1. revealed only after very direct questioning about the precise location where the newborn and parent slept in the night or two prior to coming to the office.  The practice of a parent holding their infant on their chest while they sit in a semi-upright position is likely one of the most dangerous sleeping arrangements.  Firstly the infant is not in a supine position and secondly the infant could slip down where there are soft surfaces and spaces where suffocation could occur.

2. For some families, especially those from cultures where co-bedding is the norm, there is no reason to put a finite limit to the co-bedding sleep arrangement.  However, for parents who do not want to co-bed for an extended period it is important to have a plan to start working at transitioning the infant out of the parental bed beginning when the infant is three to four months of age when their sleep development should allow this.  It is often very difficult to alter sleep transition patterns if parents wait until the latter half of the first year to make changes in sleep arrangements.

3. I try and help moms realize that it is normal and even beneficial for most breastfed infants to nurse at least once during the night even after their infant is six months of age (an age when many books say infants should be sleeping through the night).

4. Asking about the specifics of sleep for mother and infant (how well, where, and position) at each well child check is critical in supporting the breastfeeding mother.

 

References:

1. Anders TF.  Nightmares and Other Sleep Disturbances in Hoekelman, Friedman, Nelson, Seidel, & Weitzman eds.  Primary Pediatric Care third edition. Mosby Publishers; 1997: 737-741.

2. Small MF.  Our Babies, Ourselves How Biology and Culture Shape the Way We Parent. Anchor Books; 1998: 111-118.

3. American Academy of Pediatrics Task Force on Sudden Infant Death Syndrome 2005-2006.  The Changing Concept of Sudden Infant Death Syndrome: Diagnostic Coding Shifts, Controversies Regarding the Sleeping Environment, and New Variables to Consider in Reducing Risk. Pediatrics. 2005; 116:1245-1255.

4. McKenna JJ, Ball HL, Gettler LT. Mother-Infant Cosleeping, Breastfeeding and Sudden Infant Death Syndrome: What Biological Anthropology Has Discovered About Normal Infant Sleep and Pediatric Sleep Medicine.  Yearbook of Physical Anthropology. 2007; 50:133-161.

5. Ruys JH, de Jonge GA, Brand R, Engelberts AC, Semmekrot BA. Bed-sharing in the first four months of life: a risk factor for sudden infant death. Acta Paediatrica. 2007; 96:1399-1403.

6. Cavell B. gastric emptying in infants fed human milk or infant formula. Acta Paediatr Scand 1981; 70(5):639-41

7. Pinilla T, Birch LL. Help Me Make It Through the Night: Behavioral Entrainment of Breast-Fed Infants’ Sleep Patterns. Pediatrics. 1993; 91(2):436-44.

8. Lawrence RA, Lawrence RM. Breastfeeding A Guide for the Medical Profession sixth edition. Elsevier Mosby Publishers; 2005: 305-306.

 

Other Reading:

1. McCoy R, McKenna JJ, Gartner L. ABM Protocol #6: Guideline on Co-Sleeping and Breastfeeding. Breastfeeding Medicine. 2008; 3:38-43.

Continued from page 2

Sleep and the Breastfeeding Baby

COMMUNITY SPOTLIGHT       

Community Spotlight

Postpartum Doula Services in San Diego

Kim Elkins EdM, IBCLC, LLLL

 

A postpartum doula is a woman who is trained to help new mothers adjust to the birth of their baby by offering practical help, accurate information and emotional support.

She will care for the new mother by bringing her meals, encouraging her to rest, offering breastfeeding support, taking care of older siblings, and listening with sensitivity to the new mother’s feelings. She will teach the new parents how to take care of their baby, and help them to become more confident as parents.  She may also do light housekeeping, such as laundry and dishes, or run errands, so that the new mother can rest and recuperate from the birth.

Some postpartum doulas work only during the day; others are available to help during the night. Night-time services may be especially helpful for mothers with multiples, special needs babies, or postpartum depression. Postpartum doulas do not offer medical advice.

In San Diego, postpartum doulas typically charge $25 / hour and up. Several referral services are available:

 

Beautiful Beginnings               www.beautifulbeginnings.org

Birth Resource Network          www.birthresourcenetwork.org

Doulas of North America        www.dona.org

North County Doulas               www.northcountydoulas.com