Episode 43 Infant Sleep with Ann Grauer

Dr. Hillary Melchiors [00:00:00]:
Hey, Birth Geeks! We are so excited to be back podcasting again, and we are kicking off our return with a great conversation with Ann Grauer. Ann Grauer is a previous president of DONA International, postpartum doula trainer extraordinaire, and just all-around wonderful human being. So enjoy! So I'm really I'm really excited for this conversation just before we even get going.

Ann Grauer [00:00:38]:
Well, I'm glad. Thank you for inviting me back. I'm very excited about doing this. It's kind of— it's really fortuitous that you asked me at this time when the American Academy of Pediatrics just came out with their new position on sleep and also on breastfeeding. You know, human milk feeding after not having had updates for several years. So the timing was great. Y'all are amazing. Awesome.

Ann Grauer [00:01:17]:
All right. So, so I want to—

Dr. Hillary Melchiors [00:01:21]:
okay, what do you think people get wrong about infant sleep? Let's start there.

Ann Grauer [00:01:27]:
Well, It's more like, would we get anything right? Yeah. And the reason I'm saying that is because our information on infant sleep that parents have had passed down to them from generation upon generations, including through their medical providers and family lines and everything else, it's not really rooted in reality. At all. It's not rooted in human biology. It's, quite frankly, it came from the 1800s when pediatrics first started getting started, you know, and it was a bunch of old white guys who were in stiff collared shirts and issuing edicts on how babies were to be treated and whatever the fashionable moment was of the day. And it's a very weird approach to sleep. And when I say weird, I mean Western, educated, industrialized, rich, and democratic. It's that acronym approach to this is what babies should be doing.

Ann Grauer [00:02:47]:
And the problem is, um, babies don't really care. They, they are as pure as they can be as far as following instinct. And what we are doing is we've hit this place where— I mean, it's always been a struggle. It's always been a struggle ever since these edicts were put into place. But the problem is that we are now at a point in the 21st century This has been building and building and building where the, the lava is ready to just spew because we've got people who are working, returning to work with no leave, no paid leave, an increased cesarean rate that's through the roof, people not having support that they need, living away from family or having family friends who aren't supportive helping them out. In ways that they truly need help and returning to work where you have to have some sleep so that you can function and the babies aren't on board with it. So we've wound up pitting the parents against the baby. We've allowed them to be seen as enemies because it's like this baby's trying to kill me, this baby doesn't want me to sleep.

Ann Grauer [00:04:07]:
And it's like, well, no, if we had the ability to allow the baby to guide us on what we needed, if we, if we had that privilege right now of having paid leave after babies are born, if we had the ability to allow you to be able to rest truly during a postpartum period and to heal and to be taken care of the way it was intended, then you and the baby would hit a rhythm and there would be a way to tend to what needs to be done. And it would be having that help in those early days and weeks when newborns are completely inside out and upside down and everything else, so that someone else could come and hold a baby so that you could actually sleep that amazing soul-quenching sleep that you need when you are so dog tired. But we have reached this point through— I mean, as we all know, we're hitting these apexes everywhere. You know, like everything is sort of getting ready to blow throughout our society in the United States and parts of Canada as well. Because even though they have paid leave, not everybody has gracious paid leave. You know, they may be in a job where they're not able to really take very much or offered very much. And at the end of the day, everybody is suffering. The babies are suffering because they're being asked to do things they're not able to do.

Ann Grauer [00:05:48]:
They're being asked to think at a level that their brains are not ready for. And the parents are suffering because they're exhausted and they love their babies. And then on top of that, the pressure of, you know, 'You better make sure that your baby doesn't die while he's sleeping or we're going to blame you for it,' is sitting there all the time. And I don't know a parent alive who doesn't tell me how terrified they are that their baby will die of SIDS or suffocation, especially SIDS, because that's the catch-all, right? You know, and we have created this this, I mean, how do you even sleep at night at all when you have that kind of pressure sitting on top of you? And unfortunately, I feel like that in the United States, American Academy of Pediatrics and also the Ethel Kennedy Foundation working with the NIH, they have refused to acknowledge what is going on in the parents' lives. And by their refusal, They have made this at least 10 times worse, and I'm being very conservative with that number.

Dr. Robin Elise Weiss [00:07:08]:
So I was just going to ask, did they get anything right in this statement?

Ann Grauer [00:07:17]:
I think they, I think they finally started to acknowledge a little bit that, um, that it feels good to hold your baby while they're sleeping. I think they finally started to do that because they have wrestled with this for a while. Um, their last position on this, what, 2016, I think, they were very concerned about people doing skin-to-skin in the hospital. They didn't even acknowledge, you know, home or birth center births. But they were very concerned about this because they said, you know, if you do this in the hospital, you're going to do it when you get home. It's like, it's addictive. Duh. Duh.

Ann Grauer [00:08:02]:
We're going to do it because it's what babies want and need. And we're new parents. And so they were very concerned that parents would continue doing it. But that attitude is so paternalistic. And it has this ability to— shame people for doing what Mother Nature intended for you to hold your baby. And I think that they acknowledged a little bit in the update that, yeah, well, you know, yeah, you know, it's good for the baby in the beginning. You know, they at least gave us that. I think they also tried really hard to say that, well, you know, keeping them in your room for the first 6 months maybe we went too far with it when we said up to a year in our last update.

Ann Grauer [00:08:58]:
Because prior to this, you know, the weird way of raising babies, especially it's an Anglo-Saxon view because it came directly out of England and Europe, was very much this whole, you know, you put the baby in a room down the hall, the nursery. And we came to realize through some research that that's actually a really— it's a SIDS risk factor in and of itself to have vulnerable sleepers down the hall. So of course, we created baby monitors to help with that. But what we realized is it's not just us hearing the babies, it's the babies hearing the parents breathing. So they sleep at— A light enough level that if they should go into a response within their nervous system where they're going to have an apnea spell or something like that, that they will rise out of it because they're able to. So they acknowledge that, you know, we should probably have them in our rooms for this. But really what they've focused on is night sleep. They are focusing— even though they say they're talking about naps, they're also talking really about night sleep.

Ann Grauer [00:10:13]:
And a lot of people, the thought of having a baby in their rooms for 6 months is like, why would you do that? What? Oh, you don't have a nursery? You don't have a space big enough for a nursery? Versus understanding that actually it's for the biology of the baby. It helps them. But what's really interesting is that when we open this up and we stop just looking at what AAP is saying and the NIH, We realized that we have other nations and places around the world that are not looking at this the same way. Quite frankly, I've been really frustrated with the AAP for such a long time because they refuse to acknowledge what parents are going through on an everyday basis. Wanting their babies to be safe and yet needing some sleep so desperately that, you know, I've turned to the UK for more information on this because they're the best example right now of anything from a weird society that is trying to acknowledge what's really going on. And this is the work of Helen Ball out of Durham University. And their amazing website basis, Baby Information Sleep Source. They have created something that literally is a soothing, kind, compassionate, and evidence-based website so that parents can go in, get information about why is it that my baby wants me to be holding them? What is that all about? And what do I do about naps? And what do I do about other things as well? And parents can be given tips on how to decrease risk, how to decrease the risk of SIDS and suffocation and all of that.

Ann Grauer [00:12:22]:
The other thing that's really great about BASIS, and I think this is the sneaky backdoor that I really give them so much credit for, is it's got a separate section of the website devoted to pediatricians and public health agents and other people because it is loaded with the evidence. She has the summary, she has how to read evidence, she has everything that we have up until this point and walks them through and gives them tools that they can use with their patients and clients so that we can acknowledge what's really going on here for families. And the story of how they came about to me is really dynamic because, you know, just like we are at a point in the United States where the SIDS rates are stuck, you know, we're just stagnant right now. Same thing was happening in the UK and they, the Lullaby Trust, which is, it's a charity over there. So it's kind of like the March of Dimes, but it's for SIDS. The Lullaby Trust was that agency that people went to for information, and they were like, they were saying, we have to, we have to move the needle on this. Something's not working, our messaging, something's not happening. And so Dr.

Ann Grauer [00:13:42]:
Ball worked with them with focus groups, and the parents said, you're scaring the daylights out of us. We can only handle so much. So they just tuned it out. So what happened is, using evidence, they then chose to rework the messaging so that parents could hear it. So it's kinder, it's gentler, it's honest, but it's not hitting parents over the head and holding them responsible for everything. And so it's given them the tools so that they can start to look for themselves. Here is what the evidence says. We're in a situation where we're gonna, we're in a hotel room and there was supposed to be a cot in here, but there isn't because they ran out before we got here.

Ann Grauer [00:14:29]:
So what the heck are we going to do with our baby? Am I going to put my baby on the floor all by himself? Where am I going to put my baby? Am I going to let him sleep in the car seat? Am I going to put him on the sofa? And parents do this natural risk reduction and what will work best for their family. So it's highly respectful of the parents and acknowledges the challenging situation they're in. And at at the same time gives them tools so they can choose the least risky way to go for themselves. Now, Dr. Ball says it's going to be several years before we see the data on how, how has this worked, but at least they have people paying attention now and no longer tuning them out. And I think that for me, as someone who's been a parent educator for 33 years, This insidious just say no to holding your baby while sleeping or having your baby share a sleep surface with you, even if you're in a circumstance like what I described a moment ago with the hotel, it leaves parents no recourse. It leaves parents no hope. And then they're the ones blamed when things happen.

Ann Grauer [00:15:49]:
And yet at the same time, I have to note that even when there is a SIDS death where a baby was in their crib on their back exactly in the circumstances that the NIH has laid out, those parents are placed under unbelievable scrutiny. And I have someone who lost a grandchild 4 years ago to SIDS under those circumstances. And the child protective services opened up a case on them. It took a year for that case to close in spite of the fact that they'd done everything right. So it's a matter of we don't know what kind of Pandora's box we're opening on parents. Even if they do everything perfectly, but the messaging in the United States is blame the parents.

Dr. Robin Elise Weiss [00:16:47]:
The other thing is I know that pediatricians often ask lots of questions about safety when you go to a visit, right? And it's all supposed to be age-appropriate, right? Are you wearing bike helmets? Do you smoke? And people know what the expected answer should be, right? So, are you sleeping with your baby? Like, you know, and they have been trying to do better and say, where, tell me about how your baby sleeps and where your baby sleeps, right? Doing it more open-ended than do you sleep with your baby, right? Which sounds very accusatory. But I can even remember being in that situation and I was just telling myself in my head, like, I know more about infant sleep than you do. No, I'm not sleeping with my baby. Yes, I really am sleeping with my baby. But I'm doing it right, but I'm following the evidence and I'm doing all these things to make sure it's safe because that's what worked for my family and my infant. And I've often thought about this, like, the safe— the safer sex conversation, right? Like, don't tell them about condoms because they might have sex, right? And this is like, don't tell them how to safely sleep with their baby because they might, right? Do you find some of that happening as well?

Ann Grauer [00:18:03]:
I find there's a lot of that, but at the same time, I also find that there's, um, I think we're also seeing, um, some of the younger pediatricians, um, the females especially, um, are, are saying to them, um, where does your baby sleep? And they're saying, well, we sleep with their— and I'm seeing more and more people who are saying that those peds are saying to them, that's what I did with my own kids too. You know, just watch out for this, this, and this. So under the table they're doing it because, you know, when— if you are kind of the primary parent in a two-parent working household, um, and you're the pediatrician, you know, you're getting back to work very quickly as well. And so they're doing what they have to do to survive, and this is— this is being passed through. Um, some— sometimes parents are talking about— they just are straight up lying. They're just straight up lying because they're left with no recourse. You know, I had one mom who was so frustrated because she had a super fussy baby and it was either be held or be in a container all night long that he, he just really could not find a way to wind down otherwise. And they'd been using the car seat and this family had worked to rig this car seat up so he was at a flatter angle and all kinds of stuff like they had engineered it.

Ann Grauer [00:19:30]:
And the pediatrician said, oh my God, you've got to get him out of the car seat. You need him in that crib. He can't be in your arms. He can't be in your bed. He can't be here. He can't be there. He can't be anywhere. He just needs to be in his crib.

Ann Grauer [00:19:43]:
So I saw her right after she had gone to the ped, and I said, how'd it go? And she said, it was great. And I said, did he ask about sleep? And she said, oh yeah. And, and I said, oh, he's in his crib. And he said, good. Don't you feel so much better now? She goes, Oh yeah. And she said, he's in his car seat in his crib.

Dr. Hillary Melchiors [00:20:00]:
Doesn't that set up such a good precedent for that kind of relationship though with your pediatrician? I mean, like, and as a parent, 100% been there. And that disconnect between the recommendations that go all the way down into your room with your pediatrician. And then, I mean, we see the same thing with our clients, I mean, they know what they're supposed to say. Um, and, and that's what they say because again, like you said, and they're doing whatever they can to survive.

Ann Grauer [00:20:35]:
You have no choice. And it's so sad because here, here, I mean, I think a lot of parents feel that they have to take direction from the pediatrician on behaviors versus seeing this as a consultant in our life to help us with this. I mean, they're like a consultant. Um, they're the person who you're in partnership with to have— make sure the health of your baby is on track, that things are going well, come to them if they're not health-wise. But we have turned the modern pediatrician into the almighty expert on everything. And with the changes that are just out there medically in pediatrics in the last, I don't know, 30 years, there's a lot to keep up with there. How can they possibly keep up with everything else? So I think it's unfortunate that we've put them on this pedestal. The AP set it up so we would put them on the pedestal.

Ann Grauer [00:21:29]:
But everyday pediatricians tell me it's exhausting. And, you know, they can't— so they do, they're doing their best as well with what they've been told, just as we all do. As the amazing Dr. Maya Angelou always said, you do the best you can until you know better. And when you know better, you do better. But at the same time, we put parents in this position where we tell them they don't know. It's always about turning to experts. You couldn't possibly know what is the right thing to do.

Ann Grauer [00:22:03]:
It's such a shame because parents are exhausted and at the end of the day, they're going to be held responsible and not have sleep. This is when things happen. Why are some of our rates on depression and anxiety so high? What are we seeing that happens to marriages and other partnerships in that first year after a baby is born? Why are we seeing higher divorce rates and breakups and that sort of thing? And am I blaming infant sleep for all of it? No, but I am saying that it starts when you have this very black and white approach to something that is not black and white at all. And it's, it's not only just different colors, it's, it's textures and elevations and everything else. And instead of approaching it that way, we've given the yes/no approach. Yes to this, no to that. I think something that the AAP was trying to do this last time to help out is they started to address the concept of swaddles and they started to look at like, you know, weighted sleep sacks. They don't get credit for giving appropriate evidence throughout.

Ann Grauer [00:23:25]:
They cherry-picked their evidence throughout this recommendation. But, you know, the whole deal with swaddles came about because of the Back to Sleep program in 1992. This is where it all started. You know, when you first start putting babies on their back to sleep, they don't sleep that way as newborns. They, they protest. They don't do very well unless they are surface sharing with a parent due to the fact that they are not safe. They inherently know that they're not safe on their own. So that's where, you know, we started doing more swaddling.

Ann Grauer [00:24:06]:
You know, swaddling was used to settle babies but not keep them that way forever. But when you put babies in a position where they're biologically not going to respond the way you want them to respond, the parents have to have a way to manipulate it. And we saw that— we saw an uptick in swaddling being used for extended times, but parents had a hard time getting the hang of swaddling their babies with big claws, so it turned into this sleep swaddle sleep industry, and Halo was the big one that really pushed this thing forward. And the problem with this was, um, now you have these, these Velcro outfits that you can get them in and you can keep them in, but then parents became so reliant on them, as did babies, that parents are using them long past the time when they should be used. And that's because their kids wouldn't sleep otherwise. So we've seen incidents where kids have started to roll and they are not able to move their heads appropriately. And anybody who's ever had a newborn knows that you got them on the changing table and the next thing you know, a baby who can't do anything else just flipped over and you're thinking, how the heck did that happen? And they don't have the head control. So part of what they didn't address, and I had really hoped that they would in there, was that The way we are swaddling babies in the United States especially is with their hands down.

Ann Grauer [00:25:40]:
Babies are not designed to sleep with their arms straight down. No human being sleeps like that. It doesn't happen. And they're meant to have those arms at an angle and hands near their face. That's part of what goes on. So, you know, I am teaching parents to swaddle with arms up if they're going to use a swaddle, number one. And then they at least stand a chance if those arms are up that they can move their heads because they have more control over their bodies. But they didn't address that.

Ann Grauer [00:26:15]:
All they addressed were the weighted sleep sacks, like the Nested Bean one that's out there that has this weight on the baby's chest so that they'll feel like they have a hand on them so that they won't feel alone in the crib. And they're saying, yeah, don't do that when they're little. And of course, people like, how dare you tell us what to do with this thing? It's the one thing that works for my baby. But if we could just teach people to swaddle with hands up and not use this beyond the time that they're starting to really move a little bit, starting to get those hands out so they can learn to sleep with hands out, it makes it a whole, a whole lot easier. But they didn't— they missed such a golden opportunity to address that. We have, we have this entire sleep suit industry that has come about as a result of our needing to put babies back to sleep. And there is nothing to argue with on that position. There's nothing.

Ann Grauer [00:27:18]:
I mean, the data is so solid.

Dr. Hillary Melchiors [00:27:20]:
Did they specifically call out any other, like, products out there, like the sleep positioners or things like that, in that paper?

Ann Grauer [00:27:30]:
Yeah, they've always called out sleep positioners. They've always been anti-sleep positioner. And, and what they've said is it's dangerous. Well, okay, so what does it's dangerous mean? Like, I'm trying to understand it because we have zero evidence. And see, this is what I mean by cherry-picking. What, what I would like them to do is say, look, there is no evidence that this will make a difference, and that's because it hasn't been studied. Um, and we would rather you didn't because the baby could roll. Like, you know, just, just be straight with folks about what that is.

Ann Grauer [00:28:01]:
So we've got that. They've also— they also, you know, specifically, um, spoke out against like the Owlets. They didn't call them the Owlets, they gave them whatever the fancy name is for them. Um, you know, where you can see like, you know, that your baby is breathing and that the alarm goes off if, um, if not. And it's, it's picking up their heart rate and everything else. Um, and they're saying no, no, no, no, no, don't use these. And in fact, they got the FDA to make Owlet have to rethink how they were selling their product because it had a pulse ox component in it. And they said, now it's a medical-grade device.

Ann Grauer [00:28:42]:
It needs to be sold a little bit differently. So, the Owlet redid some of their marketing on it. And yet what they don't get is they're the reason the Owlet came about. Because parents are like, if my baby's asleep in a room by himself and he's swaddled, how do I know he's okay? And so parents have turned to things like this to make sure their baby is still breathing. And they're like, don't depend on it. Well, I get what you're saying, but I also get that for some parents, their anxiety level is so through the roof that that outlet may be the way that they're able to allow the baby to be in the container next to them. To hang out. They also talked about the flat sleep surface and really being careful.

Ann Grauer [00:29:31]:
They've managed to get the Consumer Product Safety Commission and of course Congress issued a law so that now if it's going to be sold as a sleep device, it can't be at more than a 10-degree angle so that the baby is less likely to be high enough up that their head can— their big heavy heads can drape over their airway and cut off their flow of air.

Dr. Hillary Melchiors [00:30:00]:
Can we just note that all three of us just did like put our chins to our chest at the same time? That was really funny.

Ann Grauer [00:30:08]:
Exactly. Yeah, this is— you get three educators together, we're going to demonstrate everything, that's for sure. But it's exactly that, you know, and I appreciate that they're doing that, but The reason the rock and play became like the hottest item on the parenting market was because babies would sleep in it because they were at an angled, at an angled sleep. And, and again, even though it's now off the market, it's not gone. There are thousands and thousands of rock and plays out there and the Facebook marketplaces, the parenting groups, It is being— they are trading these things out all the time because of the fact that parents need them.

Dr. Robin Elise Weiss [00:30:54]:
Remember baby walkers? You can still find those for sure.

Ann Grauer [00:30:57]:
Not only can you still find them, Robin, I, I don't know how this has happened, but they're actually selling them in stores again. Oh, with wheels.

Dr. Hillary Melchiors [00:31:06]:
But I know, I know from the parent perspective, most parents are of the— like, I— they have this idea that if sold in a store, it must be safe for my kid. Like, if it's allowed to be sold, then what's the problem? That it shouldn't be safe? And I would— again, resident anthropologist in the room— but I would say, like, that's very cultural that we're just like, oh, just, you know, it's up to the individual to decide what's safe for them or not.

Ann Grauer [00:31:38]:
Well, and people can be trusted to decide that if they're given good information to support it instead of, okay, we're just going to pretend you're not going to go home and do whatever with it. We're just pretending. And that's been true with the manufacturers of all the products. Because if you're a parent, would Fisher-Price still be in business if they were killing babies? You wouldn't think so. Or injuring babies or Graco or any of the other companies. And yet You know, the types of things that are happening, the recalls on infant stuff and children's stuff is nonstop. You know, I have parents and doulas subscribe to Consumer Product Safety Commission to receive their emails whenever there's a recall. I have them sign up on FDA.gov so that anytime there's a food recall for children or for formula, and they will pick that up right away, and they'll be aware of it because you kind of have to.

Ann Grauer [00:32:43]:
It's, it's really the only safety net you have to know if there's a problem with something. But oftentimes, by the time it pops up there, it's been around a long time. So we do— we have this whole infant sleep industry that has arisen. And the thing is that parents are just desperate. They just want some sleep and they want their babies to be safe. So they're thinking, okay, I can't use a rock and play. I'll use a Snoo. The Snoo is outrageously expensive, but I can rent it.

Ann Grauer [00:33:15]:
In my community, I can rent it. So I'll rent it. And maybe it works for their baby and helps them sleep. Maybe it doesn't. Maybe you have a baby who's now addicted to the Snoo and they can't get the kid out of there and they're older than 4 months and it's no longer safe for them to be in there. But we see this with every type of sleep product on the market. And it's because of the situation we've set parents up for failure. That's really what it comes down to.

Ann Grauer [00:33:44]:
And we've made them the fall guy if there's a problem. And because, for instance, with the Owlet, with the rock and play, with all of these products, what the manufacturers have said is, oh, The parents are not using the product right. If they would just use it right, this wouldn't be a problem. Thank you very much. Thank you for blaming the people who bought your product and, and had no idea. Well, we told them in there, don't use it for sleep, right? Come on, really?

Dr. Hillary Melchiors [00:34:16]:
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Ann Grauer [00:34:58]:
Now back to the episode.

Dr. Hillary Melchiors [00:35:02]:
I have appreciated some of the, like, to use this term loosely, like influencers or people on social media who review products for safety and things like that. And really push that. I'm specifically thinking of like Jamie Grayson, who does that great work on YouTube. So, but But I think that's great and reaching people how they, you know, how they consume media or whatever as well.

Ann Grauer [00:35:29]:
I think those are good things. Yeah, people like Jamie Grayson and the Car Seat Lady and other folks, they have taken social media and they have found a way to, in short snippets, get information out to families that they can digest. And what is really wonderful is I'm seeing more and more people who are able to share those, those safety pieces with them. I really see it more in the car seat industry. I really like, I really like a number of the folks who are out there doing things now, but they're, they're really showing people how to, how to make this work because, you know, again, it shouldn't take a rocket scientist to put a car seat in a car and have a kid be safe, and yet it kind of does. Right now, um, the things you have to know. And the same thing happens to the fire station to get it installed, right? I don't have any fire stations to do it anymore.

Dr. Hillary Melchiors [00:36:32]:
Yeah, uh, we have a couple. We have like a local nonprofit where you can take— well, they have like car seat techs or whatever. And I always have, you know, in our resource list we always have a few local car seat techs. But I mean, I have seen so many people putting in car seats and like really sweating like they've had a major workout after they've done it. And then it's still wrong.

Ann Grauer [00:36:53]:
And it's still wrong. I mean, how hard do we have to make this? This is not— I— come on, we— there should be a way to do this, and I think there is. I just think that if the car seat manufacturers and the, and the car manufacturers would have a little sit-down, they could make this work. And I know a lot of parents would be more than happy to grab onto a car that where they could literally make this work, it would, it would be amazing. But it's the same thing with the sleep industry insofar as they're just inundated with all these products. I think the ones that are worrying me the most right now are the nests, the ones that are the, like the, oh my gosh, the Dockatots and those types of things. Number one, they're not inexpensive. They're about $150 to $175 a pop.

Ann Grauer [00:37:48]:
And the second thing is, you know, it is that lovely nested thing where the baby lies there and they look so comfy and cozy because they are comfy and cozy. And that's part of the problem with them. And they have these very highly bedded sides that, you know, could they suffocate if they got into certain positions? Absolutely. But for many people, the Dock-A-Tot has become the answer. Like, if I can't— if you're telling me I can't surface share with my baby, okay, I'll put this nest in between me and my partner, and then neither one of us will roll over on the baby, and she can be right here. Um, and the— I see them everywhere. Everybody has a Dock-A-Tot, and everybody's putting a Dock-A-Tot in the bed.

Dr. Robin Elise Weiss [00:38:35]:
Um, so it's like a good solution.

Ann Grauer [00:38:38]:
It does. It sure does. It sure does, because babies, babies weren't designed to live in stainless steel basins, and they don't sleep well in those. And even though we've said this is what you should do, you know, you know, hard, flat, blah, blah, blah, um, and, and we do know it does make a difference. I, I sit here with the Dockatot and the Nest, and I don't mean to just pick on them because there's so many other brands out there, but The thing is that of course it is seductive to the parents and it seems like such a good idea, but then AAP also says, oh, by the way, don't use those little travel bassinets and things like that, you know, things that'll fold down and fold up. And I'm thinking, wait, why not? Parents have got to sleep. What are they supposed to do?

Dr. Hillary Melchiors [00:39:29]:
Wait, you're, you're not supposed to use those anymore? See, this is news to me. I didn't know.

Ann Grauer [00:39:33]:
Oh no, like the The bigger ones that were like the play yards, we would have called them play yards back in the day. They don't call them play yards anymore. They really refer to them as, you know, like they're a crib, they're a travel crib and a travel bassinet in it. But what I'm referring to are the ones that are smaller. So in the UK, you call them a Moses basket, you know, like a little bassinet, right? But these would be versions that are like that. And they also say, you know, that the Moses baskets aren't a good idea. When you're talking in the United States. But quite frankly, these have been used for time eternal.

Ann Grauer [00:40:12]:
I was doing some, I was doing some investigating myself the other day and looking in, in New Zealand. I can't think of what the term is, but the traditional version of it is a woven thing. But they also have modern ones that look like literally like Rubbermaid tubs that And, and there is a sleep consultant there, um, from the medical point of view who's looking at— we should be sending people home with these. So this was another version of the sleep box theory, right?

Dr. Hillary Melchiors [00:40:44]:
That's what I was thinking. I was like, that sounds like a sleep box.

Ann Grauer [00:40:47]:
Yeah, it sounds like a sleep box. And here's what's really ratty about the sleep box industry, um, is that, um, Dr. Ball started doing a little bit of looking into it because Scotland had— they got this money, all of this money, for to reduce the risk, you know, to reduce their SIDS numbers. So they put all the money into boxes, and to— we'll make these really pretty boxes and we'll give them to the families based off of the Finnish model, and we will— it'll reduce the risk of SIDS. It'll reduce SIDS. Well, they spent all the money, but You know, did you see the difference? Are the babies really sleeping in the boxes, number one? And if they are sleeping in the boxes, what Dr. Ball started to look at is, is it safe for them to sleep in the boxes? What is the box made of? What are the chemicals? It's painted pretty colors. It's got all kinds of other chemicals in it.

Ann Grauer [00:41:43]:
Is the baby breathing that in? What else are we looking at here? And so the AAP in their update says, you know, use the laundry basket or a chest of drawers, you know, a drawer from a dresser if you don't Well, that has been used. Hello, this is how our great-great-greats, you know, they did it for all of time, right, to make that happen. It's been around, but yet they're still going to give a hard time to anything that could actually fit into the parent's bed. It's really interesting. I kind of wonder, like, if you could say, well, I have— I did the drawer you said, but it's in between me and my partner. What do you think? If they would be okay with that. I don't know.

Dr. Hillary Melchiors [00:42:26]:
Well, since you, since you mentioned reducing risk of SIDS, I know that's a topic near and dear to Robin's heart for sure. The more recent scientific news that came out where they detected the enzyme that they think causes SIDS, can you talk a little bit about like how you're seeing that interpreted in the news and such, because I know you're up on that as well.

Ann Grauer [00:42:54]:
Yeah, it broke my heart. It broke my heart. Um, you know, I think that what happened, uh, was someone got wind of what was going on and they took it and ran, and then everybody else ran with it. This is an example of, you know, the media gone wild. Um, this amazing researcher who, you know, um, she lost her own baby to SIDS 29 years earlier and has devoted her entire career to working on this. Now, she discovered an enzyme that is part of the picture, but it is not the picture. It is not the whole picture. It's not even a fraction of the picture.

Ann Grauer [00:43:34]:
It's a micro fraction of what's going on. And it actually just— it gave credence to the path we were already on. That the researchers were on. And instead, the media were like, oh, that, that'll, that'll be out there, you know, woman who lost her baby to SIDS now finds the reason that, that causes SIDS to happen. And that's what everybody put out there.

Dr. Hillary Melchiors [00:44:00]:
It's a cure for SIDS, right?

Ann Grauer [00:44:02]:
It's, it's a fantastic story. And she must have been horrified. My, my empathy and sympathy is with her because they used her And unfortunately, that's not what's going on here. It's this tiny component of it. I mean, we've known for more than 15 years that it is like that. There appears to be a neurological issue that is at the root cause of this. And this work has been ongoing as they try to pinpoint it. There are no tests for it or anything else.

Ann Grauer [00:44:39]:
The enzyme kind of kind of affirm that. It didn't say, oh yep, here is the deal. Um, and so parents thought, you know, oh, all I got to do now is get my kid tested for this enzyme and we'll know. And it was so sad and unfortunate because her work got— her years and years of work got smashed with this. And I saw so many people who didn't understand that this is far more complex um, just kind of take the ball and run. So what I've tried to do is I try to go back and think what it's like to be a new parent. You know, um, I haven't had a new baby of my own, uh, for 31 years, but I try to go back and I think, what is it like? What are the things that I'm worried about? What are the things that I need to know? I try to start from there versus the Oh, I've been doing this 33 years, so I know these things. And what am I— what is the information that I'm going to need so that I can decide what's best for my family? And then I look for the resources that are going to support that.

Ann Grauer [00:45:49]:
So that's where I turn to BASIS and I turn to the Lullaby Trust, because everything they bring out is evidence-based. Everything. They don't do anything that's not evidence-based, and they are compassionate with parents. I make sure parents know about the AAP, and I also make sure they do know about the Safe to Sleep program through the NIH and Ethel Kennedy Foundation, even though I really detest their messaging, because they need to know that that's what's out there here in the United States. And they usually will say to me, but the, the stuff that's coming out of the UK is saying that you can do these other things while the US is saying absolutely not, don't do it. And I say, well, do you think babies are different in the UK than they are here? You know, do you think they're inherently different?

Dr. Robin Elise Weiss [00:46:43]:
So what would your message be for birth workers, right? Whether it be midwives or doulas or childbirth educators. I know the enzyme thing came up in, in my childbirth class just this week, right? So what would you say to a newer experienced birth worker who wants to know more information and wants to be able to give good solid evidence-based information to their clients?

Ann Grauer [00:47:10]:
Oh, awesome question, because we're always challenging ourselves on this, right? Number one, go to the sources. Go to the AAP, read their paper, go to the NIH, read that safe-to-sleep setup that they have there, then go to BASIS and read it there and see where the differences are. See what is going on. You need to, you need to have this information at your fingertips. Luckily, they're also very consumer-friendly. The other thing I think is really important is that we start to look at educators. You know, I was thinking about how different it is in some ways to be an educator now than it used to be. And I mean, I was always endlessly curious, some might say annoyingly curious, asking a lot of questions.

Ann Grauer [00:48:10]:
But we need to be endlessly curious as educators. We need to dive in and start to look at what is out there and educate ourselves better so that we know what's happening. So there are two sources that I'm feeling really good about right now when it comes to making sure that we have the info on what is going on with sleep, what is normal, what is not. And, you know, we talked about just a second ago, we, we talked about BASIS. Well, Helen Ball's information out of Durham University, she had so many people who were asking about this pretty much nonstop that she created something that can truly, truly make a difference. They have, out of Durham University, they have partnered up with a group out of Australia called Possums and Company. Possums is an organization that was started and has loads of research behind it on how babies sleep, why they sleep the way they do, and helping parents to work with their babies so that everybody gets some sleep. So Durham University took the POSSEMS training and made it accessible— has made it accessible for professionals in a shortened version.

Ann Grauer [00:49:39]:
So they've created something called Sleep Baby and You. And it is the— it's, it's for practitioners. They have two— they have this lovely, um, webinar that you go through. You go through the webinars with them, and then you're able to access some of the materials that you can use one-on-one with clients. You can't just like give them out all over the place because they hold copyrights on them, and they're trying to be very careful and make sure people know when they're using these But the really cool part about it is that the program, as you go through it, you are really understanding what you should expect to understand as to how infant sleep, how does normal sleep develop over time, and how do you adjust to the demands of what a baby needs during this time, right? And then how to work with babies. They've got some really lovely things and it's very inexpensive. It's like $70 US or so to take this training. So I think that's a really good place to start.

Ann Grauer [00:50:46]:
If everybody were taking this kind of thing who are working with families, we would all have that ability to at least have a baseline of information, right? And then the second part of that is looking at if, if I have an educator or a birth person who is really interested in knowing more about this, I would encourage them to perhaps go to the POSUMS website itself. And the reason is they have, they have programs for parents, but they also have a couple of levels of programs for birth workers and doctors and nurse practitioners and others, and so that they will have a deeper understanding and being able to explain this to parents. And I think that for a lot of people, that's really all they need, right? I think that the Sleep Baby and You would be a great beginning. I wish everybody had that. Then if they wanted to dive a little deeper, the, the POSSUMS training would give them a bit more. If they really wanted to work with families as like a sleep coach or something like that, then what I would be recommending would be looking at like Lindsay Hookway's program, Holistic Sleep Coaching, because it is fully evidence-based. It is unbelievably thorough and helps helps people. By the time they come out of Lindsay's program, they know their stuff inside and out, and they're not, they're not doing things to babies that are inappropriate.

Ann Grauer [00:52:35]:
The hard part for us is that parents are turning to sleep coaches, sleep experts, whatever, who aren't, you know, I don't mean to I don't mean to be disrespectful to people who have taken programs because they're trying to be helpful. That's really what it's all about. But you don't know what you don't know. And some of the harm that I'm hearing that families have encountered with some of the techniques that have been used on them and/or their babies. Sometimes, you know, the sleep people are very frustrated because families won't follow what they're saying. And it's like, I'm like, you know, families get to choose. Guess who's in charge? They are in charge. And even though they've hired you as a consultant, they have the right to say yes or no.

Ann Grauer [00:53:23]:
You know, like, let's show some respect for where they're coming from. And maybe they're, maybe they're just not where they need to be yet. But I find that I've not found a sleep program yet in the United States, and doesn't mean I've seen every single one that is matching the quality of these other programs.

Dr. Hillary Melchiors [00:53:44]:
Nice. Are there other resources that you make sure you share with families? Like, I always talk about safe co-sleeping, so when I, when I do that, I talk about like James McKenna's research from out of Notre Dame. Of course, again, I have always go back to the anthropologists.

Ann Grauer [00:54:04]:
Oh yeah, my people. How could you not? I mean, Dr. McKenna is part of the reason I got so into all of this, you know, back in the day because of his research. And Dr. Ballas, his compatriot, you know, both anthropologists coming at this from— and I think, thank God for the anthropologists because we're not just looking at babies like they're medical specimens. And we're actually seeing a whole family here. Uh, what, what I, I love Dr. McKenna's new book.

Ann Grauer [00:54:41]:
His, his newer book is really, really well done. And, um, it's the, you know, it's the, yeah, Safe Infant Sleep. It's, it took his original book and really turned it into what it could have been to begin with. So you have that, um, using BASIS, using the Lullaby Trust, that kind of thing. Also Lalachie League using their Sweet Sleep book. It's fantastic, and it gives real solutions for people who are nursing their babies and trying to figure out what to do. But BASIS and Lullaby Trust also address all of those things in there. They're kind of in there, and I just— I think my heart breaks because In the United States, I know that we could be doing a much, much better job of reaching families and getting information to them.

Ann Grauer [00:55:38]:
And I wish beyond wish that the AAP would open up and acknowledge that there's an entire family here. And it's not just a baby who's impacted by sleep. It's their family, it's their siblings, it's everyone who's in this. And instead of acting like, well, just do as we say, just do as we say, that's just how it is. I think that they're missing such a golden opportunity to bring parents in, in partnership and show them how much they respect them or not.

Dr. Hillary Melchiors [00:56:19]:
Do you think that AAP will have like reckoning on their roots the same as obstetrics has had at some point? I mean, I hope so. I mean, I highly doubt those pediatricians in the 1800s, the first ones ever took care of a baby, like ever.

Ann Grauer [00:56:40]:
Oh, so absolutely not, right? No, they just stood there in their stiff collars. And told other people how to do it. One of my, one of my, uh, hobbies is to collect old, um, baby care manuals, and I have them going back to the 1800s. And, um, I collect old magazines from back in the day, you know, the, the baby magazines you would get, um, in the '30s and '20s and '40s and all of that, and What's so fascinating to me is so much of the information that the AAP has given out is very much like it was, and it's all based on more stuff that was coming out of the UK at that time. And guess what? That was based on things from the 1600s and even 1400s in Europe. So it's like, um, I think it's probably time, and I, I'm very hopeful that they will start to really step up on this piece. And I'm very— I'm also very sad for the AAP because of their misstep recently from their breastfeeding committee. They call them— they call their committee sections.

Ann Grauer [00:57:54]:
So the breastfeeding section, which, you know, we now know will be— need to be like breastfeeding/chestfeeding or or lactation or whatever, so that we're using some inclusive language, that they have been working for years to get the message out that it is a normal thing for human infants to nurse for, you know, beyond a year. And because so many people in the United States think if you're still breastfeeding at 6 months, something's wrong with you, you know, like, what are you doing with your baby kind of thing. And so when they came out with their update, in the last couple of weeks, and they were talking about how, you know, 2 years. It unfortunately hit in the middle of this firestorm of what was going on, and I started seeing parents and other people freaking out and saying, read the room, you know. And what they didn't realize was that it wasn't about reading the room. They had been waiting and waiting to get this out the door and finally got out the door. And yeah, maybe it's time for the reckoning. Maybe it's time that we have— maybe this is, you know, grist for the fire so that we can finally have this conversation.

Ann Grauer [00:59:15]:
But what parents are saying is, until we have paid leave, until we have some support in place, like with childcare and returning to work and those sorts of things, you ask me at work, All of that. Yeah, you asking us to do these biological norms is in direct opposition to what we're capable of doing.

Dr. Hillary Melchiors [00:59:40]:
But I mean, the AAP doesn't write the US law. So I mean, I am fully like, I hear both sides. And I agree with both sides. Like, I want the AAP to tell me about the best evidence. But I also like, the AAP isn't passing the laws or, you know, that, you know, not protecting or helping formula production, not helping and not helping with paid leave. I mean, like, that's not their role, right? And so I agree, I'm really happy that it finally got out the door because, I mean, again, 2 years, yay. But at the same time, in my head, I was like, oh yeah, right, like, no way, no way, it's not practical.

Ann Grauer [01:00:23]:
I think I think part of it is they said 2 years, hoping people can get to a year, you know, because when they were saying a year, people could sometimes get to 6 months. So there's that bit. And while it's not their thing to do public law, they are very influential, and they have a lot of money, and they use that money for their lobbyists on Capitol Hill. And so I think what the parents are saying is use your influence You have this privilege, you have this influence. Let's see you use it because we have got to have something happen. And any of us birth workers who have ever worked with, um, a client who is also like a medical resident or even a young, you know, a young doctor or midwife or whatever, we know what they are facing and what they're having to do to get back to work.

Dr. Hillary Melchiors [01:01:24]:
Well, and I think that there's that statistic, right, like, uh, how much do pediatricians actually breastfeed their own children? And it's very, very low because they don't have time, like they have to go back to work like you were saying earlier.

Ann Grauer [01:01:38]:
And the pressure is ridiculous.

Dr. Robin Elise Weiss [01:01:42]:
Policy though, while the American Academy of Pediatrics and other groups, um, you know, the Academy of Breastfeeding Medicine, like all these policies that are out there, they are also influential for those companies who are trying to lead the way and say, hey, even though we're not being forced to do this, like there's not a law, we want to, yeah, right, by the families who are in our employ. And they are, a lack of a law, are turning to places like, um, you know, ABM and AAP to to find that information and so that they do have evidence-based policies. So I think that it's really important for us to understand that, that, you know, even if we don't have this immediate fix of everybody gets it— and I think we have in the United States a really good history of bad policy, meaning not, you know, look at family medical leave, that is not something that everyone can take advantage of, it's not paid, like we— but people point to it, they're like, hey, we've got FMLA. Yeah, that's not quite what you, what you think it is. Um, and you know, when do they find out? Oh, when they're 4 months pregnant and they're starting to work, you know, they're like, oh wait, I thought I got 12 weeks paid.

Ann Grauer [01:02:56]:
No, that's not what that means. Now that's an excellent point that it does influence companies and, and they're trying to respond in ways. I, I think my hope is that, you know, we can use this as a starting point. And what I really hope as well is that the AAP will start to work with others in regards to this, like, you know, let's— those of us who are on the same side, let's get in there together and start making a difference for families. It's— and I don't mean that they haven't been, I just mean that there is strength in numbers. And when you can show that this is coming from a across the social landscape, why would you not get in there and apply your influence and what you have in place? Everybody, you know, this is a time when tempers are very high and we are all stressed to the max on an everyday life basis. Then you add into it the families have babies during COVID and then On top of that, the issues with leave and everything else, and, you know, the fact that we've had fewer women returning to work as a result of the landscape out there. I mean, we are at a tipping point, or we're fast approaching a tipping point.

Ann Grauer [01:04:18]:
So something is going to have to come out of this. And this is one of the things that I love about having hung around for 33 years is that the younger generation is not tolerating it. They're just like, um, no, no.

Dr. Hillary Melchiors [01:04:33]:
But listen, this is why I love hanging out with y'all, because you have this perspective that the younger doulas don't have, and you have this long view that we haven't had the ability to acquire yet. And I'm not even a spring chicken doula anymore, right? So like, that, y'all, you have this this ability to look at the big picture in a way that younger doulas and childbirth professionals generally— I mean, we don't have that yet. And sorry, I'm just getting a little teary. I just love you.

Dr. Robin Elise Weiss [01:05:10]:
I think that's a really good point because I think one of the things that comforts me, having the years of experience that I have, is that I remember when every baby went to— every healthy baby went to the nursery for 4 hours for a mandatory, you know, observation, right? When we had to beg and know the special magic words to get a baby to stay 5 minutes in the room, not even skin to skin. We're talking baby burrito, right? Like, I mean, and it was like— so I can say, yes, policies do change. Yes, it is painfully slow, but it does happen. Right. And it happens because we are out there working, right? We are connecting these families in some ways. We are the architecture behind this, right? In that we're saying, hey, you're mad about this and you're mad about this. Um, let me introduce you to each other. You know, you're in a childbirth class together.

Dr. Robin Elise Weiss [01:06:02]:
You're at a reunion together. Like you're meeting other families. I have this, um, alumni community, people who've been in my doula group. Like they come and they start talking and there is those power powers in numbers. And one of the things, and we really saw this during COVID is there's power in consumerism, right? So the consumers have more power, right? It's not the childbirth educators, the doulas, the midwives, not even the doctors, right? It's really the consumer behind it. And so if we can help support them and we can help them find this information, they're going to demand it. They're going to stand up and say, I need you to make this better for us.

Ann Grauer [01:06:39]:
For sure. And you need luck on your side. You need like— that's the part that is really frustrating but wonderful too. I find it really fascinating that like you can be out there doing the work all this time and then some weird thing happens in America and suddenly everybody's on board with it and you're thinking, wow, if it had— if that thing hadn't happened, we wouldn't have gotten the rest of it to come together. So I I totally hear you on that. Um, and by the way, guys, I hope at some point you guys will do a show on, um, on, uh, the formula crisis and what we've dealt with.

Dr. Hillary Melchiors [01:07:22]:
Absolutely.

Ann Grauer [01:07:24]:
Because you're like in that heartland, aren't you, Hillary? You're like not too far.

Dr. Hillary Melchiors [01:07:29]:
I only live 100 miles from Robin, like literally from my house to her.

Dr. Robin Elise Weiss [01:07:33]:
I think she means that they're formula manufacturers.

Dr. Hillary Melchiors [01:07:35]:
Oh, well, I am in the the Formula Maker Hotline— Heartland, that is true. Yeah, yeah, yeah, we could definitely talk about that for sure.

Ann Grauer [01:07:46]:
Yeah, I think that would be a good one. And as a— as someone who's been doing this a long time too, that for me has been like, thank God they're finally getting the message out. Um, so anyway, so for someday down the road, I appreciate that.

Dr. Hillary Melchiors [01:08:01]:
Well, and before we finish up, I have to make sure that I ask to ask you one of our funny questions. So Robin, do you have any last— a last question about sleep for Ann before I ask her our would you rather question?

Ann Grauer [01:08:17]:
No.

Dr. Hillary Melchiors [01:08:18]:
You sure?

Ann Grauer [01:08:20]:
Okay.

Dr. Hillary Melchiors [01:08:21]:
Ann Grauer, would you rather be a character in the last book you read or in the last movie you saw?

Ann Grauer [01:08:30]:
Oh, the last book I read.

Dr. Hillary Melchiors [01:08:32]:
Ooh, what was it?

Ann Grauer [01:08:34]:
It was Stacy Abrams thriller While Justice Sleeps.

Dr. Hillary Melchiors [01:08:39]:
Literally, Robin's listening to this book right now.

Dr. Robin Elise Weiss [01:08:42]:
And is why I'm listening to it. And I have to say, if you're reading it, not listening to it, the narrator is amazing. So—

Ann Grauer [01:08:50]:
Oh, that's good. That's good to know because that's my only fight on books, you know, audiobooks is if I don't like the narrator, I can't tolerate it. Oh no, that book was so good.

Dr. Robin Elise Weiss [01:09:02]:
Okay, speed it up a little bit and you can't— like, the narrator doesn't matter.

Ann Grauer [01:09:07]:
Okay, I'll try to remember that. Thank you all for letting me come and talk about something that's very near and dear to my heart.

Dr. Hillary Melchiors [01:09:15]:
I would talk to you every single day if we had the time, and you're wonderful.

Dr. Robin Elise Weiss [01:09:19]:
And Ann, you have the distinction of being our first repeat guest.

Ann Grauer [01:09:26]:
That's pretty exciting. Thank you. Very excited about that. Well, glad to hear that, um, that our podcast is going to be out there and educating all of us.

Dr. Hillary Melchiors [01:09:38]:
Thanks, Ann.

Ann Grauer [01:09:40]:
Thanks, guys.

Dr. Hillary Melchiors [01:09:41]:
Well, Birth Geeks, that's it for our first episode. We hope you'll join us again and like, rate, subscribe on all your favorite podcast channels. And we look forward to bringing you more great conversations specifically tailored toward birth professionals. Thanks so much. We love to be social, so be sure to find us on Instagram, Facebook, and Twitter and use our hashtags: #AskTheBirthGeeks and #BirthGeeksUnite. We hope you'll join us again here at The Birth Geeks. Thank you.

Ann Grauer [01:10:19]:
Upgrading the conversation and helping you renew your professional moxie.