Is It Time to Change the Tune on What Health Care Providers Tell Parents about Bedsharing?

Newborn and family sleep is often a difficult but critical topic to cover in childbirth classes. Parents are getting a lot of mixed messages from many sources about where the baby should sleep and then they settle into the first weeks with their newborn and everything feels more acute and critical as the birthing person recovers and the family works hard to meet the needs of a new baby.

The fourth trimester is all about the baby making the transition to life on the outside. Their needs are insistent, they want nothing more than to be cuddled and close to their parents, and feed as often as they want. In the meantime, parents struggle to find the new normal and get enough sleep to feel able to handle life with a new baby with all the other stressors that exist (other children, jobs, relationships, physical recovery, emotional recovery and more).

New parents may discover that bed-sharing with their young baby helps everyone in the family get sleep, but they struggle with doing what feels safe and appropriate based on what they have learned about safe sleep. As both an educator and a parent, I release what a struggle sleep with a newborn can be for a parent. I am aware of the reality that young babies often end up in the parents' bed, as a solution to exhaustion and significant fatigue. Therefore, I make it a point to share about safe bedsharing. If parents are going to bedshare with their babies, they need to know how to do it safely.

Yesterday on NPR's Morning Edition, there was an excellent piece on exactly the topic of bedsharing with a baby. "Is Sleeping with Your Baby as Dangerous as Doctors Say?" is available to listen to or read, whatever is your preference. This article addresses the fact that while many people do not disclose it to others, families do sleep with their baby and the number is on the rise. According to author Michaeleen Douclef, "Since 1993, the practice in the U.S. has grown from about 6 percent of parents to 24 percent in 2015."

The most recent recommendations by the American Academy of Pediatrics published in late 2016 acknowledged that while they believe bedsharing is not a safe option, parents may be making this choice anyway, and therefore should be told how to reduce the risk of injury or death for an infant that shares their bed with a parent. The AAP states that the risks of bedsharing include "sudden infant death syndrome, accidental suffocation, and accidental strangulation."

The studies that the AAP relied on to guide them in their most recent recommendations have been questioned by researchers who study bedsharing both here in the USA and abroad. The NPR piece includes a clear and informative graphic that helps parents (and childbirth educators for that matter) understand the risk of bedsharing in relation to other common risks. In this article, James McKenna discusses what his decades of research have shown about the safety of bedsharing. McKenna's research shows that "babies have evolved to experience this closeness, night after night after night." Infant death while sleeping with a parent on a sofa, or recliner, with siblings, or with a parent who smokes or is using drugs or alcohol have historically been categorized as bedsharing. No researcher, or anyone for that matter, acknowledge that those are safe "bedsharing" conditions.

Image source: NPR.org

For healthy, full-term newborns, bedsharing may be an acceptable choice for families if it is done under safe conditions. No one is stating that with other risk factors present, bedsharing should occur. "Parents who drink or do drugs shouldn't be sleeping with their babies because they could roll over onto their child. Babies who are born premature or whose parents smoke shouldn't sleep in the parents' bed because of potential respiratory problems. Suffocation can also happen when babies sleep on sofas because babies can be trapped between a parent and the cushions" according to Peter Blair, a medical statistician at the University of Bristol who has studied SIDS epidemiology for 25 years.

Current research is finding that "for babies older than 3 months of age, there was no detectable increased risk of SIDS among families that practiced bed-sharing, in the absence of other hazards." And for babies younger than 3 months? "I would probably say there may be an increased for this group," according to Robert Platt, a biostatistician at McGill University, who analyzed the studies for the AAP.says. "And if there is an increased risk, it's probably not of a comparable magnitude to some of these other risk factors," such as smoking and drinking alcohol.

Those researchers who are studying this topic around the world all seem to agree that customizing information for each family about sleep with a young baby is critical. Discussing when bedsharing might be safe and when it should be avoided is important. When families receive information that directly applies to their situation, studies indicate that the rate of SIDS goes down significantly. This reduction has been apparent in the UK and in New Zealand, where a more customized approach has been developed.

Childbirth educators may want to consider sharing both this Morning Edition article and/or the graphics with the families in their classes. Recognizing that bedsharing happens and parents need to be provided with information on how to do it safely should be a priority for all professionals who work with parents during the childbearing year.

Science & Sensibility has covered this topic with the help of experts in the field before. You may want to check out some of our resources:

• There's an App for That: Infant Sleep App Helps New Parents to Navigate Those Challenging First Weeks and Months.
• "Don't Sleep with Big Knives" - Interesting (and Promising) Developments in the Mother-Infant Sleep Debate
• Bedsharing Image Archive Available to Demonstrate Safe Bedsharing to Families
• Safe Bedsharing - Do Childbirth Educators Have a Responsibility to Cover this Topic?
• Brilliant Activities for Birth Educators: Could Emojis Help Teach Infant Sleep Cues?
• Sleeping Like a Mammal: Nighttime Realities for Childbirth Educators to Share with Parents

Childbirth educators - how are you discussing bedsharing and safe sleep with the families in your classes? What approach do you feel has worked well? Let us know in the coments section below.

References

Bombard, J. M., Kortsmit, K., Warner, L., Shapiro-Mendoza, C. K., Cox, S., Kroelinger, C. D., ... Barfield, W. D. (2018). Vital Signs: Trends and Disparities in Infant Safe Sleep Practices - United States, 2009-2015. Morbidity and Mortality Weekly Report, 67(1), 39-46. http://doi.org/10.15585/mmwr.mm6701e1

Colson, E. R., Willinger, M., Rybin, D., Heeren, T., Smith, L. A., Lister, G., & Corwin, M. J. (2013). Trends and Factors Associated with Bed-Sharing: The National Infant Sleep Position Study (NISP) 1993-2010. JAMA Pediatrics, 167(11), 1032-1037. http://doi.org/10.1001/jamapediatrics.2013.2560

Published: May 22, 2018

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