Our culture is obsessed with infant sleep. Upon meeting perfect strangers, “How is she sleeping?” was often one of the first questions I fielded as a new mom.
“Oh, she’s a great sleeper,” I said. I might have been lying. I know these questions are mostly just a segue into hearing about how awful the other person’s kid slept. That’s fine. I’ll bite.
The truth is, to this day I have no idea if my babies were great sleepers. Because as a new mom answering these questions from strangers, I kept a terrible, dirty secret.
When we had my oldest, she was early-term and far more delicate and tiny than I was expecting a newborn to be. She struggled to breastfeed thanks to a tongue tie that also gave her painful gas, and her sleep was majorly affected. For almost three months we were in survival mode.
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And then one afternoon, I found my husband lying awake in bed with our daughter next to him, watching her sleep peacefully, blissfully unaware of how this basically made him a homicidal killer. And I did what any mom familiar with traditional “safe sleep” guidelines would do: I freaked out.
The next thing I know, I’m standing in Target lying to a stranger about how well my daughter sleeps. The truth is, that horrible little secret of mine, was that I had no idea what kind of sleeper my daughter was, because I was asleep too…
…right next to her.
Because I figured out that it was normal for babies to not sleep like adults and I adjusted my expectations to something more realistic. Because immediately after freaking out at my husband, I realized how amazingly well our baby was sleeping for the first time since–well, ever.
So I turned to the research. I couldn’t have been the only parent to notice this phenomenon. Maybe there was some data I wasn’t aware of? I prayed there would be.
Spoiler alert: There was.
Disclaimer: This post is an exploration of the evidence suggesting bedsharing is an inherently dangerous practice. It is for informational purposes only and is not a substitute for professional medical, health, or sleep advice. The American Academy of Pediatrics currently recommends against bedsharing in all circumstances. Should you choose to bedshare, be advised that failure to meet all safety guidelines can result in increased risk of significant harm to your baby–as can failure to meet all safe crib sleeping guidelines.
This was how I discovered the Safe Sleep 7 and familiarized myself with the research produced by the Mother-Baby Behavioral Sleep Laboratory at the University of Notre Dame. There Dr. James McKenna has been studying what he calls “breastsleeping” for the better part of almost four decades. What his research has found was both shocking and a huge relief. I’ll let him explain for himself (or scroll down for quick video summary):
If you don’t have time to view the interview, here’s the short version: Bedsharing can be made safe and unsafe, and safe bedsharing is a biologically normal sleep arrangement, one that is common in other cultures, that can be appropriate for some breastfeeding mothers and babies (source). Dr. McKenna is not the only researcher to make these arguments–so you don’t need to take my or just his word for it–but he is probably one of the most well-known.
Bedsharing is, of course, NOT a safe option for every mother and baby. In his research and on his website, Dr. McKenna discusses how bottle feeding is actually one of the biggest predictors of SIDS in a bedsharing arrangement.
This is not a judgment on bottle-feeding moms: His research simply found that bottle feeding infants are more likely to sleep higher up in a parents bed near pillows, more often sleep oriented away from mom, and have different sleep arousal patterns (source – start at 6:44 minutes in, or watch the whole news report for more info and a pretty balanced take on this controversial topic).
In contrast, exclusively breastfeeding infants tend to sleep lower down away from pillows, orient towards mom’s breast leaving airways exposed, and are afforded extra shielding by mom, who naturally sleeps in a protective “C” shape or “shell” around her baby (source).
Importantly, Dr. McKenna and colleagues have also found that breastfeeding mothers and babies slept in sync with one another: both mom and baby have low-stress, low-level arousals at the same times through the night. These arousal patterns prevent babies from falling into states of deep sleep that researchers believe put them at increased risk for SIDS (source, source). Even so, studies have shown that these moms do not report getting less sleep (source, source), and despite the more frequent waking, their babies do not suffer from reduced overall sleep either (source, source).
BENEFITS OF BEDSHARING
As you can imagine, learning all this was quite a relief. And bedsharing has worked out extremely well for us. I was able to:
• Get Actual Sleep
With my first baby, it took months to feel like I was getting enough sleep at night to sustain me through the day without being plagued by exhaustion. With my second baby, we started bedsharing much sooner, and I was waking up feeling rested as early as two weeks postpartum.
• Skip Sleep Regressions
Technically speaking, we didn’t truly “skip” them–both babies went through all the usual developmentally normal changes in sleep throughout their first year and beyond. But I never noticed them. Because I offered the breast when they woke, and we both went back to sleep. I honestly have no idea how many times my babies woke at night at different ages. Night wakings were such a minor interruption, I wasn’t even aware of all them.
• Protect My Milk Supply
Breastmilk production is supply and demand. When the body senses little “demand” (nursing) at night, it slows down milk production. Being close to my babies at night made nursing overnight a breeze rather than a burden, which made it easier to maintain my supply long term.
THIS IS the #1 reason moms quit breastfeeding
Learn exactly what to do–and what NOT to do– if you are worried about low milk supply (hint: special cookies and more liquids aren’t the answer!)
• Never Need To Sleep Train
I do not feel comfortable with “cry-it-out” sleep training. Not “graduated extinction” or any method that involves denying or delaying comfort to a crying baby on the basis that it’s dark outside. I don’t care if it “works,” and I have issues with the research designs of studies that say it’s “fine.” That doesn’t mean I think ill of parents who train or who feel it’s their only option. Sleep training simply goes against my instincts.
I may have gotten incredibly lucky, but neither of my babies have needed to be trained to sleep. Babies are actually really good at sleeping, and the training doesn’t actually teach how to sleep: it teaches how to sleep without you. And spoiler alert: They are capable of learning this on their own. My girls learned to sleep alone just like they learned how to walk and talk and use a potty: in time, when they were ready, at pace that was in alignment with their natural rhythms. In the meantime, they slept with me.
If bedsharing can be such a viable option for some families, why do governing bodies like the AAP so strongly recommend against it?
Most likely because it is a viable option for only some families. Precautions must be taken to bedshare safely (e.g. sober, non-smoking, breastfeeding mom, no other children in the bed, etc.) (source). Many major health organizations feel that it is easiest to recommend a simpler policy of “just don’t do it” (source).
But the truth of the matter is, parents–especially breastfeeding parents–are doing it. 42-77% of parents report sharing a bed with baby (source), and one sample showed that up to 88% of parents reported bedsharing at least occasionally. In fact, bedsharing rates have risen over the last few decades, even despite public health campaigns and strong recommendations against the practice (source, source). Even parents who never intended to bedshare find themselves doing so anyway, especially if they are breastfeeding (source, source, source, source). One study found that over 80% of parents wound up bedsharing in response to nighttime feedings despite not planning to do so (source). These are the results even when the frequency of bedsharing is most likely underreported (source).
The truth is, our infants are wired to sleep in close proximity to us, and we often feel compelled–or actively desire–to oblige (source).
Here’s a little-known secret for you:
THERE IS EVIDENCE BEDSHARING BY ITSELF IS NOT THE ISSUE
Bedsharing is the norm in many parts of the world (source), and has been for centuries (source). Japan, for example, is a first-world country where both bedsharing and cosleeping (sleeping within arms reach of baby but not necessarily on the same surface) is commonplace (source, source). But despite this, Japan has one of the lowest infant mortality rates in the world, including SIDS. Their SIDS rate is roughly half that of the US (source, source), and it continues to decline as more and more Japanese mothers exclusively breastfeed and refrain from smoking. In fact, a Japanese study found that SIDS was more common in infants who slept alone (source).
And Japan is just one example. One study found that two-thirds of mothers from 136 different cultures slept with their infants, and other researchers found that “infants regularly slept with a parent until weaning in all but 1 (the United States) of the 12 communities studied” (source).
So what has made bedsharing so hugely taboo in Western cultures?
1) BLANKET RECOMMENDATIONS (NO PUN INTENDED)
Parents aren’t provided the education they need to bedshare safely. So when they decide to do so–and remember: they are deciding to–they don’t have the information they need to make their sleeping arrangement as safe as possible thanks to a blanket recommendation against bedsharing. Authorities higher up decided that parents don’t need to know this information. How many bedsharing incidents might have been avoided if this weren’t the case?
2) SOCIAL STIGMA
Anti-bedsharing campaigns have been very successful. And for good reason: Images of babies sleeping in a parents bed next to a butcher’s knife and headboards depicted as tombstones instill the fear in parents’ hearts that was intended.
But these campaigns also have unintended consequences: Stigma associated with bedsharing in many US and Western cultures means that many parents are keeping their bedsharing habits a secret, not only from other parents but from their pediatricians as well (source, source). And tired parents who are too afraid to share a bed with their baby can–and do–wind up turning to sleep arrangements that are actually more dangerous than a parent’s bed: surfaces inherently unsafe and never recommended, like a sofa or a recliner (source).
And of course moms perpetuate bedsharing stigma too. Mention in the wrong mom group that you bedshare and you might find yourself verbally crucified (often by the very same parents who are happy to turn their baby’s car seat forward-facing as soon as possible–but that’s another blog post).
3) FEEDING NORMS & CULTURAL BELIEFS ABOUT SLEEP
From the beginning, new moms are bombarded with the idea that a “good” baby is one who will sleep long stretches as early as possible. Many parents read the sleep training manuals, top off with a large bottle–maybe offer a bit of rice cereal for good measure–and hope to be rewarded with a deeply sleeping babe.
The problem is, we now know that light sleep and night waking are protective against SIDS (source, source). And so is something else new mothers often struggle with: exclusive breastfeeding. In fact, researchers have found that it can reduce SIDS risk by as much as 73% (source). But the very same strict sleep routines moms are told they “should” be following are associated with low milk supply and stopping breastfeeding early (source). Indeed, research has shown that the distance a baby sleeps away from mom at night can impact how often a baby nurses: a distance as little as 5-10 feet away can reduce night nursing by as much as 50 to over 70% (source); this can have potentially significant ramifications on a mom’s milk supply.
Both of these things–attempts to get baby to sleep deeply and low exclusive breastfeeding rates–increase the risk of SIDS. And both are common in our culture. Add in a parent’s bed and no knowledge of safe bedsharing guidelines, and you have a significantly increased SIDS risk associated with bedsharing in Western countries.
IS A HARD-LINE RECOMMENDATION AGAINST BEDSHARING FOR THE BEST?
It turns out, the answer isn’t as black and white as I used to think. And that’s in part because most of us probably don’t have a clear picture of what “SIDS risk” actually looks like, practically speaking.
Recent research has shown that a low risk infant is less likely to die in a parents bed (1 in 16,400) than they are to be struck by lighting (1 in 13,000) or die in a car accident (1 in 9,100) or drown before age 18 (1 in 4,400), or develop a life-threatening peanut allergy (1 in 50). A high risk baby should never sleep in a parents bed, but even in a crib–the safer option of the two–they are still significantly more likely to die of SIDS (1 in 1,500) than the low risk baby sleeping in bed next to mom (1 in 16,400) (source).
These are the results even when the data surrounding SIDS deaths is notoriously biased, in part due to widely varying definitions as to what actually constitutes “bedsharing” or “cosleeping.” It is not unusual for deaths on any non-crib surface–such as couches or recliners–to be categorized as “bedsharing deaths,” even though literally no one is suggesting these surfaces are safe. And researchers have been criticized for frequently failing to control for confounding factors–extra variables that can sometimes significantly influence results–such as parental substance use, the positioning of the infant (placed to sleep on back vs. belly), etc. (source).
To my knowledge, there has been precious little research–if any at all–looking at SIDS and bedsharing statistics when all safe bedsharing guidelines are put in place. So I have to wonder: If we studied a large group of bedsharing parents following every Safe Sleep 7 guideline, what kind of decrease in overall bedsharing risk would we see? I suspect a big one. For now, at least two well-controlled studies agree that bedsharing by itself is not inherently hazardous (source, source).
In the 2010 City of Milawukee Fetal Infant Mortality Review (FIMR) Report, (the one that prompted the butcher knife ads I mentioned before) the average number of risk factors present in each SIDS death–factors like baby placed to sleep on belly, baby sleeping in a swing or on a couch, baby sleeping with toys or loose blankets, secondhand smoke, prematurity, caregiver substance abuse, and yes, bedsharing–was four.
So is bedsharing the ONLY ingredient in the recipe for unsafe sleep? I’m not so sure.
That said, based on the research we have at present, it is indeed true that the lowest risk sleep arrangement involves a low-risk baby sleeping in a crib in a parents room (1 in 46,000). But if this arrangement isn’t working for your family, it’s important to put the overall risk in perspective and consider the circumstances–and bias–surrounding the data.
The truth is, we forget that the colloquial term for SIDS before it was identified as such was actually “cot death” or “crib death.”
And we forget that crib sleeping itself isn’t inherently safe, either. In fact, there is a laundry list of safety precautions that must be taken to make it so: Make sure your crib hasn’t been recalled, check on the stability of the crib hardware, ensure the spacing of the bars isn’t greater than 2 and 3/8 inches, don’t use secondhand cribs, use only a mattress designed for your crib, check that the crib mattress fits snugly, don’t use loose fitting sheets or mattress protectors, avoid using bumpers, don’t place pillows, toys, blankets or baby positioner wedges inside the crib, position the crib away from from heaters, windows, large furniture and dangling cords, check for loose threads and strings, holes and tears, and keep baby’s crib in your room ideally for the first year if you want to cut SIDS risk in half–just to name a few.
An overdressed baby sleeping on an ill-fitting mattress surrounded by a crib bumper and nestled up against a stuffed animal is in a far more dangerous sleep arrangement than an appropriately dressed baby sleeping on a firm mattress away from pillows and blankets next to his breastfeeding mother.
Just as crib sleeping must be made safe, so too must bedsharing.
The good news is, more organizations promoting public health are realizing the importance of spreading bedsharing awareness and safety protocols. An excellent example is BASIS, an evidence-based information source for parents in the UK funded by a grant from the Economic and Social Research Council and endorsed by UNICEF UK Baby Friendly Initiative, La Leche League of Great Britain, NCT, and more.
The truth is, ALL arrangements of infant sleep come in two flavors: safe and unsafe. And no sleep arrangement is perfectly one or the other for every family: The infant who absolutely refuses to sleep in a crib is perhaps made less safe overall having a sleep deprived mother who might fall asleep holding him in a chair instead of setting up a safe bedsharing arrangement that baby will tolerate.
I’ll say it again: Not all sleep arrangements are advisable or safe for all families. If you cannot meet the safe bedsharing guidelines–you’re a smoker, your baby is bottle- or formula-fed, etc.–it is not recommended to bedshare. Doing so anyway can increase the risk of significant harm.
If you just don’t feel comfortable with bedsharing, don’t bedshare. If you don’t get good sleep knowing baby is in bed with you, don’t bedshare. You don’t have to bedshare. And many parents definitely shouldn’t.
Bedsharing is a complicated and personal decision. Make it an informed one. You’re not wrong if you feel majorly uncomfortable with the idea. Likewise, although it is not the norm in our culture to say so, you are not wrong for wanting to sleep in close proximity to your baby. Just like you’re not wrong for nursing to sleep in lieu of sleep training.
You are not wrong for doing what you need to do to get sleep and doing it as safely as possible.
You are not wrong for practicing safe bedsharing.
If you want to get a printable copy of the Safe Sleep 7 guidelines, be sure to grab one in my library of free resources for subscribers.