What did your health care practitioners recommend to you when your baby was born? Did they tell you is was acceptable to share a bed with your baby? Did that recommendation depend on any particular factors?
THE OFFICIAL RECOMMENDATION
In Western societies, unlike in many other cultures, the debate about where babies should sleep has been around for a very long time, and doesn’t necessarily get any clearer as time goes on. The American Academy of Pediatrics (AAP) has given us population-wide recommendations against any and all bedsharing. These recommendations—first released in 2005, and re-iterated in 2011—have been mirrored in many other countries. The rationale behind these recommendations is to reduce the risk of Sudden Infant Death Syndrome (SIDS).
In my practice in community health care centers, the official advice is to recommend that parents sleep separately from their babies. The reality, however, is that plenty of moms sheepishly admit to having shared a bed, or another sleeping space with their babies. The conflict that many mothers feel is real, to the point that sometimes they don’t even reveal to their healthcare providers that they are bedsharing, worried that they will be chastised. The reality (shown in many studies) is that most breastfeeding mothers will share a sleeping space with their infants in the first three months, at some point.
Enter a new word: Breastsleeping. Breastfeeding + Co-Sleeping = Breastsleeping
This concept was recently proposed by two Notre Dame anthropologists, James McKenna and Lee Gettler, in a Commentary in Acta Paediatrica, a scientific, peer-reviewed journal. It was proposed as a result of, and in support of an earlier publication that described
“the need for, and benefits of, immediate sustained contact, including co-sleeping, to establish an appropriate foundation for optimal human infant breastfeeding, neonatal attachment and brain growth” (Mobbs et al, Acta Paediatrica 2015).
With the introduction of the term ‘breastsleeping’, McKenna and Gettler said they aimed to
“resolve the bedsharing debate and to distinguish the significant differences (and associated advantages) of the breastfeeding-bedsharing dyad when compared with the nonbreastfeeding-bedsharing situations, when the combination of breastfeeding-bedsharing is practiced in the absence of all known hazardous factors”.
One of the most significant reasons to look at breastfeeding pairs distinctly is in relation to the risk of SIDS, especially as current recommendations hinge on this risk. While the actual mechanism is still not completely understood, it has been clearly established that breastfeeding is a protective factor against SIDS, and that the more one breastfeeds, the greater the protection.
Co-sleeping leads to many more breastfeeds per night, and is also associated with extended breastfeeding. In other words, moms who sleep with their babies breastfeed more often and longer than those who sleep separately. So, theoretically, if you sleep with your baby and breastfeed more, then there could be greater protection against SIDS.
BEDSHARING WHILE BREASTFEEDING IS DISTINCTIVE
The important point is the distinction between a mother sleeping with her baby if she is or isn’t breastfeeding. Current recommendations lump everyone into one group when assessing risk-benefits. The authors argue that breastfeeding mother-infant pairs are vastly different from non-breastfeeding pairs, behaviorially and physiologically, and should therefore be looked at separately when assessing risks and benefits. The distinction is critical.
Sleeping with your baby in the absence of breastfeeding is a risk factor for SIDS, not a protective factor. By having blanket recommendations, the worry is that breastfeeding may be undermined, and that parents have little or no access to information on minimizing bedsharing risks when and if they choose to share a sleeping space with their baby.
MAKE AN EDUCATED CHOICE
Let’s hope that the introduction of the new concept of breastsleeping and other research at the Mother-Infant Sleep Lab will help parents make a fully-illuminated and educated choice about how and where to sleep or not to sleep with their babies.
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Katja Leccisi, MS, RDN, author of How to Feed Your Kids: Four Steps to Raising Healthy Eaters is a registered dietitian-nutritionist in both Canada and the United States. She has spent her entire career working with families and educators in community, clinical and workshop settings in both countries as a nutritionist, and for ten years as a La Leche League Leader and Certified Lactation Consultant. Visit her website and join the conversation on Facebo