When a mother breastfeeds, she releases oxytocin, a hormone that soothes her anxieties and helps her feel a unique emotional connection to her newborn baby. Oxytocin, also known as “the love hormone,” packs a powerful punch that, while supporting healthy breastfeeding, has one potentially dangerous side-effect: it can make moms tired.
“New mothers are sleep-deprived and understandably stressed,” says Michael Goodstein, MD, a neonatologist and safe sleep and breastfeeding expert. “Add to that a state of hormone-induced calm and it’s not surprising that mothers struggle to stay awake while breastfeeding. Falling asleep is the natural inclination.”
This inclination can become dangerous because it can result in accidental co-sleeping, a risk factor for sleep-related infant deaths. Acknowledging this risk alongside the significant health benefits breastfeeding brings moms and babies begs an all too common question for maternal health professionals: How do you realistically support tired and overwhelmed mothers to breastfeed safely?
Goodstein is a faculty expert on the NICHQ-led National Action Partnership to Promote Safe Sleep Improvement and Innovation Network (NAPPSS-IIN), which aims to make safe sleep and breastfeeding the national norm. He says designating time to talk to mothers about their own sleep habits can help.
“We can’t change mothers’ natural response to breastfeeding,” says Goodstein, “and we wouldn’t want to—oxytocin is incredibly valuable for mother-child bonding. But we can do a better job of helping mothers manage their stress and their sleep habits during those early months. And in doing so, we can reduce unsafe environments.”
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Below, NICHQ’s NAPPSS-IIN team has identified three opportunities for health professionals to put Goodstein’s advice into practice, and better support healthy sleep habits for both moms and babies.
Mothers are often told to “sleep when the baby sleeps.” This makes sense in theory, but in practice can be a difficult behavior to adopt. Mothers may need to use naptime to take care of other tasks; and they may have difficulty falling asleep on command. In both cases, mothers are left even more stressed and tired, and at a higher risk of accidentally falling asleep while breastfeeding.
“Along with advising mothers to find time to sleep, we need to specifically talk to them about the importance of self-care,” says Goodstein. “Chronic stress can exacerbate sleep loss, which then becomes a health risk for both moms and babies.”
Goodstein recommends discussing alternative opportunities to help mothers recharge, such as taking a walk outside while baby sleeps in a carrier or stroller, exercising at home or reading a book while baby naps. These activities can give mothers a mental and physical break that can be just as valuable as a couple hours of sleep.
Identify each mother’s support network
Having a new baby doesn’t keep other obligations at bay for long. New moms are often left balancing the needs of their families, their jobs and their homes, which can make for a seemingly endless day when you add in regular breastfeeding.
“Talk with mothers about who is going to support them during those early months,” advises Goodstein. “This may be a significant other, but help comes in multiple forms—friends, immediate and extended family, and support groups are all important resources that new moms can tap. By reviewing these options with mothers, we can help proactively alleviate some of the stress they’re bound to feel.”
Having someone help with daily tasks—even seemingly small responsibilities, like doing a load of laundry or washing the dishes—gives mothers precious time to sleep and engage in those activities that help them emotionally recharge.
Discuss strategies for helping fussy babies sleep
Does my baby feel safe? Is she hungry? Is she wet? These three questions can help mothers and caregivers address the most common reasons for crying babies. But once these issues have been resolved, moms are often left wondering what else they can do.
“We need to do a better job of helping moms and caregivers prepare for fussy babies,” says Goodstein. “By teaching families about successful soothing techniques, we can help both mom and baby feel happier and sleep better. Swinging motions that soothe babies, checking whether the baby might have been overstimulated by the environment, playing white noise and finding a change of scenery are all helpful strategies that care teams can discuss with families and help them go home feeling prepared.”
During these conversations, Goodstein also recommends making time to highlight pacifiers. Since non-nutritive sucking is soothing for babies, pacifiers can be used to calm them between feedings, after the first few weeks of life once breastfeeding, and breastmilk volume is established. Moreover, pacifier-use is known to significantly reduce the risk of SIDS. Remember though, Goodstein cautions, breastfeeding should be well-established before families introduce pacifiers.
Ultimately, Goodstein’s examples reaffirm the need to improve conversations with mothers about breastfeeding and safe sleep, conversations that address individual circumstances and set goals for breastfeeding. Telling mothers, ‘breastfeed but don’t bed-share’ isn’t enough; instead, it’s more effective to work to understand what circumstances might make this difficult—such as sleep deprivation—and then develop plans of care that account for those barriers and reduce risks for sudden unexpected infant deaths.
Article and image courtesy of NICHQ