What new moms should know about breastfeeding at night

By Jim Leffman via SWNS

New moms looking to get some sleep whilst doing the night feed should lie on their side with the baby and let the child dictate when they are hungry, experts claim.

A new study says that too many moms suffer from sleep deprivation because they get into a routine of getting up to feed at specific times of the night.

Researchers concluded that in nature the child would be next to its mom and feed when they were hungry.

The research was published in the journal Breastfeeding Medicine and issued as guidelines by the Academy of Breastfeeding Medicine.

They emphasize the importance of moms sleeping close to their babies to minimize the need to get up.

They recommend responsive feeding backed by anthropological research which shows the evolutionary norm is the mom lying next to the child on her side breastfeeding, known as "breastsleeping."

Nighttime pumping, bottle feeding and placing the infant to sleep outside the parents' reach are all discouraged.

Dr. Arthur Eidelman, Editor-in-Chief of Breastfeeding Medicine, said: “Scientific data shows bedsharing to be associated with prolonged duration of any and exclusive breastfeeding.

“This protocol reinforces the concept that not only is human milk the normative nutritional standard for infant feeding, but that the natural physiologic feeding pattern is one of an infant-led interactive relationship with the mother with no artificial rigid arbitrary schedule or routine.

"Compared with many strategies that mothers may use to cope with the demands of nighttime parenting, side-lying breastfeeding with proximate sleeping may be one of the safest strategies for maternal and infant well-being, in the absence of hazardous circumstances.

"Physiological research suggests that it may be protective for the infant and if the natural physiology of proximate sleep is disrupted, these protections are lost.

"Accidental suffocation death is extremely rare among bedsharing breastfeeding infants in the absence of hazardous circumstances.

"Other coping strategies may have more overall adverse effects to mother and infant."

The full recommendations are:

For each recommendation, the quality of evidence (levels of evidence 1, 2, and 3) and the strength of recommendation (A, B, and C) are noted as defined by the strength of recommendation taxonomy criteria.101

1. Help parents understand normal physiology and to care for their infants in a responsive manner. It is important for health professionals to understand the normal physiological expectations and educate parents accordingly. Professional organizations should work to minimize the impact that advertising has on promoting nonphysiological practices.

Level of evidence: 2. Strength of recommendation: B.

2. In the absence of hazardous circumstances, mothers sleeping in proximity to their infants is recommended. Breastfeeding with proximate sleep in the absence of hazards may allow mothers to maximize their rest and well-being if sleep deprivation is a concern. Breastfeeding with proximate sleep may protect against sleep-related death, and is associated with responsive infant feeding and longer durations of any and exclusive breastfeeding.

Level of evidence: 2. Strength of recommendation: B.

3. Mitigate potential risks of bedsharing while allowing the infant to sleep within arms' reach. Using a sidecar attached to the adult bed if concerns exist for hazardous circumstances, or if hazardous circumstances could sometimes exist (e.g., if parents occasionally use alcohol or sedating substances).

Level of evidence: 2. Strength of recommendation: B.

4. Mitigate potential risks of bedsharing by teaching safe positioning in bed. Owing to lack of data for exclusively pumping dyads, it is unknown whether these dyads represent a hazardous circumstance for bedsharing. The C-position (cuddle curl) should be taught to exclusively pumping parents, recognizing that bedsharing is common and may occur unintentionally.

Level of evidence: 3. Strength of recommendation: C.

5. Avoid nonphysiological disruptions to maternal and infant nighttime sleep as strategies for improving parental well-being. These include nighttime pumping, bottle feeding, and placing the infant to sleep outside the parents' reach. Consider a dim red light if the need for lighting is anticipated.

Level of evidence: 2. Strength of recommendation: B.

6. Encourage the mother and infant to return to sleep without interruption after nighttime breastfeeding while bedsharing. Avoid burping the infant after breastfeeding, and avoid unnecessary diaper changes during the night. A barrier cream applied to the diaper area can help prevent diaper dermatitis.

Level of evidence: 2–3: Strength of recommendation: C.

7. Sleep training in approximately the first 6 months of life is contraindicated, and sleep training in the first year is not recommended. A cued care program for infant sleep may be a physiological-based alternative for parents who desire a sleep intervention.

Level of evidence: 2. Strength of recommendation: B.

8. Encourage the mother to sleep when the infant sleeps, when this is possible, and remind parents that not all sleep must occur during the nighttime hours.

Level of evidence: 2. Strength of recommendation: B.

9. Encourage the mother to get help with other household tasks so that she can focus on breastfeeding and caring for the infant.

Level of evidence: 2. Strength of recommendation: B.

10. Encourage the safe use of baby carriers during the day to promote physical contact with the infant. Baby-wearing can help mothers manage daytime tasks while keeping the infant calm.

Level of evidence: 1. Strength of recommendation: A.

11. Including some supervised “tummy time” may be important to help achieve developmental motor goals.

Level of evidence 2. Strength of recommendation: B

12. Avoid early introduction of solids or breast milk substitutes such as formula as a strategy to improve infant or maternal sleep. Avoid exposure to formula marketing materials in hospitals and health care settings.

Level of evidence: 2. Strength of recommendation: B

13. Encourage parents to directly monitor infant feeding and sleeping cues, and discourage use of tracking apps and monitoring devices for infant feeding and sleeping.

Level of evidence: 2, 3. Strength of recommendation: C.

14. Advocate for at least 12 weeks of paid maternity leave in countries that currently do not have it.

Level of evidence: 1. Strength of recommendation: A.