Co-Sleeping in the News

By Jo Turner, Crowthorne & Sandhurst NCT Branch

In May 2013 the BMJ (British Medical Journal) published a report that found bed sharing with parents increases the risk of sudden infant death syndrome (SIDS) fivefold in babies younger than three months, even if the parents are non-smokers.

"The current messages saying that bed sharing is dangerous only if you or your partner are smokers, have been drinking alcohol or taking drugs that make you drowsy, are very tired or the baby is premature or of low birth-weight are not effective because many of the bed sharing deaths involve these factors"

BMJ Open study by R Carpenter

This report has resulted in the National Institute for Health and Care Excellence (NICE) examining its current guidance.

"Putting babies to bed in a safe way reduces the chances of them getting hurt. We know that for the first six months of life, the safest place for a baby to sleep is in a cot, lying on his or her back, in the parents' room. Sleeping alongside a baby increases the risks to the child – including death. We currently recommend that doctors, midwives and nurses should warn parents of the risks of sleeping alongside a baby in a bed"

NICE Spokesman

NCT has responded to this study and the NCT’s Senior Policy Adviser, Rosemary Dobbs has said:

“Around half of all parents in the UK sleep with their baby in bed some of the time, either in a planned or accidental way. It is important that parents are fully informed and given information that is tailored to their individual circumstances. This includes the risks associated with sharing a bed with a very young or premature baby, as well as the increased risks to a young baby sleeping in a room alone. However, NCT does not support a universal instruction not to bed share as it could lead to an increased likelihood that a parent or carer inadvertently falls asleep while holding the baby, in a chair or on a sofa, which is much less safe for the infant. 

“More than 300 babies a year die in the UK as a result of SIDS. These deaths are concentrated among more disadvantaged families and in environments where there is smoking, alcohol or substance abuse. It is important that effort is focused where it will have most effect.  NCT would like to see the government do more to reduce poverty and disadvantage among parents of babies and young children, and strengthen its efforts to support smoking cessation and avoidance of alcohol during pregnancy and at the early stages of a child’s life.”

NCT’s Senior Policy Adviser, Rosemary Dobbs

Many other organisations have also published their own comments regarding the study.  One that discusses the points to consider when reading the study is by Unicef UK.  

“The stated objective of the paper is to resolve uncertainty about the risk of SIDS and bed-sharing, but this is not possible if essential data has not been collected. A more recent study (Blair et al, BMJ 2009) has demonstrated a significant interaction between co-sleeping and recent parental consumption of alcohol and drugs. None of these five case-control studies collected data on recent drug consumption and only two collected data on alcohol consumption. The over-arching argument is thus whether bed-sharing in itself poses a risk to infants or whether the risk is within the hazardous circumstances in which we bed-share. These older studies simply do not have the data to resolve this argument.”

UNICEF UK Response

Becoming a new parent, you are bombarded with information, rules and ‘do nots’.  This is at a time when you have so little time of your own to investigate the facts behind these headlines.  So how do you know what rules to follow?  When our parents had us they were given far fewer ‘rules’ and we are okay so can we ignore the new rules?  But knowledge of our bodies and understanding has moved on so why shouldn’t we expect more rules?  When cars were first on our roads they did not have seat belts and even on a slow journey I would not consider leaving mine off. New information and technology has assisted us with the continual ‘human development’. 

Let me talk you through my personal thoughts on this study, using some articles that I have read to assist my writings.

Firstly, I will state Abi did co-sleep with me and my husband, so you have to understand my perhaps-biased viewpoint.  Abi was born four weeks early and weighed less than 5lbs.  I was told by health professionals that skin-to-skin contact was very important.  During the day, a naked Abi would often sleep tucked in my nighty—I spent a lot of time sitting down in the early days as I had had a C-section.  When we got home from hospital it was easier for me if Abi slept in the bed (I was still suffering a lot from my C-section).  Also, it seemed natural to me for Abi to sleep immediately next to me.  Abi was tiny and slept on a pillow between us.  I do not fidget (particularly with a painful tummy) and felt comfortable like this.  Night-time feeds were easier and I needed to inconvenience my husband less to help me.  Until Abi moved into her own room at six months she still spent part of the night co-sleeping with us.  This is all clearly against the current guidelines as she had a low birth weight and I was very tired (which new parent isn’t?!).  But it felt right to me to be able to feel her breathe throughout the night.

So, what are the ‘facts’?

In the recent bed-sharing research, Professor Carpenter reviewed home sleeping arrangements of infants in 19 studies (split into five datasets) across the UK, Europe and Australasia to resolve the uncertainty as to the risk of SIDS associated with sleeping in bed with your baby if neither parent smokes and the baby is breastfed. 

Among the 1,472 babies who died of SIDS, 22.2% were bed-sharing with parents; of the 4,679 babies who did not die 9.6% were sharing a bed on the day the interview took place.

But, in the report’s own words, the data is lacking certain detail:  three of the datasets do not collect data on the mother’s alcohol consumption in the prior 24 hours, and only two datasets contain information on the mother’s drug use.  And in all data smoking is only considered post birth with no data regarding the mother smoking during pregnancy.  As all three of these factors are agreed as key SIDS risks, this does seem to let the results down considerably.

The report also uses the lowest risk group as the baseline to generate the ‘five-fold risk’ increase.  Breastfed baby girls, placed on their backs to sleep with no other risk factors present have the lowest risk of SIDS.  Using the general population, the risk of co-sleeping is smaller than 2.7.

The headlines do not mention that the greatest risk increase for co-sleeping is where the mother smokes (a 15 fold increased risk).  Some odd patterns also arise, like the similar co-sleeping risk if both parents smoke and if only the mother smokes – but if you don't co-sleep, only having the mother smoke is half as risky.  The biggest risk remains when both parents smoke and consume alcohol—if you co-sleep here the risk is 151 times greater than the baseline.  My takeaway from reviewing this is that perhaps the data pool is too small and other factors are at play here. 

None of the five datasets that the report is based on asked the interviewees if they had intended to co-sleep, only if the baby was in their bed.  This subtle distinction could have dramatic consequences in reviewing the conclusions.  Unintended falling asleep by parent and baby would mean that no actions were taken to address the risks of co-sleeping. 

From talking to some of my friends, they would never have considered co-sleeping.  They were terrified of accidently rolling onto their baby or throwing the quilt over them.

My sister purchased the Bednest as an alternative to co-sleeping as both her and her husband fidget a lot at night (is it wrong that I now know this about my brother-in-law?!).  This is a crib with a drop-down side that attaches to your bed.  If you are interested, the NCT Shop sell this. It can also be rented from the NCT for six months. (See below for Bednest reviews.)

What I have taken from all the articles I have read is that unintentional co-sleeping is dangerous, wherever that may be.  Always ensure that you put your baby to sleep in a place you consider safe, be that their cot or your bed. 

All parents need sleep.  And, yes, risks of co-sleeping exist but could we not focus on safe sleeping techniques for parents, providing safety guidance if we chose to sleep together (covers, pillows, falling out of bed being risk factors)?  Cars kill far more children than co-sleeping does but we do not steer away from using them; instead we use in a perceived safe manner.  Saying no to co-sleeping could cause more harm by causing the mother to fall asleep somewhere unsafe for both.

I will give you one word of warning on co-sleeping though.  If you start you might not be able to stop!  Abi is now 4 1/2 years and rarely do we have a night when she does not come into our bed.  We will encourage her to stop soon I am sure!

Sources

http://bmjopen.bmj.com/content/3/5/e002299.full

http://www.nct.org.uk/press-release/nct-response-increased-risks-sids-when-bed-sharing

http://www.isisonline.org.uk/news/?itemno=17810

http://sarahockwell-smith.com/2013/05/21/bedsharing-sids-why-we-have-it-all-wrong/

http://www.unicef.org.uk/BabyFriendly/News-and-Research/News/UNICEF-UK-Baby-Friendly-Initiative-statement-on-new-bed-sharing-research/

Information on sleeping safely with your baby can be found on the NCT's website.

Bednest Reviews

Lou Everatt-Fletcher, a 39-year-old probation team manager from Oxford, is mum to eight-month-old Juno
"Juno is my first child and I knew from the start that I wanted to co-sleep, but I was worried about the risks. Sadly, we had a tragic cot death in our family and it is something we have always worried about. But the Bednest allowed me to sleep easy as I could see at any point in the night that she was safe and happy. I do not do well without sleep, but it allowed us to sleep in the same room without going mad. I could feed and resettle Juno without having to get up, which in the early days after quite a difficult birth was a huge help. My husband even managed to sleep through feeds as I would wake when she began to stir and could comfort her before she started screaming. I am also a huge fan of well-designed, stylish yet practical objects. The Bednest delivers on all fronts. It looked great in our bedroom and performed brilliantly. There is no comparison."

Ericka Waller, 30, is a stay at home mum from Brighton and mum to 10-month-old Bliss
"A friend had a cot which had an adjustable side which she swore by, so I took to Google, found an image of the Bednest and fell in love. It's easy to use, is stylish and comfortable and makes life so much easier. I was very sore after I gave birth and the Bednest meant I did not need to keep getting up and down to feed. I also had to go back to work after six months so I needed to make sure I had enough rest. Having the baby so close meant that my husband did not get woken up in the night – two sleep-deprived parents is never a good thing. My baby was close to me at all times, but as she was not actually in my bed I could roll around freely without worrying I was going to squash her. I could check on her with ease, which as an anxious parent was a great comfort. And when she was unsettled I could rest my hand on her to soothe her without having to lean awkwardly over a cot or Moses basket. I could breastfeed while she was in the Bednest and if I did pick her up for a cuddle, it was also easy to slip her back in without waking her. Bednest was the first sleep space I've tried and I never needed to look anywhere else."

Raman Glazier, a 33-year-old HR Recruiter, from Acton Vale in Ealing, London, has a five-month-old boy called Willem
"The Bednest is revolutionary. We tried for four weeks to get Willem to sleep in the Moses basket and every time it creaked he would cry, but he was a different baby when we introduced the Bednest. And I truly believe that it has really helped him become a good sleeper and as a consequence we are very happy parents. Sleep is priceless, so the Bednest was an investment for all of our family. It doubles as a travel cot, which really helps when you're trying to establish a routine but still want to go away. We've taken it on holiday and bedtimes have been a smooth transition because of that."

Maxine Fletcher, 39, from Luddenden, near Halifax, is mum to Matilda, 16-months-old
"I was interested in co-sleeping and the Bednest seemed like the perfect compromise for what we were after. We wanted Matilda to be close to us, to make breastfeeding at night easy and to provide lots of nurture and close contact right from the start. We wanted her to have a very nurtured start to life and we did everything we could to build a secure, strong bond with her. I think the Bednest played a big part in helping us to achieve that. Our main concerns were not about safety and sleep, although important, but to provide that emotional care and closeness from the start. The fact that there was only a short move to pick Matilda up and feed her, often allowing me to go back to sleep again quickly afterwards was such a relief. Now she sleeps in her own cot and she appears secure and content at bedtimes. These early positive experiences must have really helped establish a good pattern for the future."

What are your views on co-sleeping? Let us know by commenting below...

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