Alice Amber-Keegan is a biological anthropologist researching infant sleep at Durham University, as part of the Parent-Infant Sleep Lab. Professor Helen Ball of the Sleep Lab and the Infant Sleep Information Source is one of the main session speakers at our event in Manchester on Thursday 6th October, and Alice has kindly contributed this blog post to Growing Families in support of Helen’s involvement in the day.
When you tell people that your research is about infant sleep, it inevitably leads to stories about how their children slept, many told with an air of nostalgia long free from the torture of sleepless nights. Although my research has been invaluable in educating me about infant sleep in general, it has also encouraged me to find out more about my own upbringing and that of those dear to me. Many of these conversations are generally light-hearted but have given me an insight into the struggles of modern day parenting and debunked many of my pre-existing expectations of what bringing up a young baby is like.
Being the youngest child in my family and not being a parent myself, I came into infant sleep research naïvely having previously had very little contact with young babies; none of my friends or close relatives have had babies and much of what I knew about infant sleep was through TV, films or pictures I’d seen. My idea of infant sleep was very ‘Eurocentric’ assuming that it was the norm for babies to sleep in cots or cribs, either in the parents’ bedroom or a specifically made ‘nursery room’. Hollywood representations of the pregnancy experience which continually display decorating the nursery as a rite of passage, preparing parents for the birth of their child, are deeply ingrained in my visual imagination and are frequently still evoked when I think about infant sleep. It came as a surprise to me that co-sleeping is such a huge and integral part of negotiating night-time care with 50% of babies in the UK having bed shared at some point by the time they are 3 months old (Ball 2002) and even more of a surprise that it is not represented in popular culture. The complexities, contradictions and moral significance of parents’ night-time infant care decisions have slowly become apparent, boggling my mind with what parents have to deal with alongside adjusting to life with a new family member.
When discussing my research with people, they regularly jest that studying infant sleep is a paradox. The idea that babies don’t sleep seems to be a generally accepted and popular notion, however parents seem to continually struggle with the level of sleep deprivation they experience and the amount of time it takes for babies to ‘sleep through the night’. These ideas are opposed with popular representations of infant sleep, such as Pampers adverts that promise ’12 hours of Dryness’ and show images of blissfully sleeping babies in cots, or sitcoms like Friends showing new mothers setting their babies down to sleep for hours on end and continuing on with their pre-baby lifestyles. Whilst discussing this with some mothers in a local sling group, one mother stood out by claiming that her expectations of her baby’s sleep were actually met;
“He met my realistic expectations initially. He was a typical baby.
I had expected him to sleep through the night in his own bed by 8 years mind”
Although this is an extreme example, I think it is important to consider the extent of sleep disruption that parents need to prepare for in order to create realistic expectations. Chung and Hoyoung (2014) note that Korean parents are more tolerant towards post-baby sleep disturbances because their “sleep less, work more” ethic gives sleep less cultural value and allows them to easily accept sacrifices of sleep. Korean parents are known to co-sleep with their infants for 3-6 years, with no specific word for bed-sharing, room-sharing or co-sleeping in Korean – it is seen as an essential part of parenting.
Studies of formula fed infants in the 1950s and 1960s were used to blueprint normative infant sleeping patterns which led to the creation of harsh and regimented sleep training models which promised to enable parents to transition back to pre-baby sleeping patterns shortly after the birth of their baby. However, for breastfeeding infants it is normal to frequently wake and feed throughout the night; the structure of human milk, which is low in fat and protein but high in sugar (lactose) encourages rapid brain growth but provides few calories per feeding and results in babies having to feed more frequently and on-demand (Jellife & Jellife 1978), meaning that ‘sleeping through the night’ is an unrealistic goal for breastfeeding parents. The necessity of frequent night feedings has consequences for breastfeeding mothers who must wake frequently to facilitate infant feeding needs. Many breastfeeding mothers have adopted same-surface co-sleeping as a tactic to negotiate night-time care, with research showing 75% of breastfed babies share the bed in their first month of life (Ball 2007). Studies have also shown that co-sleeping and breastfeeding have a mutually reinforcing relationship, with co-sleeping infants feeding more frequently (Ball et al. 2006; Gettler & McKenna 2011; McKenna, Mosko & Richard 1997), encouraging milk production and maintaining lactation (Ball et al. 2011).
As an Anthropologist, I study infant sleep from an evolutionary perspective. Understanding the significant biological immaturity of babies – they are born with one quarter of their adult brain size meaning that they go through a period of external gestation where they behave more like a foetus – can help to contextualise babies’ need for constant reassurance and close parental contact. It is estimated that it takes around a year for human infants to develop to the point that other mammals are at when they are born (Martin 1992). Constraints on pelvic width due to upright walking on two legs means that human babies have to be born early in their development, before their brains grow too large to pass out of the pelvis (Rosenberg 1992). This results in extremely immature and dependent babies that have very little control of their own regulatory systems.
The under representation of co-sleeping in popular culture arises from fears about the association between co-sleeping and Sudden Infant Death Syndrome (SIDS), and worries that publicly displaying the behaviour will encourage parents whose infants are at risk of SIDS from same surface co-sleeping to engage in the behaviour when they wouldn’t otherwise. Some SIDS prevention campaigns have focused on stopping parents from co-sleeping altogether by displaying images of infants sleeping in bed next to knives or under headstones creating associations between co-sleeping, danger and death. Previous studies have associated co-sleeping with SIDS but many of these have shown that the risk of SIDS from co-sleeping for breastfed babies in the absence of hazardous circumstances is very low (Blair 2014; Venneman et al. 2012). It is important to note that there is a significant and increased risk of SIDS from same surface co-sleeping for infants exposed to maternal smoking (prenatally and postnatally), parental use of alcohol and drugs and co-sleeping on a sofa (Blair et al. 2009; Venneman et al. 2012). However, for infants who are at a very low risk, co-sleeping has been shown to increase maternal and infant sleep quality and encourage breastfeeding which in itself has been shown to be protective against SIDS (Huack et al. 2011). Breastfeeding, co-sleeping mothers have also been shown to induce arousals in their infants that may have a protective affect against life threatening apneas and SIDS. Co-sleeping allows babies to be physiologically regulated by their mother’s body as well as enabling mothers to induce arousals, either to initiate feeding or to improve infant arousability (Mosko, Richard and McKenna 1997).
Studies have shown that co-sleeping is frequently used as a tactic to negotiate night-time care – on any particular night, for some part of their sleep, parents are sleeping with their neonates (Blair & Ball 2004). Therefore, under representations of co-sleeping are not stopping the behaviour but creating an education deficit where parents are not being informed how to do it safely and appropriately. Lack of education about safe sleeping practices and prejudices against co-sleeping can also result in parents facing stigma when discussing with health professionals, resulting in confusion about safe co-sleeping practices and increasing maternal anxieties. It is therefore important to educate parents about how to engage in safe co-sleeping, allowing them to make informed choices about their own sleeping practices.
It has been a steep learning curve researching parenting from the ‘outside’ and it has been invaluable in preparing me for challenges I am still yet to face. I am astounded by the lack of accurate information about the realities of parenting and have realised how important it is to be informed. From observing mothers negotiating night-time care in a culture that is full of conflicting pressures and stigmatisation, it has become apparent that the only way to deal with these conflicts is to empower parents to make informed decisions. Being informed can not only encourage parents to make their own decisions with knowledge and confidence, but can allow tolerance of other people’s choices and help to eliminate feelings of shame and failure. Being informed is integral in constructing realistic expectations, enabling parents to plan and manage their post-baby lives more effectively, reduce the likelihood of parental stress and allow breastfeeding mothers to be more effectively supported by peers.
Ball, H. L. (2002) Reasons to bed-share: why parents sleep with their infants. Journal of reproductive and infant psychology 20: 4. Pg. 207-221.
Ball, H.L., Ward-Platt, M.P., Heslop, E., Leech, S.J., Brown, K.A. (2006) Randomised trial of infant sleep location on the postnatal ward. Arch Dis Child 9. Pg. 1005-1010.
Ball, H.L., Ward-Platt, M.P. Howel, D. & Russell, C.K. (2011). Randomised trial of sidecar crib use on breastfeeding duration (NECOT). Archives of Disease in Childhood 96(7): 630-634.
Blair, P., Fleming, P. J., Smith, I. J., Ward-Platt, M., Young, J., Nadin, P., Berry, P. J., Golding, J., CESDI SUDI Research group (1999) Babies sleeping with parents: case-control study of factors influencing the risk of the sudden infant death syndrome. BMJ. 319:1457-62.
Blair, P.S. & Ball, H.L. (2004). The prevalence and characteristics associated with parent–infant bed-sharing in England. Archives of Disease in Childhood 89: 1106-1110.
Blair, P. S., Sidebotham, P., Pease, A., Fleming, P. J. (2014) Bed-sharing in the absence of Hazardous Circumstances: is there a risk of SIDS? An analysis from two-case controlled studies conducted in the UK. PLOSone 9: 9.
Blair, P. S., Sidebotham, P., Evason-Coombe, C., Edmonds, M., Heckstall-Smith, E., Fleming P. (2009) Hazardous cosleeping environments and risk factors amenable to change: case-control study of SIDS in south west England. BMJ 339: b3666.
Chung, S., An, H. (2014) Cultural Issues of Co-sleeping in Korea. Sleep Medicine Research 5: 2. Pg. 37-42.
Gettler and McKenna (2011) Evolutionary Perspectives on Mother-Infant Sleep Proximity and Breastfeeding in a laboratory setting. American Journal of Physical Anthropology 144. Pg. 454-462.
Huack, F. R., Thompson, J. M. D., Tanabe, K. O., Moon, R. Y., Vennemann, M. M. (2011) Breastfeeding and Reduced risk of Sudden Infant Death Syndrome: A meta-analysis. Pediatrics 128: 1. Pg. 103-110.
Jellife, D. B., Jellife, E. F. P. (1978) Human milk in the modern world: Psychological, Nutritional and economic significance. Oxford: Oxford university press.
Martin, R. (1992) Primate Reproduction in The Cambridge Encyclopedia of Human Evolution. Cambridge: Cambridge university press.
McKenna, J. J., Mosko, S. S., Richard, C. A. (1997) Bedsharing promotes breastfeeding. Pediatrics 100. Pg. 214-19
Mosko, S., Richard, C., McKenna, J. (1997) Maternal Sleep and arousals during bedsharing with infants. Sleep 201. Pg. 142-150.
Rosenberg, K. R. (1992) The Evolution of Modern Human Childbirth. Yearbook of Physical Anthropology 35. Pg. 89-124.
Vennemann, M. M., Hense, H., Bajanowski, T., Blair, P. S., Complojer, C., Moon, R. Y., Kiechl-Kohlendorfer, U. (2012) Bed sharing and the risk of sudden infant death syndrome: Can we resolve the debate? Journal of Pediatrics 160: 1. Pg. 44-48.