Sleepy Baby in Early Breastfeeding

Written by drg Retno Wiangga

 

Definition

Sleepy baby is a sleepy or inactive baby. In early breastfeeding baby who is asleep will be more difficult to suckle the breast.

The way babies are born greatly affects early breastfeeding. Normal and natural labor can make the breastfeeding process smooth.

Naturally the body prepares itself for breastfeeding. Enlarged breasts, dark areola and nipples that become supple. At 4 months of pregnancy colostrum begins to be produced. But production and milk discharge will wait until hormonal changes that occur after the baby and placenta out. Babies naturally have reflexes to search and suck.

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Pathophysiology
In normal and natural labor, hormones that work in labor also work to prepare for breastfeeding in both mother and baby. During labor the oxytocin is responsible for strong contractions. With increased oxytocin and pain during contractions, endorphins are released. Along with the release of the baby through the birth canal, catecholamines are released. Catecholamines provide a boost for the mother. When the baby is born with a high catecholamine level then he is an active baby. When skin to skin, then the baby’s suction will stimulate oxytocin. Healthy infant will alert within 2 hours after birth and baby will sleep approximately 20 hours per day but the baby is still awake to suck. In a sleepy baby, the baby will sleep prolonged and will not wake up to suck.

Causes of sleepy baby
Sleepy or inactive babies are caused by interventions in labor such as induction, epidural anesthesia and separation of the baby from the mother after the baby is born.

Intervention in labor (mother’s cause)
Induction by pitocin, pitocin does not enter the blood so that the pituitary gland is not aroused to release endorphins. Epidural anesthesia decreases the levels of the hormone oxytocin. Without endorphins and oxytocin, the catecholamines will not be released. This makes mothers and babies less responsive. Babies who are exposed to anesthesia epidural reflex and swallow it will be disturbed making it difficult to suckle in a few hours or days.

Separation of the baby from the mother after birth (causes in infants) Babies who do not do skin to skin contact after birth interfere with the baby’s ability to find breasts and stick. Babies who are treated together with her mother will get a quick response when showing signs want to drink. Physical closeness also makes the temperature, heart rate and breathing more stable so the baby will be more active suckling.

Treatment
Management or therapy that can be done to prevent the occurrence of sleepy baby ie labor should be as normal as possible and natural, as much as possible to avoid intervention in labor

The Importance of Early Breastfeeding Initiation (IMD) for at least 1 hour and in the first hour after birth

The importance of rooming in or care to join to prevent problems in breastfeeding

Case Illustration

Case 1
A new mother gave birth to her second child weighing 4000 grams through a normal delivery. After the baby is born, skin to skin was done for only 10 minutes because he was a big baby. Her first child was 2 years and 9 months and successfully breastfed until the age of 2 years. Mother is a housewife.

On the first lactation visite at 24 hours, this mother complained that her baby wasnt sucking well and slept a lot. The lactation counselor checks both mother’s breasts and nipples and they were within normal limits. Mother was assisted to breastfeed, her baby was fussy. Then counselor did a finger feeding but baby does not suck. Mother then tried to offer baby her breast, but he wasn’t suck. Baby looked sleepy and lazy to suckle.

The counselor advice mother to do skin to skin contact with her baby. One hour later, after the baby slept in a skin to skin position, mother was assisted to breastfeed, but still the baby was not sucking well.

The lactation counselor advised mother to do continues skin to skin contact and bedding in with her baby. On the second day the baby is already active, and willing to suckle continuously.
Case 2
A baby was born on a C section, spinal anesthesia was repeated for 2 times since mother still experienced pain. Mother has history of getting psychiatric medications.

The baby was born not crying and sleeping, but the baby was successfully awakened with drying and stimulation. The baby stopped crying and then sleeps again, breathing spontaneously well enough. The heart rate was stable.

Early initiation of breastfeeding done immediately on breasts of a sleeping mother. Father was accompany them while whispering adzan to the baby. Early breastfeeding initiation was done successfully for 1 hour thirty minutes. Mom was awake in the minute of 30, rubbed the baby and communicate with the baby.

Both babies in case 1 and 2 could subsequently sucked well, after continues skin to skin with the mother as often as possible, and bedding in while asleep.

Conclusion
Problems that occur at the beginning of breastfeeding such as, sore nipples, lazy or sleepy babies, and engorgement was rare if the mother undergoes normal and natural labor.

Eatly breastfeeding initiation, mother and baby skin to skin position and bedding in while asleep helped to overcome problem a sleepy baby in early breastfeeding.
References
Judith A, Lothian. The Birth of a Breastfeeding Baby and Mother. J Periant Educ 2005
Elizabeth RM, Gene CA, Nils B, Therese D. Early Skin to Skin Contact for Mother and their Healthy Newborn Infants (Cochrane Review) 2003. In The Cochrane Library, 3.
Baumgarder DJ, Muehl P, Fischer M, Pribbenow B. Effect of Labor Epidural Anesthesia on Breastfeeding on Healthy Full Term Newborn Delivered Vaginally. Journal of the American Board of Family Practitioners 2003;16(1):7-13
Ransjo-Arvidson AB, Matthiesen S, Lilja G, Nissen E, Widstrom AM, Uvnas-Moberg K. Maternal Analgesia During Labor Disturbs Newborn Behavior. Effects on Breastfeeding, Temperature and Crying. Birth 2001; 28(1):5-12

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