An Update on Bedsharing
This blog post was written by Dr. Jan Ooi, a Family Physician and Low Risk Obstetrics Provider. (7 min read)
Sleep and feeding, and the interplay between the two, are usually the top concerns for new parents. In this post Dr. Ooi extracts key information from the Academy of Breastfeeding Medicine Protocol on Physiologic Infant Care - Managing Nighttime Breastfeeding in Young Infants (2023) that she discusses with her patients at their postpartum visits.
Since 2004, most Western countries have advised against bedsharing due to concerns about suffocation and Sudden Infant Death Syndrome (SIDS). In Calgary, Alberta Health Services follows the Canadian Pediatric Society's recommendation: families should sleep in the same room, but babies should have their own separate sleep surface.
However, some countries have changed their advice on bedsharing since around 2014:
In 2014, the U.K.’s National Institute for Health and Care Excellence found there wasn’t enough evidence to clearly link bedsharing with SIDS. By 2019, they stopped giving routine advice against bedsharing.
In 2016, Spain's PrevInfad suggested that bedsharing might not increase SIDS risk for breastfeeding babies if there are no other risk factors.
In 2018, Australia started focusing on ways to reduce risks while acknowledging that many parents bedshare.
WHY THE CHANGE IN ADVICE?
Lower Risk of Accidental Suffocation
Research shows that accidental suffocation is very rare for breastfeeding babies who bedshare, as long as there are no other risk factors. Some risk factors are beyond a parent's control, such as a baby being born early or being underweight. However, there are some risks you can avoid, including:
Sharing a sofa, chair, or soft bedding with the baby
Sleeping next to someone who is drunk, using drugs, or smoking
Placing the baby on their stomach to sleep
Benefits of Bedsharing
Bedsharing might actually help protect against sleep-related deaths. It can help babies wake up more easily and make it more likely they will sleep on their back, which is safer.
Mothers who bedshare often get better sleep, with shorter periods of wakefulness and a higher chance of feeling well-rested—94% versus 80% for mothers who sleep separately from their babies.
Breastfeeding mothers who bedshare also tend to have more responsive feeding and longer breastfeeding durations.
WHAT ARE THE RECOMMENDATIONS?
The Academy of Breastfeeding Medicine provides recommendations for families who choose to bedshare. These are intended for home (not hospital) settings with mothers who are breastfeeding.
Talk About It
It’s important to have open, honest conversations with new parents to provide accurate information and help them make safe choices. Bedsharing may happen by accident when a tired parent falls asleep beside their baby and, because of the recommendations against it in Alberta, some families might not discuss it with their caregivers.
Understanding Baby Sleep Patterns
Newborns don’t have a set sleep schedule when they’re born. Melatonin from breast milk helps establish their sleep pattern, but their sleep is unpredictable.
Keep in mind that newborn sleep patterns are similar whether a baby is breastfed or bottle-fed. and whether they sleep with a parent or alone. Bedsharing can sometimes lead to longer sleep durations for breastfeeding mothers.
Know and Reduce Risks
To make bedsharing safer, follow these guidelines:
Never sleep with a baby on a sofa, recliner, or chair.
Avoid bedsharing if you smoke, or have recently used sedating medications, drugs or alcohol.
Do not bedshare with a baby who was born prematurely or with a low birth weight.
Never leave a baby alone on an adult bed.
Consider using a sidecar attached to the adult bed for added safety.
Use the C-position (cuddle curl) to keep the baby close but safe and out of reach of pillows.
Maximizing Safety
Tips to make bedsharing as safe as possible:
Use a firm, flat mattress.
Keep the bed away from walls and remove any gaps where the baby could get trapped. Placing the mattress on the floor can also help.
Avoid using a guardrail and keep heavy blankets, extra pillows, and cords away from the baby.
Make sure that sheets and blankets do not cover the baby’s face or head.
Additional Tips for Tired Parents
More advice that I often give to tired parents:
When babies feed while lying on their side they usually don’t need to be burped.
Change diapers during the night only if necessary. Use a zinc-based barrier cream to help prevent diaper rash if your baby has sensitive skin.
Try to sleep when the baby sleeps, both during the day and at night.
Get help with household tasks to conserve your energy for caring for your baby and recovering from delivery.
Using a baby carrier can reduce fussiness and help you manage tasks during the day. Studies show that increased carrying can reduce crying by 43% at 6 weeks of age.
Whether you choose to bedshare or not, focusing on getting enough rest and taking care of yourself is important for both you and your baby.
