Sleep and Breastfeeding: The Middle Path

By Gwen Kiehne, Doula and sleep coach (www.seattlefamilydoula.com)
The vast majority of people becoming parents now have lived their entire lives in the digital age. The availability of information through books, websites, magazines, parenting blogs, podcasts, forums, and social media has transformed how we parent. When parents look for information about sleep, whether it’s trying to “get things right” from the beginning or the ominous task of “sleep training,” the deluge of prescriptive opinions and advice is intense. It doesn’t help that most of it is written in language that is very judgmental, implicating the parent’s lack of commitment if the method doesn’t work just the way it was prescribed to.
In 2015, Dr. James McKenna published a paper entitled “There is no such thing as infant sleep, there is no such thing as breastfeeding, there is only breastsleeping,” and we suddenly had a new anthropological term to describe the historical cultural practice of sleeping in the same bed with ones baby and making the breast readily available to them while they sleep. Immediately, this term made waves in the parenting blogosphere, with articles like “Breastsleeping: An expert believes you should be co-sleeping with your baby,” “Breastfeeding and co-sleeping: A Biologic Imperative” and “Is Breastsleeping Best?” At the same time, article after article with “sleep tips” argues that reducing night feedings is the secret to getting better sleep and the American Academy of Pediatrics is only recently starting to soften their stance against bed sharing, citing increased SIDS risk.
Many parents find making sense of this constantly changing and often conflicting information stressful and confusing. As a sleep consultant, I find that parents often exist in a limbo where they want to protect their breastfeeding relationship, but they are also desperate to sleep more than 2 continuous hours, and they aren’t sure how much crying is too much crying. Many are feeling the pressure of returning to work or their pediatrician has suggested that, developmentally, their baby is ready to sleep through the night and they wonder what they’re doing to “hold their baby back.” Typically, a parent calls me in when they think something needs to change, but they aren’t sure what or how to do it. If this sounds familiar, know that you aren’t alone. Take a breath and sit in the comfort that this struggle is very common and, if there aren’t any clear “right” answers, well, there are really no wrong answers either.
Sleeping is just as cultural as it is biological.
There is a lot about sleep that science can describe and measure, but choices like bedtimes, where the baby sleeps, and when and how to attend to the baby at night are cultural choices. You, as the parent, get to decide what the culture of your family is. The work of James McKenna is important because it shows that bed-sharing and breastsleeping has a biological basis, it’s culturally appropriate, and globally normal. However, just because something is normal, doesn’t mean that you have to do it. Science is descriptive, not prescriptive. Having data is useful and it can certainly inform your choices, but it’s also important to think about what your values, goals, and needs are. Feeding choices, daily life and work schedules, how much sleep each parent needs to feel functional, and home layout are some things that need to be taken into consideration. Most importantly though, establishing a culture where every family member is allowed to have needs is critical for everyone in the family feeling like an equal participant in the culture of the family.
Yes, sleeping and eating are biologically intertwined activities for babies, but eventually we all learn how to separate these in to two distinct things. Generally speaking, we have separate spaces in our homes for eating and sleeping. Gradually teaching your baby that these are two separate activities is also normal and you get to decide the timing of that work.
Don’t fix it if it isn’t broken, but if it’s not working for you, risk change.
When we let outside messages drive our choices, it can lead us to feel pressure to change something that’s working just fine the way it is or to feel stuck in something that is making us tired or sick. There is no one right way for babies or families to sleep or feed. The most important question is, how is what you’re doing working for you? There’s no award for making perfect choices for 12 months, so if you’re suffering for the sake of doing something right, you might consider changing some things and you might need to get creative. You might decide to share the feeding duties at night, for example. Many families find success in splitting the night with their partner so that each parent can get 3-4 hours of continuous sleep. Once breastfeeding is established, introducing a bottle for one-night feeding can be a great way to allow some special bonding time between baby and partner (their attachment relationship is also important) and catch up on rest. Many parents are worried that their milk supply will suffer if they experiment with this. You can always consult an IBCLC if you have specific concerns, but generally speaking if you go 4 hours between feeding/pumping to start and slowly increase that space of time while adding an early morning pumping session (usually after that longer stretch of sleep when your body is most replenished) you can save milk for baby and encourage your supply in one step.
Change can be incremental.
Once you have a sense of what you want the culture of your family to look like, what your values and goals are, then you will be better equipped to decide whether to change something or not. It’s ok for changes to be incremental, the path to your goals as long as you need them to be. The spin of our information-overloaded world attempts to pull us to thinking in extremes. Embarking on a sleep learning journey or changing something about how night feedings are arranged does not need to mean that you’re weaning. It’s possible to make small changes to your sleep routines while bed-sharing or night nursing that will ultimately lead to more sleep for parents. If you’re feeling overwhelmed by even small adjustments to your routine, this would be a good time to reach out for help. Now that you have done some work to identify your values and goals, you can find a friend, parenting group, or sleep consultant that matches the culture of your family for ideas and support.