Breastfeeding and lying down

Question
I teach antenatal classes and have been asked about breastfeeding while lying down and the risks to baby if Mum falls asleep.  I am very aware of the practical reality of this happening (I did this very thing with my 4 children), and am torn between the strict "PC" answer and an answer with realism.  I would really appreciate your feedback.  I have gone through your slides and know you cover co-sleeping (slide 8) but wondered whether you could provide any other guidance specifically in relation to feeding while lying down.

Response

We prefer to take a principled approach and avoid being drawn into the specifics of every situation as ultimately, parents must manage safety in a variety of circumstances. That is the realism you speak of. Principles support you to step back from deciding for parents and support parents to figure things out backed by the principles. The triple risk understanding is also critical – interplay between infant vulnerability, stage of development and external stressor.

To protect babies through the critical developmental period of the first 6 months babies need certain conditions when they sleep. All babies in every culture and continent need these conditions every time and in every place they sleep as the developmentally vulnerable moment does not announce itself. The conditions are face-up (on the back) to protect through the vulnerable stage, face clear and airway open (straight neck) to protect against asphyxia or accidental suffocation, and smokefree and breastfed to boost resilience. More vulnerable babies (those smoke-exposed) also need the added protection of their very own baby bed when they sleep.

It is not so much about PC, but about a true assessment of vulnerability for the consequences of a sudden infant death are cruel for parents acting with low awareness of what might happen. So, to be specific for you with regards to feeding in a lying position, if parents can create the safety conditions and not fall asleep, then their baby is as protected as a baby can be. If there is any risk that they might fall asleep while feeding, then they would need to take extra care with avoiding what might be an ‘external stressor’ such as pillows, soft mattress adult bedding changes, adult and baby position changes et cetera. It is more challenging to create a safe sleeping environment when there are variables more difficult to control. But each parent must make this call and our place is to help them interpret the safety principles.

This may not be a simple black and white answer, but there isn’t one. Protection is not a single issue affair but a context of care. Some would say babies need to sleep in their own bed no matter what, and they most certainly do if more vulnerable. However, parents of more resilient babies (smokefree, breastfed) appear to be managing safety appropriately as it is extremely rare (but possible) for coroners to report deaths of babies with all the safety conditions met.  There is no doubt that there is more potential risk if a woman falls asleep while feeding. Whether it is actual or not depends on the safety setup which will vary for each situation.

In summary – promote safety principles and always come back to them when helping parents interpret them in specific situations. They are the safety checklist.