I remember lying in my bed after my second delivery in severe pain. With my first delivery, I had already endured a C-section. Four years later, I wanted to experience a “natural” delivery, so I opted for a vaginal delivery after C-section (VBAC).

The VBAC quickly turned into an emergency where the maternal-fetal medicine (MFM) physician gave me two options: Get this baby out now or undergo an emergent C-section. My mind flashed back to the arduous recovery of the C-section. I really wanted to avoid that path.

With the help of forceps and a couple of pushes, my baby was born. Drugged up on happiness and medications, I did not realize that the forceps had literally torn me up below, and I had sustained grade-3 and grade-4 vaginal tears.

Now, back home, the pain came in waves. Trying to balance breastfeeding, pain medications, treating a uterine infection, and just using the bathroom without feeling every stitch, I just lay there overwhelmed.

My favorite position to breastfeed with my C-section was side-lying, a position in which mom and baby lie down and face each other. I quickly taught my second son this position as well. Though my third and fourth sons’ delivery was easier, I employed this method of nursing. Side-lying allowed me to rest, recover, and heal in my postpartum period. Nestled with my baby, I would fall asleep and bed share.

I am a board-certified pediatrician further trained in neonatology, and a breastfeeding specialist as a certified lactation educator (CLE). In my training, I have personally been involved with two failed resuscitations of newborns that bed-shared.

So how could I even fathom bed-sharing? The answer needs a broader view, but first, let’s look at the controversy of bed-sharing.

There are two words that often get intertwined regarding sleeping next to newborns: co-sleeping and bed-sharing. Co-sleeping is sleeping in proximity to your newborn that includes room sharing and bed-sharing. Bed-sharing is physically sharing the same space your newborn sleeps in, including a bed or a sofa. Co-sleeping is a natural human behavior that promotes breastfeeding and infant development.

The American Academy of Pediatrics (AAP) recommends and supports co-sleeping up to a year. Bed-sharing can lead to an increased risk of neonatal deaths and sudden unexplained death syndrome (SUDS), previously known as sudden infant death syndrome (SIDS).

The controversy of bed-sharing is polarized. Both sides cite research and personal accounts. Just recently, in January 2020, the Academy of Breastfeeding Medicine (ABM) revised its protocol around bed-sharing. Under the right circumstances (no smokers, no prematurity, no sofa, bed on floor, and breastfeeding), ABM supports bed-sharing that leads to increased breastfeeding duration. This is in stark difference to AAP, which still currently denounces bed-sharing. Side note: Both organizations consist of board-certified pediatricians.

So, in all the noise, how did I resolve my medical training, my postpartum healing, and successful breastfeeding with my exhaustion? My village.

In my Indian culture, it is standard for moms to deliver in their maternal home and rest. A hybrid of this thought process is evident in other world cultures as well. Here, in the States, my mother, a family physician, took two weeks off after my child’s delivery. My mother-in-law would follow with another two weeks. My husband would scatter his days off accordingly. The importance of my healing was also center stage.

Prior to side-lying breastfeeding, I would inform my village. They would check on me every 5 to 10 minute increments. If my baby and I were asleep, they would take my baby away and place him in the bassinet. In the middle of the night, I placed 30-minute timers on my phone and woke my husband.

My village supported my postpartum transition. I was allowed to heal, breastfeed, and recover. The burden was not solely on me to keep this delicate newborn healthy and safe. The responsibility was disseminated to my husband, my mom, my mother-in-law, my father, my siblings, and later on in the years, my 13-year-old even helped.

My village recognized that I just had a baby!

This leads to a bigger conversation regarding the flaws with the United States’ postpartum care and the demands placed on mothers with lofty support. Metrics placed by the CDC and WHO rank the United States, compared to other developed countries, low in breastfeeding but high in maternal birth mortality, infant mortality, postpartum depression, and lack of paid family leave. All these topics can be piecemealed apart, but the concrete thread is the underlying lack of support postpartum moms face and the importance of this period in ensuring a healthy transition for not just babies but moms.

The controversy of newborn sleep again adds all the responsibility to be placed on mom. A mom who is healing, attempting to breastfeed, sleep-deprived, and just plain exhausted.

So what is and can be achieved to support a healthy postpartum transition? At the state and federal level, policies are being constructed to address postpartum mental health and paid family leave. I encourage you to be informed. At community levels, churches and organizations have newborn cloth and diaper drives. Donate to local groups. At a friend and family level, forgo the cute outfit and instead invest in postpartum doulas, lactation consultants, and meal services. While visiting, allow mom a nap.

Lastly, in the United States, if you are compelled to bed-share, please be open with your pediatrician. There might be issues that you have not been able to identify, such as postpartum depression that your pediatrician, as an objective party, can detect. You have to be breastfeeding, no smoking or smoke exposure, no alcohol, and your baby cannot be premature or low birth weight.

If you qualify and still want to bed-share, the research-based guidelines are thus:

• Mattress placement: Place the firm mattress on the floor and away from walls to prevent the wedging of the infant.
• Sleep order: The sleep order is baby and mom. Mom needs to be in a C-curved position termed “cuddle curl.” Dad can sleep elsewhere.
• Safe sleep techniques: Babies should still practice safe sleep techniques such as sleeping on backs, a sleep sack, and no blankets, soft toys, or pillows around the baby or mattress. And yes, if you want to practice this way, then you have to follow all these guidelines, absolutely no shortcuts.

In reality, few people actually execute all of them, and this is where we get into trouble. People are willing to cite pieces of research supporting their argument but fail to follow the written guidelines.

Bed-sharing is still a risk in the United States. However, moving forward, hopefully there will be more open discussion regarding individual newborn sleep decisions, identifying better postpartum support, and not overlooking the health and well-being of a major player in infant success: the mom.

Sonal Patel is a pediatrician, neonatologist, and breastfeeding specialist whose work centers on infant nutrition, early development, and maternal well-being in the fourth trimester. In 2018, she founded NayaCare, a home health clinic dedicated to improving postpartum care.

She has written widely on maternal and infant health, with articles published in Scary Mommy, KevinMD, and The Colorado Sun. She is also the author of The Doctor & Her Black Bag, which explores maternal mortality through historical and personal perspectives while offering solutions to reduce it. A TEDx speaker, she presented The Economics of the 4th Trimester.

She cofounded and serves as co-executive director of the Center for 4th Trimester Care, a physician-led national nonprofit working to transform maternal health care. She also recently cofounded Pulse Med AI to bring physician voices into the AI digital space.

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