Kathleen Kendall-Tackett, Ph.D., IBCLC, FAPA

The controversy around mother–infant bedsharing continues to grow, and mothers are frequently told to never bedshare. Is this approach effective in keeping infants safe? In order to make sound policy recommendations, policy makers need current data on where infants sleep and how families handle nighttime feedings. This presentation reviews data from recent studies on sleep location and SIDS, demonstrating that these findings are far more complex than they are frequently portrayed. This presentation also describes recent data from the U.S. sample of the Survey of Mothers’ Sleep and Fatigue, a survey of 4,789 mothers of infants 0–12 months of age. The findings indicate that almost 60% of mothers bedshare and that this occurs throughout the first year. These findings also indicate that 25% of mothers are falling asleep with their infants in dangerous sleep locations, such as chairs, sofas or recliners. Recommendations for promoting safe infant sleep are made.

Does nighttime breastfeeding elevate the risk of postpartum depression? There are an increasing number of books that tell mothers not to breastfeed at night in order to prevent depression. While this advice is well-intended, no one knows if it even works. And it can be quite problematic for breastfeeding mothers to maintain. Using data from the Survey of Mothers’ Sleep and Fatigue, a survey of 6,410 mothers from 59 countries, we examine the relationship between feeding method, where babies sleep and maternal fatigue. Preliminary analyses reveal that breastfeeding mothers report less fatigue than their formula-feeding or mixed-feeding counterparts. This presentation will also include an analysis of nighttime feedings, sleep deprivation, and depression, while accounting for other depression risk factors, such as trauma history, postpartum pain, and lack of support. All of these other factors can compromise sleep quality and increase daytime fatigue. The sample size allows us to determine the relative contribution of each and whether advising mothers to skip nighttime feedings is sound.

Survivors of childhood abuse breastfeed at the same rates as woman without an abuse history. For abuse survivors, breastfeeding can range from difficult to quite healing. The most important thing clinicians can do is to find out what the mother wants to do and work with her to have a positive experience. Childhood abuse does not have to be the blueprint for the rest of a woman's life. This session provides an overview of the latest research on the effects of childhood abuse; its impact on breastfeeding; how it can affect a woman’s body, mind and spirit; and what practitioners can do to help her cope.

The negative effects of postpartum depression, on both mother and baby, are too serious to ignore. Fortunately, there are a number of treatments for depression with empirically demonstrated efficacy, including a wide range of non-pharmacologic treatments. Almost all are compatible with breastfeeding. This session summarizes research findings on omega-3s, exercise, bright light therapy, cognitive and interpersonal psychotherapy, St. John’s wort, and antidepressant medications. It also describes the implications of each for breastfeeding.