Safe Sleep and Co-Sleeping: What the Research Actually Says

A plain-language breakdown of the current guidance — and why the real answer is more complicated than "just don't do it."

The Standard Message — and Why It Falls Short

If you've had a baby recently, you've heard it. Back to sleep. Firm, flat surface. Nothing in the crib. Baby in your room but never in your bed. End of conversation.

The American Academy of Pediatrics (AAP) updated its safe sleep guidelines in 2022 and their position on bedsharing is unambiguous: they don't recommend bed sharing under any circumstances, including for twins and multiples. HealthyChildren.org

That's a clear statement from a major medical authority and it's worth taking seriously. But it's not the only statement from a major medical authority — and the gap between what families are told and what families actually do is exactly where babies end up in the most dangerous situations of all.

What the AAP Does Recommend

To be fair, the AAP guidelines aren't just "no." They include genuinely helpful guidance:

• Room-sharing — baby in your room on a separate surface, close to your bed — decreases the risk of SIDS by as much as 50 percent, and is recommended for at least the first six months, ideally the first year. Mo

• Back to sleep, every time, on a firm flat surface with nothing in the crib.

• The risk of sleep-related infant death while bedsharing is 5 to 10 times higher when a baby is younger than 4 months. Cradlewise

• The risk of sleep-related infant death is up to 67 times higher when infants sleep with someone on a couch, soft armchair, or cushion. HealthyChildren.org

That last one is the number that doesn't get nearly enough airtime. The couch is genuinely, measurably dangerous. A bed — especially in the right circumstances — is a different conversation.

Where Other Organizations Land

The AAP is not the only voice in the room, and the international picture looks different.

The Academy of Breastfeeding Medicine took a different approach in their Protocol #6. Breastfeeding mothers and infants are not advised against bedsharing, as long as no hazardous circumstances exist. The protocol emphasizes that all parents should be educated on safe bedsharing, recognizing that bedsharing is very common, and when bedsharing is unplanned, it carries a higher risk of infant death than planned bedsharing. Wordpress

Read that last sentence again. Unplanned bedsharing is more dangerous than planned bedsharing. That's the piece the "just say no" approach misses entirely.

The ABM's position is that existing evidence does not support the conclusion that bedsharing among breastfeeding infants causes SIDS in the absence of known hazards. Liebert Pub

Meanwhile, authorities in Spain, the United Kingdom, and Norway are no longer advising against bedsharing when no hazards exist. PubMed Central

And a 2025 research review found something worth sitting with: AAP's risk elimination strategy assumes that cribs offer a universal, simple solution for all families — and this approach has not significantly reduced rates of sudden unexpected infant death in the US, which have risen since 2020. nih

The Hazards That Actually Matter

Both the AAP and the ABM agree that certain circumstances make any sleep situation — including bedsharing — significantly more dangerous.

These include:

• Sleeping on a sofa, armchair, or soft surface

• A parent impaired by alcohol, cannabis, opioids, or sedating medications

• A parent who is extremely fatigued (more on this in a moment)

• Soft bedding — pillows, comforters, blankets surrounding the baby

• Smoking in the home or by a bed-sharing adult

• Baby under 4 months, premature, or low birth weight

• Others besides parents in the bed

Remove those hazards and the risk picture changes considerably. That's not permission to dismiss the research — it's the research.

The Sleep Deprivation Problem Nobody Wants to Name

Here's the Lorie take, offered as a doula who has sat with many, many exhausted new parents at 3am: the choice is rarely between "bedsharing" and "perfectly rested parent with baby peacefully in a nearby bassinet."

The actual choice is often between a parent who has planned and prepared for bedsharing with some level of intention — and a parent who is nodding off on the couch at 4am with a newborn on their chest because they simply could not stay awake one more time.

The Academy of Breastfeeding Medicine warns explicitly that accidental bedsharing can ultimately be more dangerous than when conducted intentionally in a safe environment. UNICEF

Sleep deprivation is also a postpartum mental health risk, and it doesn't make anyone a safer or more present parent. If the realistic options on the table are "exhausted parent passes out on the couch" versus "parent makes an intentional plan to bedshare as safely as possible," that's a legitimate harm-reduction conversation — and it should be happening openly, not shamefully in whispers.

A Note for C-Section Recovery

Breastfeeding or chestfeeding lying down after a cesarean birth is not just convenient — for many parents it's the only comfortable option for weeks. When you're protecting an incision and can't easily lift a baby repeatedly in the night, side-lying nursing is genuinely easier and less physically demanding than sitting up, positioning, and returning baby to a separate surface every time.

This doesn't mean falling asleep in that position is automatically safe. But it does mean that dismissing the conversation entirely, without acknowledging the physical reality of surgical recovery, isn't actually helpful to families.

If You're Considering Bedsharing: What Safer Looks Like

This is not a recommendation to bedshare. It's information — which every parent deserves to have regardless of what they choose.

The ABM's risk minimization framework, supported by research, points toward:

• Firm adult mattress (not a waterbed, memory foam topper, or soft surface)

• No pillows, heavy blankets, or soft bedding near the baby

• Baby on their back, not between parents — alongside one parent, away from the edge

• No one in the bed who has used alcohol, cannabis, sleep medications, or other sedating substances

• No one who smokes sharing the bed

• Baby is full term and healthy

• Move the bed away from the wall to avoid entrapment

And critically: make the plan intentionally, not at 3am when you're half asleep and desperate.

What Doulas Can Do With This

This is a topic where your role as a doula is to provide information and hold space, not to make the decision for the family. Evidence-based medicine integrates compassionate use of individual patients' predicaments, rights, and preferences. Nonjudgmental counseling helps to build trusting relationships for both disclosure and effective counseling. Liebert Pub

That means:

• Know the AAP guidelines cold, because families will have heard them

• Know the ABM protocol, because it gives you language for nuance

• Know the hazard list, because that's what actually drives risk

• Ask open questions about what families are actually doing at night, because if they're not telling you, they may be doing something more dangerous in silence

The goal isn't compliance. It's safety — and safety requires honesty.

The Bottom Line

The AAP says no bedsharing, period. Other major bodies say the risk is in the hazards, not bedsharing itself. International guidance is moving toward harm reduction. The research on unplanned, accidental bedsharing makes a compelling case that teaching safe practices is more protective than a blanket prohibition that many families won't follow.

What that means for your family is a conversation worth having with your provider — and worth having before you're so exhausted you can't think straight.

Your baby, your body, your choice. Make it an informed one.

Sources: AAP 2022 Safe Sleep Policy Update; Academy of Breastfeeding Medicine Protocol #6 (2019); PMC — Bedsharing May Partially Explain Reduced Risk of Sleep-Related Death in Breastfed Infants; Frontiers in Public Health — Beyond the Rules: Parental Perspectives on Safer Infant Sleep in Shared Environments (2025)