Infant Feeding Type and Maternal Sleep Duration
by Anne Eglash MD, IBCLC, FABM
There is a widely held assumption that breastfeeding is associated with less sleep. For that reason, pregnant women with a history of bipolar disorder or seizures are periodically referred to our breastfeeding medicine practice for antenatal counseling regarding whether they should breastfeed because sleep is so important to prevent exacerbation of these illnesses. And we have all seen the trend of topping babies off with a bottle of formula before bed to promote longer sleep.
This week’s article is a recent systematic review and meta-analysis of maternal sleep by infant feeding type, and the association between co-sleeping (shared room or shared bed) and maternal sleep in the first 12 months postpartum.
This review did not include studies involving premature or ill infants, or mothers with health problems. The authors identified 7 studies that met their criteria, with a total of 6472 participants. They found that breastfeeding mothers (directly breastfeeding or pumping) had a small but statistically significant increased duration of sleep, by 14.4 minutes, as compared to non-breastfeeding mothers.
They found that the association between either sharing a room or a bed and maternal sleep duration was unclear. The studies varied too much in methodology and the definition of co-sleeping to reach a conclusion.
The researchers identified that most of the studies included in this meta-analysis were conducted in the USA among predominantly White, middle-class and highly educated populations. Non-English studies were not included.
- The average maternal night-time sleep duration for lactating and non-lactating mothers was approximately 6-6.5 hours.
- All mothers, lactating and non-lactating, slept longer after 6 months than before 6 months postpartum.
- First time mothers had the shortest night-time sleep.
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Summary
The aim of this meta-analysis was to examine the associations among infant feeding types, sleeping habits, and maternal sleep postpartum. Databases including Cumulative Index of Nursing and Allied-Health Literature (CINAHL), PubMed, and Google Scholar were searched in addition to reference lists from selected articles and other key references. A critical review of relevant articles from the data sources was conducted with attention to the infant feeding types and maternal night-time sleep. The methodological quality was assessed systematically. The pooled mean difference was calculated. Narrative summaries were also used. A total of 6,472 participants from seven studies were included in the meta-analysis. A random-effects model demonstrated a significantly higher maternal night-time sleep in breastfeeding mothers than non-breastfeeding mothers with a pooled standardized mean difference of 0.24 h (95% confidence interval 0.03–0.46, p = 0.026). Co-sleeping with infants during the night also increased the sleeping hours in breastfeeding mothers. Homogeneity was observed with a Tau2 of 0.0308 and I 2 of 44.3%. Funnel plots, Egger’s and Begg’s tests revealed no evidence of publication bias. This systematic review and meta-analysis demonstrated that breastfeeding may be associated with a longer night-time sleep postpartum and the synthesis of the literature suggested that co-sleeping with the infant was associated with longer sleep duration in breastfeeding women. Further research into factors involving maternal decisions on infant feeding types and their effects on maternal sleep is needed to better understand the mothers’ attitude toward infant feeding and their own sleep.
Major take-aways from this study are, of course, that lactating women don’t sleep less than non-lactating women, and that new mothers on average sleep less than 7 hours a night. Additionally, first time mothers sleep less.
Antenatal counseling should include guidance on sleep expectations, no matter how they are going to feed their infants. Newborn care is a job, and if a person accepts a job with expected sleep interruptions (such as being on call), then you’d expect that the person to have a contingency plan, such as going to bed early, sleeping later in the morning, or a planning for daytime naps.
In this way, it seems wise to counsel new parents that they have just accepted an additional ‘newborn care job’, and they need to plan for shorter sleep times. In addition, we need to dispel the myth that breastfeeding leads to less sleep. Antenatal counseling on sleep may help to decrease postpartum depression, anxiety, parental discord, and ‘sleep training’, and facilitate longer breastfeeding duration, by encouraging soon-to-be parents to strategize, e.g. planning to initiate sleep earlier, arranging time for naps, or accepting help from those who offer.
Mai Hoang
Just want to give a And ❤️ Dr Eglash’s comment! An excellent antenatal counseling suggestion.