We assist so many tired, exhausted and frustrated parents. With a wakeful child (or two! ), getting through each day can be tough. But there is another cost that is not so closely looked at, talked about or understood. Breastfeeding.
Parents and health practitioners understand that breast milk is best for babies. While we understand that not every mother is going to be able to breast feed her baby and there is personal choice as well, we do want to support the mothers that are doing their best to offer breast milk to their babies, not only in those first few months but beyond this.
The Australian National Infant Feeding Survey (2017) found that 90% of mothers initiated breastfeeding, but only 15.4% were exclusively breastfeeding by 6 months. (http://www.health.gov.au/breastfeeding). At Caroline’s Angels, we come to many families that are finding breastfeeding very difficult due to a wakeful baby, and are considering weaning their baby in the hope that the family will get more sleep as a result. Mother’s are trying to implement the information imparted to them from health professionals to ‘demand feed’ their baby, but this often translates to feeding their baby whenever they grizzle, are tired and each time they wake overnight. When a baby is beginning to tire, they will often start to suck their fingers, this can be often misinterpreted by a parent to think that they are hungry.
As a breastfeeding mother will often be unsure of how adequate her milk supply is or how much milk her baby is taking, especially if the baby is tired and irritable or frequently snack feeding. She is more likely to offer a quick ‘top up’ feed to ensure her baby is well satiated prior to sleep, and hoping that extra milk will keep the baby full enough to sleep for a long period of time. This feed just prior to sleep can then reinforce to a baby of what to expect to ‘feel’ and expect around going to sleep.
For babies, going to sleep is a very sensory experience. Let’s look at an example of mother Miranda and baby Liam. For a moment, imagine what baby Liam feels like being offered a feed at sleep time. Take a look at the above picture of Liam in Miranda’s arms while feeding to sleep, this will help you. Liam is tired, then sits with Miranda, one of Liam’s favourite people and also the one person he gets used to putting him to sleep as she is the only one that can feed him. There is nipple in the Liam’s mouth and a sucking motion with the taste of milk and a ‘full’ feeling in his little belly. Miranda has hold of him and gently hums and sings as well as rocks in her feeding chair. Liam relaxes as he can smell his mum’s skin and hears her heart beat. He has a lot of sensory input and gently drifts off to sleep. All of Liam’s five senses are being engaged while he is falling to sleep.
Miranda gently puts him down into the cot after falling asleep on her. Liam then stirs from a sleep cycle, which is very normal for babies to do. This is often 20-50 minutes in the day and around hourly overnight. He stirs and quickly identifies that he is not where he remembered being when he fell to sleep. He also works out very quickly that he doesn’t feel the same anymore and does not know what to do with these feelings that he has in the cot. He is tired but can’t put himself back to sleep. Liam cries not knowing what do next. Liam’s dad Nic, comes into help and give Miranda a much needed break as she is exhausted. Liam realises that this is not Miranda who can feed him back to sleep and gets very upset with Nic. Nic is patient and trying very hard but seems to be making the situation worse. Miranda comes to assist. Immediately Liam calms down when Miranda picks him up and tries to settle him. Liam then again becomes upset and Miranda then offers him a breast to calm him and he immediately goes quiet, suckles and then falls to sleep. She has tried on many nights to try and get him back to sleep without offering the breast. On some nights she has persisted for hours on end and then out of exhaustion and frustration she offers a breast and Liam immediately calms and settles. She knows as he comes up to 6 months of age that he may still need overnight feeds, but not 6-8 feeds overnight. Despite her efforts to restrict the feeds overnight, Liam just won’t settle until he gets to feed at her breast.
With Liam having 6-8 feeds overnight, Miranda is doubting her milk supply and is considering weaning him in the hope of being able to get more sleep and less feeds for both her and Liam. Miranda is thinking she has a feeding problem rather than a sleeping issue. She is also concerned that he doesn’t feed well in daylight hours and therefore needs to keep feeding him often at night as he might be hungry.
Miranda is so exhausted and overwhelmed she is contemplating giving up breastfeeding as she just can’t manage with Liam. He catnaps all day, twenty minutes here, thirty minutes there, and is cranky most of the day. With so many feeds at night she finds he is difficult to feed in the day and the only way she can see to improve the situation is to wean from breastfeeding. She knows that breast milk is the best option for Liam but can’t see how this situation will improve and everyone has told her things would be better by now. She talks to Nic about this who is very happy to support Miranda, but is also at a loss, as Liam won’t have a bar of him around sleep and settling. Nic is also finding it hard to see Miranda so tired and frustrated. Miranda has sought advice and has been told to keep demand feeding her baby.
Before Miranda weans Liam, we suggested that she try a few things. Firstly, we asked her to move the breast feed away from settling. We helped Miranda get as good of a feed in as possible, then offer a top up milk feed, by offering her breast again, a little before bedtime as she was not convinced that Liam had taken enough milk. We did ask her to offer this top up out in the living area and keep him awake. Then to have a break of 20 minutes before taking him to the bedroom and settle him to sleep. We suggested she still hold Liam as he was used to being in her arms but without a feed. The first day or two was harder than usual to settle Liam, but he accepted that he would would fall asleep without a breastfeed and this too gave Miranda confidence that he didn’t need the feed in order to settle. The nights started to improve and with Miranda keeping a diary of feeds and sleeps, she noted things were a lot better. She noted that feeds had dropped to 2-3 per night and Liam was sleeping longer overnight as well as a longer sleep once per day too.
With baby Liam now sleeping longer in the day, he was waking hungry and rested. This gave him gave him the energy and focus to take one a full breast feed. With less feeds at night and the energy to feed well, this was helping him feel more full for longer and in turn helped him sleep longer both night and day. With snack feeding in the day, Liam would get to sleep and then as he roused from a sleep cycle, he quickly identified that he was feeling hungry, woke and had another feed which reinforced is snack feeding. By addressing his sleep, Miranda had helped Liam to sleep longer, and extended his feeds out in both the day and night. Miranda now felt more in control of her breastfeeding as she could start to predict when Liam would take a feed. She also noticed an improvement in her supply as both her breasts were being emptied off regularly by Liam, which send hormonal feedback to Miranda’s brain to stimulate a greater production of milk. With all these positive improvements, the breastfeeding relationship between Miranda and Liam was going really well.
He was feeding better in the day and Miranda was feeling a little more rested and starting to enjoy feeding Liam again. There was no more fighting during the day to get him to take milk. After a another week, Miranda was feeling better with more rest and was keen to tweak a few more areas of Liam’s settling routine for further improvement. The upside was that Miranda’s mental health had improved, her milk supply had increased and she had decided to continue breastfeeding Liam. Miranda and Nic both marvelled at how one simple change had helped improve so many aspects of life with Liam. For Liam it was a replication overnight of how he fell to sleep. He started to expect to feel like he was feeding when he stirred from sleep cycles overnight. When he realised those feeling were not present he persisted with his parents until those feels were replicated for him and then he could identify how to fall back to sleep. As Nic was not able to breastfeed Liam, he protested loudly until Miranda came and offer what Liam understood he needed in order to return to sleep. Once the milk feed was spaced away from settling, these feelings were no longer connected to sleep and Liam was able to return to sleep without needing to breastfeed, he also accepted Nic’s help on occasion. Sometimes he still needed Miranda and Nic to assist him, other times he did it on his own, and the number of feeds soon reduced overnight as a result.
We checked in again with Miranda six months later. She was still breastfeeding Liam and would do so indefinitely.
With the breastfeeding rates dropping so sharply from birth to just before six months of age, we need to look at how we can support breastfeeding families. When babies are rested because they are getting adequate sleep, and waking hungry from day naps in particular, we find that babies hungrily feed with nutritive sucking. Drawing off their mother’s milk and emptying the breasts regularly. This will in turn satisfy the baby’s appetite and be able to last a few hours rather than want to snack feed all day. When breasts are emptied, hormones travel to the mother’s brain to alert her body to start producing more milk as stores are now low and this keeps her breast milk supply up. With a satisfied tummy and the breastfeed well away from settling this cycle of rested + hungry baby = nutritive and good feeds. In our work as baby sleep specialists, we are find that by spacing breast feeds away from sleep, that mother’s are able to continue breastfeeding as well as manage more sleep from their baby, which in turn leads to more rest for them.
Breastfeeding a baby has benefits to both mother and child. Professor Jane Scott of Curtin University, recently described these on air with ABC journalist Penny Johnston.(Aug 4th, 2018) Prof Scott contributed to the Australian infant feeding guidelines. She is also a practicing dietician. The ABC Baby Talk podcast covered that apart from the benefit of nutrition, the baby’s immune system is strengthened by breast milk. That when a baby is affected by childhood illness such as a chest infection or diarrhoea, the severity of the illness may well be reduced if the baby is breastfed. This then reduces the chance that the infant needs to be hospitalised. For mothers, the benefits are that there is a reduced risk of breast and ovarian cancer. Breast milk has bioactive components in them which are not found in other animal milk or formula. Podcast link http://www.abc.net.au/radio/programs/babytalk/babytalk-the-politics-of-breastfeeding/10047992
Professor Scott went onto discuss that having support for mothers in the early days of initiating breastfeeding and ongoing, can also help improve the longevity of breastfeeding between an infant and it’s mother. Caroline’s Angels ensure’s that all of our practitioner’s have a background in either Midwifery or Maternal Child Health so they can support you if you are struggling with feeding and sleep. We wish to support, promote and protect breastfeeding. If you are wishing to formula feed or express and offer your milk via bottles, we will also support you 100% on your parenting journey.