Sweet Sleep Nighttime and Naptime Strategies for the

Breastfeeding Family

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be certain to consult with your doctor before making any decisions that affect your or your
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A Ballantine Books Trade Paperback Original

Copyright © 2014 by La Leche League International

All rights reserved.

Published in the United States by Ballantine Books, an imprint of Random House, a division
of Random House LLC, a Penguin Random House Company, New York.

BALLANTINE and the House colophon are registered trademarks of Random House LLC.

Library of Congress Cataloging-in-Publication Data

Wiessinger, Diane.
Sweet sleep : nighttime and naptime strategies for the breastfeeding family / Diane Wiessinger
and [three others].
pages cm
At head of title: La Leche League International.
Includes bibliographical references.
ISBN 978-0-345-51847-7 (paperback : acid-free paper) — ISBN 978-0-345-54991-4 (ebook)
1. Breastfeeding. 2. Sleep. 3. Breastfeeding—Safety measures. I. La Leche League
International. II. Title.
RJ216.W59 2014
649′.33—dc23
2014019411
 www.ballantinebooks.com

Book design by Elizabeth A. D. Eno

v3.1
To you. Listen to your heart. Rest on the research.
Sweet sleep to you and your little ones!
 foreword

What if?
What if everything we did as mothers wasn’t under constant scrutiny? What
if every natural decision our bodies and our hearts led us to wasn’t cause for a
Facebook frenzy? What if every time we took our breastfeeding babies to bed
with us it wasn’t seen as irresponsible parenting? What if we didn’t have to
follow someone else’s notions about sexuality, nurturing, and where our babies
should sleep?
What if we could parent organically, without criticism, following our
biologically programmed instincts, honoring the hormones that hundreds of
thousands of years of mammalian parenting have placed in our bodies, brains,
and, yes, breasts?
What if you had the education, resources, and support to make your
nighttime choices with confidence, not fear?
I know how it could start: with the courage and devotion of a group of well-
informed researchers and writers who speak up on behalf of safe bedsharing
for breastfeeding families. It would take a book rooted in science, born out of
love, and driven by a passion for helping mothers care for their breastfeeding
children at night. That’s the book you hold in your hands.
Sweet Sleep is all about understanding and responding to your baby’s
nighttime needs, understanding the challenges of the sleep decisions you
make, and learning to parent safely and securely so that you all sleep better
and grow stronger: baby, mama, family, and community.
Mayim Bialik, PhD, CLEC
Sleep (or the lack of it) looms large for parents-in-waiting—and it is pointless
to pretend that your sleep will not be disrupted by your new bundle of joy.
His stomach is tiny, and he will need frequent feeds all around the clock—he
cannot wait eight hours through the night to be fed just because you need to
sleep. He doesn’t know that you will come back once you leave his sight. If he
feels abandoned, he will cry frantically—it’s his only method to attract
attention and bring himself to safety. If he cries frantically, it will take a long
time for him to calm down and you will have to help him.
The experience of sleep, and of being le alone for sleep, is very different
for babies than it is for adults. The more quickly you can understand your
baby’s needs—for comfort, food, reassurance, contact, love—the less disruptive
nighttime baby care will become, and the less anxious you will feel. Rigid
guidance that insists the only place your baby should sleep is flat on his back
in a crib with a firm mattress ignores the reality that most babies do not die
unexpectedly during the night but that all babies need frequent feeding,
tending, comforting, cuddling, and loving. How to strike a balance between
risk avoidance and need fulfillment?
Baby care is about trade-offs—balancing your baby’s needs with your own
needs, and adapting “official” recommendations to your own situation rather
than following every guideline at all costs. This book takes issue with some of
the sleep guidance currently given to parents by official organizations and
“experts.” It explains why, whom that guidance is meant to influence, and
what it is intended to accomplish. If you are not the mother and baby the
guidance is directed toward, if compliance would carry a greater risk in
another aspect of baby care than noncompliance, you should make your own
informed choice about which guidance to follow. This book gives you the
tools to do so.
The dramatic departure that this book offers is to approach sleep safety via
the management of risks to infants in different sleep scenarios. It offers a
packaged method (called the Safe Sleep Seven) to help parents identify risks
they should avoid, and to reassure those parents whose babies fall into the
“minuscule risk” category. And as one would expect from La Leche League,
this book takes breastfeeding and safe sleep sharing as normal facets of baby
care.
It makes no guarantees: it doesn’t guarantee that your baby will be a good
sleeper (be wary of books that do) or that your baby will be absolutely safe.
There are no guarantees in life, and tragic events sometimes happen even in
the absence of observable risks. The authors do a great job of explaining the
magnitude of different risks—those you take every day without thinking and
those you agonize over unnecessarily. They also point out those instances
where parents sometimes unwittingly increase their babies’ risk because the
reasons behind key guidelines are not properly explained—and parents take a
greater risk in trying to eliminate a lesser one!
This book is like having a wise grandmother in your pocket. It’s an antidote
to new-parent sleep anxiety and the scary tales that you may have been told. It
carefully guides you through your options; it unpacks the sensationalist
headlines about SIDS and the old wives’ tales about spoiling. It puts you in
control and encourages you to make decisions that suit your family aer
carefully considering your situation, your baby, and your needs. It gives you
permission to trust your instincts (although the only permission you need is
your own).
It debunks many myths—some of which are held sacred in certain quarters.
I have no doubt this book will cause controversy, and I know that its authors
have therefore done their homework very carefully. They have consulted with
numerous specialist researchers and read hundreds of research papers. The
questions they have asked and the evidence they have amassed have caused
them not only to challenge the one-size-fits-all approach to infant sleep safety
recommendations but also to challenge the dominant cultural viewpoint about
“normal infant care” in modern society. Aer many months of reading and
discussing the issues with them, I feel a warm sense of satisfaction that they
have reached conclusions very similar to my own, which are based on my
training as an anthropologist, 18 years of firsthand research in this field, and
my experience as a mother.
The fundamental fact embedded in this book is that breastfeeding mothers
and babies bedshare, and do so whether they are advised against it or not. It is
a baby care strategy that makes sense to breastfeeding mothers, and it works
for reducing the disruption of frequent night feeds, maintaining breastfeeding,
and meeting their babies’ emotional needs and their own sleep needs
simultaneously. It’s what women and babies have done for millennia, though
we now do it in sleep environments very different from those of our
predecessors. This book gives guidance not only on whether to bedshare but
also how to bedshare as safely as possible. It firmly brings discussion about
bedsharing into the open and provides an important resource for
breastfeeding mothers in the 21st century. I could not be more pleased to
introduce it.
Professor Helen Ball, BSc, MA, PhD
contents

Cover
Title Page
Copyright
Dedication

Foreword
Preface
Introduction

Part I: Sleeping Better

Chapter 1 Quick Start: Ten Minutes to Better Sleep Tonight
Chapter 2 The Safe Sleep Seven

Part II: Mothers and Babies Together

Chapter 3 Attached and Attuned
Chapter 4 Normal Sleep

Part III: Sleep and Bedsharing Practicalities

Chapter 5 Naps
Chapter 6 Nights
Chapter 7 Sleep Personalities and Places
Chapter 8 Working
Chapter 9 Alternate Routes
Chapter 10 Your Own Sleep Needs
Chapter 11 Gentle Sleep Nudging Methods
Chapter 12 Sleep Gadgets
Part IV: Sleep Ages and Stages
Chapter 13 The First Few Days
Chapter 14 The First Two Weeks
Chapter 15 Two Weeks to Four Months
Chapter 16 Four Months to Toddlerhood
Chapter 17 Toddlerhood and Beyond

Part V: Safe-Sleep Science

Chapter 18 Sleep-Training Concerns
Chapter 19 Suffocation and SIDS: Reality and Risks
Chapter 20 Bedsharing Controversies and Common Sense

Part VI: Help

Chapter 21 Defusing Criticism
Chapter 22 Your Frequently Asked Questions (FAQ)
Chapter 23 Getting Help, Giving Help

Appendix: Tearsheet Toolkit

Acknowledgments: With Our Thanks
Notes
Picture Credits
New-baby greeting cards joke about the 2:00 a.m. feeding, but at 2:00 a.m., it’s
no joke. Too many of today’s new mothers feel like zombies during the day,
desperate for sleep that their night didn’t provide. Their babies wail, their
partners complain or take turns walking the floor. Every feeding means time
out of bed. Sleep training takes nerves of steel, but it’s starting to look
appealing. And everyone asks, “Is he sleeping through the night yet?”
Breastfeeding mothers can have even more concerns: “How and where do I
nurse at night, and what if I fall asleep? How and where do I nurse lying down,
and what if I fall asleep? Should I nurse my baby to sleep, and what if I fall
asleep? Would it be easier just to pump and have my partner bottle-feed at
night? Would formula or solids make him sleep better? How do I switch sides
lying down? Are we safer on the sofa? If I let this baby into my bed, will she
ever leave?”
And maybe the most pressing question of all: “If breastfeeding works best when
I keep my baby close and nurse frequently, but everyone tells me it’s not safe to be next to
my baby for one-third of every day, then how on earth can I keep breastfeeding and keep
my sanity?”

Breastfeeding ≠ Bottle-Feeding
Sweet Sleep starts with a few reality checks. Breastfeeding isn’t just bottle-
feeding with a better-looking container. In fact, a breastfeeding mother and
her baby are oen viewed by researchers as a single unit—a “breastfeeding
dyad”—with hormones, instincts, and reflexes that promote safe and nurturing
interactions. It’s an age-old recipe for mothering that research is just beginning
to rediscover.
We’re rediscovering, for instance, that the mothers who get the most sleep
of all new mothers are—surprise!—the ones who sleep right beside their
exclusively breastfed babies, just as mothers always did before they were told
not to. But today’s breastfeeding mothers are warned that this simple solution
isn’t safe. Since other arrangements mean less sleep, they’ll try anything to get
more rest. It might be a crib, a sleep-training method, nighttime bottles of
formula, or a sofa, any of which can actually increase risk. There’s a limit to
how far a culture can bend normal, healthy biology before something has to
give. This book’s purpose is to help you use built-in instincts and research-
based information to choose a healthy, responsible path that meets your
family’s, your baby’s, and your own needs.

There’s Risk—and There’s Risk

Nighttime has always had risks. A mostly unconscious baby in the care of a
mostly unconscious mother? Not ideal. But it’s also not humanly possible to
stay awake 24/7. So what’s a mother to do?
Aer analyzing the research and talking with researchers, we’ve developed
the Safe Sleep Seven: seven very clear criteria that address the risks of Sudden
Infant Death Syndrome (SIDS, or crib death) and suffocation. Meeting all
seven means that your baby’s risk of SIDS when he’s sleeping next to you in
your bed is no greater than when he’s alone in a crib. And following this
book’s Safe Surface guidelines hugely reduces any breathing risks no matter
where your baby sleeps.
In fact, we’re recommending that all breastfeeding mothers prepare for
bedsharing whether or not they ever intend to do it, since research finds that
most breastfeeding mothers do sleep with their babies at some point and
preparing for bedsharing is safer than accidentally falling asleep together. And even
those researchers who are concerned about bedsharing agree that by four
months, it’s a non-issue.
These ideas may not be what you’ll hear from your family, friends, or
health care providers, so we’ll back them up with research every step of the