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Recent Study Finds that Controlled-Crying Causes No Apparent Long-term Harm: Should We Recommend This Practice to Parents?

October 30th, 2012 by avatar

 

 

“Crying it out” and sleep issues have always been a “hot” topic amongst parents and many of today’s parents look to childbirth educators and others for information on how best to prepare for and deal with their infant’s sleep habits.  Talking about infants and sleep can be as flammable a topic as talking politics.   Today’s post is by regular contributor Kathleen Kendall-Tackett takes a look at recent study on the long-term effects of controlled crying and shares her thoughts on the validity of the study and examines the potential shortcomings and limitations.  How do you speak about sleep and infants in your classes or with your clients and patients?  Do you have information that parents have found particularly helpful? Let us know in the comments section of today’s post.- SM

Image credit: Fotolia stock photo

A recent article in Pediatrics (Price, Wake, Ukoumunne, & Hiscock, 2012) reported on the long-term effects of a controlled-crying intervention for parents of infants 8 to 10 months old. The children were assessed five years post-intervention and showed no apparent harm. The media response to these findings has been overwhelming. Could this be the answer that weary parents have been waiting for? The authors certainly thought so. In fact, they concluded that practitioners could “confidently” recommend this approach.

Before we recommend this approach to parents, let’s step back for a moment and consider whether this recommendation is warranted. We must critically evaluate both the current study and where it fits within the larger literature in maternal-child health. In my view, there are a number of serious limitations to this study that call into question whether we should recommend this practice to parents.

Study Design

In the Price et al. (2012) study, the researchers randomly assigned parents to either intervention or control groups. In the intervention group, parents received instruction in controlled crying, i.e., to wait an increasing amount of time before responding to their infants’ cries, or “camping out,” which involved staying with their infants until the infants fell asleep on their own. The parents in the control group received “usual care,” which meant no specific recommendation regarding infant sleep. At earlier time points, the authors found that the controlled-crying intervention prevented depression in mothers and improved babies’ sleep.

At the five-year follow-up with 225 families (69% of the original sample), the researchers found that the intervention did not adversely affect the parent-child bond, the mother’s depression level, the child’s level of adjustment, or their cortisol levels. Indeed, they noted, that there were no adverse effects. However, there were also no long-term benefits. Still, the authors concluded that practitioners could recommend this technique to prevent postpartum depression and improve infant sleep.

Study Limitations

There were a number of limitations to this study. Below is a brief synopsis.

The Impact of Context: The Cumulative Effect of Childhood Adversities 

Context is an important consideration when evaluating potential harm caused by a parenting technique. In other words, how many parental missteps does it take for children to show evidence of lasting harm? Fortunately, children are resilient and don’t require perfect parenting.  However, chronic bad parenting does harm children and the effects are cumulative (Shonkoff, Boyce, & McEwen, 2009). Chronic bad parenting has also been described as childhood adversity in such major research studies as the Adverse Childhood Experiences Study (Centers for Disease Control and Prevention, 2010) and New Zealand’s Dunedin Multidisciplinary Health and Development Study (Danese et al., 2009).

So does controlled crying cause infant harm? If it occurs in families with generally warm, responsive, and loving parents, probably not. Because children are resilient, they can endure a lot. Family strengths can buffer any potential negative effects.

I am more concerned about the impact of controlled crying when it takes place in high-risk families. This is a key limitation in Price et al. study. A full 31% of their original sample was lost to follow-up. Most of these families were identified as “high disadvantage.” In other words, the group most likely to be negatively affected by controlled crying was not in the follow-up study.

Assessing “Dose”: The Chronicity and Severity of the Experience

When assessing potential harm of a practice, it’s also important to consider chronicity and severity. In terms of infant sleep, we need to know how often controlled crying was used in an average week, how many weeks or months that the parents employed these techniques, and in an average episode how many minutes elapsed before the parents responded to their babies. I would expect more long-term negative effects if parents did not respond to their babies’ cries for long periods of time (such as 45 minutes or longer), and that they used this technique for months on end. In contrast, if parents used this technique a few times and for a few minutes, there probably wouldn’t be any negative effects.

Chronicity and severity is basically a way of factoring in “dose” of the intervention. This important nuance was totally absent from the Price et al. study. From their article, we know little about what the parents actually did. A full range of practices was grouped together in the “intervention group.” Indeed, we also don’t know what the “control” group did. These parents could have easily implemented a controlled-crying program for themselves using one of the myriad of books for parents on sleep training. Given the wide range of practices that likely occurred in both the “intervention” and “control” groups, I am again not surprised to see no significant difference.

Was the Intervention Actually Effective, Even in the Short Term? Accounting for the Hawthorne Effect

Another problematic aspect of this study has to do with the research design’s inability to account for the Hawthorne Effect. The Hawthorne Effect was first noted by industrial psychologists who were testing the impact of minute changes in illumination on productivity in factory workers. When they raised the level, employees reported that it was “better” and productivity increased. When they lowered the level, it was also “better” and productivity increased.  In other words, any intervention was described as helpful. It’s basically a placebo effect for behavioral interventions.

The Hawthorne Effect could also be behind the positive results for the controlled-crying intervention. Earlier papers from this same research sample found lower rates of depression and better sleep among the mothers in the intervention group. Yet these results do not demonstrate that it was the controlled-crying technique per se that actually caused the effect. Perhaps it was simply a matter of the mothers appreciating that someone was listening to their concerns. Controlled crying was compared to “usual care.” A better test for the effectiveness of this technique would have been to compare it with another intervention (such as educating mothers about the developmental normality of infant waking at 8 to 10 months, and brainstorming about ways the mothers could get more rest and cope with fatigue). Given that the authors are actually recommending this technique, this standard of evidence is a minimum.

Does Controlled Crying Cause Long-term Change to Cortisol Levels? 

One concern that critics of controlled crying raise is that this technique changes infant physiology and alters the production of the stress hormone cortisol. To address this concern, the authors assessed cortisol levels of the children at two different points during a single day at age 6. They found no significant differences in cortisol levels at age 6 between the intervention and control groups, which further reassured them that their techniques were not harmful.

Unfortunately, these findings alone do not mean lack of physiological harm. To demonstrate lack of harm, the authors needed to measure cortisol levels during infancy: before, during, and after the intervention. Did controlled-crying elevate cortisol levels? How high were those levels and how long did they remain elevated? The authors did not measure this.

The question we need to ask is what happens to babies when their mothers do not respond to their cues? One way this has been studied is by examining the impact of maternal depression on infants. Maternal depression impairs mothers’ ability to respond to their infants’ cues. Infants whose mothers do not respond to their cues  tend to have elevated cortisol levels (Feldman et al., 2009). Even when non-response is temporary, babies still find it stressful. In the still-faced mother paradigm, mothers are asked to not respond to their infants’ cues in a laboratory setting. This research is designed to mimic the effects of maternal depression. The still-faced-mother experiments increase babies’ cortisol levels (Grant et al., 2009). And the effect of chronic maternal non-response can last long past infancy (Douglas & Harmer, 2011; Luijk et al., 2010; Murray, Halligan, Goodyer, & Herbert, 2010).

So why the concern about cortisol? Mainly, it’s this: cortisol is quite toxic to brain cells. If cortisol is elevated for short time, it likely causes no damage. But if cortisol levels are repeatedly elevated because the infants are experiencing long and repeated incidents of being ignored when they cry, it can be a problem. The brain is at its most vulnerable in the first five years, so soaking the developing brain in cortisol is not a good idea (Buss et al., 2012).

The authors of the current study claimed no effect of cortisol just because there was no difference between the groups at age 6. In my opinion, the lack of difference between the groups does not mean lack of harm. For some of these children, the effects of elevated cortisol in infancy could be more subtle. Cortisol levels likely returned to normal in the intervening five years, unless there was ongoing adversity. Unfortunately, cortisol that was elevated in infancy could have still affected vulnerable brain cells, even if current levels are normal. The measures Price et al. used were not particularly sensitive. And these effects would likely not show up without more sensitive measures.

What About Breastfeeding?

The final limitation of this study is rather stunning. Price et al. did not measure the effect of infant feeding method on sleep or maternal depression. Yet feeding method has a direct effect on both maternal sleep and postpartum depression, which are the two main factors the authors claim to address with their sleep intervention. This omission is particularly surprising given that Australia, the authors’ home country, has one of the highest rates of breastfeeding in the world. It is far from a marginal issue.

Recent studies have demonstrated that exclusively breastfeeding mothers get more sleep and are less likely to be depressed than their mixed- or formula-feeding counterparts. They take fewer minutes to fall asleep, sleep longer over the course of a night, and report more daytime energy and better physical health than their mixed- or formula-feeding counterparts (Doan, Gardiner, Gay, & Lee, 2007; Dorheim, Bondevik, Eberhard-Gran, & Bjorvatn, 2009a, 2009b; Kendall-Tackett, Cong, & Hale, 2011).

Given these findings, isn’t it strange that breastfeeding was not even enquired about, let alone controlled for? If the study was conducted in a country with low breastfeeding rates, this omission would be somewhat understandable. But it makes no sense from a study conducted in a country with one of the highest breastfeeding rates in the world.

Conclusion

So what can we take away from the Price et al. study? Should we recommend the controlled-crying technique to parents? Based on the limitations of this study, I do not recommend this approach. The sample size is small, the follow-up sample is missing the children most likely to be negatively affected, their assessment of their intervention did not account for the Hawthorne/placebo effect, they have not measured dose of the intervention, nor have they accounted for feeding method, which recent research has soundly demonstrated as being related to both variables that are of key interest: maternal fatigue and postpartum depression.

My objections to this approach are not new. When I first encountered the Price et al. study, I remembered a study this same group of researchers published 10 years ago in the British Medical Journal demonstrating that controlled crying lessened the risk of postpartum depression (Hiscock & Wake, 2002). I was specifically struck by this response to it from a German physician (Perl, 2002).

As a German, I am unhappy to find fairly undiluted ideas of militaristic Nazi infant care uncritically repeated by these Australian care providers. The Nazis understood very well the crucial effect of letting young babies cry on their future development and made this a central theme in their child care. As a scientist, I find it hard to believe that all of the results of mother-infant sleep research of the 1990s completely escaped the authors’ notice.

In closing their article, Price et al. stated that organizations, such as the Australian Breastfeeding Association, were unduly negative towards controlled-crying techniques and based their positions on research that had not been “updated since the mid-2000s.”

Thus, there is a pressing need to deliver evidence-based information to parents and health care providers, which could be achieved, in part, by updating position statements, policy documents, and training curricula to reflect our current findings that behavioral sleep techniques are both effective in the short- and medium-term and safe to use in the long-term (p. 8).

Given recent findings in neuroscience, childhood trauma and adversity, and breastfeeding and maternal sleep, which are not accounted for in the Price et  al. study, I’d respectfully advise the authors to do the same. I’d further urge healthcare providers who are considering recommending these techniques to consider the limitations to the current study and to consider alternative approaches that can meet the needs of both mother and baby.

References

Buss, C., Davis, E. P., Shahbaba, B., Pruessner, J. C., Head, K., & Sandman, C. A. (2012). Maternal cortisol over the course of pregnancy and subsequent child amygdala and hippocampus volumes and affecive problems. Proceedings of the National Academy of Sciences USA, 109(20), E1312-E1319.

Centers for Disease Control and Prevention. (2010). Adverse childhood experiences: Major findings  Retrieved May 16, 2011, from http://www.cdc.gov/ace/findings.htm

Danese, A., Moffitt, T. E., Harrington, H., Milne, B. J., Polanczyk, G., Pariante, C. M., & Caspi, A. (2009). Adverse childhood experiences and adult risk factors for age-related disease: Depression, inflammation, and clustering of metabolic risk factors. Archives of Pediatric and Adolescent Medicine, 163(12), 1135-1143.

Doan, T., Gardiner, A., Gay, C. L., & Lee, K. A. (2007). Breastfeeding increases sleep duration of new parents. Journal of Perinatal & Neonatal Nursing, 21(3), 200-206.

Dorheim, S. K., Bondevik, G. T., Eberhard-Gran, M., & Bjorvatn, B. (2009a). Sleep and depression in postpartum women: A population-based study. Sleep, 32(7), 847-855.

Dorheim, S. K., Bondevik, G. T., Eberhard-Gran, M., & Bjorvatn, B. (2009b). Subjective and objective sleep among depressed and non-depressed postnatal women. Acta Psychiatrica Scandinavia, 119, 128-136.

Douglas, J.-L., & Harmer, C.-J. (2011). Early morning cortisol response and emotional processing in adults exposed to postnatal depression in infancy. European Psychiatry, 26, 479-481.

Feldman, R., Granat, A., Pariente, C., Kanety, H., Kuint, J., & Gilboa-Schechtman, E. (2009). Maternal depression and anxiety across the postpartum year and infant social engagement, fear regulation, and stress reactivity. Journal of the American Academy of Child and Adolescent Psychiatry, 48(9), 919-927.

Grant, K.-A., McMahon, C., Austin, M.-P., Reilly, N., Leader, L., & Ali, S. (2009). Maternal prenatal anxiety, postnatal caregiving and infants’ cortisol responss to the still-face procedure. Developmental Psychobiology, 51, 625-637.

Hiscock, H., & Wake, M. (2002). Randomised controlled trial of behavioural infant sleep intervention to improve infant sleep and maternal mood. British Medical Journal, 324(7345), 1062-1065.

Kendall-Tackett, K. A., Cong, Z., & Hale, T. W. (2011). The effect of feeding method on sleep duration, maternal well-being, and postpartum depression. Clinical Lactation, 2(2), 22-26.

Luijk, M. P. C. M., Saridjan, N., Tharner, A., Van Ijzendoorn, M., Bakermans-Kranenburg, M. J., Jaddoe, V. V. W., . . . Tiemeier, H. (2010). Attachment, depression, and cortisol: Deviant patterns in insecure-resistant and disorganized infants. Developmental Psychobiology, 52, 441-452.

Murray, L., Halligan, S. L., Goodyer, I., & Herbert, J. (2010). Disturbances in early parenting of depresssed mothers and cortisol secretion in offspring: A preliminary study. Journal of Affective Disorders, 122, 218-223.

Perl, F. M. (2002). Infant sleep intervention or Nazi drill? Rapid response to Hiscock & Wake. British Medical Journal. Retrieved from http://www.bmj.com/content/324/7345/1062?tab=responses

Price, A. M. H., Wake, M., Ukoumunne, O. G., & Hiscock, H. (2012). Five-year follow-up of harms and benefits of behavioral infant sleep intervention: Randomized trial. Pediatrics, 130(4). Retrieved from www.pediatrics.org/cgi/doi/10.1542/peds.2011-3467

Shonkoff, J. P., Boyce, W. T., & McEwen, B. S. (2009). Neuroscience, molecular biology, and the childhood roots of health disparities: building a new framework for health promotion and disease prevention. JAMA, 301(21), 2252-2259. doi: 301/21/2252 [pii] 10.1001/jama.2009.754

About Kathleen Kendall- Tackett

Kathleen Kendall-Tackett, Ph.D., IBCLC

Kathleen Kendall-Tackett, Ph.D., IBCLC, FAPA is a health psychologist and board-certified lactation consultant. Dr. Kendall-Tackett is Owner and Editor-in-Chief of Praeclarus Press, a new small press specializing in women’s health. She is a research associate at the Crimes against Children Research Center at the University of New Hampshire and a clinical associate professor of pediatrics at Texas Tech University School of Medicine in Amarillo, Texas. She is Editor-in-Chief of the journal, Clinical Lactation, a Fellow of the American Psychological Association, and is president-elect of the APA Division of Trauma Psychology. www.KathleenKendall-Tackett.com

 

Babies, Breastfeeding, Childbirth Education, Depression, Guest Posts, Infant Attachment, Maternal Mental Health, Parenting an Infant, Research , , , , , ,

Nighttime Breastfeeding and Maternal Mental Health

[Editor's Note: This is the first post from our new regular contributor, Kathleen Kendall-Tackett, Ph.D., IBCLC. Kathleen writes about breastfeeding, perinatal/postpartum mental health, and psychoneuroimmunology (PNI). She writes on her site, Uppity Science Chick, "Few fields of study are more exciting (than PNI), and they touch a wide range of seemingly unrelated topics: trauma and health; breastfeeding; postpartum depression. PNI studies help us understand risk factors for chronic disease and can teach us all how to live healthier lives."  I'm very excited to welcome her here so we can all take part in these breath-taking discoveries. - AMR]

There is a movement afoot in childbirth education and perinatal health urging mothers to avoid nighttime breastfeeding to decrease their risk for postpartum depression. We know that if mothers follow this advice, it will have a negative impact on breastfeeding. But let’s put that issue aside for the moment and consider whether avoiding nighttime breastfeeding will preserve women’s mental health by allowing them to get more sleep. In short, is this good advice?

At first glance, it may seem to be. Since breast milk is lower in fat and protein than formula, we might assume that breastfeeding mothers sleep less than their formula-feeding counterparts. And when a mother’s mental health is at stake, avoiding nighttime breastfeeding might be worth the risk. However, recent research has revealed the opposite: that breastfeeding mothers actually get more sleep—particularly when the baby was in proximity to the mother. And that has major implications for their mental health. So if you want one more good reason for mothers to exclusively breastfeed their babies, here it is.

Breastfeeding Mothers Get More Sleep

In a study of 33 mothers at 4 weeks postpartum, Quillin and Glenn (2004) found that mothers who were breastfeeding slept more than mothers who were bottle-feeding. Data were collected via questionnaire that recorded 5 days of mother and newborn sleep. When comparing whether bedsharing made a difference in total sleep, they found that bedsharing, breastfeeding mothers got the most sleep and breastfeeding mothers who were not bedsharing got the least amount of sleep. Mothers who were bottle-feeding got the same amount of sleep whether their babies were with them or in another room.

Sleep patterns of 72 couples were compared from pregnancy to the first month postpartum via sleep diaries and wrist actigraphy (Gay et al., 2004). Most of the mothers were at least partially breastfeeding (94%) and 80% were exclusively breastfeeding. Most of the babies slept in their parents’ room and 51% regularly slept in their parents’ beds. Sleep and fatigue outcomes were not associated with type of birth, parent-infant bedsharing, or baby’s age. Mothers who were exclusively breastfeeding had a greater number of nighttime wakings (30 vs. 24) compared with mothers who are not breastfeeding exclusively. The exclusively breastfeeding mothers slept approximately 20 minutes longer than mothers not exclusively breastfeeding.

In a study of mothers and fathers at three months postpartum, data were collected via wrist actigraphy and using sleep diaries (Doan et al., 2007). The study compared sleep of exclusively breastfed infants vs. those supplemented with formula. In this sample, 67% were fed exclusively with breast milk, 23% were fed a combination of breast milk and formula, and 10% were exclusively formula fed. Mothers who exclusively breastfed slept an average of 40 minutes longer than mothers who supplemented. Parents of infants who were breastfed during the night slept an average of 40 to 45 minutes more than parents of infants given formula. Parents of formula-fed infants had more sleep disturbances. They concluded that parents who are supplementing with formula under the assumption that they are going to get more sleep should be encouraged to breastfeed so they will get an extra 30-45 minutes of sleep per night.

Not only do breastfeeding mothers get more sleep, but the sleep they get is of better quality. This study compared 12 exclusively breastfeeding women, 12 age-matched control women, and 7 women who were exclusively bottlefeeding (Blyton et al., 2002). They found that total sleep time and REM sleep time were similar in the three groups of women. The marked difference between the groups was in the amount of slow-wave sleep (SWS). The breastfeeding mothers got an average of 182 minutes of SWS. Women in the control group had an average of 86 minutes. And the exclusively bottle-feeding women had an average of 63 minutes. Among the breastfeeding women, there was a compensatory reduction in light, non-REM sleep. Slow-wave sleep is an important marker of sleep quality, and those with a lower percentage of slow-wave sleep report more daytime fatigue.

The most recent study was published in the journal Sleep, a major sleep-medicine journal not necessarily known for their support of breastfeeding. This was a study of 2,830 women at 7 weeks postpartum (Dorheim et al., 2009). They found that disrupted sleep was a major risk factor for postpartum depression. But here is where it really gets interesting. When considering what disrupted sleep, they found that the following factors were related to disturbed sleep: depression, previous sleep problems, being a first-time mother, a younger or male infant, and not exclusively breastfeeding. In other words, mothers who were not exclusively breastfeeding had more disrupted sleep and a higher risk of depression.

Conclusions

The results of these previous studies are remarkably consistent. Breastfeeding mothers are less tired and get more sleep than their formula- or mixed-feeding counterparts. And this lowers their risk for depression. Doan and colleagues noted the following.

Using supplementation as a coping strategy for minimizing sleep loss can actually be detrimental because of its impact on prolactin hormone production and secretion. Maintenance of breastfeeding as well as deep restorative sleep stages may be greatly compromised for new mothers who cope with infant feedings by supplementing in an effort to get more sleep time. (p. 201)

In sum, advising women to avoid nighttime breastfeeding to lessen their risk of depression is not medically sound. In fact, if women follow this advice, it may actually increase their risk of depression.

References:

Blyton, D. M., Sullivan, C. E., & Edwards, N. (2002). Lactation is associated with an increase in slow-wave sleep in women. Journal of Sleep Research, 11(4), 297-303.

Doan, T., Gardiner, A., Gay, C. L., & Lee, K. A. (2007). Breastfeeding increases sleep duration of new parents. Journal of Perinatal & Neonatal Nursing, 21(3), 200-206.

Dorheim, S. K., Bondevik, G. T., Eberhard-Gran, M., & Bjorvatn, B. (2009). Sleep and depression in postpartum women: A population-based study. Sleep, 32(7), 847-855.

Gay, C. L., Lee, K. A., & Lee, S.-Y. (2004). Sleep patterns and fatigue in new mothers and fathers. Biological Nursing Research, 5(4), 311-318.

Quillin, S. I. M., & Glenn, L. L. (2004). Interaction between feeding method and co-sleeping on maternal-newborn sleep. Journal of Obstetric, Gynecologic and Neonatal Nursing, 33(5), 580-588.

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Are maternity units too noisy?

June 11th, 2010 by avatar

alarmbell

According to a recent article in the Boston Globe, hospital noise has become problematic and researchers, along with some hospital administrators, are starting to listen.

From The Boston Globe article:

In 2005, a team of researchers at Johns Hopkins University led by the engineers Ilene Busch-Vishniac (now the provost at McMaster University) and James West looked at the best available historical data and found that, since 1960, the average daytime noise level in hospitals had doubled. At night, it was four times louder.

So what’s the buzz all about? The numerous studies cited in this article repeatedly point to concerns and, in many cases, concrete evidence that hospitalized patients tend to fare much worse as decibel levels rise. Vitals signs (blood pressure, heart and breathing rates and body temperatures) are less stable. Perceived pain and therefore request for pain medication is higher. Newborns in intensive care nurseries stay longer and can potentially suffer hearing damage. Surgical patients take longer to heal.

For me, this suggests the obvious question about mothers who are supposedly resting up from childbirth—particularly the ~30% of US women who are recovering from cesarean section deliveries—and what type of true “recovery” they are garnering during their 48 – 72 hour stays.

Some cultures around the world take the postpartum recovery of a woman so seriously, they expect mom to do nothing but remain at home, sleeping, eating and nursing her baby for upwards of forty days. In the United States, our hustle and bustle, noise-filled culture accompanies a woman’s postpartum experience.

Typical doctor’s orders on a maternity ward dictate a woman’s nurse(s) to visit her room no less than once every four hours to perform basic nursing duties—and assuming baby is rooming in with mom, there is often times a completely separate schedule of nursing visits for the newborn. But, following each of my three hospital birth experiences, I seem to recall the door to my room swinging open and shut many more than six times in a twenty-four hour period. Between doctors performing medical rounds, someone from the nutrition department collecting food orders, lactation specialists making their daily visits, hospital photographers stopping in for a quick snapshot of each bundle of joy and occasional hospital volunteer drop-ins, there’s actually very little time for a woman to rest following the birth of her baby.

Sleep studies tell us that when a person’s sleep is frequently interrupted, they are less likely to slip into non-REM sleep—the mode of rest during which growth and healing is most likely to occur. With overhead pages echoing down the halls, sitcom canned laughter from the neighbors’ too-loud television, and, let’s face it, the sound of multiple babies crying in poorly insulated quarters, it’s no wonder most women leave the hospital more rather than less tired when they entered. (And, if you’ve recently been pregnant, you’ll likely recall how tired you felt by the end of your third trimester.)

But it’s not just the postpartum wing where noise is a problem. The L&D room can be a rather cacophonic place as well. With fetal monitors tapping out the baby’s twice-per-second heart rhythm, constantly spewing out reams of paper, and bing-bonging an alert every time the baby’s heart rate falls outside certain parameters…with patient controlled analgesia pumps pumping and beeping away…with alarms sounding every time an IV line gets kinked or the bag empties…with a infant warming table blaring when it reaches its preset temperature…with labor and delivery nurses, aides, technicians, nursery nurses, midwives, doctors, PAs and possibly residents and interns floating in and out, a hospital birth room can become as busy as the intensive care department.

We know from observing animals that from an instinctual basis, it’s pretty darned hard for childbirth to take place amidst noise and lack of privacy. And, surprise, surprise: human beings are no different. Could the ever-increasing rates of labor augmentations, epidural usage, suction-assisted deliveries, and cesareans for “failure to progress” be explained, in part, by hospital setting noise? Is it possible that with every “unnatural” sound we hear, our bodies shut down just a little more—whether during the process of birth, or during the healing, resting, and mother-baby bonding period that is supposed to occur afterward?

Recently, a dear friend of mine delivered her second baby. Having shared a room with another woman in the postpartum wing, my friend initially spoke favorably of her experience being so close to another puerperal woman. “That’s when I realized how much I needed to be with other women following my birth experience,” she confessed.

But our conversation quickly turned to the idea of a postpartum floor lounge—a place specifically designed for mothers and babies…a spa reception-like setting where women could sit in comfortable rocking chairs and heavenly couches, nurse their babies, share stories, exchange words of advice and encouragement amidst quiet music (or no music at all) and dim lighting, drink from the endless supply of healthy teas, water and juices, and languish in an uninterrupted setting for as long as they desired.

“It wasn’t exactly ideal sharing a [hospital] room with someone else,” she later told me of her two-day postpartum roommate. “I could hear all their conversations and she constantly had the TV on. But still, I learned a lot about myself and my needs following my second baby’s birth.”

In the United States and many, if not most other developed nations, women do not look forward to a 40-day lying in period following childbirth. So, that cultural practice being what it is, perhaps hospitals that are currently looking at their facility-wide noise levels and amelioration plans should also contemplate the overall setting of the labor, delivery and postpartum wing.

This is a guest post by Kimmelin Hull, PA, LCCE. Kimmelin is a Lamaze Certified Childbirth Educator, mother of three, and author of A Dozen Invisible Pieces and Other Confessions of Motherhood. You can visit Kimmelin at her blog site: http://kimmelin.wordpress.com.

Photo by debsilver, used under a Creative Commons license.

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