EPISODE 55

Why do we feel Sleepy and Thirsty while Nursing? A look at hormones...

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Episode Transcript

April 30, 2021

Why do I get so sleepy and thirsty while breastfeeding?

This is Maureen Farrell and Heather O’Neal and this is The Milk Minute. We’re midwives and lactation professionals bringing you the most up-to-date evidence for all things lactation. So you can feel more confident about feeding your baby, body positivity, relationships, and mental health. Plus, we laugh a little or a lot along the way.

So join us for another episode.

Welcome to this week’s episode of The Milk Minute Podcast. Today we’re talking about oxytocin, who is our friend, but also can make us very sleepy and thirsty when we’re breastfeeding. And we need to talk about why in the hell that happens. Absolutely. So I thought maybe we’d start with a listener question from Kelsey.

Kelsey had told us, she said, “I am so thirsty when I nurse. The first two weeks were the worst. A few minutes into every feed. I was thirstier than I’ve ever been in my life. It’s a little better now that we’re at four weeks, but why the heck does this happen? My husband has never filled more water bottles in his life. He’s my official water boy.”

I think everybody needs a wa wa wa water boy. Yeah, absolutely. And, and so basically there’s two theories around why breastfeeding causes thirst at that time. One is that it’s due to oxytocin release and the next is that it’s a learned response. So let me talk about the oxytocin release first. A lot of studies were indicating that oxytocin plays a role in regulating the body’s fluid intake, but also like the way that we exchange salts over cellular walls, you know, like all these really, really complex cellular activities are partially regulated by oxytocin.

So that’s really good to know that oxytocin plays a role in regulating your body’s fluid intake. And part of then, talking about the learned response is that these surges of oxytocin are really more prominent in the first couple of weeks of breastfeeding. Like they’re bigger changes for your body, bigger levels of oxytocin.

And so after a certain amount of time, then your body just learns, okay, now we’re breastfeeding. We’re going to be thirsty. And learned responses are really strong in humans. Do you think like we’re going to be thirsty because we’re going to need to replace the fluid to make more milk? You know, all of that is theory. Right.

One of these studies kind of went into, yes, you use fluids to make milk, but also then your whole metabolic process changes and how you use insulin when you’re lactating, how you exchange salts and sugars and things like that into the bloodstream and then into the milk. So like fluid regulation and homeostasis in the body is actually like ridiculously complex and I don’t know how anything is ever alive.

Because is it’s just like, wow, our cells do a shit ton of stuff. So yeah, so this was the two part thing. And the thing that we hear all the time, right is “I get really thirsty when I’m breastfeeding,” or “I get really sleepy when I’m breastfeeding,” or maybe both.

What was it for you by the way? I think it was mostly feeling tired when I breastfed. Yeah. Mine changed between pregnancies and babies. So my son, I was both and it was hardcore. So he was like a late pre-termer, and I was also a C-section so lots of fluid shifting after surgery. Right. So like waking up sweating in the middle of the night where I’ve completely soaked through sheets and I’m like, okay, so my body’s trying to get rid of some fluid here.

I see that. I had the sweats really bad too. And I was like, I’m sorry, is this menopause? Or am I lactating? Like, what is, what is happening? And like you wake up and you’re like, Is this pee? Is it baby pee or my pee? Is it sweat? Or maybe just milk? What if it’s all three? And this is why we need an affiliate with a mattress protector company.

So if you have one out there, let us know. We can’t tell you enough. Put down several. It’s a wet process in the postpartum period. Yeah I had one of those zipper ones that’s like supposed to protect your mattress from mold and then the one that was easy to put on and off and wash. Nice. Yeah, I still have that. Also.

Don’t take it off till after kindergarten. Anyway. Yeah, I nursed my son and I would, within one minute, my eyes would be closing and he’d be, my arm would start to roll out and he’d start to roll out. And the only thing that would wake me up is the fact that he was trying to take my nipple with him and it hurt.

And I’d be like, Oh my God, how long have I been out? Oh, and then the thirst of course, where I’d be stuck there. And so I got in the habit of just, and this is where the learned behavior comes in, I got into the habit of going and getting a bottle of water before I even sat down to nurse because I knew it was going to happen.

Yeah, exactly. And then like, it’s really hard in humans to separate, what is a learned behavior? What’s a biological process? Are they different? You know, are they separate? Does one lead to the other for a reason? Hmm. Yeah. Does it matter? Does it matter? Does it matter? I don’t think it matters, but it’s interesting to think about it.

I don’t think it matters, but I think that it’s important for you all to understand that this is a normal thing that happens. So you don’t freak out and think that you need to drink a gallon of water a day to keep your milk supply up. So when you’re not pregnant and nursing and you’re thirsty, how many times have you heard people say, if you’re thirsty, you’re already dehydrated.

Okay. Maybe, maybe, but it makes me want to punch you in the face. Yeah, I’m doing the best I can to hydrate. I don’t have a Camelback that I walk around with. I also just want to be like, no, no, no. Like thirst is there for a reason, like we feel thirst so that we drink. It’s not like a bad thing to feel thirsty.

Like I can’t tell you how many times I felt guilty when I felt unnatural feeling like thirst. Where I’m like, Oh God, I haven’t been keeping up on my hydration. This feeling of thirst is just more shame that I need to put on myself. So if you’re feeling like that, stop it. And right now, just have a glass of water, calm down, just listen to your body.

It’s okay. It’s fine. You can be like, Oh, Hey body, thanks for telling me I’m thirsty. I appreciate that. I think a more likely indicator is if your urine looks like caramel syrup, you’re very dehydrated already. If you feel thirsty and your urine looks like a normal human’s urine, go get a glass of water.

This was a question somebody else asked today, too. When we were kind of asking if people had questions pertaining to these episodes. Somebody asked, okay but actually how much water do I need to drink? And we can talk about that a little bit, briefly, because the answer is, I don’t know how much water you need to drink.

I know how much water I need to drink. You know, a lot of people are like, okay, you take your weight in pounds and then you add whatever. And then it’s that many ounces. That’s not super accurate. That can kind of give you like an estimate. I think it’s like half of your weight in pounds or something is how many ounces you should drink, but like that doesn’t take into account your specific body type, your specific exercise regimen, all of that. How hot it is, how much you sweat.

So first, if you’re thirsty, drink water. Right? You want to drink to satiate thirst, but a lot of people have trained themselves not to listen to those cues. So look at your urine. If it’s been four hours and you haven’t peed, that’s too long. Really we should be peeing like every hour or two. And I know that’s like, disruptive and frustrating. But when you pee that often your pee is clear and it doesn’t smell. True. And that tells you you’re well hydrated.

Everybody right now is like, damn it. And that, and I think that’s a good indicator. It is kind of the like late indicator, but it’s really definitive. Now, if you’re taking like a bunch of B vitamins and stuff. Yeah. Your urine is going to be like fucking neon, no matter how much you drink, but those are, you know, or if you eat a lot of asparagus or eat a lot of beets.

Yeah. Those will change your urine color. But like, You should kind of become familiar with that. Look in the toilet every time, you know, when you’re like, Oh, that is the color of lemons. Yeah. Well, let me just quickly say though, from my standpoint, when people come to me with that desperate look in their eye, and they’re asking you for specific rules to follow for like perfecting their breastfeeding journey and they need really concrete numbers, we have to make sure that we give you something because otherwise you’re going to go on Google and pick something very extreme and then hurt yourself.

I think those people are not happy with me as a midwife. Yeah. You’re like calm down. They’re like, I can’t, physically. I’m just like, there is no rule exactly. Well, you know, I definitely will say the guideline of half your body weight in pounds as how many ounces you need is a pretty safe way to go. So like, if you’re a person that does nothing but drink monster energy drinks pre- pregnancy, and you need something to go off of to get a new normal, that’s a good place to start and then follow your body’s cues after that.

I had a patient once who I didn’t give specific guidance to, and I just told her to drink plenty of water. That’s all I said. Just drink plenty of water. And she drank so much water that she actually gave herself water intoxication. And the next morning when I came in, it looked like she was having a stroke.

She couldn’t move her left hand. She was slurring her speech and I called a stroke page on her. And I was like, Oh my God. God. And like, we couldn’t figure out what was going on. Oh I’d shit, my pants. And then her husband finally told me, yeah, I mean, I don’t know. She’s really tired because she was up drinking water all night.

And I said, what? He’s like, yeah. One of those pink pitchers of water. She drank one every hour, all night long. And I was like, Oh my. So I have to be really careful about being kind of specific about what guidance I give people. So if you want to use that as a guideline, do so, but listen to your body first and foremost.

Can we agree on that? Yeah. And don’t feel guilty if that number for you is say 120 ounces per day and you can only drink 90, like 90 is probably fine then. Yeah. Yeah, you’re gonna make it. Yeah.

Okay. So in summary, talking about what oxytocin does in your body to make you thirsty when you nurse, what it does is you put the baby on, oxytocin surges, your milk lets down. Just before you put the baby on, really. Yeah. Right. Just looking at and holding your baby usually causes people to start that oxytocin response. Right. Hearing your baby cry oddly enough, does that. Right? That’s when a lot of people experience a letdown like through their shirt, right?

Yeah. But anyway, so it starts sometime around the time you’re thinking about feeding baby. Right? And then you begin feeding baby, and you start feeling thirst because oxytocin is in charge of moving water around in your body as well as helping you nurse your baby. Yes. As well as affecting the muscle cells in your milk ducts.

Right. All right. Let’s move into sleep and why you get sleepy whenever you nurse. Okay. Most people think of oxytocin as the love hormone, and it like promotes feelings of calm and relaxation and safety, right? The snuggle hormone. We love it. All the warm and fuzzies. Cool. That was an easy one.

It turns out, not the only answer. So while I was Googling this, right, I see like this little mention somewhere of prolactin. And I was like, wait a second. I thought I knew what prolactin did. It turns out I know nothing about prolactin. I mean, I know a little bit, right.

To recap, if you’re like, wait a second, what the hell is prolactin? So prolactin is the main hormone of lactation that after you deliver your placenta, and we get rid of most of the progesterone of pregnancy, your body produces prolactin to tell your body to make milk, right. Pro lact, more milk. It’s great. And you have these receptor sites in your milk making cells that accept prolactin.

And it’s like, it’s this very nice process. It’s very clean and simple. Okay. It’s not. So prolactin exists in animals who are not mammals who do not lactate. What? I know. My mind is blown. My mind is blown. Why would that be there? Because it’s one of the hormones of sleep. Is it? Yes, I am shocked. Y’all wait.

I just like, I read that and it was the study about some other animal that were not mammals. And I was like, I’m sorry, am I reading this right? This is about prolactin? Are we talking about like reptiles that sleep and freeze themselves to death in the winter? I don’t think it was that, but it was talking about birds in one of the studies.

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Who do not feed their babies milk and they lay fucking eggs. Like they don’t have placentas. Yeah, I know. So prolactin is like older than lactation, like in evolution. Oh. You know, placentas and lactation. Those are like things that happened after birds and reptiles and stuff. And dinosaurs.

So, okay. So then I was trying to go for like, okay, humans, prolactin, sleep. And I found some studies that had, you know, both men and women, you know, like all the sexes and genders represented because prolactin is present in all humans. The main study that I used was really interesting.

And I’m going to read a couple of little excerpts. It was actually from a book on sleep physiology. Sorry, it wasn’t a study. It was from the Second Edition of the Review of Sleep Medicine. And so like prolactin is all tied up in like dopamine and what’s the, melatonin. I was like, it starts with an M.

Yeah, like it’s really interesting. So prolactin levels start to rise after you fall asleep. Well that makes sense because your milk increases in the middle of the night. I know, I know. I’m so excited. I’ll try not to interrupt you. It’s okay. Spoiler alert guys. This is why we tell you to pump at like 3:00 AM. Yeah. Okay. So prolactin levels begin to markedly rise after sleep onset with the maximum levels occurring before you get up in the morning and the lowest levels around noon.

Well, that makes a whole ton of sense. I don’t know why I didn’t know this before. And why aren’t there more studies on this? I don’t know, but I just got so excited to read chapter three, called Sleep Physiology. So if you’re not sleeping and if you’re waking up all night, that affects your prolactin levels, which affects your milk, which is why when we talk to people to get one full REM cycle overnight, that’s why. It works.

See, literally the next thing I’m going to read, are you ready? Okay. Interrupted sleep results in blunting of the nighttime prolactin rise. Dude. Dude, mine is blown. This is why working parents, no, seriously, this is why working parents can’t keep their supply up most of the time, because when they’re up all night with baby and then they go to work and they wear themselves out and they never get a nap and they never get back on a schedule.

Oh, interesting. I know. And like the general secretion of prolactin in your body is just really strongly related to sleep onset. Right? That’s when your body is used to experiencing prolactin. So that’s why, and we know that prolactin rises most sharply in the first 10 minutes of feeding. So that’s why when you start feeding your baby, you’re like, mm, kind of sleepy right now because your body’s like, yeah, we sleep with prolactin.

That’s what we do. And we’ve been doing it way longer than we’ve been feeding a baby. Since, probably since you were in the womb. Since you were a hermit crab on the ocean. Yeah. It’s just, I just feel in awe of the human body. Yeah. And evolution is wild guys. Dang. Okay.

So just to summarize that for you and bring it all back to center here, prolactin is used to sleep, which has been used to sleep for a long time, and you have the most prolactin overnight. Prolactin also increases your availability of milk that your cells are able to make. So that’s why you have the most milk when you wake up in the morning. When you wake up and your cans are just giant and swollen, it’s because you’ve had prolactin because you’ve been asleep. Which is why you were asleep, cause you had prolactin.

So then in the middle of the day, when you go to feed your baby, feeding your baby also spikes your prolactin more aggressively and quickly. It’s not so much of a slow burn, right? It’s more of like a giant spike, right? So immediately within, you know, however many minutes of nursing, you might start to feel tired. So amazing.

And also. Safety concerns. Let’s just go over a couple of those really quick. If you are a person, like I was, who dangerously fell asleep quickly every single time you nursed, you need to make sure you’re nursing in a safe place. Like somewhere soft. Somewhere soft. If you happen to drop your kid, don’t worry about it so much.

It happens. We’ve all done it. We’ll do it again. You’ll probably drop my baby. It’s yeah. And I won’t tell you about it because it’ll just stress you out. Pad yourself with pillows, you know, nurse on the couch. Make sure that, you know, sit the floor on a comfy pillow. Right. Right. And if you’re laying down to nurse, make sure that you have a more firm mattress so baby doesn’t roll in and suffocate on your breasts.

Yeah. And you know, I did want to mention specifically, there was a study about prolactin levels that literally mentioned that shift workers are screwed. Like people who work overnights. And I just really wanted to mention that too, because that’s like probably the number one question that nurses ask us.

Right. Cause every nurse at some point is going to work overnights, like, and they’re just like, how do I manage this? I’m not getting enough sleep. When I get home, I have to be awake with my kids, at least this many hours, you know? And so their sleep is so fucked, you know, and a lot of them take melatonin in the middle of the day to sleep quickly. Which might help, actually.

You think? Yeah. So there was some mention of like artificially taking melatonin helping the body create the rest of the like sleep hormone combo. Which I have known doctors and lactation consultants to recommend melatonin to people with low milk supply. Interesting. So there might be some legit science behind that, but I’m not like, I’m not officially recommending that.

Cause I didn’t fall down the melatonin rabbit hole. Just the prolactin one. Yeah, TBD.

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Okay. So now that we’ve gone through the exciting world of hormones and sleep and thirst, let’s thank a patron. Shall we? We shall. Thank you to Roxanne from Melville Long Island for becoming our newest patron. We sent you a black milk minute t-shirt and a titty tumbler, and you’re going to be invited to our monthly live.

All of our $20 a month patrons are invited. We spend at least an hour answering all of your questions, chatting, just having fun. Yeah. And also people are making friends in there, which is just the best thing ever. There’s a lot of pregnant people that are around the same time pregnant, and they’re becoming a little support system, which I did not expect out of the Q and A’s, but it is a very happy accident.

So if you need a little bit of support and you want to spend some time with me and Maureen and get your questions answered, become a patron at www.Patreon.com/MilkMinutePodcast.

And can I plug for how cheap that is by the way? Because a lot of people are going to look at this and be like 20 bucks a month? I don’t know. But seriously, You get an hour free lactation consult with that with two professional lactation people. You get a new community. And really like, it’s not been like a big list of questions that you have to wait and wait and wait, you know, everyone’s had like one or two questions and we go super in depth on them.

If there are no really good questions, like last time Heather just did a whole little mini class. Yeah. Yeah. We just talked about whatever we’re like, Hey you know what? If everyone’s feeling good cause you’re pregnant and maybe you don’t know what questions to ask, I’m just going to start teaching you about what you need to know.

Like let’s prepare to have a breastfeeding friendly birth or getting a good first latch or how to upregulate your supply. And like in real life, minimum, an hour consultation, minimum is going to be 80 bucks out of pocket. Oh yeah. I charge more than that. Yeah. Yeah. No. Most people are going to have to pay a hundred, 150 bucks per hour out of pocket, because it’s really hard to charge for lactation consulting with your insurance.

FYI, every insurance, it doesn’t even matter what insurance you have. It is. Yeah. And not only just that, but you get to develop a relationship with us. And so, you know, if you’re with us throughout your whole pregnancy and postpartum period, you could literally build a relationship with us over the course of a year.

We know you; we know what your problems are and that way we’re all caught up. And we’re going to be like, Hey, last time you were worried about this. Is that still a problem? Right? You want to like check in about it? Hey, why don’t you just email me next week if you still have that problem. Right? We’re invested. Like we want to see you succeed now, right?

Hey guys, it’s Maureen here and I wanted to let you know about my Etsy shop. I am an artist and a designer, and I have a shop where I make educational breastfeeding posters, shirts for birth workers, like for your favorite nurse or midwife, shirts for people who are lactating, mugs, stickers, all kinds of stuff.

Some of my birth paintings are on there. It’s an eclectic collection and it’s really beautiful. So if you want to find that you’re going to go to etsy.com/shop/thewanderingwom6, except instead of a B it’s a six. So that’s that wandering womb with a six instead of a B.

So now that we’re back in the alcove, we are going to do a little award segment. Yes, I’m really excited. This is my favorite segment, as you all know. And today we are going to give an award to Linda C who’s in our breastfeeding group.

She says I’ve been surviving early teething with my three month old. It was my birthday this week. And on my birthday was her worst day yet. I tried to feed her as much as she could handle, which could be like 10 to 15 minutes. She usually eats 30 to 40 minutes, typically. And then she pumped. I’m almost night potty training my toddler. So that’s rough too. Oh my God. Linda.

Oh girl. Yeah, you are a queen. So teething is rough. It can be very rough and, you know, when I asked my pediatrician, who I love and trust very much, how do you know if they’re teething? The answer was, “well until they have teeth they’re teething.” And I was like, Oh, okay. So it can increase their saliva, which makes their saliva more acidic, which can actually change the pH of your nipple, which can increase the sensitivity of your nipple.

Not to mention they’re crying all the time, fever like, Oh, diarrhea. Sometimes they get random diarrhea from the acid in their mouth from their saliva. So Linda, we’re going to give you, you’re going to get the Chompy Mick Chomperson person award because I said so.

All right, everybody. Thank you so much for joining us for another episode of The Milk Minute Podcast. Make sure that you look us up on Facebook and Instagram and Patreon and all the places. Yeah. Yeah. We’re everywhere. And of course, if you want to share your breastfeeding win with us, you can email us at [email protected]

Or if you just want to say hello, drop us a line. Tag us in a story. Or if you made a huge mistake and you’d like to tell us about it we would actually like that, please. Yes. And of course, don’t forget to subscribe so you never miss an episode. Thanks folks.

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