Academy of Breastfeeding Medicine Publishes New Bedsharing Guidelines

By Melissa Bartick, MD, MSc, FABM

The Academy of Breastfeeding Medicine has released its updated Bedsharing and Breastfeeding Protocol. The protocol presents evidence-based recommendations synthesized by an international collaboration of authorities on the topic who conducted a rigorous review of the literature.

Aimed at physicians and other health care professionals caring for families who have initiated breastfeeding, the protocol recognizes that bedsharing promotes breastfeeding.  In contrast to recommendations by some organizations, breastfeeding mothers and infants are not advised against bedsharing, as long as no hazardous circumstances exist. The protocol emphasizes that all parents should be educated on safe bedsharing, recognizing that bedsharing is very common, and when bedsharing is unplanned, it carries a higher risk of infant death than planned bedsharing.

Hazardous circumstances include sleeping with an adult on a sofa or armchair; sleeping next to an adult impaired by alcohol, medications, or illicit drugs; tobacco exposure; preterm birth; and never having initiated breastfeeding.

The ABM protocol takes a “risk minimization” approach, emphasizing a discussion of risks and benefits of bedsharing with parents. This type of approach is being increasingly adopted in countries such as the UK and Australia. “Having conversations about safe bedsharing is important for removing stigma around the topic and facilitating open and honest dialogue between parents and providers,” says Dr. Lori Feldman-Winter, Professor of Pediatrics at Cooper Medical School in Camden, New Jersey and one of protocol’s authors. Dr. Feldman-Winter serves as co-faculty chair on the National Action Partnership to Promote Safe Sleep (US), and she was also an author of the American Academy of Pediatrics’ 2016 protocol on safe sleep.

ABM was pleased and honored to collaborate with three of the world’s leading experts on this topic: anthropologists Helen Ball and James McKenna, and epidemiologist Peter Blair. Dr. Blair, Professor of Epidemiology and Biostatistics at the University of Bristol (UK) is chair of the International Society for the Study and Prevention of Perinatal and Infant Death (ISPID), and Dr. Ball, Professor of Anthropology at the University of Durham (UK), directs the Durham Infancy & Sleep Centre, as well as serving on ISPID Board. Dr. McKenna is known for his ground-breaking work from his Mother-Infant Sleep Lab at the University of Notre Dame (Indiana, USA). Dr. Kathleen Marinelli, Clinical Professor of Pediatrics at University of Connecticut Medical Center and co-author, was instrumental in arranging the participation of Drs. Blair, Ball and McKenna.

In creating the protocol, we rigorously reviewed all available evidence about risk. In addition, we put the current research and evidence into historical context, noting that solitary sleep and artificial feeding are related and were recent developments in human history. We noted that some marginalized and low-income populations have a higher rate of sudden infant death as well as a higher rate of artificial feeding, thus measures to increase breastfeeding and lower the exposure to hazardous circumstances in these populations are important.

“The welcome fall in unexpected deaths over recent decades has come about through risk reduction advice being closely aligned to the available published evidence. This protocol takes the same approach,” says Dr. Blair. 

Breastfeeding is important for safe infant sleep when bedsharing. “When bedsharing next to their mothers, breastfeeding infants sleep on their backs, and are naturally positioned away from pillows and objects that might obstruct their airways. Breastfeeding mothers form a protective position around their infant,” says Dr. Ball. Dr. Ball’s team provides detailed information for families through the Baby Sleep Information Source.

“Breastfeeding while bedsharing comprises a unique set of behaviors between mother and infant known as ‘breastsleeping,’ which also results in increased time breastfeeding compared to separate sleep,” notes Dr. McKenna.  Breastfeeding is associated with a lower risk of Sudden Infant Death Syndrome.

As the person charged with seeing the protocol through to fruition from writing to approval, I found the process of achieving consensus on the evidence and recommendations to be both challenging and rewarding. It required working closely with many people who held a variety of differing viewpoints and experiences on the topic and finding common ground. We are thus especially satisfied that this protocol represents the best evidence-based and practical recommendations for clinicians. We hope this protocol will be widely used.

Melissa Bartick, MD, MSc is an internist at Cambridge Health Alliance and Assistant Professor at Harvard Medical School. 

Posts on this blog reflect the opinions of individual ABM members, not the organization as a whole.