to at of do or What’s sleep? do in of - Black Mothers' Breastfeeding...

Sweet Sleep and the Safe Sleep Seven 9/9/2016

© Linda J. Smith / BFLRC 2016 1

THE SAFE SLEEP 7: NAPTIME AND NIGHTTIME

STRATEGIES for the BREASTFEEDING Family

Linda J. Smith, MPH, IBCLC

Black Mothers Breastfeeding Association

7th Annual National Seminar

Beyond the Mom: Reframing the Approach to Maternal Care

October 14, 2016

Objectives

• Describe normal sleep for infants and their mothers

• Explain the Safe Sleep Seven

• Discuss baby‐proofing your bed and nap strategies

9/9/2016 © Linda J. Smith / BFLRC 2016 2

What’s normal sleep?All new mothers have fragmented sleep

All babies wake frequently in first 6‐9 months

Frequent feeding is normal, babies are not ‘convenient’


Infant sleep

• “A human infant is biologically designed to sleep next to its mother’s body and to breastfeed intermittently throughout the night, at least for the first year of its life.

• And however distant and removed contemporary western urban cultural environments are from the overall care and infant vulnerabilities… [of] hundreds of thousands of years ago, it still remains true that nothing a human neonate [newborn] can do or cannot do makes sense except in light of the mother’s body –

• James McKenna and Lee Gettler• McKenna, J. J., Ball, H. L., & Gettler, L. T. (2007). Mother‐infant cosleeping, breastfeeding and sudden infant death

syndrome: what biological anthropology has discovered about normal infant sleep and pediatric sleep medicine. Am J Phys Anthropol, Suppl 45, 133‐161.


Infant Sleep

• Short 60‐90 minute cycles and feeding intervals• May combine two cycles occasionally, once a day

• Immature liver can’t sustain blood sugars till 6‐9 months

• Double birthweight in 4‐6 months

• Small stomach: size of a chicken’s egg from 2‐6 months

• Breastmilk digests quickly, fosters brain growth

• Breastfeeding & bedsharing are mutually reinforcing


Mother’s sleep

• Postpartum mothers have fragmented sleep

• Many new moms take 1‐3 naps every day

• Body is recovering from pregnancy & birth

• Breastfeeding floods her & baby with oxytocin

• Expect mother to be drowsy during breastfeeding

• Mother often falls asleep while baby is still nursing

• Plan for safety EVERY time you nurse




the Safe Sleep Seven©

3 adult factors: nonsmoker, sober, breastfeeding mother

3 baby factors: healthy, on back, unswaddled in light clothing

Safe surface


Safe Sleep Seven ©2014 La Leche League International

• No Smoking

• Sober Parents

• Breastfeeding Mother

• Healthy Baby

• On his/her back

• Lightly Dressed (not swaddled)

• Safe Surface


No smoking

• Prenatal smoking = HIGHEST risk factor for SIDS (5‐fold)

• Any smoking in the home increases risk of SIDS • Dose‐related, up to 7‐fold higher

• It’s not enough to smoke outside the house• Smokers exhale carbon monoxide for >24 hours after every cigarette; CO is heavier than air

• How far away from the smoker’s mouth is ‘safe?’• Carbon dioxide dissipates within 8 inches

• No information on distance for carbon monoxide


Sober Bedpartners

• Smothering (not SIDS) is HIGHLY related to alcohol use

• Drunk bedpartners are less aware of baby

• Alcohol appears in milk• About 1% of maternal dose transfers quickly to milk

• Milk levels same as blood (does not accumulate)

• Babies don’t nurse as well when alcohol is in milk

• Metabolizes (clears) at about 1 ounce per hour

• Reduces milk production somewhat

• Myths about beer


Breastfeeding mother

• Nursing mothers sleep differentlywith their babies• Arm above or under baby’s head

• Legs bent, frequent touching & adjusting position

• Baby stays in en face position with mother

• Baby orients & moves toward breast

• Mother does not roll away and roll back

• Synchronized sleep cycles!

• Nursing mothers get the most sleep of any new parents

• Formula feeding more than doubles the risk of SIDS

• Formula may suppress arousal in vulnerable babies


Cuddle Curl confirmed in infrared sleep studies


https://www.dur.ac.uk/resources/isis.online/RMP‐15mid.jpg

Richard, C., Mosko, S., McKenna, J., & Drummond, S. (1996). Sleeping position, orientation, and proximity in bedsharing infants and mothers. Sleep, 19(9), 685‐690.

Ball, H. L. (2003). Breastfeeding, bed‐sharing, and infant sleep. Birth, 30(3), 181‐188.



Healthy Baby

• SIDS risk is higher if baby has a respiratory illness

• Formula fed children have higher rates of sickness

• Formula fed babies are more likely to die, even in the USA

• No evidence that safe bedsharing increases risk to baby


On his back (supine)

• “SIDS” = no reason found for a baby’s death

• Prone position increases SIDS risk • Prone (face‐down) position causes deeper sleep

• Some babies go into bradycardia (slow heart rate)

• A few can’t arouse out of that deep sleep / bradycardia

• No known warning signs for which babies are at risk• Possibly a brainstem defect

• Face‐up assures open airway, no smothering/suffocation


Lightly dressed

• Same layers/thickness of clothing as adults• Whether bedsharing or in own sleep space

• No heavy covers or quilts

• Blanket sleeper or light blanket

• NO SWADDLING • Swaddling is an independent SIDS risk

• Overheating is a SIDS risk

• Arms and legs must be free to move

• “Skin to Skin” or Kangaroo Mother Care are GREAT


Safe Surface Checklist©2014 La Leche League International

• Avoid smothering risks:• Sofas & recliners

• Softness & sagginess

• Spaces between mattress & headboard, walls, side rails

• Bedpartner who thrashes or sleeps exceptionally soundly

• Other children

• Pets that could interfere

• Clear your bed of:• Unused pillows

• Stuffed toys

• Heavy covers & comforters

• Anything that dangles or tangles

• Check for possible hazards• Distance to the floor

• Landing surface

• Sharp, poking or pinching places


Close to you day and night

• Within sight and sound of responsible adult• Family noises do NOT disrupt infant sleep

• Family smells (aromas) may be improve arousals

• Wear‐carriers provide passive movement, convenience• Slings: “TICKS” for safety (Tight, In view, Close enough to kiss, Keep chin off chest, Supported back)

• Other tie‐on soft carriers for babies <6 months

• Side‐car devices attached to family bed

• Portable “Moses Baskets” kept near you

• NO sleeping in car seats except during car rides


baby‐proofing your bed and nap strategiesBaby‐proof your bed ANYWAY because sleep happens

Side‐car devices are good options

Avoid couches and recliners

Safety on unplanned surfaces – secure baby to your body

Don’t be tempted by sleep training – highly stressful

Bedsharing and breastfeeding are mutually reinforcing




Sleep training: BAD IDEA

• Long history of adult control of children – bad outcomes

• Babies need human contact – we’re mammals!

• Montagu: “External Gestation” of 9‐12 months

• Kind touch is remembered deep in the brain

• Early care has lifelong implications – positive or negative


NO NO NO!


This would be safer if baby was secured on dad’s chest

Maybe – if near adult


Babywearinghttp://babywearinginternational.org


YES yes yes

9/9/2016 © Linda J. Smith / BFLRC 2016 23 9/9/2016 © Linda J. Smith / BFLRC 2016 24

https://www.isisonline.org.uk/image‐archive/



Bottom line:

“Baby‐proof the bed because sleep happens.”



Breastfeeding is at risk when mothers and babies don’t share sleep Santos 2009


courtesy La Leche League– Hong Kong

Babies are at risk when mothers and babies don’t share sleep safely


Greatest sleep comes with exclusive breastfeeding and bedsharing

Doan et al 2007

Ball &Blair 2004


Greatest sleep comes with exclusive breastfeeding and bedsharing

Mothers and babies need to know how to do it safely


Bottom line:

“Baby‐proof the bed because sleep happens.”





Resources and references

• http://www.isisonline.org.uk/ ISIS provides information about normal infant sleep based upon the latest UK and world‐wide research

• Sweet Sleep: Nighttime and Naptime Strategies for the Breastfeeding Family (2014). www.llli.org/sweetsleepbook

• University of Notre Dame Mother‐Baby Behavioral Sleep Laboratory http://www.nd.edu/~jmckenn1/lab

• Durham University Parent‐Infant Sleep Lab http://www.dur.ac.uk/sleep.lab/

• Academy of Breastfeeding Medicine Protocol on Co‐Sleeping www.bfmed.org

• McKenna, James. Sleeping with Your Baby.Washington, DC: Platypus Media 2007 http://www.platypusmedia.com/node/70

• Ball H, Inch S, Copeland M. The Benefits of Bedsharing (video) http://www.markittelevision.com/breastfeeding_titles.html


Resources

•www.llli.org/sweetsleepbook•https://www.isisonline.org.uk/•http://cosleeping.nd.edu/


The Safe Sleep Seven and Sweet Sleep book©2014 La Leche League International


Diane WiessingerDiana WestLinda J. SmithTeresa Pittman

http://www.llli.org/sweetsleepbook

Thank you!


[email protected]

937‐438‐8458


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