My third child was born in 2009. She arrived a few weeks early, although it was not early enough to be considered preterm. When we came home from hospital, she immediately fell into a routine, which mainly consisted of sleeping all the time and waking for only brief moments during certain times of the day. She was a very quiet baby and hardly every cried. This was very unusual for me, because my older two were not as laid back and quiet as she was. I had breastfed two babies, nursed through a pregnancy, and tandem nursed. I felt like a pro, and immediately worked on getting a good latch and starting our breastfeeding journey together.
As the days passed, she began to sleep more, and I began to fall apart. I have always had depression and anxiety, as well as some "quirks" or "obsessions" that could be related to OCD. However, during the postpartum period, my mental health issues become even worse. I have had PPOCD, and I will go into more detail about that in a future post. For the sake of this post, I will simply explain it by saying that my OCD was in control of my mind and body, and I was nowhere to be found. I obsessed over everything and anything. My world spiraled out of control, and unfortunately, my baby was affected by it (as were my other children).
So, back to the sleepy baby. She never woke to eat. She may have woken up once or twice a day to eat, but she would sleep nearly all day if I let her. I knew I needed to wake her more. I knew it was my job to make sure she was eating enough, but I failed at doing that. We started visiting the doctor and her weight steadily declined. Her diapers were scarce or full of dark urine and pink-colored crystals (see below). She was dehydrated, and they were ready to diagnose her as failure to thrive. She never cried. She never woke to eat. I was failing my daughter. I was failing to provide her with the nourishment she needed.
I was consumed by my irrational thoughts and feelings, and I had let her sleep through too many feedings. Sometimes, I would try to feed her and she would fall asleep in the middle of the feeding. I tried all the tips; taking a layer of clothes off, stroking her cheek, switching sides, etc. Nothing worked. I can admit, I did not put as much effort into as I should have. The time had come, I had to give her formula. During all of this time, it was like I was in a dream or a trance. Going through the motions, without even really being there. Family members stepped in and starting feeding her by bottle (as did I). She began to gain weight, and the doctors said she was doing much better.
She continued to sleep more than anything and still had to be woken for feedings. However, things did get better as she got older. Yet, to this day, she is still the only child that sleeps a solid 10 to 12 hours per night. I worked on my own issues and tried to get her back to the breast. At that point, she was about 3 months old, had nipple confusion, and had developed a preference for the bottle. I tried to pump, but it did not work well. Ultimately, she became a formula fed baby.
Babies do not always wake to eat, and for a mom who is also suffering from something like PPD or another type of postpartum mental health disorder, the result can be disastrous. I did not purposely neglect her; if she cried I would go to her. I tried to feed her, but I often let her sleep through the night, because I thought she would wake if she was really hungry. In the end, looking back, I do feel that in some ways I neglected my responsibilities to her. I feel like we missed out on a crucial stage of bonding. I have enjoyed a wonderful breastfeeding relationship with my other babies, and I did not have that with her. I could barely hold her at one point, and we missed out on that way of bonding, as well. I do not think having to switch to formula is the worst possible outcome, but I do feel that we missed out on something special.
I try not to worry too much over what happened, because my worries always turn into obsessions. I do feel guilty, because I did fail her. Now, I try to hug her and tell her I love her. I try to play with her and be there for her when she cries. I try to make up for the mistakes I made, even if I made those mistakes because I was not in the best frame of mind at the time.
So, how can a mom know if her baby is sleeping through feedings? Many moms probably won't need to worry, because some babies seem to nurse around the clock during those first few weeks. However, a sleeping baby does not always wake to eat, so moms should watch for a few important signs that their baby is not getting enough breast milk.
Signs to Look for
Weight gain: This is a big one, but not the only sign to look for. Breastfed babies should be measured on growth charts for breastfed babies, not general growth charts that many pediatricians use. If your baby continues to lose weight after your milk comes in (about 1 to 4 days after birth) then there may be a problem, such as sleeping through feedings or an improper latch. Babies usually regain their birth weight by two weeks after birth (but it may take another week). Breastfed babies usually gain about 5 to 7 ounces per week.
Diapers: This is the biggest clue for a breastfeeding mom to know if her baby is getting enough. Newborn babies should have 5 to 6 wet diapers per day and 3 - 4 dirty (stool) diapers per day. In the first few days of life, babies will excrete meconium, which will look black, then turn to green or brown. Babies who have 2 - 3 stool diapers per day should have very large stools, not just a small staining. Urine should be pale and odorless. Stool should be yellow by 5 days after birth. Stool diapers may become more infrequent as a baby gets older, and some babies only have a stool diaper once per week by 6 to 8 weeks of age.
Urate Crystals: I referenced pink-colored crystals in my post, which are actually urate crystals. Here is a picture of what it may look like. The baby's diaper may have pink or orange-colored crystals in it, which some parents may think looks like blood. It is caused by overconcentrated urine, and it will usually go away if milk intake in increased. Some parents may notice the crystals in the first few days after birth, but they should not be present once mom's milk comes in--if baby is getting enough.
Number of Feedings: On average, a breastfed baby will nurse anywhere from 8 to 12 times per day. Some babies are more efficient and some need to nurse for comfort, so this number may vary. However, there are signs to check to see if the baby is removing milk from the breast effectively.
Feeding Effectively: You should see your baby suck a few times, then swallow. You may be able to hear your baby swallow throughout the feeding. You may feel let down, which may may feel like a tingling sensation as your baby begins removing milk from the breast. It may take a few minutes into the feeding to feel let down. Your breast should feel lighter and softer after a feeding, but this may change once your baby is older and your milk supply has regulated (about 12 weeks after birth).
Your Baby: Is your baby alert and happy after a feeding? Is your baby meeting milestones? These are good clues that everything is OK, but they are not easy to see in a baby who is very sleepy.
Waking a Sleepy Baby
If your baby is not getting enough milk and sleeping through feedings, you will need to wake your baby to nurse. It is crucial to nurse often during the first few weeks, so your baby gets enough milk and for you to establish a good supply. Here are some tips for waking a sleepy baby.
- Remove a layer of baby's clothing.
- Keep your baby close to you, and try lots of skin to skin contact.
- Offer the breast every two hours.
- Stroke your baby's cheek, rub his or her back, or tickle his or her foot to encourage your baby to wake up.
- If your baby falls asleep at the breast, try switching sides during the feeding.
- Change your baby's diaper before the feeding.
- Dab a cool washcloth on your baby's forehead.
- Give your baby a bath before the feeding.
- Sing and talk to your baby during the feeding. Make eye contact too.
- Encourage let down by hand expressing or using a pump right before nursing, that way your baby will instantly get milk and may take in more.
If you are are concerned about your baby getting enough milk or sleeping through feedings, please contact a Lactation Consultant or Breastfeeding Counselor as soon as possible. So many pediatricians will suggest supplementing with formula to help the baby gain weight, which may or may not be necessary. Also, introducing artificial nipples and bottles too early can result in nipple confusion or nipple preference.
If you are feeling out of control, anxious, or depressed after your baby is born, there is no shame or guilt in reaching out for help. Do it as soon as possible, so you can start enjoying life with your new baby. Look for a counselor or therapist, ask your doctor for a referral to a psychiatrist, find a support group, ask family and friends for help--do whatever it takes for you to get the help you need. You and your baby deserve it.
References (These sites have lots of valuable information):
Bonyata, Kelly. "Is baby getting enough milk?." Kellymom. N.p., 14 June 2011. Web. 19 Nov 2011. <http://www.kellymom.com/bf/supply/enough-milk.html>.
Sears, . "Getting Enough Milk?: How to Tell." Ask Dr. Sears. N.p., n.d. Web. 19 Nov 2011. <http://www.askdrsears.com/topics/breastfeeding/faqs/getting-enough-milk-how-tell>.
Smith, Anne. "Waking a Sleepy Baby." Breastfeeding Basics. N.p., n.d. Web. 19 Nov 2011. <http://www.breastfeedingbasics.com/articles/waking-a-sleepy-baby>.
*Disclaimer* I am not a medical professional. The information I share on this blog is based on my own experiences and through my own research. While I always try to provide accurate, factual information, you should still consult with a professional if you need medical or lactation advice.