Transcript:
This is Maureen Farrell and Heather ONeal and this is The Milk Minute. We’re midwives and lactation professionals bringing you the most up-to-date evidence for all things lactation. So you can feel more confident about feeding your baby, body positivity, relationships, and mental health. Plus, we laugh a little or a lot along the way.
So join us for another episode. Welcome back to the Milk Minute Podcast, everyone. Hello. We, I, okay. I’m excited about today’s episode. We I you us all of us together. I got too excited. No. So we’re gonna do a two part episode, and this is part one, and we are going to focus on bed sharing, breastfeeding co-sleeping and that whole topic right of controversy.
Quick trigger warning. We do mention SIDS, no detailed stories about SIDS. No, nothing like that. We are not here to emotionally put you through turmoil, but we do need to mention it because that is pretty much the crux of all decision making when it comes to how you choose to feed and sleep.
Yeah. We’re gonna talk about infant death in this episode and part two because we’re going to talk about the risk of infant death during sleep. Right. So if you’re like, nope, can’t handle it. We’ll see you in two weeks. And if you’re here for the ride, just, you know, feel free to stop and take a minute if you need to.
Yes, please always feel free to stop. Yes. Get a snack, get a cup of tea and put your feet up. Come back or don’t. We won’t know. Yeah, exactly. Let’s start with a question. Okay, great. I’m here for it. Ask me, Heather. Okay. So this is from our patron Cecilia in Italy. Okay. Cecilia says I’m working from home with enough flexibility to breastfeed baby.
However, I’m starting to build up a little emergency stash in the freezer because who knows? I’m using the haakaa. Thanks again for past advice on that, by the way, but it kind of hurts slash burns a little. Is that normal? I’m thinking maybe it’s because I’ve never had anything apart from baby suckling on my breasts and pumping even with the haakaa is different and I need to get used to it? Question mark.
I think you’re right. I had the same experience using the haakaa where the first, like two weeks I was like, wow, this is just never comfortable. I tried a bunch of different brands. Turns out they were all uncomfortable. What I did do to make it more comfortable was instead of putting it on by bending the flange back like it you’re supposed to, I just simply squeezed the bulb and shoved it on.
Yeah, that’s what I do too, actually. Yeah. I don’t do the flippy method anymore because it’s like too it’s too much jarring almost. It’s like pinchy, pully, burnie, weird. I don’t know. So yeah, I just did that and it, sometimes I would have to adjust it a little bit more.
It like doing the flippy method seems like you get it in right the first time, but it’s a lot. And also just be cautious of where your nipple placement is in the haka. So I, I do the vertical squeeze methods, you know, I squeeze the actual haakaa. And I start the flange at the top of the breast. And then I kind of fold. I kind of just like bend it down and then release.
I do the complete opposite. Yeah. Well, you have to, based on like your anatomy, like, you don’t know what’s going on inside your breast, so just try different things. So I usually start with that because the nipple is more at the top of the flange opening, kind of like the baby’s roof of the mouth.
So if the nipple is placed more upward than in the direct middle or downward, it makes more sense to me. But yeah, there’s no exact science. No, I, I do basically the same thing in the opposite way where I squeeze it and I lay my areola on the bottom of the haakaa with my nipple kind of pointed right at that narrow neck.
And then I put the thing, put it back toward me and then my nipples kind of toward the top. I think the moral of the story is there’s no rules about how you put the haakaa on and we absolutely encourage you to like play and just figure it out. Yeah. Just experiment, you know, your boob isn’t broken. No, if it doesn’t respond to the haakaa. You know, 10 milliliters is normal.
One drop is probably not .Like if you are getting one drop, it’s kind of like, all right, let’s play with placement. Yeah. And if you try it seven different ways and it still doesn’t work, then maybe it’s not, it’s not working for you. Yeah. And really I did feel significantly like consistently uncomfortable for the first couple weeks I tried.
And then now I’m like, oh, I forget it’s on and fall asleep with it there. Oh my God. You know, I do have a patient who sleeps with her ladybugs on. Nice. And I said, is that uncomfortable? And she said, no. And she wakes up and there’s three ounces in there in the morning. And I’m like, what? Sounds cool. All right, whatever works for you.
How do you keep ’em on? Do you sleep sitting up like a mummy? You know, like, you know, you can really flatten them in your bra pretty well. I cannot sleep with a bra. Also, even if I did, I would wake up with like one boob out some, you know, like it just doesn’t. But if you already do that, why not? My friend, Susie, shout out Susie who works labor and delivery.
She came to work one morning and she said, oh my God, you guys, she was like, last night I fell asleep in my husband’s muscle tank and the, the sleeves were cut all the way down. And she said she woke up and both of her giant boobs were out each side of the arm holes and just the t-shirt was in the middle.
And she said, her husband looked at her and went, wow. Wow, Susie, that’s pretty hot. It’s how I feel like every time I sleep in a tank top, there’s like one out, one way, one out the other. It’s hard to be sexy, whatever. Okay. Well, I hope that helps you Cecilia and I hope that helps anybody else trying to troubleshoot the haakaa. We do have a couple patrons to thank.
I would love to thank Katie Brewer from Irvine, California, as well as Katie Baker- Cohen. Thanks guys. Thanks Katie’s. Very exciting. We love new patrons and we would love for you guys to join us. So yes, please do. And that link to join is in the show notes. Just a reminder, also that both Maureen and I do consults and the links to schedule with us are always in the show notes of every episode.
So, you know, depending on where you are in your journey, If you happen upon us in episode 100 or 200, whatever it’s gonna be. If we do this 10 more years, it’ll be episode 500. That link will always be there for you if you decide you need us. Okay.
All right. It’s Maureen here. And I want to tell you that I have finally set up a link so you can instantly book virtual lactation consults with me. Oh, thank the Lord. I know Heather, it took me a long time to take the leap from in person visits to virtual, but I did it. You’re gonna love it. I love doing virtual consults.
They are the best. It serves more people. I’m so glad you took the plunge. Thank you. And if you guys out there wanna book some time with me, you can go to HighlandBirthSupport.com and then click on my lactation services tab. Is that H I G H L A N D? Yes. Okay. I will see you on zoom every.
Well, how do we wanna begin Heather? I mean, I guess let’s start with the controversy. Okay. You know, like you can’t even mention this topic without people feeling the big ick inside. Yeah. Yeah. It’s tough. In the USA, let’s start out that way because the stigma or cultural norms around this vary a lot across the world.
But here in the US, if you mention sleeping with your baby in your bed, like I’m the, as somebody who has pretty exclusively done that, I can tell you that the responses I’ve gotten vary from like uncomfortable to outright hostile. Yeah. Oh yeah. Yeah. And actually, funny story. When I started researching this episode, I was actually thinking I didn’t bed share, so I hope I can relate to this. And then the deeper I got into the research from where I realized, yeah, I did.
I just didn’t think it was bed sharing in the traditional way that I previously thought it was so if you don’t think this applies to you because you put your baby in a crib or a bassinet. Listen up because it actually might, and that’s also fine. So I don’t feel residual shame from like previous decisions that I made with sleeping with my kid.
But it is good for me to know that I’m not like separate and different from Maureen. Like we just did different things and I’m still actually in the group of bed sharing, even though I didn’t think I was. I think that you would have a hard time finding a parent who has never done that. Mm-hmm I think you’d have a very hard time finding parents who admit to it or the extent of it, or the ability to recall, right.
Because you’re bed sharing most likely cuz you’re exhausted. Mm-hmm. And then it’s like, you’re getting a survey from your doctor or it feels more like an interrogation and you’re like no, I, I don’t bed share. So my baby always sleeps in a crib. So you’ve never fallen asleep with your baby ever? Yeah. No.
And that’s the thing that is a challenge in presenting this episode, right? Is that we have a lot of anecdotes and we don’t have a lot of evidence that from studies that were conducted in a really accurate way or from data that was collected in a way that excludes the right information includes the right information.
Because a lot of this is self-reporting. I can almost guarantee if I polled all of you out there and said, did you ever bed share? Sleep with your baby in your bed? Most of you would say no. Where the reality is most of you have done that. And that is the problem with a lot of the research on this.
And, you know, we have statistics lumped in from people who bed share on purpose and that’s their intended plan and people who didn’t intend to. So it’s a very muddled topic. Yeah. And because there’s not really an exact definition of what bed sharing entails, it makes it hard to replicate these studies too. Mm-hmm. So like, is it you did it one time? You do it three times a week?
Is it just overnight or does this include naps too? Right. And what if the baby is sleeping a whole arm’s length from you on a hard flat surface like they do in Hong Kong? Or how about in New Zealand where the baby sleeps on top of the covers between the parents instead of under the covers?
So this can super mess with the research and, you know, I would say traditionally what they seem to have agreed on possibly in a gray area is that bed sharing is typically described as sleeping with any adult at any time in the last two weeks when that adult is also sleeping. Right. So yeah, not just like you’re having a contact nap and you’re scrolling your phone.
But what if you’re asleep, but you don’t actually think you’re asleep? Oh, I have so much to say on this today. Yeah, it’s, it’s pretty wild and you know, we have to look too at frankly we, as a species, as far as we can tell evolve to sleep with our babies, pretty much like every other mammal, because it is not safe to sleep apart from your babies. Right.
And specifically human infants are born with only 25% of their adult brain volume. Right. And they’re especially needy compared to our other mammal friends.
And so close proximity to mom in particular, or the breastfeeding parent makes sense with an infant that’s so reliant on others for survival. Like, it does not actually make sense if you think about it in any other way. Like, oh, of course this thing that requires literally everything for me should be in another room.
Right. And it’s like, okay. Every healthcare organization agrees that if we minimize the separation between mom and infant, we have better health outcomes for both and better breastfeeding outcomes. And then on the same turn, they’re like, but don’t sleep with your baby. Right. And also if anything bad happens, it’s your fault.
Sure. But we don’t know what causes it, but it’s definitely your fault. Yeah. Sleep with one eye open. That messaging is really a mind fuck as a new parent, especially as a first time parent, you know. And say you have a baby in the hospital and everybody is checking in on you all hours of the day and you have the bassinet and the nurse and everything.
And then they’re like, okay, go home where you have none of the help we just gave you. You have to somehow, you know, get this infant to sleep on their own in the same room as you, but not in the same bed or else, you know, SIDS s your fault cuz you didn’t follow the guidelines. It’s crazy.
Yeah. And kind of the way I think about this also is that all babies are different. Yeah. I’ve met a lot of babies. You guys, a lot of babies in my life at this point, and they are all extremely different in what they request from you. And I like to think of breastfeeding as a conversation between you and your baby. So every time you get together in breastfeed, your bodies are conversing.
And that’s really important because the joke of parenthood is that you’re always a step behind your kid developmentally. Like you don’t know, they, they wake up and they’re completely different. And now you have to adjust to their new developmental stage that they’re in. And so when you come home from the hospital and you had your best laid plans of not co-sleeping and you were, you had this whole like bassinet situation worked out and you were like, definitely gonna do it.
And you read all the books on how to do it safely. And then you get a kid that cries all night long, repeatedly for months. And the doctor keeps saying, I don’t know, they’re medically well, you know, this is just a first baby problem. You know, you’ll get used to it. Or, you know, even eventually you’ll learn how to function on no sleep and he’ll grow out of it.
And you’re left there with no options because no one is willing to actually talk to you how to maybe think about changing your sleep pattern so you can breastfeed more, get your baby and your body back on the same page, because maybe we’re missing that important nighttime conversation that that baby really needs.
Yeah. And, you know, maintaining a good sleep schedule as a new parent is really important for your health, too. And it, so I was of course decided to listen to the ologies podcast about sleep in preparation for this. I did too. Oh, yay. I love Alie Ward. Yeah. And I was just like, cuz I was trying to actually just figure out the whole like light sleep, deep sleep REM sleep thing.
Mm-hmm and they mentioned how the REM sleep cycles don’t happen until at least 90 minutes into your own sleep. And coincidentally newborns tend to have 90 minute sleep cycles, like in their entirety. Yeah. And breast milk is digested in 90 minutes. It’s interesting. So, you know, I think we should be doing everything we can to preserve parental sleep, whether that means we’re encouraging safe bed sharing or safe crib sleeping.
Yep. And there’s no way for us as providers to know what’s going to be best for somebody else. Yeah. But let’s talk about, you know, let’s, let’s talk about it today because we want you guys to feel like you have the information where you can make that decision. And then the providers that are listening, have the information so that they can have responsible conversations with their patients.
Yeah. And let me holler at the other lactation consultants listening right now because there’s actually research about you guys, and how you feel about the situation. And so I did find this one study and by the way, reminder, all of the research studies that we use are linked in our transcript. Yeah. That you can find in our show notes if you wanna go read it yourself.
But lactation consultants in general, feel restricted from even discussing bed sharing with clients due to this stringent guidelines. And this is an issue because many lactation consultants are actually working with parents during a really important time when they are at a critical time for infant safe sleep decision making. Yeah. Like between hospital discharge and the two week pediatric visit, like right. Yeah. Or the, or the six week maternal visit, like that’s lactation. Right. And most lactation consultants do agree that overnight feeding helps the breastfeeding longevity and the relationship in general. Mm-hmm.
So this one study showed that many LCS feel that the abstinence policy of no bed sharing is it’s unrealistic. It’s unrealistic. It’s only, yeah. Abstinence has never worked as a method guys. I mean, and we should know that about everything at this point. Like if we present something as a no choice, like a no option scenario, it doesn’t foster honest communication, right.
And honest communication and trust leads to better health outcomes. And I think most providers just are afraid of liability. Yep. You know, I did it, you know, I was lucky enough to have a family doctor who asked, like, is baby sleeping in a crib? And I was like, no. And she was like, okay. Like, do you know how to safely bed share?
And I was like, yep. And she was like, okay, like, there is a slightly increased risk. And I was like, okay. She was like, okay, let’s talk about something else. Like, yeah, moving on. Thank you. And that’s not most people’s experience here. And also at the hospital. I just wanna say like, it has happened at the hospital.
Okay. Where we’ve had a bad outcome from that. Yeah. But also think about what’s happening in the hospital. You know, you’re in those really uncomfortable beds that are never flat. Well, they’re not safe. They’re not safe for bed sharing. No. In the US. Now there are other countries that are introducing hospital beds to the maternity ward that are safe for bed sharing, or that have bassinets built in.
Yeah, wouldn’t it make sense to actually have them sleeping in a place that resembles what they’re gonna be doing at home so you can show them how to do it correctly for when they do go home? Yeah. You know, I just, I get that, like the labor beds have to be a certain way. Sure. But they move for postpartum anyway.
Exactly. So why not just have it set up that way? With, you know, some of ’em I’ve even seen have the attachable bassinet. Mm-hmm. They’re cool, which is really neat. And then instead of your nurse coming in, being like, if you fall asleep with that baby in bed, again, I’m gonna be forced to report it. And, or they’re just continuously charting, like found infant asleep in bed with parent again, placed in bassinet.
Will reeducate, reeducate, reeducate. Yeah. And it’s like, oh God, you, what you mean is like shame, shame, shame. And the problem actually is she’s exhausted. Like, can you maybe take the baby and hold it for her so it doesn’t cry?
Man. I wish I could remember where it was. I remember seeing an article and pictures from a maternity ward where it was like more of an open system. But they paired up two new mothers and their babies, like in the same space, just really interesting. And in these like safe bed sharing beds and everything, and I was like, ugh. That’s kind of cool. Yeah.
But, what was that study that we, I forget what episode it was for, but when you put a bunch of new moms and the babies in the same room together, yeah, the parent will only wake up to the cry of their own baby after a few days. Like you just get in tune with it and, you know, I just wanna also mention that along with all these anthropological studies about how, like, probably we were co-sleeping with our babies forever as hominins or whatever.
But we weren’t doing it in isolated nuclear family groups. No, we were doing it with women all around us. Right. Constantly having babies, feeding each other’s babies in the middle of the night, helping holding, doing all the additional chores. Like it’s not the same. And so it’s just very unrealistic and rude, in my opinion, to think that one person who just birthed a baby is supposed to also never sleep and provide food for a baby 24/ 7.
And it just, it doesn’t make sense to me. Yeah. Okay. So let’s talk about who is most likely bed sharing? Who bed shares, Heather? Who does it, except for me? Is it hippies? Is that what it is? Actually, most of the research that I found from prior to 2004 classified the typical bed sharer as a young, non-white, single mother of low means, unemployed with five or more kids who lives in an overcrowded dwelling with a lower socioeconomic status father.
Wow. I feel like that sounds judgey. Mm-hmm. But we do have I don’t know. I, I was looking at like health outcomes and bed sharing among communities and they are really different because bed sharing, if you are, if you have lesser means is going to look different, then somebody who is bed sharing and they can buy a new mattress and they can get all the safe things that they’re supposed to get and blah, blah, blah. Mm-hmm.
And I think now it’s becoming a much more popular thing among parents who have more means, who have more education. Maybe they’re just talking about it more. And also in, in my, and this is anecdotal, yeah. But in my experience, working with working parents, who have to get up and work a 10, 12 hour shift the next day, or maybe they only see their baby for like an hour awake a day.
It’s really important for them to maintain their relationship with their baby. Yeah. When they don’t see them that often. And they want to bed share just to feel that closeness and that bond. Right. And they feel super guilty about it. And I really always try to be like, don’t feel guilty about the fact that you want to feel close to your child.
Let’s just talk about how we can do that safely. Yeah. And actually this study I found from the UK considered bed sharing relatively common over there. And you know, so if you’re from the UK, write in and tell us your story. But this study actually showed the strongest correlation with bed sharing was breastfeeding, not socioeconomic status or, you know color of your skin or anything.
It was more like if you’re breastfeeding, you’re most likely more commonly bed sharing and that it was more common amongst affluent families with resources in the first month of life, which is hugely different from the previous research that I found. Yeah. And I wonder too then, like, what is their messaging about it?
Right. Because in the US, we have what we call the abstinence only approach , but it’s, it’s technically the ABC approach. Alone, on their back, in a crib. And that comes right from the AAP and the CDC. And currently the statistics are somewhere at over 60% of parents in the US have bed shared before whether or not that’s their norm, whether or not they planned to.
So most parents have done it, will do it, whatever. And the ABC education that everybody’s getting hasn’t changed that. And this has been a pretty hard line the AAP has been taking since like the late nineties and it’s not working the way they want it to. Well, there’s been a, so we’ve actually started now to see that different countries report infant death differently, and it’s really hard to distinguish SIDS.
Sudden infant death syndrome versus SUID sudden unexplained infant death versus ASSB, which is accidental suffocation and strangulation during sleep. So now, you know, what we’ve actually seen is the rates of SIDS have decreased by 50% since the 1990s back to sleep movement. But have plateaued since 2001, but there’s been an increase in SUID and ASSB rates, right.
Which we didn’t really use before then. Right. So perhaps they’ve just been reporting them differently and nothing has actually changed since eliminating the fluffy pastel bumpers in the nineties. Right. And that’s what really bothers me a lot of the time when we have healthcare providers taking this hard line status and just being like the evidence supports sleeping alone in a crib.
You know, it, it reduces the risk of infant death and we’re like, okay, but does it really? Because the research is muddy, it is muddy. And we don’t know that the alone, back, crib approach has decreased sleep related deaths. And what we do know right is that parents are going to fall asleep with their kids. The AAP basically says, it’s okay to take your baby to bed to nurse, don’t fall asleep, then get back up and put them in a crib.
Folks. If you lay down to nurse your baby in your own bed where you’re super comfy, you’re probably gonna fall asleep. Yeah. And the reality is too, a lot of the time I hear patients say things like, well, I was up all night and I didn’t get a wink of sleep. And that’s actually a huge red flag for me because if you are sedentary and you think you didn’t sleep, you’re probably wrong.
If you were up and moving and you’re like, I was painting and doing a project and, you know, whatever. Okay. Maybe you didn’t sleep and you really pulled an all nighter. However, light sleep, as far as your brainwaves go is not that different from being awake. It can happen in small spurts and we don’t usually remember.
And you can’t control it. Yeah. Sleep happens. You know, it just happens. It’s like a natural thing that your body does when it needs it. And your body’s selfish and it’s not gonna be like, oh, sorry, you had something else going on. Right. If you give like three out of the four triggers that it’s sleeping time cuz you’re in your own bed and you’re laying down and then you get, and it’s dark and then you get a hormonal rush of oxytocin, which does make you sleepy.
And we did an episode on that, which we will link in the show notes, on how oxytocin makes you sleepy and thirsty, it’s gonna happen. Yeah. And then if you’re like, okay, I’m gonna fall asleep in my bed and you’re afraid to nurse there. Then you’re like, I’m gonna nurse on the sofa or a recliner or that chair that somebody bought me off my registry, which are all more risky places to sleep with a baby.
Tell us why. So the reason those are more risky is because baby is more likely to essentially get smushed between you and a pillow. We know pillows are a high risk for suffocation for baby. Couches are just structured pillows. Like, you know, recliners are often really pillowy. They have cracks baby can fall down in.
And here’s the thing. When you fall asleep, you essentially experience full body muscle paralysis, right? Except for your breathing, your eye movement, your heart, like all your involuntary stuff, but you’re not aware enough to hold your baby. And it is normal then in your sleep for your muscles to relax and for them to stop responding.
So you are at a high risk for allowing your baby to slip into a crack and then really be, be in a dangerous position. There was another study that found that 44% of parents who are nursing in those kind of places like the chair, the recliner, whatever that they have fallen asleep there at least once.
And that scares me. That they’re aware of, right. That they’re aware. And a lot of people eventually come around to bed sharing, but only, you know, if they didn’t plan out originally, but only after they go through a lot of these really high risk arrangements to get there. And I don’t like that. Right. Like by the time they realize they have an actual problem, right.
They’ve already done a lot of risky things to get back to a lower risk thing. That’s maybe a little bit more risky than the thing they were trying to do in the first place. It’s really convoluted. And, you know, we’re trying to figure this out in the most vulnerable time of our lives, with the least amount of sleep, the least amount of blood flow to our brains, you know, and that’s really hard.
And then on top of it to have unsupportive friends and family who are like your baby’s gonna die if you bed share. Or pediatricians who are saying that. I mean, frankly, like you’re on Facebook and TikTok and like that’s all you see about it. It’s wild. Yeah. Didn’t you see? What was that one thing that you saw that was like a graphic of. Oh, so there was this old commercial that basically it was like a PSA, you know, and it depicted the mother as a meat cleaver.
Oh my God. Next to her baby in the bed. And then the headboard said something like, this is your baby’s final resting place. Like what the fuck? Yeah. That is wild to me. Relax and enjoy motherhood. Careful. You could be the one to do it. Yeah. And I, and I absolutely understand that babies have been smothered by their parents.
You know that babies have suffocated in beds before. However showing people things like that when we know that, like basically telling them to crib sleep and that’s it, and that doesn’t reduce bed sharing, like that just seems like a whole fucked up dynamic to me. Yeah. It seems inappropriate. It seems like it doesn’t help people make better choices and it just makes them really afraid.
Well, I, I mean, and this translates to a lot of different areas of parenting. Mm-hmm. So anytime there’s like a severe rampant issue with babies, I feel like the parents get blamed a lot. And whenever, I mean, I kind of think of it as like, if this is so common, why are we blaming the parents? I don’t think we have all the pieces of the puzzle.
Right. And for an exam as, just as an example, like chronic diaper rash. Like when you take your baby in for chronic diaper rash, the first thing they usually say is, are you changing your baby’s diaper enough? Yes. Are you changing your baby’s diaper enough? Yeah, we use really absorbent, disposable diapers.
Yeah. That wick the moisture completely away from the baby’s skin. So like of course we’re changing the diaper. Yes. And it, and it’s just like so offensive because like, I remember being that parent. And like blow drying my baby’s butt and like making, letting them go diaper less for days with pee and poop everywhere.
And then you go to the pediatrician and they’re like, are you changing the diaper enough? I’m like, I’m not even using a diaper. My whole house is covered in poop. And it’s, that’s not the issue. The issue is probably a microbiome disorder. Yeah. You know, that reminds me. This, that part’s not new.
My mother-in-law her first son, who has had a number of health issues, you know? But he was one of those babies who was like colicky and never stopped breastfeeding and literally just like on her breast, 24 hours a day for the first like six months. And like he had one of those diaper rashes where his butt was bleeding and her doctor basically told her it was her fault and all for like weeks, she would literally just like dip him in a sink full of warm water.
And like, let things drip off. Cuz if you touched his butt, he would scream. Mm-hmm. And then she would like fan it dry. Yeah, that’s what I did with Heidi’s. Poor little baby. She was bleeding like crazy from her and it was all over her vagina too. And I was just like, this is the worst, right.
Instead of your doctor being like, wow, that’s really bad. Like how, how can I help you with that? You know, tell me what you’ve tried. Right. And then we’ll go from there. Well, like another classic example is back in the day when they were seeing that all these two year old’s were anemic, and just assuming that mothers weren’t feeding the children correctly.
Right. Or that like, it was like, oh, because breast milk doesn’t have enough iron. Right. And then now they’re, they’re like, oh, actually it’s from early cord clamping and your baby just started out anemic and now they’re extra anemic and it’s okay. So maybe we should stop pointing the finger at the parents all the time?
Mm-hmm. Not saying these weird, like unicorn one offs don’t happen, but, you know, anyway, we’re just trying to remove a lot of the stigma today. Yeah. So in an effort to do that should we do a little talking about like what exactly is SIDS and all of that. And then the current research on it.
Yes. Okay. So SIDS, the big, scary thing that all of us fear from the moment when we have a child is defined as the sudden death of an infant that we cannot explain after case review or autopsy. So essentially a baby died and we tried to figure out why, and we could not. Unexplained. Right. But something different is S U I D sudden unexplained infant death, which is known as the sudden unexplained death in infancy as an overarching term for all unexpected deaths, basically, whether or not we actually tried to find out what was going on, whether or not there was an autopsy, whether or not there was a case review or an investigation.
And then A SS B. So Accidental suffocation, strangulation. That is when we have an infant death, we look into it and we are like, okay, they asphyxiated, they were smothered. They stopped breathing. They, you know, were strangled by something. Like we found the cause. Those are the three main things we’re talking about today, as far as risk though, for infant sleep.
Right. And there is some research out there showing that it, it’s not all bed sharing, that is a higher risk for SIDS. Mm-hmm. The biggest risk is when a baby is sleeping with someone other than the mom and dad. So siblings, that’s a big one cuz you know how hard kids sleep. Mm-hmm. And they definitely aren’t wired for sound like you are. Like you had a baby and I’m gonna also point you to our older episode, mom genes.
Mm-hmm. Talking with Abigail Tucker about how our brains change postpartum. And, you know, your brain is definitely wired in such a way that you are in tune with your baby, way more in tune than anybody else. So that’s why the risk is a little bit less, right. And we’ve been trying to put the pieces together in the SIDS puzzle for a long time, right?
Because we care a lot about our infants and to have something where babies are dying and we don’t know why is alarming to us as a society. And so, you know, the AAP and the CDC, you know, we’ve been trying to be like, okay, we’ll sleep this way and put your baby this way. It used to be, they had to sleep on their bellies.
Now they have to sleep on their back. You know, and, and the side, remember the phase where all babies should sleep on their side and they made those special wedges just to keep them on their side. Now they’re like no wedges ever. And all of these interventions we’ve done, haven’t made that much progress, but we have some new research.
Do you wanna talk about it? Yeah. I’m also gonna give a nod to Dr. Carmel Harrington in New South Wales. This is a doctor who actually lost her son to SIDS 29 years ago, which launched her into her lifelong research into the why behind SIDS and Harrington and her colleagues compare dried blood samples taken during the newborn heel prick test.
Mm. You know, so the PKU or newborn screen from 655 healthy babies. So that’s a very good sample. And 26 babies who died from SIDS and 41 babies who died in infancy from other causes. And they found that the SIDS babies had lower levels of an enzyme called BCHE.
So this enzyme actually plays a major role in the brain’s arousal pathway. Mm-hmm. And this could indicate an arousal deficit, which reduces an in infants ability to wake or respond to the external environment such as overheating or a blanket over the face. And this could cause vulnerability for SIDS.
So this, although this test is not accurate enough to be used in the newborn screening yet it hints that of normally low levels of a chemical linked to the brain’s arousal system could be involved in causing these babies to die suddenly in their sleep, which makes sense to me.
And, you know, Dr. Harrington is not saying like, oh, this is the end all be all, but it’s a piece of this puzzle that’s really important. And it makes sense because we have known for a long time babies who wake more often at night are less vulnerable to SIDS. And that’s why it’s recommended you sleep in the same room as your baby.
Right? Because your own night sounds rouse them from sleep more. And also breastfed babies. Yes. Oh, go ahead. They’re at a lower risk for SIDS. So we know breastfeeding reduces the risk for SIDS. You know, we kind of know all these little pieces to the puzzle that we’re trying to put together and how to keep babies from dying in their sleep.
And also formula feeding is a risk factor, right, for SIDS. And so that’s how that piece ties in also mm-hmm. And yeah, and that’s part of the reason we’re even talking about it today is because how you feed your baby influences the risk profile. And of course, as always, that is not to say that if you made the choice to formula feed, like you have chosen higher risk for SIDS. No.
That’s obviously, no one is out there doing that. But it is to say if you’re formula feeding, for whatever reason, you should be aware that your infant’s risk for SIDS is very minimally higher, but it exists. Mm-hmm. And also the article about the enzyme deficiency also mentioned that, although there was a strong correlation, I think it’s like one to one and a half times greater the risk if you have this enzyme or if you’re missing this enzyme, is that what it was, you’re missing?
Yeah. If you didn’t have enough of the enzyme. It’s still less than the risk of SIDS if you smoked in pregnancy. Yes. Which is about three times the risk. Yeah. And you know, that’s the interesting thing is we have had more recent research about bed sharing.
We used to, the older research, said that all bed sharing increased the risk of SIDS. Newer research shows that it is a very similar risk profile in fact, to crib sleeping and that the rates of SIDS in safe bed sharing situations under, let’s see. For babies older than three months, there was no detectable increase in the, in, in the rates of SIDS, among the families that practice bed sharing without hazards in the bed versus crib sharing.
And for babies younger than three months, the risk of SIDS increased slightly, but the kind of risk increase where you’re like, okay, technically it’s three times as great, but the risk is still so infant decimal, your baby is much more likely to be struck by lightning in those three months of life.
So if that helps you kind of understand that small, small number we’re talking about, it’s like, it goes from like one in 37,000 or something to one in like 17,000. Well, this is starting to sound more like a VBAC question, you know, like that whole scenario. Does remind me of the uterine rupture.
It’s like the absolute risk versus the relative risk. Yeah. Like the absolute risk of your baby dying from sudden infant death syndrome is very rare, but relative to someone who lets their baby sleep with them, with pillows and the heat on yes, who smoked, you know, it’s like you’re 150 times greater risk relative to someone who doesn’t do those things.
Right. Another interesting piece of the puzzle is that SIDS rates worldwide are not correlated with bed sharing rates. They’re not relational to each other. It’s not like communities who bed share more, have higher rates of SIDS. That is not the case. There are many communities with very high rates of bed sharing, have some of the lowest rates of SIDS in the world.
Other communities with very high rates of bed sharing, have some of the highest rates. Yeah. And you’d think that would be the biggest indicator of all, right? You would. But it, oh, well anyways, but one of the things that I do wanna kind of reframe our discussions around this is that there are other risk factors for SIDS and for parents making unsafe sleep choices with their babies and all of that.
And if our healthcare providers are not having open honest conversations about that, where they’re like let’s talk about your infants risk profile for SIDS and like, oh, they were born pre-term and oh, they’re formula fed and oh yeah. They also have this health condition that nobody told you increases their risk for SIDS.
You know, maybe you’re gonna make a different sleep choice if you had an honest conversation with your provider about that versus not having it and kind of not understanding that whole risk profile. But frankly, many pediatricians and, you know, baby healthcare providers in the US refuse to talk about bed sharing, period.
They, they say there is no safe bed sharing, even if you’re like, well, it’s safer. They’re like nothing. That does not exist. You know, there’s a huge risk of suffocation. And frankly, if the risk is at all greater than crib sleeping, we are not allowed to talk about it. And I’ve seen some ridiculous videos, you know, from pediatricians who are like, well, if I stayed up every night for 30 nights in a row with my baby and didn’t give into bed sharing, you don’t have to either.
And I’m just like, what the fuck is this? What, what world are we living in that, like, that is the perspective that we’re educating people from. Right. Well, and also like we’re getting there in some ways with other topics, but not quite this one. So like for the smoking, for example, yes, we did an episode on smoking and breastfeeding.
The benefits to breastfeeding period far outweigh formula feeding and smoking, you know, so they’re like, okay, you’re gonna smoke. We still recommend that you breastfeed because those benefits are amazing compared to smoking and formula feeding. Right. And let’s talk about how to reduce your use.
Exactly. Same thing with bed sharing and breastfeeding, right. It should be the same conversation. And we are going to talk more about that in part two of this episode. So we’ve gone over SIDS, sudden unexplained infant death, accidental asphyxiation and strangulation, why the research sucks. Kind of the basics of what is bed sharing and why do we care about it as breastfeeding professionals?
And next week, we are going to go more into about a little bit more about that breastfeeding dynamic. How you actually safely bed share. How we educate people about that. And then we’re just gonna talk about why every single parent should know this and what we should all be doing as parents to keep our babies safer, period.
Yes. Yes. Yes. I agree. So I’m sorry if this first part felt a little bit convoluted, there was just a lot of groundwork we had to lay, I think, to get to the more practical side of it. And to just let you guys know that we are not going to judge you for your sleep choices. And we would like every parent to be educated about those choices.
Yeah. Please do what you feel is right. And do it in the safest way you can and, and that’s it. I mean, that’s parenting, it’s like, you’re not gonna nail it. Okay. Every parent is just trying to survive and we’re all doing the best we can. And we at the Milk Minute Podcast believe that you are doing the best you can.
Let’s take a quick break to thank our sponsor, Aeroflow. Aeroflow is your one stop shop to get the most popular breast pumps and accessories through your insurance. Yeah. So don’t let your insurance go to waste. Why don’t you let Aeroflow do all the dirty work for you? You never have to call your insurance when you use Aeroflow and they remind you when you’re eligible for free replacement parts.
Yep. So when you’re tired in your postpartum period and you’re wondering why your pump isn’t working as well, you might get a text that says, did you know you need replacement parts? And you say, I did not know that. Right? You push a button and boom; they show up at your door. Thanks, Aeroflow. Thank you so much.
Go ahead and check out the link to Aeroflow in our show notes and order your pump through them.
It’s time for the award in the alcove. Oh yeah. All right. So we talked a lot about the UK today because they had some good studies. So let’s give a shout out to a friend in London town. Hmm. This is Suzanne Papin. Okay. From London. Hello, Suzanne. Suzanne says, thanks to your podcast and all the support in this group, we just celebrated it an entire week without formula.
We’re still using bottles of expressed milk for about half the feeds, but he’s back on the breast after a serious nursing strike. I’m so happy as we were told to supplement from day one, which led to a bottle preference and me producing less and less.
Yay. Can’t thank you enough, Suzanne P from London. Sorry, not on Instagram. That’s okay. Congratulations Suzanne, on meeting your goals. That’s so exciting. We’re gonna give you the Go Getter Goal Setter Award. Can’t say it 10 times fast, but it doesn’t mean it’s not amazing. Yeah, you’ve done a lot of work to get from where you started to where you are and we sincerely congratulate you on that and hope that you continue to find ways to simplify your breastfeeding with your baby and to feel really fulfilled.
Yes. We’re so proud of you. Good job. Way to take this information and use it in a way that works for you. Yeah. And thanks for listening to another episode of the Milk Minute Podcast. How we navigate this system that is just not set up to support lactating parents is by educating ourselves and others and spreading the good word about this show.
Spread that good word folks. And if you want more from us and behind the scenes personal stories, or if you just wanna support this project and make breastfeeding education more accessible to everyone, you can become a patron at Patreon.com/MilkMinutePodcast.
Yes, please. Yes, please. We’d love to have you, and I hope you guys have a great day and a good night’s sleep and we’ll see you for part two next week. Bye-bye bye.
Sources:
How Dangerous Is It When A Mother Sleeps With Her Baby? : Goats and Soda : NPR
The Safe Sleep Seven – La Leche League International (llli.org)
Reduce the Risk of SIDS & Suffocation – HealthyChildren.org
Ball, Helen L. (2007) “Bed-Sharing Practices of Initially Breastfed Infants in the First 6 Months of Life”. Infant and Child Development. (16) 387-401. https://doi-org.wvu.idm.oclc.org/10.1002/ajpa.21426
Devlin, Hannah. The Guardian, May 22, 2022,“Enzyme in babies’ blood linked to risk of sudden infant death syndrome” https://www.theguardian.com/society/2022/may/13/enzyme-in-babies-blood-linked-to-risk-of-sudden-infant-death-syndrome
Gettler, Lee T., McKenna, James J. (2010) “Evolutionary perspectives on mother–infant sleep proximity and breastfeeding in a laboratory setting” American Journal of Biological Anthropology. https://doi-org.wvu.idm.oclc.org/10.1002/ajpa.21426
Hodges, Nichole, L. McKenzie, Laura, B. Anderson, Sarah, E. Katz, Mira, L. 13, February 2018, “Exploring Lactation Consultant Views on Infant Safe Sleep” Maternal and Child Health Journal.(2018) 22:1111–1117. https://doi.org/10.1007/s10995-018-2495-0
