Bedsharing (co-sleeping, breastsleeping) can be a topic that challenges many childbirth educators.  Expectant families can receive a lot of conflicting advice from health care providers, friends and families and the internet.  The best prenatal intentions of where their young baby will sleep often do not align with realities once parents are in the early months of living with their infant.  It is estimated that worldwide more than 40% of infants under the age of three months bedshare with their parent and between 20-25% in the USA and the UK.  This figure is probably underestimated due to parents not accurately reporting the true sleep location of their young infant sleep due to fear of judgment from professionals or family and peers.

The Academy of Breastfeeding Medicine (ABM) just published their updated protocol: Bedsharing and Breastfeeding: The Academy of Breastfeeding Medicine Protocol #6 Revision 2019 and their goal is to “clarify the currently available evidence regarding the benefits and risks of bedsharing, and offer evidence-based recomendations that promote infant and maternal health through increased breastfeeding duration…for dyads who have initiated breastfeeding and are in home settings.”

The American Academy of Pediatricians’ most recent infant sleep guidelines, published in Fall, 2016, acknowledged that parents are likely to bedshare and provided recommendations for how to do so safely.  I discussed this in a Connecting the Dots post at that time.

Research indicates that nighttime proximity increases breast/chestfeeding duration and inclusivity.  Exclusively breast/chestfed  children are less likely to die from Sudden Infant Death Syndrome (SIDS) or Sudden Unexpected Infant Death (SUID).  Health care providers have a responsibility to discuss how to bedshare safely in order to protect infants and help families recognize unsafe bedsharing conditions.

The ABM discusses the term “breastsleeping” and defines it as “a biologically based model of sustained contact between the mother and infant, starting immediately after birth, in which sleeping and breastfeeding are inextricably combined, assuming no hazardous risk factors… Described in cultures around the world, the breastsleeping mother and infant feed frequently during the night while lying in bed together, and by morning, the mother may not recall how many times she fed or for how long.”  Research into sleep safety needs to consider the differences in both behaviors and physiology for both the breastsleeping family and the family that shares a bed but is not breast/chestfeeding.

A discussion on safe sleep should initially take place during prenatal visits with health care providers and continue to be discussed during the postpartum visits as well.  Perinatal professionals such as childbirth educators, doulas, and lactation consultants can also introduce the topic with their clients and students.  All parents should be advised of both the benefits and risks of bedsharing and separate sleeping arrangements for their infants.  These discussions should be conducted respectfully, provide accurate and updated information and take place with all parents regardless of their sleep location intentions.  Information on what constitutes safe bedsharing must be communicated.  It is very important for families to understand when it is hazardous to bedshare and when bedsharing is not appropriate.

In Bedsharing and Breastfeeding: The Academy of Breastfeeding Medicine Protocol #6 Revision 2019, The Academy of Breastfeeding Medicine provides a thorough review of the current research and also recognizes the limitations of this information.  Their suggestions for future research include:

• How can death investigation techniques be improved to determine whether the death of an infant can be fully explained by asphyxia?
• Is there a significant risk from bedsharing in the absence of all hazardous circumstances?
• Is there a relationship between bedsharing risk and infant age and mode of feeding (adjusting for all hazardous circumstances) (breastfeeding, expressed milk feeding, donor milk feeding, and human milk substitutes)?
• What is the best advice for a safe sleep environment for nonbreastfeeding infants?
• How do multiple bedsharers in the absence of hazardous risks, including bedsharing of twins, impact the safety of the infant? Does the location of the infant in the bed, for example, between the parents or on the edge of the bed next to the mother, make a difference for safety?
• Are in-bed devices and sidecars safe and efficacious, especially for infants in high-risk situations, and if safe, what are their effects on breastfeeding?
• Can the C-position (‘‘cuddle curl’’) be adopted by nonbreastfeeding bedsharers and is it effective in reducing SIDS?
• Is providing supportive information to parents on ‘‘breastsleeping,’’ as defined in this protocol as a separate category of bedsharing, protective or risky to provide these parents with better specific guidance?
• Is there autopsy evidence of the effect of feeding hu- man milk substitutes that can establish a causal link between feeding human milk substitutes and SIDS?
• Do the risks of death from SIDS due to early weaning and potentially related to the lack of safe bedsharing outweigh the risk of death from SIDS from bedsharing in nonhazardous circumstances? There are many con- founders and this will be difficult to study.
• To what extent does maternal obesity modify the risks and benefits of bedsharing?

Our responsibility as childbirth educators does not change with this new publication.  All the families attending our classes should be instructed in safe bedsharing guidelines as indicated in this update as well as safe recommendations for infants sleeping separately.  The new ABM document offers resources for perinatal professionals to understand and have access to the most current research available.

Photo source: Baby Sleep Information Source, licensed for use under Creative Commons, 2016

References

Peter S. Blair, Helen L. Ball, James J. McKenna, Lori Feldman-Winter, Kathleen A. Marinelli, Melissa C. Bartick, the Academy of Breastfeeding Medicine, Michal Young, Larry Noble, Sarah Calhoun, Megan Elliott-Rudder, Laura Rachael Kair, Susan Lappin, Ilse Larson, Ruth A. Lawrence, Yvonne Lefort, NicoleXy Marshall, Katrina Mitchell, Catherine Murak, Eliza Myers, Sarah Reece-Stremtan, Casey Rosen-Carole, Susan Rothenberg, Tricia Schmidt, Tomoko Seo, Natasha Sriraman, Elizabeth K. Stehel, Adora Wonodi, and Nancy Wight.Breastfeeding Medicine.http://doi.org/10.1089/bfm.2019.29144.psb

Published: January 10, 2020

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