Blanket Rules: The secret world of Co-sleeping

For a number of years Midwives - and other healthcare professionals - have been advising women NOT to share beds with their babies, as a point of best practice. But many women continue to ‘bed-share’ all the same…So what is this secret world of Bed-sharing all about? And why are mums choosing to ignore the advice of the ‘experts?’

Why midwives say no

“For many years, the Department of Health has advised that the safest way for a baby to sleep is on its back, in its own cot or moses basket in the parents’ room for the first 6 months”  Professor Mark Baker, Director of the NICE Centre for Clinical Practice

Midwives base their practice on the most up-to-date, ‘best available’ evidence, which is what informs NICE Guidelines and Department of Health guidelines.  So any Midwife who is commenting on safe sleeping will be singing from this hymn-sheet, as it were.

It is a Midwive’s professional obligation to provide you with this information.  However, what you chose to do with this information is ultimately your choice.

So what’s the evidence?

The Information and advice on co-sleeping largely relates to its association with sudden infant death syndrome (SIDS) – where babies die suddenly and seemingly inexplicably.   However, the exact causes of SIDS are unknown.

The most recent NICE guidelines on SIDS and co-sleeping was updated in 2014.  The evidence reviewed for this guideline showed that there was a statistical *relationship* between SIDS and co-sleeping, but there was no clear evidence to say that co-sleeping directly causes SIDS.

Consequently, since we have some evidence to suggest that there *may* be a relationship between co-sleeping and SIDS, the party line is to err on the side of caution, as it were.

Blanket Rules; Your choice

As with every aspect of maternity care – and life at large! – there is no one size fits all policy.   Different parents will chose to negotiate information differently; everyone couple and every situation is unique. 

However, what the 2014 guidelines do tell us, is that the association between co-sleeping and SIDS is likely to be greater when certain additional risk factors exist:

-       When women or their partners smoke

-       Parent or carer has recently consumed alcohol

-       Parent/carer drug use

-       Low birthweight or premature infants.

Given that a number of these factors may be present in any case, at any one time, it is difficult to come to any conclusions about the absolute risk of bed-sharing, in relation to SIDS. Indeed, La Leche league emphasises that we must be cautious when interpreting this data, as there is little consistency in accounting for other factors which we know may also significantly increase the likelihood of SIDS.

“The four biggest issues associated with SIDS are smoking, laying a baby facedown for sleep, leaving a baby unattended and formula feeding” La Leche League

Underworld or real world? Reckless, Realistic, Pragmatic?

In reality, we know that many women (and particularly breastfeeding women) do choose to co-sleep with their babies for a variety of reasons: from comfort and bonding to sheer practicality.  There has thus been a move towards giving advice and information to parents on how to do this more safely.

“infants should always sleep on their backs, on firm surfaces, on clean surfaces, in the absence of (secondhand) smoke, under light (comfortable) blanketing, and their heads should never be covered…. The bed should not have any stuffed animals or pillows around the infant and never should an infant be placed to sleep on top of a pillow or otherwise soft bedding.” The baby sleep laboratory (see links below for more information on safe co-sleeping)

Could co-sleeping actuality be safer?

There are many advocates of co-sleeping that suggest that *if practised safely* co-sleeping may actually be safer for babies.  Dr James McKenna from the mother and baby sleep laboratory is one such advocate.  He focusses on the advantages of co-sleeping in relation to bonding and attachment, as well as the evidence demonstrating it's physiological benefits, such as infant breathing regulation and more successful breastfeeding.

“Infants and children sleeping in isolation is a recently devised cultural practice to which the human species is not adapted…Our young thrive and grow optimally when they feel safe — in close proximity to familiar, nurturing caregivers.” Dr Mckenna

My own personal gripe with co-sleeping advice is that it AGAIN undermines mothers, and their ability to instinctively care for their own babies, perpetuating the trajectory that women, and women's bodies, are somehow a danger to their own babies.

Professor Helen Ball’s research at Durham Univeristy has gone some of the way in dispelling such myths: her research shows that when sleeping with their breastfed babies mother’s actually adopt ‘protective’ positions in bed that makes smothering a baby with bedding, or 'overlaying' them actually rather difficult and unlikely.  Similarly she highlights the significant health benefits to both mother and baby as a result of bed-sharing mums breastfeeding more successfully, and for longer.

Ultimately, every woman, and every couple will come their own conclusions about what works for them.

Given the dubious causality in the evidence; and in light of emerging new research -demonstrating the physiological and psycholigical benefits of co-sleeping - we must stay open and responsive to the possibility that what we know - or what we think we know about co-sleeping - could in fact be misguided.

After all, this wouldn't be the first time that 'the experts' have been proven wrong, revealing that Mums know their bodies, and their babies best….

 

 

 

 

 

What mums say:

 Emma:  “My first baby is 4 months old and we co-slept from day 1, despite every health professional I encountered telling me not to. They also told me I shouldn't breastfeed her to sleep. And some even said I should leave her to cry because she needs to learn to be independent (Wtf?!)  I chose to co-sleep partly because it's easier to feed her at night, but mainly because she won't go to sleep unless she's in physical contact with me - which I've learnt is completely normal and not a sign of a 'sleep disorder'.

I think if I were less confident and didn't have the support of my mum (she's a psychologist and mother of four) then the opinions I encountered may have made more of an impression on me. The NHS should give a more balanced view of these issues and not allow midwives and health visitors to present their own opinions as facts. They should also accept the fact that most parents will co-sleep at one time or another, often by accident, and the best way to prevent SIDS is to educate people about how to do it safely. (The current attitude is a bit like teaching abstinence as the only form of contraception!).”

Marilena:  “I co-slept with my daughter, from birth and I currently sleep with my baby boy. It's been my saviour. I have no idea how mums who do not do it, survive the early weeks.  For both of my children, I was advised not to bed share by some professionals. Others were much more open.

There seems to be a real gulf of confidence and widely polarised views.  My experience of sleeping with my babies has been nothing but positive. I didn't dread those first 6 weeks like everyone else. My babies slept well at night, they nursed when needed without waking me up too much.

I always know where my baby is. Both of them just nestle up to me. We sleep right on the edge of the bed with baby on the side. I've never once had an issue with baby possibly falling off. They were/are glued to my side. And equally, smoothering them is pretty impossible if you follow good practice. I wear clothes to bed and do not pull my duvet over my waist. The baby has his own sleep bag. If I ever feel over-tired I place him in the Moses. I never put him in the middle of us, and my partner doesn't co-sleep with baby.

When I sleep close to my baby, their breathing matches mine and feels calmer. We both sleep much better, which means I am a better mother in the morning and my child a dream to manage the next day as they are well rested.

I get so frustrated when I hear terribly sad stories of babies dying in the parents bed and co-sleeping gets the bad rap. But if one were to look into the incident more, you'd probably find out the parents were not following the guidelines.”

Claire, Midwife and mum of 3: “I did it with all mine, initially by accident as I fell asleep when they where breastfeeding for the millionth time, mine were all bad sleepers (they were all 1 year plus when they slept through). It meant I was able to stay reasonably sane and got the most sleep I was ever going to get. As a Midwife I always explain how to safely co-sleep and say they will probably end up doing it unintentionally."

Kasia, mum of Mia (5) & Masimba (1):  When Mia was little, I would get up at night, pick her up, sit up, and feed her sitting completely upright (while reading a book or watching something), which meant I had to wake up completely, be aware of what I was doing for at least 30 minutes and then fall back asleep. By the time I fell asleep Mia was usually ready for her next feed (or that's how it felt). So one night I felt I was nodding off and my arms relaxed. And while I always had her on a pillow and didn't sit right on the edge of the bed, I felt like she could have potentially rolled out of my arms and hurt herself or end up sleeping in conditions that would be unsafe (for example on a fluffy duvet or with her face towards the mattress.) It never occurred to me to feed her while lying down until that night. But from that moment on that was what I did - if I was awake enough I would put her back in the Moses basket, if I wasn't, we just both fell asleep. 

After a few nights I realised I am very aware of her at night and just left her in our bed. I nursed her to sleep until she was over a year. After that she started to feed, then fuss about a bit and falling asleep without nursing and one day I just realised she's not nursing to sleep anymore. The process was very child-led and gradual. 

The same is currently happening with Masimba - he nurses, and then he sort of rolls about, cuddles up and either falls asleep on his own or nurses for a few more seconds before dozing off. With him, I wasn't worried at all about squishing him. I just knew I would know where he was. 

In terms of advice - it seemed to me that there was loads of advice on babies' sleep, but all of it on how to make baby sleep safely in a cot bed and nothing about safe co-sleeping. But I never actively seeked advice on co-sleeping, so I don't know what would have been offered if I asked.”

Sharron: "I cannot imagine missing out on all of those sweet moments together drifting off to sleep, watching her sleep or waking up with her.  If she had not been in my bed for the past ten years, I would have missed so much."

Phillipa:  “We had our daughter in with us many times, as she was a poor sleeper and used to go into instant melt down if you weren't there within 3 seconds of her waking and then it would take an hour to calm her down. My husband is a very heavy sleeper but there was no chance he would squash her. For years, even if there was just a stray teddy in the bed, he would wake right on the edge of the bed. We all got a better night's sleep, and my daughter has turned out fabulous!”

 

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