Is chest-to-chest sleeping dangerous?
by Consuela Hendriks
We know for certain that side sleeping and tummy sleeping in a cot is dangerous . But what about chest-to-chest sleeping?
Lots of babies prefer sleeping chest-to-chest, especially for the first few weeks. It’s highly likely the mother will wake up when the baby shifts position. This type of co-sleeping will maximize sleep for both parent and baby and probably prevents total exhaustion, which might actually be more dangerous.
There is no research though around the safety of this sleeping arrangement. There are opinions and advice though.
Skin-to-skin care (SSC), defined as the practice of placing infants in direct contact with their mothers or other caregivers with the ventral skin of the infant facing and touching the ventral skin of the mother/caregiver (chest-to-chest), is recommended for all mothers and newborns, regardless of feeding or delivery method, immediately after birth (as soon as the mother is medically stable, awake, and able to respond to her newborn) and to continue for at least 1 hour, as defined by the World Health Organization’s (WHO’s) (Feldman et. al., 2016).
But what about night-time sleep?
According to Dr. Nils Bergman from the University of Cape Town in South Africa, healthy newborns should sleep on their mother’s chest for the first few weeks of their life to achieve optimal development.
Infants must be skin to skin, chest to chest, upright (not less than a 30% incline off of horizontal or more) for optimal breathing effects, and mothers should sleep with infants in kangaroo care as long as they wear a tube top sufficiently long to tuck into their slacks so the infant cannot fall down or out while mother sleeps, and mother must be sleeping in upright position supported by two to three pillows (Bergman et. al., 2010).
Red Nose states that “Sleeping baby on their tummy on the parent’s chest, often skin to skin, is an excellent strategy for settling an infant, and can help them self-regulate their temperature, as long as the baby and their airway are being observed (either by the nursing parent or another adult caregiver). A parent falling asleep with a baby prone (on the tummy) on the parent’s chest and unobserved can be problematic as prone positioning reduces baby’s arousal mechanisms that protect baby’s airway; baby’s nose may become obstructed by clothing, or parent’s body or breast; or an unobserved baby may become positioned with his/her chin to chest, which will also obstruct baby’s airway.” (Red Nose statement, 2019). They consider night-time chest-to-chest sleeping unsafe.
However, it is probably safer to co-sleep in a planned chest to chest position in a well set up bed than falling asleep on a sofa or armchair. Let’s face it. Primate infants have slept in their mother’s arms for millions of years, and our species hasn’t gone extinct.
Because the lack of research I asked James McKenna what his thoughts are. His response:
“There is really no need to avoid the chest to chest (ventral-ventral) sleep position as it is 45 million years old and if ever there is a human universal infant-maternal sleep position, this is it. Of course, like all things with baby care, an attentive and responsible mom is the prerequisite but using her own instincts and natural behaviors toward her infant and her vigilance the infant need not always be put back down on its back rather than on her body. An infant sleeping prone on its mother is NOT the same thing at all as an infant sleeping prone alone on an inert mattress surface. An infant on mom’s chest is riding (literally with her breathing movements) good vestibular stimulation…with her rhythms and contact, enjoying multiple sensory signals and cues including fragrances from her milk…and carbon dioxide exhaled from mom’s breath…and providing breathing sound… that stimulates the phrenic nerve to get rid of C02, which is a small reminder for the baby to take another breath.” (Direct quote from email to me)
So, is it safe? According to James McKenna it’s biological normal.
Safely practiced breastsleeping (a breastfeeding mother-baby pair sharing a bed during sleep to facilitate breastfeeding); a well-prepared bed for bedsharing or a cot in sensory proximity (within arms’ reach) of the caregiver are really the safest options, according to James McKenna.
La Leche League
Sweet Sleep/La Leche League International (Wiessinger et. al., 2014) mentions that lots of newborns sleep best on their mother’s sloping chest. They advise to make it a solid friction fit and to make sure that there aren’t any crevices or pillows (including your own) in places that could cause a problem.
They also say: “If the propped-with-baby-on-chest position is what gets you the most sleep in those early days or weeks, make it commonsense safe and go for it.”
On their website they state that “Leaning back with your baby facing your chest is not a risk.” and “Stomach-sleeping on a flat, horizontal surface increases the risk of suffocation and SIDS unless the surface is a parent’s chest.”
However, I think there should always be a personal risk-assessment, especially when parents are extremely sleep deprived and when other conditions are not in line with international sleep guidelines. Risk-factors of SIDS and fatal sleeping accidents, either alone or when combined with bedsharing are: sharing a sofa with a sleeping adult (‘‘sofa-sharing’’); infant sleeping next to an adult who is impaired by alcohol or drugs; infant sleeping next to an adult who smokes; sleeping in the prone position; never initiating breastfeeding; sharing a chair with a sleeping adult; sleeping on soft bedding; being born preterm or of low birth weight (Blair et. al. 2020).
So, without advising for or against chest-to-chest sleeping, this post was meant to inform and reproduce what the experts say, so you can make your own informed decision.
Bergman, N., Carney, G., & Ludington-Hoe, S. M. (2010). Kangaroo care for the preterm infant. ICAN: Infant, Child, & Adolescent Nutrition, 2(3), 165-169.
Blair, P. S., Ball, H. L., McKenna, J. J., Feldman-Winter, L., Marinelli, K. A., Bartick, M. C., & Academy of Breastfeeding Medicine. (2020). Bedsharing and breastfeeding: the academy of breastfeeding medicine protocol# 6, revision 2019. Breastfeeding Medicine, 15(1), 5-16.
Feldman-Winter, L., Goldsmith, J. P., Watterberg, K. L., Cummings, J. J., Benitz, W. E., Eichenwald, E. C., … & TASK FORCE ON SUDDEN INFANT DEATH SYNDROME. (2016). Safe sleep and skin-to-skin care in the neonatal period for healthy term newborns. Pediatrics, 138(3).
McKenna, J. J., Ball, H. L., & Gettler, L. T. (2007). Mother–infant cosleeping, breastfeeding and sudden infant death syndrome: what biological anthropology has discovered about normal infant sleep and pediatric sleep medicine. American Journal of Physical Anthropology: The Official Publication of the American Association of Physical Anthropologists, 134(S45), 133-161.
McKenna, James J., “Safe Infant Sleep: Expert Answers to Your Cosleeping Questions” (2020). Faculty Book Gallery. 452.
Wiessinger, D., West, D., Pitman, T., & Smith, L. J. (2014). Sweet sleep: nighttime and naptime strategies for the breastfeeding family. Ballantine Books.