Episode 122 - How to get your baby to sleep
Mel:
[0:00] Welcome to the Great Birth Rebellion podcast. I'm your host Dr Melanie Jackson. I'm a clinical and research midwife with my PhD and each episode I cast a critical eye over current maternity care practice by grappling with research and historical knowledge to help you get the best out of your pregnancy, birth and postpartum journey. Welcome everybody to today's episode of the Great Birth Rebellion podcast and today we have Dr. Pamela Douglas with us because we are talking on the topic of newborn sleep and Dr. Pam Douglas is a leading author. She's an Australian GP. He's like, no, absolutely not.
Mel:
[0:44] What I understand. It's true. Well, what I know of you, Pam, is that you're an Australian GP and international leader in the care of parents and babies, that you're a writer and a researcher. And over the last 20 years, Dr. Pam Douglas has published the evidence base to the programs known as Neuroprotective Developmental Care. So we're going to dive into what that is. And you've translated that research into education programs for parents and health professionals. Models and you've also written 30 publications and a book called the discontented little baby book, and i'm going to stop going on about you now so that you can give us a really thorough introduction to yourself who are you what's your role qualifications what do you do in your day-to-day.
Pam:
[1:44] Well, thanks, Mel. And it's such a pleasure to be here talking with you. Congratulations on all the fabulous work that you're doing. So I am a GP, a proud GP, 1987 actually, which is a while ago now. Yeah.
Mel:
[2:03] I was three at that time.
Pam:
[2:06] I don't say that. Well of course I watch my own children moving into their 30s but I have always had a special interest in the care of families and babies so in 1994 I qualified as an international board certified lactation consultant and practice midst of general practice as a breastfeeding medicine physician in IBCLC for many years. And it's true that I began to develop a research interest in what was going on in this space of post-birth care for families with babies, in part because...
Pam:
[2:51] The diagnosis of infant gastroesophageal reflux disease started in my home city of Brisbane and then began to spread throughout Australia and indeed overseas. And, of course, although we don't want to miss true reflux disease in small children, there was enormous inappropriate diagnosis and treatment of our babies with, you know, anti-secretory medications and so on. So I became really interested in over-diagnosis, over-treatment, and how there were big blind spots, these huge blind spots, Mel, as you'd appreciate.
Pam:
[3:33] Around, well, the breastfeeding, but also what was happening around baby sleep and big blind spots around our bubbies who were crying and fussing so much in those first 16 weeks or so of life. So I began to publish research from about 2005, seeing that this was a way to perhaps make a contribution to paradigm shift in the way we, as a health system, as health professionals dealt with parents and babies and opened the first possum's clinic actually in 2011, began to deliver the possum's sleep program in that context and also, of course, working with breastfeeding and the cryofus problems. Brought that book out, The Discontented Little Baby Book, in 2014 and it's in a new edition now as well as available in Dutch and being translated into Italian.
Mel:
[4:28] Amazing.
Pam:
[4:29] For a minute. And And then have developed up what is formally referred to as neuroprotective developmental care, currently available for health professionals through the NDC Institute. And indeed, we've also got a providers and educators version, but registered health professionals can become NDC accredited. And then the whole other side, the parent-facing side with the Possum Sleep Program. So neuroprotective developmental care is a way of making sense of what's going on. For our families with babies across those domains of baby's health and well-being, the gut, for instance. Also, the central importance of parental mood and well-being, maternal emotional well-being, health.
Pam:
[5:20] And then those three areas of sleep, of a baby's sensory motor needs, how do we protect sensory motor development, and feeds, breastfeeding feeds. So neuroprotective developmental care or the POSMS programs come out of the lenses of evolutionary biology, complexity science, and also that particular holistic lens of a generalist's approach to the care of family. So my GP orientation, I guess, that sort of holistic wraparound clinical care that's as concerned with the heart as it is with the knowledge or, you know, holding the heart alongside the knowledge that's so important for families to have.
Mel:
[6:07] Yeah. A lot of this terminology would be so foreign to us as parents and as healthcare providers. And that's one of the reasons why I really wanted to talk to you because I think that your perspective is quite unique. But in the... Current dialogue around baby sleep and parenting and also in terms of the information that we give to parents as care providers I think we're incredibly underprepared to help parents care for their newborn baby sort of outside of the basic physical needs so I'm really excited to understand everything that you just described so let's.
Pam:
[6:49] Go for it
Mel:
[6:49] Let's go for it so um so you talk about neuroprotective developmental care which will be a fairly new term I think to most people listening so can you explain what you mean when you talk about neuroprotective developmental care?
Pam:
[7:04] Yeah well the developmental care refers to how the way we care for interact with our little people changes as they grow and develop right but we want to have a kind of care available that's developmentally appropriate for that bubby. So with our toddlers, as you know, we can't always give them what they want. We can stay heart-connected. We'll often need to set boundaries with them as part of responsive parenting of toddlers. But that's quite different to our tiny bubbies who really just have, if you like, a biological need for that responsive care. I talk about the dial on the sympathetic nervous system. So we're aiming to keep our little bubbies as dialed down as we can, really, from the moment of arrival on this planet. We're just aiming to experiment with what it might be that's going to keep that little person dialed down, which is not to
Mel:
[8:06] Say… When you say dialed down, so what would typically dial a baby up?
Pam:
[8:16] Yes, so we don't always know, of course, why a little one's dialed up. But the hunger for milk is a big one. Now, in those first few days, as you know so well, Mel, it's more the great hunger for suckling, that neurological drive to suckle. And then, of course, the great need for caloric nourishment gradually kicks in. So that hunger for milk is one big thing. Another big area that's often poorly understood still in our world, particularly after the baby's reached about two weeks of age, is what we might call a hunger for rich and changing sensory motor nourishment. So we can unpack that together a bit, if you like, later. Just even in the very, let's talk that newborn who's just arrived into the world. So we know that there's this sort of powerful need for physical contact, for being up close to that loving adult, loving parents, loving mother's body, which of course wraps the baby around with sensory motor nourishment, stabilises their physiological systems and dials babies down.
Pam:
[9:26] And there's the basics like the need for warmth, but that frequent flexible access to the breast in the first time. Hours, days of a little person's life meets that powerful biological need for the sucking, it meets the need for caloric intake, but more broadly, it meets that need to know that for the baby to be a part of, if you like, a loving adult body, an extension of a loving adult body.
Mel:
[9:58] So would we think about that as we parent newborn babies is not putting them under sort of unnecessary duress by denying those fundamental needs of closeness and suckling and obviously their basic physical needs of being warm. So when you say dialed down, would that be keeping the babies in a state of, I guess, less stress?
Pam:
[10:24] For yes yes it's true absolutely i try not to use the word stress because you know it's it's a kind of loaded word isn't it the whole of life the impact of life upon our human organisms is a certain kind of stress isn't it but yeah but but if we're able to keep our little ones i think of it as dialed down then actually we're optimizing the settings of their stress response in fact the thought is that that can have lifelong impacting because the first 16 weeks is a time of real neurological sensitivity for our bubbies and as you know and your listeners will know it's
Pam:
[11:08] It's a time of life when, you know, some babies, they cry, they cry a lot. Now, in the POSMS programs or NDC, Neuroprotective Developmental Care, we would both say, yes, this is a time of neurodevelopmental sensitivity and it will pass. But there's usually a lot that we can do, actually, to help that little one dial down. If you're getting the kind of clinical support, I guess, that our NDC practitioners are offering, which is right across all of those domains and particularly helping with feeding issues, these sleeping issues and sensory motor needs, which are often still so poorly understood by our health system. And so, yes, a time of neurological sensitivity, the first three to four months, but there's often a lot that we can do to help dial a little one down. It's terribly distressing for parents when they have a baby who cries a lot. And there's often quite a lot that we can do.
Mel:
[12:13] Sure. Okay. So what I'm hearing, if I'm going to summarise this, is that essentially in the first, obviously from the minute they're born, but up to 16 weeks where there's significant neurological development that goes on for a baby. And that there's ways that we can positively influence that change. And so you're calling it neuroprotective developmental care. And so I'm assuming that there's a type of approach to caring for a newborn that would be, I don't want to say neurodestructive, but that doesn't facilitate that development.
Pam:
[12:57] Yes, yes. And I should just acknowledge Hyda-Lise Al's work with PREMIES. She did, and she had a term. It was a bit different to neuroprotective developmental care, but somewhat similar. And I've always thought I'm trying to offer something similar for our term bubs in the post-birth period. So just to acknowledge Hyda-Lise Al's work. Yes, so I suppose also I should, as a caveat, say, Mel, I think of the mother-baby pair or the parent-baby unit, if you like, as... Complex system that's incredibly resilient. So I just know, let's say someone's listening here and they've had a really rough start and the bubby's crying a lot more than they want. I just would want that family to know that there's a profound and biologically driven resilience within their family system and within that little bubby. So we don't need to fear bad developmental outcomes if you like so just to give it that context but we we like to make things as as optimal as we can to kind of support the development of our little people and and so that's what you and I are talking about I just want to put it in context because I know for those who've had a rough trip rough journey we don't want to be compounding despair when it's not necessary because there's a tremendous resilience.
Mel:
[14:24] I'm very glad you said that because in my head I'm thinking of parents who are currently awaiting their new babies and doing everything they possibly can to get ready. But, of course, we all have a story and many people listening have already got babies that now if they listen to this thinking, oh, my gosh, what did I do?
Pam:
[14:44] Yeah. It's all about workability, not perfection, and so much in life is out of our control. Including what happens with our parenting and so we just give it our best shot and trust in the resilience of that child but let's address the things that might optimise because it is a time of exquisite neuroplasticity as you were saying those first 100 days after the birth so what might optimize a little one's developmental outcomes well these are things of course that are so familiar to Mel but um
Pam:
[15:27] The hospital setting has become quite good at the skin-to-skin contact in the first hours after the birth of that little person. If it's gone awry because your little one's been off in Neku, it's okay. We're talking about complex systems, resilient systems here, so I just want to say that. But if we can do that, of course, it is fabulous. and it gives that little bubby opportunity to turn on his or her mammalian reflexes to find their way to the breast and start to get oriented and come onto the breast. And what we do know is that Frequent and flexible access to the breast or frequent and flexible removal of milk really from the breast in those first few days really does help set the milk supply, the milk production in a way that will meet the baby's needs. So you're advocating
Mel:
[16:27] For a more flexible and sort of not rigidly timed feeds in that early period.
Pam:
[16:36] Very much so. So the possum's concept of frequent and flexible feeds is actually quite a bit different to what you might hear of as demand breastfeeding. Firstly, we wouldn't frame it like a woman doesn't have to wait for a baby to give cues. In fact, in the possum's programs, we don't really give parents lists of cues for anything, whether it's sleep or breastfeeding, because that can really disempower parents because you just have to experiment. We don't know. We have no idea. No one knows what your baby is really trying to communicate. But we just experiment. We try one thing. We try another thing. That's the whole process of parenting. And as we move out of the first couple of weeks of life, in the possums programs, we're always talking about two tools. We've got milk or sensory motor nourishment. For these tiny little newborns, of course, milk, milk, milk is just to the breast is our big go-to without any coercion or pressure, no pressure to the breast. And this, of course, Mel, is where we run up to big health system blind spots around breastfeeding. But frequent flexible feeds, before we even get onto that, is just...
Pam:
[17:55] You know, I'm often saying to women, look, don't look at the clock, but maybe 12 times each breast in a 24-hour period would be normal for, I actually think, a majority of women to maintain their supply and meet their baby's needs for adequate weight gain. So without looking at the clock in ways that are often very erratic and not always lasting for long at all 12 times each breast would be a kind of rule of thumb but you see the bubby mightn't have
Pam:
[18:29] Been on for very long now and you might just think in 10 minutes time oh I'm going to offer again I think that might help dial my little one down it can be tremendously irregular erratic but we do want frequent flexible offers of the breast much more perhaps than we're used to thinking of in our society we don't need to be draining the breast I suppose I'll just throw this out since we're having this conversation yeah because that can make women feel as though they're locked into the breastfeeding chair we don't need to be draining any breast most milk is transferred within the first two letdowns actually not that not that women usually feel their letdowns but I just say that because it can be quite brief at the breast or you might have had enough and you take the bubby off knowing that you'll offer again if the little one's dialing up so yes I could go on a bit about frequent flexible feeds because it's quite a it is a paradigm shift but so important actually to be able to to you know meet the little one's caloric needs that concept of frequent flexible feeds and also to just have the breast as that kind of tool in a way that makes the days as easy and as enjoyable as possible because to my mind that's the most important thing about breastfeeding it just makes the days as easy as possible and enjoyable Yes,
Mel:
[19:55] We used to talk about the path of least resistance with our feeding journey and, you know, we co-slept with our babies and just made the rest always available and I guess partly it was because I instinctually felt like that's what I wanted to do and what my baby wanted to do. But honestly, it just, I could not be bothered fighting for another way to nurture my baby because it just, it felt like the easiest.
Pam:
[20:26] Exactly, Mel. It's one of the big things in the Possums programs, you know, it's about what works for you in your unique context as a mother, as a parent. What's easiest and most enjoyable? How can we grow joy in early life? In fact, that's even the possum's motto, growing joy in early life. Because we do live in a society that's quite rule-bound when it comes to parenting. And it's scary because you hear that if you don't stick to these rules, you know, thinking sleep, for instance, it's true with breastfeeding, but sleep too, then somehow, you know, let's say if you're not sticking to rules that you might hear around sleep, you do hear parents at all, that it will impact on their child's capacity to learn at school age or their child's behaviour down the track, which is actually misinformation if you look at the research. But parents will walk over hot coals to do the right thing for their bubby. So if they're getting this information, let's say about sleep, it's really scary. So they try very hard to do what
Pam:
[21:40] They've heard is the appropriate thing to do and it's the sleep training of course that's very dominant in our society at this time gosh i had hoped 10 years ago i mightn't have to say that still but but it actually still is very dominant even though the research would show us there's eight systematic reviews that i'm aware of now and mel you'd know how a systematic review pulls together all the existing research that shows that sleep training doesn't decrease frequency of night waking for parents, but it's still dominant. And parents don't even, you'll have folks who are offering, you know, like sleep coach work and so on. They mightn't even use the word sleep training these days. They might say, no, I do gentle, responsive work around sleep.
Pam:
[22:32] It's actually still using fundamental principles that come out of the first wave behavioral or sleep training approaches and in fact it's the possum sleep program that has been the real paradigm shift in the research literature starting from 2014 really a shift from a whole into a whole new paradigm which you know I think would feel very um just intuitive to you but when we're repairing big social movements then we have to go about that in very wise and clever ways and as health professionals we have to be able to do that that repair in a way that's very respectful of other health professionals and very respectful of parents and how they're making sense of their baby's behavior so it actually requires a great deal of care and skill I think to deliver but wouldn't it be great to have a world where we didn't need to do that that sort of repairing
Mel:
[23:36] Yeah well I think too you know I parented my first baby in the context of completing my phd.
Pam:
[23:46] Amazing.
Mel:
[23:48] Right. So there was a lot of motivation for me to try and get the baby down in the bed because I thought when the baby's down sleeping, I could get some work done on my PhD. And I remember spending about two days trying to get the baby down when he was asleep. And I thought I am spending 45 minutes of my time after he'd gone off to sleep in my arms because we did, contact naps you know just pop them in the carrier and I fell asleep and then I thought oh okay they're asleep maybe I can put them down and get a little bit of work done and I just found it the most time-consuming adventure and eventually just went what are you doing just keep them on and so I used to stand at the kitchen bench typing away with the baby on my back and I'd carry on with everything in my day so.
Pam:
[24:41] Much very good PhDs have been done like that
Mel:
[24:45] Well but it was so um unusual you know I'm coming from that perspective but also, aware that their everybody's lifestyle is different yeah you know and and i wonder if we like to be as in control of our day as we possibly can and society encourages that kind of scheduled living well.
Pam:
[25:06] The way i frame that is around our baby's needs to reach and changing sensory mode and i'll get this will make sense in a minute so our babies do have this powerful biological need for rich and changing sensory motor nourishment which is actually laying down those neural pathways for the rest of their lives and our interior environments are very low sensory babies typically dial up after the first couple of weeks of life once they sort of wake up out of those first two weeks they'll dial up inside our homes just because there's not enough going on from a sensory point of view. And so actually being out and about keeps the baby's style down. And if we can get really socially engaged, you know, meeting up with friends, all the parents' groups, getting lots of walks in, and the babies just love it, being out walking. Now, I say this because the truth is that some of our little ones, our baby's sleep needs are incredibly variable, right? So we can have, let's say, a two-month-old who
Pam:
[26:21] Hardly needs nine hours total in a 24-hour period. We know this from the big cohort studies that have been done internationally. And then we can have another two-month-old who might need nearly twice that amount of sleep. So incredible variability.
Pam:
[26:37] The one who only needs eight and a half or nine hours total in a 24-hour period will only take five minutes here, 10 minutes there during the day, like maybe half an hour total during the day or whatever. And so with that kind of bubby, you can see that it's not going to work to be able to get our paid work or our PhD or whatever done while the little one's sleeping during the day. And so whilst we're often saying to parents, whatever works for you and your family is brilliant, but often it doesn't necessarily work to be trying to get paid work or PhD responsibilities or whatever done when the bubby's sleeping, if you've got a baby who's average to low sleep need during the day. So, and so this is where I guess in terms of scheduling, this is, I finally got to it Mel, the scheduling is that I'm always saying, let's schedule in the days, let's, to the primary carer, I will say, let's schedule in the most interesting socially engaged day you could possibly create for yourself with the baby in tow outside of the house. And so the baby, sleep looks after itself on the go if there's this context of rich and changing sensory motor nourishment.
Pam:
[28:06] You know, happens as soon as we step outside the house, really. And it's that kind of scheduling of things that you'll enjoy as a primary carer, that's really important at this time of life, because we wake up exhausted. So to think, okay, what am I going to do today? It's just never get out of the house, you know, but if we've got it all planned, I'm meeting with this friend at 10 for coffee at 11 o'clock, I've got a little, whatever, swimming class or music class, you know this afternoon we're going for a walk then that kind of scheduling is really powerful for families but the sleep just looks after itself if the little one is having frequent flexible access to the breast let's say primary care is breastfeeding woman or we can use the bottle if it's a family who is using the bottle in ways that are frequent and flexible using the concept of paste bottle feeding. I've got some good free videos available actually for families on the NDC Institute site under free resources that illustrate things like paste bottle feeding and yeah,
Pam:
[29:13] Your two tools and then out and about having the most enjoyable day with sleep. Just looking after itself. We're not trying to get the baby to sleep. We're not trying to keep the baby asleep um we're just is it milk is it sensory motor nourishment how can i have a day that i really enjoy oh that's such um
Mel:
[29:37] That is such freeing information because women often talk about how much easier looking after their baby is when they have a house full of visitors or they go outside and actually do something. I know. It's doom and gloom when you wake up at six or five or four in the morning you know to discover that you've got another potentially 18 hours of you know day to do, before somebody comes and is with you for the day again. Yeah, I mean, I personally found that easier too. I would always just say if the baby was unsettled, I used to just take their pants off and put them outside.
Pam:
[30:23] Exactly. That's right. That's right. That's right. That's right. Yeah, they love to have a good kick without the nappy. I mean, the newborns, maybe less so, but as soon as they're sort of, yeah, it really works, doesn't it? And I just frame that as sensory motor nourishment. They love it, you know.
Mel:
[30:42] There you go. So there's a scientific reason why us as parents actually find it easier to parent when we're not in the house all alone.
Pam:
[30:52] Exactly.
Mel:
[30:52] Because actually the baby is finding life easier and, as you said, is dialed down when they also have that level of stimulation.
Pam:
[31:01] That's it. That's it. You see, in the POSMS programs we don't even use the concepts of overtiredness or overstimulation because they really come out of those first-wave behavioral sleep training approaches. It's like a philosophy, really, because in the 1970s, when I was 14 at school, we had to do, the girls had to do mothercraft, and that's what we were taught. We were taught, you know, routinized feeds. We were taught don't let the baby get overstimulated, bad for the nervous system. We were taught routinized sleep. This is way before the advent of evidence-based medicine. It's actually a philosophy that started in the 50s and 60s. And kind of, you can see, we live in times of such profound disruption around our relationship, if you like, with the environment, with the planet.
Pam:
[31:58] And it comes out of a particular worldview and that same worldview that hasn't really understood our relationship with biological systems has informed the dominant approaches here to, let's say, infant sleep and even to some extent still to breastfeeding, but certainly infant sleep. So we're still, the sleep training approaches would tell parents that it's kindest to you as our mother to entrain your baby's biology of sleep. And you entrain your bub's biology by putting in place these routinized approaches to sleep. You know sleep breathe sleep which is a physiological falsehood actually but parents will hear sleep breathe sleep first tide signs get them down try to get these big blocks of sleep during the day get them down at you know seven o'clock in the evening or whatever try to have 12 hours in bed overnight don't let them get overtired overstimulated try to teach them to self-settle by not developing up bad habits. Don't let them feed off to sleep or be cuddled off to sleep. Try to develop up
Pam:
[33:22] Positive association with the cop, all of this misunderstands. It actually misunderstands what triggers sleep. Sleep is not triggered by associations. It's only under the control of the two biological sleep regulators, the circadian clock or body clock, and then sleep pressure, the sleep wake homey stat. They're the two things that control all of our sleep, but our baby's sleep. And so if we want to get in sync with our little one's sleep, What we need to understand is how to work with the bubby sleep regulators.
Pam:
[33:57] And that's the key. And so there's developmentally normal night waking. And I always say to parents, I'm so sorry to have to say this, but I know from the big cohort studies that have been done now, it is normal for our bubbies to wake every couple of hours right into toddlerhood, way beyond. Absolutely normal but the key thing is for all of us to get back to sleep really quickly and we do know that our breastfeeding women are getting as much or more sleep overall than our families who are needing to use bottles for instance so the trick is we want to get our sleep as in sync with your body clock as possible and then when that bubby wakes back to sleep as quickly as possible and usually that's with the feed breastfeed yeah if the woman's breastfeeding um
Pam:
[34:55] Then we have in our society a real problem with excessive night waking. And in fact, the excessive night waking is from disruptions to the body clock. And that occurs because, actually, of all of this very unhelpful advice that is dominant in our society. So our society and our health system, with its dominance of sleep training approaches, even if they're not being called that anymore, even if people are saying it's responsive settling or whatever.
Pam:
[35:28] In fact, the emphasis on trying to get big blocks of sleep during the day, trying to have bubbies in a sleep situation for long periods of time, let's say 12 hours overnight, ideas around tired signs to get them down, this actually disrupts baby's body clock settings. And we can end up with these patterns of waking every half hour, every 45 minutes, every hour. We'll all have bad nights but when we're getting patterns sleep is all about patterns over time so when we're getting patterns of excessive night waking that's when working with the possum sleep program to do a reset can really make such a difference to family's well-being and enjoyment actually um is it making sense now when i say all of this absolutely
Mel:
[36:23] And i'm just thinking to myself how big this is and how absolutely this one episode is not going to give parents the big golden answer to all of their sleep needs for their babies. So just any parent who's listening and thinking, oh my gosh, we are in this pattern. And I can see some places where you could make this whole sleep situation easier for you. In the show notes, we're going to put all the details for Pam's programs and all of her website information available so that if you're resonating with this message where you can see places where you could make this whole journey easier for you and your baby.
Mel:
[37:06] That you start to tap into some resources because this episode is not going to be the golden answer the idea is that we're introducing this new idea well it's not new I mean it's you know new to a lot of people listening but it's definitely counter-cultural so for a lot of people they're listening and thinking oh man even me as a care provider and as a parent who I believe parented intuitively, still had the belief, you know, and I'd read things that said, if your baby has slept for less than 45 minutes, you can't count that as a sleep. And I thought, wow, my first baby never slept then ever, did not get a day sleep in his life. You know, and so I thought, wow, that can't be true, because he's a very well and healthy 11 year old now. It's highly unlikely that he was repetitively sleep deprived for the first two years of his life. But yeah, I guess I want to encourage parents if any of this is, new information to you and it's interesting that that PAM's website is the place that you're going to find extensive information the idea today would be to introduce it.
Pam:
[38:17] Can I just jump in there because we've got a when baby comes home kind of program it's for parents who are expecting a bubby to just sort of get them oriented for those first hours and days and weeks so it just sort of supplements the usual antenatal key but with a specific focus on how to get things on track um so
Mel:
[38:42] Yeah i'm feeling the collective sigh and breath out of every parent listening that we just so nice.
Pam:
[38:49] You say that it's yeah yeah
Mel:
[38:51] That we just don't have to commit to these unrealistic expectations around our baby's sleep and that it's okay to intuitively, parent and as you said go for the most enjoyable least resistant path and that actually, babies are wired to survive and to rest and we just have to not get in the way of that by the sounds of things.
Pam:
[39:19] Yes, yes, exactly. And then as a health system, we want to, you know, this is talking to Mel, really, you know, how it is with educating our health professionals. So I think we need this twofold thing of parents bringing back the power. This feels right to me. And this is what I'm going to do with my bubby. And then as health professionals, I guess, you know, an invitation to join us really in the NDC Institute where we're looking at a whole new skill set for supporting parents in just growing joy, which is so good for the baby's brain. I mean, it's good for us. It's so good for the baby's brain. You know, we just want to grow enjoyment. Yes.
Mel:
[40:03] Yeah. Well, can we take a chance to describe sleep physiology for babies? You know, some of the dominant language is, you know, they have a 15-minute REM cycle and then they will go into their deep sleep cycle. And then when they finish that, they'll rotate back into that again. I mean, this is the information that I've seen shared.
Pam:
[40:26] Yes. Yeah.
Mel:
[40:27] But what is the actual science of newborn and young baby sleep physiology?
Pam:
[40:33] Yeah, yeah. Well, you see, you'll notice in the POSMS programs that we just don't ever talk about sleep architecture for our newborns, let alone our infants and toddlers, because actually those estimates around sleep cycles are quite misleading. Sleep, human sleep is designed to be incredibly adaptive. So we know that newborn sleep is kind of mix of active, quiet sleep. We don't even use that description so much for our newborns.
Pam:
[41:09] But as parents, we kind of don't even have to think about it. Sleep is sleep. It'll often just be for a few moments, let's say at the end of a feed. Very common, we put a bubby down and the bubby wakes. Very normal, just means that the baby didn't need more sleep at that point in time. The sleep pressure wasn't that high. And they'll cry, so we want to pick them up. But that doesn't mean they have to go back to sleep, you know. We can just be so relaxed about all of this. So, yeah, so we just think it's really disempowering to give parents graphs or figures around sleep cycles because it's not helpful. It's true that a breastfeeding woman, let's say, may often give a little one, say, 10 minutes if the bubby's gone to sleep with breastfeed, which is biologically normal. Of course, this is a very powerful tool for dialing our little ones down and then the sleep regulators. kick in. We don't have to burp or hold up right afterwards because that can be very disruptive actually and has no benefit, believe it or not. I know this sounds weird when I say it, but we don't have to be burping our babies.
Pam:
[42:17] We don't want to disrupt that sleepiness, but breastfeeding women might just sort of wait 10 minutes or so because the little one is likely to fall into deeper sleep before they try putting them down. But as those of you who have babies will know, it's just so usual you do that and then up wide awake and then it's on with the day a little transitional breastfeed very often and then on with the day
Mel:
[42:41] I used to do what we called it the like the ninja roll away from the baby so I'd feed the baby to sleep and then gradually lie down with the baby and then shuffle my body away slightly and then when I think that the moment's right just pop my breasts out and sort of ninja roll off and hoping that they hadn't noticed I was gone.
Pam:
[43:07] That's it. That's so funny. Exactly. Exactly. I think any... Woman listening in who's had a baby will identify with this. Actually, and the word ninja, it just, I love that. And it just makes me think, I've got this whole section in the sleep program on caring for you as the primary carer. Very often the woman, but I don't like to make assumptions, of course. But I've got a whole section there on caring for you, which essentially translates strategies out of acceptance and commitment therapy, which is a fabulous modern form, if you like, of CBT, but I think in certain ways, more empowering for parents in the perinatal period, but also self-compassion, which is just so huge, isn't it? And one of the articles I called, How Can We Become a Self-Compassion Ninja? And so when you were saying the word ninja there, I was thinking, yeah, let's become self-compassion ninjas as well.
Mel:
[44:13] It's not just sleep ninjas.
Pam:
[44:16] Exactly.
Mel:
[44:17] So then what I'm hearing is that we don't need to cling to specific times or even length of sleep for our babies. And you described earlier that actually each baby will be different in the amount of sleep they need.
Pam:
[44:35] Absolutely. Absolutely.
Mel:
[44:36] And we can't know which one our baby is except through noticing. Is that correct?
Pam:
[44:41] Experimenting. That's it. You know, the big thing with our newborns is just circadian cues, like the cues that because the bubby's body clock at birth is not at all mature, you know, but can really support that rapid maturation of the body clock settings by just... Daylight noise activity, even little naps, let's say we pop the bubby down, it's in the midst of light noise activity. As you'd be aware, Mel, the baby needs to be in the same room as a loving carer anyway, whether it's day or night time to protect sleep safety. And so light noise activity, the evening is kind of like daytime, light noise activity. There's a lot of misunderstandings out there around melatonin and dimming lights and so on in the evenings. It's frankly quite depressing, I think, for families to feel they have to do that.
Pam:
[45:44] So we've either got light noise activity and any sleep that's happening on the go is in the midst of light noise activity. Or the big sleep at night where we're still eye-contacting, cuddling, nurturing in the night. But the big circadian cues are of darkness, quietness, less activity. So right from birth, light noise activity during the day and then, you know, the circadian cues, if you like, of the big sleep at night. That is what will help your little one's body clock get in sync with yours as quickly as possible. It's quite common, you know, for me to see parents coming in at a six-week, eight-week mark just beyond sleep deprived, like it's just horrible. And their bubby has this kind of reverse setting on the circadian clock doing these huge
Pam:
[46:38] Naps during the day but then the mother might experience it as breastfeeding all night or all this groaning and grunting and writhing through all the night we can't get any sleep and it's because the bubby's body clock settings at night are sort of ready for daytime level of activities and the little one might go in and out of some light sleep and just keep feeding feeding or might be doing a lot of sort of half asleep but groaning and grunting and parents can't get any sleep. So even there, we need to be thinking about, right, how do we get your bubby's body clock more in sync with yours? But, of course, this is where parents are often given inappropriate diagnoses,
Pam:
[47:23] Like, oh, the baby wakes whenever you put him down because he's got reflux or the bubby's groaning and grunting all night because of gut dysbiosis or allergy or wind pain, whereas really it's the sympathetic nervous system dialing up, which does cause gut events because the gut's like a second brain, but it sort of flips it, you see. The baby's dialing up and then you will hear some wind being passed or there'll be a little puke, swallow back or whatever. So it is often quite a time of sleep crisis in those first couple of months. And again with the possum's sleep program we just look at in in in gentle appropriate ways for a tiny little being who's just arrived on this earth how can we get that body clock in sync with the parents i mean right across all their physiological systems really we're just wanting to get that mother and baby parents and baby as in sync as we can so that things are as enjoyable I think a possibility what
Mel:
[48:30] Are the initial strategies that you suggest for those parents who feel like their baby's sleep cycles are switched and the nights are so unsettled.
Pam:
[48:38] Yeah Yep. So often this is where parents are thinking, well, my baby's got to get these big blocks of sleep during the day. Sleep breeds sleep. So the problem at night is possibly that he's not getting enough or she's not getting enough sleep during the day. So the concept of contact napping is often something we'll talk about in this situation. Because I'll say how incredibly good it is for your little one that she's being wrapped, he's being wrapped in so much physical contact with you. It is so good for our babies. But it can, if we're always holding the little one against us when they're napping during the day, it can almost become a womb-like situation or a nighttime-like situation where the little one is doing big blocks of sleep. And that then disrupts the body clock settings at night over time. It always takes time, a couple of weeks, to change body clock settings or to impact on body clock settings. So in this situation, both affirming how incredibly fortunate that little one is to have all that body contact is so good. But why don't we experiment? I'm just putting a little one down.
Pam:
[49:59] When they've gone off to sleep. And if they wake, then the sleep pressure wasn't that high. Often there's a little transitional breastfeed, but not to go back to sleep, just on with the day, rich and changing sensory motor nourishment, you see.
Pam:
[50:16] So actually, we want big focus on sensory motor nourishment, drinking in the world, being out there on adventures, like going for a walk or getting down to a cafe if you live in a town or city or going out to have a look at the farm if you live on a farm you know just getting out where there's such complexity shopping mall if it's too hot to be out in the in the sun whatever it is that's not inside your home I'm afraid you know because it's so much work to meet a baby's sensory needs one-on-one inside the low sensory interior of a home but if we can just get out the world does it for us it's so much less work and housework you can do next year
Mel:
[51:03] Yes you can.
Pam:
[51:05] Maybe dirty
Mel:
[51:07] Clothes for the whole year it's very tricky isn't it i mean i find parenting a one job a day journey so if i managed to pack or unpack the dishwasher i figured i'd done my one job for the day and I mentally tick off that I yes it's very challenging.
Pam:
[51:28] And you can see I'm just sort of trying to put ideas out there because Karen's just that primary carer just experiments she patches it together she tries out different things so
Mel:
[51:43] We're talking full exciting days and quiet settled nights.
Pam:
[51:49] Yes, although the evenings is a whole thing Mel because
Pam:
[51:53] You can see that the sleep pressure is rising in the evenings.
Pam:
[51:59] And so parents just know, like you just know, that your baby's sleep pressure's rising and the baby's becoming more fragile. But the dilemma is that often it is two exhausted parents looking at each other or indeed a solo parent doing yet another shift after a day of very hard work on her own. So the evenings are quite a vulnerable time for families and particularly, you know, internationally, babies go down to sleep a lot later than in our society here in English-speaking countries because here we've got the sleep training advice, which has become, it's kind of permeated as normal, which is, you know, healthy sleep is a nice early bedtime for babies and children. But internationally if you look at the research bedtime is more like you know nine closer to parent bedtime depends on the baby's sleep needs and often of course in cultural contexts where there's a great deal happening in the evenings full of rich and changing sensory motor nourishment so it's quite a dilemma for us in our world where there's high levels of parental exhaustion inside a home in the evenings, baby sleep pressure rising, of course we're hanging out without baby to go to sleep I mean that is just, of course we are the dilemma being
Pam:
[53:28] And look, if everything's going well with sleep at night, we don't need to worry. But the dilemma, of course, is when we've got the excessive night waking and then a little one who is dropping off to sleep really early in the evening, maybe waking 1am or 2am and from then on every 45 minutes or every hour, you know the pattern because it's so normal. It doesn't have to be normal. It's so common in our society and it's utterly exhausting for the primary carer. So the evenings, actually, if we're needing to make changes, I'm always encouraging those parents to be getting really social in the evenings or scheduling in adventures like Thursday nights we go down to the local work. Italian cafe or, you know, we meet with friends for a barbecue or we bring people over or we just even go out for evening walks if you can do it in your climate.
Pam:
[54:23] Anything that meets that baby's sensory motor needs in a way that's as easy and as enjoyable as possible for that parent or those parents. It's a big dilemma. So many primary carers are doing it on their own, even in the context of another parent's involvement there's evenings are a really vulnerable time the many women and their babies or primary carers and babies and and what can help is to think really creatively about how to bring in rich and changing sensory motor nourishment so that you don't have to do it all so that we keep that little one dial down while the sleep pressure is growing really really high until you reach that point where you know my child absolutely needs to sleep and then it might just be that little breastfeed you see and off to sleep and you're not spending long long periods of time trying to bounce a little one to sleep you know locked away in a in a dim bedroom trying to breastfeed the little one to sleep but it takes an hour because that's a sign that the sleep pressure isn't high enough and so we just want to be come come back out it didn't work come back out into the living room and rich and changing sensory motor nourishment until sleep is easy it just doesn't take long because the sleep pressure is is so high right does that make sense now it
Mel:
[55:49] Does take home message if you're busting your butt trying to get your baby to sleep, it probably isn't ready for a sleep.
Pam:
[55:59] Yes, exactly.
Mel:
[56:00] I guess the challenge is I've caught myself trying to put my baby to sleep when I was tired.
Pam:
[56:07] Of course.
Mel:
[56:09] And I think, please just go to sleep because I need to go to sleep. And I guess that's why it's important in your program where you talk about caring for yourself so that potentially you're not parenting out of exhaustion. You're parenting because you've noticed the needs of your baby. Can can you talk about because you talk about q-based care, What does that mean? Part of the philosophy of the way that you care for families is to encourage cue-based care. Can you elaborate on that?
Pam:
[56:46] Yeah. Well, I would never give lists of cues, right? But it's just this dialing up. That's the basic way a baby communicates, isn't it? And the dialing up can be just even coming up out of sleep, starting to do all that groaning and grunting.
Pam:
[57:05] Back arching and then getting a bit grizzly so the dial's coming up more and then the baby who's crying has the dial turned up full and a scream is the dial is so on full bore you know so the idea of cue based care is we're just experimenting with keeping our baby dial down so in a way it's what we've already said um so it's not giving lists of things like rubbing the eyes or the eyes looking red because that's all so misleading actually or yawns see I can yawn because I'm relaxing not because I need to put my head down to go to sleep I can yawn and I don't even know why I'm yawning but but we we often give parents these lists of cues which is very confusing because cues are always contextual what's going on in that unique family's life at that minute so we just talk about the dial and cue based care is can we keep that little one as dialed down as we possibly can we can't always we give it our best shot and then enormous self-compassion and uh and knowing that even if we're not able to dial our little one down
Pam:
[58:22] Parents who've got older children will know this too. You know this, you know how it is. We just can't always pretend to dial that little puppy down when we want to and there's this enormous resilience actually. It's patterns over time of intending to keep our little one just dialed down as is sensibly possible as a pattern over time and then enormous lashings of self-compassion.
Mel:
[58:48] And I suppose in a practical sense, if you're a parent and you've got a baby who you believe all their needs are met except they are tired and crying, obviously that's a baby that's dialed up. Are there settling strategies that are nurturing, neurodevelopmentally nurturing to a baby that can help turn the dial back and help settle that baby to sleep?
Pam:
[59:18] Yeah. So you'll see I often don't use that phrase, settling strategies, because I've been so concerned that it's arisen as a kind of compensation to disruptions around breastfeeding, frequent flexible offers and then an understanding of a baby's needs for rich and changing sensory motor nourishment. So in fact, coming to the breast, the woman's breastfeeding is the fundamental settling strategy, isn't it? And then the second strategy, depending on, you know, it's just the change of sensory environment. So in fact, it might be either, oh, the breast or the bottle, or I'm just going to step out onto the deck if you're lucky enough to have a deck or I'm just going to go down the backyard if you're lucky enough to have a backyard or let me just try to get out of the apartment for a minute to see if that's going to work since the baby didn't want the rest.
Pam:
[1:00:17] So we've got these two fundamental tools. So the stuff that people often put under this umbrella of settling strategies become a form of sensory motor nourishment but often quite exhausting for that primary carer. So a settling strategy might be framed as bouncing on a football, let's say. You'll see people, say, rocking a pram. All very exhausting. So I think let's just do, let's frame it this way. There are two basic tools to dial a baby down. Is it milk and is it a change of sensory motor nourishment? and then the sleep regulators will kick in when the baby's dialed down. But we're not...
Pam:
[1:01:01] Trying to make the baby sleep even though we kind of are inside ourselves because we're exhausted but the idea is is that we're just thinking okay sensory motor experience and then sleep happens if that makes sense um so yeah so obviously we all end up rocking bubbies at times and they go to sleep you know it's like but you can see that's a kind of sensory motor nourishment and what worries me is that families can find themselves doing that for an hour, an hour and a half every night when in fact, Bubby's sleep pressure is not that high and they could be out on the floor with the baby having a good time in the living room, you know, bringing friends in for an evening, going out to visit the rallies where there's lots of babies, even tiny babies, as you would so well know, are transfixed by older children. They just love to watch kids running around. So the more social we can get in the evening while the bubbly sleep pressure is rising, the less work we have to do from a sensory motor point of view. And then the breast is just on and off, no pressure, but oh, you want breast? In the evenings, there's often a lot of on and off the breast because it's a time of very high sensory need.
Mel:
[1:02:21] So I'm hearing just a letting go of all of the fundamental rules I'm using rules in inverted commas that we've been invited to adopt and believe about newborn sleep to take the path of least resistance that breeds the most joy and, let go of this idea of yes sleep cues and my baby looks tired and bouncing and rocking and like you know there's white noise makers and putting babies in quiet rooms and self-settling can we can we talk a little bit this intention to have their baby self-settle by by setting up a series of cues, and this is certainly what I was told to do, was, okay, your baby needs, your body's baby needs to be alerted to the fact that it's time to sleep. So wrap them in the same blanket, have them in the same room, provide them with the same cues. It might be a song or a, bunny toy or something or a, you know, white noise maker, fill it with familiar cues and then your baby will know it's time to go to sleep.
Pam:
[1:03:41] Yeah, such dominant advice, but it really misunderstands how sleep works because sleep doesn't occur in response to environmental associations. It's a fundamental misconception in the sleep training approach, actually, that's become sort of the dominant set of beliefs around sleep. So sleep associations don't send babies to sleep. Being dialed up gets in the way of baby sleep. So we do want to keep our little ones dialed down when the sleep pressure's climbing. But the only trigger for sleep is high sleep pressure. And then that's modulated by the body clock settings overall so all of that is it's so dominant Mel and it's a real misunderstanding you mentioned white noise the idea that white noise induces sleep see that's not borne out in the research and in fact if anything we have to be mindful of the decibel impact of white noise we don't really know the impact of white noise on those sensitive developing
Pam:
[1:04:58] Auditory processes, auditory systems in the baby's ear and brain. You know, I'm thinking the SNOO here, for instance. I've got a whole article where I really look at the evidence around the SNOO. There's no evidence to show that it works.
Mel:
[1:05:13] What's a SNOO?
Pam:
[1:05:15] Oh, these become, look, it's, you know, we just, as parents, we just experiment our way through. So we try all of these things and they're promoted. It's a mechanised bassinet.
Mel:
[1:05:26] Oh, the ones that rock.
Pam:
[1:05:28] Rocks, yeah, and the baby's effectively swaddled in with a sort of Velcro wrap and it has a white noise machine as well. It doesn't work and it's promoted as decreasing unsettled behaviour, but actually if you look at the research, that's not the case. And arguably there's downsides to it. So I remember writing, I've got this whole article in there on the SNHU and why perhaps you might choose not to invest all that money in the snooze.
Mel:
[1:06:03] I don't know what you're talking about now. And my next question is about controlled crying. Yeah, so controlled crying, and I think every desperate parent has resorted to it and realised how, you know, they commit to it as an idea because of how important sleep is at that time because of how tired they are and how much they want to get into some kind of routine for their baby. But how emotionally demanding it is to hear your baby crying. And so can you talk us through what's happening for a baby who's going through this process of control crying, which often involves popping them in a room without acknowledgement that their cries need attention?
Pam:
[1:06:46] Well, firstly, as we were saying, the sleep cues, they're not going to work. They're not going to affect the situation. Although what we can get is a kind of conditioned dialing up in response to those sleep cues. So babies, of course, are very smart.
Pam:
[1:07:02] And they can quickly learn that when I go near the cot or when the certain music is played, it's going to be upsetting. And so they start to cry immediately in anticipation. That's what I would call a conditioned dialing up. So there is that association. It's not to do with sleep, but it's to do with distress and learning that particular situations are going to be very upsetting. So it's a conditioned dialing up. And we do see that in response to sleep training. Or the bubby who wakes in the night, parents may say she goes from 0 to 100 and they've been trying to put in place some of the sleep training methods just because they're exhausted and don't know what else to do and you experiment as a parent. But the little one has learned when they wake, they don't know if they're going to get depressed, they don't know if they're going to be picked up. And so they quickly, a minute, they're almost awake.
Pam:
[1:07:56] The dial's on for 0 to 100. So there is that capacity to learn associations. It's not to do with the biological process of sleep, but it's to do with the environments that we're setting up around sleep. They can cause a conditioned dialing up in the baby. But your specific question was about the baby who is dialing up when put down in the cot with the idea that parents are just trying out the idea that the baby needs to learn to self-settle, that if they don't respond or often it's a graduated thing, isn't it? You leave the room for such and such period of time and then come back and then you go out for a longer period of time. So it's what's called graduated extinctions.
Pam:
[1:08:41] Attempt to gradually extinct the dialed up response, if you like. It's behavioural, first wave behavioural strategy. Well, the little one is dialed up. So what you're asking me really is what are babies experiencing when the sympathetic nervous system is really dialed up high? To be frank, I think it's fear.
Pam:
[1:09:08] You know we can talk about talk about it in different ways and you can see why I prefer to talk about it as the dial on the sympathetic nervous system because if I talk about stress parents don't want to be stressing their babies and yet babies do cry very often if we talk about fear when the baby wakes and is not close to the parental body I think that's what's happening from an evolutionary perspective from an evolutionary perspective not being close to the parental body in the night is an extremely dangerous situation and our little ones are definitely shaped to expect the parent body like the mother's body or parent body and so one way of characterizing that dialing up Sympathetic nervous system on high floor is fear. Now, even though overall we know that these sleep training approaches actually don't decrease the frequency of the night waking, it is possible for them to extinguish this approach, to extinguish a baby's drive to cue. So if the cues aren't responded to, there'll be some little bubbies who'll just cry and cry and cry and they just keep crying.
Pam:
[1:10:27] And it could be in the first 16 weeks that the dial sort of gets a bit stuck on high for bubbies who are crying a lot because it's all so neuroplastic at that time. So one of the things that can contribute to babies who cry a lot in the first three to four months of life are use of the sleep training strategies that have been, you know, parents are just told to do this. And it can just cause that little dial to get stuck on high so the bubby is more likely to cry tiny little triggers that nobody can really see or knows what's going on but the dial gets stuck on high.
Pam:
[1:11:04] So we've got these little ones. There's some, though, who just actually learn not to cue and that might be viewed by our health system as a positive outcome But there's actually, if you really look at the neuroscience, there's very... Good reason to be concerned that our little ones who aren't queuing as much then don't set up trajectories of to and fro interaction in quite the same way babies you know down the track we're developing as they're developing we're developing these reciprocity chains of to and fro communication and that depends on the bubby's queuing and initiating as well so i don't think we we want to be teaching our little ones not to cue actually most um most bubbies just keep on crying but there is that little cohort who are vulnerable for whatever reason who kind of learn to not cue if they're not being responded to and i think they're the ones who need special attention response to very subtle cues actually um so that we teach them that we will respond to your cues and we can build up our to-and-fro interactions, our reciprocity chains that are so clearly in the research optimising developmental outcomes. Yeah.
Mel:
[1:12:30] A way that I'd heard it described previously, and it could be a bit extreme, but that basically the babies lose hope that anyone's coming and then that that sets up a little bit of mistrust from the baby toward its parents. Where it starts to learn that, yeah, its parents won't listen to its cues.
Pam:
[1:12:55] Yeah. So I think, yeah, that's a way of making sense of it, isn't it? I think I do like to remind parents, because so many parents have experimented with these approaches because we have a health system that's advising them that this is what you do to be a good parent and we all want to be a good parent. So I do like to put it in the context of the incredible resilience of most families, most babies, and that we naturally experiment and that it's quite reasonable and understandable to have experimented with this. But I think as health professionals and as a health system, this is where I say, no, this is not an appropriate public health set of strategies to be putting out around our baby's sleep. It's not understanding what's so clear in the neuroscience, that there will be genetically or, you know, for other reasons, vulnerable bubbies who quickly learn not to cue and we know that that can, for some, have impact on trajectories long-term. So as a health system response, I think we have to see a paradigm shift in this if we really want to be responding to the evidence and indeed to the needs of our families with babies in a way that's congruent with being in 2024.
Mel:
[1:14:21] And I can't imagine parenting my babies without them offering cues. For me, parenting was about observing my baby and learning from my baby about what they needed and then my job was to provide that and then that taught them what they could expect from me as a parent even in the long term and so even now as we parent our children I'm aware that I'm parenting for connection and relationship well into their 20s and 30s and 40s exactly you know so that when they have a need they always think when if I need something my mum's there and she's alert to what I need and it's safe to tell her what I need that's how we approach yes.
Pam:
[1:15:06] Absolutely absolutely absolutely
Mel:
[1:15:09] Yeah that's it beautiful wow I mean we could talk forever and I feel like we will most definitely need to have another podcast episode at the very least because I feel like we just barely scratched the surface of your knowledge base well.
Pam:
[1:15:25] It's true that i could talk for hours with you mel and and it's true that later in the year um the possums breastfeeding and lactation program i'm hoping to have that well and truly out by christmas so i'm in the last phases of that so but there's always so much to talk about with with someone as engaged deeply engaged as you are in in this space mel and it's a real pleasure
Mel:
[1:15:49] Oh it's so good we're gonna put all of the information for your website and is that where everybody can find all of your resources and yes.
Pam:
[1:15:58] Well it's there's the possum sleep program.com um which is full of resources even you know breastfeeding resources actually but the caring for you and then the the baby sleep program the toddler sleep program the newborn sleep program sensory motor nourishment so all of that's tucked away in there it's it's it's very rich and audio it's all in audio then there's at dr pamela douglas is my son Bless him drives this now for me. So that's the social media handle across the various platforms. And then the NDC Institute has a lot of free resources on it for parents, but it's also where health professionals go. Or indeed, those like our doulas who aren't necessarily registered health professionals, there's an NDC for providers and educators. There's training for them, but there's training for registered health professionals there, for the midwives, for instance, who I know are so supportive of what you're doing.
Mel:
[1:16:57] Oh, fantastic. So there's something for everybody, for parents, for health professionals and for other care providers in this space with young families.
Pam:
[1:17:07] That's it.
Mel:
[1:17:08] Amazing. So I suppose what we're encouraging parents and health professionals to consider, and you alluded to it earlier, is that evidence-based care is actually a really new concept in healthcare. It hasn't been that long where health providers have thought hey maybe we should research this and give people advice based on what we discover by examining things and so sleep recommendations have come out not from evidence and and have just been a story told throughout history.
Pam:
[1:17:42] That's so true, Mel. And if something, the Possum Sleep Program has been the original revolution, really. In 2014, we first started to bring this out, been delivering it prior, but a true revolution in baby sleep. And in fact... If it looks a bit like possums, it might be derivative. I'd say go to the source because we've got a genuinely evidence-based program and also the evaluations that show that what we're doing actually, you know, we need to build up layers and layers of evaluations, but essentially there's nothing else as a genuine paradigm shift away from sleep training that has this level of evidence base in terms of evaluation studies, let alone the evidence base out of which the program itself has been translated through using best practice implementation science. There's nothing else like it actually, Mel.
Mel:
[1:18:44] I think you're right. And your website's got a whole list of publications that support these ideas. They're not ideas, they're discoveries. And so now we can apply them more confidently to parenting. In fact, they're very honouring of, I think, parental instinct around caring for your babies. And for a while, we've been saying to parents, you know, don't follow the rule books, follow your baby. And that's okay. But I think this also gives parents permission to let go of some of the prehistoric ideas and some of the advice that they might get from their mums and grandparents and well-meaning friends and healthcare providers. So I'm grateful that you're pioneering this space.
Pam:
[1:19:28] Thank you, Mel.
Mel:
[1:19:29] Yes. And I do hope for people who are working through this and still haven't solidified their ideas around sleep for their baby or stuck in situations that they're not finding joyful, that they'll find your programs and be able to do it.
Pam:
[1:19:43] Thank you, because we'd really value everyone's support. So thanks, Mel.
Mel:
[1:19:47] Oh, you're welcome. Thank you for being here on the Great Birth Rebellion podcast. To get access to the resources for each podcast episode, join the mailing list at melaniethemidwife.com. And to support the work of this podcast, wear the rebellion in the form of clothing and other merch at thegreatbirthrebellion.com. Follow me, Mel, @MelanieTheMidwife on socials and the show @TheGreatBirthRebellion. All the details are in the show notes.
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