CDC Releases US Breastfeeding Report Card

As part of the CDC, the Division of Nutrition, Physical Activity and Obesity released the 2013 Breastfeeding Report Card.

Beginning breastfeeding is at an all time high of 77% with an increase in skin-to-skin and rooming in playing key roles.  Yet not everyone rooms in or has skin-to-skin policies at their hospital:

Top five states with the highest beginning breastfeeding rates include Washington (87.9%), New Hampshire (88.5%), Idaho (91.8%), Colorado (89.1%) and California (91.6%).  Top five states with exclusive breastfeeding at six months include South Dakota (26.3%), Alaska (26.8%), California (27.4%), Idaho (27%) and Wyoming and New Hampshire tied at (24.9%).

States with the highest skin-to-skin were Maine (77.8%), California (79.6%), Oregon (77.4%), Vermont (90%) and Alaska (70%); rooming-in states were Alaska (95%), Washington (83.8%), California (72.6%), Idaho (70.4%) and New Mexico (69.2%).

We are improving but we still have a long way to go!  With Breastfeeding Week within site, let's push for better education and support to mothers for breastfeeding!

View the entire Report Card here.

Bottled Up - the Film!

Last week, I found out that one US hospital had abandoned their efforts to achieve Baby Friendly status because of artificially inflated economic number presented to them.  After 30+ years in this business, I thought I'd seen everything and had become accustomed...almost complacent...to this type of corporate attack on our mothers, babies and future societies.  Oh, but wait.  This angered me more than I can tell you.

Fast forward to today when I viewed the trailer to the powerful new film, "Bottled Up - The Film".  With an advisory board that includes IBCLCs, MDs, and PhDs plus moms who breastfed, this film is one that will shake the newborn world like "The Business of Being Born", rocked the birth world.

As I watched this trailer, I was cheering that someone now shows the real dirty little truth about the business of formula companies and the cultural shift to bottlefeeding rather than the best food - breastmilk.  Yet when I heard Bill Maher say that breastfeeding was a private function like masturbating or "pissing" - I got mad.

View the trailer on their website here: http://www.bottledupthefilm.com/bottled-up-the-film/

It will encourage and empower you.  And it could make you angry. 

What are we doing to future generations...for the almighty buck and for convenience?

Ten Facts About Maternity Care You Should Know

A profession that recommends best practice care yet shuns evidence-based care is contradictory and in danger of implosion if the receivers of that care discover the contradiction.  Therefore, a combination of fact distortion and suppression of education is the key to avoiding revelation and implosion.

1.    The maternal mortality rate in the US is 12.1 deaths per 100,000 live births.  This number is greater than 40 other countries in the world. (Source: Amnesty USA Deadly Delivery: The Maternal Health Care Crisis in the USA, 2010).
 

2.    Cesarean sections are partly to blame for the rise in the US Maternity mortality rate. (Source: California Maternity Quality Care Collaborative, 2011).

3.    The FDA has not approved the drug Cytotec for use as an induction agent for childbirth.  http://www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/ucm111315.htm

4.    The US Food and Drug Administration has issued alerts about the use of vacuum extractors used during labor/birth, including fetal hemorrhage, shock and death. http://www.fda.gov/MedicalDevices/Safety/AlertsandNotices/TipsandArticlesonDeviceSafety/ucm230309.htm

5.    The Joint Commission, the body that accredits US hospitals, encourages a reduction of cesarean rates to the limit suggested by the World Health Organization ~ 15-20%. (Source: The Joint Commission Specifications Manual for Joint Commission National Quality Core Measures, 2010).

6.    “A baby born by cesarean surgery is more likely to be admitted to a neonatal intensive care unit or NICU physically separated from his or her mother, thus making establishing breastfeeding more difficult.” (Source:  Impact of Birthing Practices on Breastfeeding, 2011).

7.    Women’s birthing preferences are shaped by economic position and availability of local birthing options. (Source:  Social Science & Medicine, 2012 Aug. 75(4) 709-16)

8.    All drugs given to a mother during labor cross the placenta to the fetus/baby.   (Source: Anesthesiology 1995 83(2) 300-308)

9.    The US breastfeeding rate on initiation is 76.9% (2009), 47.2% at 6 months, and 25.5% at 12 months. (Source: CDC Report Card, 2012)

10. There are 14 risks of formula feeding infants.  INFACT Canada has a brief annotated bibliography that is in a pdf format and easy to print and give to parents and care providers.  http://www.infactcanada.ca/fourteen%20risks%20of%20formula%20feeding.pdf

Another Rush to Implementation? Human Breastmilk from Genetically Modified Cows

From the CDC’s mPINC  of 2009 to the Surgeon General (US) Call to Action to Support Breastfeeding in 2011 to the Healthy People 2020 targets, we are all familiar with this country’s (and global) initiative to increase health of newborns and young children through exclusive breastfeeding.  More and more hospitals are working toward and achieving the Baby Friendly Hospital Initiative (BFHI).  And while this is all good news, there is some not so good news…if a baby is not breastfed, that means the baby is formula fed.  Statistics show repeatedly that infants who are formula fed are more likely to die no matter where they live on this globe.  And the health threat isn’t only for the children.  The incidence of maternal illness in those who do not lactate are higher for situations such as postpartum depression and breast and ovarian cancers.

Just when we thought we were making headway in the world of BFHI and staff training to facilitate labor practices that promote breastfeeding, a stunning development is making the rounds again in social media: genetically modified cows produce human milk.

In 2011, scientists in China announced their success in producing a human genetic coding in the DNA of Holstein cow embryos, thus producing a herd of cows that make a milk with the same nutritional properties as human breastmilk, but with a taste even stronger and sweeter. “The genetically modified cow milk is 80% the same as human breastmilk,” said lead researcher Dr. Li Ning. At that time, over 3000 cloned cattle lived on an experimental farm in suburban Beijing, announced the researchers at the State Key Laboratory of Agrobiotechnology of the China Agricultural University.  Researchers were able to create a cow that produced milk with the human proteins lysozyme and lactoferrin.

But some interesting questions arise from this and it is the professionals who are asking. 

JH from Iowa said “On one hand, as a mother who had a horrible time breastfeeding because of low supply and an infant who was allergic to virtually every commercial formula and was unable to get donor milk, I think this COULD be a great alternative and save a lot of stress and anxiety over feeding infants quality nutrition.  However as a scientist, I am concerned about the safety of this, especially regarding future dairy allergies and what the other 20% contains.  I would want to know much more about the research and how the genetic material was obtained before making a decision one way or another.”

SD from West Virginia stated, “I’d rather see this much time and energy put into opening more human milk banks in the USA instead of worrying about striving for more GMO foods.”

AG from Wisconsin mentioned, “If it works out, and the product will make money – as long as they can keep the arsenic and such out of the cows’ diet.  People are uncomfortable with this kind of large animal cloning until they need the product it produces.  It may result in less processed milk formulas, which could be healthier for children.  It also seems like a gateway to more genetic experimentation.”

All too often in medicine, we find something potentially amazing discoveries and rush to implement them.  However, do we truly research the side effects both immediate and long term?  In many instances, we do not.  And this may be another time when we rush to implementation.

What are your thoughts?

World Breastfeeding Week - Lamaze Calls Out Breastfeeding Barriers to Support Continued Rise of Breastfeeding Rates in the U.S.

Welcome to the World Breastfeeding Week Blog Carnival!  From August 1-7, we'll be featuring breastfeeding experts sharing their expertise about breastfeeding and breastfeeding issues.  Each day will bring something new!  Day 6 features a personal interview with Lamaze International President, Michele Deck.

Yesterday, August 6, I had the privilege to speak to Michele Deck, Lamaze International president and childbirth educator. We talked at length about World Breastfeeding Week/Month and what part Lamaze is playing.

               

“I am encouraged and thrilled to see the breastfeeding trends moving up.  Lamaze is dedicated to support of all breastfeeding mothers, especially those without cultural support.  Lamaze isn’t just about childbirth education – Lamaze Certified Childbirth Educators can also act as breastfeeding support.  Social media such as Facebook can help educators promote their services – the educators shouldn’t underestimate their power!”

Breastfeeding rates across the country continue to climb, with nearly 77 percent of moms initiating breastfeeding - the largest annual increase over the previous decade - and increases in breastfeeding at six and twelve months, according to the Centers for Disease Control and Prevention (CDC) report, “Breastfeeding ReportCard – United States, 2012.” The report comes on the first day of World Breastfeeding Week (August 1-7), and National Breastfeeding Month (August), annual events dedicated to raising breastfeeding awareness and removing the barriers to breastfeeding, both in the United States, and worldwide.

“This encouraging increase shows that the evidence around the benefits of breastfeeding is compelling to pregnant women, and the health care providers and hospitals that care for them,” said Deck. “Scientific research shows breastfeeding helps ensure babies are well nourished, protected against disease, and given the best chance to develop optimally. What women need most often is good information and support to get breastfeeding off to a good start, and to help them reach their breastfeeding goals.”

According to the CDC report, there are also national improvements in hospital maternity care practices that support breastfeeding; however, the indicators show that there is room for improvement to ensure moms are getting the quality care that can help them reach their breastfeeding goals. Valuable resources and information for expecting parents, like Lamaze’s Push for Your Baby (www.PushForYourBaby.com), are aimed at giving expecting parents the tools to push for the best care practices for moms and babies, including those that support breastfeeding education and awareness.

“While breastfeeding is natural, it doesn’t always come naturally,” said Deck. “Many moms have difficulties establishing breastfeeding and some of this may be due to birth practices that aren’t the best for moms and babies. Pregnant women can help to push for the best birth and breastfeeding experiences by using childbirth education to understand the most common barriers and how to navigate them.”

In honor of breastfeeding awareness, Lamaze calls out the following top five breastfeeding barriers within the first 24 hours of birth to help expecting moms prepare for the best breastfeeding experience:

1.   Unnecessary birth interventions:  While there are many unknowns during the birthing process, women can seek maternity care practices backed by science that can make birth safer and healthier. Fetal monitors, confinement to bed, artificially starting or speeding up labor and cesarean surgery can make birth more difficult and lead to a harder start for breastfeeding. For example, women whose babies are delivered by cesarean surgery can face a delay before the mature milk comes in. Pregnant women can find more information about reducing these and other challenges in childbirth by visiting Lamaze’s Push for Your Baby resources at: www.lamaze.org/ChildbirthChallenges. 

2.    Separating mom and baby: Abundant evidence shows that mother-baby, skin-to-skin care beginning right after birth and continuing uninterrupted, for at least one hour, or until after the first feeding for breastfeeding women, helps mothers, babies and breastfeeding. Skin-to-skin care helps a mom feel more confident, respond more quickly to her baby’s needs, reduces stress and makes breastfeeding easier. There are also clear benefits for babies: they breastfeed sooner, longer and more easily, they cry less, have more stable temperatures and blood sugar levels, have lower levels of stress hormones, and adjust more easily to life outside of the womb.[i]

3.    Use of pacifiers or other artificial nipples before breastfeeding is well established: Does the hospital nursery use pacifiers or bottle-feed babies without need? It’s an important question for expecting parents to ask. Studies show that early pacifier use may interfere with breastfeeding, and could decrease mom’s ability to exclusively breastfeed and reduce the duration of breastfeeding. Artificial nipples should be avoided until breastfeeding is well established (after about four weeks).

4.    Supplementing breastmilk with formula: Breastmilk is best for babies. Formula simply does not provide the added nutritional and health benefits of breastmilk that’s naturally packed with antibodies, and should not replace formula unless there is a compelling medical reason to do so. Even the few days following birth are vitally important. The breasts produce a vital substance called colostrum, which protects the baby from illnesses and provides important nutrients.

5.    Lack of postpartum breastfeeding support: Many new moms need breastfeeding support after hospital or birth center discharge. Support may include: a home visit or hospital postpartum visit, referral to local community resources, follow-up telephone contact, a breastfeeding support group, or an outpatient clinic. This is a good time for a mom to talk about any challenges she may be having, and get the help she needs to give her baby the healthiest start.

"While breastfeeding decision-making can spark controversy among moms, improving breastfeeding awareness is not about passing judgment,” said Deck. “It’s about considering the scientific evidence and giving women the support they need to achieve their breastfeeding goals.

“Lamaze has a mechanism in place.  Our short and long term goals include promotion of breastfeeding.  We’ve been involved in conversations with the March of Dimes and the U.S. Surgeon General.”

As part of World Breastfeeding Week, Lamaze International partnered with the world’s leading dedicated juvenile products retailer, Babies“R”Us^®, to host in-store events nationwide, where new and expectant moms had the opportunity to learn valuable information and practical tips on how to prepare for a successful breastfeeding experience. The “Nursing Basics for New Moms” events took place on August 4 at 1:00 p.m. local time.

To find out more about breastfeeding in the workplace, Deck also offers a Q&A video on breastfeeding options for working women here:

About Lamaze International

Lamaze International promotes a natural, healthy and safe approach to pregnancy, childbirth and early parenting practices. Knowing that pregnancy and childbirth can be demanding on a woman’s body and mind, Lamaze serves as a resource for information about what to expect and what choices are available during the childbearing years. Lamaze education and practices are based on the best and most current medical evidence available. Working closely with their families, health care providers and Lamaze educators, millions of pregnant women have achieved their desired childbirth outcomes using Lamaze practices. The best way to learn about Lamaze’s steps to a safe and healthy birth is to take a class with a Lamaze certified instructor. To find classes in your area, or for more information visit: www.lamaze.org.

About Push for Your Baby

Push for Your Baby was created by Lamaze International to provide expectant parents with the support and information needed to push for the safest, healthiest birth possible. Knowing how to spot good maternity care is the key to getting it, and through Lamaze childbirth education classes, parents-to-be can get the tools needed to have the best birth day. For more information visit: www.PushForYourBaby.com.

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[i] Moore, E. R., Anderson, G. C., & Bergman, N. (2012)). Early skin-to-skin contact for mothers and their healthy newborn infants (Review) Cochrane Database of Systematic Reviews.

World Breastfeeding Week - Common Problems

Welcome to the World Breastfeeding Week Blog Carnival!  From August 1-7, we'll be featuring breastfeeding experts sharing their expertise about breastfeeding and breastfeeding issues.  Each day will bring something new!  Day 6 features Mary Shay RN, MS, ICCE, IBCLC, a lactation consultant, talking about Common Breastfeeding Problems.

Some of the most common breastfeeding problems I see relate to the basics; positioning for one. Moms can read, twitter, blog and gain information from a variety of sources but when it comes to getting started, it’s the hands on practice that is important. Teaching a Mom to tuck the baby in close and to latch deeply and showing her how are so basic and yet easily missed and overlooked by staff. Misinformation about soreness and hurting in the beginning are common and teaching this isn’t so with good positioning and latching is surprising to new Mothers. The “Ah” factor and smile when good positioning and latch are done confirms the importance of this along with good milk transfer and baby’s out puts. It also prevents problems after discharge when home alone and growing in the role of Mother.

          Another important problem is routine hospital practices that separate Mom’s from their infants, not only in the first hours of life but in the days that follow. Skin to skin provides so many great benefits and getting the routines to change can be a challenge. The ways I have seen the staff grow and accept this is by doing a research project on our unit and encouraging staff to become certified in Skin to skin. As staff begin to understand and actually see the benefits (bonding, temp. control, stabilizing of blood sugar and weight) they accept this whole heartedly.

          As we celebrate World Breastfeeding Week, going back to the simple basics can be a good focus. It’s exciting to see the positive influences and changes that are coming from the support from so many places, the wave has started and it is sweeping across our nation. 

Mary Elliot Shay, RN, MS, IBCLC 

Mary is a certified lactation consultant at Upper Valley Hospital in Troy Ohio.  She has devoted most of her life to helping mothers breastfeed, in a variety circumstances.  Mary's knowledge base and devotion to breastfeeding has made her an invaluable asset to the community in which she lives.

World Breastfeeding Week ~ Myths (and old wives tales) about Breastfeeding

Welcome to the World Breastfeeding Week Blog Carnival!  From August 1-7, we'll be featuring breastfeeding experts sharing their expertise about breastfeeding and breastfeeding issues.  Each day will bring something new!  Day 5 features Donna Walls RN, BSN, ICCE, IBCLC of Dayton, Ohio.

First, Happy World Breastfeeding Week, an opportunity to celebrate the joys of breastfeeding!

Second, we are going to dispel some of those myths that just won’t go away, like the size of the breasts determine the amount of the milk a woman can produce. In fact, the external size of the breasts have nothing to do with the ability to produce milk. Most women have one breast that is larger than the other and the smaller breast often makes a larger amount of milk.

Donna Walls RN, ICCE, IBCLC

Foods have always been a hot topic in lactation circles, usually lists of all the foods you can’t eat while breastfeeding. The truth is, there really isn’t any food that must be avoided. Spicy foods are often denied, but these foods form the basis of many cultures and do not cause concerns in those newborns. Those foods labeled “gas-forming” also have no real basis in fact to remove from the diet. Some infants may have a reaction to cow’s milk in the mother’s diet, but this is no reason to eliminate milk from all mother’s diets.

One of those myths that won’t go away is that babies need to nurse for long sessions to get the high-fat hind milk at the “end” of the feeding. Recent studies show that the milk fat is distributed throughout the entire feeding. Some very efficient babies nurse shorter periods with more milk fat in the foremilk. Mandating that mothers force longer feedings will not enhance weight gain and is a practice that is not supported by research. Encouraging baby-led feedings, feeding with cues for frequency and length of feedings, and not the clock, will provide the best nutrition. 

   

Many women worry about not having enough milk in the first days. New mothers need to be reassured that they have all the food their newborn needs right from the beginning. Colostrum is the first milk and is present in the breasts in the last part of the pregnancy and ready for the first feedings. An average feeding of colostrum is about 1 teaspoon, plenty to fill the newborn’s stomach which is about the size of a shooter marble. Early feedings are ensured when moms and babies spend lots of time snuggling skin to skin when babies can smell the milk.

Donna Walls RN BSN, ICCE, IBCLC

Donna has been an RN for 32 years and for 30 years, has worked with expectant and new parents.  She is a certified childbirth educator, Lactation Consultant, and  has a Diploma in Herbal Sciences from Australasian College.  In 1995, she developed and opened the first Alternative Birth Center within a hospital setting in the state of Ohio.  Donna created the Early Lactation Care Specialist program because of her passion for babies, mothers and lactation.  She is an internationally known author and speaker, presenting workshops, programs and speaking at conferences. Donna also works with hospitals, helping to set up their Baby-Friendly Programs.  You can reach her at daswalls@aol.com.

World Breastfeeding Week ~ On my Heart, In my Soul, Through my Eyes

Welcome to the World Breastfeeding Week Blog Carnival!  From August 1-7, we'll be featuring breastfeeding experts sharing their expertise about breastfeeding and breastfeeding issues.  Each day will bring something new!  Day 4 features Misti Ryan from Bay Area Breastfeeding and Education, LLC.

Beads of sweat forming on her forehead and tears streaming down her face, a sweet momma looks up at me briefly in between long, loving gazes at her newborn.  No words were necessary as her face wore the expression of gratitude and elation.  We sit in silence for a moment listening to the rhythmic thup, thup, thup of that sweet baby at the breast.  I stroke baby’s soft, little head, careful not to disturb the latch that took so long to achieve.  Inside, my heart is floating, and relief floods my soul…

…and in that stillness, I am reminded of the weighty responsibility my work carries with it.  Time and time again I am invited into homes, entrusted with the management of one of baby’s most important basic needs.

 

Who am I?       

What makes me so special?       

Nothing.

I don’t carry a magic lactation wand or a pouch of latch dust.

          I am simply a lactation consultant who

simply loves moms,

          simply loves babies,

                   simply loves breastfeeding,

and has simple goals:

          meeting moms where they are,

 helping more babies get breastmilk,

helping more moms breastfeed.

Short of my family, nothing gives me more satisfaction than knowing I have helped one more baby get even one more drop of breastmilk, empowered one more mom to push through even one more feeding…

          …. respected the mom who decided whole-heartedly to throw in the towel, supported the mom that had no idea what to do when milk came in after the birth of her stillborn.

Where has our reverence gone? Despite recent efforts, our culture continues to struggle with promoting and supporting breastfeeding. 

·         Pregnancy and birth are perpetually medical-ized, squelching what should be a natural progression.

·         Well-meaning but erroneous information is passed along serving to confuse moms rather than encourage them.  

·         Younger generations have lost their models after decades of the suffocating marketing ploys of formula companies. 

The right message has been all but extinguished: Breastfeeding is not the best way to feed your baby…it is the way to feed your baby.  The tasks ahead are not for the faint of heart:

·         Normalize pregnancy and birth.

·         Standardize evidence-based breastfeeding education for health care providers.

·         Nurse in public to model breastfeeding.

What can you do today to promote and support breastfeeding?  Happy World Breastfeeding Week!

Eyes close, tiny fists open as baby falls off the breast, signaling a full tummy.  Momma wipes away a dribble of milk from the corner of the baby’s mouth.  “Thank you,” she says quietly, “I was going to quit.”  I think out loud, “It’s not me, it’s all you, momma.”

For baby, every drop counts…For momma, every minute is worth it.

Misti Ryan, BSN, RN, CCE, IBCLC, RLC

Co-Owner, Bay Area Breastfeeding & Education, LLC

www.bayareabreastfeeding.net

International Board Certified Lactation Consultant (2011)

Labor and Delivery Nurse (1998)

Certified Childbirth Educator (1999)

Accredited La Leche League Leader (2004)

RTS Pregnancy Loss Bereavement Counselor (2004)

Certified Early Pregnancy Ultrasound Tech (2010)

World Breastfeeding Week ~ "Don't Sleep With Big Knives"

Welcome to the World Breastfeeding Week Blog Carnival!  From August 1-7, we'll be featuring breastfeeding experts sharing their expertise about breastfeeding and breastfeeding issues.  Each day will bring something new!  Day 3 features Kathleen Kendall Tackett Ph.D., IBCLC, RLC, FAPA, who has given us her permission to reprint this editorial.

 “Don’t Sleep with Big Knives.”:

Interesting (and Promising) Developments in the Mother-Infant Sleep Debate

The City of Milwaukee launches
their most-recent
infant sleep campaign.

On November 9, 2011, amid much fanfare and media attention, the city of Milwaukee unveiled their latest campaign to promote safe infant sleep. The images are disturbing to say the least—they were designed that way. "Co-sleeping deaths are the most preventable form of infant death in this community," Barrett said.  "Is it shocking? Is it provocative?" asked Baker, the health commissioner. "Yes. But what is even more shocking and provocative is that 30 developed and underdeveloped countries have better (infant death) rates than Milwaukee."  A campaign such as this has a noble goal: to prevent infants from dying. But does this type of campaign keep infants safe?  The tragic answer is “no.” In less than two months after this campaign was launched, two more infants had died in Milwaukee in what the press described as “cosleeping deaths.”

On January 3, 2012, WITI-TV, the affiliate Fox News in Milwaukee reported this:

One-Month-Old Infant Dies in Co-Sleeping Incident

Medical Examiner's Report Says Baby Was Sleeping On Floor with Three Other Children

The second death was of a 10-day-old infant who had died while sleeping with three other children on an adult bed.  Neither of these infant sleep locations was safe and should not be classified as “bedsharing deaths.” The sad take-away we can learn from these cases is that “simple messages,” may be headline-grabbing. But in the end, they do not communicate what parents need to know to keep their infants safe while sleeping.

In the same month as the Milwaukee campaign was launched, the American Academy of Pediatrics issued their new policy statement and follow-up technical report (American Academy of Pediatrics & Task Force on Sudden Infant Death Syndrome, 2011a, 2011b) on infant sleep-related deaths. In their press release, they stated that they were “expanding [the AAP guidelines] on safe sleep for babies, with additional information for parents on creating a safe environment for their babies to sleep.” 

When I first read through this statement, it didn’t seem to differ all that much from previous statements, particularly on the issue many of us are interested in—namely, their recommendations regarding bedsharing. That recommendation did not really change. But in reading the full statement, there were some interesting, and dare I say hopeful, developments.

The AAP Policy Statement (2011a) lists their Levels A, B, and C recommendations. A-Level recommendations are those with the strongest evidence. Number 3 of their Level-A Recommendations is that parents and infants room share, but not bedshare (p. 1031). They based their recommendation on the results of a new meta-analysis of 11 studies comparing 2,404 cases where infants died (28.8% of whom bedshared) with 6,495 healthy controls (13.3% of whom bedshared). They calculated the odds ratio and found that it was 2.89 (95% CI, 1,99-4.18).¹  Based on their calculation, bedsharing increased the risk of SIDS by almost three times. But wait…..The authors noted that there was “some heterogeneity in the analysis” (p. 45). The heterogeneity in question referred to the fact that several of the studies included infant deaths that took place on a chair or couch (a situation that greatly increases the risk of infant death), not just those that took place in an adult bed with a non-smoking, non-impaired parent. 

Footnote: An odds ratio of 1.0 indicates no increased risk. Above 1.0 means increased risk. The higher the number, the worse the risk.

This issue has, of course, dogged the bedsharing debate for more than a decade. The authors themselves acknowledged that this was a difficulty (Vennemann et al., 2012).

Only recent studies have disentangled infants sleeping with adults in a parental bed from infants sleeping with an adult on a sofa. This is certainly a limitation of the individual studies and hence of the meta-analysis (p. 47).

But hopeful sign number 1: the AAP statement specifically differentiates between bedsharing and the broader term, “cosleeping,” which often includes all deaths that take place outside of a crib. I hope that this distinction will trickle down into future research studies.

And there’s more. Vennemann et al. (2012) noted that bedsharing was much more hazardous with a smoking mother (OR=6.27; 95% CI, 3.94-9.99) than a non-smoking mother (OR=1.66; 95% CI, 0.91-3.01).  So there was still some increased risk if an infant slept with a non-smoking mother. But remember that this analysis included studies where babies died on couches and chairs. The next analysis was by age of infant. For infants less than 12 weeks, the odds ratio was 10.37 (95% CI. 4.44-24.21).  But for older infants, 1.02 (95% CI, 0.49 - 2.12), i.e., no increased risk.  Another analysis looked at whether bedsharing was routine.  They found that if bedsharing was routine, the odds ratio was 1.42 (95% CI, 0.85-2.38).  If bedsharing was not routine, but happened on the last night, the odds ratio was 2.18 (95% CI, 1.45 - 2.38). The authors noted that the risk was NOT significantly elevated in the routine-bedsharing group (although I note that there does seem to be some elevation in risk, probably due to the studies that included couch sharing).

The next interesting issue is regarding their recommendations on chair or couch sharing with an infant. This has been a long-standing concern of mine due to the massively increased risk of infant death if parents fall asleep with infants on these surfaces. In fact, I have spoken with quite a few parents who routinely do this because they want to avoid bedsharing. Here’s what AAP says.

Because of the extremely high risk of SIDS and suffocation on couches and armchairs, infants should not be fed on a couch or armchair when there is a high risk that the parent might fall asleep (AAP, 2011a, p. 1033).

Further, they acknowledge—and seem to affirm—feeding babies in bed, but putting them in their own cribs for sleep.

Therefore, if the infant is brought into the bed for feeding, comforting, and bonding, the infant should be returned to the crib when the parent is ready for sleep (AAP, 2011a, p. 1033).  

Unfortunately, this statement does not acknowledge that it’s quite easy to fall asleep in bed: 70% of mothers in our study who fed their babies in bed said that they fall asleep there (Kendall-Tackett, Cong, & Hale, 2010). And many a new parent would argue that that is precisely the point. There needs to be some recognition of, and planning for, that contingency.  But other than that, I am happy to see this recommendation included.

The final point that I would like discuss is the role of breastfeeding in SIDS prevention, and how bedsharing has a role in sustaining breastfeeding. For example, Helen Ball (2007) found, in her longitudinal study of 97 initially breastfed infants, that breastfeeding for at least a month was significantly associated with regular bedsharing.

We, in the breastfeeding world, have been saying this for a very long time (Academy of Breastfeeding Medicine, 2008; McKenna & McDade, 2005; McKenna & Volpe, 2007). But now the SIDS researchers are saying it too. For example, Vennemann et al. (2009) found that breastfeeding reduced the risk of SIDS by 50%. (Yes, this is the same Vennemann whose meta-analysis was cited above.) Regarding breastfeeding, Vennemann et al. (2009) said the following.

We recommend including the advice to breastfeed through 6 months of age in sudden infant death syndrome risk-reduction messages (p. e406).

Peter Blair and colleagues (Blair, Heron, & Fleming, 2010) went further and highlighted the role of bedsharing in maintaining breastfeeding. (Peter Blair is also a co-author on Vennemann et al., 2012.)

Advice on whether bed sharing should be discouraged needs to take into account the important relationship with breastfeeding (p. 1119).

So I am hopeful that we may be reaching a possible accord on this issue. While the AAP will probably never come straight out and recommend bedsharing, it would be helpful if they acknowledged that it will likely continue, and that our role is to help all parents sleep as safely as possible--either with or near their infants. Such a statement is possible. I’d like to close with the words from the Canadian Paediatric Society (Canadian Paediatric Society & Committee, 2004/2011).

Based on the available scientific evidence, the Canadian Paediatric Society recommends that for the first year of life, the safest place for babies to sleep is in their own crib, and in the parent’s room for the first six month. However, the Canadian Paediatric Society also acknowledges that some parents will, nonetheless, choose to share a bed with their child…..

The recommended practice of independent sleeping will likely continue to be the preferred sleeping arrangement for infants in Canada, but a significant proportion of families will still elect to sleep together…….

The risk of suffocation and entrapment in adult beds or unsafe cribs will need to be addressed for both practices to achieve any reduction in this devastating adverse event (emphasis added).

References

Academy of Breastfeeding Medicine. (2008). ABM clinical protocol #6: Guideline on co-sleeping and breastfeeding. Breastfeeding Medicine, 3(1), 38-43.

American Academy of Pediatrics, & Task Force on Sudden Infant Death Syndrome. (2011a). Policy Statement: SIDSand other sleep-related deaths: Expansion of recommendations for a safe infant sleeping environment. Pediatrics, 128(5), 1030-1039.

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Vennemann, M. M., Hense, H.-W., Bajanowski, T., Blair, P. S., Complojer, C., Moon, R. Y., & Kiechl-Kohlendorfer, U. (2012). Bedsharing and the risk of sudden infant death syndrome: Can we resolve the debate? Journal of Pediatrics, 160, 44-48.

Kathleen Kendall-Tackett, Ph.D., IBCLC, RLC, FAPA is a health psychologist, IBCLC, and Fellow of the American Psychological Association. Dr. Kendall-Tackett is Editor-in-Chief of Clinical Lactation, clinical associate professor of pediatrics at Texas Tech University Health Sciences Center, and owner of Praeclarus Press. More information on the mother-infant sleep debate can be found at http://praeclaruspress.com/sense-sensibility.html