Why bedsharing among breastfeeding mothers will not be eradicated and what ethical (harm reduction) steps must be taken to accommodate it

Background:
The American Academy of Pediatrics has recommended aggressively against any and all caretaker-infant bedsharing, making no distinctions between breastfeeding and bottle/formula feeding environments, and treating all bedsharing as if it carries a singular inherent risk. However, many experts acknowledge that bedsharing outcomes fall on a continuum ranging from potential benefits to high risk depending on how and by whom bedsharing is practiced. Despite recommendations against it, bedsharing is common in the U.S. (e.g. 70-80% in Los Angeles), and particularly among breastfeeding mothers. For many, this happens without the benefit of information on how to make the adult bed safer for infants, since such information is typically excluded from educational materials in favor of a “just don’t do it” message.

Methods:
Data from sleep studies of the physiology and behavior of breastfeeding-bedsharing mother- infant pairs is compared with data collected from two large internet surveys of bedsharing- breastfeeding mothers, illuminating their perceptions, attitudes, practices, and evaluations.

Results:
Breastfeeding mothers cite numerous advantages to bedsharing, including increased mother-baby sleep time, compensatory time working mothers spend with their babies, less infant crying, and easier and more frequent nightly breastfeeding with augmented durations. Observational and physiological studies confirm these perceptions. Recent research has found that in the absence of hazardous factors bedsharing does not carry an increased risk, and after three months of age it may be protective for breastfed infants. To be both ethical and credible, the AAP-NICHD sponsored “Safe to Sleep” campaign should modify its unqualified recommendation against bedsharing for breastfeeding mothers.