Sleep & the Breastfed Baby, Part 1
When I was a new mom, the most common question I was asked about my new baby was "How is he sleeping? Is he sleeping through the night?"
It always felt like there was a measuring stick being held up to him - and me - judging whether we were achieving parenthood's first big milestone of sleeping through the night. (Which by the way, is a very modern western ideal.) My baby was nursing every few hours and I didn't really mind…except I started to feel like there was something wrong, or at least I wished I could respond to the constant questioning with the answer people wanted to hear. With my subsequent three babies, I learned to side step the question by answering with, "She's sleeping like a baby!" This change of perspective brought a peaceful acceptance of night nursing that allowed me to enjoy those middle-of-the-night feedings... or at least to better cope with them knowing it was normal.
Not only is it normal for a breastfed baby to night nurse, but it is also beneficial.
This is almost completely lost on our society that is used to formula feeding patterns. Studies show that babies who sleep long stretches at night are at increased risk of Sudden Unexplained Infant Death Syndrome (SIDS). They are more likely to get into a prolonged deep sleep and less likely to rouse out of it if their oxygen drops. The frequent night wakings of a healthy baby help increase arousals which keep babies in safe sleep states. One of the reasons formula fed babies wake less often is because artificial substitutes are difficult to digest, so the formula sits in their tummies longer giving them a feeling of fullness. They also aren't impacted by the ups and downs of milk supply. In contrast, breastmilk is easily digestible, helping babies to rouse when its time to eat again. Studies have found over and over again that the small frequent feeds of a breastfed baby lead to better health outcomes and prevent obesity. Most mothers and babies need 8-12 breastfeedings per 24 hours to sustain a full milk supply, even beyond the newborn period, because feeding patterns are restricted by mom's milk storage capacity (click pic right). If there are long stretches between nursing sessions, the accumulating milk in mother's breasts signals her body to decrease production.
It varies for every mother/baby pair, but after two months postpartum 8 feedings per 24 hour day with one 5 hour stretch seems to be a common tipping point before the signals to decrease supply are triggered. Interestingly, 5 hours is also the medical definition of sleeping through the night. If the 5 hour stretch is regularly exceeded, most women will experience a gradual decline in milk supply and struggle to achieve their personal breastfeeding goals. It may not always be immediately apparent, but after weeks or months of baby "sleeping through the night," mother may start to notice her supply and baby's weight percentiles have dropped to a concerning level. In fact, the so-called 4 month sleep regression is often a result of low milk supply after a period of baby sleeping through the night.
When does the 5 hour guideline no longer apply?
We recommend mothers continue to night nurse until around 9 months of age. At that point, baby is established on solids and a gradual decline in milk supply becomes part of the normal weaning process. The notable exception before 9 months, is a mother with an unusually large breast storage capacity (see picture) who may be able to maintain a full supply even with a baby sleeping long stretches.
Thankfully, there ARE solutions to help you maximize supply AND sleep: