The classism and racism of the Academy of Breastfeeding Medicine’s embrace of bedsharing

newborn baby and mother sleeping together

The Academy of Breastfeeding Medicine is now on record as supporting the deadly practice of bedsharing.

The ABM just published a revision of its sleep protocol and it amounts to little more than special pleading for a practice that kills tens of thousands of infants a year (SIDS and suffocation).

It is a stunning violation of medical ethics, placing as it does a process (breastfeeding) over an outcome (safe babies).

The ABM’s principal “argument” is that while bedsharing is deadly, the babies of privileged white women are immune.

It is also a not so subtly classist/racist screed that focuses on distinguishing its core constituency — privileged, white women — from poor women, many of whom are women of color. Indeed, it’s principal “argument” is that while bedsharing is deadly, the babies of privileged white women are immune.

I suppose we shouldn’t be surprised that the ABM’s bedsharing protocol is unethical since its mission statement is unethical.

A Worldwide Organization Of Medical Doctors Dedicated To The Promotion, Protection, And Support Of Breastfeeding

Medical ethics requires supporting the health and wellbeing of PATIENTS, not processes. Perhaps lactation physicians initially believed their own marketing slogan, “breast is best.” But over the past 20 years, the scientific literature has made several things quite clear:

1. Breastfeeding is NOT best for every baby and every mother
2. Aggressive breastfeeding promotion has such significant risks that exclusive breastfeeding has become the LEADING cause of newborn re-hospitalization
3. Lactation professionals have encumbered breastfeeding with multiple onerous practices that are dangerous and ironically don’t increase breastfeeding rates

Now, the ABM is adding its tacit blessing to a practice that is deadly. Why? Because it purportedly “supports” breastfeeding:

Overall, the research conducted to date on bedsharing and breastfeeding indicates that nighttime proximity facilitates breastfeeding duration and exclusivity… Existing evidence does not support the conclusion that bedsharing among breastfeeding infants (i.e., breastsleeping) causes sudden infant death syndrome (SIDS) in the absence of known hazards. Larger studies with appropriate controls are needed to understand the relationship between bedsharing and infant deaths in the absence of known hazards at different ages.

If we break down the careful language, we are left with this:

Nighttime proximity is associated with breastfeeding; causation is unproven. It seems that the babies of privileged women are at lower risk. We don’t really know for certain.

No matter.

The ABM’s justification for its unethical stance is rationalized in two ways: anthropological and classist/racist.

The anthropological rationale is — not to put too fine a point on it — academic bullshit:

The concept of “breastsleeping” was proposed to describe a biologically based model of sustained contact between the mother and infant, starting immediately after birth, in which sleeping and breastfeeding are inextricably combined, assuming no hazardous risk factors. Described in cultures around the world, the breastsleeping mother and infant feed frequently during the night while lying in bed together, and by morning, the mother may not recall how many times she fed or for how long… The behavior and physiology of breastsleeping dyads may be different from that of bedsharing nonbreastfeeding dyads, signifying that the safety assessments for bedsharing with breastfeeding versus feeding human milk substitutes likely require different approaches.

When was breastsleeping first described? In ancient Egypt? In the Middle Ages? By anthropologists in the early 20th Century? No, no and no.

It seems that breastsleeping was first described in 1992 by — surprise! — a lactation professional. As far as I can determine, it does not appear in the anthropology literature to this day, although many of the lactation professionals who promote it are anthropologists by training.

The classist/racist special pleading is even more disturbing.

The ABM acknowledges that bedsharing dramatically increases the risk of infant death but rationalizes a special standard for the babies of privileged women, by and large white women. Indeed throughout the protocol there are strenuous attempts made to distinguish privileged white women from everyone else.

SIDS is most common among low-income and some marginalized communities in wealthy countries, with the world’s highest prevalence of SIDS occurring among U.S. American Indians/Alaskan Natives (combined) and non-Hispanic blacks …


These are factors that increase the risk of SIDS and fatal sleeping accidents, either alone or when combined with bedsharing.
• Sharing a sofa with a sleeping adult (“sofa-sharing”)
• Infant sleeping next to an adult who is impaired by alcohola or drugs
• Infant sleeping next to an adult who smokes
• Sleeping in the prone position
• Never initiating breastfeeding
• Sharing a chair with a sleeping adult
• Sleeping on soft bedding
• Being born preterm or of low birth weight

Wealthy white women don’t sleep on sofas. Wealthy white women don’t smoke. Wealthy white women have a low rate of preterm birth. I could go on, but you can probably see the pattern.

The ABM concludes:

Accidental suffocation death is extremely rare among bedsharing breastfeeding infants in the absence of hazardous circumstances …

That’s just another way of saying “accidental suffocation death is rare among breastfeeding infants of privileged white mothers.”

And for the Academy of Breastfeeding Medicine, privileged women and their babies seem to be the only ones who count.