By Mara Cvejic, M.D.
Few things astonish me more than the transformation of a new mother suffering from chronic sleep deprivation. It's like a terrible magic act: The curtain goes down on a happy expectant mother brimming with nervous excitement, and when it rises again there is a barely recognizable dull shell of the person standing before you. It's terrifying to behold in its severe forms. I'm still haunted by a former patient who was also a physician, struck with a particularly punishing bout of insomnia and sleep deprivation after her first newborn son was born. She had attempted to go back to work after just three weeks and wound up in my office, reduced to a disheveled heap of tears and helplessness. "My mind just doesn't work," she told me. "I'm the Grinch at home and at work, always exhausted and angry."
Yet despite all the formidable evidence of sleep deprivation in the everyday person, the scientific evidence of what happens to the postpartum brain is positively astounding -- it thrives. A study published by the National Institutes of Health in 2010 actually shows that a mother's brain grows from just 2-4 weeks to 3-4 months post delivery without any significant learning activities. The gray matter of the parietal lobe, pre-frontal cortex, hypothalamus, substantia nigra, and amygdala all form new connections and enlarge to a small degree. The imaging study confirms what animal studies have shown in the past -- that these brain regions responsible for complex emotional judgment and decision-making actually bulk up with use. Rationale to the study shows that mothers who have positive interactions with their offspring -- soothing, nurturing, feeding, and caring for them -- are performing a mental exercise of sorts. Their learned coping skills in the face of novel child-rearing actually muscularize their brain.
Coping in the face of necessary sleep deprivation is a concept well known to me -- long hours of call, travel amongst time zones, shift work, emergency calls from relatives related to a sick loved one. The Grinch is a more than reasonable fairytale comparison to how I feel when I have to force myself through a day after no sleep. But one salient fact differentiates the new mother from all of these life challenges -- it never ends. You do not get to turn off your beeper at the end of the day and nobody is there to take your place. And I doubt the words, "Your brain is getting so big," are going to pacify the overwhelmed and harried new mom. In the hopes of discovering new and novel coping skills to dole out to patients, I set out to research how the mothers of the world get by. What I found was more than I bargained for.
According to the Danish National Board of Health, it is recommended to keep your baby sleeping outside in the cold, in weather that can get as cold as -5 degrees Celsius. This is already a policy in Swedish day care centers, and mothers practicing on their own are instructed to obtain alarms to remind them to go outside to retrieve them following naps. The principle behind this practice embodies the idea that exposure to cold builds the baby's immune system and also allows them to sleep sounder. Sleeping baby equals sleeping momma. This seems to be the extreme arctic version of the Ferber method.
In Finland, the tradition of having infants sleep in a cardboard box stems from the government as well. A 75-year institutional practice of sending new mothers a gift of clothes, towels, and condoms in a large cardboard box saw an unusual but notable trend. Mothers who received the box used the box as a makeshift cradle, and over a short period of time, an unmistakeable drop in infant mortality was seen. One might also remark that this is an awfully economical way to beat the odds as a new mom. It might not be a cardboard box, but the Swiss have adapted an entirely different model in their maternity wards. The hngematte is what I could only describe as a mini hammock that has been placed in each room. The baby can swing and bounce in the makeshift cot, meant to simulate the womb and transition the child to the harshness of the new world. While early commentaries suggest that this is an unconventional or beatnik method outside of Switzerland, I found several posts by desperate mothers brimming with praise for the hngematte and testimonials suggesting it was becoming a trend in new-age families to improve a newborn's sleep.
In addition to special sleeping devices, mothers from Japan and Sweden adapted ritualistic tendencies to induce or keep their children asleep. Japanese mothers perform the "ton-ton" or light belly tapping on the infant after being laid to sleep after a feed. Swedish mothers describe methodical bottom buffing as the baby is placed prone, or on the belly. Perhaps the strangest custom I found was from Bulgarian women, who spit in newborn babies eyes to ward off evil spirits, saying, "May the chickens poop on you."
In a surprisingly refreshing tact, many of the Asian traditions focus on the care of the mother. The eating habits of the Korean mom suggest only eating seaweed soup to induce postpartum rest in the mother. Food and warmth are also a focus of the Malaysian confinement of pantang. Steeped in the belief that the women's life force is her fertile womb, she undergoes a 44-day period of internment to focus on relaxation, hot stone massage, lulur (full body exfoliation), herbal baths, and hot compresses. Typically a bidan, what can only be described as a live-in midwife and nanny combined, is hired to attend on the new mother. This is sometimes a family member, such as her mother or mother-in-law.
Reclusiveness is also seen in the Dominican Republic. It is expected that a new mother and her child will not be seen at all during the first months of the new baby's life. In Hong Kong there is a month-long confinement that necessitates hiring a replacement mother or housekeeper, called a pui-yuet. The Chinese tradition of having the mother retire to a warm, dark room and only focus on sleeping and eating sounded very enticing until I understood that they were not expected to bathe or shower during this period either, as this can reduce your internal warmth.
Alas, to be honest, the question that I set out to answer only produced more questions. Hammocks, spa treatments, hired help, warm foods, arctic cradles, and cardboard... there does not appear to be a universal answer to coping with sleep deprivation as a new mom, so most of the world seems to have adapted their own. It occurred to me then that perhaps the growth that we see in the minds of mothers doesn't come from the coping act itself, but from the fact that they came through on the other side as much in love with their child as before.
And so I find myself back to where I started with the platitudes that I thought I would never give. So before you let a Bulgarian woman spit in your baby's eye, remember dear Grinch what they say -- your brain will grow three sizes that day.
"The Plasticity of Human Maternal Brain: Longitudinal Changes in Brain Anatomy During the Early Postpartum Period: Theoretical Comment on Kim et al. (2010)," Craig H. Kinsley, PhD, and Elizabeth A. Meyer, PhD, University of Richmond; Behavioral Neuroscience, Vol. 124, No. 5.
Mara Cvejic, M.D., is an associate professor of neurology and sleep medicine in the Neuroscience Institute at the University of Florida in Jacksonville. She is a former sleep medicine fellow at the Stanford Center for Sleep Sciences and Medicine. This Center is the birthplace of sleep medicine and includes research, clinical, and educational programs that have advanced the field and improved patient care for decades. To learn more, visit us at: http://sleep.stanford.edu/.