Safe Sleep 7, Bedsharing and Breastfeeding
"In most parts of the world, babies sleep close to their mothers, as they have through most of history." — The Womanly Art of Breastfeeding
If you've ever found yourself drifting off while nursing your baby in the middle of the night, you are in very good company. Research suggests that 60–75% of breastfeeding mothers bedshare at some point, even those who never planned to. Yet the conversation around bedsharing in the United States is often one-sided, a flat "never do it" directive that leaves exhausted families without the evidence-based guidance they actually need to stay safe.
As an IBCLC, my goal is to give you the full picture: what the research actually says, how bedsharing and breastfeeding are deeply intertwined, and how to do it as safely as possible if you choose to or if you simply fall asleep nursing and want to have prepared your sleep space in advance.
What Is the Safe Sleep Seven?
Developed by La Leche League International and outlined in the landmark book Sweet Sleep: Nighttime and Naptime Strategies for the Breastfeeding Family, the Safe Sleep Seven is a set of research-supported criteria for safer bedsharing. When all seven are met, the research indicates that a baby's risk while bedsharing is no greater than their risk sleeping alone in a crib.
1. NON-SMOKER No smoking in the home or outside. Secondhand smoke significantly affects infant breathing and raises SIDS risk.
2.SOBER ADULTSNo alcohol, recreational drugs, or sedating medications for any adults in the bed. Sobriety preserves the protective awareness nursing mothers naturally have.
3.BREASTFEEDINGBaby is breastfed day and night. Breastfeeding hormones keep mothers physiologically attuned to their baby's cues even during sleep.
4.HEALTHY FULL-TERM BABYBorn at term and in good health. Premature or medically fragile infants have different needs and this framework may not apply.
5.BABY ON THEIR BACKFace-up is the safest position. Breastfeeding mothers who nurse side-lying naturally shift back to a face-up position when feeding ends.
6.LIGHTLY DRESSEDNo swaddling, no heavy blankets. Baby should be dressed similarly to you to prevent overheating — a known SIDS risk factor.
7.SAFE SLEEP SURFACEA firm, flat mattress with no excess pillows, soft bedding, stuffed animals, or gaps. No sofas, armchairs, or waterbeds. Any gaps between the mattress and headboard or wall should be firmly filled.
IMPORTANT NOTE
The Safe Sleep Seven was designed specifically for breastfeeding families. Partners who are bottle-feeding or not the nursing parent should be aware that they do not share the same hormonal attunement as a breastfeeding mother, and additional precautions may be warranted.
One of the most important things I tell every family I work with: prepare your sleep surface whether or not you plan to bedshare. Because sleep happens, often unexpectedly. Falling asleep nursing on a prepared, safe surface is far safer than falling asleep on a sofa or recliner, which carries dramatically higher safety risks for baby.
Why Bedsharing Matters for Breastfeeding
Breastfeeding and bedsharing are biologically complementary. They evolved together. Understanding this connection helps explain why so many breastfeeding families naturally gravitate toward sharing sleep, and why it works.
More Night Nursing, More Milk
Prolactin (the hormone responsible for milk production) peaks in the early morning hours. Frequent nighttime nursing directly stimulates supply. Bedsharing makes those night feeds easier, faster, and less disruptive, which means babies nurse more often and mothers produce more milk.
Longer Breastfeeding Duration
Research consistently shows that mothers who bedshare breastfeed for longer than those who don't. The ease of nighttime access removes one of the most common barriers to extended breastfeeding: sheer exhaustion from getting up repeatedly in the night.
Better Sleep for Everyone
Contrary to what many people assume, breastfeeding mothers who bedshare report getting more sleep than bottle-feeding mothers, not less. Babies who bedshare tend to rouse less fully between feeds and return to sleep faster, as do their mothers.
The Biology of Mutual Awareness
Research by Dr. James McKenna at the University of Notre Dame's Mother-Baby Behavioral Sleep Laboratory has shown that breastfeeding mothers and their babies exhibit synchronized arousals during sleep, they naturally shift between sleep stages together. This biological connection means a nursing mother is primed to respond to her baby even without fully waking.
"Breastfeeding mothers who bedshare often nurse in a side-lying position. When a baby comes off the breast, they naturally roll onto their back. The mother returns to her protective 'cuddle curl' position. So the mechanisms that keep a baby safe are built into the very act of breastfeeding in bed."
LA LECHE LEAGUE INTERNATIONAL, SWEET SLEEP
The US in Global Context: Breastfeeding Rates
The United States lags significantly behind much of the world in breastfeeding rates and the numbers are striking when placed alongside countries where bedsharing is culturally normalized and widely practiced.
The pattern is difficult to ignore. Countries where bedsharing is practiced widely, often because it is culturally normalized and approached with safety guidance rather than blanket prohibition, consistently report higher breastfeeding rates and lower SIDS rates than the United States.
The US SIDS Rate: A Closer Look
The United States has one of the highest SIDS rates among high-income nations. Data from 2012–2014 showed that SIDS rates ranged from 0.05 deaths per 1,000 live births in Sweden to 0.39 per 1,000 in the US, with the US ranking near the top among developed countries. In an earlier comparative study of 13 nations, the US ranked second highest, behind only New Zealand.
Meanwhile, Japan, where close to 40% of families bedshare regularly, has some of the lowest infant mortality and SIDS rates in the world. In 1990, before international safe sleep campaigns, Japan's combined SIDS rate was approximately 0.35 per 1,000 live births. In the US that same year, it was approximately 1.3 per 1,000.
It is important to note that international SIDS statistics involve real complexity: countries use different definitions and diagnostic criteria, which affects direct comparisons. However, the broad pattern, lower SIDS rates in countries with high breastfeeding rates and culturally normalized bedsharing, is consistent across multiple research analyses.
Research suggests that the way in which bedsharing is practiced matters far more than bedsharing itself. Unsafe sleep surfaces, smoking, alcohol, and formula feeding are the risk factors that drive infant mortality, not the proximity of a sober, breastfeeding mother to her baby.
EVOLUTIONARY PARENTING / JAMES MCKENNA, UNIVERSITY OF NOTRE DAME
Studies that have found associations between bedsharing and elevated SIDS risk have often failed to separate out these compounding variables, particularly alcohol use, smoking, and the type of sleep surface. When these factors are controlled for, bedsharing alone becomes a non-significant predictor of SIDS. The risk, it appears, lies not in closeness itself, but in unsafe closeness.
The Sofa Problem: Why Safe Guidance Matters
One of the most important arguments for honest, evidence-based bedsharing education is this: telling families "never bedshare" doesn't stop bedsharing from happening. It just means families fall asleep unprepared often in far more dangerous places.
Falling asleep with a baby on a sofa or armchair carries a dramatically higher risk than bedsharing on a prepared, firm surface. Yet this is exactly what happens when exhausted breastfeeding parents try and fail, to stay awake during nighttime feeds, having received no guidance on how to do it safely if they drift off.
This is why the recommendation in Sweet Sleep is that all breastfeeding families should prepare their sleep surface regardless of their intentions. Preparation is not permission, it is harm reduction
When Bedsharing Is Not Recommended
The Safe Sleep Seven framework is not a blanket endorsement of bedsharing in all circumstances. There are situations where bedsharing carries elevated risk and should not be practiced:
Any adult in the sleep space smokes or has smoked during pregnancy
Any adult has consumed alcohol, sedating medications, or substances
Baby is premature or has medical conditions affecting arousal
The sleep surface is a sofa, armchair, recliner, or waterbed
There are heavy duvets, pillows, or soft materials near the baby
Baby is swaddled
If you are unsure whether your situation meets the Safe Sleep Seven criteria, please reach out, working through the specifics of your family's sleep environment is exactly the kind of support an IBCLC is here to provide. <3