Sleep-feeding

Settling your baby at night
Many new parents find it hard to care for
a new baby during the night. There may be times when your baby is still unsettled after feeds. Skin-to-skin contact between you both can help to settle her. If you are breastfeeding, offering your baby your breast again can help too, even if she has just fed. If your baby cries for long periods, she may be unwell. Seek medical advice. If you are very tired it may
be safer to breastfeed lying down in bed than sitting upright on a chair or sofa.
Breastfeeding and sharing a bed with your baby
Based on quality scientific research, the public health organisation Red Nose includes ‘breastfeed baby’ as one of their six safe sleeping messages. Breastfeeding reduces
the risk of Sudden Unexpected Death in Infancy (SUDI). Many parents find it easier to breastfeed at night while sharing a bed
with their baby as they are able to respond more quickly to their baby’s needs. Mothers who share a bed with their baby tend to breastfeed for longer, both exclusively and
in total length. When sharing a bed with her baby, a breastfeeding mother tends to form
a protective ‘C’ shape around her baby. This position, which many mothers adopt by instinct, helps to keep baby at breast level and stops him from moving under covers or into any other bedding. When breastfeeding next to his mother, the baby will usually be lying on his side. When he is not feeding, he should be placed on his back to sleep. If you think you may fall asleep during the feed, make sure he has room to return to his back after the feed where his face will be clear of your breast and any bedding. It is very important to ensure he has a clear face and head in shared sleep spaces to protect his airway.
Sharing a bed with your baby
Red Nose recommends that babies sleep in their own safe sleeping space next to the parent bed for the first 6–12 months of life to help prevent infant deaths. However, it knows that many parents may choose to or have no option but to share a sleep surface with their baby. The evidence suggests that it is not bed-sharing alone that is dangerous, but other factors where bed-sharing occurs. Many parents find that bringing their baby into their bed helps them to care for her at night. Australian studies have found that 75–80% of babies spent at least some time sharing the parent bed in the first 6 months of life, whether parents had meant to bed- share, or not. It’s important to know how to make bed-sharing safer in case you happen to fall asleep with your baby. Adult beds were not designed with infant sleep safety in mind and may contain hazards for babies. There are also some cases where shared sleeping greatly raises the risk for babies and parents should avoid these.

It is not safe to share a bed with your baby:

If anyone sleeping in the bed is a smoker or
if the mother smoked during pregnancy.
If you have consumed any alcohol or taken
illegal drugs or medicines that make you sleepy. An Australian study found that alcohol or drug use was present in 70% of infant deaths involving a shared sleep surface with a baby.
If you are very tired, to a point where you would find it hard to respond to your baby.
In the early months, if your baby was born
very small or premature. If their airway becomes blocked, these babies are more likely to suffocate, as they are less able to respond by moving.
In addition:
• Do not sleep with your baby on a sofa,
waterbed, armchair, bean bag or other soft surface. Sofas are particularly dangerous and should be avoided.
Do not let your baby sleep in a bed, on a sofa, bean bag, car seat or pram if no one is watching her.
Never place a baby to sleep in a bed with other children or pets.
Make sure every person caring for your baby knows about safe sleep. Makeshift and improvised sleeping arrangements are often the most dangerous for babies and most
likely occur when parents are exhausted or
their baby is ill.
• If your baby is formula-fed, it is safer for
your baby to sleep in a cot in your room.
If sharing a bed with your baby:
• Sleep your baby on her back — never on her
tummy or side.
• If your baby lies on her side to breastfeed,
return her to her back to sleep. Do not place items around her that may stop her returning to the back-sleeping position.
• Make sure the mattress is firm and flat.
• Make sure that bedding cannot cover your
baby’s face.
• Sleep your baby beside one parent only,
rather than between two parents.
• Ensure your partner knows your baby is in
the bed.
• Instead of bedding, a well-fitting infant
sleeping bag may be used so that the baby
does not share the adult bedding.
• Do not wrap or swaddle a baby if sharing a
sleep surface.


Contacts
To obtain copies contact:
Australian Breastfeeding Association
Tel: 03 9690 4620 (9 am–5 pm Monday – Friday) Email: info@breastfeeding.asn.au
Level 3, Suite 2
150 Albert Road
South Melbourne VIC 3205
PO Box 33221
Melbourne VIC 3004
For further information contact:
Breastfeeding Information and Research
Tel: 03 9690 4620 (9 am–5 pm Monday – Friday) Email: bir@breastfeeding.asn.au
Website: www.breastfeeding.asn.au
ABN: 64 005 081 523 RTO: 21659
Acknowledgements
ABA would like to acknowledge Dr Pete Blair BSc(Hons) MSc(Leic) PhD(Bristol), Jeanine Young BSc(Hons) PhD, and the Baby Sleep Information Source (BASIS) (www.basisonline.org.uk) for their contribution to making this leaflet.


















































The National Breastfeeding Helpline is supported by funding from the Australian Government.
© Australian Breastfeeding Association March 2019





WEB Bed-sharing and your baby the facts MAR 2019
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Getting a Good Night’s Sleep: Another Perspective


@ Dr Sarah J. Buckley 2005, revised 2016 www.sarahbuckley.com
Previously published in Playtimes, the magazine of the Playgroup Association of Queensland, May 2002, also published in Natural Parenting (Australia) no 2, autumn 2003 

For more in-depth information on co-sleeping see Chapter 13 “Mothers, Babies and the Science of Sharing Sleep” in Gentle Birth, Gentle Mothering: A Doctor’s Guide to Natural Childbirth and Gentle Early Parenting Choices (Sarah J Buckley, Celestial Arts, 2009). 

As a GP [family physician], writer and mother of four, I have concerns about information that parents are being given about young children and sleep. This includes official advice to families from Queensland Health  in “How Does Your Child Sleep?”(Playtimes, Oct 2001) and in books such as Richard Ferber’s Solve Your Child’s Sleep Problems.

Ferber’s controversial methods (“Ferberizing,”) include leaving children alone to cry for increasing periods (so-called “controlled crying” or “crying it out”.) These sources suggest that the best solution is to shut crying children in their bedrooms for prolonged periods so that they “learn to go to sleep alone”.

Advising parents to ignore the cries of a distressed child, for however long, may be counterproductive to developing the loving and trusting parent-child relationship that will endure over time. I wonder how many of us would want our partners or friends to treat us this way if we were alone at night, and feeling upset and frightened?

But it is not only the potential impact of these methods on parent-child relationships that concerns me. Scientific and anthropological research recognises that our babies need constant care and attention because of their extreme immaturity. Unlike other mammals, they cannot keep themselves warm, move about or feed themselves until relatively late in life, which makes dedicated maternal care crucial to our offspring’s survival (McKenna 1996). Therefore, our children have developed behaviours and expectations, to ensure that they get the care and protection that they need in infancy and beyond.

For example, for a baby the safest place is in the mother’s arms—and this is still true today in many parts of the world. This applies equally at night, when sleeping right next to the mother, also called bed-sharing, gives the baby protection, temperature regulation, emotional reassurance and breast milk. It’s a perfect system, and what babies have become hard-wired to expect, over millions of years of human evolution.

For our ancestors in the wild, carrying infants kept them safe from hazards and predators, and attending quickly to infant cries kept everyone safe from the attention of predators. Similarly, sleeping with babies was critical to ensure that the baby would survive to the morning.

This system of care–sometimes called “proximity seeking”–generates significant parental rewards and efficiencies. Bed-sharing gives us less disturbed sleep because mother and baby both get into the same cycles, and our babies will wake to feed when we are both in light sleep. We can do more breastfeeding for less effort and therefore maximise the contraceptive effect.

We will also benefit from the extra doses of two breastfeeding hormones. Oxytocin, the hormone of love, is stimulated by both breastfeeding and skin-to-skin contact, and keeps mother and baby soft and loving with each other. Endorphins are the hormones of pleasure, making mother and baby relaxed and sleepy—just right for night feeding. No wonder bed-sharing mothers and babies wake up with a smile. Worldwide research confirms the safety of bed-sharing, as long as parents are not smokers, very overweight, or under the influence of drugs or alcohol, and attention is given to avoiding the hazards that go with our soft Western bedding.

Bed-sharing, where adults and children share the same surface, is one form of co-sleeping, which is a wider term that includes children sleeping in the same room in variety of configurations. Infant sleep researcher James McKenna defines co-sleeping, which includes sleeping in the same room. as mother and infant being within range of two senses, eg hearing and sight.

The combination of breastfeeding with bed-sharing, also known as”breastsleeping,” (McKenna 2015) has a specific repertoire of behaviours that may be particularly adaptive–and safe–for mothers and babies. Breastsleeping babies are usually protected from common bedding hazards by the mother’s position, and babies are more likely to sleep facing the mother than on their stomachs, which may also be protective against Sudden Unexplained Death in Infancy (SUDI).

Experts in SUDI and bed-sharing note, “For mothers who breastfeed, do not smoke or drink alcohol, and do not use recreational drugs the evidence of an increased risk from bedsharing is very limited.” (Fleming 2015) Breastleeping mothers and babies are more likely to breastfeed for longer (likely because of the ease of nighttime feeding),  which offers further protection against SUDI.

Standard advice around infant sleep is based on a cultural belief that children will not become independent unless we force them. Research suggests that the opposite may be true. According to one expert, “Research… confirms that indulgence of early dependency needs leads to independence” and “A mother’s reliability and receptivity promote trust and emotional stability in her child” (Klein 1995). In other words, when we treat our children with love and respect for their needs, we can plant the seeds for a lifetime of happiness—and relaxed sleep.

For me, the benefits of bed-sharing do not end with babyhood. My older children have been equally sweet and cuddly at night, and sharing sleep into the pre-school years has its own rewards. For example, sleep becomes a time to share intimacy and loving feelings, especially when the day has been gruelling or conflict has arisen. For me, there is nothing as sweet as lying next to my child as he or she drops into dreams (and often we do this at the same time). Our family has avoided the bedtime battles or night terrors that are considered normal in our culture—and remember that our culture is out of step, in global and historical terms, in not sharing sleep between family members.

Every co-sleeping family that I have met has their own unique arrangement that can change and adapt over time. At the time of writing, our middle two children were sleeping together in a double bed, and our eldest Emma, 10, had graduated, in her own time, to her own bed. We continued to lie down to settle Zoe, 8, although she says she can put herself to sleep now. Jacob, 5, often joined us in the wee hours. We have had a king-sized bed that we turned around to make it 6’6” wide and 6’ long—a real family bed for many years.

These three older children are very confident and sociable, and have no problems with different routines when they sleep over with their friends. Why would they, when sleep has always been easy and pleasurable for them?

My youngest, Maia, who is 15 months as I write this, continues to fall asleep most nights with Mother Nature’s best toddy—breast milk.

Since my first baby, I have gained more confidence and experience with co-sleeping, and honestly, some of the things that are said to discourage co-sleeping strike me as crazy. For example, I have read in many places, including in the earlier mentioned article, that if we cuddle or nurse our baby to sleep, they may awaken later and “…may not be able to go back to sleep because their environment has changed.” As an adult waking up, I don’t remember how I got to sleep. It seems to me that our babies simply want to be held and nursed to sleep because it is pleasurable, biologically adaptive, and it works.

A family bed might not suit everyone, but we can consider that co-sleeping is what we as humans have evolved to do with our young, and it is what our babies and small children expect. When we ask our children to sleep alone all night, we are stretching their biological capabilities and there is a good chance they will protest.If this happens, we can choose to take their feedback seriously and work to find loving, gentle and co-operative solutions.

There are many different possibilities, and families can choose what works for them and their children.

For example, some families have invited an older child back into their bedroom and found that a “dose” of co-sleeping, or even sleeping on the floor (in what Emma calls a “nest”) is all that is needed, especially during stressful transitions.

In many families, as in ours, one parent lies down with a child or children until they fall asleep, giving reassurance at the time when it is most needed. Sitting quietly or meditating also work well at this time, and I am less likely to fall asleep myself.

When one of our children wake in the dark hours, we have often gone into the child’s bed—double beds work best for obvious reasons—and fallen asleep until morning. Currently, this is my partner Nicholas’s specialty, and it is very sweet to find him relaxed and tangled up beside the children in the morning

When a child is sick or needs extra care, having him or her in our bed, only an arm’s length away, feels good. Needing an extra dose of Mama or Daddy is a good enough reason most of the time, and I notice that sleeping together promotes harmony in a subtle and beautiful way.

As parents, we are in it for the long haul. “Ferberizing,” “controlled crying,” and “crying it out” are short-term solutions that may not promote the connectedness and trust that we want for our children and families in the longer-term.

Our children will outgrow their dependency needs—including the need for company at sleep time—in their own time.  Providing love, reassurance and guidance when it is most needed will help to maximise growth and happiness in the short and long terms.

As one !Kung mother from the African desert responded upon hearing that Dr. Spock advocated ignoring our children’s cries, “Doesn’t he understand that he’s only a baby and that’s why he cries? You pick him up and comfort him. When he’s older, he will have sense and he won’t cry any more.”

References

Dolton, Irene. How Does Your Child Sleep? Endorsed by Queensland Health.Playtimes Oct 2001

Fleming P, Pease A, Blair P. Bed-sharing and unexpected infant deaths: what is the relationship?  Paediatric Respiratory Reviews 16 (2015) 62–67

Klein, Paul. (Spring 1995). “The needs of children.” Mothering magazine (U.S.) (74): 39-45.

McKenna JT,  Gettler LT. There is no such thing as infant sleep, there is no such thing as breastfeeding, there is only breastsleeping Acta Pediatrica 2015

McKenna, James. (1996). “Babies need their mothers beside them.” World Health, the Journal of the World Health Organization (March-April).

Konner, Melanie. (1991). Childhood. Boston: Little Brown & Co.

Recommended Reading:

Our Babies, Ourselves – How Biology and Culture Shape the Way We Parent (Doubleday 1998) by Meredith E. Small

Night Time Parenting (La Leche League Intl. 1999) by William Sears

Sleeping with your Baby (2007) by James McKenna