Evolutionary theory on why babies wake their mothers in the night

A leading evolutionary biologist has put forward the theory that an infant’s tendency to wake up in the night may have been a Darwinian tactic to make mothers breastfeed more, thus reducing their fertility and limiting the number of siblings that will be born, which in turn improved a child’s chances of survival.

Breastfeeding acts as a natural contraceptive during the first six months after birth, stopping women from menstruating. Encouraging the effect would have been beneficial for our ancestors, because the fewer siblings one had, the more competition there would be for scarce resources, and the lower the risk of infectious disease spreading, argues Professor David Haig, of Harvard University.

Read more: Babies evolved to wake new mothers in the middle of the night as a survival tactic, claims Harvard biologist The Independent 10/4/14

Pregnant women who snore give birth to smaller babies

Experts said snoring may be a sign of breathing problems which could deprive an unborn baby of oxygen. A new study led by Dr Louise O'Brien, from the University of Michigan's Sleep Disorders Centre found that pregnant women who snore are more likely to give birth to smaller babies. The study found that chronic snorers, who snored both before and during pregnancy, were two thirds more likely to have a baby whose weight was in the bottom 10%. They were also more than twice as likely to need an elective Caesarean delivery, or C-section, compared with non-snorers. Snoring is a key sign of obstructive sleep apnoea, which results in the airway becoming partially blocked, said the researchers, whose findings appear in the journal Sleep. Dr O'Brien added: "If we can identify risks during pregnancy that can be treated, such as obstructive sleep apnoea, we can reduce the incidence of small babies, C-sections and possibly NICU (neo-natal intensive care unit) admission that not only improve long-term health benefits for newborns but also help keep costs down."

Pregnant women who snore give birth to smaller babies, study reveals The Mirror 31st October 2013

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...

Should your baby have a dummy?

The advice about dummy use from the Cot Death Charity FSID seems fairly clear: "Settling your baby to sleep with a dummy – even for naps – can reduce the risk of cot death.", however the research isn't nearly so clear as that. The Analytical Armadillo, also known as lactation consultant Charlotte Young IBCLC, takes a look at all the research and how FSID came to this conclusion:
http://www.analyticalarmadillo.co.uk/2010/10/ask-armadillo-pacifiers-sids-whats-deal.html

Napping when your baby naps

A recent, small-scale, study seems to suggest that mothers who nap interact better with their babies.

So, what does this mean for new parents? Even a few naps per week when you are significantly fatigued can be help promote more positive interactions with your baby! The authors also suggest that scheduling weekend naps may be useful for mothers that cannot nap during the week.

http://www.secretsofbabybehavior.com/2013/01/new-study-effect-of-maternal-napping.html

Review: The Essential Baby Care Guide

The Essential Baby Care Guide is a fabulous new DVD set that has been created by the Essential Parent Company. The 8 hours of content provide comprehensive information on 1. Feeding, 2. Care & Development, 3. Sleeping, and 4. First Aid and Accident Prevention.

The resource has been created with new parents in mind and is designed to provide information on everything you need to know from birth to 12 months, though as the parent of a 14 month old I can confirm that it contains some very valuable information which extends beyond it's target audience.

I have to say that having agreed to review this item I was a tad surprised when it arrived and was over 8 hours long! Not only did I think that sounded very long, I also thought it would need 'expert' reviewers to do it justice. As soon as I sat down to watch, I was hooked. Robert Winston is a great presenter. His gentle voice is easy to listen to and informative. At the beginning of each disc, he describes this resource as a parenting course which you can attend from your living room. That's just what it is: it covers everything, from the very basics, yet without being condescending. The advantage of being on disc rather than a course is that you can watch it again, whenever you wish, or when the information is needed.

If I was expecting my first baby now, I would definitely be buying this. I remember that feeling of getting home with Arthur and thinking, "right, we have a baby - what on earth do we do now?"  Of course I had books, but, well, when you're just had a baby there's not a great deal of time to read books! Watching a DVD is much more manageable. I could have sat in the nursing chair and watched this quite easily. It's also better than a book because you can see what they are talking about, they show you how, instead of just telling you.

Although my son is now 14 months, I still found the resource valuable. For example, after watching the section on sleep I realised that actually we could have a sleep problem. I hadn't noticed because Arthur sleeps well at night and always has, but having seen the DVD I decided that we would tweak his nap times slightly, and rearrange our schedule on a Friday to make sure he got his afternoon nap. He now sleeps even better.

As I mentioned, I am not an expert on any of the topics, but as the resource is advised and narrated by Professor Robert Winston and includes expert advice from The Royal College of Paediatrics and Child Health, UNICEF UK Baby Friendly Initiative, St John Ambulance, Midwives and Sleep Experts, Meningitis Research Foundation, The National Literacy Trust, and the Child Accident Prevention Trust, I think we can be sure that it offers sound advice.

I certainly makes sense to me. A great resource.

If anyone else would like to borrow these DVD's and write a review that would be great. We already have an expectant first time mum lined up to take a peek, but if there are any new parents out there (who have the time) who would like to view please let me know.

We are hoping that once the review process is over the resource will be held by the antenatal teachers so that more parents to be get the chance to preview the resource.

There are several  official videos to be found on YouTube, and you may also want to like the Essential Parent Facebook Page to get updates, tips and competitions

If you would like your own copy, it is available nationwide from John Lewis, Amazon and www.essentialparent.com.  This website also has more information about the resource, plus some videos, tips and previews. You can buy the whole set for £35 or individual DVD's for £10 each.

If you wish to buy the full set, you can get £5 off  and purchase at reduced price of £30 by purchasing direct from www.essentialparent.com and entering the code ElyNCT at checkout. For each DVD set sold The Essential Parent Company will donate £5 to the branch.

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Controlled Crying "Safe"

Research published in the peer-reviewed medical journal Pediatrics, on long-term effects of controversial sleep-training techniques, found that there was no harm on children’s emotional development, their mental health and ability to deal with stress nor the child-parent relationship. The study did not include infants younger than seven months old. The researchers noted that behavioural techniques are known to effectively reduce infant sleep problems and associated maternal depression in the short- to medium-term.

For more information on the study and a detailed explanation of the research and its conclusions, read the NHS Behind the Headlines article on it.

It could be YOU that's keeping baby awake: Babies more likely to have sleep problems if mothers are depressed

Researchers from Pennsylvania State University found that mothers with greater symptoms of depression and worries behaved in ways that disrupted their babies' sleep. The depressed mothers were more likely to pick up their sleeping babies and move them into their own bed to silence fears about whether the child was hungry, thirsty or comfortable, the study published in journal Child Development found. They were also more likely to respond to baby sounds that don't necessarily require a response.

The MailOnline 18/4/12