Sleepy Baby in Early Breastfeeding

Written by drg Retno Wiangga

Sleepy baby is a sleepy or inactive baby. During the early breastfeeding stage sleepy baby may have difficulty in breastfeeding. The ways babies born are greatly affects early breastfeeding. Normal and natural labor can make the breastfeeding process running smoothly. Naturally the mother’s body prepares itself for breastfeeding. Some symptoms are enlarged breasts, dark areola and nipples that become more supple. At four months of pregnancy colostrum begins to be produced. However the production and milk discharge will be postpone until hormonal changes that occur after the release of the baby and placenta. At the end, babies are also have natural capability to search and suck the mother’s breast.

Pathophysiology
During normal and natural labor, several hormones influence the labor process. These hormones will also affecting the breastfeeding preparation for both mother and baby. The hormone oxytocin is responsible for strong contractions. With increased oxytocin and pain during contractions, endorphins are also released. Along with the release of the baby through the birth canal, catecholamines are also released. Catecholamines provide an energy boost for the mother to go through labor. When the baby is born with a high catecholamine level, then he or she becomes an active baby. Moreover, a skin-to-skin contact and the baby’s breast suction will stimulate oxytocin production. Healthy infant will become alert within 2 hours after birth and then the baby will sleep approximately 20 hours per day but the baby is still awake to suck. In a sleepy baby situation, the baby will undergo a prolonged sleep and will not wake up to suck.

Causes of sleepy baby
Sleepy or inactive babies are caused by interventions occur during the 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)
During the labor pitocin might be used during the Induction. The pitocin does not enter the blood, which impair the arousal of pituitary gland to release endorphins. Epidural anesthesia decreases the levels of the hormone oxytocin. As the result of low endorphins and oxytocin level, the catecholamines will not be released. This makes mothers and babies less responsive. Babies who are exposed to anesthesia epidural may have disturbance in their reflex and swallow ability, making it difficult to suckle in a few hours or days.

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Separation of the baby from the mother after birth (causes in infants). Babies who do not have skin-to-skin contact after birth might have difficulty to find breasts and stik to the mother. Babies who are treated together with her mother will have a quicker response to show the eagerness to drink. Physical closeness also makes the temperature, heart rate and breathing become more stable and the baby will be more active in suckling.

Treatment
Treatment that can be done to prevent the occurrence of sleepy baby is to make labor as normal as possible and natural. The labor process must be done in this way to avoid intervention that maight impair the breastfeeding process after birth.

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 Reports

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

On the first lactation visite at 24 hours, this mother complained that her baby was not sucking well and slept a lot. The lactation counselor checks both mother’s breasts and nipples and they were within the normal limits. Mother was assisted to breastfeed, her baby was fussy. Then the counselor did a finger feeding but baby did not suck. Mother then tried to offer baby her breast, but there was not sucking. 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 the baby still 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 was already active, and more willing to suckle continuously.

Case 2
A baby was born on a C section and the 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 was done immediately on the breasts of a sleeping mother. Father was accompany them while whispering adzan to the baby. Early breastfeeding initiation was done successfully for one hour and thirty minutes. Mom was awake during thirty minutes of the process, rubbed the baby and communicate with the baby.

Both babies in case 1 and 2 could subsequently sucked well, after a continuous skin-to-skin contact with the mother. This should be done 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.

Early 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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