SAFE SLEEP FOR BREASTFEEDING BABIES
Mothers and babies sleeping together is a normal, healthy, shared instinct as old as humankind. But certain situations can make this normal behavior unsafe. Let’s see what it takes to avoid those situations so you can enjoy being with your baby awake or asleep.
The two big safety concerns with shared sleep are suffocation and Sudden Infant Death Syndrome (also called SIDS, Crib Death, or Cot Death). They are not the same thing, their causes are different, and that’s important to know when you’re setting up a sensible sleeping arrangement. SIDS is an unexpected infant death under a year of age that can’t be explained any other way. The biggest risk factors can be avoided. Suffocation is death from a lack of oxygen, from a blocked nose and mouth or becoming tightly wedged, or choking. Protecting your baby from suffocation just means preventing problem situations – usually simple and straightforward to accomplish.
THE SAFE SLEEP 7
The authors of LLLI’s book, Sweet Sleep: Nighttime and Naptime Strategies for the Breastfeeding Family, have boiled safe infant sleep down to these 7 items.
If you are
- a non-smoking mother who is
- not taking drugs or medications that interfere with normal awareness, and is
- breastfeeding – that is, your breast is your baby’s food and comfort spot, day and night –
And if your baby is
- healthy – full term with no major health issues,
- on his or her back when not nursing,
- not swaddled or overheated,
And if you are both
- on a safe surface
then you have eliminated all the major SIDS risks, and have hugely reduced or eliminated suffocation risks.
Here’s a closer look at the Safe Sleep 7:
1) Exposure to smoking is by far the biggest risk factor for SIDS. Smoking during pregnancy means a baby’s SIDS risk is higher right from birth. Exposure to smoke after birth – even if the smoker doesn’t smoke in the house and sleeps away from the baby – is also a big risk. The greater the exposure, the greater the risk, but even being in a smoky room raises an infant’s risk of SIDS.
2) Being out of the care of a responsible adult is another major risk factor for SIDS. Having your baby sleep in a separate room – even a lovingly prepared nursery, even with a monitor – increases the risks of SIDS and suffocation. Alcohol, sleep aids, and any other drugs or medicines that make you less alert, increase your baby’s risk. To be truly safe, a baby needs to be within sight and touch of a responsible adult.
3) Formula-feeding doubles the risk of SIDS. It’s thought that the less the formula, the lower the risk. Bottle-feeding itself is a risk factor for suffocation. The mother who feeds her baby at breast automatically puts her baby near her breast for sleep and curls her body around the baby in what’s sometimes called a “cuddle curl”. Her arm above the baby’s head keeps the baby from scooching up into the pillows. Her thigh below the baby’s feet keeps the baby from scooching down. And the baby has a strong urge to stay near her breast – the ultimate source of food and comfort. It’s not possible for the mother or anyone else to roll onto a baby in that protected cove. But it doesn’t work the same for bottle-feeding mothers and babies. If a baby doesn’t seek the mother’s breast, or if a mother puts her baby near her face instead of in that protected space, the baby is at risk for moving away from the mother and pushing into soft pillows and bedding.
4) Premature babies, seriously ill babies, and babies with chronic health issues have a higher risk of SIDS and possibly of suffocation. They may be challenged by the same conditions that are desirable for full-term, healthy babies.
5) A major risk for SIDS is leaving a baby alone on his or her tummy for sleep. Breastfeeding mothers and babies have that one covered. Mothers and babies typically lie on their sides to nurse in bed. When they finish nursing they typically roll onto their backs (the mother returns to her cuddle curl position when she shifts onto her side again). So no need to worry about your baby’s position if you fall asleep nursing.
6) Overheating is a risk factor for SIDS. No need to dress your baby any more heavily than you dress yourself. And swaddling isn’t safe bedsharing; babies need their arms and legs free, to bat the covers away, nurse, and shift into better positions.
7) Making a safe surface is mostly just common sense. Make sure your mattress is firm enough that your baby doesn’t roll into the trough your body makes and get stuck there. If your bed is close to a wall, you can move the bed farther away or put yourself between the baby and the gap so your baby can’t become wedged. Is there a gap between mattress and rail? You can stuff this space tightly with a rolled towel or small rolled blanket. Make sure there are no cords or sharp corners. Your own light bedding and pillow are fine; avoid heavy quilts and comforters. Stuffed animals, bolsters, infant “sleep positioners”, and extra pillows should be removed. Some mothers make a soft “landing pad” next to the bed in case of falls. Some just put their mattress directly on the floor for a while, or make up a blanket-bed on the floor while they think about a more permanent arrangement. If you have a bed partner, sleep between the baby and your partner for now, until you’re sure of everyone’s nighttime behaviors.
Couches and recliners have too many cracks, corners, crevices, and cushions to be safe places for sharing sleep, or even for really drowsy nursing. That’s why planning ahead for a safe place to sleep with your baby is important, even if you don’t plan to use it.
A sidecar or bedside bassinet/cot can be a good compromise because you can scoot your baby in and out of your bed. But make your bed safe anyway, for those times when you fall asleep before moving the baby. Think of it as your very first form of child-proofing.
WHAT DOES YOUR BABY GAIN FROM BEDSHARING?
- Longer breastfeeding. Research and major health organizations recommend at least a year of breastfeeding, preferably two or more. Babies who sleep alone are more likely to wean before their mothers wanted them to.
- More food, at healthy intervals. Babies who sleep alone tend to nurse less often and take in less food. Despite what some books still say, babies are built for frequent snacks, not widely-spaced feasts.
- Normal infant sleep patterns. Long, deep sleep isn’t healthy for young babies. A breastfeeding, bedsharing mother rouses slightly many times in the night without realizing it, to kiss or stroke her baby or to adjust the baby’s position or covers. All those little stimulations are important for normal, healthy infant sleep.
- Gentle and automatic guidance into more mature sleep patterns. No need to fight with each other over it.
WHAT DO YOU GAIN FROM BEDSHARING?
- More sleep! Research shows that bedsharing, breastfeeding mothers get the most sleep of all new mothers. Mothers who sleep away from their babies rouse less often but more completely and actually get less sleep overall.
- Less stress. Your baby’s rhythms and your own rhythms actually synchronize, so that your baby tends to waken gently when you do, and you tend to waken gently when your baby does. No wailing from another room that jolts you awake unexpectedly. As one mother said before she started bedsharing, “At night I felt like he was the enemy.”
- Easier nursing. Once they get the hang of it, most bedsharing mothers just roll onto their side to nurse. How often does their baby nurse at night? Their answer might be, “I’m not sure.”
Not everyone’s situation matches the Safe Sleep 7. What if your baby is wholly or partly formula-fed? Or your partner smokes? Or you feel your bed is too soft? Or your baby is ill? Parenting is never one-size-fits-all, and that’s where responsible, informed decision-making comes in. You’ll find more information in the resources at the bottom, to help you find an arrangement that you’re comfortable with.
MOST IMPORTANT OF ALL
No matter what your situation is, or what nighttime arrangements you plan, be sure to set up a place where you can fall asleep together as safely as possible. Even if you have no plans to bedshare, on a night when you just can’t stay awake, you won’t fall asleep with your baby on the sofa. You’ll have a much, much safer place to go.
FOR MORE INFORMATION
La Leche League International’s Sweet Sleep, Nighttime and Naptime Strategies for the Breastfeeding Family covers everything from infant sleep study results to how to wriggle away from the toddler you just nursed to sleep. And there are pages that you can tear out to share with healthcare and daycare providers.
In addition to Sweet Sleep and the Safe Sleep 7, there are some excellent online resources.
The Academy of Breastfeeding Medicine’s protocol on bedsharing https://www.bfmed.org/assets/Protocol%20Number%206%202019%20Revision.pdf is an excellent resource for your baby’s healthcare provider, and reassuring reading for you. There are also visuals from several of the Academy’s bedsharing conference presentations https://www.bfmed.org/bedsharing-and-breastfeeding-resources.
BASIS (Baby Sleep Information Source) https://www.basisonline.org.uk/ has great research-based information on the biology of normal infant sleep, with practical information to help you make decisions that fit your family.
Dr James McKenna’s Mother-Baby Behavioral Sleep Lab https://cosleeping.nd.edu/ website presents the Lab’s research on how mothers and babies normally interact at night, with guidelines for families and information for healthcare providers.
Each resource has its own style and purpose, and all of them have years of solid research behind them. Find the parts that work for you… and sleep sweet!
Image by Rob Mank, courtesy of Baby Sleep Information Source, with thanks