Well, I'm going to go ahead and jump in on this one.  I have heard all
the arguments against "allowing" or even "encouraging" a breastfeeding
baby to sleep through the night.  I have noticed that a lot of what we
talk about on Lactnet (certainly not all!), is based on theory and/or
personal preference/philosopy of parenting.  This is good, for these
things generate ideas which prove helpful to many -- but not for all.

As professionals, we need to constantly look at issues through the sieve
good, clinical research.  Granted, not everything has been studied well
enough or long enough to lead to a firm conclusion.  I think sleeping
through the night for breastfeeding babies is one of these areas.

I did a literature review last year and found VERY LITTLE on the
subject.  What I did find were studies which were based on small sample
size.  But, I also found that what literature was there, on the whole,
tended to support the following:
1.    Sleeping through the night (usually defined as minimum of 6 hours
-- 12 - 6 am) did not cause a problem with insufficient weight gain,
mother's milk supply, or duration of breastfeeding.

2.    It SEEMS  that breastfed babies may be able to "sleep through the
night" even a little earlier than ABM babies.

Now, there could be "costs" for allowing/encouraging BF babies to do
this..... the LAM method would probably not work, for one.  I'm sure
there will those who will say that other costs could include "infant
depression", SIDS, poor maternal/child attachment, etc.  If this is the
case, then where is the "hard" evidence?  It seems that most of these
concerns are based on theory, or studies (or study authors) which may
suggest such sequelae.

Are theories or personal philosophies bad?  Certainly not.  They are the
germ cells for research.  But, they are not the research conclusions.  I
believe that we tread on shaky ground when we "factually state" a
cause/effect when the "fact" is heavily based on theory/philosphy, with
little or no sound research findings for support.

For many women, having a healthy baby who is able to sleep through the
night without any interference with her breastfeeding for as much or as
long as she desires is considered a very positive thing.  And, what
research has been done tends to support that this is possible.

I have been reading Lactnet posts which concur.  To say that a
breastfeeding baby does not wake at night indicates some pathology,
seems to me to be a stretch.  If the baby is healthy throughout the 24
hours period, it could also mean that this uninterrupted sleep may even
be contributing to the infant's health.  At worst, sleeping through the
night does not seem to be harming him.  If there is a concern, then let
the physician do a check-up.  If all is well, then stop fretting.  There
simply are too many cases where healthy breastfed babies sleep through
the night to state conclusively that this is harmful, without solid
research to support such a statement.

For cultures or for women who have the luxury of or a belief system to
engage in night nursings, great.  Even then, there are still some
unanswered questions regarding any positive or negative future results
of this practice.

For cultures and women where a stretch of rest is considered valuable
(i.e. a mom employed outside the home and a culture where is practically
necessary), the duration of breastfeeding can be positivly impacted by
developing or allowing the capability of infants to sleep through the
night.  Again, there are unanswered questions as to any positive or
negative sequelae.

Human beings, including babies, have a fair range of adaptability.
There are also pros & cons to almost any approach to feeding, sleeping,
and parenting.  We need to learn much more about the pros and cons of
any approach, and that needs to be based on solid research, of the type
subject to peer review.

This is why I don't choke when the AAP, after evaluating research, makes
a statement that a concept is inclusive or not supported by the
available research.  This may simply mean that there just is not enough
research done on a question, or that the research that has been done is
"soft", or that the research actually supports a conclusion other than
what has been surmised.

I was at a conference the other day and a participant responded to a
discussion with the statement.."We know that there is a whole body of
research out there which shows that............" and she went on with
her point.  Having had an interest in the topic, I knew that there was
not a "whole body" of solid research which would stand up to peer
review.  In my mind, and I'm sure that any other participants who were
more familiar with the scientific process and academia, her statement
actually discredited her comments.

We ALL need to look critically at our positions on many aspects of
breastfeeding.  "Always" and "never" concepts are rarely reality.  We
must keep an open mind about issues which lack enough solid research to
confirm our position.  Otherwise, our credibility with those in position
to help us effect change.  Even more importanty, our ability to discover
truth, even if that truth means that there is more than one "safe" or
"right" way to do something, will be sacrificed on the alter of our
opinions.
One more point.  When we point out the error of another approach or
viewpoint, we need to make sure that what we say has not been taken out
of context, is outdated, is hearsay, misquoted, or even pursposfully
miscontrued.  We become upset when breastfeeding is presented in a
negative light, with worst case scenarios and incomplete or even
erroneous information put into print for a large population to read and
accept as "fact".  If we are not willing to accept this type
inappropriate communication and journalism, then we, too, must be
faithful in making certain that our verbal and written communication is
based on current information, kept in context, and seen or read with our
own eyes and heard with our own ears.

Keep on theorizing and developing or revising philosphy, but never
forget that is what you and others are doing.   Whenever it is possible
to do so, find the solid scientific evidence to answer the question.
Always stay committed to the truth, as best we can know it, even if it
means adjusting our opinions and practice.

Sandy Hess

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