More and more mamas seem to be asking questions about co sleeping in bed, co sleeping and breastfeeding, how to co sleep safely, co sleeping a newborn, and bedsharing with newborn. The short truth is that breastfeeding and co sleeping/bedsharing go together like peanut butter and jelly!
The Problem with the AAP’s Recommendations on Co Sleeping
As new parents, we’re preached to never, ever put our babies in our beds. We are never given any other education besides how to put your baby to sleep on a firm surface away from you. What does this lead to?
Regardless of what the American Academy of Pediatrics (AAP) says [28], many parents still bedshare because it’s biologically normal and instinctual. Often parents still end up sleeping with their babies regardless of everyone around them telling them to never do it.
In 2015, a U.S. Centers for Disease Control and Prevention survey found that 61 percent of American babies bedshare at least some of the time.
These rates, with the constant information to never sleep with your baby, leads to a lot of unsafe co sleeping environments because the information on how to do it safely is not easily provided [1, 2].
However, the AAP has stated it is “less hazardous to fall asleep with the infant in the adult bed than on a sofa or arm chair” [29].
Bedsharing vs Co Sleeping
These two terms can mean the same thing: sleeping with your baby in the same bed as you. However, co sleeping also can mean having your baby sleeping in the same room with you, also called room-sharing.
Research has found that the benefits of co sleeping include:
- Regulated temperature and breathing for baby [3,4]
- Provides parents and baby with better sleep [5]
- Increased rates of exclusive breastfeeding [12]
- Reduced risk of supply issues [13]
Is this Bedsharing or Breastsleeping?
Dr. James J. McKenna at the University of Notre Dame has a Ph.D. in Anthropology and runs the Mother-Baby Sleep Laboratory: the only place to have conducted studies watching thousands of breastfeeding mothers and babies sleep together to study the safety.
McKenna has proposed a new concept called, ‘breastsleeping’ to resolve the bedsharing debate and distinguish the differences and advantages of breastfeeding and bedsharing moms and babies when compared to non-breastfeeding and non-bedsharing moms and babies.
Additionally, there are hazards that must be avoided when bedsharing to make it safe. One of the safe co-sleeping guidelines by McKenna includes exclusively breastfeeding.
McKenna states that breastsleeping was made to acknowledge “(i) the critical role that immediate and sustained maternal contact plays in helping to establish optimal breastfeeding; (ii) the fact that normal, human (species-wide) infant sleep can only be derived from studies of breastsleeping dyads because of the ways maternal-infant contact affects the delivery of breastmilk, the milk’s ingestion, the infant’s concomitant, and subsequent metabolism and other physiological processes, maternal and infant sleep architecture, including arousal patterns, as well as breastfeeding frequency and prolongation; and (iii) that breastsleeping by mother-infant pairs comprises such vastly different behavioral and physiological characteristics compared with nonbreastfeeding mothers and infants, this dyadic context must be distinguished and given its own epidemiological category and benefits to risk assessment.” [1]
Bedsharing or Co Sleeping is Better for Breastfeeding
Co sleeping and bedsharing rates are higher amongst breastfeeding mothers [13] And as I mentioned above, one of the benefits of co sleeping is higher rates of exclusive breastfeeding [11], but why?
Co sleeping facilitates more breastfeeding! When comparing mothers who breastfeed, the mothers who co-sleep were found to breastfeed twice as much overnight compared to those who didn’t co-sleep.
One study found that mothers and infants who co-slept in a way that facilitated mother-infant access found greater successful sucking compared to babies who were in the standalone bassinet group [14]. Upon follow-up with the same mothers, it was found that these effects of co sleeping continued at 16 weeks, with twice as many mothers co sleeping both breastfeeding and exclusively breastfeeding [11].
Furthermore, stimulation of the nipple is necessary for the production of prolactin. A hormone that allows for milk production. At night is when the levels of prolactin in mothers are highest therefore, it’s important to nurse overnight for positive effects on milk production and maintenance of a mother’s milk supply [12]. Basically, by bedsharing, you reduce the chances of having milk supply issues.
What About SIDs?
While there’s no evidence that proves that breastfeeding causes a reduction in SIDS for co sleeping/bedsharing babies, there is sufficient evidence that suggests this is the case. Most prominently, this data is found in cross-cultural studies where co sleeping and breastfeeding are the norms and they have substantially lower rates of SIDS than cultures where these aren’t the norm, such as the U.S. [15,16,17]
For instance, Japan has long been successful in maintaining low SIDS rates which are generally half of the other developed nations, and co sleeping/bedsharing is the norm there. Additionally, in Japan it’s common that the youngest bedshares with their mother until the next baby comes, and then continues to co-sleep, but typically on the other side of the partner in bed.
risk factors involved in sids
In 2009 there was a study in Alaska that looked at risk factors involved in SIDS deaths. In this study, there were 291 SIDS/asphyxia deaths out of 246,126 participants, and the researchers had sleeping arrangement information for 246 of these [18]. With the bedsharing information on 246 of the SIDS baby deaths, researchers found that 99% of them had at least 1 risk factor and 29% had more than 2 risk factors. The results included:
- 26% of babies were put to sleep prone (on their tummy)
- 13% of infants were sleeping with someone that is not their primary caregiver
- 75% used tobacco
- 43% of infants were sleeping with someone who was impaired with drugs or alcohol
- 17% of infants were sleeping on a sofa or waterbed
All of these risk factors are included in Dr. McKenna’s Safe Cosleeping Guidelines to avoid if you’re bedsharing.
Still, it’s possible that breastfeeding may not lower SIDS risk, however, we do know breastfed babies are generally at much lower risk [19, 20, 21, 22, 23]. breastfeeding itself does reduce the risk of SIDS; in a meta-analysis on the relationship between breastfeeding and SIDS, it found that breastfeeding more than halves the risk of SIDS, and exclusive breastfeeding has an even greater effect [24]. Furthermore, both duration and frequency of breastfeeding are relative to SIDS, greater duration and frequency leads to a lower risk of SIDS [4].
What Else May Be Different About SIDS Rates in Japan?
In Japan, overall maternal smoking and alcohol rates are lower. These are both practices identified as NOT compatible with bedsharing according to James J. McKenna.
Furthermore, Japan commonly has lower-risk beds. Most families there sleep on futon mattresses on the floor which are firm, and their bedding is simple, not fluffy, with fewer sheets and blankets. This also fits James J. McKenna’s safe bedsharing guidelines.
The Difference Between Breastfeeding and Formula-Feeding
Dr. James McKenna has an additional hypothesis for how breastfeeding may reduce the risk of SIDS for co sleeping parents. He hypothesizes that arousals from breastfeeding keep the infant from falling into a deeper sleep which may lead to a “failure to rouse” [25]. This “failure to rouse” has been discussed as a potential source of SIDS – infants who go into too deep of sleep become unable to come out of it.
Additionally, research has found that maternal-infant behavior while bedsharing is different amongst breastfeeding mothers than in formula-fed infants [26] with specific behaviors such as facing the infant and having the infant lie at chest level, being more prominent in breastfeeding mothers and babies. This may also result in a safer bedsharing method that occurs naturally for breastfeeding mothers and babies.
Furthermore, research has also found that:
- Exclusively breastfed babies and breastfeeding moms have been seen to be more sensitive to each other’s movements
- Breastfeeding mothers and infants arouse more frequently to each other’s arousals
- Breastfeeding mothers compared to bottle-feeding mothers spend more time in lighter sleep (even when not bedsharing)
- Bottle-fed infants have an increased tendency to move away from their mothers at night
“What if I create a “monster” and I want my bed back?”
I can totally see and understand where some parents may come from on this point. If parents form an attachment parenting bond to their baby, of course, the baby will be used to that and expect it. This doesn’t change that it is natural and instinctual for them to desire it from day one of being born.
Every single baby is different, but your baby isn’t going to be going to sleep naturally on their own at 2 months old without you or your breast.
Mobbs states, “The behavioral and health risks resulting from impairment of this defining mammalian relationship deserves attention as there is considerable contrary information provided by multi-national commercial interests”. “For breastfeeding mothers, the decision to bedshare proves often to be an unexpected no-brainer explaining why perhaps a quiet but seismic shift towards adopting bedsharing in western cultures despite medical recommendations against it is occurring as BF re-establishes itself in many western countries as the cultural norm.” [27]
And if you desire your bed back you can use the tips in ‘How to Implement Boundaries with Breastfeeding’ (Coming soon!).
With the high rates of parents in the U.S. bedsharing with their babies at some point in time, it’s crucial that parents are given evidence-based information on how to do it safely. Furthermore, I believe it’s biologically normal and healthy for moms and babies to practice bedsharing and breastsleeping if they can do so safely.
Dr. James J. McKenna’s Safe Bedsharing Guidelines
Dr. James J. McKenna’s Safe Cosleeping Guidelines include:
- No smoking
- Not taking sedatives, medications that may make it difficult to arouse from sleep easily, or drugs including alcohol
- No bottle-feeding, only breastfeeding
- Both parents are aware and ok with it
- If baby is <1, no older children in the same bed or sleeping with older children
- Long hair needs to be tied up
- “Extremely obese persons or others who may have difficulty feeling where exactly or how close their infant is in relation to their own body may wish to have the infant sleep alongside but on a different surface, such as a cosleeper attachment.”
- Healthy, full-term baby
Additionally:
- Bed pulled away from walls
- A light blanket rather than a large, thick comforter
- Mattress low to the ground
- No swaddle
- Baby on their back
- You breastfeed and sleep in side-lying C-shape position (demonstrate and have picture of doing this in my bed with pillow for support)
If this isn’t an option for you, what else can you do?
Co sleeping by having your baby sleep in the same room as you. Have a bassinet right next to your bed that you can reach while you’re lying in your bed.
I’d love to hear what you think, please leave your comments below! And be sure to check out Dr. James J. McKenna’s book: Safe Infant Sleep.
Questions or Comments on “Co Sleeping: The Truth You Need to Know”
If you have any questions or comments, please leave them below👇🏻
Talk soon, mama!
– Katelyn Lauren
DISCLAIMER: This post contains affiliate links, meaning I may get a commission if you decide to purchase something through my links at no cost to you. Please read my Disclaimer for more info.
DISCLAIMER: This post is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding you or your baby’s health. Please read my Medical Disclaimer for more info
Sources
[2] How Cosleeping Can Help You and Your Baby
[3] “New” practice of bedsharing and risk of SIDS
[6] Bedsharing and Breastfeeding: The Academy of Breastfeeding Medicine Protocol #6, Revision 2019
[7] Research Review: Academy of Breastfeeding Medicine Releases Updated Bedsharing Guidelines
[8] Safe Cosleeping Guidelines
[10] Researchers propose ‘breastsleeping’ as a new word and concept
More Sources:
[11] Breastfeeding and mother-infant sleep proximity: implications for infant care.
[12] Lactogenesis. The transition from pregnancy to lactation
[13] The prevalence and characteristics associated with parent-infant bed-sharing in England
[14] Bed sharing on the postnatal ward : breastfeeding and infant sleep safety.
[15] International Child Care Practices Study: infant sleeping environment
[16] Epidemiology of sudden infant death syndrome in Japan
[17] Sudden Infant Death Syndrome In Hong Kong: Confirmation Of Low Incidence
[18] Infant bed-sharing practices and associated risk factors among births and infant deaths in Alaska
[19] Breastfeeding and maternal and infant health outcomes in developed countries
[21] Four modifiable and other major risk factors for cot death: the New Zealand study
[22] Breast feeding and the sudden infant death syndrome in Scandinavia, 1992–95
More Sources:
[23] Fredrickson DD, Sorenson JF & Biddle AK. Relationship of sudden infant death syndrome to breast-feeding duration and intensity. Am J Dis Child (1993);147:460.
[24] Breastfeeding and reduced risk of sudden infant death syndrome: a meta-analysis
[26] Parent-infant bed-sharing behavior : Effects of feeding type and presence of father
[27] Mobbs EJ, Mobbs GA, Mobbs AE. Imprinting, latchment and displacement: a mini review of early instinctual behaviour in newborn infants influencing breastfeeding success. Acta Paediatr. 2016 Jan;105(1):24-30. doi: 10.1111/apa.13034. Epub 2015 May 25. PMID: 25919999; PMCID: PMC5033030.
[29] https://www.cpsc.gov/s3fs-public/AAP_Sleep%20Death%20Policy%20Statement%202016.pdf
Leave a Reply