Melissa Bartick, MD, MSc, FABM works as a hospitalist at Mt. Auburn Hospital in Cambridge MA, is an internist and is an Assistant Professor in Medicine at Harvard Medical School. She has numerous breastfeeding publications in peer-reviewed journals. She served as the chair of the Massachusetts Breastfeeding Coalition from 2002 to 2014, where she was also a founder of Ban the Bags. She served on the Board of Directors of the United States Breastfeeding Committee from 2009-2015. She has served on the Board of the Academy of Breastfeeding Medicine since 2019, where she has coauthored clinical protocols, including the 2020 Bedsharing and Breastfeeding protocol. She was founder of the Breastfeeding Forum of the American Public Health Association, where she served two terms as chair. She is founder and co-chair of her state’s Baby-Friendly Hospital Collaborative. She has blog contributions to the Huffington Post, the WBUR CommonHealth Blog, among others. Dr. Bartick received her BA from the University of Virginia and holds an MSc in Health and Medical Sciences from University of California, Berkeley and an MD from University of California, San Francisco. She works as a hospitalist at Mount Auburn Hospital and is the mother of two grown sons. As of June 2020, she is pursuing an MPH at Harvard School of Public Health.
Expert recommendations around infant sleep fail to recognize the concept of “breastsleeping,” relying on an evolutionary anomaly of artificial feeding and solitary sleep as the norm for infant behavior. Breastfeeding comprises a sum total of human behavior that is more than just nutrition. With focus on the ingredients of milk, and the delivery of expressed milk, it is easy to overlook the importance of breastfeeding on proximity to mother and human contact. Recommendations for infant sleep and breastfeeding, including the “Baby Box,” are seen as risk reduction strategies, without regard to the evolutionary norms of human behavior. If “breastsleeping” were recognized as the evolutionary norm, we would be focusing on risks of separation, not risks of bedsharing. Such risks may potentially be profound, but are as yet little studied. The 2016 AAP safe sleep recommendations are critically reviewed here, as are updates in progress toward a more evolutionarily balanced model.
Bedsharing promotes breastfeeding, but many authorities recommend against bedsharing for all mothers, citing safety concerns, particularly risk of sudden infant death syndrome or suffocation risks. Here we will review the normal physiology of mother-infant sleep, and the historical context in which such recommendations evolved. In addition, many populations have high rates of bedsharing with low rates of death. In this context, we will review the evidence around bedsharing and the most current evidence-based recommendations. Some risk factors for SIDS are more powerful than others, and we will review the best ways to minimize such risks, including a social-determinants of health approach. In some circumstances, bedsharing may carry particular risks and it is important to be able to discuss these issues with parents without stigma. We will discuss counseling of all parents in the “risk-minimization” approach, which would also allow for promotion of breastfeeding.
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