In a small room there is a woman and the baby she is trying to put to sleep.
She has to stick to the routine: sing the nursery rhyme Baa Baa Black Sheep ten times – exactly. But the charm stops working.
So the woman and her husband pat the baby. They rock him and walk around the room. Sometimes it takes hours.
The woman becomes obsessed with routines; the steps to wash the baby’s bottles, the order to hang the washing on the line.
She can no longer sleep, even when her son, Lucien, is sleeping. And she becomes so anxious that her husband has to settle their son whenever he is home.
This was four years ago. For the mother, whose name is Alice Deby, the whole experience was searing.
‘‘I was fairly convinced that he had a good chance of dying and given my low opinion about my parenting skills, I felt very concerned that I wasn’t going to be able to save him. I wasn’t going to be vigilant enough – so I had to stay awake,’’ says Deby.
‘‘I knew there was something wrong ... but I didn’t want to admit there was a problem in case someone took my baby away.’’
Deby’s husband and doctor eventually realised she had severe post-natal depression and convinced her to be admitted for help at the mother and baby unit at Northpark Private Hospital, in Bundoora. The unit helps new mothers with depression and anxiety, as well as sleep and settling difficulties. To its patients it is known as a ‘‘sleep school’’, the term widely used to describe early parenting centres.
Of course not every person who attends a sleep school has a psychiatric illness, but most are at their wit’s end. These parenting centres help shell-shocked parents cope with the many confounding aspects of babies and toddlers, from unsettled nights to challenging behaviour.
The demand is fierce, and it is growing. Patients must have a referral from their GP and undergo a phone interview. Even then, the wait for a place on a residential program is usually at least three months. At the state’s three publicly funded early parenting centres – Tweddle Child and Family Health Service in Footscray, the O’Connell Centre in Hawthorn and the Queen Elizabeth Centre in Noble Park – staff field between 20 and 60 phone inquiries from miserable parents every day.
Sleep remains – overwhelmingly – the reason parents seek out parenting centres. Once they arrive it often becomes clear that other aspects of their familial ecosystem need tweaking.
The mental health of exhausted mothers is often in poor shape, they may be socially isolated or struggling to raise their children without the help from far-flung family.
Sleep deprivation and maternal exhaustion can contribute to mothers developing postnatal depression or anxiety, according to the Post and Antenatal Depression Association.
At Tweddle, all patients are screened for postnatal depression and almost half the mothers and a third of the fathers report a problem with their mood.
As well as help with sleep and settling, there are parenting classes at Tweddle on how to interact with your baby, services in Geelong, Terang and Bacchus Marsh, a program for women in prisons and friendship groups for parents with kids with a disability.
In a dining room at the centre’s Footscray headquarters, a mother stirs a sugar into her cup of tea, texts her partner and keeps watch for the nurse who will tell her when her babies have woken from their nap.
Samantha Swann, 24, has five-month-old twins – Jason and Isabella Vongvixay. This morning she is tired but optimistic: ‘‘I always assumed sleep school was just a place you come to get help with sleep, but we’ve done lots of sessions on how to read your baby’s cues.’’
When a parent rings Tweddle a member of the admissions team spends about half an hour going through a set of 80 questions to assess the situation.
It is often the first time the parent has been able to debrief. They might talk about having a traumatic birth, family violence, drug or alcohol issues, being an older parent or using IVF, says Tweddle communications manager Kerrie Gottliebsen.
‘‘There’s a grand landscape of stuff to wade through before we can simply say the baby’s not sleeping.’’
The strain that poor sleep places on relationships can have profound implications for both parent and child. Research into infant brain development shows good relationships promote brain cell growth, says Tweddle practice lead psychologist, Dr Kanthi Sayers.
In a very stressful family environment, babies don’t learn how to regulate their emotions and the physical growth of neural pathways can be stunted.
It was important that parents learn how to respond to baby cues and understand when they need to be picked up and cuddled, Dr Sayers says.
Tweddle uses a ‘‘responsive’’ style of settling, which doesn’t use timing and reacts to the level of distress in a baby’s cry.
It can be very daunting for an exhausted parent to sit alone in a room with a crying baby. At Tweddle they have someone at their elbow to help them through, says Sayers. ‘‘Being attuned to the baby’s needs is the most important thing’’.
But what if you don’t even know what that means? If the first mewling baby you have ever held was your own?
Gone are the days of a cuppa and a chat over the fence with a female neighbour, who might also help with babysitting and send over a load of scones.
New mothers often find themselves isolated; many of their contemporaries work during the day and families are often overseas or interstate.
Parenting skills are no longer learnt through the prism of a large family and many new parents have never changed a nappy or settled a baby.
Yet more information is available than ever before. Google the words ‘‘baby and sleep’’ and you will find thousands of sites offering advice, opinion and endless forum comments. Much of it is polarising. At one end of the spectrum, attachment-parenting advocates claim that only co-sleeping and feeding on demand will cement a lasting bond, while on the other routine-driven parents watch the clock and insist controlled crying does no harm.
Caught in the middle are tired, confused women facing another long day with little sleep. It’s little wonder that their mood often suffers.
Trying to add some science to the mix is Helen Stevens, a maternal and child health nurse at the O’Connell Family Centre. Stevens is also one of the directors of Safe Sleep Space, a private business that helps parents with settling issues.
In collaboration with Mercy Health, La Trobe University, the University of North Texas and Safe Sleep Space, Stevens is undertaking a study on the levels of cortisol – or stress hormone – in the saliva of babies who are patients at the O’Connell sleep school.
The research builds on a 2010 study undertaken at a New Zealand sleep school that looked at the levels of salivary cortisol in mothers and babies when controlled crying was used to put the babies to sleep.
It found that while mothers’ cortisol levels decreased after a period of using controlled crying, the babies’ cortisol remained high even when they appeared to quietly go to sleep without being comforted by their carer.
Stevens decided to replicate this research at a sleep school that did not use controlled crying to see if the results were different.
The results will better inform the practices used in sleep schools, she says.
‘‘It’s about babies telling us what they need and us teaching parents what children are saying so they can better respond to them.’’
So what is ‘‘normal’’ infant sleep? The answer isn’t straightforward says Gillian Nixon, a paediatric sleep physician and associate professor at the Melbourne Children’s Sleep Centre at the Monash Children’s Hospital.
This centre treats children with complex sleep problems, from sleep apnoea to settling issues.
Nixon usually sees older children, who have already visited sleep schools and need to undertake overnight sleep studies or clinical assessment.
Sleep is an easily identifiable issue for parent but there is a lack of information about what’s normal for a baby, she says. ‘‘If it’s a problem for their parents then it’s a problem,’’ Nixon says.
Even the medical literature is confusing, with an infant ‘‘sleeping through’’ referred to variously from as little as four hours to as much as a whole night of sleep.
At the Masada Private Hospital mother and baby unit in East St Kilda, the decor is more polished and the optional extras, such as massage, more extensive than their public counterparts.
The unit opened in 1996 with five beds, and added an extra 15 to cope with demand in 2011.
When these new beds were added the wait time for a residential stay dropped to about three weeks, but recently it has increased to eight weeks.
Unlike the public sleep schools, patients at Masada are given the option of taking a sleeping tablet for the first two nights while the staff settle their babies for them.
The rationale, says unit manager Patsy Thean, is that patients are so exhausted when they arrive that they have trouble absorbing new information. After a rest, it becomes easier.
The five-night program is very structured, with parent education on the principles of baby sleep, looking after themselves and suitable settling and feeding routines.
‘‘When we improve the sleep the babies feed,’’ says Thean. ‘‘These things are all tied together, and if one gets knocked out then it ends up in a vicious circle.’’
Mother of three, Jen, has come to Masada with her youngest child, Gus.
He wakes often and she doesn’t want to disturb her other children when she is trying to resettle him.
Feeling exhausted, Jen is happy to take the sleeping tablets and let the staff take over initially.
She understands some mothers feel worry about leaving their babies but says she is much less nervous the second time around: ‘‘I knew this was what he – we – needed.’’
Masada use a timed approach to their settling, something that raises a few eyebrows among staff at other sleep schools. Thean calls it ‘‘progressive waiting’’ – parents listen to the baby’s grizzle or cry and go in to reassure them at short and then longer timed intervals, though there is flexibility to go in more often if the baby is distraught.
The results at Masada are good, says Thean. About 85 to 90 per cent of mothers report that their babies are starting to sleep more and have settled into a day routine.
A week after returning home Jen says Gus is making good progress: ‘‘I was quite tired when I left from the intensity of the week but we had staff who were really excellent and consistent.’’
For Alice Deby, her five-week stay at the Northpark proved a major turning point in the first months of her son’s life.
She remembers sitting on a couch in the hospital corridor next to the ‘‘wailing wall’’, where all the baby monitors were hung.
One mother taught the others how to crochet and women would sit there together and burn off nervous energy with a needle and yarn while listening for their baby’s cries.
‘‘It was a bit of a graduation once you got to the stage where you could sit there and listen for your baby and not have to have a nurse right there helping the whole time,’’ Deby says.
The sleep school was the turning point, the key thing that helped her recover. Not the medication, not the counselling, although those things certainly helped, she says.
‘‘It was learning to settle my baby and getting confidence and hope.’’
Miki Perkins is a senior reporter who writes on social affairs.