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 …

And:

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.

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  • Heidi

    The obsessed with bedsharing person on my Facebook page, whose child is 3 years old now FFS, is sharing some recent story from the NYPost that is telling parents to “OMG calm down your baby won’t suffocate from bedsharing.” Or you know, they might! I wanna say, “Girl, it’s the NY Post! It’s a crappy tabloid pumped out by Murdoch first of all. But secondly, it’s kinda weird why you’re this passionate about infant bedsharing when your kid is 3. Aren’t you too busy attachment parenting to post about attachment parenting all the time?” Everyone else is judgemental but it definitely doesn’t come across as judgemental when you post about how letting your kids sleep alone is cruel and all the other AP propaganda.

  • mabelcruet

    Personally, I think anyone who claims bed-sharing is safe, and who, in a professional capacity, is prepared to tell mothers that it is safe, should first be made to attend an autopsy on a baby found dead in the parental bed. They won’t have to wait too long for one to come along, we have several hundred a year in the UK. And then they should be made to attend the inquest into the baby’s death, and made to listen to the crying and wailing from the parents when they give evidence about their dead baby, and when they hear the pathologist say that there was no natural disease present, and that death was likely to have been accidental overlaying.

    Some of the risks of co-sleeping in the same bed can be mitigated with careful planning, but it is never going to be risk free.

    • rational thinker

      I would never be able to do your job. Any doctor promoting this should attend an inquest and autopsy of and infant that did not have to die. I knew a loss mother ( baby suffocated on her chest when mom fell asleep) and even thought it was many years after and two more kids later she still brought it up in conversation every day and then eventually became a drug addict from depression. I haven’t heard from her in a few years but I did find out she lost custody of her other 3 kids to her ex husband.

      • mabelcruet

        What frustrates me most is the stereotypical case histories. Most of us paediatric pathologists work in regional or supra regional centres, meaning we get cases from multiple different hospitals and multiple different coronial jurisdictions, but regardless of that, it’s the same thing over and over and over. Unsafe co-sleeping bed-sharing, sofa-sharing, spontaneous co-sleeping rather than planned, parents who claim to smoke only outside the house (yet there are overflowing ashtrays in every room). And in court I hear the same thing from parents over and over-they claim they were not told the risks, that they got given the guidance and the leaflets but claim they were told ‘I’m supposed to tell you that you shouldn’t sleep with your baby, but that’s not true and we all know it’s safe,’ by a health visitor or nurse, or versions of that. I don’t know how truthful this is, or whether this was the parents inaccurate recollection or interpretation, but it happens too often for comfort for me. I’ve heard parents say they were told it was safe because a mother would always instinctively know where her baby was in bed and it was impossible for her to overlay. I’ve heard them say that they were told that breast feeding would prevent cot death, so if you breast feed, bed-sharing is perfectly safe. Again, I don’t know what they were told, and whether it’s their own interpretation or misunderstanding, but it’s from different parents in different regions all making similar statements, which to me suggests either the guidance is unclear and needs to be made more absolute (“Do not, under any circumstances, share a bed with your baby”), or that there may be health care professionals who are undermining the official department of health guidance and bringing their own bias into it.

        I know there have been calls to make bed-sharing illegal. In my region, we’ve had a few attempted prosecutions of parents who had bed-shared and sofa shared whilst drunk. It is illegal to be responsible for a child under the age of 3 whilst intoxicated, and charges of child neglect or cruelty can be made. Most of the prosecutions we’ve had ended up failing because we can’t pinpoint exactly when the baby died and we didn’t know what the parents blood alcohol level was at the time of death, so you can’t prove they were drunk when the baby died. It’s a technicality, but it’s been used here to say the parents were found innocent and not responsible for the death, which isn’t true. We had one successful prosecution:a father who was legless drunk a full 8 hours after the baby was discovered.

        It’s honestly got to the state now that generally, if I have a case of a baby found dead in their own bassinet I usually find a natural cause of death, and in a baby found dead in bed with parents, I find nothing and death is most likely due to positional asphyxiation.

        • KQ Not Signed In

          I’ve always wondered about the bedsharing with a parent who smokes – what about that increases the risk to the baby? Obviously secondhand smoke around an infant (or anyone) is bad. But how does an adult who smokes entirely outside increase the risk specifically?

          Note: I am not supporting or encouraging bedsharing OR smoking. My kid is 9 and we didn’t bedshare when it was relevant. But I am curious about the reason smoking ups the risk. Alcohol and drugs make total sense as they are impairing.

          • StephanieJR

            I may be talking out of my arse here, but I think I’ve read about ‘thirdhand smoke’, which is the chemical residue left over after the cigarette is finished, usually on the clothes, hair and skin of the smoker, and which can be transferred to the infant through normal interactions such as holding/breathing on them. You don’t want any of these chemicals on your child, so maybe it’s another risk factor.

          • mabelcruet

            It’s multifactorial we think. There is some very interesting data that is coming out indicating that maternal smoking during pregnancy is probably far more important than previously thought, and its the interplay between a number of different mechanisms both antenatally and postnatally. Overall, it seems to be dose related, so the risk goes up the more you smoke.

            Smoker’s babies are often slightly smaller with a degree of suboptimal growth and suboptimal utero-placental function. It’s a combination of nicotine and carbon monoxide related damage. If you took two babies of the same birth weight, one of whom had a mother who smoked during the pregnancy and the other one didn’t, the smoke exposed baby has a higher risk of death even though they are both small.

            There is also data showing that organ development in babies of smokers could be retarded or abnormal leading to some degree of suboptimal function, like in the infant brain you get some neuronal network disorganisation, sympathetic nervous system innervation problems and neurotransmission aberrations. This is where the new research is being done-its showing structural aberrations in the brain stem of the baby, in the areas that control respiration.

            This leads to a suggestion that in utero nicotine exposure causes brain stem anomalies that results in their hypoxic arousal mechanisms not working properly. Some autopsy data shows that infants of smokers have signs of established hypoxic-ischemic cellular injury in the brain and the heart which probably occurred in antenatal life, may have been caused by suboptimal placental function and may have been sub-clinical, but if the baby continues to be in a vulnerable environment exposed to post-natal passive smoking, this could affect autonomic nervous system function and lead to poor temperature control, and poor heart rate and respiration control. There’s a suggestion that these microdamaged areas could then affect the baby if they contract an infection-a minor viral illness that most babies shrug off could turn more serious if there is underlying damage.

            At birth, smoker’s babies have reduced lung volume, poor airways control, less lung compliance, more airways obstruction-their airways don’t react normally and this is mediated by nicotine in utero causing collagen and elastic fibre abnormalities in the airways. The effect of this is increased risk of infection, and also increases their vulnerability if they are in a risky environment (like co-sleeping, big duvet, pillows etc). This starts very early in fetal life-babies practice breathing in utero, breathing the amniotic fluid in and out and that helps the lungs grow and develop-fetuses who syndromes causing muscular abnormalities meaning that can’t breathe in utero frequently die at delivery because they simply don’t have enough lung tissue to survive. Nicotine affected babies are similarly affected (obviously to a much lesser extent).

            The risk of cot death whilst bed sharing is higher in smokers, and that could be due to microenvironmental changes. There is data showing that cotinine (a nicotine metabolite) is increased in babies who bedshare with a smoking mother compared to those who still have a smoking mother but who don’t bed share.

            There’s also a more nebulous issue which is far harder to quantify, but parents who smoke around their children and whilst pregnant tend to be rather more ‘chaotic’ in their parenting. We see features like babies missing appointments with the health visitor, or babies being a bit underweight, or having untreated bad nappy rash, or parents who tend to use alcohol and drugs more frequently, or tend to pay less attention to their infant’s health and ignore early signs of illness. Nicotine exposed babies have reduced immune function and poorer response to inflammatory conditions like infection so its a double whammy-they are more likely to get infection and more likely to get sicker with infection.

            All in all, smoking whilst pregnant is really not good for the baby, and just cutting down isn’t going to do very much. You need to stop smoking before conception to give your baby the best chance of optimal growth and development.

          • Justanrph

            What about babies who roll early? Mine didn’t like sleeping on their backs and had figured out how to get onto their sides and stomachs about the time I went back to work- so just before 3months. If they were to have had a cot death and be found on their stomach after rolling into that position, how would that have been classified? Assuming nothing was otherwise wrong.

          • mabelcruet

            In my own practice, I generally would call this SUDI-undetermined. The issue with prone sleeping is that it can interfere with breathing, the airways can be occluded because the baby can’t lift their head from the mattress. Head control starts at about 3 months, but it takes another couple months before the baby has strong head control. That means that even if a baby can roll at 3 months, they might not necessarily be able to lift their head up-essentially, they’ve put themselves into a very compromised position.

            At the inquest, the circumstances of death would be explored-the coroner will ask the parents for statements, and its not uncommon for them to say they put the baby on their back to sleep, but the baby moved. In the UK, the coroner only has a limited number of findings that he can make (natural, accidental, misadventure, unlawful killing, suicide, open verdict etc). He can also give a narrative verdict exploring the circumstances leading up to death and why its difficult to determine a specific cause. So cot deaths with no pathological disease present but with a history of being found face down would generally be a narrative verdict, or an open verdict as a specific registerable cause of death cannot be determined. However, in other parts of the world, the term SIDS is still in use.

          • KQ Not Signed In

            Thank you for such a thorough and fascinating answer!

            Follow up question: What if it’s the father or partner who smokes, rather than the birth mother? If the birth mother didn’t smoke at all – does the risk still go up? Because I have consistently heard that “an adult who smokes” as a risk factor, but your answer – quite reasonably – focuses on prenatal smoking and parents who smoke around infants.

            BTW excellent diplomacy roll there

          • mabelcruet

            Peter Fleming and Peter Blair (from Bristol university) did a huge study into cot death, they looked at over 300 cases and each case was matched with 4 controls. There is data from this study to show an increased risk to babies with paternal smoking.

            Maternal-only smoking during pregnancy increases the odds 2.6 times (once you’ve taken confounders into account). If its the dad that smokes, and he smoked during the pregnancy and afterwards, the risk of infant death is less than that of maternal-only smoking, but higher than in non-smoking fathers (about 1.5 increased odds). The risk go up the more smokers in the family home. As far as I remember, there was no statistical evidence to show that the location of smoking activities affected the risk-we frequently get told that the smoker only smokes outside and not in the vicinity of the baby, but its very likely that that isn’t always truthful (seeing as though the police usually find evidence like ashtrays around the house).

          • KQ Not Signed In

            Thanks! This is so interesting, and I’ve always wondered. I really appreciate all the information!

          • Kaia Rose

            Thank you for your answer. I had wondered the same thing. Not to copy KQ, but your insights are always fascinating.

          • mabelcruet

            Thank you. I have to keep telling myself that my experience is extremely biased-I only ever see the worst outcomes, and obviously never go anywhere near the 99% of pregnancies and babies that do absolutely fine. And because we work in a regional centre and get cases from all over, it gives me a false impression that baby loss is more common than it actually is, and each individual unit only gets a handful of cases a year. So although my posts tend to be all doom and gloom, most pregnancies and babies are fine (when I’ve had a bad run, I sometimes I go to the neonatal unit to ogle babies-there is a room they call the ‘fattening up’ room where the ex-premies stay for a while to put on weight before discharge, and its lovely seeing all the little chubsters and that cheers me up)

        • rational thinker

          I knew two other babies that almost died but were found in time. Both were in their own cribs napping during the day (sleeping on stomach) and in each case the baby had spit up/ vomited and were breathing that in, both cases same thing baby was blue when found but thankfully were found in time. Each baby was under 3 months old. Are cases like this considered cot death/sids?

          • mabelcruet

            Using the term SIDS at a paediatric pathology conference will end in fisticuffs! There is a big difference between European pathologists, USA pathologists and Australasian pathologists and we argue endlessly about this. In the UK, we no longer routinely use SIDS as a final diagnosis, we prefer SUDI (sudden unexpected death in infancy). The definition of SIDS is multifaceted, and each part of the diagnostic criteria has to be fully met before we use it-the last time I had a case that I put out as SIDS was 2005. It is only used for those cases where a baby of the right age is found dead in their own sleeping space and no natural cause of death can be determined despite a full autopsy examination (including all the reams of ancillary testing we do), full scene examination and examination of the circumstances leading up to death. So that automatically excludes all co-sleeping bed sharing deaths.

            In USA, there was a push to classify as SIDS type I and SIDS type 2. SIDS type 1 is classic type SIDS (meeting the criteria above), and SIDS type 2 was for those cases where there were certain factors in the death that couldn’t be excluded as potentially relevant, so the proposed classification was that bed-sharing deaths with no other worrying features would be classed as SIDS type 2.

            USA pathologists don’t like the term SUDI (sudden unexpected death in infancy) because its not a final diagnosis-its a starting diagnosis. We would class this sort of death as SUDI-undetermined, which reflects our genuine conclusion that we don’t know why the baby died, we didn’t find any specific natural or unnatural death, but the circumstances of death (bed-sharing) are such that we can’t exclude overlaying or accidental suffocation, over heating etc.

            The rest of us really don’t like SIDS type 1 and 2-I think the motive is benign, in that it is an attempt not to stigmatise the parents by saying their baby died of SIDS, rather than saying the cause of death is undetermined, but its not truthful and its not accurate.

            The near-miss cases you describe wouldn’t have been classed as SIDS in the UK because part of the definition is ‘baby put down to sleep on their back in a safe sleeping environment’, and stomach sleeping in a 3 month old isn’t a safe position. In USA, it probably would have been classed as SIDS. If the autopsy had shown pneumonia, for example, then obviously it would have been classed as that. It’s not uncommon for us to find natural disease in the very young babies when they are in their own beds. I’m not a clinician, and its been a very long time since I did clinical medicine, but in general serious ill health in infants can be difficult to pinpoint. They can compensate significantly until all of a sudden their system collapses. I’ve had cases where baby had been fine at lunchtime, got a bit grizzly mid-afternoon, wasn’t interested in feeding at supper, and died by 10pm-literally a few hours to plummet into sepsis. And they don’t have the expected symptoms-babies with pneumonia aren’t going to be coughing up sputum or developing pyrexia, what they will have is being very quiet, having a low temperature and very cold feet. So its difficult for parents to judge whether they should call for medical assistance if all your baby has is blotchy cold feet. And its also difficult for a doctor to decide as well, because the disease process evolves so quickly and so oddly in babies.

  • Reyna Elizondo

    I wish there was a study proving that USA hispanics have a lower rate of SIDS because the bloody listen to their mothers more than to a lactation consultan (and more than likely have another adult helping caring for the kid because is traditional in latinoamerica) I still remember how my mother told me: “I dont care what you or any stupid doctor saids, that baby is hungry” and gave a already made formula bottle. God bless her. (She also made sure i didnt fall sleep with the baby on my arms)

  • I couldn’t get through the article yesterday because my eyes were rolling out of my head. The stupidity. It burns.

  • Lizzy Reiley

    I’m poor and white and I don’t smoke, do drugs or drink. I also don’t breastsleep or bed share. I practice the ABCs of safe sleep. Idk. I didn’t know only white and wealthy women make healthy choices like not smoking and not doing drugs?

    • fiftyfifty1

      It’s not that ONLY white wealthy women do these things, but rather that white wealthy women do these things in much higher rates than the general rate.

  • Susan Lemagie MD

    I was told last year by a young physician that college-educated women didn’t have to worry that their bedsharing babies would die of SIDS. Somehow their education would protect their babies. I don’t see this in the list, but it may as well be there; same kind of twaddle.

    • SheResisted

      The Hankes say the death of a child tests your faith to its core and forever leaves you with a broken heart. In their case, it also spurred Sam, a pediatric cardiologist, and Maura, a kindergarten teacher, into action.

      One year later, on what would have been their son’s first birthday, the couple founded a nonprofit they called Charlie’s Kids Foundation to raise awareness of pediatric sleep-related deaths. The foundation provides resources for new parents, educates families, and promotes dialogue about safe sleep practices.

      “We have made it a mission of ours to try and do everything we can to make sure other families don’t suffer that loss,” Sam Hanke says. “We have to share our story — even if it hurts — because it is so hard to hear when others lose their babies. This can be prevented, and spreading that message is what keeps us motivated.”

      The Hankes now have two other children and say they stress to parents that following these recommendations may not always be easy, but the alternative is unbearable.
      https://www.webmd.com/baby/news/20180212/baby-suffocation-deaths-from-cosleeping-rise

      • Lurker

        But it sounds like they were trying to do the right thing! He was trying to stay up with the baby, not cosleep with him. When you’re trying to do the right thing and even that doesn’t work, because sometimes it’s just not physically possible to keep yourself awake anymore, what else is there? Even their foundation’s advice is “find a way to keep yourself awake when holding your baby.” He had the TV on to keep himself awake. It didn’t work. The problem with safe sleep advice is it’s all “Don’t do X” and not “This is what actually works and is physically possible for a human being.” Because what’s left after all the “don’ts” ends up being things like “Stay up for 72 hours straight and spend that time taking care of a vulnerable infant” (I know how commenters here would feel about that possibility if it was referring to rooming in at the hospital immediately after birth) and “take naps on the weekend” (because I can go M-F without sleep, can’t you?) and “hire a night nurse” (because we all have thousands of dollars left after just spending tens of thousands of dollars on a birth, right?). My husband and I made it a week taking turns staying up with my sleepless baby before we started falling asleep with him in much less safe places (the couch) and resorted to pulling all the blankets and pillows off the bed and cosleeping because it seemed like it had to be safer. And not one safe sleep activist has ever been able to tell me what the better alternative would have been.

        I’m not arguing that cosleeping is completely safe. I avoided it with my second, because it was avoidable. But it didn’t feel avoidable with my first, and all anyone can tell me is “you should have avoided it” and not HOW.

        • MelJor

          Circumstances like that are extremely hard. I have no doubt that you and your partner were really struggling and probably made the best choice you could given what you had. I think you are right, that it is a hard line to have between saying trying to be supportive of making things safer and being permissive/saying co sleeping is better. I think new parents need more support. I think they physically need helping hands to take naps, and make meals, and get what they need to parents the best way they can. I’m sorry you had to choose between two bad choices, and I am glad things turned out ok. Cosleeping in circumstances like your makes sense to me (as in I get why people would do it, and really empathize with how hard those nights are) and I fully admit to having co slept with my toddler during illnesses for similar reasons. But much more than people like you, I encounter other parents who made minimal effort to avoid co sleeping (or proudly did it in the hospital, while medicated!) and act like co sleeping is BEST and inherently safe because they are breastfeeding/X/Y/Z. Those same parents also often love to complain about how their kiddo is partying at 2am and look at me like I sprouts a third head when I recommend a sleep training resource to teach their kids that 3am is not when 12m olds get to play. I think we would do parents more service if we talked about how hard the sleep deprivation will be, and that using all the soothing techniques is amazing with newborns, but also as they age a lot of kids needs help weaning off of these soothing techniques to get a sound night of sleep.

          • EmbraceYourInnerCrone

            Listening to your baby cry when you first put them down is hard, but I try to encourage my nephews and nieces to NOT wait until the baby is asleep to put them to bed. If they get used to being put in their crib awake, fussing for a little while and soothing themselves to sleep it is easier in the long run. I think we do parents a dis-service telling them that your baby is going to not bond with properly and be insecure all their life if you let them cry it out for 15/20 minutes before they go to sleep.

          • alongpursuit

            This is absolutely the best advice I received with my second baby. It goes against the “skin to skin as much as possible” ideology, but I started putting my baby in bed if she had been awake for a while and had already been fed and changed. At first she would cry, but usually after 2-3 minutes she would be sleeping.

          • EmbraceYourInnerCrone

            I was lucky, and I also found swaddling worked at least in the first couple of weeks, so did soothing music to mask the noisy apartment building we lived in.

          • Lurker

            Well, sure, but it also does parents a disservice to suggest that putting a baby down awake will result in “fussing for a little while” or at worst crying it out “for 15/20 minutes.” Kids are different. My oldest once cried for 6 hours straight on a long car ride. Never calmed himself down, never tired himself out, never fell asleep. (We stopped a couple times in desperation – he was fine when we got out of the car. Nothing was wrong, so eventually we decided we just needed to press on.) The ones who WILL fuss it out for 20 minutes are not typically also the kids who are keeping their parents awake for 22 hrs/day. What’s great advice to help prevent easy babies from forming bad habits is not particularly helpful for babies who will scream for hours on end.

            I’ve had a baby I could swaddle and put down awake and sometimes he’d sleep and sometimes he’d fuss and sometimes he’d coo and sometimes he’d cry. It’s not like I think it’s bad advice. But it is advice that was absolutely irrelevant to my oldest.

          • AnnaPDE

            This. Maybe it’s cultural, and obviously it’s changing over time, but the obsession of having to leave the room quickly while baby is awake seems like a specifically Anglo obsession from a European perspective.

            Some babies don’t do the “fussing a bit and then sleeping” thing. Some of this subset are at least happy to fall asleep if you rock them, or put them to bed and stay with them until they’ve dozed off (which should take shorter as baby grows)… where’s the exact issue in helping them this way? The “rod for your own back” argument curiously doesn’t apply to having to feed, bathe, bum-wipe etc a child for years on end, but somehow a few minutes at bedtime are a big imposition. (Note: Few minutes. Hour-long sessions are obviously something that needs improving.)
            That the other dominant voice is “just sacrifice every single minute and still feel insufficient” is obviously not helping.

        • mabelcruet

          There is a difference between planned and unplanned sharing. Unplanned co-sleeping on bed or sofa is more dangerous than planned-if you make the decision to bed share, most parents will work out how to reduce the risk, like you’ve described. You’ve removed cushions and pillows, you’ve thought about the bed surface etc. This in itself is going to be protective to some extent.

          What I see most commonly (as a paediatric pathologist who does the autopsies on babies who die) is co-sleeping that was unplanned and spontaneous. Its parents who are so tired that they fall asleep accidentally on the sofa, or in a chair. Or they bring the baby into bed for feeding and fall asleep before they return them to their cot. A sadly common scenario is a parent who has been taking drugs or drinking alcohol, who brings the baby into bed for a spontaneous cuddle and then falls asleep.

          Planned bed sharing reduces the risk, not eliminates it entirely, but it is safer than unplanned co-sleeping, and if this works for the family then most parents will read around and look at what they can do to reduce the risk as much as possible (and frankly, maternal smoking is one of the biggest risks so any non-smoking mother is off to a good start anyway).

          Sofa-sleeping scares me-the common scenario is that because of the reduced space on the sofa, the baby ends up being pushed against the back of the sofa squashed by the parents body and asphyxiates because they physically can’t take a breath. Or ends up being pushed face first into suffocating cushions because of the movement of the parent. I’ve had cases where the baby was placed onto the chest of the parent, and then dad clamped his hands on to the baby’s body to prevent them rolling off, but the dead weight of a parents hands when they fall asleep is enough to prevent the baby breathing. If it gets to the stage where you are falling asleep on the sofa with your baby in an attempt not to bed-share, you’d actually be far safer sharing the bed, especially if you’ve removed pillows and so on. You have to do what works for your baby and family, and if co-sleeping is the only way your little one would sleep, then working out a way to do that more safely is being a responsible parent, which is what you did.

    • EmbraceYourInnerCrone

      Did you tell said young physician he was wrong and an idiot I hope?

      • Susan Lemagie MD

        It was a young pregnant woman who was trying to educate me about “breast sleeping”. I was shocked. I live in Alaska, which has the highest rate of SUID in the nation.

        • EmbraceYourInnerCrone

          Ah, sorry for assuming the doctor was male, I should not do that.
          Maybe it’s my age but I can not understand how someone could think that a 100 to 200+ lb adult could safely sleep in a bed with a 5 – 15 lb infant/newborn who in most cases can’t even roll over by itself, the physics don’t work…and I hate the “breastfeeding mothers have special senses so they will know where the baby is and not smother them” F’ing magical thinking which also erases any parent that is not a breastfeeding mother.

          • mabelcruet

            For a while, the Royal College of Midwives in the UK had maternal obesity as a risk factor for sudden death when bed-sharing. The theory was that a larger parent may have less awareness of where the extremities of their body were, and possibly slept more deeply because of sleep apnoea. As a larger person myself, I’ve never noticed that I’m unaware of my outlying regions-I’m actually very aware of where they are (and very good at judging whether I can squeeze my fat carcass between chairs in a restaurant, for example) so I’m not sure where they got this from or what research it was based on.

          • rational thinker

            There was a case in the US where a 900+ pound ( cant remember the exact weight) woman who could barely get out of bed was babysitting her 2 year old nephew. Sometime during the day her nephew became trapped under her leg and suffocated to death. It was very much an accident but the state charged her with murder anyway and even modified the doors of the courthouse so they could prosecute her in court. I think a documentary was made about it.

          • mabelcruet

            That’s awfully sad. I wonder why the state chose to pursue a conviction when it was accidental? Did they think the parents had been neglectful leaving the baby in the care of someone who couldn’t look after him properly? But then the parents should have been charged too, maybe.

          • mabelcruet

            I just googled her-it was her younger sister beat the poor child to death so Marya thought that as she was so close to death because of her obesity, she would take the blame and invent a cover story. Her attorney worked it out, the younger sister got 15 years in prison, and Marya lost 800 lb following surgery. But seeing the photos of her before the weight loss, she’s just puddles of flesh covering the entire bed, so it would be easy to be on top of something or having it lost in your folds and not actually notice it. I’m technically obese (BMI hovering around 30) but that’s a different order of obesity entirely. I find it hard to understanding the dynamics of family relationships in cases like this-if she can’t get out of bed, and can’t get out of the house without firemen knocking the wall down, then its her family who are keeping her supplied with food. Surely they can see what they are doing is life threatening?

            We had a very sad case here of a girl in Wales who weighed around 800lb or so at the age of 18, she was called Britains fattest teenager. She went to a far camp in USA and lost loads of weight, but the day she arrived back at home, her mother hadn’t bothered getting any fresh food in the house and instead ordered a huge takeaway and fish and chips, and the girl put the weight back on within 2 years. Not long after that, the side of her house had to be demolished so that she could be taken to hospital for treatment for heart failure and respiratory failure.

          • rational thinker

            I didn’t know all that. The documentary I saw did show her having the weight loss surgery. I guess the documentary was made before the truth came out that he was beaten to death. The mom did get charged with neglect for letting someone who could not even get out of bed babysit and then the court accepted it as an accidental death from what I remember of the documentary. Im glad the truth was eventually found out about that poor little boy.

            A lot of husbands/wives of people that are that big are called “feeders”. They think its attractive/sexy so they feed them tons of food on purpose. So the blame kind of goes 50/50. In Marya’s case her boyfriend was feeding her a lot of food and wanted her to be as big as possible. I guess its kind of a fetish.

            It happens with parents too. Sometimes the adult child feeds the parent or the parent feeds the child. I saw a couple on tv once and the woman had always been a little on the larger side her whole life but not huge. Then she met her husband who was not overweight himself but had a fetish for large women.He started “feeding” her soon after they met and now she is somewhere over 600 pounds. He openly admits he fed her to make her that big and he loves her body. So wherever there is a person so large that they cant get out of bed there is always a feeder or two nearby.

          • mabelcruet

            I saw a documentary a while back about super morbidly obese people which followed them through weight loss surgery. There was one woman who was in heart failure and wasn’t fit for surgery until she lost some weight, so they kept her in a hospital so they could regulate her intake. But she didn’t lose weight despite this, and it turned out her family were smuggling takeaways and burgers in for her. I’ve also heard of people who had weight loss surgery but sabotaged it by liquidising all their food so they could still eat all their favourites. I think for people like this, some intensive psychology and counselling would be absolutely necessary to help them get on top with whatever driver is pushing them to over eating-you’d have to have a lot of emotional issues to eat yourself to that size.

          • rational thinker

            Yes they should go through some kind of mental therapy. Maybe family members too, cause if you cant even get out of bed how the hell else are they getting food. Family members are big enablers in these cases.