to at of do or what’s sleep? do in of - black mothers' breastfeeding...
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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
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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’
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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.
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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
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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
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Sweet Sleep and the Safe Sleep Seven 9/9/2016
© Linda J. Smith / BFLRC 2016 2
the Safe Sleep Seven©
3 adult factors: nonsmoker, sober, breastfeeding mother
3 baby factors: healthy, on back, unswaddled in light clothing
Safe surface
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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
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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
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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
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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
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Cuddle Curl confirmed in infrared sleep studies
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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.
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Sweet Sleep and the Safe Sleep Seven 9/9/2016
© Linda J. Smith / BFLRC 2016 3
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
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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
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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
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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
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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
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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
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Sweet Sleep and the Safe Sleep Seven 9/9/2016
© Linda J. Smith / BFLRC 2016 4
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
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NO NO NO!
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This would be safer if baby was secured on dad’s chest
Maybe – if near adult
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Babywearinghttp://babywearinginternational.org
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YES yes yes
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https://www.isisonline.org.uk/image‐archive/
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Sweet Sleep and the Safe Sleep Seven 9/9/2016
© Linda J. Smith / BFLRC 2016 5
Bottom line:
“Baby‐proof the bed because sleep happens.”
Linda J. Smith, MPH, IBCLC
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Breastfeeding is at risk when mothers and babies don’t share sleep Santos 2009
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courtesy La Leche League– Hong Kong
Babies are at risk when mothers and babies don’t share sleep safely
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Greatest sleep comes with exclusive breastfeeding and bedsharing
Doan et al 2007
Ball &Blair 2004
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Greatest sleep comes with exclusive breastfeeding and bedsharing
Mothers and babies need to know how to do it safely
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Bottom line:
“Baby‐proof the bed because sleep happens.”
Linda J. Smith, MPH, IBCLC
9/9/2016 © Linda J. Smith / BFLRC 2016 30
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Sweet Sleep and the Safe Sleep Seven 9/9/2016
© Linda J. Smith / BFLRC 2016 6
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
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Resources
•www.llli.org/sweetsleepbook•https://www.isisonline.org.uk/•http://cosleeping.nd.edu/
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The Safe Sleep Seven and Sweet Sleep book©2014 La Leche League International
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Diane WiessingerDiana WestLinda J. SmithTeresa Pittman
http://www.llli.org/sweetsleepbook
Thank you!
Linda J. Smith, MPH, IBCLC
937‐438‐8458
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