The theme for this year's World Breastfeeding Week (August 1-7) is "BREASTFEEDING: A Winning Goal -- For Life!" It's a great theme and there's no question scientifically that breastfeeding is very important to both a child's and mother's lifelong health. But goals are one thing -- real life is another.
Like many new parents, Monica discovered that her biggest breastfeeding obstacle happened at night. She'd put her baby Ryan to sleep alone in the crib like she thought she was supposed to. Then he'd cry. She'd drag herself out of bed, pick up her screaming baby, sit down to nurse, try to stay awake, put him back in the crib, stagger back to bed, and hope, hope, hope he stayed asleep for at least two hours, which he usually didn't. This got old fast. After only a few days, she was beyond exhausted. Eventually, out of pure desperation and sleep deprivation, she brought Ryan into her bed and lo and behold, they both got more sleep. Monica had just discovered the age-old secret to successful breastfeeding at night: bedsharing.
Bedsharing works so well because breastfeeding mothers and babies are hardwired to be together during vulnerable sleep periods. Babies have higher stress levels and less stable heart rates and temperatures when they're separated from their mothers. Mothers feel stress when they're separated from their babies. When they bedshare, the baby's happier and doesn't have to cry to get the mother's attention, and she doesn't have to get out of bed -- she just latches the baby on and maybe even falls back to sleep. She automatically lies on her side facing the baby with her lower arm up and knee bent. This creates a protected "cove" that keeps her from rolling toward the baby and prevents anyone else from rolling into that space. The baby stays oriented toward her breasts in that safe cove, away from pillows. Their sleep-wake cycles synchronize so that they both have low-stress, low-level arousals through the night. This instinctive and mutually beneficial behavior probably explains why research has shown that the new mothers who get the most sleep are the ones who breastfeed exclusively and bedshare.
Whether from desperation or convenience, or because it's simply so delicious, two thirds of breastfeeding mothers do bedshare at some point. Yet one of the most intense messages new mothers hear is to never, never sleep with their babies in an adult bed. So they often feel guilty, worrying that they're sacrificing their baby's safety to get more sleep. Many don't tell their doctors when they're asked where the baby sleeps. And who can bear to tell Grandma the beautiful crib she gave them isn't being used?
"Never Bedshare" sounds great on paper (or billboards). But the public health agencies promoting it forget that babies need to be fed at night. And they don't take into account that breastfeeding releases hormones that makes mothers feel sleepy during the feeding. So where are mothers supposed to breastfeed their babies at night? They never say.
Mothers are left struggling to find a place to feed the baby where they can doze during the nursing. Thinking that it's too dangerous to bring the baby into their own bed, research has shown that almost half of mothers sleep with their babies on sofas, upholstered chairs, or recliners at some point. But that's an incredibly risky place for suffocation because of all the crevices and padding, and it's not usually comfortable enough for more than a night or two. Another common solution is to "train" the baby to sleep longer, but child development research has found is stressful for both babies and parents and tends to be ineffective in the long run. Or some mothers use formula at night so the baby will sleep longer or someone else can feed the baby, even though using formula in itself is a SIDS risk. Any of these "solutions" can cause the breastfeeding relationship to be cut short.
What many breastfeeding mothers (and doctors!) don't realize is that while the Never Bedshare warnings are a one-size-fits-all message, not all babies are at equal risk. Maternal-infant sleep researchers have found that there are seven main risk factors for SIDS and suffocation: 1) adult smoking, 2) a caregiver under the influence of alcohol or other sedatives, 3) formula-feeding, 4) a baby with a health problem that prevents normal arousal from sleep, 5) baby sleeping on his stomach, 6) an overheated baby, and 7) a baby sleeping on a surface with gaps, crevices, or pillowy objects. La Leche League International (llli.org), the world's oldest and largest volunteer breastfeeding organization, calls these seven bedsharing risk factors "The Safe Sleep Seven." If a breastfeeding mother doesn't smoke or go to bed sedated, and her healthy, not overdressed baby is sleeping by her side on his back on a safe surface, then she and her baby meet "The Safe Sleep Seven" and they are at extremely low risk for either SIDS or suffocation. And even the researchers who warn against bedsharing agree that by about four months, bedsharing by any responsible, nonsmoking adult is as safe as having your baby sleep separately in a bassinet or crib.
Teaching parents about The Safe Sleep Seven and how to make their bed surface safe for bedsharing is the most effective way to protect babies from SIDS and suffocation. This is true even if they don't ever plan to bedshare, because a pre-planned bed beats a sofa or recliner every time. It's also simple childproofing. Most parents go to great lengths to protect outlets and cabinets because they know accidents can happen, no matter how watchful they are. Not every mother and baby can bedshare safely, but it's still safer to for every mother to make her bed as safe as possible just in case.
For breastfeeding mothers and babies who meet The Safe Sleep Seven, bedsharing can be a wonderful way to enjoy a cuddly and better night's sleep together, confident that their danger risk is about as low as possible. And bedsharing means it's a whole lot more likely that they'll breastfeed successfully for lifelong health. A winning goal, indeed.
Editor's note: The American Academy of Pediatrics recommends against bedsharing. Read more on their website here.
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