La Leche League released a book about breastfeeding and bed-sharing. They suggest that it is the first infant sleep book directed solely to breastfeeding families. There is one thing I do love about very topic-specific books like these: they don't waste time apologizing. They don't need to spend any time on "Well, breastfeeding is best, so if you can ...", or "We're not making any judgement if you formula-feed, because every mother is different and every situation is different ...", blah blah blah. They jump right in with Given #1: You're breastfeeding, and breastfeeding is awesome. They assume you've already done your research and decided that breastfeeding matters to you. Because, really, are you going to reach out to La Leche League if you're dedicated to feeding with formula? Probably not.
The next "given" they talk about is an interesting one. The introduction describes how they started out writing the book intending to discuss ALL types of sleep arrangements including those where the baby sleeps alone, down the hall. But in combing through the research, they could not rationally make that suggestion, that bed-sharing showed such clear benefits to both mother and baby, the entire focus of the book shifted. Given #2: Bed-Sharing is awesome. (They also define "bed-sharing" in a scientific way, forgetting the too ambiguous term "co-sleeping".)
Getting those out of the way in the first few pages really set a great tone for the book. This is not a wishy-washy, "whatever works best for you" kind of book. It makes it clear that bed-sharing IS SAFE, and sleeping separately poses greater risks to the baby and to the mother-baby breastfeeding relationship.
I liked the layout of the book (and not just getting the "givens" out of the way right off the bat). The first chapter is, not kidding, two pages long. It is basically a 1-sheet for "I need to get some GD sleep right effing now" ... a "I'm tired as hell and I'm not going to take it anymore" cheat sheet. This is brilliant. How many of us have dragged our tired selves (and our tired babies) to the bookstore to find a solution -- any solution -- that will get everyone to sleep better TONIGHT? And in that state, I don't have time to read through a 450-page book (cause this book is pretty long). I need that cheat-sheet. It covers the very basics of the "Safe Sleep Seven", their criteria for bed-sharing:
If a mother is:
1. A non-smoker
2. Sober
3. Breastfeeding
And her baby is:
4. Healthy
5. On his back
6. Lightly dressed and unswaddled
And they:
7. Share a safe surface
Then the baby’s risk of SIDS is no greater than in a crib, and any breathing hazards have been hugely reduced.
The next page is the emergency "make your bed a safe surface tonight" guide, including having your partner and pets sleep somewhere else, remove everything except your pillow, the fitted sheet, a top sheet, and a light blanket, and place baby in the middle of the bed on his back. They make it clear that they'll get into more detail in Chapter 2, but for now, get some sleep. I love this. It's so real, and acknowledges the desperation many parents feel when they haven't slept in days (and this theme of desperation and real-life dilemmas came up a few times, which was refreshing).
Chapter 2 covers these criteria in more detail. They cover nearly all the nitty-gritty details you need to set up your bed-sharing safely -- mom is sober, non-smoker, and breastfeeding; baby is full-term and on his back; and bed is a bed (not a sofa or a chair) with no big blankets, cords, or gaps. Presumably, if you meet all these criteria, you'll be fine. If you've got more time (or are reading this book before the baby comes), the following chapters go into tremendous detail about the mother-baby dyad, "normal" sleep patterns for adults and babies, different arrangements for naps and nights, and infant personalities (and how that translates to calming and sleep).
Chapters 13 through 17 go through the baby's development and how that affects sleeping and nursing -- these chapters were chocked full of great, practical tips for calming babies, setting up patterns, and getting adult things done. I wished these chapters had been earlier in the book, maybe before the chapters detailing sleep gadgets (and why they're all terrible), and specific parenting situations like working outside the house, adopting, etc.
Interestingly, the chapters on Sleep Training and SIDS and Suffocation were at the very end of the book. Readers (including me) may have preferred them to be earlier, since these are big, real-life topics that come up most often: "She cries unless she's in your bed? You've just got to let her cry-it-out and she'll get the hang of sleeping alone" and "But the APP says a baby in your bed will die of SIDS. I don't know why, but that's what they say. Don't do it." But these chapters HAD to be at the end, because everything we learned throughout the whole book led up to these arguments. We needed to learn what normal sleep behavior looked like and what safe bed-sharing looked like BEFORE tackling sleep training and SIDS.
I especially appreciated how SIDS and suffocation were addressed, because they were addressed separately. The main issue in bed-sharing recommendations is that they combine SIDS and suffocation risks (or confuse the two), so parents don't know what they're protecting their child from. The authors separate these issues in a clear and concise way. Any baby is at risk for suffocation (which includes smothering, entrapment, strangulation, and choking), and we CAN prevent it by removing soft bedding, pillows, toys, wires and cords, ribbons and ties, and small objects from the baby's sleeping area, making sure the parents are sober (or not taking any sedative medications), and keeping other children and pets separated from the baby's sleep space. They also handle the discussion of SIDS -- which is an incredibly frightening topic -- with tact, making it clear that only vulnerable babies (with an underlying cardiorespiratory or brainstem problem) in that vulnerable time period (0-6 months) who are exposed to outside stressors (smoking, stomach sleeping, etc.) are at risk for SIDS. They lay out the four biggest risk factors (smoking, stomach-sleeping, unattended sleeping, and formula-feeding), hit on the other correlations (overheating, prenatal care, obesity, etc.), and address other popular theories and (off-gassing of mattresses). I finished that chapter with a much calmer and straightforward understanding of the real risks of SIDS and the real ways we can prevent it -- even when we can't detect which babies are "vulnerable".
The "Bedsharing Controversies" chapter was interesting, but really only relevant to professionals, since I'm not sure most moms care about research methodology or financial influences. Also the references index was 22 pages long, in size 6 font, which made my heart happy.
The main problem I had this with book was one that I have found in other LLL publications (and at meetings, sometimes). While the un-apologetic "just nurse the baby to sleep" advice was refreshing (and backed up with scientific discussion of hormones), the authors did not always fully address the real life issue that comes up in different family dynamics -- namely, Dad (or other non-breastfeeding caregiver) putting the baby down to sleep. Partners are only mentioned in context of "My husband doesn't want the baby in our bed" or "Partner can hold baby while you take a nap". There is a brief mention of "nudging" child to fall asleep without mom, but only after her is a toddler. And even then, when suggesting "substitutions" such as extra stories or a later bedtime, they negate the premise by stating "On the other hand, are you substituting something that actually takes more time and energy than just nursing?" (p. 188) In answer to the question about traveling without the baby for a business trip, they suggest taking the baby with you, instead of figuring out how baby can be cared for by dad. The tear-sheet for daycare providers was helpful -- suggesting a bottle and lots of rocking for the breastfed, bed-sharing baby -- but the chapter about working outside the house and having the child in daycare spends more time emphasizing how babies in daycare are at greater risk of SIDS and how their stress hormones may stay elevated through preschool if they go to daycare. Bottom line: it's best to delay it as long as you can. While this is probably the best evidence-based advice they can give, it's not exactly practical, and probably only serves to create more anxiety for mom.
I feel like LLL often falls back on the "just nurse the baby, and everything will be fine" argument, when sometimes that is just not practically going to happen. I was surprised that this book ignored the very real question of "but what if I want my partner to put the baby to sleep?", since the rest of the book responds to similar, popular questions (e.g. "My MIL says he's never leave our bed" or "Will co-sleeping ruin my sex-life?") with real suggestions ("try saying this" and "see if you can move baby to the pack n play after she falls asleep"). Additionally, the authors make a wonderful case for realistic policy recommendations -- since the majority of breastfeeding mothers ARE going to fall asleep with their babies, let's make it safe. Why can't we extend that logic: since the majority of mothers ARE going to leave the house someday, let's give some practical tips for someone else putting this breast-fed child to sleep.
Overall this is a great book to have on the shelf, and a great read for any breastfeeding parent. Even if you do not PLAN to bed-share, it's worth a look. Studies show that 60-75% of mothers will bring baby into bed with them at some point, even if they didn't plan to bed-share. One study found that 44% of mothers who nurse on sofas or recliners fall asleep there, which is not safe. Odds are you'll end up nursing your baby in bed -- why not make it safe now, just in case?
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