Breast milk is the milk produced by the mammary glands and is a natural source of nutrition for newborns. Breast milk contains immunomodulatory, anti-inflammatory, and antibacterial compounds that aid in lowering the short- and long-term risks associated with chronic childhood pediatric disorders such as respiratory infections, ear infections, and diarrhoea. It has a positive impact on the cognitive and psychomotor development of the child.1
Babies may experience excessive sleepiness as a result of rough birth, premature birth, feeding difficulties, jaundice, overstimulation, or breast engorgement. Baby sleepiness is a major risk factor for poor milk production, as routinely expressing milk from the breasts is a crucial signal to produce more milk. If the baby continues to feel sleepy and does not feed properly after the mother's milk has arrived, the mother's breasts are likely to become engorged or develop mastitis. Engorgement or mastitis can make the mother feel worse and limit her milk production even further.
Understanding sleepy babies
The cholecystokinin (CCK) hormone causes the infant to fall asleep during breastfeeding. This hormone is secreted in the intestines of breastfed babies, making them feel full and subsequently sleep. When there is no milk or the supply of milk is reduced, the baby becomes sleepy. It's completely normal for babies to sleep to recuperate from birth, especially if you had a difficult delivery or used pain medications during labour. Proper feeding position allows babies to breastfeed more effectively while avoiding drowsiness. Make sure that babies expand their mouths widely and cover part of the areola.
Benefits of finding the right position
The position of the baby's body is vital for strong attachment and successful breastfeeding, as it prevents many types of nipple injuries. A good sucking technique is thought to be essential for establishing breastfeeding, ensuring milk transfer, and preventing lactation complications. To confirm a good latch, check the following every time you nurse your baby:2,3
- Their chin is pressing against your breast, and they can breathe through their nose
- Their mouth is wide open and fill the areola (not just your nipple)
- Their latch doesn’t hurt
- They start with short sucks before sucking slower and deeper
The feeding session can be extended by returning the baby to the breast after the first withdrawal to see if the baby continues to eat. If your newborn falls asleep after a few minutes of breastfeeding, wake them up so they can eat a full meal and reach the fattier and more delicious milk that is released near the end of the feeding
Adequate milk supply can be promoted by:4
- Nursing every 2 hours during the day and every 3 to 4 hours at night
- Breastfeed your infant for at least 15 minutes on each breast. Do not restrict nursing time
- Gently massage the breast before and during feeding
- Use relaxation techniques to reduce stress and increase breast milk flow
- Spend approximately 20 minutes after feeding for skin-to-skin contact with your infant
- Make sure the infant is in the correct and latched position
- Offer both breasts at each feeding
- Use breast compression to help empty the breast during feeding
- Pump milk immediately after breastfeeding during the day and rest at night
Common breastfeeding positions for sleepy babies
The cradle hold is probably the most common breastfeeding position, as it provides you with optimal control.
- Sit on a comfortable chair or bed with pillows or cushions around you to stabilise the cradle
- Place your infant on your lap, facing you
- Place your infant's head on your forearm, nose to the nipple. The length of their body should be supported by your hand
- Place your infant's lower arm under your arm
- Make sure your baby's ears, shoulders, and hips are all straight
- The biggest advantage of the cradle position is that it promotes a more relaxed posture and frees up your arms
Tip: If you are sitting in a chair, place your feet on a stool or small table to avoid leaning forward, which can cause back pain.
The football breastfeeding position, which is also known as the clutch hold or underarm, involves facing your baby toward your breast and positioning them beside you with your elbow bent. Your baby's body will rest on your forearm, and it's important to use your hand to support your baby's head. If necessary, use your free hand to provide additional support to your breast. This position may require a pillow or some form of support.
The football hold has the advantage of being a good position for mothers who have had a Cesarean section (C-section) as well as mothers with large breasts.5 This position is also suitable for mothers who have twins and want to breastfeed both babies at the same time. The football hold also makes it easier for babies to swallow milk, which is beneficial for mothers who have a strong milk ejection reflex.
The side-lying breastfeeding position involves lying on your side with your baby next to you, aligning your bodies in the same direction. Use the arm opposite to the side you are lying on to support your baby, and if needed, cup your breast. This position keeps your infant's head at an appropriate angle, bringing the baby and breast closer together.6
The advantage of this position is its suitability for women who have undergone a C-section or experienced difficult delivery, as well as for nighttime breastfeeding. This position is also good for babies who spit up frequently.
Laid-back breastfeeding, also referred to as biological nursing, is when you lie back on your bed or sofa in a comfortable, semi-reclined position. Your baby is placed tummy to tummy on your body so that their head is near your breast. Both you and your baby can relax in this posture, allowing your baby to explore and latch at their own pace.
The main advantage of this feeding position is that it stimulates the baby’s innate feeding reflexes, which could help them latch on to the breast accurately and reduce discomfort and nipple trauma.7 In addition, laid-back feeding ensures that babies are well-supported on the mother’s body.
Additional tips for successful feeding sessions
- Undressing your baby and placing them on your chest (skin-to-skin) increases their feeding reflexes and helps stimulate food cues
- Positioning and latching – If your baby is not latched and positioned properly, it will be difficult for them to get milk, and breastfeeding may be painful. Upright positions may help your baby stay awake long enough to breastfeed
- Breast compressing – Using the free hand to gently squeeze the breast while feeding can help keep the milk flowing at a faster rate and thus keep the baby feeding longer
- Switching sides – Once your baby slows down, sucking on the first breast, offer the other breast before the baby falls asleep. By switching and repeating, you can keep the baby awake and actively feeding for long periods of time
- Looking for active feeding – Pay close attention to your baby and see if they are actively moving their jaw to suck and if you can hear them swallowing. If your baby is not getting enough milk, they will likely fall asleep hungry, and your milk production will continue to decline
How long do newborns sleep?
Newborn babies sleep a lot; they may sleep for 18 hours out of every 24 hours — usually for 2-3 hours at a time, with longer periods of sleep of four to five hours considered a good measure. It is normal for a newborn to feel quite tired during the first 24 hours after birth.
Is my baby too sleepy?
To support weight gain and enhance your milk production, expect the following patterns in your newborn:
- Breastfeeding effectively a minimum of 8-12 times within a 24-hour period
- Feed actively from one or both breasts during each feeding session, swallowing regularly
- Nurse at least every 2-3 hours, measuring from the start of one feed to the beginning of the next, with one more extended sleep of 4-5 hours
- Experience periods where the babies breastfeed intermittently for several hours, typically occurring in the evening
- Weight gain starts from day four and reaching birth weight restoration by approximately two weeks
Which breastfeeding position helps in reducing gas?
Try laid-back breastfeeding. In this position, you recline on your back (either flat or at an angle) with the baby positioned belly-to-belly with you. When you are on your back, and the baby's head is above the breast, gravity assists in slowing down the milk flow.
- Babies sleep a lot but typically wake up every 2-3 hours for feeding
- If your baby sleeps for more than 3 hours without waking up to nurse, it's important to gently wake them for breastfeeding. This is essential for their well-being and ensures the maintenance of your milk supply
- Hand-expressing or pumping breast milk can be a temporary solution if your baby sleeps for an extended period without nursing
- Recommended breastfeeding positions for a baby include cradle hold, football hold, side-lying position, and laid-back position
- Successful feeding sessions involve practices such as skin-to-skin contact, correct breast latching, breast compression, and seeking active lactation
- Seeking breastfeeding assistance promptly is highly beneficial for maintaining your milk supply and resuming breastfeeding
- Rouw E, von Gartzen A, Weißenborn A. Bedeutung des Stillens für das Kind. Bundesgesundheitsbl [Internet]. 2018 Aug 1 [cited 2024 Jan 15];61(8):945–51. Available from: https://doi.org/10.1007/s00103-018-2773-4
- Goyal RC, Banginwar AS, Ziyo F, Toweir AA. Breastfeeding practices: Positioning, attachment (Latch-on) and effective suckling – A hospital-based study in Libya. Journal of Family and Community Medicine [Internet]. 2011 Aug [cited 2024 Jan 15];18(2):74. Available from: https://journals.lww.com/jfcm/fulltext/2011/18020/breastfeeding_practices__positioning,_attachment.7.aspx
- Wambach K, Riordan J. Breastfeeding and human lactation, enhanced fifth edition [Internet]. Jones & Bartlett Publishers; 2014 [cited 2024 Jan 15]. 986 p. Available from: https://books.google.jo/books/about/Breastfeeding_and_Human_Lactation_Enhanc.html?id=lDb3BQAAQBAJ&redir_esc=y
- Wambach K, Spencer B. Breastfeeding and human lactation [Internet]. Jones & Bartlett Learning; 2019 [cited 2024 Jan 15]. 836 p. Available from: https://books.google.jo/books/about/Breastfeeding_and_Human_Lactation.html?id=s5S4DwAAQBAJ&redir_esc=y
- Pehlivan N, Demirel Bozkurt O. Comparison of cradle hold versus football hold breastfeeding positions after cesarean section in primiparous mothers. Breastfeeding Medicine [Internet]. 2021 Nov [cited 2024 Jan 15];16(11):904–8. Available from: https://www.liebertpub.com/doi/abs/10.1089/bfm.2021.0029
- Puapornpong P, Raungrongmorakot K, Laosooksathit W, Hanprasertpong T, Ketsuwan S. Comparison of breastfeeding outcomes between using the laid-back and side-lying breastfeeding positions in mothers delivering by cesarean section: a randomized controlled trial. Breastfeeding Medicine [Internet]. 2017 May [cited 2024 Jan 15];12(4):233–7. Available from: https://www.liebertpub.com/doi/abs/10.1089/bfm.2016.0193
- Wang Z, Liu Q, Min L, Mao X. The effectiveness of the laid-back position on lactation-related nipple problems and comfort: a meta-analysis. BMC Pregnancy Childbirth [Internet]. 2021 Mar 24 [cited 2024 Jan 15];21(1):248. Available from: https://doi.org/10.1186/s12884-021-03714-8