What should new parents expect?!

Sally Hogg is a mother who works in children’s policy, research and practice, and has done extensive work on the subject of excessive crying in infants.  She is now the lead for the Mums and Babies in Mind Project, from the Maternal Mental Health Alliance.  Our thanks to Sally for her support for Growing Families: Facts, Fiction and Other Stuff.  Here she discusses parental expectations and the realities of new parenthood.

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I often need to go to bed quite early and nearly always fall asleep as soon as my head hits the pillow. In the morning, I am ready to get up as soon as my alarm goes off (although I have a toddler, so don’t need an alarm these days!).

My husband, on the other hand, needs time to relax and ‘switch-off’ before he can sleep. And in the morning, he has multiple ‘snoozes’ before he’s ready to face the world.

When it comes to food, I need a good breakfast early on, but then can go without food until lunchtime. My husband likes a later breakfast, but needs to eat and drink regularly or else he gets ‘hangry’.

You may be wondering why am I writing all this in a parenting blog.

Good question.

I want to illustrate how people can be really different, even in some very basic ways. We have different characteristics and constitutions. It’s part of how we are made.

And babies are just little people. So they are all different too.

This may seem obvious, but I think it is such an important point for expectant and new parents to keep in mind.

The parenting books, public opinion, and sadly some professional advice too, can lead us to believe that all babies should be the same, that they will have similar sleeping and feeding patterns, and that there are simple rules and routines that we as parents can, and should, follow, to get our babies to behave in the expected way.

Not enough recognition is given to the fact that every baby, every parent, and every situation is different. Ok, so the 10-point plan in the baby book MAY have helped the author’s baby to sleep. That doesn’t mean it will work for Joe and Joanne Blogs and their baby.

Parenting isn’t about sticking to someone else’s 10-point plan. It’s about getting to know your baby and their likes and dislikes, strengths and struggles, and finding a way through that works for all of you.

I heard some wonderful advice recently; One mum asked another at what age she stopped feeding her baby at night. Her answer,

“We just gave him what we needed, and when he stopped needing it, we stopped giving it to him.”

Simple.

If parents expect their baby to feed, sleep, cry and behave like other babies (whatever that actually means), then it’s more likely that they will feel something is going ‘wrong’ in the first few months when their baby doesn’t match these expectations. They may start to believe that they, as parents, are doing something ‘wrong’ because their baby struggles to sleep, for example, or that there is something ‘wrong’ with their babies because they cry or feed more than others. This line of thinking leads parents to beat themselves up; to get stressed, or to try and find endless cures or solutions to ‘problems’, rather than settling in to find the best way to parent the wonderful, unique baby who has joined them.

There are lots of examples of how, when parents expect that they, and their babies, will have a textbook experience, the reality can be really difficult.

We know, for example, that postnatal depression is more prevalent among mums who plan to breastfeed and then don’t, compared to both those who don’t plan to at all, or those who plan to and do so. It’s really hard when we struggle to be the parent we expected ourselves to be.

We also know that the expectation is that parenting will be a magical time. And the (misplaced) belief that everyone else feels that way, makes it hard for the 20% of mums with mental health problems to talk about their feelings and seek help.

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Conversely, we know that when we prepare parents for the fact that things might get difficult, it can make a big difference. The NSPCC found that showing parents a 10 minute film explaining the reality of how much babies can cry, and how stressful this can be for parents, had a significant and prolonged effect on parents’ confidence, their ability to talk to others about problems, and their use of different soothing techniques.

And when midwives and health visitors spend just 10 minutes helping new parents get to know their baby and understand his or her unique characteristics, and how easy (or not) he or she find it to stop crying, or get to sleep (using an approach called the NBO), this helps parents to feel closer to their baby and more confident as a parent, and reduces the incidence of postnatal depression.

I don’t want to suggest that parents-to-be should expect to parenting to be difficult, breastfeeding hard, or babies to cry a lot. But they need to be prepared that they may experience these things, and that if they do, it doesn’t mean there is anything wrong with them or their baby. It’s part of the normal rollercoaster of parenting, and there’s a lot of support out there to help.

If I had to tell parents what to expect when they have a baby, I’d tell them to prepare to meet your own fantastic, individual little person. And don’t expect anything to be like you read in the books.

 

Sally Hogg
September 2016

Infant Sleep: Expectations and Reality

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.

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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.

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Image courtesy of Rob Mank & the Infant Sleep Information Source

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.

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Image courtesy of Rob Mank & the Infant Sleep Information Source

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.

 

Alice Amber-Keegan
September 2016

 

References

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.

All Change! Some totally new parenting advice is about to arrive!

Our thanks to Mary Nolan for writing for us on the subject of parenting advice, confusion and consistency.  Mary is one of our main session speakers at the Growing Families: Facts, Fiction and Other Stuff event in Manchester this October, and will be delivering the section on Understanding Baby, in conjunction with Helen Ball of the Durham University Parent-Infant Sleep Lab.

Mary trained as a nurse in the 1970s and then as a childbirth educator with the NCT. She has worked with parents across the UK and has trained educators in Australia, New Zealand, Ireland, Belgium and Germany. She has published several books including, ‘Antenatal Education: A Dynamic Approach’, ‘Home Birth: The Politics of Difficult Choices’, and chapters in ‘Essential Midwifery Practice: Intrapartum Care’ edited by Denis Walsh and Soo Downe. Her PhD examined the impact of antenatal education on women’s choices around pain management in labour and her research into women’s and men’s experience of early labour, what women want from antenatal classes, and health visitors’ engagement with new fathers has been published in peer-reviewed academic and professional journals.

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My father is 88 years old – a truly splendid octogenarian who maintains a keen interest in a world which he sometimes finds confusing. He is not slow to remind us – with a twinkle in his eye – that advice is like fashion; it comes and goes and if you hang onto what you wore/were told in the 50s/80s/00s, you’ll eventually find yourself ‘on trend’ and doing ‘the right thing’ again after being out of fashion and doing ‘the wrong thing’ for a couple of decades!

He’s particularly keen to point out that the parenting my mother considered appropriate – three meals a day (sitting at the family table) and only water and fruit in between, and bed-time before 8pm are now being advocated again. (Along with real butter which my Dad loves!)

It’s hard today being a mother or a father or a kinship carer or anyone who has charge of children and wants to do the best they can to ensure they are physically, emotionally, socially and spiritually healthy. And people like myself, who are in the business of parent education and research, don’t always make life easier – although we are totally committed to finding the very best evidence to give to parents and co-parents.

Helping out at a playgroup the other day, I was startled to hear two young mothers (mid to late twenties) talking about what kind of milk to give their babies. The babies in question were adorable little girls of around 4-6 months of age. The babies were sitting in their pushchairs smiling amiably at each other and occasionally demanding some attention from their moms which was very willingly given. I presumed that the mothers were discussing breast milk v formula, or different kinds of formula. Not so. The mothers were discussing when to give cow’s milk and whether it should be full fat or semi-skimmed. The conclusion they came to was that it was all right to change from formula (which both babies were receiving) to full fat cow’s milk at 6 months of age. The World Health Organisation and the Department of Health recommendation is not to give cow’s milk before a year at the earliest. It’s one of the few recommendations that has been consistent over quite a long period of time.

These were clearly devoted and conscientious mothers with healthy and happy babies. So how could they have got hold of such wrong information?

It’s not just mothers, of course, who are victims of the confusion that inevitably arises when health information changes from one week to the next, or is transmitted in a confused way or is different according to which health professional you speak to. Health professionals are confused as well. While leading a seminar recently for a bright and dedicated group of student midwives, I found myself in a debate with one young and ardent student about whether caesarean section was as ‘good’ as vaginal birth. I mounted the usual (and, to my mind, correct) argument that caesarean can be a life-saving operation for some mothers and babies and that we are fortunate to have easy access to it, but that vaginal birth has many advantages that may affect the new baby for the whole of their life. I therefore suggested  that it is the midwife’s role to support women and their birth companions physically and emotionally to have a straightforward vaginal birth whenever possible. The student quite definitely did not agree with me and felt that vaginal and surgical birth should be presented as equal options.

You might be thinking now that I have made these two stories up for the sake of this Blog – but, actually, I haven’t. Both are true and both incidents occurred in the last month.

Rachel Law

Research into health promotion is very clear that conflicting and inconsistent advice leads (who would have guessed?) to conflicted and inconsistent parenting. And that inconsistent parenting doesn’t help young children to feel secure and ‘get a grip’ on the world. The baby and toddler are busy developing a template for life. Their fast-growing brains are trying to sort out which behaviours lead to which responses. As humans, we all need to feel pretty certain that our actions will have predictable outcomes if we are to function effectively on a day-to-day basis and avoid becoming anxious and indecisive. As a very young child, I need to know, for example, that food arrives at certain times and that eating it makes me feel content; that smiling at dad and reaching out to him elicits a warm playful response, and that pulling grandma’s hair hard makes her sad. I need my mom and dad, or whoever is looking after me, to do things in ways that I come to recognise as ‘how things are done in our family’. If mom and dad are continually changing the way in which they look after me because the advice they are receiving is always changing, that’s not particularly good for me as the little person on the receiving end of that inconsistent parenting.

For me as a birth and parent educator, and an academic who’s interested in how to transmit accurate health and child care messages, the age of social media is challenging. Twitter and Facebook can function rather like a game of Chinese whispers with a message starting out as one thing and becoming something very different by the time it reaches the hundredth or the thousandth or the ten-thousandth recipient. For parents and co-parents, trying as hard as they can to be not just ‘good-enough’ parents, but excellent parents, ever changing advice is a nightmare.

It’s a conundrum. So what advice would I give about advice???!! I think exactly the same as I would have given when I first started practising as a parent educator about 30 years ago. Choose one person who you have reason to believe knows what s/he’s talking about and understands the way in which you want to parent, or one website that has been recommended to you by a health professional, or one book that is authoritative (the reliable ones generally have reference lists so you can check the research on which they’re based) and stick with that person or information source. As a very wise friend once said to me (rather shockingly, I thought at the time), ‘Even better than loving your children is being consistent’.

 

Mary Nolan
August 2016

The practicalities of sharing a bed with your baby

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.

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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)

Bedsharing Donts

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)

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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:

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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.”

Elena Abell
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.
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