Mary Francell, Bellingham, Washington, USA
La Leche League Leaders are often asked about night nursing and infant sleep. In 2014, LLLI published the well-researched book Sweet Sleep: Nighttime and Naptime Strategies for the Breastfeeding Family which answers many frequent questions and is an excellent resource for both Leaders and parents. Soon after the publication of Sweet Sleep, leading infant sleep researcher James McKenna and his colleague Lee Gettler coined the phrase “breastsleeping” to describe the biological symbiosis of mother and child sleeping together and nursing throughout the night, calling it “humankind’s oldest and most successful sleep and eating arrangement.” McKenna expands on this concept and addresses common questions in his most recent book for parents, Safe Infant Sleep.
In some Western societies, the cultural belief that separate infant sleep is desirable often leads to difficulties with breastfeeding. Frequent nursing, including at night, is necessary to establish and maintain a full milk supply, but the practice of having to fully rouse, retrieve a baby from a crib and nurse sitting in a chair often becomes unsustainable. These mothers sometimes turn to sleep training (leaving a baby to cry themselves to sleep), which, in addition to causing significant emotional distress for both infant and parent, often results in a lower milk supply and early weaning. Bed-sharing and breastsleeping, the biological norm for our species, allows babies to nurse frequently throughout the night without either the mother or baby fully awakening.
The most common concern expressed by opponents of bedsharing is a belief that it can result in suffocation of the infant or sudden infant death syndrome (SIDS). In 2019, the Academy of Breastfeeding Medicine (ABM) released its revised protocol on bedsharing, written by Drs. McKenna, Peter Blair, Helen Ball, Melissa Bartick and others. The authors looked carefully at the current scientific literature and stated, “Existing evidence does not support the conclusion that bedsharing among breastfeeding infants (i.e., breastsleeping) causes sudden infant death syndrome (SIDS) in the absence of known hazards.” One of these known hazards or risk factors is feeding artificial milk substitutes. Breastsleeping may be protective against SIDS due to nursing infants spending less time in deep sleep, although further research on this subject is needed.
The ABM protocol provides a comprehensive survey of the evidence and can be a helpful resource for parents to share with their healthcare providers and others. It also provides guidance on safe bedsharing practices, such as avoiding soft bedding and never sharing sleep with an infant on a sofa or recliner. In addition, the document outlines harm reduction strategies when risk factors are present. For example, if a caregiver other than the mother smokes, that person should be encouraged to sleep in another room. Room sharing, with the baby on a separate surface, can be encouraged for high risk families and parents should be counseled to always place a sleeping infant away from anyone who is under the influence of alcohol and drugs.
When La Leche League Leaders are asked about co-sleeping and bed-sharing, they can provide information from several resources to help the parent decide on the best sleeping arrangement for their family. The new ABM protocol in particular contains counseling guidelines and scientific evidence to promote safe infant sleep while protecting the breastfeeding relationship.
Sweet Sleep: Nighttime and Naptime Strategies for the Breastfeeding Family by Diane Wiessinger, Diana West, Linda J. Smith, and Teresa Pitman 2014
Safe Infant Sleep by Dr. James McKenna 2020
There is no such thing as infant sleep, there is no such thing as breastfeeding, there is only breastsleeping, by James J. McKenna and Lee T. Gettler. Acta Paediatrica (Accepted August 2015)
Mary Francell and her husband Howard are the parents of three adult children. She has been an LLL Leader for over 25 years and is a contributing editor for Leader Today. Mary is an International Board Certified Lactation Consultant (IBCLC) in private practice in Bellingham, Washington, USA and currently serves as Associate Area Professional Liaison for LLL of Washington, USA. She writes the blog What Babies Need at www.whatdobabiesneed.com