This post by Growing Families organiser Elena Abell was originally shared on her personal blog platform, Trust Your Baby. Elena works as a Business Unit Director for healthcare communications company Watermeadow Medical in Witney, Oxfordshire. Her background is molecular biology having studied to PhD level at Imperial College London, and she is also a qualified babywearing consultant. You can find out more about Elena and the other three members of our conference team here: https://growingfamilies.co.uk/conference-team/
You will see that Elena references the University of Durham Parent-Infant Sleep Lab in her post: we are incredibly fortunate to have Professor Helen Ball as one of our main session speakers at the conference in October. Expecting a baby? New to parenting or wanting to explore more about what you know? About to become a grandparent? Supporting new families? Then this conference is for you!
With thanks to the Infant Sleep Infomation Source website and photographer Beverley Latter for the image at the top of this page.
Newborns have a terrible habit of not wanting to sleep where National guidelines say they should be sleeping (i.e. in a cot).(1) It’s not terribly surprising when you think about it though. Newborn babies are working on instinct, programmed over millions of years of evolution, and what a baby’s instinct is telling it is that ‘mum’ means safety, warmth and food. In fact, research on human and nonhuman primate infants has demonstrated that an infant’s most fundamental physiological systems such as breathing, heart rate, sleep, and temperature regulation are affected by the presence or absence of parental contact.(2-5)
Given all this, why on earth wouldn’t a baby want to sleep anywhere else but right next you?
So, if through trial and error (like so many new mums) you find that the only way to get your newborn to sleep is having them sleep on or right next to you, then you’re not alone; BUT, chances are you might also be totally unprepared for doing so safely. Even if you have made a conscious decision before baby arrives that you might like to sleep with your baby in bed (bedsharing), there’s surprisingly little information out there on the purely practical aspects of HOW to do it, for example, what position is mum supposed to sleep in relation to baby, what sort of covers are you supposed to use and where exactly do the covers go, where does dad figure in this whole bedsharing plan, how do you stop baby rolling out of bed and so on and so on. It seems to me, many of the books reviewing bedsharing are so intent on providing all the research evidence, that the practical side of bedsharing (i.e. exactly HOW to do it) tends to be a bit of an afterthought. To me, describing the practical side of things (including some good diagrams), is one of the most important aspects of safer bedsharing and I know I would have benefited from some straighforward information on what to buy in preparation for bedsharing, and how to do it as safely as I possibly could.
Let’s just get something straight first though…..there is no absolutely ‘safe’ place for your baby to sleep. Just because anthropologists and infant sleep researchers (and me) argue that mother-baby contact during sleep is a biologically ‘normal’ human behaviour does not mean it is inherently safe (although arguably neither is sleeping alone in a cot).(6,7) As Prof. Helen Ball from the University of Durham Parent-Infant Sleep Lab so eloquently puts it….
“As with many aspects of daily life from preparing food to crossing the road, it is the context and manner in which these activities are conducted that make them safe or unsafe.”(8)
What I aim to do in this post, is provide some very practical suggestions (with diagrams!) for setting up a mother-baby sleep environment, that is as safe as it can be, and is in line with the latest published research evidence and guidelines.
First up, let’s look at some of the big DON’Ts as per the latest guidelines and research evidence.(9-12)
So now we’ve had a look at some of key ‘DON’Ts’ let’s have a look at some of the ‘DOs’, including exactly HOW breastfeeding mothers and babies sleep next to each other. There are many publications on mother-baby sleep behaviour showing that when a breastfeeding mother and a baby routinely sleep in physical contact, they sleep very close together facing each other, and tend to wake up and go back to sleep at the same time.(5,13) Breastfeeding mums who bedshare tend to lie on their side facing their baby, curled around them adopting a protective C-shape (see diagram below).(adapted from 13) The baby is positioned level with their mother’s breasts, and the baby sleeps in the space created between the mother’s arm (positioned above her baby’s head) and her knees (drawn up under her baby’s feet).(14-16)
In fact, current evidence suggests that this C-shaped position is a universally exhibited, instinctive behaviour, adopted without previous instruction or discussion by breastfeeding mothers in order to protect their newborn babies.(13,17)
Before we go on, I should mention that the practical advice provided here is for mothers who are exclusively breastfeeding their babies as this seems to reduce the risk of SIDS.(18) This is likely to be because breastfeeding mothers and babies sleep together in very different ways than do non-breastfeeding mums (i.e. those bottle feeding using formula or expressed breast milk).(15) Formula-feeding mothers appear to spend less time facing their baby and they do not adopt the ‘protective’ C-shaped sleep position as consistently as breastfeeding mothers. Breastfeeding mothers and babies seem to arouse from their sleep together, more frequently than formula feeding mothers and babies and breastfeeding mothers and babies also wake more often.(15) It is not currently known whether non-breastfeeding mums are likely to maintain the same level of vigilance and synchrony during sleep that is exhibited by breastfeeding mothers. So, for the time being it is recommended that non-breastfeeders put their baby down to sleep in a cot by the bed.(5)
So we’ve had a look at the mother-baby sleep position, but what about the bed area itself? The TrustYourBaby safe sleep environment diagram below considers 7 main factors for a mother sleeping with a singleton baby in a bed:
1) Other people in bed: Baby should never be left in an adult bed unsupervised. By far the safest way of sleeping with your baby is for the mother and baby to sleep in a bed on their own.(19) If dad or partner is to sleep in the bed as well, then baby should be placed on the mother’s side of the bed not between the mother and the father/partner until the baby is at least 6 months old. This is because fathers (or partners) are generally much less aware of their babies. It is generally not advisable to have other children in bed with you and your baby.
2) Baby anti roll-out protection: A mechanism to stop baby falling out of bed should be installed on the mother’s side of the bed. The ideal option is a bedside cosleeper where the cosleeper mattress is contiguous with the main bed mattress (see the NCT website for an excellent and comprehensive review of cosleepers available to buy). Another way of stopping baby rolling out is to push the bed up against a wall but there should be no gaps between the wall and the mattress. Toddler bed rails on the other hand, should be avoided until babies are least 1 year old as there appears to be an increased risk of entrapment between the rail and the mattress.(20) If you do use a rail, mesh rails are better than those with slats as the slats can pose a strangulation risk.
3) Back to sleep: The back to sleep advice(11) still applies even with bedsharing and while it’s safe to assume baby will be lying on their side to breastfeed as per the ‘instinctive’ mother-baby sleep position described above, baby can be rolled onto their back once they are safely asleep
4) The bed: A queen, kingsize or super kingsize bed is the ideal size for bedsharing if both parents are in the bed with baby. If mother is on her own in the bed with baby then a double bed is OK. The mattress on which you place your baby should be firm, and you should not sleep with your baby if your bed is a waterbed or other very soft surface.
5) The bedcovers: Light bedclothers such as a duvet cover with no duvet inside, or a summer tog duvet should be used. Bedclothes should come up no higher than the babies middle, and mum can use the hand that is uppermost to control the position of the bedclothes during the night.
6) Mother and baby’s clothing: Depending on the season, light bedclothes will mean mum perhaps needs to wear additional nightime clothing than she might normally, for example a longsleeve top that keeps her top half snug. Baby should be placed in the same number of layers as mum to prevent overheating.
7. Pillows: Baby should be placed well below the level of mum’s pillows. If done correctly, the C-shaped protective position adopted by the mother should stop baby creeping up under the pillows as mum’s arm is placed above baby’s head.
I’ll leave you with some sage advice from the amazingly good ISIS (Infant Sleep Information Source) website (seriously, EVERYONE with a baby ought to read the info on this site):(21)
“There is no easy ‘one size fits all’ advice for the complex issues surrounding a topic such as bed-sharing as the risks and benefits vary greatly from family to family
Parents need information with which to make informed decisions, and should be encouraged to weigh up any potential risks and benefits of bed-sharing in light of their own individual circumstances. This information is clearly detailed in the UNICEF leaflet ‘Caring for your baby at night’, on the NCT website and via La Leche League.”
June 2016 (first published October 2014)
1. http://www.nhs.uk/Conditions/pregnancy-and-baby/Pages/reducing-risk-cot-death.aspx Accessed 5th October 2014.
2. Korner AF, Thoman EB. The relative efficacy of contact and vestibular-proprioceptive stimulation in soothing neonates. Child Dev 1972;43(2):443-53.
3. Christensson K, Siles C, Moreno L, et al. Temperature, metabolic adaptation and crying in healthy full-term newborns cared for skin-to-skin or in a cot. Acta Paediatr 1992;81(6-7):488-93.
4. Ludington-Hoe SM, Johnson MW, Morgan K, et al. Neurophysiologic assessment of neonatal sleep organization: preliminary results of a randomized, controlled trial of skin contact with preterm infants. Pediatrics2006;117(5):e909-e923.
5. Ball H. Research Overview: Bed sharing and co-sleeping. http://www.nct.org.uk/sites/default/files/related_documents/2009-Ed48-Bed-sharingandco-sleeping.pdf. Accessed 5th October 2014.
6. Drago DA, Dannenberg AL. Infant mechanical suffocation deaths in the United States, 1980–1997. Pediatrics1999; 103: e59.
7. McKenna JJ, McDade T. Why babies should never sleep alone: A review of the co-sleeping controversy in relation to SIDS, bedsharing and breast feeding. Paediatric Respiratory Reviews 2005;6,:134–152
8. Ball H, Blair PS, Ward-Platt MP. “New” practice of bedsharing and risk of SIDS. The Lancet 2004;363
9. Hunt CE. Small for gestational age infants and sudden infant death syndrome: a confluence of complex conditions. Arch Dis Child Fetal Neonatal Ed 2007;92(6):F428–9.
10. Sullivan FM, Barlow SM. Review of risk factors for sudden infant death syndrome. Paediatr Perinat Epidemiol 2001;15(2):144-200.
11. http://www.unicef.org.uk/Documents/Baby_Friendly/Leaflets/caringatnight_web.pdf Accessed 5th October 2014.
12. Carroll-Pankhurst C, Mortimer EA Jr. Sudden infant death syndrome, bedsharing, parental weight, and age at death. Pediatrics 2001;107(3):530-6.
13. McKenna, JJ et al., Mother-infant cosleeping, breastfeeding and sudden infant death syndrome: what biological anthropology has discovered about normal infant sleep and pediatric sleep medicine. Am J Phys.Anthropol. 2007;Suppl 45:133-61.
14. Baddock SA, Galland BC, Bolton DP, et al. Differences in infant and parent behaviors during routine bed sharing compared with cot sleeping in the home setting. Pediatrics 2006;117(5):1599-607.
15. Ball H. Parent-infant bed-sharing behavior: effects of feeding type and presence of father. Human Nature2006;17(3):301-18.
16. Richard C, Mosko S, McKenna J, et al. Sleeping position, orientation, and proximity in bedsharing infants and mothers. Sleep 1996;19(9):685-90.
17. Ball HL, Klingaman KP. 2007. Breastfeeding and mother-infant sleep proximity: implications for infant care. In: Trevathan W, Smith EO, McKenna JJ. Evolutionary medicine, 2nd ed. New York: Oxford University Press. p 226–241.
18. Hauck FR, Thompson JM, Tanabe KO et al., Breastfeeding and Reduced Risk of Sudden Infant Death Syndrome: A Meta-analysis. Pediatrics 2011;128(1):e103–10.
19. Hauck FR and Herman SM. Bed sharing and sudden infant death syndrome in a largely African-American population. Peadiatr Child Health 2006;11 (Suppl A):16A-18A.
20. Nakamura S, Wind M, Danello MA. Review of hazards associated with children placed in adult beds. Arch Pediatr Adolesc Med 1999;153(10):1019-23.
21. https://www.isisonline.org.uk/hcp/where_babies_sleep/parents_bed/Accessed 5th October 2014.