Christina mentioned the fear that information about frequent waking among 
breastfed babies will encourage mothers to formula feed their babies.  There 
is some evidence that formula-fed babies do wake less frequently than 
breastfed babies.  However, that is not the only variable which impacts a 
mother's restfulness.  The total amount of sleep time is also important. We 
need to give mothers the whole picture, not just one small part of it.  Here 
is some research which indicates that, while formula feeding results in less 
frequent night waking, mothers who formula feed are not more well-rested 
than their breastfeeding counterparts.

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=9423387&itool=iconabstr&query_hl=2
Issues Compr Pediatr Nurs.  1997 Apr-Jun;20(2):115-23.
Infant and mother sleep patterns during the 4th postpartum week.
Quillan, SI

Using modified Barnard and Eyres (1979) Sleep/Activity Records, 44 mothers 
recorded diurnal sleep and awake times for themselves and their infants 
during the 4th week postpartum.  Independent two-way analyses of variance, 
using a two-factor design (3a x 2b), compared data from each mother and each 
infant.  Independent variables were (a) parity groups (mothers feeding their 
first, second, or third infant) and (b) feeding method (breast vs. bottle). 
A statistically significant difference (alpha = .05) was apparent between 
breastfed and bottle-fed babies regarding the number of awakenings and the 
hours of night sleep, with breastfed babies awakening more and sleeping less 
at night.  But there was no statistically significant difference in the 
hours of total sleep diurnally.  Mothers exhibited corresponding differences 
in sleep patterns, with a statistically significant increase in night waking 
for breastfeeding mothers.  Infants in this study averaged 14.6 hours of 
sleep in 24 hours, which is in contrast to the 15.5 to 17.3 hours of sleep 
commonly reported in nursing texts based on studies from the 1960s.
***********
When I conducted a pubmed search looking for studies related to feeding 
method and night waking, I found several which noted that there is a 
relationship between frequent night waking in breastfed babies and early 
termination of breastfeeding.  So, I don't think we should sweep this under 
the rug.  It is something to discuss with women, something I talk about 
frequently in my breastfeeding support groups.  I urge moms to rethink 
normal infant sleep rather than trying to change the baby.  I ask them to 
consider things from the baby's point of view, consider what is biologically 
normal and consider the implications of forcing a baby to sleep for long 
periods.  One article from 1998 
(http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=9709710&query_hl=2 
 ) specifically advises, "More support for dealing with night-waking might 
prevent early termination of breastfeeding."  I think we would be wise to 
heed this warning and help moms find ways to cope.  For me, personally, 
learning from other moms that frequent night waking is common helped me to 
adjust to my new sleep schedule.  The oft-given advice to "watch the baby 
not the clock" was particularly helpful.  I began to feel much more 
well-rested when we replaced our VCR with a new, cheaper model which had no 
clock on it.  When I nursed my first-born in the rocker while watching 
late-night TV, I had no idea how long he had been nursing.  Once I mastered 
the side-lying position for breastfeeding, I turned the clock away from me 
to accomplish the same thing.  I have advised moms to do the same because I 
think it makes it easier to go back to sleep when baby wakes you up if you 
are not counting the minutes you've been awake, nor calculating how much 
time you have before your alarm will go off.

Sara Dodder Furr, MA, LLLL, IBCLC
Lincoln, Nebraska 

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