new mothers as an endurance test should speak volumes yet this is rarely acknowledged by health care professionals.
The subject of sleep needs to be discussed with women antenatally, especially those who may have pre-existing mental health conditions or identified as being at high risk of developing PND. Sleep is not a dirty word. It is a fundamental human need and is essential to promote mental well being.
Dads or birth partners should be a welcome addition to the postnatal ward. There is no golden rule that states all parenting duties should fall to the mother. Allowing partners to remain on the postnatal ward overnight ensures a mother is able to rest properly whilst her baby is cared for in the same environment, dads can enjoy skin to skin too!
Women should be encouraged to think about how they will protect their sleep, especially during the early days when establishing breast feeding (or not) or simply adjusting to new motherhood. It would be incredibly unrealistic to expect to be able to sleep through the night, but a plan to enable the new mother to have a few hours uninterrupted sleep during a 24 hour period can literally be a life saver. Friends and/or relatives can be instrumental in achieving this.
Midwives and health visitors are notoriously good at knocking on the door to perform a postnatal visit just after a mother has finally fallen asleep after a wakeful night then reminding her to ‘sleep whilst the baby sleeps’ as we leave. Co-ordinating these visits with a mother and her support network can ensure that precious ‘sleep time’ can be protected and she is able to sleep whilst friends or family take over with baby for a few hours.
24 hours of sleep deprivation can lead to symptoms of psychosis in healthy adults, similar to those observed in schizophrenia. Sleep deprivation also triggers a key biomarker in psychosis important in the research of anti-psychotic drugs and has been proven to lead to a re-wiring of the brains emotional circuitry. Is it any wonder women can begin to experience a significant deterioration in their mental well being when this goes on for much lengthier periods of time?
As health care professionals we must not be afraid to address the fact that, for some women, sleep must be prioritised. We are not interfering in the parent-infant bond by suggesting a woman think about a sleep plan in the same way we would encourage her to make a birth plan. Psychiatric disorders are a leading cause of maternal death according to the most recent MBRRACE-UK report (2014) and sleep deprivation has been identified as a contributory factor in many of these cases. Sleep should be considered equally as important as any other intervention necessary to maintain good physical or emotional health. If we want to be truly baby friendly we need to first achieve ‘mum friendly’.