Bed-sharing means that the baby sleeps in the same bed as the parent or parents. Despite prevailing recommendations to avoid bed-sharing in the first three months of a baby's life, many parents opt for it to enhance family sleep. The innate sense of security that comes with keeping your baby close is hard to ignore.
Interestingly, this closeness echoes an evolutionary norm – mothers across cultures slept with their babies until the early 1900s. The trend of separating infants from their mothers gained traction during the 20th century, coinciding with an increase in hospital births and a decline in breastfeeding in favor of formula feeding. Back then, mothers were encouraged to adhere to strict feeding schedules, disregarding the baby's cues and their own maternal instincts.
The baby sleeps on its back with its head at the mother's chest level. The mother faces the baby, with her lower arm over the baby's head and knees naturally drawn up. This sleeping position is dubbed the cuddle curl, C-position, or protective C.
Benefits of bed-sharing
Bed-sharing not only promotes healthy sleep patterns but also encourages beneficial feeding habits for a newborn. Babies thrive on frequent, small feedings, given their small stomach size and the quick digestion of biologically tailored breastmilk.
By allowing on-demand breastfeeding day and night, babies maintain a steady and balanced intake of energy and nutrients, especially as the composition of breast milk changes throughout the day. Nighttime breastfeeding also supports the mother's milk production, thanks to an elevated level of the milk-producing hormone prolactin at night. Therefore, bed-sharing helps mothers to reach their breastfeeding goals and to breastfeed for as long as they want.
Studies indicate that bed-sharing mothers wake more frequently than those who have their baby in a separate bed, but these interruptions are shorter and synchronized with the baby's natural sleep-wake pattern. Frequent wakings serve as a potential protective mechanism which may reduce the risk of Sudden Infant Death Syndrome. Bed-sharing normally results in more sleep for the mother compared to if she would get out of bed to attend to the baby.
Sleep is essential for new mothers, since it supports healthy functions of the immune and nervous systems, and healing. Encouraging well-functioning sleep positions for breastfeeding mothers is a well-known and effective strategy for supporting healthy sleeping habits for postpartum families.
Risks of bed-sharing and how to mitigate them
There are two safety risks associated with bed-sharing: Sudden Infant Death Syndrome (SIDS) and suffocation. SIDS is a term used for sudden and unexplained death within a baby's first year of life. It saw a significant decline in the '90s when recommendations shifted to having babies sleep on their backs. Today, approximately 1 of 6000 Swedish babies die from SIDS. Suffocation is when the baby has died from lack of oxygen, from blocked airways, being tightly wedged or choking.
Factors that mitigate the risk of SIDS:
Protect the baby from cigarette smoke during pregnancy and afterwards
Breastfeed, or bottle-feed with breastmilk, if possible
Allow unrestricted nighttime breastfeeding or pacifier use
Make sure the baby does not get overheated
Let the baby sleep in your bedroom, even if he or she sleeps in a separate bed
Do not let the baby sleep in a car seat for longer than necessary
Vaccinate the baby following the national vaccination program for children
Regardless of whether the baby sleeps in your bed or in a separate baby bed like a cot or a crib, it is essential to create a safe sleep environment. To avoid the risk of suffocation, the baby should sleep on a firm mattress without loose objects near the face. That includes pillows, blankets and stuffed animals. Even a crib bumper or baby nest can pose a risk since the baby’s face can end up pressed against the soft padding. A sleep sack is a good alternative to a baby blanket. If you want to use a blanket anyway, make sure it does not reach higher than the baby's chest level and tuck the ends under the mattress to keep it in place.
In addition to what has been mentioned above, there are a few extra considerations to keep in mind if you plan to bed-share with your baby.
Bed-sharing is safest when you are:
Smoke-free (applies to everyone sleeping in the same bed as the baby)
Not under the influence of alcohol, drugs, or medications affecting your level of consciousness (applies to everyone sleeping in the same bed as the baby)
Breastfeeding
And your baby is:
Full-term and healthy, with normal birth weight
Sleeping on his or her back when not breastfeeding
A spacious bed with a flat, firm mattress is crucial. Falling asleep with the baby on a sofa or in an armchair is associated with an increased risk of SIDS and suffocation accidents. Other children or pets should generally not sleep in the bed at the same time as the newborn baby, but feel free to make your own risk assessment.
If there are two adults in the bed, the baby should sleep on the breastfeeding parent’s outside, but far enough from the edge so there is no risk of him or her falling off. Many parents choose to remove the legs of the bed to reduce the distance to the floor, and/or put a mattress on the floor next to it as an extra precautionary measure.
Why bed-sharing is not recommended for non-breastfeeding babies
Bed-sharing in combination with breastfeeding is the biological norm. The sleeping position and the sleep-wake pattern that, according to scientific research, is safest for bed-sharing babies occurs naturally when the baby also breastfeeds. This sleeping position is known as the cuddle curl, C-position or protective C, and looks like the baby sleeping with his or her head at the level of the mother’s chest, and the mother is sleeping on her side, facing her baby. Breastfeeding also offers natural protection against SIDS. Babies who are partially breastfed also get some protection.
Why do the National Board of Health and Welfare (Socialstyrelsen) discourage bed-sharing?
The National Board of Health and Welfare’s official recommendations are based on the assumption that parents may struggle to eliminate identified risk factors that could make bed-sharing unsafe. Therefore, they discourage bed-sharing for the baby’s first three months of life.
The lack of sufficient information about safe bed-sharing practices has led to the spread of baseless recommendations based on cultural norms and personal values. A common recommendation from health care workers and representatives of the National Board of Health and Welfare is to use a baby nest to improve safety while bed-sharing. The National Board of Health and Welfare has not officially made a claim about baby nests, but in other countries, like England and the USA, authorities advise against letting babies sleep in such products since they generally do not meet the requirements for a safe sleep environment. Furthermore, baby nests disrupt the natural sleeping position conducive to nighttime breastfeeding.
The advice to let the baby sleep in a baby nest is based on the assumption that the mother poses the greatest risk to the newborn baby, and that bed-sharing is safe as long as the baby is surrounded by padded edges and/or pillows to prevent the mother from inadvertently rolling over the baby in sleep. This way of thinking is entirely backwards, as the padded edges and pillows pose the real risk. By sleeping together in a position that promotes on-demand breastfeeding, the baby gets natural protection against SIDS through breast milk and sucking. The mother's C-shaped body also creates a protected space in the bed where the baby can sleep safely. Because the baby sleeps with his or her head at the level of the mother's chest, the adult's pillow also poses no risk.