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Saturday, 9 March 2013

Put away the clock: The beauty of nighttime breastfeeding

 
"Is she sleeping through the night?"

This is probably one of the most common phrases a new parent will hear.

I just typed 'baby sleep' into Google, and it returned 362 million results—with the top hits headed 'getting a baby to sleep', 'help your baby to sleep', 'teach your baby to sleep'.

Where does this obsession, this market, this world-wide 'problem' come from? Homo sapiens, human beings as a mammal, have been breeding for thousands of years. We need little encouragement to eat or drink or to reproduce. Have we really evolved into such an intelligent, complex species yet managed to somehow make a complete mess of something as essential to survival as sleep?

Baby Sleep—a highly lucrative market
News.com.au recently published an article that perplexed me somewhat. Entitled Broken sleep 'normal' for parents with breastfed babies, the article was an attempt to reassure parents that it is perfectly, biologically normal for breastfed infants to wake multiple times during the night to breastfeed. However, after citing the study that claims to reassure parents of the normalcy of night-waking in breastfed infants, the article summarises with a quote explaining the success of introducing solids to seemingly solve night-waking, and a quote from Tizzie Hall claiming baby routines have some benefit in persuading a baby to conform to adult sleep stretches: 
'"In my experience, breastfed babies who follow a routine will sleep through the night sooner than a baby fed with a bottle," Ms Hall said.'
In other words, it might be 'normal' (news.com.au's use of inverted commas would imply otherwise), but you can (and probably should) try and fix it.

Anyone who has cared for a newborn could probably tell you why we are so obsessed with 'baby sleep'. The sun goes down, and the digits on the clock glow like accusations into the night. Counting the minutes, adding up the hours, pacing the halls with an infant who cries or stares happily at you, and you wonder, as your eye-lids droop like paperweights, if you'll ever sleep more than forty-minutes in a row again.

Babies don't sleep like adults. Babies snatch little snippets of sleep around the clock, waking irregularly and requiring parental assistance to be soothed to sleep. A newborn in particular still runs on 'womb time': where in utero they were held and fed constantly, 24/7. So newborns often take a bit of adjustment to get used to the outside world, the day/night cycle, and the strange and unsettling new sensations in their digestive system that is hunger, fullness, wind, bowel movements.

Additionally, more often than not, our adult lifestyles simply aren't conducive to accommodating the tiredness that results from prolonged interrupted sleep. We have work schedules to adhere to, we have other children to take to school and to care for. We have large houses to clean, meals to prepare, mountains of clothing to wash. And more often than not, as mothers we're alone in those houses and our partners are held to their work commitments by rules and regulations that leave little wiggle-room for parental flexibility.

In an article that explores the discrepancy between biologically normal infant sleep and western cultural infant-care practice, Dr James McKenna et al write:
'... evolutionary pediatrics makes it clear that notions about what human infants need and why, especially as regards nighttime sleep and feeding patterns, seems to reflect far more about what societies want parents to be and infants to become (self- sufficient and independent) rather than what infants actually are—exceedingly dependent, and unfinished ‘‘extero-gestates’’ to use Montagu’s (1986) description. Indeed, especially in early human infancy—and from an evolutionary point of view—reference to the mother’s body is critical to understanding not only what infants need but what they can and cannot do and why. After all, as Hrdy (1999, p. 69) aptly puts it: ‘‘For species such as primates the mother IS the environment . . .’’ meaning that practically nothing about a human infant makes sense except in light of the mother’s body.'  (McKenna et al, 2007)  
The way we expect our babies to sleep (separately from parents, without breastmilk, independent of parental assistance, and for exceedingly long stretches) is at complete odds with how our biology instructs babies to sleep: close to mother's body, rousing frequently for the survival and comfort of mother's breasts and nutrients of breastmilk.

As a society we do, however, show a tolerance to some level of interrupted sleep in the early weeks. But for some reason, our culture tends to frown on this pattern continuing any longer than a handful of months. By the time our babies are several months old, most people expect the baby to sleep long stretches uninterrupted, and to need little or no parental assistance to settle upon waking. Consider again the news.com.au article linked above:
"... breastfeeding mum Melanie Lawrence managed to get daughter Scarlett, now six months, to sleep through the night only at five months when she introduced some solids."
Despite the fact that the World Health Organization (WHO) continue to urge parents to breastfeed exclusively for a minimum of six months, many parents feel pressured to feed solids earlier in order to achieve longer stretches of sleep. For other parents, the well-meaning advice might be to give a bottle of formula to a breastfed baby, or to leave baby to cry, or to pat baby in the cot, or any other manner of 'fix' to 'get' a baby sleeping longer stretches.
'The dominant expectation for these initial months is parental sleep deprivation—their infant’s sleep patterns do not match their own, and parents, desperate for a ‘‘good night’s sleep,’’ seek the magic solution for achieving a somnolent baby. Baby’s grandmother advises a large bottle of formula at bed time so that baby will not wake to be fed in the night. Others suggest adulterating the formula with baby ce- real for greater infant satiation or medicating baby with proprietary infant pain killers or colic remedies ... to ‘‘knock the baby out.’’ Friends sing the praises of ‘‘Ferberizing the baby’’ or similar infant sleep training programs employing an oxymoron known as ‘‘controlled crying.’’ Parents, who feel all else has failed, resort to the painful approach of ‘‘crying it out’’—and while their infant screams alone in an adjacent room, they lie awake racked with guilt, forcing themselves to resist respond- ing, reassuring each other ‘‘it is for his own good’’—until the infant eventually collapses from exhaustion into sleep.'  (McKenna et al, 2007)  
It stands to reason, then, that anyone with a wakeful older baby or toddler feels like a complete failure. I've been there!

I recall hearing a saying amongst natural horsemanship circles: 'people don't have problem horses—horses have people problems.' I think the same is true with human infants. It's not the baby that has a 'sleep problem'—it's that the adult/s in the house aren't equipped to deal with the biologically normal interrupted sleep of an infant.

How are babies so different from what we culturally expect—and try desperately to obtain via a myriad of sleep 'programs'? And what affect does this have on our babies, and our mothers?
'.. arousals lead to the baby breathing more stably over time, and to more variable heart rates and breathing. Variability in breathing patterns of infants is good and a sign of health, ordinarily, and such variability is  often associated with more substantial inhalations of oxygen, leading to shorter apneas in deep stage of sleep from which awakenings can be difficult (see Richards et al  1998). Moreover, if practice makes perfect than the more arousals induced by various forms of co-sleeping the better the arousal skills that potentially can act protectively in response to a cardiac or pulmonary crisis.  
Babies are not designed to sleep through the night in the first six months, at least, of life. They are designed to wake often to breastfeed. Breastmilk does not have dense calories i.e. caloric staying power that keeps a baby sleeping, in the way that cows milk does, for example as it is obviously designed for optimal cow brain growth and development.' (Dr James McKenna)
Human babies are designed to sleep alongside their mother, to breastfeed frequently, and to wake frequently to ensure survival. Breastfeeding reduces the risk of SIDS. But our (patriarchal) cultural preference is for babies to sleep independently and to re-settle alone. We have a high breastfeeding initiation rate that drops significantly within weeks—thusly stripping parents of Mother Nature's intended sleep-inducing mechanism: the close, quick and easy comfort of a mothers breast throughout the night.

Human infants are born exceptionally immature. Human infants are designed to receive breastmilk; breastmilk is designed to be quickly and completely digested, and to be consumed frequently and in small doses to aid such digestion in an immature gastrointestinal system and to accommodate and nourish the rapid body and brain growth human young undergo in the early years.

Breastfeeding releases a hormone called cholecystokinin, (CCK) in both mother and baby. CCK causes both mother and baby to feel sated at the end of a feed. Breastmilk also contains CCK.  (1) Moreover, prolactin, the hormone responsible for lactogenisis II (milk production) and sometimes referred to as the 'mothering hormone' naturally occurs in the mother's body in higher levels at night. (2)

Quite simply, babies and their mothers are designed to stay close to each other, and to rouse frequently to breastfeed throughout the night.

There is no truth to the myth that a co-sleeping baby will never sleep independently. Otherwise, mosts humans would still be sleeping alongside their parents. It's what we've done as a species for pretty much the majority of our existence, and what most of the world continues to practice. It's just we in the West that do things (oddly) a little differently.

My now five-year-old slept alongside me and breastfed frequently through the night since birth. She began to go longer stretches at night without breastfeeding some time in her third year, and she was gently night-weaned when she was about three. She remained sleeping alongside me in bed, sometimes in her own bed that was pushed up to mine, sometimes rolling right over to sleep under my arm. Just recently, she quite suddenly declared that she would like her own room. She goes to sleep with a cuddle from myself or my husband, in her own room, and stays there until she wakes in the wee hours of the morning and creeps in alongside me, usually without waking me at all.

Feeling exhausted? From one breastfeeding mother to another, from one mother of wakeful babies to another, I suggest you put away the clock. Time serves no purpose in your bedroom but to remind you of something that our culture, despite all it's good intentions, just doesn't have biologically right.

Learn about safe co-sleeping and breastfeeding laying down. Minimise your priorities in the day (do you really need to mop that floor today, or can it wait until tomorrow?) Ask for practical help with cooking and housework, surround yourself with nurturance and good support. Forgive yourself for not being perfect, remind yourself that you are wise and your baby is normal—and will outgrow this. Eventually. And in years to come you will look back and miss those cuddles.

Peace and love to you. xo


References:
(1) Bodribb, Wendy. Breastfeeding Management (3rd edition). 2006. Pg 101.
(2) Bodribb, Wendy. Breastfeeding Management (3rd edition). 2006. Pg 7.