Thursday, January 5, 2012

{Ottawa Doula} By Letting Your Child Cry-It-Out, Will You Fix Your Depression?

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A well-known researcher in Australia (Harriet Hiscock) is responsible for the first large, controlled study of infant sleep interventions (cry-it-out) for mothers with postpartum depression. Although conducted almost 10 years ago, the evidence continues to be used today in Australia (and abroad), with many healthcare workers advocating for sleep interventions to help with maternal depression. One of these popular online networks is Babycenter, which most of you have probably consulted at one time or another.

At first glance, the evidence from this study seems to favour the sleep intervention (as opposed to the "control group," where mothers were given an information sheet on normal sleep patterns, with no advice). The sleep intervention is simply a cry-it-out (CIO) technique - either by leaving the room and waiting longer and longer intervals, or by "camping out" and allowing your child to cry while you sit by the crib or bed.

When reviewing the evidence more closely, we discover several questionable aspects of the study:

  • There is no blinding - participants know whether they're receiving the intervention or control, so they're more apt to want to please the researchers, by reporting that CIO worked.
  • Depression scores fell in both the intervention and control groups, which suggests that depression will just improve with time, regardless of the intervention (depression scores did fall slightly more in the intervention group, but was not significant. A more signifcant drop was found when they looked only at mothers with more severe depression)
  • By 4 months, this improvement in mood was no longer significant for the intervention group. Meaning, all of the mothers in the study (regardless of doing CIO or not) had improved
  • Depression scores increased for "persistent sleep problems" - meaning, depression got worse when babies didn't repond to the CIO techniques
  • In a follow-up study, 1 in 5 children's sleep problems had returned
So what does all of this mean?

The study does show that CIO techniques seems to improve both baby's sleep patterns and mothers who have more severe depression. What is worrisome is that the evidence is weak for women who are experiencing mild depression (which may just be an extension of the baby blues - I've discussed the difficulty in diagnosing these symptoms in a previous post). So CIO techniques are touted as the "fix" for any woman approaching their doctors with signs and symptoms of depression.

How could CIO fix your depression? Well, we all know that most of us feel more emotional when we lose sleep. Dealing with a child who wakes frequently during the night may become a source of anxiety for women who are already feeling low. So the answer? Let your baby cry, get a good nights rest, and soon you'll be a happy, healthy mama!

Why this line of argument doesn't work for me

If you've let your child CIO, I'm sorry if you're offended by this post. I don't agree with CIO, although I'm not here to judge you. I'm here to support women who may be experiencing signs/symptoms of PPD (postpartum depression), and who've been told to allow their babies to cry so that they may feel better. Here's my issue:

"Normal" infants wake up frequently in the night. This is a fact of life, which extends across all species who breastfeed their offspring. Frequent night waking is NOT a problem.

Depression is multi-faceted, and a "quick fix" is not the answer. The answer is more support for new mothers, more education on gentle baby care, and realistic expectations of what it means to be a new mother

CIO is harmful to parent-child relationships. Please read Annie's post over at PhD in Parenting. This is not just an opinion - it has been proven with high-quality research

CIO works (sometimes) in the short term, but many babies will go back to night waking after any small changes, such as teething, sickness or travel.

CIO can create more depression and anxiety for mothers, as it forces them to ignore their infants' needs and deny their own feelings/desires - mothers are designed to respond to their crying infants.

CIO can lead to mental health issues later in life, as it raises cortisol levels, which remain high long after the CIO has been completed. So if you're depressed, wouldn't it make sense to respond to your baby, in the hopes of warding off the development of your child's own mental health issue?

There are other ways to get more sleep. This goes back to my "more support" point. New moms need to spend their entire first months focusing on resting and recovering from birth. Other cultures seem to get this idea - our culture praises the mom who jumps out of bed and loses 20lbs in 2 weeks.

If you are a new mom struggling with postpartum life, you will be bombarded with advice from parents, in-laws, doctors and websites, all telling you to put your child down and "fix" yourself by getting a better night's sleep.

Only you can make the best choice for your family, but I strongly believe that COI is not a long-term solution for depression. My blog post on PPD touches on some of the things you can do to get help, and resources here in Ottawa.

I'll finish by quoting Annie here, who says:

"Rates of depression are skyrocketing. Violent and senseless crimes are on the rise. As human beings, we need to spend more time being there for each other, showing compassion, nurturing our children. Learning that you can’t count on your parents to be there when you need them is a tough lesson to learn that early in life and can be a root of many of the social problems we are facing today. I want to give my kids every chance possible of escaping depression and staying away from violence. And I’m convinced that nurturing them and responding to their needs at night, as I do during the day, is the first step in the right direction."

1 comment:

  1. Although I have been active in the childbirth and early parenting sphere for 20+ years CIO methods just won't go away.It seems western societies thrust towards independence at an early age is still very firmly entrenched- despite the cost long term to the larger society. I very much have held to a wonderful quote from a La Leche League source that I heard years back . " baby a baby WHILE its a baby- so you won't have to baby it the rest of its life". How many wounded emotionally immature persons do we meet each day who's genesis of problems began with a parent wanting to get their own needs met whilst ignoring the basic biological and emotional needs of the youngest in the household? Too many I am afraid.


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