Bedsharing a highly positive variable for breastfeeding duration Madeleine Love, Private 25 April 2007 Dear Della, Helen, Judith, and publisher Lisa,Thank you very much for summarizing the breastfeeding experiences of women in my home city. I was a little frustrated though that a major influence on positive breastfeeding outcomes (mother and baby sharing a night-time sleep surface or within touching reach of each other) had not been included as a variable. I write this letter to implore future breastfeeding duration studies to include "night-time surface-sharing" as a variable.The predominant nighttime co-sleeping behaviour of mother-infant pairs in developing populations (where breastfeeding is universally successfully established), contrasts dramatically with the "standard" night-time practices in western developed populations where the establishment of early successful breastfeeding is certainly not "normal". The most successful breastfeeding population in the post-developed world, Norway, in it's "How you breastfeed your baby" pamphlett prepared for new mothers and published by the Norwegian Directorate for Health and Social Affairs advises the following for Nighttime Feeding: (Translated from Norwegian) "With the lowest possible light, take the baby up to you in the bed when you breastfeed, and you should there fall asleep together if there are not any dangers associated with it", offering a few accompanying advisories on safe practice. "Hvordan du ammer ditt barn" http://www.shdir.no/vp/multimedia/archive/00004/IS-2092_4513a.pdf. The few studies which have included bed-sharing as a variable have found a highly positive association with successful breastfeeding. Listing a few:(South-East England) Clements MS et al, “Influences on breastfeeding in southeast England”, Acta Paediatr. 1997 Jan;86(1):51-6.(North-East England)Ball HL, “Breastfeeding, Bed-Sharing, and Infant Sleep, Birth 30:3 September 2003 181-188(England)Blair PS and Ball HL, “The prevalence and characteristics associated with parent-infant bed-sharing in England”, Arch. Dis. Child. 2004;89;1106-1110(New Zealand)Ford RP, Mitchell EA, Scragg R, Stewart AW, Taylor BJ, Allen EM. “Factors adversely associated with breast feeding in New Zealand”, J Paediatr Child Health. 1994 Dec;30(6):483-9 (abstract)(United States - whole population)Willinger M et al, “Trends in Infant Bed Sharing in the United States, 1993-2000, Archives of Pediatrics & Adolescent Medicine, Vol. 157 No. 1, Jan 2003McKenna JJ, Mc Dade T, “Why babies should never sleep alone: A review of the co-sleeping controversy in relation to SIDS, bedsharing and breast feeding”, Paediatric Respiratory Reviews (2005) 6. 134-152, citingMcCoy et al, “Frequency of bed sharing and its relationship to breast feeding”, Developmental and Behavioral Pediatrics 2004; 25: 141-149 and McCoy et al, “Population-based study of bedsharing and breastfeeding”, Pediatric Research 2000; 47: 154ATime series bed-sharing trends can be compared with breastfeeding data from Mothers Survey, Ross Products Division of Abbottgiven respect to data fromLi R, Zhao Z, Mokdad A, Barker L, Grummer-Strawn L, “Prevalence of Breastfeeding in the United States: The 2001 National Immunization Survey”, Pediatrics 2003;111;1198-1201and with regard toRyan AS, “The Truth About the Ross Mothers Survey”, Pediatrics Vol. 113 No. 3 March 2004, pp. 626-627(Alaska)Gessner BD, Porter TJ, “Bed Sharing With Unimpaired Parents Is Not an Important Risk for Sudden Infant Death Syndrome”, Pediatrics Vol. 117 No. 3 March 2006, pp. 990-001Together with breastfeeding data from Mothers Survey, Ross Products Division of Abbott as above.In addition, the International Child Care Practices Study:Nelson EAS, Taylor BJ, “International Child Care Practices Study: infant sleeping environment”, Early Human Development 62 (2001) 43-55gave the world a look at the prevalence of bed-sharing in urban co-horts in a number of world cities. While expressing concern about the inter-cohort methodology consistency, and warning of the inappropriateness of extending urban co-hort finding to population experience, it was nonetheless clearly apparent that the Stockholm cohort (within the second-best breastfeeding post-developed population, Sweden), had strikingly high incidence of bedsharing (65% of 3 month olds on a particular night) in comparison to cohorts of less-successful breastfeeding nations (Brisbane, Australia - 30%). Stockholm's fully breastfeeding rate at 3 months ~85% (early 2000's), and Brisbane's may be estimated at around 50%. That these series of concurrences between successful breastfeeding and bedsharing goes beyond association to "essential behaviour for success" has been given support by the early ground-breaking work ofBall HL, Ward-Platt MP, Heslop E, Leech SJ, Brown KA, “Randomised trial of infant sleep location on the postnatal ward”, Arch Dis Child 2006;91:1005-1010finding that mothers who shared a sleep surface with their infant on their first two nights in hospital made more than twice as many attempts to breastfeed through the night, established more than twice as many successful breastfeeds, the babies put in twice as much feeding effort , and over the long term (16 weeks) these mothers were twice as successful at breastfeeding, in comparison to group of mothers with the standard care rooming-in plastic cot.While there will obviously be concerns for the unknown SIDS variable, it has to be clearly stated that no SIDS case control study has ever been able to arrive at an odds ratio for non-smoking bed-sharing breastfeeding mother infant pairs (and none have tried). In today's environment most SIDS happens in the diametrically opposed demographic to the successful breastfeeding demographic, yet this is the demographic shown to be more likely to be bedsharing. The risks are so very low for breastfeeding bedsharing mothers, and variable requirements for SIDS studies so high, that statistical certainty would require a case-control study of unmanageable size. Certainly the high bedsharing, high breastfeeding populations of Norway and Sweden have SIDS+unexplained infant death incidences in the 0.2-0.3 range, generally well below those of other post-developed populations. With respect to accidental rollovers, this also is an event of extreme unlikelihood for breastfeeding mothers who are following the simple precautions for safety, and likely to be below the chance of an infant accident associated with a cot. Competing interests My greatest mothering regret is that I didn't sleep with my first baby until secret whispers from women at Australian Breastfeeding Association meetings told me that they slept with their babies. I was very upset that I had not been told that this was a common (and apparently near-necessary) practice amongst successful breastfeeding mothers, following near-failure breastfeeding my first child. I slept with my second and third babies and the experience was incomparable - no fatigue, no mastitis!