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Nighttime Breastfeeding and Maternal Mental Health

[Editor's Note: This is the first post from our new regular contributor, Kathleen Kendall-Tackett, Ph.D., IBCLC. Kathleen writes about breastfeeding, perinatal/postpartum mental health, and psychoneuroimmunology (PNI). She writes on her site, Uppity Science Chick, "Few fields of study are more exciting (than PNI), and they touch a wide range of seemingly unrelated topics: trauma and health; breastfeeding; postpartum depression. PNI studies help us understand risk factors for chronic disease and can teach us all how to live healthier lives."  I'm very excited to welcome her here so we can all take part in these breath-taking discoveries. - AMR]

There is a movement afoot in childbirth education and perinatal health urging mothers to avoid nighttime breastfeeding to decrease their risk for postpartum depression. We know that if mothers follow this advice, it will have a negative impact on breastfeeding. But let’s put that issue aside for the moment and consider whether avoiding nighttime breastfeeding will preserve women’s mental health by allowing them to get more sleep. In short, is this good advice?

At first glance, it may seem to be. Since breast milk is lower in fat and protein than formula, we might assume that breastfeeding mothers sleep less than their formula-feeding counterparts. And when a mother’s mental health is at stake, avoiding nighttime breastfeeding might be worth the risk. However, recent research has revealed the opposite: that breastfeeding mothers actually get more sleep—particularly when the baby was in proximity to the mother. And that has major implications for their mental health. So if you want one more good reason for mothers to exclusively breastfeed their babies, here it is.

Breastfeeding Mothers Get More Sleep

In a study of 33 mothers at 4 weeks postpartum, Quillin and Glenn (2004) found that mothers who were breastfeeding slept more than mothers who were bottle-feeding. Data were collected via questionnaire that recorded 5 days of mother and newborn sleep. When comparing whether bedsharing made a difference in total sleep, they found that bedsharing, breastfeeding mothers got the most sleep and breastfeeding mothers who were not bedsharing got the least amount of sleep. Mothers who were bottle-feeding got the same amount of sleep whether their babies were with them or in another room.

Sleep patterns of 72 couples were compared from pregnancy to the first month postpartum via sleep diaries and wrist actigraphy (Gay et al., 2004). Most of the mothers were at least partially breastfeeding (94%) and 80% were exclusively breastfeeding. Most of the babies slept in their parents’ room and 51% regularly slept in their parents’ beds. Sleep and fatigue outcomes were not associated with type of birth, parent-infant bedsharing, or baby’s age. Mothers who were exclusively breastfeeding had a greater number of nighttime wakings (30 vs. 24) compared with mothers who are not breastfeeding exclusively. The exclusively breastfeeding mothers slept approximately 20 minutes longer than mothers not exclusively breastfeeding.

In a study of mothers and fathers at three months postpartum, data were collected via wrist actigraphy and using sleep diaries (Doan et al., 2007). The study compared sleep of exclusively breastfed infants vs. those supplemented with formula. In this sample, 67% were fed exclusively with breast milk, 23% were fed a combination of breast milk and formula, and 10% were exclusively formula fed. Mothers who exclusively breastfed slept an average of 40 minutes longer than mothers who supplemented. Parents of infants who were breastfed during the night slept an average of 40 to 45 minutes more than parents of infants given formula. Parents of formula-fed infants had more sleep disturbances. They concluded that parents who are supplementing with formula under the assumption that they are going to get more sleep should be encouraged to breastfeed so they will get an extra 30-45 minutes of sleep per night.

Not only do breastfeeding mothers get more sleep, but the sleep they get is of better quality. This study compared 12 exclusively breastfeeding women, 12 age-matched control women, and 7 women who were exclusively bottlefeeding (Blyton et al., 2002). They found that total sleep time and REM sleep time were similar in the three groups of women. The marked difference between the groups was in the amount of slow-wave sleep (SWS). The breastfeeding mothers got an average of 182 minutes of SWS. Women in the control group had an average of 86 minutes. And the exclusively bottle-feeding women had an average of 63 minutes. Among the breastfeeding women, there was a compensatory reduction in light, non-REM sleep. Slow-wave sleep is an important marker of sleep quality, and those with a lower percentage of slow-wave sleep report more daytime fatigue.

The most recent study was published in the journal Sleep, a major sleep-medicine journal not necessarily known for their support of breastfeeding. This was a study of 2,830 women at 7 weeks postpartum (Dorheim et al., 2009). They found that disrupted sleep was a major risk factor for postpartum depression. But here is where it really gets interesting. When considering what disrupted sleep, they found that the following factors were related to disturbed sleep: depression, previous sleep problems, being a first-time mother, a younger or male infant, and not exclusively breastfeeding. In other words, mothers who were not exclusively breastfeeding had more disrupted sleep and a higher risk of depression.

Conclusions

The results of these previous studies are remarkably consistent. Breastfeeding mothers are less tired and get more sleep than their formula- or mixed-feeding counterparts. And this lowers their risk for depression. Doan and colleagues noted the following.

Using supplementation as a coping strategy for minimizing sleep loss can actually be detrimental because of its impact on prolactin hormone production and secretion. Maintenance of breastfeeding as well as deep restorative sleep stages may be greatly compromised for new mothers who cope with infant feedings by supplementing in an effort to get more sleep time. (p. 201)

In sum, advising women to avoid nighttime breastfeeding to lessen their risk of depression is not medically sound. In fact, if women follow this advice, it may actually increase their risk of depression.

References:

Blyton, D. M., Sullivan, C. E., & Edwards, N. (2002). Lactation is associated with an increase in slow-wave sleep in women. Journal of Sleep Research, 11(4), 297-303.

Doan, T., Gardiner, A., Gay, C. L., & Lee, K. A. (2007). Breastfeeding increases sleep duration of new parents. Journal of Perinatal & Neonatal Nursing, 21(3), 200-206.

Dorheim, S. K., Bondevik, G. T., Eberhard-Gran, M., & Bjorvatn, B. (2009). Sleep and depression in postpartum women: A population-based study. Sleep, 32(7), 847-855.

Gay, C. L., Lee, K. A., & Lee, S.-Y. (2004). Sleep patterns and fatigue in new mothers and fathers. Biological Nursing Research, 5(4), 311-318.

Quillin, S. I. M., & Glenn, L. L. (2004). Interaction between feeding method and co-sleeping on maternal-newborn sleep. Journal of Obstetric, Gynecologic and Neonatal Nursing, 33(5), 580-588.

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  1. August 1st, 2010 at 06:59 | #1

    While I agree that discouraging breastfeeding at night as a practice is emphatically *not* sound routine advice, I do think it needs to be considered on an individual basis. I personally had extremely severe PPD after my first daughter and I was not getting enough sleep. We co-slept and woke every two hours or more to nurse and my husband and I remember it as some of the worst time of our lives. I don’t have many memories of it because it was such a fog of sleeplessness and mental misery. I believe that my PPD was prolonged many months because it took so long to get to a place where I was able to get deep, healthy sleep. I clearly do not cope well with interrupted sleep and I have noted this even when I do not have a newborn, now that my children are older. My husband does the majority of the nighttime parenting and I have to sleep with earplugs.

    When my second daughter was born we created a plan that we put into place when she was two weeks old. From 12 to 5am, my husband was in charge of soothing our baby, whether it was with a bottle of pumped milk or just holding her. This allowed me a period of five hours of sleep and it was just what I needed to cope. My PPD was not as severe and virtually disappeared within a month of birth. I also felt more capable of parenting both of our children during my waking hours.

    As a doula, I work with a variety of moms who cope differently with sleep deprivation. I always try to help the families determine whether they are coping or not when they express that they are struggling with sleep after their babies are born. I am so grateful to have many tools to be able to recommend to help each family find their individual solution.

    It is so important to not make a mother feel like a failure because she requires the help of a partner to get through difficult nights. While many mothers may enjoy co-sleeping and be able to cope with night wakings, there are many who are not. Telling them they *should* be is not helpful and may set up an adversarial situation with their baby. These moms need good, actionable plans to help them feel healthy and balanced, which is necessary for bonding and recovery.

  2. avatar
    Karen
    August 1st, 2010 at 21:58 | #2

    How a mother nighttime nurses may have an impact too.
    With my first she slept in a crib down the hall. She nursed about every 90 minutes for the first 6 months. I would get up (post C-section), walk down the hall, sit in the rocking chair in her room, nurse her, go back to bed, repeat every 90 minutes throughout the night. It was exhausting. For subsequent babies I tried having them in our bed, which didn’t work well as I was concerned about keeping my husband awake or him rolling on the baby or the baby falling off the edge of the bed.. Now my newest baby and I are in a room by ourselves, in a bed by ourselves and I’ve never been so well rested. Of course, that isn’t a possible or desireable solution for everyone but it works great for us. Until this baby, I was doing what I thought I was *supposed* to do (baby in crib in separate room, the ‘family’ bed) but not until I did what *I needed* to do, did things work well.

  3. avatar
    Karen
    August 1st, 2010 at 22:00 | #3

    PS. And yes I had/have PPD/A and the absolute worst bout was when I was co-sleeping (I use that word loosely) on the couch with a newborn and a 3 year old.

  4. August 2nd, 2010 at 08:08 | #4

    Thank you, Kathleen, for that fascinating information. I want to share it with my doula clients. Looking forward to seeing you this weekend at the DONA conference!

  5. avatar
    tracy
    August 3rd, 2010 at 04:32 | #5

    I breastfed exclusively all 3 of my children, I had PND with my second but I found that lack of sleep with all 3 was never a problem and all my babies slept in bed with me on my chest that is where they fed fell asleep and where I woke with all 3 of them next morning me on my back them on my chest and never did I ever had a lack of sleep problme

  6. August 3rd, 2010 at 11:38 | #6

    @Vanessa
    Hi Vanessa:
    Thanks so much for posting about your experiences. I’m really sorry that you had such a difficult time.

    I wanted to write back and clarify a couple of points. It’s impossible to say everyone you want in a blog post. But I thought a little more info would be helpful.

    My main concern is about blanket advice to new mothers about avoiding nighttime breastfeeding to lower risk of depression. Mothers with depression are frequently told that they need to give supplements. People who recommend this are trying to help. But they are likely making the problem worse because they are further compromising the mother’s sleep. Supplementation and/or avoiding nighttime breastfeeding may be the solution in some cases. But it is not always (or even usually) the answer.

    Here are a couple of additional points.

    1) My article does not preclude partner help and support at all. That really can be a great solution for women. In fact, in the presentation on this topic, I specifically note that if women are really having a tough time, trying to sleep for a 4-5 hour stretch can make all the difference.

    2) I really wasn’t recommending that everyone bedshare. It is the easiest way to continue breastfeeding. But for some women, it is a bit too much. However, a baby alone in another room isn’t a good option either, even according to the AAP. Mainly because it is not safe and increases risk of SIDS. An adjacent sleep surface can be a good alternative.

    3) It occurs to me, in reading your post, that depression itself may have had a large hand in your ongoing fatigue and sleeplessness. Unfortunately, depression wreaks havoc on sleep. So even if babycare isn’t an issue, sleep is still very much compromised in depressed people. When depression is treated, sleep tends to improve. While it may have seemed obvious that the baby was causing your sleeplessness, depression probably had a larger role.

    In short, taking a thorough history and evaluating the mother’s sleep will likely be more helpful than making a blanket recommendation to avoid nighttime breastfeeding. It might be a case where the mother needs to have treated depression to improve her sleep, rather than eliminating nighttime feedings.

    I hope this helps.
    Kathy

  7. avatar
    Simone
    August 3rd, 2010 at 14:06 | #7

    All I have to say is if it weren’t for nighttime breastfeeding I would have been walking around like a zombie all day-of course we practice co-sleeping so that might have something to do with it!

  8. avatar
    Alicia
    August 4th, 2010 at 00:32 | #8

    I found my night time feedings the most blissful… the house was calm & quite just the baby & I were awake (or rather awake enough to get the feeding done!). I found the day time feedings to be the most stressful… my toddler wanted attention, the dog wanted out, the cat wanted in my lap for pets.
    If I had ever considered supplementing my breastfed baby with formula it would have been during the day!

  9. avatar
    Mimi
    August 4th, 2010 at 20:51 | #9

    It makes sense to me that breastfeeding mothers *in general* get more sleep than bottle-feeding mothers *in general*, but only because I suspect that neither group of mothers gets much help in the nighttime feeding department. I didn’t see any of these studies (e.g. Quillin and Glenn) address WHO was doing the bottle feeding. As someone who has exclusively breastfed two children, I can see that if *I* were the one handling bottle-feeding at night, I would indeed get less sleep, because it would take longer to prepare a bottle than to breastfeed. However, bottle feeding would have allowed my husband to do night feedings, and that, I think, would have made a huge difference.

    My mother, for example, bottle-fed me, and she and my father traded nights “on duty” — meaning that EVERY OTHER NIGHT she got a full night’s sleep. Compare that with my going many, many months before having a night of uninterrupted sleep. I say this as a committed breastfeeder: getting a full night’s sleep even once a week would have helped my mental health tremendously. With both my children, the fog lifted once they started sleeping through the night; I became happier, more patient, more energetic, less anxious, and overall a better mother.

    For all these reasons, I find it frustrating to see this research summarized as “Breastfeeding mothers are less tired and get more sleep than their formula- or mixed-feeding counterparts.” First, could you at least say “tend to be” rather than “are”? And second, how could I possibly be more tired if I were getting to sleep soundly all night long while my husband was formula-feeding our child? The potential participation of the mother’s partner/helpers doesn’t seem to be acknowledged here.

    Again, I say this as a breastfeeding advocate who has exclusively breastfed two children (and is still breastfeeding the younger of the two). I think breastfeeding is great, but in some cases I think we oversell it, to the detriment of our credibility. I know I get less sleep this way, and it’s still the choice I made and would make again.

  10. August 5th, 2010 at 11:13 | #10

    Great post! I have noticed the advice often in popular culture to “let dad take a night feeding so mom can get more sleep.” It doesn’t seem to really hold up in practice.

    My personal experiences as a breastfeeding mother–even of a newborn–was that I most often felt “surprisingly well-rested.” I experienced little to no of the classic sleep-deprived mother signs and I attributed this to breastfeeding. I marveled at the sense of perfect nighttime harmony that I experienced with my babies–I remember saying, “during the day, he confuses me, but at night it is like we are in perfect harmony.” The symbiosis of waking seconds before baby needed to nurse amazed me. And, since they slept right next to me it was extremely easy to not completely waken. As they got older, I would often wake in the morning not able to clearly recall whether I had woken during the night at all–and if so, how many times–though, baby would be on a different side, so I knew I must have!

    As toddlers, both my boys went through a period of extra-night nursing and being very rough while nursing at night and I remember saying–hey, I’m more sleep-disrupted now with a two year old than with a two month old! What’s up! (and this was my cue that night weaning was a good idea).

    Though, I will also say that have seen some pretty serious sleep deprivation cases as an LLL Leader that have made me realize that breastfeeding on demand all night CAN, individually speaking, be a link to depression in some mothers. However, I think various practitioners take anecdotal experiences too seriously in making blanket recommendations–either anecdotal from personal experience or from very serious client cases. On the flip side, this can also include me! I recognize in myself that my positive night-nursing experiences and sense of nighttime harmony and symbiosis, etc. skew my own approaches to working with breastfeeding mothers on sleep issues–I feel I have failed to take seriously several mothers’ very serious depression/night-nursing experiences, because I had personal blinders on about my own harmonious experiences and thought they must certainly be exaggerating (and/or culturally conditioned to see a “problem,” where none really existed other than popular opinion about babies being able to “sleep through the night”).

  11. avatar
    S. jones
    August 5th, 2010 at 16:36 | #11

    Yeah, I think this is such a hard subject because sleep is important to mothers mental health. There is such a variation in formula and breastfeeding mothers in how much sleep mothers are getting. Some breastfeeding mothers will have there baby to bed all night long by six months others will not. I think its sad for people to be against breastfeeding for the simple fact of sleep alot of factors need to be considered when determining post partum depression. For instance, heres a big one maybe, if the mother has no sense of the people or things around. Maybe cannot even figure out her own name. That would probably be an indication there is post partum depression. But not getting enough sleep is not one of them. The person whom came up with this idea probably has perfect children whom never had any issues with anything. Good for them, pin a rose on their nose and give them a million dollars for having the perfect children. Mean while quit with the puedo diagnosis which they have not idea about in the first place.

  12. avatar
    Jenny
    August 5th, 2010 at 23:39 | #12

    I know that with my oldest, when co-sleeping had never occurred to me, I felt so uncomfortable with him down the hall from me. It just felt wrong. And then when he’d wake after 90 minutes of sleep, what a nightmare. I was so tired while sitting up to nurse him it was sheer misery. Finally I told my husband “just give him to me.” And we both went back to sleep while nursing. From then on, co-sleeping it was. With my youngest, my 4′th child, I’d so perfected co-sleeping and nursing lying down that I never even needed naps during the day (helped that he was a pretty good sleeper overall.) When I hear people who are opposed to co-sleeping, I just quietly feel badly for them. I would have never though I could sleep with a baby in my bed, I’m a super light, bad sleeper. But that just meant that worrying about my baby made it even worse. I underestimated both the effect of prolactin and the comfort of having my baby right there where I needed him to be. I had PPD with my oldest, and with my youngest it was better (but I also took zoloft with my youngest.) I’m a huge proponent of co-sleeping, we never even put up our crib with my youngest, no need for it.

  13. avatar
    mystic_eye
    August 5th, 2010 at 23:56 | #13

    While I know this article isn’t really about co-sleeping, I want to point out that room-sharing is unsafe if anyone sleeping in the room smokes. There’s lots of information (and misinformation) about safe bed-sharing but not so much about safe room-sharing.

    However I do have to say that I think most of the “not coping” with night-wakings has to do with the unreasonable expectations placed on women during the day. Firstly, particularly in the US, women tend to have to work outside the home, but even those who stay home don’t get the kind of help that they once did. You really only have to go back 2-3 generations to get to a time when it was almost unheard of for a mom to be alone. A family member or hired help was nearly always around. Also children were expected to play outside on their own (or at the neighbours) from an early age.

    If moms weren’t expected to work/do all the childcare during the day and do most of the housework (and more housework than was once done, certainly more toys to pick up these days) and provide and “educationally enriched” environment for children, etc they’d probably be more able to nap with their baby or even stay in bed all day when its a rough time.

    Its easy to blame breastfeeding, its almost as easy to blame night-waking. But babies haven’t changed, their needs haven’t changed, so if depression or stress is more of a problem its pretty clear that something else is a problem. In fact in traditional cultures its common for people to nap throughout the day. Its also not so far back that it was expected that the community help each other out, whether it was making furniture for a new homestead or giving jarred foods to a newlywed couple, or taking food to a new mom.

    I would bet if you went to an Amish community, you’d find really low rates of depression and tiredness. The same for other traditional societies.

  14. August 6th, 2010 at 00:18 | #14

    Hi everyone: thanks for your great comments so far. I do want to address some of the questions Mimi raised in her post. (see below)

    It makes sense to me that breastfeeding mothers *in general* get more sleep than bottle-feeding mothers *in general*, but only because I suspect that neither group of mothers gets much help in the nighttime feeding department. I didn’t see any of these studies (e.g. Quillin and Glenn) address WHO was doing the bottle feeding.

    Actually Teresa Doan’s study did study this aspect and found that if dads were feeding the babies with a bottle, they got more sleep if they used breast milk vs. formula. But the moms with the most sleep were those who were exclusively breastfeeding (about a 40 difference that can make the difference between function and very fatigued).

    As someone who has exclusively breastfed two children, I can see that if *I* were the one handling bottle-feeding at night, I would indeed get less sleep, because it would take longer to prepare a bottle than to breastfeed. However, bottle feeding would have allowed my husband to do night feedings, and that, I think, would have made a huge difference.

    My mother, for example, bottle-fed me, and she and my father traded nights “on duty” — meaning that EVERY OTHER NIGHT she got a full night’s sleep. Compare that with my going many, many months before having a night of uninterrupted sleep. I say this as a committed breastfeeder: getting a full night’s sleep even once a week would have helped my mental health tremendously. With both my children, the fog lifted once they started sleeping through the night; I became happier, more patient, more energetic, less anxious, and overall a better mother.

    KKT: But as a breastfeeding mother, a full night with no breast every other night would have dropped her milk supply down like a stone. So while that might work for an exclusively formula feeding infant, i doesn’t seem practical for an exclusively breastfed infant.

    For all these reasons, I find it frustrating to see this research summarized as “Breastfeeding mothers are less tired and get more sleep than their formula- or mixed-feeding counterparts.”

    KKT: What I mean by this is that overall there are striking difference in the amount of sleep moms get and how tired they feel depending on how they are feeding their babies. But as with any biomedical research, there were be patients who are exceptions to the rules.

    First, could you at least say “tend to be” rather than “are”? And second, how could I possibly be more tired if I were getting to sleep soundly all night long while my husband was formula-feeding our child? The potential participation of the mother’s partner/helpers doesn’t seem to be acknowledged here.

    There have been two interesting studies and sleep and women’s relationshis with their adult partners. These show that if a woman doesn’t trust her partner, she doesn’t downregulate enough to get deep sleep and is more tired. How about a new mom? Would she be able to downregulate enough to get good sleep if her infant is away. The few studies that has looked at this phenomenon suggest that they would not get good sleep when the baby is away.

    Again, I say this as a breastfeeding advocate who has exclusively breastfed two children (and is still breastfeeding the younger of the two). I think breastfeeding is great, but in some cases I think we oversell it, to the detriment of our credibility. I know I get less sleep this way, and it’s still the choice I made and would make again.

    Believe me, I’m not trying to oversell this. I just don’t want to see it be undersold, The first thing people assume is that breastfeeding is the cause of all these sleep problems. But what the new research is showing is exactly the opposite. Even in our survey of 6410 new moms, we found these same striking differences. Breastfeeding moms can certainly still be tired–she is still postpartum, remember. But…..the advice about giving supplements, based on several recent studies, suggests that that advice will increase sleep problems and won’t be helpful. But we always have to look at women’s experiences on a case by case basis.
    I hope this helps clear things up.
    Thanks for writing.
    kathy

  15. avatar
    Cordelia
    August 6th, 2010 at 09:32 | #15

    I think I need some clarification on the statement “breastfeeding mothers who were not bedsharing got the least amount of sleep” – I took this to mean that they got even less than bottlefeeding mothers. In that case much of the impact on sleep quality for the mother seems to depend more on where the baby sleeps, not how he is fed. Or does this simply mean that they got less sleep than bedsharing, breastfeeding mothers?

  16. avatar
    JR
    August 6th, 2010 at 12:31 | #16

    In my opinion, 33 moms collecting five days of sleep patterns DOES NOT equal quality research. Give me a break.

  17. avatar
    Deb
    August 7th, 2010 at 08:41 | #17

    I’ve been thinking about this article for a while now. I have to say I’m terribly disappointed in it. Breast-feeding co-sleeping parents may be getting the most sleep (apart from formula feeding parents that share the night-time load) however, co-sleeping is NOT SAFE!!

    And I must agree with JR – there really isn’t enough data to draw firm conclusions from. This is not a long-term study and the cohort groups simply cannot be big enough with just 33 participants total.

    I can see how breastfeeding co-sleeping moms do get the most sleep. They can nap thru the actual feeding. However, they still need to burp their babies and change diapers. They may get that minimal bit more of sleep, but not that much and certainly not enough to avoid PPD if they are predispositioned to it. And again, co-sleeping is not recommended by the AAP and it is not safe and should not be recommended.

  18. August 7th, 2010 at 14:02 | #18

    @Deb
    There have been a few studies on co-sleeping, but they often combine unsafe and safe co-sleeping into one group, and then compare it to crib-sleeping. Some of the “co-sleeping” practices have been people falling asleep on the couch, and the baby rolling into the crevices; baby sleeping with other small children, or adults under the influence of various drugs (including illicit drugs, alcohol, and OTC meds like Benadryl); babies on water-beds; babies on very soft mattresses, and other admittedly unsafe practices. What has not been shown is that co-sleeping as recommended by such doctors as Dr. Sears and Dr. McKenna (which eliminates those things, and probably others), is actually unsafe.

  19. avatar
    Mariah
    August 7th, 2010 at 15:15 | #19

    Co-sleeping is safe, all it takes is a little common sense. I keep seeing this statement about co-sleeping being dangerous, when the statistics on SIDs show it’s much more likely when a baby is alone in a room. I would love to see a decent study done on co-sleeping. As a parent of a premature infant with severe reflux and stop-breathing episodes co-sleeping was the best thing we could have done, I wholeheartedly believe that a proximity, warmth, smell and sound of mom nearby provides vital stimulation and comfort to a newborn(much as kangaroo care does). I have co-slept with both of my children, my parents co-slept with all 8 of their children … I do not believe we are the exception and somehow narrowly escaped danger!

    In regards to the supplementing, honest to god – my husband did get up with the baby at night at first. It did not help, I could not rest and all that happened was we were both exhausted and stressed. I, personally, do get much more *restful* sleep by breastfeeding at night.

  20. avatar
    Teri Shilling
    August 8th, 2010 at 18:10 | #20

    I was wondering what the source is for this statement:

    “There is a movement afoot in childbirth education and perinatal health urging mothers to avoid nighttime breastfeeding to decrease their risk for postpartum depression.”

    I want to STRESS that that is NOT part of the curriculum for a Lamaze class! As a Lamaze accredited program (Passion for Birth) that has trained over 1500 Lamaze childbirth educators, that has never been recommended, suggested, or modeled!

  21. avatar
    Aravinda
    August 8th, 2010 at 22:22 | #21

    Night-time nursing was the easiest nursing of all – neither of us woke up completely and it was emotionally satisfying to see her filling up while asleep.
    Nursing to bed was a lovely way for both of us to fall asleep too.

  22. avatar
    Kathy Kendall-Tackett
    August 9th, 2010 at 09:43 | #22

    Hi Teri:
    I’m glad to hear that this is not part of the Lamaze curriculum. Unfortunately, it is offered as a webinar for other CE groups. And there are now hospitals that are making this a part of their efforts to prevent depression. One hospital in Toronto has published guidelines about their program. And I started hearing about similar programs at other places in the US, so I felt that it was time to address it specifically.
    Thanks for asking.
    Kathy

  23. August 9th, 2010 at 14:29 | #23

    “I can see how breastfeeding co-sleeping moms do get the most sleep. They can nap thru the actual feeding. However, they still need to burp their babies and change diapers.”

    Actually, as a nighttime nursing mom to three now grown babies, I quickly learned how to double diaper at night, eliminating most diaper changes (yes, you still have to do the poopy ones). Also, bf babies don’t swallow air when they feed like their bottlefed counterparts, so I didn’t burp them at most feedings, either. Nursing is the best lazy-mom tool there is! I never understand why people say bottlefeeding is easier – it never looked easier to me.

  24. avatar
    Teri Shilling
    August 10th, 2010 at 07:06 | #24

    Thanks for clarifying that it wasn’t Lamaze childbirth educators who were promoting this!
    I do appreciate you bringing this to others awareness!

  25. avatar
    Hannah
    August 11th, 2010 at 14:25 | #25

    Much to the discontent of some family and friends, my husband and I decided to co-sleep with our first child. I also chose to exclusively breastfeed. Our son, now 9 months old, is healthy, happy, and quite beyond his counterparts developmentally. All three of us get between 12 and 14 hours of sleep each night. My son also takes three naps a day. I am sure our relationships with one another are stronger because of co-sleeping and breastfeeding. During the night, my son just latches himself on and off…no one loses sleep. Why is it that these practices are so frowned upon? They are the most natural things to do. I find it incredibly sad that mothers are brain-washed into thinking our motherly instincts are wrong; that society knows best. And yes, co-sleeping and breastfeeding are not acts that every mother can do. However, society need not discourage women from these acts. Cultures all over the world embrace them- it is our misguided culture that wishes to avoid collectivism and train people to thrive on an individualistic way of life. Let’s start trusting ourselves and providing our children with what they need. Mother knows best.

  26. avatar
    Deb
    August 18th, 2010 at 12:00 | #26

    Actually, as a nighttime nursing mom to three now grown babies, I quickly learned how to double diaper at night, eliminating most diaper changes (yes, you still have to do the poopy ones). Also, bf babies don’t swallow air when they feed like their bottlefed counterparts, so I didn’t burp them at most feedings, either. Nursing is the best lazy-mom tool there is! I never understand why people say bottlefeeding is easier – it never looked easier to me.

    I’m currently nursing my 3rd (he’s 2 months) so I do know a thing or two about night-time nursing.

    This one poops with every feed. There is no avoiding the diaper issue. And he also always has a burp… as did my others.

    Kudoz to those of you who were able to do the family bed thing safely, but it doesn’t work for everyone.

    Also, I still believe that co-sleeping isn’t a safe choice for most people. Those who have a desire to do so do the research and make their beds safe for this practice. However, if it was recommended to all new nursing moms as a way to get a bit more sleep, I’m not convinced that many people would take the time/effort to do the research to make the arrangement safe.

    Personally, if I co-slept, I would get less sleep from being stuck in one position all night. As well, my newest is a very noisy and wiggly sleeper! Getting up for 15-30 minutes once or twice a night is much more ‘restful’ for me.

  27. avatar
    Deb
    August 18th, 2010 at 12:00 | #27

    Quote:
    Actually, as a nighttime nursing mom to three now grown babies, I quickly learned how to double diaper at night, eliminating most diaper changes (yes, you still have to do the poopy ones). Also, bf babies don’t swallow air when they feed like their bottlefed counterparts, so I didn’t burp them at most feedings, either. Nursing is the best lazy-mom tool there is! I never understand why people say bottlefeeding is easier – it never looked easier to me.
    —————————————–
    I’m currently nursing my 3rd (he’s 2 months) so I do know a thing or two about night-time nursing.

    This one poops with every feed. There is no avoiding the diaper issue. And he also always has a burp… as did my others.

    Kudoz to those of you who were able to do the family bed thing safely, but it doesn’t work for everyone.

    Also, I still believe that co-sleeping isn’t a safe choice for most people. Those who have a desire to do so do the research and make their beds safe for this practice. However, if it was recommended to all new nursing moms as a way to get a bit more sleep, I’m not convinced that many people would take the time/effort to do the research to make the arrangement safe.

    Personally, if I co-slept, I would get less sleep from being stuck in one position all night. As well, my newest is a very noisy and wiggly sleeper! Getting up for 15-30 minutes once or twice a night is much more ‘restful’ for me.

  28. August 20th, 2010 at 06:32 | #28

    I really enjoyed this and think it’s so important to draw attention to the fact that breastfeeding mothers aren’t just a self-sacrficing bunch– we may actually be doing this to get some sleep. I have written about your article– links below– hoping to help further the discussion. Many thanks, Ceridwen Morris

    http://blogs.babble.com/being-pregnant/2010/08/04/could-breastfeeding-at-night-actually-mean-more-sleep-for-mom/

    http://blogs.babble.com/being-pregnant/2010/08/17/debating-nighttime-breastfeeding-no-formula-for-success/

  29. avatar
    kate
    August 28th, 2010 at 23:08 | #29

    @mystic_eye

    AMEN SISTER!

  30. avatar
    Hoyamama
    October 21st, 2010 at 10:53 | #30

    I can’t imagine how breastfeeding would allow for more, and better, sleep for the mother. I suppose if all you had to do was wave a perfectly-formed nipple in your A+ nurser’s face to get and keep things going, it would work. But I think for many mothers, breastfeeding is a lot more complicated. In my case, it requires a strategic arrangement of various pillows, rolled blankets and burp cloths, the deft application of a nursing shield so my baby can latch, a continuous wrestling match with my flailing-limbed baby, gymnastic maneuvers of my torso to minimize my baby’s reflux, a break to burp, change, and wake him, continuous relatching when his mouth isn’t open wide enough, and the constant fear that he will decide to start screaming his head off instead of finishing his feed. Quite frankly, I literally break into an anxiety-induced sweat at every breastfeeding session. For me, there is nothing peaceful, restful, or relaxing about breastfeeding. Warming and washing bottles sounds really, really easy if you ask me.

  31. avatar
    Kathy Kendall-Tackett
    October 21st, 2010 at 17:14 | #31

    We have a study of 6410 moms and we have found that bf mothers get more sleep overall,they take fewer minutes to get to sleep. Bf mothers report more energy and greater physical wellbeing, consistent with better quality sleep That won’t be true for all moms. But it is more likely to be reported by msot bf mothers. Our findings are consistent with previous studies. So though it may seem counterintuitve, it’s a robust research finding.
    I hope that helps a bit.

  32. avatar
    Judith Rooks
    November 9th, 2010 at 15:21 | #32

    Dear Kathy,

    This is all very interesting. I wonder though if moms who breastfeed exclusively might be more likely to not be working outside the home and those who supplement might be more likely to have had to return to jobs. If so, having to get up and go to work verses not having to get up and go to work might explain some of the association between exclusive breastfeeding and getting more sleep. I want to share this info with my step daughter, who will have to return to her job. I also think it would be useful to provide more information on the pros and cons and safety of co-sleeping, which is a subject that is very scary to many women.

    With regards,
    Judith Rooks

  33. March 2nd, 2011 at 17:13 | #33

    Highly important material, glad I found this amazing site, Appreciate it.

  34. avatar
    E.C.
    June 29th, 2011 at 21:52 | #34

    I find this article’s conclusions misleading. The author concludes, based on only four small sample studies, that breastfeeding mothers suffer less postpartum depression than non-breastfeeding mothers. Period. The Dorheim study (the most comprehensive study cited) does NOT unequivocally state that mothers who exclusively breastfeed suffer less depression. It lists several over risk factors. All recent research (citing the 2011 world congress on women’s mental health), conclude that sleep deprivation is a leading cause of postpartum depression. Very few (if any) scientifically valid and reliable studies cite breastfeeding as the sole protective factor. In fact, there are so many other factors to consider (history of depression and anxiety, partner support, prior sleep disturbances..) that making blanket statements can be dangerous to the mental health of postpartum women. Some women struggle with breastfeeding, or simply don’t feel comfortable doing so. Let’s not stigmatize those who choose to formula feed. While the science around the benefits of breast milk for infants is solid, there is still a lot of research to be conducted about mothers with perinatal mood and anxiety disorders. I sincerely hope that reasonable people read the studies themselves and draw their own conclusions.

  35. avatar
    Kathy Kendall-Tackett
    June 29th, 2011 at 23:03 | #35

    Thanks for your comments on this article, but I believe that you have misread it, specifically, the comments I made about the Dorheim et al. 2009 study and the conclusions I made. This is what I actually said regarding the Dorheim article.

    The most recent study was published in the journal Sleep, a major sleep-medicine journal not necessarily known for their support of breastfeeding. This was a study of 2,830 women at 7 weeks postpartum (Dorheim et al., 2009). They found that disrupted sleep was a major risk factor for postpartum depression…. When considering what disrupted sleep, they found that the following factors were related to disturbed sleep: depression, previous sleep problems, being a first-time mother, a younger or male infant, and not exclusively breastfeeding. In other words, mothers who were not exclusively breastfeeding had more disrupted sleep and a higher risk of depression.

    I did not make a blanket statement here, but noted that a) sleep disruptions were related to depression, and that b) one of the risk factors for disrupted sleep was not exclusively breastfeeding. Based on these findings, it is reasonable to conclude that because exclusively breastfeeding mothers had fewer sleep disruptions and better quality sleep overall, that this lowered their risk of depression.

    In no way was a trying to “stigmatize” women for not breastfeeding. What I was doing, and still stand firmly by, was recognizing that breastfeeding was actually lowering women’s risk. That doesn’t mean that it eliminates the risk. But it challenges the current recommendation floating around in the postpartum depression field that women should avoid nighttime breastfeeding in order to prevent depression. The majority of the current evidence suggests that that strategy can actually make things worse–specifically because the mothers sleep less and have poorer quality sleep.

    We have also found the same in our recent study of 6410 mothers. These data are found in our article in the recent issue of Clinical Lactation. But here is a preview. (Kendall-Tackett, Cong, & Hale, 2011, Clinical Lactation, Vol 2-2)

    a) Breastfeeding mothers got significantly more hours of sleep than mixed or formula-feeding mothers.
    b) Breastfeeding mothers had more energy and reported better physical well-being.
    c) Breastfeeding mothers reported significantly lower levels of depressed mood and anhedonia, and lower rates of depression overall compared with mixed- or formula-feeding mothers.

    Please note that these benefits are for the MOTHERS, not the babies. The reasons for these findings are complex and based on the research in psychoneuroimmunology. This mechanism is described more fully in my article in the International Breastfeeding Journal http://www.internationalbreastfeedingjournal.com/content/2/1/6.

    As for research on perintal mood disorders, I would also refer you to my book, Depression in New Mothers, 2nd Edition (2010, Routledge), which has well over 1,000 articles references and discussed. The goal of my original blog post was to discuss one specific area within the postpartum depression field, and specifically challenge some current advice being offered that runs counter to the results of a number of recent studies–including our own. The larger overview of the causes of PPD and other perintal mood disorders is in my book.

    So this isn’t a case where we are pitting the baby’s needs against the mother’s. It’s recognizing breastfeeding’s potentially highly protective role in maternal mental health. Rather than chucking it aside, we need to find out what the mother wants to do. And if she wants to continue breastfeeding, she needs our full support.

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