| Asleep at the
breast
what to
do if the baby keeps falling asleep while nursing
Babies fall asleep at the breast all the time, and who can blame them? It's cozy, safe, and involves warm milk. It's a problem though, when mom wants to get up, put the baby down, and do something like shower, or pee and the baby wakes up and wants to eat again. So what's up? In the first 24 hours of life, newborns fall asleep because most got shoved though a very small hole and probably don't feel all that hot because of it. Plus, as medical professionals, we give many drugs to moms and babies that make both sleepy afterwards. There are very many reasons that I harp about babies going to breast as soon as possible after delivery; one of them is that newborns have about 2 hours of really awake time after delivery and then sleep, soundly, for about the next 20. Nursing during that 20 hours of sound sleeping can be very discouraging sometimes. Why are we waking them up to begin with? In the first couple of weeks of nursing, mom needs to establish her milk supply. Suckling at the breast causes a release of the hormone prolactin, a necessary hormone for making milk. Prolactin levels rise during the first 2 weeks, eventually coming to a plateau after that. So frequent and effective sucking on the breast during that 2 weeks is important to establish an adequate level of prolactin. Prolactin starts to dip after 3-4 hours without stimulation at the breast and that can make mom's milk supply less than necessary. Infants in the first few weeks of life fall asleep because there is no milk coming: the infants response to a hard nipple and the presence of milk. The flow slows and they rest. The idea, then, is to keep the flow of milk going. One technique to keep the milk coming is called breast compression and basically involves squirting the roof of the child's mouth with milk to keep them sucking. As they nurse longer from one side, the composition of the mature milk (not colostrum) changes from low-calorie to high calorie, low fat to high fat. The more high fat containing milk (hindmilk) the kids get, the longer they theoretically will go in between feedings. This increase in hindmilk can help with gassiness and weight gain. Another technique that works quite well, but one we wouldn't use for more than the baby's first few days of life, is called switch nursing, where you keep switching the baby back and forth between breasts during the same feeding. As the flow of milk slows and the baby's sucking subsequently slows, you switch to the other side. That way, we keep the flow of milk going during the feeding. Eventually, however, when your mature milk supply is established, this technique can lead to a foremilk/hindmilk imbalance which leads to a gassy, hungry baby. Again, it's not a technique that we would do for much longer than the first week of life. Other things to do
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