Do Strict Baby Sleep Routines Work | What Research Really Says

Ceridwen

Welcome back to the Postpartum Prep Podcast. If you're new here, my name is Ceridwen and here on the Postpartum Prep Podcast we talk about all things preparing for life after birth. We talk about feeding your baby, we talk about sleep, we talk about your mental health and your baby's mental health, and there's so much more that we cover.

We recently did an episode on baby-wearing, next week I have an episode about preparing for parenthood as a dad coming, which that will be really exciting. But today I have, oh my gosh, I'm so excited for today's guest. Today we have Professor Amy Brown.

Professor Amy Brown is a maternal and child public health expert at Swansea University where she directs the Lactation, Infant Feeding and Translational Research Centre. Her work combines her psychology background with infant feeding support. She has dedicated two decades to addressing barriers to breastfeeding and studying perinatal mental health and has published over 150 research papers and led projects that inform global policies on infant feeding.

She's written several books about infant feeding and parenting, which are amazing resources for both parents and professionals. We will actually talk about one of her books in the episode and so I'm sure by the end of this episode you'll understand exactly why her books are absolutely worth the read and why I'm so excited to have her on as a podcast guest today. In this episode we'll be talking about her research around strict infant routines and we're going to be exploring whether strict schedules and routines for babies are actually helpful and what the research says about this.

And we'll also be talking a little bit about the concept of informed choice and Amy will give us some great amazing tips about how to make more informed choices about your baby. I'm just so excited to share this conversation with you so without further ado let's just get straight to it. Oh my gosh, sorry, we're actually not going to get straight into it because I have a little bit of explaining to do.

You will understand when you hear this episode. I don't even know how to explain this. Basically I have a different voice in this episode for a few reasons.

So first of all I was really sick when we recorded this but I didn't want to miss the recording with Amy so I sound a bit weird because of that. I also have a different accent in this episode. Basically my family is from the UK and I grew up in the Cayman Islands so I basically have two accents that I use when I'm with different people.

Make it make sense? I don't know. But I basically in this episode, like right now I would say I have like a pretty American accent.

This is my version of an American accent at least. But in this episode I have a British accent. It's very weird and I don't know.

I just don't want you to be surprised or like what the heck is going on when you hear this episode. But yeah, okay. So don't mind that but otherwise please enjoy the episode.

Thank you Amy for being here today and joining us on the Postpartum Prep podcast. I would love to know if you could just give us a brief introduction to who you are and what you do.

Amy

Yes, so I am a Professor of Maternal and Child Health in Swansea in Wales in the UK. My research, oh gosh it's been going on since I was pregnant with my first baby who is now 19 and a half. My research looks at feeding babies, becoming a parent, all the psychological side of that, the mental health side, all the worries and anxieties that parents might have.

And I try to take those worries and research them and see what is true and what isn't true.

Ceridwen

Amazing. I am a big fan of your research and all your books as well. Today we are going to be talking about your research, talking about books, your research on baby books, specifically baby books that promote strict infant routines.

Here on the Postpartum Prep podcast we have a lot of listeners who might be first time mums and maybe don't know what we're talking about when we say strict infant routines. So I was just wondering before we kind of get into it whether you could explain to us how you would define strict infant routines.

Amy

So the idea we had for that specific research project was looking at these books that tell you to really parent your baby in a certain way. So it's the idea that your baby will do stuff according to the clock. So you would put your baby down to sleep at a certain time and you would wake them up at a certain time and you would feed them at a certain time and if they cried and they were hungry outside of that, you wouldn't feed them.

It's the idea that you can kind of program babies in a way that you can expect a baby to do a certain thing and need a certain thing at a certain time. So it's not kind of the idea, you know, there are lots of books that would say you can have a bedtime routine and you can encourage your baby to start sleeping a little bit more at night and all these things you could try. It's not that.

It's very much the idea that here is a schedule for your baby and if you just do these things, your baby will follow that schedule and sleep and eat and wake up and even be cuddled at certain times of the day or not.

Ceridwen

Wow. And so I would love to know what inspired you to research this. Why did you want to learn more about this?

Amy

Yeah. So I first became interested in the whole idea of this when I was pregnant with my first baby. So now we're talking 20 years ago and you'll know this experience that as soon as you're pregnant, people start talking to you about how you're going to look after that baby and they'll ask you all sorts of questions like, are you going to breastfeed them?

I'd even have people asking me, are you going to do a sleep routine for them? I don't know. I'm six weeks pregnant.

I don't know why this baby is going to sleep. And I just had so many questions on this topic. And I'm a psychologist by background, so I'm really interested in eating behaviour.

And there was this whole overlap with it because there's this whole idea of very restrictive eating when you're trying to parent older children, not being great for them. And it's best to try and encourage their appetite. And the questions kept coming.

Are you going to breastfeed them? Are you going to put them in a feeding routine? And back then it was the question was, are you going to feed them on demand?

And I'm like, the idea of a baby being demanding seems a little bit odd to me, but there we go. And it kept coming once they were born. It was like, well, are you breastfeeding them?

Are they good? That was a big one. Are they a good baby as if you could have bad babies?

Do you feed them whenever they want? And it's like, yes, they're hungry. And I just soon realised that there was all this pressure on new mums in particular to get their baby in a routine.

And I became so fascinated about this whole idea. I did a PhD on it, which specifically looked at the impact of trying to have a routine for your baby on whether breastfeeding went well or not. And it was that whole question, is he fed on demand?

Do you feed him whenever he wants? And I knew from everything I'd read about breastfeeding and normal baby behaviour that your baby knew when they were hungry. They knew when they needed a feed and that feeding wasn't just about milk.

It was about comfort. It was connection. So when your baby signalled for a feed to me, that meant they wanted to be fed and that was my role to pick them up and feed them.

And I just also knew from all the reading that I had done that that was best for my milk supply as well, that I knew that the more you fed the baby, the more milk you made and the less you fed the baby, the less milk you made. But I kind of realised that this wasn't sort of mainstream knowledge at the time, that a lot of people really thought you could and you should get your baby into routine and feed them really strictly and you should maybe feed them every three hours or four hours. So I got so fascinated by that, I did a whole routine into why mothers thought their baby should be in a routine, why they thought that that was the best idea for breastfeeding or for any baby, and then the impact on that of their feeding experiences.

And it was such powerful data, but it just showed throughout all the different studies that I did, that when you try to feed your baby like that, when you try to determine when they were hungry rather than letting them signal when they needed a feed, that was when your milk supply started to drop. And then women often started reporting that they were having a lot of difficulty feeding their baby, that their baby was very fussy or wouldn't latch on very well and it was because they were so distressed and hungry when it came to a feed. And then the milk supply dropped, it became more and more painful and women eventually stopped, usually before they were ready, and they were really distressed about that.

It just really reiterated that whole idea to me that your baby is a little human being, it knows when they're hungry, they know when they're full, they know when they want comfort. But there are so many negative and pressurising messages out there that for some reason just really want you to feed your baby in a routine and really want you to put your baby in a routine. And I think that's really complicated about why that happens, but there was so much pressure on these parents to have a good baby.

And it just all fell apart really. I've just been fascinated by it ever since.

Ceridwen

Yeah, and I think that's why your research has really taken off, because I think so many people can relate to that exact same experience you had, where you're being told things that seem to be the complete opposite of what you're also being told. And also in reality, in practice with your baby, you might just not, I think a lot of people relate to the experience of, you know, the book says this, but your baby is just not doing it. And it's such powerful research.

I would love if you could give us maybe a few more of the highlights of your research, of kind of the findings from this study about whether the baby books, promoting strict routines, kind of how did it work in practice? Did the mums like these books? Did they find them helpful in practice?

Amy

So we went on to do a number of studies about this. So one of the first studies I did was with a collaborator of mine, Dr Bronia Arnott, and we actually devised a scale where we were measuring how much parents thought their baby should be in a routine. So it was predominantly mothers filling this in.

And it was asking, you know, things like, I try to feed my baby in a routine, I try to get them to sleep in a routine, I'm worried about this, I'm worried about my baby, I feel a lot of pressure about it. And it really showed that the more kind of anxious a mother felt about whether a baby should be in a routine or not, the more she tried to put her baby into a routine, and then the more it was all likely to go wrong and breastfeeding was likely to stop. And that was always just so sad for me that, you know, there was so much distress involved and there's so much pressure to put your baby in this routine and you were told only feed them at a certain time, don't even pick them up at a certain time, you know, make sure they sleep at a certain time.

It was just so detrimental to everything, how they felt about themselves, how much they were able to breastfeed, you know, just the whole impact of all of that. So we published a couple of papers, then it was back, gosh, I think it was about 12 years ago now, and then one of my master's students back in, I think it was about 2015, 2016, was really interested in this topic area and Victoria Harris. So for her master's dissertation, we looked at just the impact of trying to follow these routines upon mothers, and we published a number of papers from that.

The first one really looked at whether it was possible to follow this guidance, so whether the whole idea of teaching your baby to be in a routine was actually plausible or not, was it actually real. So if you kind of take a step back and look at how many baby books are on the market, there are so many that sell you this idea that you can put your baby in a strict routine and you should. They have sold millions and millions and millions of copies, far more than any book that talks about the normal behaviour of babies, that babies are these vulnerable little tiny mammals that need you, and they wake up for all sorts of reasons, and they need you at night for all sorts of reasons, and breast milk's really easily digested, and that's good, but it means that they feed lots, and they feed for comfort, and they feed for connection. If you write a book on that, you will sell nowhere near as many copies as if you write a book that says, right, I've got the solution, if you just follow this book, you'll get a full night's sleep, you'll get your life back, you won't be controlled by your baby. So we asked mothers whether they'd tried to use these books, and whether it had worked or not, and out of all the participants who took part in that, we found that about 15%, so somewhere around 10 to 15%, felt that they could follow the advice in the books, that they read the book, and they tried it out with their baby, and it seemed to work.

We didn't actually measure how it worked, or whether it worked on sort of a standardised level, so that could just be their perception that it worked, but what we think was going on is that maybe these babies were just a bit more laid back, perhaps, kind of natural tendencies to sleep a bit more, feed a bit less, just like humans, we sleep more, feed less, eat less, you know, want more contact, less contact, and some babies, just like children, you know, they're easier to encourage into things, so we think it was those babies that you kind of could get them to sleep a bit more, or feed a little bit more spaced out, but the vast majority of mothers in that study said, no, it didn't work, it just didn't work for me, I tried, and for some they went, oh, right, well, I tried that, rubbish, but throw it in the bin, forgot about it, or they just kind of went, oh, well, I can't be bothered to try this, it seems completely at odds with my baby, it's not working, can't be bothered, but for a really big chunk of those mothers, they ended up feeling really distressed, they were upset, they were even more anxious, they felt that they should have been able to follow it, and it was their fault, or they weren't doing it right, or that they'd failed yet again, and they weren't able to do anything, and for some who told us in the study, you know, trying to put their baby into this routine made their baby's behaviour worse in their eyes, so the more they tried to put their baby into a routine, the more the baby fought back, essentially, and went, nope, I'm not going to do that, so every time they tried not to feed it, the baby got more and more distressed, or they tried to put their baby to sleep, and the baby just really did not want to, and they found that far more distressing than the behaviour in the first place, so this is what really worries me, because for that very small group of mothers, they felt better if they could get their baby in a routine that worked for them, great, and it's not saying, you know, never try this, but it's kind of saying, you know, this is going against your baby's biology, babies are vulnerable, they need to be fed frequently, they don't sleep lots, that's just dead, and that's what they're doing, and just kind of that warning with it, really, and never the idea that you should, because one of the big things that has struck me across the whole of my research career into infant feeding is we're not very good at supporting women with feeding in their baby when they say what they're doing is difficult, so they say, oh, I'm breastfeeding, and I'm finding it really tough, you know, my baby feeds every hour, I'm really tired, I've had loads of problems with latch, I'm in pain, our complete tendency is to go, right, stop, then, as if doing something that is difficult isn't worth doing, and you should just not do it, whereas actually, she might really want to breastfeed, and it might be really important to her for all sorts of reasons, or it might be a tricky period to get her through it, and she should be able to have support for something that she's personally finding really tiring, and I think that's what really works for this whole conversation about routines, too, that you might be able to possibly train your baby to sleep a bit more, it's probably not going to work particularly well, but you don't have to want them to sleep through the night, you're allowed to follow their normal behaviour, that's all right, that's not making a rod for your own back, that's supporting their normal behaviour, and you're allowed to do that, that's a good thing, you're supporting them, and you can still complain, you can go, my baby woke up every hour last night, it was awful, and someone can say, right, here's a cup of tea, slice a cake, I'll hold them for a bit, that's great, whereas everybody's kind of response is, well, put them in a routine then, leave them to cry, and that's not what you want, you just wanted support with caring for your very normal baby.

Ceridwen

I think that's why this research is so important for new mums to hear, because, you know, my personal experience was I had read, whatever I'd read online, the first thing that came up on Google, and I was, nothing was even wrong with my baby, you know, I wasn't even concerned about my baby's sleep, but I was just like, hmm, I wonder how much they should be sleeping, so I Googled it, and of course that's where the cascade of distress began, because I'm reading, oh, my baby doesn't sleep like that, I better start getting them into what this, whatever I read in one Google search said I should be doing, and then it's, they're not doing that, so my own distress begins, and I think that's, and I think that's a really relatable, I think a lot of mums experience that, and this is where actually, the only thing that kind of eventually got me out of that was I trained in sleep myself, in infant sleep, and actually learned the reality of kind of this, exactly kind of what you're talking about, how do babies actually sleep, what is really normal for infant sleep, which is not what actually came up in the first Google search that I did, it took me, I don't think parents should have to go through a professional training to get this kind of information, but it is like stopping that distress over, is something wrong with my baby, am I doing something wrong, and I think one thing this brings me to is, I've been reading your book, Informed is Best, which is where you talk about how to kind of spot, you know, what information might be less helpful than others, and also helping the parents who read it to be able to make more informed choices, would you be able to give us kind of your definition of what an informed choice really means, and maybe some examples of how we could make more informed choices when it comes to baby sleep routines?

Amy

Yes, so the whole title for Informed is Best came about because at the time I was writing it, there were all these arguments around the best language for breastfeeding, so I don't think it's used quite so much yet, but I'm sure a lot of parents will still have heard of it, it was this whole idea that breast is best, and that phrase to me, I really really disliked it on so many levels, because it's not particularly helpful, we all kind of start to understand, you know, that breast milk, breastfeeding is really protective for babies, and for maternal health as well, no one's going to argue with that, but just by saying our breast is best, you should, it doesn't actually help you to do anything, and then it can make you feel absolutely terrible, if you're not able to, and you didn't get the support you needed to be able to do that, and it also kind of creates a sort of like system where, you know, the best choice, and the best parent, and everything, and then at the time we also had the phrase that came in kind of direct contrast to breast is best, of fed is best, so it didn't matter how you fed your baby, and what a lot of people behind that message were trying to say is, please stop feeling guilty, this is not your fault if you haven't been able to breastfeed, you know, you definitely shouldn't be feeling pressure and guilt, but the opposite side of that was then women in particular were feeling, you know, that their feeding preferences were being invalidated, that nobody was listening, just everybody was going, it didn't matter if they were having breastfeeding difficulties, so at the time I was just really embroiled in this whole argument about phrasing, and I just remember saying, you know, it's not breast is best, it's not fed is best, it's informed is best, it's the concept that, you know, you should get enough correct information, and good evidence, and you know, enough information that you can make the decision that is best for you, that, you know, if we talk about a baby routine, there might be all sorts of reasons why a parent decides that they are going to try and see if they can get their baby into routine, and if they have all the information about normal baby behaviour, and whether that routine will work or not, then they were informed going into that. If they are just told, yes, buy my book, if you buy my book, your baby will sleep through the night, that isn't being informed, that's being misled, so it just came up with this idea that, you know, for all your decisions around pregnancy, around birth, around babies, there's no right decision for everybody, we have the evidence, but you also have your life, and you have your personal circumstances, and your preferences, and, you know, all the kind of context of your life, and all the things that might be going on, and what you deserve is kind of, you know, information that is evidence-based, that is free from bias from people who have commercial interests in this, or who will make money out of your decision, in a kind of unscrupulous way, you should just get that information, and then you should be supported to make the choice that is best for you. So that's kind of where that title came from, can you get on a book cover.

Ceridwen

Might be a bit long, and it's, that's such an important, and I love the idea that it's not, you know, I think it's very unique kind of book for new parents, because so many books are like, this is what you should do for your baby, versus your approach is, well, I'm not going to tell you what you should do, but let's actually discuss how you might make that choice about what you should do. It's a completely different approach, I suppose, yeah.

Amy

It was more about kind of putting the parent back in control, and understanding that there is always going to be so much influence out there, there's always going to be so much pressure from friends, from family who did it a certain way, you're going to have the commercial interests involved, you're going to have the people selling specific books that will promise you something, and kind of taking a step back and going, all right, well, I don't think we can escape all of that, so how can you judge what is good information or not?

And, you know, there's so much sensationalisation, is that a word?

Ceridwen

Yes, I think so, sensationalisation.

Amy

It is now, of research and headlines, and you see it all the time in the news, don't you? You know, if a pregnant woman eats this, her risk of this goes up five times, and you just think, okay, but what is the actual data? Who was involved in the study?

What did the study do? Was it based on three people? You know, it teaches you skills, really, to go, all right, I know what I want, I know my life, I'm going to look at what research is out there, not I'm going to go to Google Scholar and read millions of papers, although you can if you want, you might be interested in doing that, but it's about choosing who to trust and what to trust, and kind of understanding how the whole industry out there tries to mislead parents and tell them there is a right way for everything.

Ceridwen

Do you have any, you know, obviously, the mums should just go and read this book, which I can highly recommend it, I'm loving it, but if we could give like maybe one or two top tips about how to kind of make more informed choices when they're looking at all this information?

Amy

I guess the biggest one is recognising who is saying it. So what is the background and why are they trying to say it? So have they got an agenda?

Are they trying to sell you something that seems unbelievable? Your Google search, for example, we know that people can pay money to have stuff come up higher up the Google search. So, you know, I know so many times that when I've put a breastfeeding question into Google, the first hit that comes up is usually from a former company, because they've paid for that prioritisation.

That's certainly not to say that formula companies cannot give accurate information, but when they're trying to sell you a product at the same time, it's just being aware that, okay, is this the best source for the information? Are they 100% acting in my interest? Can I find the same information elsewhere?

So if you Google something and you go, oh, right, this says I can get my baby into a routine. Is it from somebody selling a sleep training business? Or do a few different people say this thing?

Do people from different backgrounds say it? So it's really just following through and asking who's telling me this, and why are they telling me this? I think the other thing is with anything that you see in the media, taking a step back, and if it really feels applicable to you, trying to do a little bit of detective work to see where the information has come from.

Because news outlets, you know, they want more readers. They want more money. They want more people to read it.

And if they put a really boring factual headline in, you know, you can see the headline now, can't you? A kind of sensationalist one would be, if you buy this book, your baby is twice as likely to do this. And the kind of really boring one would give you all the factual information about what the actually showed.

So again, it's just kind of thinking about that. A big one that I always see in the media and drives me absolutely crazy is when they use kind of, you know, that technique, and they go, if you did this during pregnancy, your baby is three times more likely to experience whatever. And it's usually a bad, scary thing, isn't it?

But they cry, and you go, three times more likely, that sounds dreadful. But if you then have a look at the research paper, and it says, well, you know, babies, you know, whose mother didn't do this, had a like 0.001% chance of something happening. If they then have a, how many zeros did I use?

0.003 chance, that's three times as much, but still highly unlikely. And that's what the media do so much.  It's just coming back and thinking, who are the trusted sources on your topic choice? You know, what do you want?

And, you know, if being very baby led and very responsive to your baby and just following their normal cues and behaviour is important for you, you need to look at the people who are knowledgeable about that and aren't trying to persuade you otherwise. So it's about you really trying to get to those unbiased sources that just give you factual information. And that can be really hard.

Ceridwen

Yeah, I think it's such an interesting thing, because as a new mum, you kind of, you know, I was just very trusting that everyone would just want to help. And obviously, it's not that they don't want to help, but it's, I didn't realise that part of becoming a mother was going to be kind of having to put my science hat on and actually learn about how to navigate all this information for myself, rather than just being told what I should do. And I think, you know, we've talked about examples with sleep routines today, we talked about feeding and the impact on feeding.

And this has been a really great conversation about how we can build our landscape of understanding in this messy and sometimes very noisy world of infant baby advice.

Amy

I think noisy is such a good, such a good word. Yeah.

Ceridwen

I would love to ask you just one final question before we move on to our Q&A. I ask this to everyone that comes on the podcast, if you could think back to when you were first pregnant 20 years ago with your first, is there any advice you could give to yourself before you'd actually entered into life with your new baby?

Amy

Oh, gosh, I think it would be, be as gentle and kind to yourself as you would be to others. Does that sound too cheesy? 0.007 No, but it is. It's about being kind to yourself. No one knows what they're doing. If you love your baby and you respond to your baby and you cuddle your baby, your baby is very, very lucky.

They will probably fall off the bed or you'll nearly drop them or you'll give them the wrong food or something at some point. I mean, I've got all sorts of stories. But it's just forgiveness for yourself and kindness and recognising that you're becoming a new person, I guess, that, you know, you've become a mother too.

You're a new person. Be kind to yourself through that as well.

Ceridwen

I love that. I feel like I'm going to take that away.

Amy

Yes, I think everybody actually needs that.

Ceridwen

Thank you so much. We are going to we'll pause here. We're going to go to our Q&A episode.

So everyone who's listening, check that episode out next. It should be it will be released the day after this one, or if you're listening to this episode in the future, it should already be released. So we'll go and check that out.

And Amy is going to be giving us some. She's going to be answering some questions about building a postpartum support network. So thank you, Amy.

And I'll see you in the next episode.

Gosh, I am just so in awe of Amy and of her research. And I'm so, so grateful that she's come on here to share it with us today.

You can learn more about Amy on her website, professoramybrown.co.uk. And you can also find all of her amazing books here. She has books that would be helpful for whether you're pregnant or if you're already postpartum or if you're a professional, like there's honestly, she just has so many amazing resources. And I really, really highly suggest you go check it out.

If you are currently pregnant, you might be interested in her book, The Positive Breastfeeding Book, which is about everything you need to feed your baby with confidence. If you're a professional, I highly recommend reading Why Breastfeeding Grief and Trauma Matter. This is the book that originally got me when I was training in lactation, this book was just everybody was talking about it.

And personally, it helped me a lot. But it was also just so inspiring to the book. It talks a lot about the social political systems that can impact breastfeeding.

And honestly, it really inspired me to want to make more of an impact on the greater picture of how we can support breastfeeding. So if you're a professional, I highly recommend that book. If you're a parent, I highly recommend it as well.

But I think it can be inspiring for everyone. I'm also really curious to read her new book, Why One Child Families Matter, because I'm pretty sure that we are going to end up being a one child family as well. So I'm sure there is so much amazing research in that book as well.

All right, well, thank you for listening today. If you are new here to the podcast, please make sure that you are following or subscribed. And if you enjoyed this episode, it really helps the podcast to grow when you leave a review.

And it is my dream to continue offering this kind of support completely for free for expecting parents. And I just really need your help to help the podcast grow. So leaving a review is the best way you can do that on Apple Podcasts or Spotify.

Lastly, if you know of any other moms or parents or grandparents or anyone else who would benefit from this episode, I honestly think I just I can't believe we're not talking about this research that Amy did more. I feel like it is really powerful. And if you know anybody who would also benefit from hearing about it, please share the episode with them.

Let's spread this message with everyone we can. When you're done listening to this episode, be sure to head on over to Amy's Q&A episode about building a postpartum support system. We talk about for pregnant moms how you can start building your postpartum support system, whether you have family nearby or not.

And we also talk a little bit about how as a society we can better support postpartum moms and babies. So be sure to check that episode out next. I will see you there.

Bye for now.