Interesting article from Penny Lane, MSN, CNM of the Boone, Clinton, Montgomery County Breastfeeding Coalition (in Indiana). It has much good information on why babies often awake during the night and why mothers’ expectations for babies to sleep to the night at an early age are so frequently not met.
May 30, 2010 – As a midwife, I have come to the conclusion that the vast majority of mothers who fail to succeed at breastfeeding really struggle with understanding newborn behavior and their challenges really aren’t breastfeeding specific at all. Mothers are over whelmed. They don’t understand their baby’s cry. They have unrealistic expectations of their baby, and of themselves. Bedsharing is one step in moving towards breastfeeding success. However, realistic expectations must be understood.
Babies sleep very different from their parents. They don’t sleep exclusively at night. They don’t sleep all night and doing so is not safe. They fall asleep differently than adults and have shorter sleep cycles.
Parameters of Infant Sleep
Newborns require twenty hours of sleep per day, yet they only sleep in 2-3 hour bouts. Their circadian rhythms begin to emerge around the third month. A newborn’s sleep cycle (REM through quiet/deep sleep and back to REM) is about sixty minutes, compared to ninety minutes for an adult.
Adults drop quickly into non-REM, initially sleep cycles include little REM which increases to morning. Infants however, drop first into REM and then progress to non-REM after twenty minutes or more. This is why babies are so easily woken during the first half hour after you have laid them down. From birth to three months of age, 40-50% of infant sleep time is made up of REM sleep.
It is an unfortunate expectation of our society to expect “good babies” to sleep through the night. This isn’t a biological truth however, at least for typical, healthy breastfed babies.
Uniqueness of Human Babies
Human infants are neurologically underdeveloped at birth. They continue fetal rate of brain growth through the first year. While other mammals are born much more mature than humans, with even the ability to almost walk out of the womb, our hips simply aren’t large enough to birth a mature human brain. (Imagine birthing a one year old!) Therefore, human mothers are responsible for maintaining proximity to their newborn to help regulate newborn temperature, provide frequent feedings, safety and regulate infant physiology. Human babies are completely dependent on mom.
“Every primate baby is designed to be physically attached to someone who will feed, protect, and care for it…they have been adapted over millions of years to expect nothing else” (Small, 1988).” Euro-Americans have attempted to parent like cache species (like kittens and bunnies). Those mammals however have litters and those babies nest in away that provides them warmth. Their milk is also higher in fat, sustaining them for longer periods of time. This strategy is not optimal for human babies.
Historical Novel
Prior to the early 20th century, infants in western society slept with their mothers. “The bosom of the mother is the natural pillow of her offspring” (Dr. Conquest, 1848). Then during the 1920s, ‘child experts’ arose and influenced society greatly. Watson believed that no child could have too little affection, while a good ‘Truby King’ baby preferred solitary confinement to human interaction. The primary discourse of child-rearing revolved independence, self-control and self-reliance. Western society still fears spoiling a child.
Scientific baby care over whelmed mothering during the World Wars, including development of formula, baby care products, and even manuals. Isn’t it ironic that we now are inundated with a multitude of products that essentially work to replace the mother? We have rockers, cribs, soothers, vibrating seats, hammocks, heart tones from teddy bears… If being on mother is the wrong place to be, then why should we buy products that are designed to imitate the warmth and comfort of mom?
The Importance of Physical Contact
Mothers aren’t simply feeding factories. In fact, a fabulous research study conducted in 2002 demonstrated that monkeys prefer the warm, soft maternal model without a feeding source to that which only offers food. Physical contact is vital.
We know that physical contact that soothes and calms infants, promotes sleep, conserves heat/energy, and is an analgesic for newborns. We also know that separation is stressful. Premature infants are less agitated and have less apnea, bradycardia and more stable oxygen saturation. Mothers have less anxiety, they are more efficient in newborn care and they breastfeed more effectively.
Bedsharing
A large body of evidence demonstrates that approximately half of all babies are sleeping with their parents in the adult bed. Many parents had no intentions of doing so originally, but because of necessity brought baby into the adult’s bed. Some parents sharing doing so because they had no other sleeping arrangement for the baby. Others had anxiety regarding the infant’s health or safety, yet many more recognized the ease and convenience bedsharing provided night time breastfeeding or quickly appreciated how closeness settled the infant. Providers simply can’t ignore this very common parenting practice.
Sleep Contact Behavior
Breastfeeding bedsharing mother-infant pairs sleep together in a characteristic manner. Mom’s typically have their arms up to facilitate easy access to the breasts by the baby, with needs curled up under the lower end of baby. Infants oriented towards their mother’s breast, assumingly due to olfactory direction. This brings baby down out of the pillows, constrains baby by mom, controls the height at which the blankets will cover baby, makes it very difficult to roll onto baby, and brings mom in close enough to monitor the temperature and breathing of baby.
Mothers who have never breastfed, yet bedshare with their infants demonstrate very different sleeping behaviors. They do not curl up around their babies as a breastfeeding mother would, and they sometimes turn their back to their babies. They don’t orient to their babies for the same amount of time that breastfeeding moms have demonstrated during bedsharing.
Uninterrupted Night
Mothers feel babies are too demanding. They have other children to care for. They feel babies feed too often. Baby was unsettled on the breast, but sleeps better on formula. However research has demonstrated that those who brought their babies to bed realized a longer breastfeeding duration, and greater sleep hours.
McKenna et all has observed feedings twice as frequently when bedsharing occurred then when babies sleep alone. Ball et all conducted a RCT on a postnatal ward: baby in bed with mom, baby in side cart crib, and baby in bassinet. Couples were videotaped and researchers found babies in the bed with mom or side car, fed twice as frequently or more. Mothers whose babies slept in the bassinet beside the bed were missing feeding cues.
Videos demonstrated difficulty in replacing babies into the crib after feeding. As babies fussed, mothers would either place a pacifier or rock the crib in attempt to settle baby, rather than offer breast. Attempting to feed more frequently, resulted in greater breastfeeding success. Prolactin was increased.
Bassinettes are inferior to bed/side-car crib for breastfeeding initiation.
Can advice to all mothers not to bedshare be justified on the available evidence?
Is the with-holding of evidence from mothers about the benefits of bedsharing ethical?
How is avoiding discussion about bedsharing with parents good practice?
“The benefits of bed-sharing, particulary to breastfeeding, affect a great many more babies, and so are as important – or more so- than the small risk of SIDS.” ~Ball, 2010
From the Breastfeeding Coalition of Boone, Clinton, and Montgomery Counties, Penny Lane, MSN, CNM, Chairperson
