With so much contradictory information about whether it’s safe for mothers to share a bed with their baby, it’s easy to see why parents are confused. The release yesterday of a paper in BMJ Open added to this confusion, by warning all parents to simply avoid bed sharing because it increases the risk of SIDS (sudden infant death syndrome) five-fold.
We know that sharing a bed with a baby can be risky in certain circumstances, such as when bedding is soft and the baby can overheat, if there are siblings and pets on the bed, and if you smoke, or are under the influence of drugs or alcohol. Falling asleep with the baby on an armchair or couch can also be dangerous.
But for the many mothers who want to bed share with their baby, risks can be minimised to provide a safe sleeping environment.
Outdated and inconclusive
The BMJ Open study provides weak evidence about the risks of bed sharing for low-risk mothers who breastfeed and provide a safe sleeping environment.
The researchers selectively analysed data from five international studies from 1987 and 1998. It doesn’t include other data sets from more recent studies, which use more comprehensive data collection procedures and definitions.
A further weakness is that 60% of the information on alcohol and illicit drug use was missing, which the authors replaced using complex statistical methods. There was also no data on use of prescribed and over-the-counter medications, which are likely to be common in the first few months after birth, when the SIDS risk is highest.
The authors claim there is an increased risk of SIDS for breastfed babies under three months, even in a safe bed-sharing environment. This claim is confused by the fact that this breastfeeding data was either not available in the original studies or it merely stated whether babies were breastfed at birth.
Another problem is that the number of control babies bed sharing may have been underestimated, as those who may have shared a bed for a portion of the night and didn’t wake up in the parental bed would have been classified as “room sharers”, leading to inflation of the risks associated with bed sharing.
This study should therefore not be used as basis for public health policy for low risk breastfed babies bed sharing in safe sleeping environments.
What does the recent research say?
Sharing a bed with your baby has not been found to be inherently dangerous if the known risk factors for SIDS are eliminated.
A 2009 study from the south-west of England examined 80 SIDS cases over four years and compared them with randomly chosen control families. In their analysis, the researchers excluded known risk factors such as smoking, alcohol and substance use, and falling asleep with baby on a sofa or armchair. When these risks were eliminated, the rate of bed sharing in the SIDS group was actually lower (6%) than the control group where there were no deaths (10%).
A 2009 Alaskan study also found that 99% of SIDS that occurred while sharing a bed involved known risk factors such as maternal smoking or sleeping with someone affected by substances.
Bed sharing and breastfeeding
For many mums, sharing a bed with their baby is instinctual and a cultural norm, with up to 50% of all babies and 70% to 80% of breastfed babies having shared the parental bed at some time.
We know that bed sharing can help settle infants and it promotes successful breastfeeding. Research has shown that breastfeeding has a direct protective effect against SIDS, reducing the risk by half. This level of protection increases for babies who are breastfed for more than eight weeks.
The protective effect of breastfeeding against SIDS may, in part, relate to the higher prevalence of bed sharing among breastfed babies. Breastfed babies who share a bed with their mother benefit physiologically and have fewer pauses in breathing and more stable temperatures, oxygen saturation and heart rhythms than babies who sleep alone.
Breastfed babies who bed share also naturally tend to lie on their backs with their mothers instinctively cocooning them and protecting them from bed covers.
Current guidelines are counterproductive
It’s important to have public health policies that will reduce the rates of infant deaths associated with sleep. But current state and national public health polices show little insight into the realities of night-time parenting. They say it’s okay to breastfeed babies in bed but they must be placed in their own cot before they fall back to sleep.
With so many parents sharing a bed, such rigid information can be counterproductive. A 2012 Australian study reported health professionals believed that “by insisting on a strict no co-sleeping stance” they “alienate mothers”, which results in them “shutting down” communications with health-care professionals.
This view was confirmed by the mothers interviewed in the study, with one describing the policy as a “scare tactic”. As a result of the policy, some mothers said they had resolved not to disclose their intentions to bed share. This was particularly so for women from cultures where bed sharing was considered normal.
Mothers and babies who breastfeed and bed share in a low-risk environment should not be discriminated against – they should have access to information that is tailored to minimising the risk to their babies, by health professionals who are well informed and sensitive to their needs. Only then can the channels of communication remain open and risks of infant death be minimised.
State and national government health authorities urgently need to redraft their policies to enable open discussion of safe sleep and provide options for mothers who intend to bed share.
In the meantime, if you share a bed with your baby or are considering doing so, you can find a detailed discussion of these issues here and evidence-based information on normal and safe infant sleep on the ISIS (Infant Sleep Information Source) website.