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Well the good news and the bad news is that it is normal for babies to nurse every two hours around the clock during the first 6-8 weeks of life! Another piece of good/bad news is that being tired in no way affects the milk supply- in fact too much 
sleep without interruption will cause a low milk supply.
This is because the hormone responsible for milk-making, prolactin, only lasts for about three hours after a nursing. If four hours go by without nursing the brain makes another hormone called Prolactin Inhibiting Factor which interferes with milk production. Since prolactin, the milk making hormone, only lasts for 3 hours we can do the math and discover that 8 feedings a day is the bare minimum number of feedings we can expect a baby to get by on during the first six months of life. We can also surmise that if the nursings take place more frequently than every three hours that the milk supply should be even more plentiful and indeed that is true.
Mothers who nurse more than 8 times a day have better milk supplies, and happier babies. Since 8 nursings a day is the bare minimum, and nursing 10-12 times a day is better that means that it must be normal for nursings to take place around the clock and abnormal for babies to sleep thought the night. Don't ask me why pediatricians still push "sleeping through the night" as normal...they need to get an education about how the brain and breast work together to make milk.
So let's think about what happens when a baby is given a bottle of formula even just once a day. Let's say a baby is nursed at 10 pm and then two hours later when the baby is hungry again at midnight the baby is given a bottle of formula. Since breastmilk is more digestable than formula we might expect the baby to sleep longer than the 2 hours she sleeps on breastmilk. Let's say she sleeps between 3-4 hours after a bottle of formula, that means she won't be ready to nurse again until 3am or 4am. Since the last breastfeeding was at 10 pm that means between 5 or 6 hours have elapsed between breastfeeds. The breasts will feel really full at 3 or 4 am from going unemptied so long but the fullness is deceptive. The breasts are really full thanks to the really frequent breastfeeds that took place before 10 pm, but after 1pm the negative hormonal effects of going too long between nursings begin to have their effect which will manifest not at the 3am or 4am feeding but at the subsequent breastfeedings.
If this "relief bottle of formula" is a one time event it probably won't do much harm but if it is done regularly it will mean that the baby will be unsatisfied and unsettled after a lot of breastfeedings during the day because it is not possible to just skip one feeding without affecting the milk supply going forward.
As babies get older they use their calories more efficiently so many mothers find that during 2-4 months of age the baby that had previously nursed every two hours around the clock may start sleeping one long stretch of 4-6 hours at night. As long as the rest of the nursings of the day are about two hours apart most moms find they have enough milk to keep their babies satisified even though they have this one long stretch which is suboptimal from a hormonal point of view. If the baby is unhappy at the breast during the day the mom needs to wake the baby during the long stretch of sleep for a nursing to recover her milk supply.
Other mothers find during the 2-4 month period that their babies do not take a 4-6 hour stretch at night but they do start to go a little longer between all the nursings of the day- going every 2 1/2 to three hours between nursings whereas previously they never went longer than 2 hours between nursings.
Around six months of age many babies revert back to taking the breast every 2-3 hours at night because the fat content of milk is higher at night and when they are growing rapidly as in the newborn period or learning to sit alone and crawl this extra fat helps myelinate the nerves that make these developmental advancements happen. After these developmental changes have taken place the baby will go back to sleeping longer stretches at night until the next major myelination takes place when babies are learning to walk around a year of age.
So since sleeping through the night is not physiologically normal and babies have a couple of reversions back to frequent night nursings what is a mom to do to feel rested????
Well it helps to think about all the generations of breastfeeding moms that came before the era of bottlefeeding- what did they do to survive on broken sleep? Well for one thing they did not have their babies down the hall. They did not get up out of bed and try to stay awake while nursing a baby in a chair. They slept with their babies and they didn't have to fully wake up and neither did the baby for night nursings. They learned how to nurse in the side lying position and fall right back to sleep while nursing.
If co-sleeping were inherently dangerous for breastfeeding mothers and babies the human race would not have survived. Modern moms can learn how to safely co-sleep too. All it really involves is a firm mattress on the floor (no bed frame) and staying in the bed with your baby (using a crib or bassinet if the baby is sleeping alone) and never leaving the baby in the bed with anyone else. Non-lactating women, dads and other kids don't have the hormones of lactation. The hormones of lactation alter the sleep states of breastfeeding mothers so that they are excellent caregivers even in their sleep. (See the work of sleep researchers James McKenna and Helen Ball)
Another thing nursing moms can do to feel more rested is just change their sleep habits. It is tempting to stay awake after the baby goes to bed for the night or to get up early ahead of the baby the next day to get things done, but this is some of the deepest and longest stretches of sleep a baby will take. When a baby is young it is important for moms to take advantage of these longer deeper stretches of infant sleep to get the rest they need. When the baby is older many moms find that they can choose either to go to bed a little later or get up a little earlier than the baby does and still feel rested, but moms with young babies need to obey the golden rule of new motherhood - "sleep when the baby is asleep."
(December 2007) (
