s/o bedsharing and SIDS

jcsumm0

Here's another perspective on that study that came out last week that we discussed.

https://www.laleche.org.uk/content/bed-sharing-breastfeeding-and-risk-sids

Emerald27

I saw this this morning!

I also saw these and saved them. They're a pamphlet for providers to give to new parents. A great resource:

kindacrunchy

@Emerald27 do you know why a mother has to be breastfeeding for bedsharing to be considered safe? What is the evidence behind that? 

ETA: Nevermind I should have read the article first.

Emerald27

@kindacrunchy‌

"Breastfeeding changes where and how the baby is placed next to the mother, to begin with, and the infant’s arousal patterns, how sensitive the baby and the mother are to each other’s movements and sounds and proximities, as well as the infant’s and the mother’s sleep architecture (how much time each spends in various sleep stages and how and when they move out of one sleep stage into another) are very different between bottle feeding and breastfeeding mother-infant pairs. Not only is the physiology or sensitivity of the mother to the baby, and the baby to the mother completely enhanced if breastfeeding and if routinely bedsharing, i.e. each reacting to each others sounds and movements and touches compared to the bottle or formula fed, bedsharing mothers and infant, but breastfeeding mothers and infants arouse more frequently with respect to each others arousals, and breastfeeding mothers and infants compared with bottle feeding mother-infant pairs spend significantly more time in lighter rather than deeper stages of sleep. Lighter sleep makes it easier for a mother and infant to detect and respond to the presence of the other, making the bed sharing arrangement much safer.

Breastfeeding mothers typically place their infants under their triceps, mid chest level, and often sleep on their side curling up around the infant protectively with their knees often pulled up under the infant’s feet. This position may be instinctive but it does not happen when a mother bottle feeds her baby. Indeed, bottle fed infants are typically placed much higher up on the bed and near pillows (and sometimes on top of pillows, very dangerous) that can obscure the infants air flow, and expose infants to potential gaps (head board to mattress) into within infants could slip.

Also, bottle feeding-bedsharing infants move in directions away from the mother, thus, increasing the risks of some kind of asphyxial event, compared with breastfeeding infants, according to the research by Dr. Helen Ball. (Please check out her website at the University of Durham). That is why Dr. Ball and myself agree that bottle fed infants are safer if they sleep alongside their mothers on a different surface but not in the same bed."

- Dr. James McKenna, Mother-Baby Behavioral Sleep Laboratory, Notre Dame University

Emerald27

@kindacrunchy‌ Sorry...it's just easier to copy and paste from a reliable source. One of the safety guidelines for bedsharing is that baby is breastfed. Cosleeping is recommended (with baby within sensory distance of parents and, if possible, within arms reach...just not in the bed) for all babies, though.

kindacrunchy

Thanks @emerald27! It gave a little bit of reasoning in the article OP posted but I am still glad I asked since you posted a more in depth explanation. What would your opinion be on a baby who is breastfed but also supplemented with formula? We had major supply issues, stemming from tongue tie, with DD#2 so we had to supplement. I am hopeful that this time we will be able to EBF but for the sake of being realistic since I also had supply issues with DD#1 who wasn't tongue tied if we do need to supplement would bedsharing be safe or only co-sleeping? 

persephonerose

It's cool to see it described like that @Emerald27. We started bed sharing around 7-8 months and I did sleep almost exactly like the article describes and DS1 never moved away from the boob.  Our bed sharing has changed a lot since we weaned at 15 months.  DS1 moves all around the bed now!

Emerald27

kindacrunchy said:

Thanks @emerald27! It gave a little bit of reasoning in the article OP posted but I am still glad I asked since you posted a more in depth explanation. What would your opinion be on a baby who is breastfed but also supplemented with formula? We had major supply issues, stemming from tongue tie, with DD#2 so we had to supplement. I am hopeful that this time we will be able to EBF but for the sake of being realistic since I also had supply issues with DD#1 who wasn't tongue tied if we do need to supplement would bedsharing be safe or only co-sleeping? 

This is an excellent question! Please weigh in with your thoughts too, @jcsumm0‌!

I think a lot of it depends on how you're supplementing. If you're pumping to replace any feedings that are given by bottle (like working mothers do), or if you're supplementing using an SNS, or have baby at the breast at each feeding even if "topping up" with formula after feedings (which is not recommended), then I think you're ok.

The gray area comes in when baby is breastfed only part-time, meaning gets a few feedings per day but is otherwise bottle-fed.

ETA: I want to look into this further, so please give me bit to see if I can find a good, reputable recommendation for such a situation.

kindacrunchy

Emerald27 said:

Thanks @emerald27! It gave a little bit of reasoning in the article OP posted but I am still glad I asked since you posted a more in depth explanation. What would your opinion be on a baby who is breastfed but also supplemented with formula? We had major supply issues, stemming from tongue tie, with DD#2 so we had to supplement. I am hopeful that this time we will be able to EBF but for the sake of being realistic since I also had supply issues with DD#1 who wasn't tongue tied if we do need to supplement would bedsharing be safe or only co-sleeping? 

This is an excellent question! Please weigh in with your thoughts too, @jcsumm0‌! I think a lot of it depends on how you're supplementing. If you're pumping to replace any feedings that are given by bottle (like working mothers do), or if you're supplementing using an SNS, or have baby at the breast at each feeding even if "topping up" with formula after feedings (which is not recommended), then I think you're ok. The gray area comes in when baby is breastfed only part-time, meaning gets a few feedings per day but is otherwise bottle-fed. ETA: I want to look into this further, so please give me bit to see if I can find a good, reputable recommendation for such a situation.

Is the not topping off recommendation a new one? DD#2 is 3 years old and that is what was recommended with her by the LCs we saw. I would BF her then give her a couple ounces of formula and then try to pump to stimulate more production. In the end it didn't work and my supply just kept diminishing even with a hospital grade pump.

Emerald27

Also, @kindacrunchy‌, frequent nursing and lots of skin-to-skin will help ensure an adequate supply. Having baby checked for ties in the hospital (and have them revised before you're discharged if possible), will help too!

Supplementing should be a last resort when struggling with supply issues, because anything baby gets that isn't from the breast will lower mom's supply further. Make sure any supplementing you consider doing is managed by someone very knowledgable about breastfeeding, and consider using and SNS rather than bottles, and supplementing with your own pumped milk rather than formula, if you can (and if it's even an issue for you this time around!).

Emerald27

kindacrunchy said:

Emerald27 said:

kindacrunchy said:

Thanks @emerald27! It gave a little bit of reasoning in the article OP posted but I am still glad I asked since you posted a more in depth explanation. What would your opinion be on a baby who is breastfed but also supplemented with formula? We had major supply issues, stemming from tongue tie, with DD#2 so we had to supplement. I am hopeful that this time we will be able to EBF but for the sake of being realistic since I also had supply issues with DD#1 who wasn't tongue tied if we do need to supplement would bedsharing be safe or only co-sleeping? 

This is an excellent question! Please weigh in with your thoughts too, @jcsumm0‌!

I think a lot of it depends on how you're supplementing. If you're pumping to replace any feedings that are given by bottle (like working mothers do), or if you're supplementing using an SNS, or have baby at the breast at each feeding even if "topping up" with formula after feedings (which is not recommended), then I think you're ok.

The gray area comes in when baby is breastfed only part-time, meaning gets a few feedings per day but is otherwise bottle-fed.

ETA: I want to look into this further, so please give me bit to see if I can find a good, reputable recommendation for such a situation.

Is the not topping off recommendation a new one? DD#2 is 3 years old and that is what was recommended with her by the LCs we saw. I would BF her then give her a couple ounces of formula and then try to pump to stimulate more production. In the end it didn't work and my supply just kept diminishing even with a hospital grade pump.

---------------------quote quote quote------------------------
Topping up is one of the "booby traps" that are detrimental to mom's supply. Your supply may have diminished further because baby was not satisfied at the breast. If baby is not satisfied after nursing at both breasts, the typical recommendation is to continue switching breasts and offering again, which signals a further letdown and increases production. It can take a couple days for your body to respond well and increase your supply, but it works.

Think of milk intake in a "total daily" amount. When you finish a feeding with formula, your body thinks that that much less milk was needed by baby that day. Baby also becomes used to the constant flow of bottles vs the massaging "work" of removing milk from the breast and the waiting between letdowns, and she may become fussy for the bottle sooner and sooner. With every extra ounce supplemented, your body is signaled to make one ounce less of breastmilk...the cycle continues until baby is not satisfied at the breast, even when mom's breasts are still producing.

Emerald27

I suppose, too, it depends on why you're supplementing: if it is for weight gain, that's one thing. If for fussiness at the breast, that's another.

If baby is not gaining weight appropriately, the first step is to check latch and ask how frequent baby is getting a "good" feeding (@ least 20 minutes every 2 hours during the day, every 3 hours at night, and on demand in between). If baby is sleepy or not nursing enough, supplementation is usually not the answer. However, if the latch is good and baby is nursing well but still under weight, some closely monitored supplementation via SNS with mom's pumped milk can help baby get back to a healthy growth rate.

If baby is fussy at the breast after feedings, typically the answer is not supplementation, but figuring out the underlying cause and solving it. Does mom have a forceful letdown and perhaps an oversupply (causes same symptom), or could baby be sensitive to something in mom's diet? Lots of possibilities, including low supply - the best answer for which is skin-to-skin and more frequent nursing.

Emerald27

theresat858 said:

That image doesn't show the actual rules for safe bedsharing -- not few covers, NO covers above the parents waist, and not "no extra pillows", but no pillows.

Not how I prefer to sleep. 

A bed-side cosleeper or side car crib is a great option that is far safer for baby, and doesn't require a breastfeeding mother. 

Which guidelines do you use? We follow Dr. McKenna, who allows pillows (well above baby) and a light blanket.

Emerald27

theresat858 said:

Emerald27 said:

theresat858 said:

That image doesn't show the actual rules for safe bedsharing -- not few covers, NO covers above the parents waist, and not "no extra pillows", but no pillows.

Not how I prefer to sleep. 

A bed-side cosleeper or side car crib is a great option that is far safer for baby, and doesn't require a breastfeeding mother. 

Which guidelines do you use? We follow Dr. McKenna, who allows pillows (well above baby) and a light blanket.

I'm not sure of the source of those guidelines, but any blankets by your face could end up by baby. 

I did not bedshare until DD was 8 months old on a vacation, nor do I intend to bedshare with this one. It seems like a completely unnecessary risk to baby.


Right right. The blanket should stay at waist height.

Cosleeping with a bassinet or sidecarred crib or some other way of keeping baby close is awesome too!! One of the most important bedsharing guidelines is that the parents should feel comfortable with the decision to sleep with baby. If you're not comfortable, definitely go with another option!

MorganWP

We bedshare but only for a few hours in the early morning. Usually between the last night feeding and waking up for the day.

For the rest of the night we just roomshare, DD's crib is in our room. I much prefer that. I feel as though we all get a better sleep when we're in our own beds.

We're going to do the same with this LO.

kindacrunchy

Emerald27 said:

I suppose, too, it depends on why you're supplementing: if it is for weight gain, that's one thing. If for fussiness at the breast, that's another.

If baby is not gaining weight appropriately, the first step is to check latch and ask how frequent baby is getting a "good" feeding (@ least 20 minutes every 2 hours during the day, every 3 hours at night, and on demand in between). If baby is sleepy or not nursing enough, supplementation is usually not the answer. However, if the latch is good and baby is nursing well but still under weight, some closely monitored supplementation via SNS with mom's pumped milk can help baby get back to a healthy growth rate.

If baby is fussy at the breast after feedings, typically the answer is not supplementation, but figuring out the underlying cause and solving it. Does mom have a forceful letdown and perhaps an oversupply (causes same symptom), or could baby be sensitive to something in mom's diet? Lots of possibilities, including low supply - the best answer for which is skin-to-skin and more frequent nursing.

Yeah we were supplementing because DD was losing weight. She lost if I remember correctly over a pound and a half in her first week and as far as anyone could tell at the time she "had a great latch" (I don't know how many effing times I heard that) so that is why started. The pedi freaked me out and basically said I had to supplement at that point. We continued to do feedings on demand and tried to supplement sparingly making sure to always pump after feedings too. Lots of skin to skin and all that. Her tongue tie was found and corrected at 2 weeks but we weren't able to rebound from it. Thanks for all the info!

pinkshades05

kindacrunchy said:

Emerald27 said:

I suppose, too, it depends on why you're supplementing: if it is for weight gain, that's one thing. If for fussiness at the breast, that's another.

If baby is not gaining weight appropriately, the first step is to check latch and ask how frequent baby is getting a "good" feeding (@ least 20 minutes every 2 hours during the day, every 3 hours at night, and on demand in between). If baby is sleepy or not nursing enough, supplementation is usually not the answer. However, if the latch is good and baby is nursing well but still under weight, some closely monitored supplementation via SNS with mom's pumped milk can help baby get back to a healthy growth rate.

If baby is fussy at the breast after feedings, typically the answer is not supplementation, but figuring out the underlying cause and solving it. Does mom have a forceful letdown and perhaps an oversupply (causes same symptom), or could baby be sensitive to something in mom's diet? Lots of possibilities, including low supply - the best answer for which is skin-to-skin and more frequent nursing.

Yeah we were supplementing because DD was losing weight. She lost if I remember correctly over a pound and a half in her first week and as far as anyone could tell at the time she "had a great latch" (I don't know how many effing times I heard that) so that is why started. The pedi freaked me out and basically said I had to supplement at that point. We continued to do feedings on demand and tried to supplement sparingly making sure to always pump after feedings too. Lots of skin to skin and all that. Her tongue tie was found and corrected at 2 weeks but we weren't able to rebound from it. Thanks for all the info!

Some of the hardest tongue-ties to catch are the posterior (back of the tongue). Nat had a Type 3 that got clipped when she was 2mo. Look for a triangle under the tongue--that's a big indicator to get it checked out.

As for bed sharing, we did from day one. Nat didn't like the cosleeper and I slept in a position that did not allow me to roll over. I also got the best rest because night wakings were short and I didn't have to get up (DH changed all the diapers). I totally agree that bed sharing can be done safely! But that doesn't mean it's right for everyone. If you aren't comfortable with it, there are plenty of other options

Dubsgirlie

You'll never convince me that bed sharing is a good, or even OK idea. Especially when baby is really young.

MsMacual

Love the info posted here!  I was a family bed kid- as my mom would say- sometimes you just did what you needed to do!  We safely bed share with our now 33 mo son.  He was in a bassinet in our room until about 6 mo (ours is bigger than most and he was on the smaller side).  He also reverse cycled so I was nursing him about every 2 hours until he was 12 mo- co sleeping made it possible for me to get enough sleep to function.  My opinion (and this purely is my opinion) is that, like everything parenting related, there are safe and not safe ways to do it.  We rarely drink and don't use any type of drugs (even taking advil is rare in our house) and we waited until our son could roll over and hold his head up until we regularly had him in bed with us.  I am planning on keeping #2 our of our bed until he is bigger- mostly b/c #1 still sleeps with us a few nights per week and he moves around a lot.  I'm most concerned that he'll roll over on the baby, which sadly has been the source of some infant deaths.  

Emerald27

@MsMacual‌ Per the guidelines published by Dr. James McKenna, infants one year and under should not sleep with other siblings. If both babies will be in your bed, it is always safest to put the older child between you and DH or even on the outside next to DH, and to keep the new baby always next to you on the outside.

HappyCianci

Good info! We still bed-share with out three-year old, though that's about to change to make room for the new little one.

After some deliberation, we've decided to side-car a crib for this baby, rather than put her on our mattress, which was our original plan. Even though our family bed is two beds wide (and she'd get her own whole bed!) I realized I wasn't comfortable with the potential for her to get wedged between the wall and the mattress if she rolled over. We're going to start with the side-car, so she has the bars on three sides, and then transition back to our two-mattress family bed when she's big enough to have a little more control and/or alert us if she gets stuck.

I really hope to avoid "unintentional bed-sharing," which happened to us frequently with my son and which always felt risky to my. I would nurse him in our bed, then pass out in exhaustion, only to wake up hours later with him positioned poorly on a pile of blankets in our bed. It freaked me out!

Emerald27

@HappyCianci‌ One way to prevent risky episodes of unintentional bedsharing is to realize that falling asleep while nursing is common (and normal due to hormone release), and always prep the space you nurse in side-lying for safe bedsharing. That way, when and if you do fall asleep, baby will be in a safe environment.

MsMacual

@Emerald27- thanks. Our older son has recently started wanting to sleep in his own bed and room so my guess is that he'll be fully transitioned to his room by time our younger son is out of the bassinet.