Is it safe to breastfeed lying down?

The verdict

Feeding lying down is safe, and for many people it is the position that makes night feeds survivable. The question this page has to answer is not really about the position. It is about what happens when you fall asleep, because at some point most parents feeding at night do.

Unicef UK Baby Friendly's own figures put the scale of it: on any night, twenty-two per cent of babies will bed-share, and around half of babies in England and Wales will have slept in an adult bed with one or both parents by three months, whether intended or not. Planning for that is not permission-giving. It is the only realistic approach.

The Lullaby Trust's position is that breastfeeding reduces the risk of sudden infant death syndrome, and that if you feel you might fall asleep, it recommends you prepare the bed to make it safer for baby. That single sentence is the whole strategy.

When sharing a sleep surface is never safe

These are not preferences. The Lullaby Trust states that co-sleeping with your baby is very dangerous if you or anyone in the bed has recently drunk any alcohol, if you or anyone in the bed smokes or the baby was exposed to smoking in pregnancy, if you or anyone in the bed has taken any drugs or medication that make you feel sleepy, or if your baby was born prematurely, before thirty-seven weeks of pregnancy, or weighed under 2.5kg. In these scenarios, it says, it is always best to put baby in their own sleep space, such as a cot or Moses basket.

The NHS gives the same list: do not share a bed with your baby if they were born prematurely or weighed less than 2.5kg or 5.5lb at birth, and do not share a bed if you or your partner smoke, drink alcohol or take drugs or medicine that makes you feel sleepy.

Note that the smoking rule applies even if nobody smokes in the bedroom, and applies to smoking in pregnancy. Note also that the alcohol rule says any alcohol, not too much alcohol. And note that "medication that makes you feel sleepy" includes the pain relief and sedation covered on our anaesthetic pages.

Never a sofa, never an armchair

This is the one rule that carries the largest risk and is most often broken by accident. The Lullaby Trust: never fall asleep on a sofa or armchair with your baby, as it significantly increases their risk of SIDS. They are also at risk of accidental death as they can easily slip into a position where they are trapped and cannot breathe.

The NHS says the same: do not sleep on a sofa or in an armchair with your baby.

Unicef UK's figures show why this rule is separated out. The risk of SIDS while co-sleeping on a sofa is around one in 203, against a background risk for all babies in England and Wales of around one in 3,710. Co-sleeping after alcohol or drugs carries a comparable risk of about one in 203, and co-sleeping with a regular smoker around one in 919.

Why UK guidance does not simply say never

Unicef UK Baby Friendly is explicit that telling every parent never to co-sleep, or saying nothing at all, is not safe, and can increase the risks to babies. Its reasoning is worth reading in full because it explains a policy that is often misread as permissiveness.

Young babies wake frequently at night and need to be fed and cared for somewhere. In most homes this will be in bed or on a sofa or armchair, simply because there is no other comfortable place. Parents can easily choose the more dangerous sofa over the less dangerous bed because they are trying to follow advice to never bed-share. Mothers can try and sit up rather than lie in bed to breastfeed in order to stop themselves falling asleep, and so risk falling asleep in a more dangerous position than if they had been lying down. Many abandon breastfeeding altogether as they are so exhausted.

Its conclusion: sleeping on a sofa or chair with a baby is very dangerous and should always be avoided, and if parents fall asleep with their baby they are much safer in a bed than on a sofa or chair. And the headline claim behind the whole approach: if no baby co-slept in hazardous situations, we could potentially reduce co-sleeping SIDS deaths by nearly ninety per cent.

Unicef UK also warns against the opposite failure: shocking messages that imply that all or any co-sleeping leads to death are not helpful, because they do not reflect the evidence, they frighten parents and staff, induce guilt and close down honest conversations.

The US position is different, and we are not going to blur it

The American Academy of Pediatrics does not take the risk-minimisation approach. Its safe sleep guidance states that babies who sleep in the same bed as their parents are at risk of SIDS, suffocation or strangulation, that parents can roll onto babies during sleep or babies can get tangled in sheets or blankets, and it recommends room-sharing without bed-sharing, which it says helps protect against SIDS in the first year of life. It also advises making sure not to fall asleep on an armchair or a sofa while holding your baby.

Red Nose Australia sits closer to the US position on the headline: the safest place for a baby is in their own safe sleep space, and Red Nose does not recommend co-sleeping. It then gives risk-reduction advice for parents who do, and states that you should never co-sleep or lie down holding baby if you are overly tired or unwell, if you or your partner have recently consumed alcohol, if you or your partner smoke even if not in the bedroom, if drugs that make you sleepy have been taken, or if your baby was premature or small for gestational age. It also says never to co-sleep with a baby on your chest.

So: the UK, through the Lullaby Trust, Unicef UK and the NHS, tells you how to make an unplanned bed-share safer, because it accepts that it will happen. The AAP recommends against bed-sharing outright. Both agree completely on sofas, alcohol, smoking, sedating medication and prematurity. If you read only one of the two, you will misunderstand the other.

Making the bed safer, if you might fall asleep

The Lullaby Trust's practical steps: keep pillows and adult bedding away from your baby, along with any other items that could cover their head or cause them to overheat; remove slatted or decorated headboards; do not bring other children or pets into the bed; check that baby cannot be trapped between the mattress and the wall or in the bedframe; and never leave your baby alone in an adult bed.

Add a firm, flat mattress, baby on their back when not actively feeding, and no gaps. Do the preparation before the night feed, not during it.

The side-lying position itself

Lie on your side with your baby facing you, nose level with your nipple, body in a straight line and tummy against you. Support your own head with your lower arm rather than draping it over the baby, and keep the space above their head clear of pillows and duvet.

Where guidance differs

The UK, through the Lullaby Trust, Unicef UK Baby Friendly and the NHS, takes a risk-minimisation approach: it names the circumstances in which bed-sharing is never safe, and helps everyone else prepare the bed.

The US, through the American Academy of Pediatrics, recommends room-sharing without bed-sharing for at least the first six months and warns of SIDS, suffocation and strangulation risks from bed-sharing.

Australia, through Red Nose, does not recommend co-sleeping but publishes detailed risk-reduction advice for those who do.

Canada, through the Canadian Paediatric Society, recommends the baby sleeps in their own space in the parents' room and notes that breastfeeding and being smoke-free both reduce SIDS risk.

The absolute rules are identical across all four: never a sofa or armchair, never after any alcohol or sedating drugs or medication, never if anyone in the bed smokes, and extra caution for babies born premature or small.