Book Review- Safe Infant Sleep: Expert Answers to Your Co-sleeping Questions

Author: James J McKenna
Publisher: Platypus Media, USA, 2020
Reviewers: Sarah Hudson & Katie Fourie

Sharing a sleep surface with your baby is, and has been, the biologically normal way for babies to sleep. In this book, Dr James McKenna introduces the term ‘breastsleeping’ and puts together decades of research on parent-infant sleep. With a background in biological anthropology Dr McKenna explains the biological basis for human infants to need to be in constant physical proximity with a carer and how this conflicts with the values of Westernised societies which has historically promoted independence at all costs. He shares his observations of the impact of cultural ideology on public health messaging and highlights the issues around the interpretation of the research. While acknowledging that “no sleeping arrangement guarantees full protection” McKenna reassures new parents that elective bedsharing (as opposed to unplanned or ‘chaotic’ as he puts it) is the safest form of bedsharing. McKenna also notes that regardless of how an infant is fed, whether breastfed, mixed fed or formula fed, parents and infants benefit emotionally, physically, and psychologically from remaining in close proximity throughout the day and night.

The book is broken into short chapters some of which, e.g. when explaining very specific research technicalities, can be a little heavy going at times. It is written in a conversational tone with his own experience of navigating this area as a parent trying to reconcile his academic knowledge, his intuition as a parent, and the conflicting messages he received from health professionals along the way. He includes a series of schematics and diagrams that make seemingly abstract concepts easy to understand. The book is well-referenced and there is a section full of resources and further reading for those who are interested in learning more. There is also an appendix of anti-bedsharing campaign posters which were absolutely heart-breaking to look at.

Safe Infant Sleep is a must read for all parents and anyone working with families with young children. It contains essential information that will help to counter the multitude of sleep books that lead new parents to doubt their intuition. It aligns well with the La Leche League philosophies and indeed, provides a scientific basis for parental behaviour promoting breastfeeding and loving parenting during the night as well as the day. We highly recommend this book for group libraries.

Compiled by Katie Fourie, BRC 2021.

Continue ReadingBook Review- Safe Infant Sleep: Expert Answers to Your Co-sleeping Questions

My Favorite Place

  • Post category:Sleep
  • Reading time:7 mins read

We were waiting for our food to be served at the restaurant and the children decided to pass the time with a game. One person had to guess a word chosen by the others, and the others had to give little hints.
“Mum’s favourite location” my youngest daughter said, ending the game on the first clue because everyone in my family knows the answer to that. My favourite place in the whole world is my bed. And like many mums (to the chagrin of many dads) my favourite thing to do there is to sleep. I dream of sleep, preferably in long unbroken stretches.

In retrospect, even in the years B.C. (before children) sleep and I have always had our issues. I  remember playing the game Trivial Pursuit, where one of the science questions was “How long does it take the average person to fall asleep?” It’s been years but I remember the answer because I was so shocked by it. In my pre-child existence, I always took a long time to fall asleep, about an hour. I’d run through all of the details of my day, think of alternate snappy answers to questions that I should have said, and review and rehearse upcoming interactions. But I knew that one hour was long for most people so I shaved my answer down to twenty minutes. The correct answer was seven. Seven minutes! To my childless self that was astounding.

Having children was a wakeup call for me to the womanly art of sleep management. No one knows sleep deprivation quite so intimately as the mother of an infant. No question that it’s rough in the early days.
Many a new mother makes the comment that they understand now why it’s used as a method of torture. Post-kids I could and did fall asleep in seconds. But I still could not rid myself of my love of sleeping and my addiction to large doses of it. I experienced withdrawal like a junkie, when my baby woke me up I was irritable and irrational.

Part of overcoming my addiction was education. Our culture – but not our babies – seems to view the eight hour uninterrupted sleep as a sacred right. Our babies are not designed that way, their little tummies need filling up and they have a need to check in and make sure we are close by.

I read some of Dr James McKenna’s work. He studies mother-baby sleep in his lab at Notre Dame University in the USA. His research quashes the myth of unbroken sleep. The truth is that all of us sleep in cycles that include deeper and shallower stages. Most of us do wake up in the night, but usually we go back to sleep without awareness of these wakeful periods.

Dr McKenna’s studies have shown how breastfeeding mothers and their babies who share sleep spaces develop a rhythm to their sleep patterns. Fighting this rhythm and trying to control it is what just about did me in as a mother.

Our nights would go like this:
• 11 pm; fall asleep with baby.
• It’s 1:34 and the baby is awake. Feed, change, make calculation about how much sleep I’d got…
• Jeez, it’s 3:32! More calculations. Not even two hours!
• Sheesh!! It’s 4:19!!! Mental calculator going again. Indulge in self pity for several sleep-wasting minutes. Have trouble falling back asleep because of resentment.
• For crying out loud, does that clock really say 5:22?!!!! Work self into a tizzy about how many wake ups I’d had. Try to decide if it’s worth it to even go back to sleep. On and on they went, these horrible nights,
and it was during the height of my misery that I knew I needed to do something. It was high time for some practical mother to mother support from some LLL mothers. They had some great suggestions which I’d like to share with you.

I wasn’t happy to take the advice of the sleep training set – though it seemed at the time that the world was divided into two groups, mothers who bragged that their babies slept through the night and people who advocated the cry it out method. What I needed to hear was that night time waking was normal and manageable – it just needed to be tweaked.

The best of the tweaks came from a mother who said, “You know, you could get rid of the clock in your room.” This was a stroke of genius. For me, a significant part of my night time waking issues was my own attitude about it and that clock wasn’t helping. Those nightly mathematical calculations were adding fuel to a fire that needed to be put out. Another mum gave me her tip, “Don’t change your baby’s nappy in the night. Most nappies these days are pretty absorbent and often last right through.” “If they don’t wake up fully,” another mum added, “they won’t poo.” I found that to be true for my babies also. All that changing just served to wake us both up further, so that I’d be trying to chill us both out from a full boil instead of keeping the flame low from the start. A midwife friend shared her tip of cutting two round holes in a sweatshirt to make access easier in the night also. And gradually my baby and I got unconsciously skilled at breastfeeding too, so that we could both do it almost without thinking about it, almost in our sleep.

When my second son was little, I overheard my husband bragging at what a good baby he was. “That child has slept through the night since the day he was born,” he said. Of course, this was completely untrue. The difference was that none of us was making a big deal about it; I’d developed the knack of breastfeeding in our semi-awake state. We all slept better. My bed stopped being a battleground and
sleep stopped being a contest I was determined to win.

My oldest child is 20 years old now, and I can’t count the number of unbroken nights of sleep I’ve had since his birth, and the birth of his siblings. For those of you beginning your motherhood journey, you probably don’t want to know that there haven’t been many. I am proud to say I am no longer keeping score. Though my bed still is my favourite place in the world, my children know that they are my
favourite people.

Co-Sleeping Safely
Make sure that your mattress is firm and fits tightly in the frame, avoid waterbeds, recliners, couches or armchairs.
Provide a smoke-free environment; exposure to cigarette smoke increases the baby’s risk of SIDS
Sheets should fit your mattress snugly.
Always place your baby on his back to sleep, including after breastfeeding.
No one who shares sleep with your baby should drink alcoholic beverages, take drugs, be exceptionally obese, be on medication that makes him or her less alert, or be too unwell or exhausted to be aware of the baby.
Consider keeping your young baby next to his mother only, because mothers seem to be especially aware of their babies in bed, keep an adult between any older child and your baby.
Make sure the sides of the bed are either tight against the wall or far enough away from the wall that your baby can’t become trapped. Or use a bed rail on the side of the adult bed.
Keep the bed low to the ground, maybe even on the floor, to minimise any falls.
Keep pets out of the bed the baby will be sleeping in.
Keep loose pillows or soft blankets away from your baby’s face, avoid nightclothes or hair ties with  strings or attachments that might pose a strangulation risk.
Avoid thick bedding and dressing the baby too warmly – close bodily contact increases body temperature.

Good Nights by Jay Gordon, MD and Maria Goodavage, and Sweet Dreams by Paul Fleiss, MD, taken from LLL information sheet Safe Sleep, available from LLLNZ
“Sleeping with your baby” by James McKenna, New Beginnings 2009; 26(1): 4-9

Dr Alison Barrett is an obstetrician, who still gets up in the night for babies – they are just no longer her own.


Continue ReadingMy Favorite Place

Breastfeeding My Baby to Sleep

  • Post category:Sleep
  • Reading time:7 mins read

“I have always breastfed my baby to sleep, and this has worked quite well for us.  But now that he is seven months old, everyone is telling me that he really should be able to go to sleep on his own by now.  I have tried putting him to bed awake but it ends in tears for both of us.  I don’t mind breastfeeding him down for a while longer, but I worry about this habit in the long term – I might like an evening out when he is a bit older.  Is there anything I need to do now to make it easier later?”


Janet Wilson, Papakura – Trusting your gut feeling is such an important part of parenting! It sounds like you are feeling the way that is best for you, but are questioning yourself on the opinions of others. If you shut out the rest of the world, can you ask yourself if there even IS a problem?  Is there anything that can take the place of you and breastmilk at bedtimes?  If it is working for you and your family then it might not need to be ‘fixed’.

When we stop breastfeeding, for whatever reason and at whatever stage, we need to replace the comfort of the breast with something else – Other Mothering.  Is there something easier and less stressful, at the moment, than breastfeeding your baby to sleep?

In the early weeks, months and years of mothering there is nothing surer than change – what your baby is doing today may change tomorrow.  As they grow and develop at the breast they are learning and observing with you, in their happy place.  This stands our children in a great place to be able to take the proverbial big steps (going to sleep without breastmilk, going without you for increasing periods of time, walking…) when they are ready.  There are probably lots of things you can try, and there are certainly lots of books written about how to ‘make’ your child do A, B, C. There is, however, no book written for your child.   Follow your heart.  You ARE the expert on your baby.  Kia kaha!

Amanda Riches, Morrinsville – You sound like you are doing a wonderful job meeting your baby’s needs.  Many babies continue to breastfeed to sleep until they are two years old and even later. Slowly they seem to need it less and less until they fall asleep lying next to you or you just put them to bed one night without that last breastfeed.

If you are concerned about the future you can start introducing a sleep signal to use before breastfeeding to sleep, for example singing a song like Twinkle Twinkle Little Star then breastfeed or using a special toy/blankie that is used only for sleep times; place it between yours and baby’s tummy as you nurse to sleep then place it in the cot with him (my daughter had a fascination with my satin nightie so I made a cotton and satin blankie she now rubs between her fingers as she falls asleep).

Also many babies calmly and quietly fall asleep on daddy or grandma with no trouble but if mummy even thinks about trying to get baby to sleep without breastfeeding first, baby may strongly disagree and it turns into a battle with many tears. You can get your partner or mum to start attempting to rock baby to sleep every so often. Good luck and don’t let other people tell you what is right
and what is wrong because it sounds like you are doing what feels right for you and your baby.

Lisa Ross, Dunedin – It can often feel like our babies will never outgrow the needs they have now but they truly do, when they’re ready.  Often trying to push them to do something any earlier can cause the opposite – for them to cling to us more, need us more.  Often if we go with the flow and let them know we are there for them, in return they will let us know when they feel secure enough to move on.

Seven months is still very young and babies don’t understand very much at that age.  My baby who fed to sleep till far beyond seven months old, stopped long before she stopped breastfeeding completely and is a confident, independent, bright and easygoing eleven-year-old. Plenty of studies show that babies whose needs are met, become secure independent adults capable of forming healthy relationships.

Chris Gower-Rudman, Rotorua – A little bedtime routine is useful – even at this age.  Mum could do the dinner and bath thing before bed, as she may already be doing, and add a bedroom routine such as reading a story (looking at books) or singing a song before feeding baby to sleep. There is nothing wrong with feeding the baby to sleep except for the odd time when Mum may not be there to do it.

It is probably helpful to feed the baby in the room he is going to sleep in, rather than in front of the TV. This helps baby to associate other things beside just breastfeeding with going to bed and sleeping. It would be useful to have the baby’s father help with part of the routine so Dad and baby are familiar with it.

It is also a good idea to talk about what the routine is and if Mum is going to go out, tell the little one what is going to happen eg Daddy (or Grandma/Aunty Sue/teenage neighbour) will read you a story in your room/bed and sing you a song and hold your hand until you go to sleep.  If it doesn’t quite turn out like that, one night out of routine is not really a problem in the grand scheme of things.
Enjoy this cosy time with your baby.

Megan Lilley, Tauranga – I always breastfed my first daughter to sleep. It worked for her, me, and my husband. When I did return to some part-time evening work when she was eight months old, he was able to give her dinner, some expressed breastmilk and sit and read with her (or watch rugby) until she fell asleep.

Of course I had to always breastfeed her to sleep!  Although I was fine with this, I did think at the time – maybe I would try to do things differently next time. I was a bit envious of not just being able to put my baby to bed and walk away (like it seemed other mothers could do).

Second baby and guess what, I breastfed her to sleep every night till she was four-and-a-half, and apart from her being quite heavy to carry from the couch to her bed at the end of an evening, I loved every minute of it. It was our quiet time at the end of a busy day and who doesn’t love holding a sleeping baby/child in their arms?

Ten years after my first baby, and number three arrived (now two years old).  Yes, some days I do think “Oh I wish I could just put him to bed for a day sleep without having to lie down beside him till he drifts off,” but you know what? I wouldn’t change a thing. I am his world and he falls asleep in my arms every day and night, touching my skin in his milky bliss. There are never any tears or tantrums. There is no stress. For the 14 other hours of his waking day he is dynamite and I struggle to keep up with his energy and behaviour. For the times that he is breastfeeding off to sleep he is perfect in my arms, loving, gentle, warm, sleeping and still. I treasure it every day and I would do the same again if there ever was a next time round.

Continue ReadingBreastfeeding My Baby to Sleep

Ah, Nights…

  • Post category:Sleep
  • Reading time:6 mins read

I tried to nurse my husband’s elbow once. Groggy, desperately sleep-deprived, I heard my baby cry and fumbled in the bed for him, putting the nearest warm thing to my breast. But my son was down the hall, in his own crib, where we returned him aftermost nursings. That’s why I was sleep-deprived.

Our first routine was for my husband to get up each time the baby cried, and bring him to me to nurse (sitting up) on Side One. Then my husband would get up, take the baby to the bathroom, change his diaper, and return him to me to nurse (sitting up) on Side Two. Then my husband would get up and return the baby to the crib down the hall. Three trips out of bed each time those eight pounds of energy woke up. That lasted three nights.

But it took us two babies to get it completely right. Our second baby shared our bed from the start, with a rubber-and-flannel sheet under baby and mother to catch any drips from either one. There was an extra diaper handy at bedside until he stopped pooping at night, an extra nightgown or two until I stopped leaking, and a nightlight in the early days to help me line up my inexperienced partner of unaccustomed dimensions without either of us moving from our nest.

I nursed the “bottom breast” until it was soft, and later in the night rolled over a bit farther to nurse the “top breast”, looming over him like a tent, elbow resting on the far side of him. When his doctor asked me how often he nursed at night, I answered, “I have no idea,” and thought how right and simple that answer was.

Nights weren’t perfect, of course. Parenting never is. There were gaps in the bedding that let in cold air. There were nights when I wished he would just sleep. There were semiconscious wrestling matches between a father who wanted part of the bed to himself and a little boy who liked to sleep with his leg over Dad’s. But we never knew night terrors or head banging two childhood behaviors that Americans consider normal and zoos consider signs of stress in their monkeys. I never walked cold floors. He woke happy in the morning and so did we. And no “body pillow” can match the relaxation and peace of cuddling a child in bed.

Our sleep arrangements varied over time; our policy was to do whatever gave the most people the most rest tonight. Once he graduated to his own bed, he and his brother often shared it, or he came in with us partway through the night. Or I moved in with him a luxury for me, because his was the most comfortable mattress in the house. When he stopped waking in the night and stopped climbing in with us we reminded our children that they were always welcome, but they said, “Oh, no thanks.” And that was that.

We miss the smell and feel and snuggliness of those little bodies. It’s a time that comes only once, and we’ll never get it back. Maybe if our grandchildren come for overnights…

Safe Sleeping

Is it safe to sleep with your new baby? Of course. Imagine a cave woman laying her newborn in a separate niche in the cave for the night, well away from the warmth and protection of her body. Now that’s unsafe sleeping!

It’s also unsafe to have gaps that would allow your baby to slip between bed and wall, or between mattress and frame, or to lay your baby on poofy pillows, bedding, or mattress from which he can’t free his face.

And it’s not safe to sleep with a baby if you’re severely obese, or have been drinking heavily or taking drugs that keep you from rousing normally.

There. That’s out of the way. What’s left? Adults who are never completely unconscious (or they’d fall out of bed), sleeping with a very lumpy object (with a head like a grapefruitsized rock) that yells when it’s squeezed. Works fine.

What do you gain? Normal breathing and heart rates for your baby, without the breathless periods so often observed in solitarysleeping babies. Normal baby sleep which does not mean long hours of deep, hardtorousefrom sleep, though that might seem desirable. An even body temperature, warmer and more stable than the most expensive hospital babywarming unit can provide. A mellower baby at night, with far less crying. Safety from fire, kidnapping, and goblins. Lots of languid cuddle time.

You certainly gain vastly easier babycare, especially if you learn to breastfeed lying down during the day, when your tolerance and inventiveness are intact.

Infant sleep researchers believe solitary sleep may be linked to higher rates of SIDS.
This is a very difficult relationship to prove, since sleep arrangements change and since SIDS may have multiple causes. But we do know that many of the risk factors associated with SIDS are increased when babies sleep alone, and that cultures that share sleep tend to have low rates of SIDS. Shared sleep is as old as humankind, and small children crave it.

Shared sleep takes many forms. At our house, a lack of creativity kept us in an antique bed narrower than today’s standard double. Many nights there were four of us in it! If I had it all to do again, I would invest in a kingsized mattress and put it on the floor for those early years of parenting. Everyone would have plenty of room, and even an acrobatic toddler couldn’t fall far. We sacrificed comfort for convention, in a part of the house that no one but the sleepers themselves ever saw or used. Silly.

For more thoughts on sharing sleep with your baby, see William Sears’s book, “Nighttime Parenting,” published by La Leche League International and available through their online catalogue and in most libraries and bookstores.

Sweet dreams! And remember that nowhere is it written that parenthood includes 8 hours of unbroken sleep. Going to bed earlier helps!

© 2001 Diane Wiessinger, MS, IBCLC
136 Ellis Hollow Creek Road Ithaca, NY 14850
Used with permission
Continue ReadingAh, Nights…