Bedsharing and Breastfeeding
by Anne Eglash MD, IBCLC, FABM
According to the authors of this week’s CQW, more than 40% of infants in Western societies share a bed with a parent at night, at some point, in the first 3 months of life.
However, the US Center for Disease Control endorses the 2016 American Academy of Pediatrics recommendations for a safe sleep environment, which states that infants should room-share but not share a bed with parents, although they also cite evidence that breastfeeding reduces the risk of SIDS.
Breastfeeding success necessitates frequent feeding, such that it should be considered normal and healthy for breastfeeding infants to wake up at night to feed. It is therefore of natural consequence that a breastfeeding mother feels compelled to keep her nursing infant close to her at night, to accommodate frequent feeding. This is the case for mammals in general, and was the case for most families until the early 20th century, according to this week’s publication. This situation creates cognitive dissonance, which can lead to guilt, shame, and fear among parents that they cannot ‘get parenting right’ especially as they compare themselves to families whose young infant sleeps all night. This may lead to unintended consequences, such as sleep training, which in turn may lead to a drop in milk production.
The updated 2019 Academy of Breastfeeding Medicine Protocol #6 Bedsharing and Breastfeeding is a highly recommended resource for anyone who counsels families on breastfeeding and infant sleep. The authors provide clear evidence that if bedsharing is done safely among breastfeeding infants and their parent(s), the risk of SIDS does not increase. The protocol outlines hazardous conditions that would preclude bedsharing.
- Breastfeeding the baby at night on a sofa or recliner, during which time the mother typically dozes off.
- Sleeping next to an adult who smokes.
- Sleeping next to an adult who is under the influence of drugs or alcohol.
- Bedsharing with the infant lying on their side.
- Bedsharing with the infant lying on their stomach.
- Bedsharing but never initiating breastfeeding.
- Bedsharing on soft bedding.
- A premature or low birth weight infant who is bedsharing.
- Bedsharing with the infant sleeping in an in-bed device such as a wahakura.
See the Answer
No abstract available. Read the protocol.
Although it is recommended that infants be placed supine whether in a crib or when bedsharing, the researchers state that it is not common for breastfeeding infants to stay on their back when bedsharing. Breastfeeding infants who bedshare tend to lie on their sides facing their mother. This positioning, described in the article as the 'C-position' or 'Cuddle Curl' is a natural and safe, protective position for the bedsharing nursing infant.
One strategy to help families who would like a modified version of bedsharing is to consider an in-bed device such as the wahakura. A study has shown this device to be safe and uninterruptive in the frequency of breastfeeding.
The relationship within a nursing dyad bedsharing at night is termed 'breastsleeping,' because of the frequent interactive relationship between sleeping and breastfeeding overnight. Using the term 'breastsleeping' for nursing dyads allows us to recognize that the dyads have a different relationship and physiology as compared to a parent and infant who are simply bedsharing. For example, research cited in this protocol demonstrates that breastsleeping infants spend less time in stage 4 (deep) sleep, and more time in stage 1-2 (light) sleep, which itself may be protective from apnea and SIDS. This also allows infants to nurse more often at night, helping to maintain milk production, prevention of the return of ovulation and promotion of optimal infant growth.
In clinical practice, it is time to refer to breastsleeping when talking to families about sleep at night. Using a different term enables a conversation about how this is a different phenomenon than simply bedsharing, that is protective of SIDS if done safely. Families need to feel empowered about their intuitive sense of bedsharing at night and they deserve guidance and praise, rather than conflicted information leading to cognitive dissonance and guilt.