Breastfeeding, getting sleep, and bed-sharing 🤞

In Manitoba, Birth Workers regularly confront challenges in supporting parents. We provide detailed information to help parents make informed decisions for their children. Our evidence-based resources sometimes provide worldwide views, highlighting that practices differ across cultures. The greatest challenge I see for new parents is establishing healthy breastfeeding practises, and coping with sleep deprivation. A new parent’s sleep schedule will be impacted by the needs of a newborn infant. This is a normal change/challenge. We must be responsive in our approach to newborns. This isn’t discussed openly, therefore is not normalized, but pathologized . Infants require our attention, care/bodies, because they are underdeveloped creatures. What does that mean for us? How can we do this while following a lengthy list of insane expectations…Most parents are not prepared for what this is. We don’t want to be criticized - were too tired. We don’t want to cause harm - were afraid…It is our responsibility to keep our babies alive!! That’s BIG. So, what if we just put all of that aside, what if we were to focus on what our little infant tells us? Simplify, and follow cues. If overnights are hard, and they will be for most, catch more naps, ask for help in the spaces you occupy, work in shifts, get familiar with risks associated with sids, and familiarize yourself with safe bed-sharing. It’s amazing what 30 mins of sleep can do intermittently during the day/night.. Your infant will need you 24/7. You will be required to respond to them, this is a need. A call to action, if you will. Get comfortable, and follow the Safe 7 (posted below).. The evidence on sids does not point to safe bed-sharing. In fact, countries with high rates of breastfeeding and bed-sharing have some of the lowest sids rates. Safe bed-sharing encourages breastfeeding, and sleep. Therefore, improves breastfeeding outcomes, and reduces the risks of sids when done safely. Find out the facts with a 360 lens. Make the choices that are best for your family. If you aren’t comfortable with bed-sharing, there are options out there, but keep baby close so that you can be responsive to their needs. I breastfed both of my daughters, and practised safe bed-sharing. I could not afford to be sleep deprived as a single mom. I breastfed Ruby for 2 years, then Yona, 12 years later, until she was 7. We still share a bed, she is now 9 yrs old. I understand this isn't for everyone, but you might find a balance that works for you. I hope the following offers support, and a glimmer of hope to what is fact, and what is possible.

Breastfeeding and Safe Sleep

• Reducing the risk of sids (sudden infant death syndrome)

• Connection between sleep and nighttime feeding

• Managing nighttime feedings

• Understanding different recommendations
  
  

Sids, or Sudden Infant Death Syndrome, is a rare but serious cause of death in infants under one year old. It is most common in babies aged 2 to 4 months. The rates of sids differ worldwide; the highest rates are in New Zealand and the US, while Japan, the Netherlands, Norway, and Sweden have the lowest rates. In developing countries, higher infant death rates are often associated with infectious diseases, and many places lack information about SIDS.

SIDS Risk Factors - The triple risk model = Three factors must be present

1. Infant vulnerability - Premature or low birth weight, other.

2. Rapid Development - Learning to roll, or sleep cycle maturing early on

3. Environmental factor - cigarette smoke 

• Prone or side sleeping

• Prenatal/pp cigarette smoke and drug exposure (no evidence on vaping, but 10/10 advise against)

• Soft coverings such as pillows, and blankets, objects in the sleep space

• Prematurity

• Low birth weight

• Overheating

• Unsafe bed-sharing

• Not being breastfed

Keep your focus on environmental factors, because these are within our control.

Reducing the risk 

The goal is to lower changeable risks as much as possible. Sometimes, we may not be aware of underlying infant vulnerabilities.

• Back to sleep ( baby always sleeps on their back)

• Baby in the same room as their parents/guardians for minimum six months

• Not too hot! (16-20 degrees celsius)

• Avoid smoking, vaping and secondhand smoke

• Firm sleep surface

• Breastfeed if you can, for as long as you can

• Keep crib free and clear of pacifiers, blankets, and sleeping products

The breastfeeding/chestfeeding and sids link

• Well-established research that breastfeeding reduces the risk of sids by up to 50%.

• The longer the duration, and the more exclusive, the greater the protection.

• It is unclear what the protective mechanism is:

Arousal response

Parental sensitivity

Immune components

Better myelination of the brain

More DHA

                       (Hauck et al,2011;Vennmann et al,2009;Thompson et al,2017)

? Improved gut microbiome activating/strengthening body systems

? Increased resilience to infectious diseases, respiratory disease, viruses due to antibodies from human milk biomes

Feeding and sleep are highly interrelated

There will be disruptions to the parents sleep schedule

• Infants from birth to beyond 6 months old need to wake and feed regularly

• Only 15%-20% of 6-18 mo old sleep through the night.

• Humans are ‘carry’ animals - because of the human infant’s very vulnerable size/development at birth, we are designed to cuddle and carry our infants until they are developmentally mature enough to be independent.

• Species specific milk composition drives the infant’s feeding intervals

• Affected by maternal milk storage capacity

• Infant temperament affects behavior and ease of settling.

  (Ball,2003;Brown and Harries, 2015;Hysing et al, 2014)

Trying to keep your infant awake during feedings, or control feeding intervals? Good luck with that 🙂

Let's talk about the hormones that impact your baby’s night feeds!

• Ghrelin - regulates energy output/input by adjusting hunger cues based on stomach emptiness. Hormone that makes your stomach rumble. Can adjust hunger based on how full your stomach is. Also responds to low blood sugar.

• Orexin - Promotes wakefulness and appetite - sometimes infants will feed because they are awake, not because they are hungry, and they must be able to do so. You are basically watching them listen to their bodies.

• Leptin - Is released by the baby! A satiety hormone, which decreases appetite. Makes you feel full and content. ‘Milk drunk’, fat content increases as does leptin. Appetite is regulated during breastfeeding.

• Cholecystokinin - The hormone responsible for the NREM sleep that babies fall into during or after feeding. This hormone decreases appetite and increases NREM sleep. To try and interrupt this response, is fighting a losing battle. 

• Brain derived neurotrophic factor (BDNF) - Induces sleep and reduces appetite, challenging the idea that infants/babies eat for pleasure. A baby's brain will prioritize its needs. A baby's need for food is greater than their need for sleep. Babies do not ‘comfort feed’. “ The human brain growth spurt begins during the third trimester of pregnancy, and continues throughout the first 2 yrs of life, coinciding with the lactation period.”(Viberg et al.2008)

(Kapas,2010;Shukla and Basheer,2016;Cordeira and Rios,2011)

Babies may be hungry because they are awake, not waking because they are hungry, based on their metabolic responses. Feeding and sleeping are closely related. You can stop the night feeding, but in turn will not stop night waking, because the relationship is interconnected. 

What is developmentally normal? Infants have a need for responsiveness, and to be close to their parents.

Responsive Feeding (Night and Day) and Milk Supply

• Avoid putting babies on feeding schedules!

• Maintenance of milk supply is driven by frequent milk removal

• Age of the baby, and the stage of lactation may change infant feeding frequency

• Feed when you see feeding cues

• Feeding can be dictated by storage capacity, and the baby may need to return to the breast more frequently if storage capacity of breast/chest is less.

• Feed responsively

If feeding responsively is what a baby needs, then how do I balance my sleep?? Things are getting REALLY HARD.

• Parents will face societal pressures, unrealistic expectations, lack of support, lack of resources.

• The feeling of being open 24 hrs!

• We pathologize instead of normalizing infant night sleep. It is in fact normal for infants to feed at night. 

The reality of nighttime parenting

• Exhausting 

• Different people have different sleep needs and thresholds 

• Many parents are simply unprepared

• Culture influences expectation

• Unrealistic expectations

• Societal and family pressure

How to make night feeds easier, and how to cope with fragmentation?

• Being in the same room

• Taking shifts

• Nightlight

• Learn to feed lying down

• Early nights & naps during the day

• Realistic expectations

• Bed-sharing

The controversy around bed sharing

• Current guidelines advise against bed sharing in the US and Canada. The US has the highest percentage of SIDS in the world. Japan has the lowest SIDS statistics in the world, but also the highest percentage of bed sharing. 

•  In Canada ⅓ of babies bed share.

(Gilmour et al, 2019)

• Parents often withhold this info for fear of shaming

Current Safe Sleep Guidelines in the UK

• Keep baby away from the pillows

• Make sure your baby cannot fall out of bed, or get trapped between the mattress and the wall.

• Make sure pj’s can't cover baby's face or head.

• Don't leave your baby alone in bed, even the smallest babies can wriggle.

• It’s not safe to bed-share if your baby was born very small or preterm

• It’s not safe to bed-share if you are intoxicated or under the influence of any drugs or medications that may cause drowsiness.

• Do not sleep with your baby if you or anyone else is a smoker/vaper 

• Do not put yourself in a position where you could doze off in a sofa or armchair. 

Current Safe Sleep Guidelines in Australia/New Zealand

https://rednose.org.au/resources/%20education

https://images.app.goo.gl/uVxnKu7Vex1ayBYF8

Research tells us that sids is not related to bed-sharing. 

In Pakistan, India, and Japan bed-sharing is common practice, and sids rates are lower than average. 

(Crane and Ball,2016; Pease et al,2017;parks et al,2017;goldstein and kinney,2017)

Numerous studies find that there is a positive correlation between bed-sharing and prolonged duration of breastfeeding. 

(Ball et al,2016;McKenna and Gettler,2016;Marinelli et al,2019)

Leave the decision making up to parents to make informed choices.

These are the facts to consider as you make informed choices 🙂

• Breastfeeding significantly reduces the risk of sids

• Nighttime breastfeeding can be hard

• Bed-sharing facilitates easier breastfeeding

• There are ways to make bed-sharing safer

• Bed-sharing is not universally discouraged around the world

• In countries where bed-sharing is the norm - sids rates are lower, but they also have higher breastfeeding rates.

• It's difficult to make informed decisions with so much controversy and a lack of a clear consistent message. 

• Sleep deprivation impacts milk production, decision-making, appetite, hormone levels, relationships.

• Breastfeeding is the best way to feed your infant. Exclusively for 6 months, up to 2 yrs and beyond will continue to build resistance to modern day viruses, infectious diseases, and enhance cognitive development.

If you want help, if you need support? Please reach out to me, or have a look in the resource list on my site for breastfeeding resources.