In praise of the side-lying position
By Cordelia Uys, NCT Breastfeeding Counsellor
When I was breastfeeding my babies (all now in their 20s), by far my favourite way to nurse them was in the side-lying position. Not only would I always use it for night-time feeds, but I would also feed them in the side-lying position during the day when I wanted to rest or nap. No matter how comfortable you are in a sitting position, there is nothing that compares to the relaxing feeling of having your whole body supported by a mattress. Reading is one of my favourite pastimes, and I made my way through dozens of novels while nursing my babies in the side-lying position. In fact, I actively looked forward to breastfeeding in that position. Nowadays, whenever I do a home visit, I leave showing the side-lying position to a new mum to last, so she can stay like that while I let myself out.
A game changer
The position is such a game-changer that it makes me feel sad that some mothers don't realise it can be done safely, and never get to experience it. I once met someone who had breastfed her child for a whole year without ever using the side-lying position; I honestly couldn’t imagine how she had managed it.
What nursing mothers say about the side-lying position
To encourage more women to try this position, I asked members of a large Facebook group for London-based nursing mothers to share their experiences of feeding in the side-lying position. Forty-three members responded, and I have used their comments in this article. Many referred to the side-lying position as a life saver, godsend or game changer.
Safety concerns
Many women are reluctant to try this position for fear of falling asleep and rolling on to their baby, but there are safety measures that can be taken that make rolling on to the baby extremely unlikely.
‘I didn’t do this with my first as I was anxious about bed-sharing in general, [but] when I had my second, I was much more clued up on safe sleep and feeding positions and we co-slept and I fed in the side laying position from the very start.’
‘Such a game changer for me, I’m lying in this very position feeding my 3-month-old right now! Wish I’d been confident enough to do this earlier on with my firstborn as it allows both of us to drift back to sleep much quicker in the night.’
‘With my first I was too scared to bedshare, and I got zero sleep as she just wouldn’t settle and I’d be up and about trying to settle her or nursing most of the night. However I’ve recently had my second baby and I have given up on trying to get her to sleep off me. She sleeps right on the boob, or just off it next to me in my bed. And I’m getting 7/8 hours of sleep a night. I can be a better mother for both my children when I’m not absolutely sleep deprived and I’m really actually enjoying having her next to me and waking up to her little chubby cheeks in the morning. It was scary the first night, but I follow the safety recommendations and have realised I won’t roll on my baby as I’m in the recovery position. It’s been magical for us, and I’m really hoping to encourage other mamas on the fence about bed sharing.’
Safety recommendations from the Lullaby Trust
Please see this Lullaby Trust leaflet for detailed information on how to make bed-sharing as safe as possible:
When bed-sharing, it is vital to follow these safety recommendations:
Keep pillows and duvets away from your baby. It’s a good idea to use a sheet and blanket instead.
Make sure the bedclothes cannot cover your baby’s face or head.
Don’t put your baby between you and your partner.
Don’t bed-share if there are pets or older children in the bed.
Make sure your baby cannot fall out of bed or become trapped between the mattress and wall.
Don’t leave your baby alone in the bed, as even very young babies can wriggle into a dangerous position.
Don’t swaddle your baby when they’re in bed with you.
Don’t bed share if you are your partner have been drinking alcohol or have taken legal or illegal drugs that might make you drowsy.
Don’t bed-share if you’ve slept fewer than 4 hours in total in the last 24 hours.
Sleep research
Breastfeeding hormones
Breastfeeding mothers produce hormones that help them relax and fall asleep more easily, and which also help them to be in tune with their baby and prevent them from going into a deep sleep.
Prof Helen Ball, an anthropologist based at Durham University, who runs the website https://www.basisonline.org.uk/ and is one of the UK’s leading researchers into infant sleep, has filmed hundreds of mothers sleeping with their babies, and she has observed that when bed-sharing, breastfeeding mothers instinctively curl their body around their baby in a protective position.
‘Initially I was worried about rolling on to her, but I found you just have this innate skill to curl your body around them to protect them. I would definitely recommend this position to any tired mother!’
‘S and I love this position; it’s relaxing and comforting for both of us. I often fall asleep for a bit like this but never roll over and S is always safely cocooned by my arm and body.’
The recovery position
Please bear in mind that in the medical name for the side-lying position is the ‘recovery position’. The reason we put an unconscious person into the recovery position is so that their arms and legs prevent them from rolling forward on to their front.
‘We co-slept and whenever he woke up, I just popped him on and went back to sleep... Your stretched-out arm and legs prevent you from rolling over as it’s just not possible.’
Sitting up to breastfeed at night is risky
Research has shown that when breastfeeding mothers adhere to the safe sleep recommendations, the risks to a baby of bed-sharing are low. In fact, if parents bed-share while following the safety guidance, it is considerably less risky that if a mother feeds her baby at night sitting on an armchair or sofa, because if she were to fall asleep while sitting up, her baby could easily end up in a dangerous position.
‘It’s so much safer than sitting up in bed feeding trying to stay awake! At 20 months, I still use this position.’
Professor Peter Fleming
On 30th July 2021, at a webinar from the Royal Society of Medicine on the new NICE guidelines on postnatal care, one of the speakers was Prof Peter Fleming who pioneered the Back to Sleep campaign that massively reduced the incidence of SIDS.
Prof Fleming discussed bed-sharing and stated categorically that when parents bed-share on a firm mattress, (but never on a chair or sofa), and follow the safety guidelines, in particular never bed-sharing if they are smokers, or if they have been drinking alcohol or taking any kind of drug or medication that would make them drowsy, the risks of SIDS are no greater than when a baby sleeps in their cot.
Breastfeeding reduces the risk of SIDS and bed-sharing is association with a longer duration of breastfeeding
Breastfeeding reduces the risk of SIDS (Sudden Infant Death Syndrome). The best way to maintain breastfeeding is to feed a baby responsively - day and night. Bed-sharing is associated with a longer duration of breastfeeding (please see graph below), because it facilitates responsive feeding, and makes night-time parenting easier.
The many benefits of the side-lying position
The side-lying position allows nursing mothers to get more sleep at night
Lots of women will bed-share all night and won’t even be aware of how often their baby feeds:
‘I didn't know this position existed with my first baby and I believe because of this we struggled to co-sleep, so I ended up spending most nights bent over her cot trying to get her to sleep, getting zero sleep myself! I was shown it by a friend when my second baby was a couple of months old and I loved it. I've now used it since my third baby was a couple of days old, she's almost 5 months now and we're so happy co-sleeping and getting way more sleep than if I was trying to get her to sleep in a cot!! We've used this position throughout the night and we both happily dose back to sleep together, after she's wiggled around looking for the boob (she doesn't wake up crying because she knows I'm there!), some mornings I don't even remember having woken up! It's changed my life!!!’
‘It really was a game changer, enabled me to get well needed rest and feed through the night without really having to wake much. Even now (he’s 14 months) I can’t tell you how often he wakes as I barely register it.’
‘One major reason I don’t want to stop breastfeeding is because the nights are so easy! Bed sharing and breastfeeding in the side-lying position are such a dream, I rarely feel sleep deprived and I can’t imagine having to get up out of bed to warm milk.’
Game changer that allows me to fall back asleep a lot quicker after he’s finished as I don’t have to get up and sit down (and thus be fully awake and then unable to get back to sleep).’
‘We co-slept for 9 months and side-lying feeding was the only thing that kept me from becoming a zombie. We still feed side lying for first milk at 15 months.’
‘I now use this position during night feeds so that I can get some rest whilst baby feeds. It saves me having to wake up fully and position and feed baby, so ultimately, I get more sleep as I easily fall back to sleep again after baby has fed. I’ve also felt confident co-sleeping too because of this position.’
‘My OH occasionally asks: ‘how did N sleep last night?’ and I’m like: ‘I actually can't remember!’’
‘My baby is 7 months, and she falls asleep quickly [in the side-lying position]. I love how I can just roll away once she has fallen asleep without disturbing her, no fighting to go to sleep and none of the ‘as soon as I lay her down, she wakes up’ drama we had with her older sister!’
‘It’s saved our nights since I went back to work’.
Other mothers prefer to put their baby back in their cot after a feed, but still find side-lying invaluable for settling their baby:
‘On nights where she just wouldn't settle, instead of bouncing around rocking from side to side, I would simply get undressed and lay in bed with her feeding. She would fall fast asleep, completely relaxed and I would eventually put her into her next-to-me cot.’
Side-lying can allow you to get a bit more sleep in the morning with an older baby or toddler
‘I still feed our youngest (22 months) like this in the mornings, allowing a little bit more sleep and nice cuddles before the day starts. If he wakes up anytime before about 6.30 then I’ll bring him into bed and have a snoozy feed before getting into the shower. He’s now comfortable enough to just go back to sleep when I do sneak off to get ready and then he hits daddy on his back when he wants him to get up and start breakfast!’
The side-lying position helps with daytime naps too
‘I’m at the point in my breastfeeding journey where I’d like to put baby down when she naps in the day and so using side lying position is helping me feed baby, who then naps, and I can peel myself away to enjoy a hot (decaf) coffee.’
‘A good way to get a bit of rest for me and baby is already lying there half-asleep so it is just a matter of wriggling away to let them continue to sleep.’
‘I highly recommend it if you want to get some relaxation, doze and snuggle.’
The side-lying position works really well for women with large breasts
‘Defo a game changer. I have a 5-week-old, had a hard start with breastfeeding, have big breast plus developed mastitis. I was overcomplicating myself with cushions, holding my breast to help the baby, plus hurting my back. Since I learned how to feed her in this position, I’m actually enjoying breastfeeding!!!’
The side-lying position works well for women with oversupply
‘It let him cope with oversupply in early days. He could let milk leak out instead of sputtering so much.’
The side-lying position works well for new mothers who find sitting difficult
‘This has been my go-to position since the beginning. I injured my tail bone giving birth and this plus the episiotomy made it really difficult for me to sit’.
‘I remember writing an email to you, Cordelia, at 3 a.m. asking you to come help me learn exactly this position, as after the birth it was very painful for me to sit or lay on my back. It was a game changer.’
The side-lying position helps cope with cluster feeding
‘I found this position an absolute life saver. Cluster feeding in the evening was made really pleasant by just lying in bed and watching some TV while she fed.’
The side-lying position is really comfortable!
‘No stress on muscles plus I can use my phone! I’m actually laying on my side feeding as I type right now!’
‘I have M.E./CFS and a lot of shoulder/neck pain, so cradle/cross cradle was quite a strain for me; being able to feed lying down has also saved so much energy.’
‘Best position ever. Everyone gets sleep this way. I even do it on the floor in the living room for day-time feeds. I do it lying down wherever possible! To the point where I have to practice upright feeding now and then just to make sure I can still do it!!’
The side-lying position is lovely for closeness and cuddles, what the Japanese call skinship
‘This position enables both of us to get back to sleep in quick time and provides an amazing intimacy and closeness.’
‘It’s such a lovely way to get proper cuddles when they get older.’
The side-lying position is helpful when the weather is hot
‘It really made such a difference to me particularly during the really hot weather when holding him across my body was just really really uncomfortable for both of us!!’
Video of mother latching her baby in the side-lying position
Video of baby breastfeeding in the side-lying position
Get help from a qualified breastfeeding supporter if you are struggling with this position
If you are struggling to make the side-lying position work, ask a breastfeeding counsellor or lactation consultant for some guidance. I’ve never yet come across a mother who didn’t love this position once she’d been shown how to do it.
‘The side lying position radically transformed my breastfeeding journey. Cordelia taught me how to position myself and baby safely and this gave me the confidence to try it out.’
‘I was shown this position by a lactation consultant when my daughter was a few days old. I have never looked back.’
The side-lying position can be trickier for women with smaller breasts
‘I initially couldn't get the hang of it and thought it was because my boobs were too small (and I do think this makes it somewhat harder)…A friend who is a BF peer supporter showed me how to when my first was a few weeks old.’
Some tips for making the side-lying position as safe and comfortable as possible
To avoid needing to place your baby between you and your partner when offering your baby the breast closest to your partner, you can flip yourself and your pillows round, so that you are lying with your head where your feet would normally be, facing away from your partner. (See illustration below).
Place a pillow between your thighs to protect your back.
Place the same number of pillows under your head as you would usually use while sleeping.
Make sure your head is on the pillows, but your neck and shoulder are on the mattress.
Make sure the breast you’re going to feed from is flat on the mattress.
If someone else is around, ask them to shove a pillow into the small of your back. This is deliciously supportive.
Make sure both you and your baby are fully facing each other, both lying on your sides.
Either tuck your baby’s lower arm under your body, or along the surface of the mattress, so that their arm doesn’t prevent your bodies from touching closely.
You want to aim for an asymmetric latch, so start with your baby’s nose opposite your nipple, and bring their chin into the breast first by pulling them into your body via their shoulders.
Place a small, rolled-up towel or baby blanket along your baby’s back, to hold them in place while they’re feeding. Make sure it stops at the nape of your baby’s neck, so they can turn their head away from you if they want to. Once they’ve finished feeding, if you are still awake, you can remove the towel/blanket, and roll your baby on to their back. N.B. your body will prevent your baby from rolling on to their front.
Use a waterproof mattress protector so your mattress does not get soaked in milk.
If you have lots of milk, you might want to place a towel under your breast and your baby.
To avoid needing to place your baby between you and your partner when offering your baby the breast closest to your partner, you can flip yourself and your pillows round, so that you are lying with your head where your feet would normally be, facing away from your partner.
Bedsharing and breastfeeding comfortably at night with a toddler
A mother asked:
‘I loved feeding in side-lying at night for the first year or so of my daughter’s life, but after a certain point I found it uncomfortable because of the length of her body and her legs being in the way…’
Some suggestions she received:
‘I found once they were older and with my boobs being quite big, that side lying was better when feeding from the top boob rather than the bottom.’
‘I agree, top boob is now easier and it stops the nipple twiddling. My son has very long legs and he actually puts them on top of me now as well, so his body is a bit twisted but he’s not a newborn anymore so that’s not a big deal. You could also straighten your legs or arch your back to move your hips further back to create more space.’
‘Pillow at your back, bottom leg bent, child’s legs over yours for bottom boob. Swap your legs and put child’s under for top boob. You can also interlace legs with your kid. (Currently feeding 6wk old and almost 3yo). Actually, a 2yo plus can lay on top of you too… ideally on side you want to roll them off onto once asleep. I found he really liked the legs over mine from c. 1 years. He’s tall. And makes it all like a cuddle.’
Links:
Academy of Breastfeeding Medicine Clinical Protocol #37: Physiological Infant Care—Managing Nighttime Breastfeeding in Young Infants:
Bedsharing may partially explain the reduced risk of sleep-related death in breastfed infants: https://www.frontiersin.org/articles/10.3389/fped.2022.1081028/full?fbclid=IwAR1jPzlL55iG0k4wDYcF5QUoSYTbMr-TCNcwW3asbeUx3EmPXz_MhFRw4i0
Video explaining the side-lying position: https://www.youtube.com/watch?v=MZARPE9RUGE
Lullaby Trust safe sleep guidance: https://www.lullabytrust.org.uk/safer-sleep-advice/co-sleeping/
Basisonline - website dedicated to evidence-based research into infant sleep: https://www.basisonline.org.uk/
Safe Infant Sleep and Breastfeeding Are Partners: https://www.psychologytoday.com/us/blog/moral-landscapes/202203/safe-infant-sleep-and-breastfeeding-are-partners?
Baby Sleep: How to bedshare safely, from mums who no longer hide it: https://www.bbc.co.uk/news/uk-northern-ireland-67916722.amp