PND and the advice people give that just makes things worse

Here’s the thing about PND, we don’t really know what does cause it. But we do know what the risk factors are, lack of sleep is indeed one of them, as are stress and feelings of failure - so why are we advising mothers with PND or mothers already at risk of PND to engage in practices that will most likely increase their stress levels and interfere with their sleep even more?

Another day and another mum in one of the facebook groups I frequent is being told to trade her baby’s health and wellbeing for her own.

The mum has been diagnosed with PND, and her ever so helpful mother in law has taken that fact as proof that the mother should change everything about her parenting practice.

Here are the mother in law’s suggestions - The baby in question is 7 weeks old, btw.

• Limit Night feeds- she should be dropping them and sleeping through by now
• Give her water
• Limit co-sleeping
• Move the 3.5 year old into his own bed so that mum can sleep
• Get everyone into a routine

Now even if we ignore the fact that the first two suggestions here are potentially deadly; (Failure to Thrive from insufficient calorie intake, and Water Intoxication are both very real threats if this advice were to be followed) how exactly are any of those suggestions supposed to help with PND?

Oh that’s right the magic PND cure all which is Mummy getting a straight 8 hours.

Sorry, but I call bullshit on that.

I am so sick of seeing PND advice that focuses exclusively on the mother, and exclusively on her sleep.

Now before you get all angry at me and declare how bad sleep deprivation is or how much  it can fuck with you, my own mother got Post Natal Psychosis. So yeah, I know it can. I have seen first hand the drastic impact that missing even one night’s sleep can have on my mum.

Before I went on Young Endeavour, and to Summer Camp as a camp counsellor (at probably the only US summer camp where staff are expected to be both bunk counsellors and activities counsellors), and before my boy was born I was all kinds of freaked out about the impact that losing large chunks of sleep for extended periods of time could have on my own mental health.

And that is one of the main driving forces that led me to bed sharing.
 
Because for most mothers, bed sharing equals more sleep. It’s the biological norm after all. So I really just do not understand why so many health professionals and “concerned” family/friends think that putting the baby in it’s own room and trying to get them to sleep through the night is going to help?

Night time feeds are biologically necessary at 7 weeks. Hell they’re biologically necessary for most 7 month olds. Most 7 week olds are biologically incapable of sleeping through the night, and it’s the ones who do sleep through that actually have a problem, not the ones who don’t. Routines are completely useless with a 7 week old, because a 7 week old should be being fed on demand, no matter the feeding method.

All of this means that the most likely scenario should a mother apply advice like the above is that they will end up with a starving, cranky and sleep deprived baby whose emotional and physical needs are not being met. This means that they are less likely to sleep on their own or for long periods of time creating a catch 22 cycle where the mother is now sleep deprived too even if she wasn’t before. This of course is going to cause the mother to feel stressed, cranky, and like she’s a failure.

Here’s the thing about PND, we don’t really know what does cause it. But we do know what the risk factors are, lack of sleep is indeed one of them, as are stress and feelings of failure - so why are we advising mothers with PND or mothers already at risk of PND to engage in practices that will most likely increase their stress levels and interfere with their sleep even more?

That’s just doesn’t make sense!

PND is not a parenting style. It's not due to how you're parenting. Women who have routines for their baby get pnd. Women who formula feed get PND. Women who sleep their baby in a seperate rooms get pnd. It's not your fault and it's not what you're doing  - Nicole Maree

All sorts of things can cause PND.

Syntocinon interference, traumatic births, having people dismiss your pain and trauma, lack of ability to create or regulate oxytocin, separation from baby after birth, stress, returning to work, cultural expectations to do it all, cultural expectations of baby behaviour, lack of support networks, previous mental health issues, single parenthood, deployed/FIFO partner, marital issues, sleep deprivation, hormone imbalance, having a high needs baby, isolation from old friends, difficulty making mum friends, a partner who lumps everything on you.

The potential triggers are varied. The solutions should be as well. 

If we actually want mothers to get more sleep and be less stressed then we should be focusing on finding the root cause of any feeding issues and fixing them, encouraging safe bed-sharing and co-napping and working to create a culture with a maternal rest period  (where the only things mum has to worry about doing in the first month are recovery and bonding) adequate maternity leave, paid parental leave, more equal distribution of household and parenting tasks between partners and a return to living with extended family/friends or having live in household help.

But that would mean recognising how far our capitalist culture has strayed from our biological norm, and apparently nobody wants to do that.

Back to the idiocy of PND advice. Unfortunately many mothers are also encouraged to give up breastfeeding (so that dad can feed baby and mum can therefore sleep or because “you just don’t need the extra stress”).

Now considering that a lot of people with PND have difficulty bonding with their child, why on earth would we want to encourage mothers with PND to stop breastfeeding unnecessarily?

Every breastfeed pumps the body full of oxytocin encouraging bonding. Nature made it that way for a reason. Guess what else spikes oxytocin? Smelling your baby’s head, cuddles, shared baths, and skin to skin. Yet instead of encouraging mums to strip off and sleep cuddling their baby whilst breast-sleeping - giving both mum and bub a triple dose of oxytocin for hours at a time, we encourage them to put baby in his/her own cot, clothed, with a bottle.

Yeah, that makes sense!!!!

Seriously, Head meet brick wall.

Not only does this deprive mum of the much needed oxytocin boost, it deprives the baby too, which can cause their brains to be literally altered for the worse - wiring their brain for less oxytocin receptors. This makes it it more likely that they will struggle with empathy and connection, be more likely to suffer depression and generally have problems with bonding throughout their entire lives.


It’s massively detrimental to take a fragile the mother baby bond and give them health advice that is most likely to sever that atachment, or at least stagnate it. Talk about creating a public health problem.

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Link - How Oxytocin makes a mom 
Link - The Neuroscience of Attachment 
Link - How Oxytocin might help Autism
 Link - Why Nursing is important even if you bottle feed

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This perception that bottle feeding is somehow less stressful or equals more sleep is also completely flawed. Bottle feeding means that someone has to get up out of bed, go to the kitchen, heat the milk, bring it back, hold baby whilst they feed, then get baby back to sleep. You are up for a good half an hour or more. In a bed-sharing dyad with a properly established breastfeeding relationship baby stirs, mum stirs, baby latches possibly with a little help from mum, baby dream-feeds, mum drifts back to sleep. You are awake for a couple of minutes, you don’t have to get up or even sit up, you can do it all with a red-night light so you aren’t disturbing your circadian rhythm, and baby didn’t even have to cry to get your attention.  Plus when you bed-share your sleep cycles regulate with your baby so that you both wake and stir at the same times. Even if baby feeds 30 times a night, you are only just hitting the same amount of lost sleep as one overnight bottle feed produces.

Yeah I know,  it’s not always that easy. I remember very well. My child had feeding issues and couldn’t feed effectively, we didn’t learn to side-feed until probably 5 months (once you do, it’s a game changer). But even with a baby who couldn’t just self-attach I quickly gave up on the idea of doing a bottle feed overnight because bottle feeds caused far more disrupted sleep than breastfeeding in bed did. There’s a reason it’s the biological norm.

So discouraging breastfeeding makes absolutely no sense, unless there are underlying health or trauma issues. If there are those underlying issues need to be addressed and each particular mother needs to make the call for themselves as to which will cause them more stress and more grief - persisting with breastfeeding or switching to formula/donor milk.

Finally there is the incredibly insane advice I’ve seen given far too many times, that mum should leave the baby with dad/grandma for the weekend and go to a hotel.

Look I get where this is coming from, mum gets to truly rest, no house to clean, no guests to deal with, nothing to do but relax and recover. Only there's a major flaw here. She’s most likely not able to relax because all her instincts are screaming that she should be with her baby. And for good reason. Babies should not be left without their mother unless it is absolutely unavoidable. Even if you have to go to hospital for something, any hospital worth it’s salt will provide rooming in for your baby, and help you to be able to keep your baby with you for as much time as possible.

Sending mum off to a hotel causes mum’s instincts to go on alert, which in turn puts her body on alert, causing stress. It’s also causing the body to assume that baby has died, because that’s the only logical reason for such a sudden stop in breastfeeding, so your body’s messengers tell the brain to stop producing milk. Meaning you come back from the weekend with secondary lactation failure. Unless you pump the whole weekend, in which case, you are certainly not getting more sleep than you would at home. As for baby, well their brain is freaking out, assuming that mum has died or forgotten them, so dad/grandma/whoever is probably going to have a child that is inconsolable for hours with stress until they eventually pass out from exhaustion. If they are “lucky” baby will only scream for a short while before their instincts tell them, mum’s dead, and they go into survival mode, where they stop screaming so as not to attract predators. Now yeah, dad/grandma etc is actually there, as long as baby is being held and comforted throughout they will adapt and go “ok, i’m still safe, not going to be eaten by a tiger, calm down, it’s ok.”. But there is absolutely every chance that when mum returns two days later the mother-baby bond will be damaged.


Again, why the hell are we encouraging mothers who have PND, many of whom are already struggling to bond with their babies to leave their babies and further weaken that bond?!

This time I can tell you why, it’s because our culture has separated the mother from the baby so much that we don’t even think about nurturing both together. We simply assume that the best way to nurture mum, for mum to get rest and recover and have her needs met is by being baby free. The rest of the world think we westerners are completely nuts!

Every culture that values mothers, that values mother and baby health (and even a large number that don’t) have maternal rest traditions. Instead of shipping mum off alone or with the girls or with hubby to the hotel for the weekend for “a break” the extended family and villagers converge on the new mother. But rather than having to play hostess to an endless stream of visitors, Mum spends the whole time resting. The family/villagers do all the cooking, the cleaning, the running around after other kids, the entertaining visitors and things like nappy changes and tummy time. Mum just sleeps, spends time with her baby, works on breastfeeding, gets given daily massages, gives her baby daily massages, gets bathed in healing oils and herbs, fed nutritious meals and doesn't have to leave the house. She doesn’t have to leave her bed. She’s surrounded by her sisters/cousins/friends/mother etc so she’s not isolated and starved for adult company. They all follow the same traditional babycare methods they have for centuries, many of which are the biological norm or co-incided with scientist recommendations based of Fourth Trimester research - so there’s not likely to be stress or disagreements in parenting style. Nor is it likely that a new mother will enter motherhood so drastically lacking in understanding how to breastfeed, how to look after a baby or what normal infant sleep, behaviour and feeding patterns look like. There’s no “culture shock” for new parents. 

Oh and also, they wet nurse. Or dry nurse as the case may be, with grandmas and fathers often stepping in as substitutes when necessary.

That is what support looks like.

If we were serious about helping end PND, instead of doling out utterly unhelpful advice that is actually more likely to increase PND rates, we would be taking a long hard look at birthing practices, the utter failure that is the majority of breastfeeding “support” and running public awareness campaigns that break down the entirely cultural (and scientifically inaccurate) claims that “babies should” xyz.

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