Ina May's Guide to Breastfeeding

Sleeping Arrangements

Where is your new baby going to sleep? A generation ago, you probably would have found a bassinet and a crib and thought little more about it. Now you may be trying to decide whether you should keep your baby in bed with you at night (called bed-sharing, co-sleeping, or the family bed) or put her to sleep in a bassinet or crib. Which way is better? There’s no easy answer to this question—different solutions work better for different families.

Emotions sometimes run high surrounding the choices parents make about the sleeping arrangements for their young babies, just as they do about the choice between nursing and the feeding of substitute formulas. Proponents of one sleeping style sometimes become so judgmental about the other choice that they act as if those who make different decisions couldn’t possibly be good parents. In reality, some parents begin sleeping with their babies, only to later find out that co-sleeping doesn’t suit either them or the baby (and vice versa).

Babies are unique little beings, each with her own personality and needs. There may be differences within the same family; some families find out that the sleeping arrangement that worked for one of their babies does not suit a younger sibling or that an arrangement that worked well for a young baby needs to be changed as the baby grows older. For this reason, I recommend that you do your best to keep an open mind as you think about which style most appeals to you (and your spouse or partner) and then be flexible enough to change if your first choice doesn’t work out.

Proponents of co-sleeping maintain that it makes breastfeeding easier (a claim that is undisputed, by the way) during the early weeks, when new parents are most exhausted. They also believe that it creates a more trusting relationship between parents and babies because it keeps babies from suffering from feelings of abandonment during the night. Other benefits include:

·   Better sleep for mother and baby.

·   A reduced risk of sudden infant death syndrome, when the principles of safe co-sleeping are followed.

·   Women who return to jobs outside their homes and are separated from their babies for much of the day often feel that sleeping together helps them regain a strong sense of connection with the baby (and also helps them keep up their milk supply).

On the other hand, those who promote putting babies to sleep in bassinets or cribs also say that their favored sleeping arrangement reduces the risk of sudden infant death syndrome, helps mothers and babies sleep better, and teaches babies good sleeping habits.

We’ll look more closely at the safety information for both of these arrangements, but first I want to point out that it’s generally safer for your baby to sleep lying on her back or side than to be tummy-down, whether in the family bed or in a crib or bassinet. There is agreement that putting young babies to sleep on their backs cuts the risk of suffocation or strangulation. Statistics from several countries that have promoted babies sleeping on their backs show significantly lowered rates of sudden infant death syndrome since these programs began in the late 1980s. Of course, there are some babies who object to sleeping on their backs, who will put up quite a fuss until they are placed on their tummies to sleep. If you have one of these, you’ll have to use your best judgment as to what works better for your particular situation.

Some parents worry that a baby who vomits while lying on her back might choke in this position. Babies with gastric reflux disease shouldn’t be placed on their backs to sleep, precisely because they do vomit so frequently.

Safety Information for Co-Sleepers

If you have read much about co-sleeping, you or your relatives may have encountered some of the negative publicity that has been given to this sleeping arrangement. The American Academy of Pediatrics (AAP)—specifically the AAP’s Task Force on Sudden Infant Death Syndrome—made a policy statement in 2005 saying that co-sleeping is hazardous to babies. The Canadian Paediatric Society also recommends that babies sleep in cribs placed in the parents’ room for at least the first six months of life. The AAP task force based its recommendation upon a survey of all the sudden infant death syndrome cases recorded in New Jersey between 1996 and 2000, in which the researchers collected information on bed-sharing status, lifestyle factors, sleeping position, and type of bed environment. Tellingly, most of the bed-sharing sudden infant deaths for which they found data involved unsafe sleeping positions (babies sleeping on tummies rather than on their backs), mothers who were smokers or drug users, and low-income mothers in homeless shelters that lacked safe sleeping environments for babies. In the latter cases, some of the mothers were sleeping on a couch with the baby and one or more older children.

It’s also worth noting that not all pediatricians heed the recommendations made by the AAP with regard to raising their own children. Dr. William Sears, for instance, has written extensively about how his wife and some of their eight children taught him how much value co-sleeping can have for many families. There is obviously a lot of difference between responsible co-sleeping and the kind of unplanned co-sleeping that is likely to have influenced the policy statements mentioned above.

The safety of co-sleeping with a very young or small baby is dependent upon several factors. It’s not for:

·   Parents who are heavy sleepers.

·   Parents who are smokers.

·   Parents who drink alcohol.

·   Parents who are very obese.

·   Parents who sleep with older children or pets.

·   Parents who are under the influence of any drug or medication that interferes with their awareness and ability to be awakened.

·   Babysitters.

Each of these factors raises the risk of accidental suffocation and asphyxiation of a baby, particularly during the first six months of life. For this reason, it’s a good idea to have a crib that you can use for those nights when you or your partner have had something alcoholic to drink or are sleeping more soundly than usual for whatever reason.

Co-sleeping is nothing new; it has almost certainly been the predominant mode in human sleeping patterns over time. What has changed a lot over time is the way that adults in urbanized cultures sleep. Wherever it is practiced, safe co-sleeping requires the right kind of bed environment.

Avoid the following:

·   Sleeping on a couch with your baby.

·   Sleeping on a bed with loose sheets, duvets, covers, or scattered pillows.

·   Sleeping on a waterbed or soft mattress.

·   Sleeping on a mattress with a crack between it and the wall in which a baby can become wedged.

·   Sleeping under an electric blanket.

·   Having a headboard or footboard on your bed in which the baby’s head could get caught.

·   Placing your bed near a window-shade cord or curtain in which a baby could become entangled.

It’s also a good idea to avoid a mattress set on a frame if there is any possibility that the baby could become caught between the mattress and the frame. For this reason, some parents choose to put their mattress directly on the floor, in the middle of the bedroom. This latter option has advantages when your baby becomes older and begins to roll over, scoot, and crawl, because the fall to the floor will be only a few inches, compared to the two-to three-foot fall from the average bed you are likely to find in a furniture store.

Keep in mind that your baby shouldn’t be put to sleep alone on your bed. If she needs to go to sleep before you are ready to sleep with her, put her first in a crib and then move her when you are ready to go to bed.

Don’t overdress your baby if you plan to co-sleep. It’s quite easy for a baby to overheat while sleeping with an adult, since adults give off a lot of body heat. If you are interested in co-sleeping with your baby but are worried that you might sleep too soundly, there are several products now available that are designed to protect a small baby from suffocation. Two examples are a crib that can be fastened next to your mattress and a portable crib that can be placed in your bed. You can improvise one of these arrangements yourself by attaching your baby’s crib to your bed with bungee cords.

Another option is to buy an enclosed hammock that can be hung just above your side of the bed. This allows for easy nursing, because you can untie the knot, lower the hammock to your level for feeding and soothing, and then raise the hammock back up, tying the knot at whatever height you like best. This arrangement also allows you to rock your baby if she isn’t quite settled enough to sleep. I remember seeing many Chinese babies in Malaysia who were put to sleep in small hammocks like this. Once you have the hammock, you’ll need a frame above your bed, a pulley, a rope, and a peg. This is usually an inexpensive arrangement to set up.

When Co-Sleeping Isn’t So Easy

There is no doubt that co-sleeping turns out to be a completely satisfactory arrangement for many, many families and does live up to the claims made by its most fervent proponents. However, it doesn’t seem to work for everyone. For some families, the reality of co-sleeping doesn’t measure up to the ideal. Some babies and parents just sleep better when they have some distance between them, especially as the baby grows older. Problems sometimes arise because of a lack of true or continuing agreement between the baby’s parents about co-sleeping. If your partner begins to complain about co-sleeping, it’s important that you talk together so you can understand what is bothering him about the arrangement. It may be that you and the baby are doing fine, but Dad is beginning to wonder if he’ll ever get any attention, loving, or sleep again. Maybe you and your partner can’t get in the mood with the baby right there in your bed; perhaps you’re afraid that you might wake your sleeping little one. Of course, finding places other than the bedroom for lovemaking can solve this problem, though spontaneity often has to give way to planning and scheduling some time together (especially when you have only fifteen minutes here and there). Whatever the problem is, solving it so that everyone’s feelings are taken into account is a must.

Night Crawlers, Thrashers, and Kickers

As babies grow older, co-sleeping parents are sometimes presented with challenges they hadn’t anticipated. The same baby who slept for longer stretches during the first weeks of life when close to her mother’s body may begin to exhibit different behavior after a few short months. She may become an active night crawler who wakes everyone up to play for an hour or two during your prime sleeping hours. When this happens four or five times a night and things need to get done the next day, even the most patient mother may start reviewing her choices. It’s one thing to have sleepless nights when your baby is less than four months or so old, when her stomach capacity is relatively small and she needs to eat more frequently than older children do. It’s another situation when an attention habit, not hunger, is what drives her to wake up. The eight-or nine-month-old baby who nurses during the night and then falls back to sleep is not a problem. It’s the one who keeps parents awake for hours on end during the night by fighting sleep when satiated.

Some babies escalate the amount of cuddling attention they want during the night. Nursing two or three times no longer suffices; now the baby calms down and goes to sleep only when held on Mom’s chest after a nighttime feeding. If Mom obliges by becoming the human pillow for a rather heavy child, the ante goes up, and sometimes she won’t settle for less than sleeping across Mom’s throat. That is what I mean by an attention habit. Another variation on this theme is the baby who lets you know that it’s time to wake up by sitting on your head. Even if these antics seem cute at first, how cute will they be as your baby gets heavier and heavier? How will you respond? Remember, if you give your baby affection (the breast) when she can’t be hungry and she’s doing something you’d rather she didn’t do, you will be reinforcing this behavior, which means that you’ll be likely to get more of it. The most important thing is that you are responsive to your baby when she needs you—not that she must be in constant contact with your body throughout the night in order to feel secure enough to sleep.

Some parents who think that their frisky baby will miss sleeping in their bed find out that she sleeps quite well once she is transferred to a crib. Babies who initially put up a fuss about sleeping anywhere besides the family bed can come to prefer sleeping in a crib and may even sleep more soundly alone.

If the thought of putting your scooting, thrashing baby into a crib doesn’t work for you, you might try swaddling her first. Rambunctious babies between the ages of about four to seven months will often settle down and sleep much better if swaddled.

I believe that gradual changes generally work better than sudden ones. Let’s say that your thriving older baby is used to falling asleep at your breast and you want to move her to her own space for sleeping. You might begin by first teaching her how to fall asleep without nursing. One way is to give just a short feed at bedtime, lie down with her, and then turn out the light while she’s still awake. Tell her it’s time to go to sleep and then refrain from interacting with her. If she’s used to falling asleep around this time, she’ll probably do so even without your breast in her mouth. Don’t worry if she crawls around a little before this happens. Just calm yourself and keep from stirring her up in any way.

The next step in this sequence is to repeat these actions, and, once she’s asleep in your bed, move her into her new bed (which you should keep in your room for now). After she gets used to this, you can try moving her bed into her own room.

If your situation includes your baby’s father, you can also try having your partner be the one to rock the baby and settle her into bed. In this scenario, you should be in another room, so that the baby doesn’t see or smell you. A variation on this that works for some people with enough space is for Dad and baby to sleep together, while you sleep in a different room. This accomplishes night weaning for some families with thriving older babies. When it feels right, you can get the baby to sleep on her own, and you and your partner can return to sleeping together.

Safety Information for Crib or Bassinet Sleeping

Here are some important safety tips for your baby when she is sleeping alone:

·   The mattress should be firm and have a fitted sheet that can’t come loose when your baby moves on it.

·   Keep all soft bedding, pillows, and stuffed animals out of the crib.

·   Look for a solid wood crib with a nontoxic finish (since your baby may start chewing on it someday).

·   Make sure that the crib is well designed (especially if it is an old one), with bars that are too closely spaced for a baby to wedge her head between them.

·   Don’t allow any smoking in the room where your baby will be sleeping.

More About Mattresses for Babies and Adults

Choose mattresses carefully. Just a few decades ago, all mattresses were made of nontoxic materials, such as cotton, kapok, wool, straw, or feathers. People in many parts of the world sleep on grass or straw mats. Nowadays, most mattresses available contain materials made of formaldehyde, chemical fire-retardants, plastics, or petroleum-based chemicals. Some of these expensive, extremely comfortable mattresses emit toxic gases that make the adults who sleep on them feel sick. Obviously, no baby or child should sleep on such a mattress, especially in the tummy-down position. Some research that I find quite credible attributes much of the high risk of sudden infant death syndrome in Western countries to babies’ reactions to the toxic nerve gases emitted by mattresses containing compounds of antimony, arsenic, or phosphorus.1This type of outgassing is bad enough, but it becomes worse when, after a few months of use, common household fungi get into the mattress, creating an even higher level of outgassing.2 For this reason, it is wise to avoid using a mattress for your baby that has already been used by an older child, unless you wrap it in a thin polyethylene mattress cover. (This is a kind of plastic that doesn’t outgas.) For more information, go to: Even a new mattress that smells like plastic should be wrapped in this kind of mattress cover as a safety precaution.