Thursday, October 15, 2009

Co-Sleeping in the News

A new study in the British Medical Journal has linked co-sleeping with Sudden Infant Death Syndrome. But read between the lines and it quickly becomes clear that, like all SIDS studies, there are many more factors at play than the fact that the deceased baby was sleeping with its parents.

For a start, it is a startling fact that among the 80 mothers of babies who had died, 25% had drunk more than 2 units of alcohol in the previous 24 hours. This compares to only 2% of mothers in a control group (though these figures may be skewed by the fact that the mothers of deceased babies were questioned at the weekend, when they were more likely to have been drinking). When drugs were also taken into account, the proportion of mothers of deceased babies who had been affected by drugs or alcohol climbed to 31%.

The finding that has hit the headlines hardest is that in 54% of the 80 cases of SIDS, the baby had been sleeping with a parent (which means that in 46% of the deaths, the baby was sleeping on its own). But this does not mean in a bed, safely adapted for co-sleeping. In fact 17% of the SIDS children had been sleeping on a sofa, versus 1% of the non-SIDS cases. The use of pillows was also found to be a statistically significant factor in the SIDS cases. I wonder how many more had been in a chair, sleeping on a parents' knee after a night feed where the parent had desperately tried to stay awake to avoid the terrible risk of taking the baby to bed.

Factors that were also found to be associated with SIDS, but which are less likely to be associated with co-sleeping were swaddling, maternal smoking during pregnancy, preterm birth, ill health, stomach sleeping and sleeping alone (not in the parents' room).

The presence of bedding over the head or face of the baby, a side sleep position, excessive bedding and clothing and postnatal exposure to tobacco smoke were not found to be associated with SIDS.

Tellingly, the researchers themselves said that co-sleeping should not be demonised. Their conclusions support what co-sleeping advocates have been saying all along: parents should be educated about safe co-sleeping before birth. That means not consuming alcohol or drugs prior to sharing a bed with a child, not smoking, not co-sleeping on a sofa or in a chair and not co-sleeping if the parents or the baby are very ill (though this is perhaps the occasion when our instincts make us more likely to bedshare). It also means keeping the baby next to its mum, having a safe sleeping environment with no dangerous gaps, keeping pillows and duvets away from the baby (which should preferably be on top of the covers with its own blanket, though I only did this for six months) and making sure the baby sleeps on its back (or possibly its side).

I know that having my baby in a cot in my room is in theory the "safest" sleeping arrangement. But I also believe there are positive benefits to sharing a bed, and my child would miss out on these benefits if she slept alone. It is very easy for the medical community to recommend using a cot, but the reality on the front lines of parenting can often make that a very difficult ideal to achieve. My daughter cannot usually be placed in a cot without waking, so cot sleeping would necessarily involve a lot of crying and that is not something I am prepared to inflinct on her. That is just my experience; it is possible that if she had been an "easier" baby, I would never have bedshared at all.

Cot sleeping became popular as bottle feeding went on the rise. Breastfeeding babies feed more frequently and for longer than bottle fed infants, and can only be fed by their mother. The night-time parenting of a breastfed baby is therefore easier if the baby co-sleeps some or all of the time. Co-sleeping is much more compatible with breastfeeding, and as breastfeeding numbers increase it is inevitable that more mothers will co-sleep (a recent study in the north-east found that 65% of breastfeeding mothers sometimes co-slept).

The NHS and UNICEF have not changed their advice to parents - cots are safest, but if you co-sleep, follow the above safety guidelines. Now, a study into SIDS where the co-sleeping babies were all doing it safely in a bed with responsive parents... wouldn't that be something?

14 comments:

Bullajabbar said...

This is one of those studies that seems bad if you didn't do post graduate research or know how to read a research paper. For one thing 54% of the SIDS deaths were among those who co-slept, well that is right around half, meaning that 46% occurred in a non-co-sleeping environment (around half). The conclusion by the study even states
"Many of the SIDS infants had coslept in a hazardous environment" (http://www.bmj.com/cgi/content/abstract/339/oct13_1/b3666). Which when you read any "how-to" advice on co-sleeping, it will clearly state that one should not co-sleep on the sofa or when they have been drinking or doing drugs.

One thing people never take into account when they are looking at the outcome of a study based on statistics is the statistical voodoo that takes place during the data gathering process. They mess around with numbers until they get something that makes sense and fits their hypothesis(I hated doing that in my dissertation).

So I hope you are right and people read between the lines, and say "oh that is interesting but I will be smart and not take mind altering substances before sleeping with my little one".

Thanks for bringing this study to our attention.

carol b said...

I haven't had time to digest the findings fully, but I was angry when I caught radio one's news report on this - which simply implied that the act of co-sleeping effectively caused the deaths.
Many people will only hear the short headline and jump to conclusions...

Thanks for posting this.

Bullajabbar said...

If people would just look at some of the articles posted, none of them say that co-sleeping is a BAD thing, which I was pretty impressed with, but that you just need to be aware and have good judgement.

Cave Mother said...

Bullajabar - thanks for your informative comment. I hadn't managed to find the actual BMJ study on the web.

Carol B - yes, the brief headlines were misleading. However I was pleasantly surprised that the newspaper reports didn't say "Co-sleeping is bad". I don;t like the way the newspapers confuse proper bedsharing with general co-sleeping on any surface, though.

Liz said...

Have you seen the UNICEF statement about this research? http://www.babyfriendly.org.uk/items/item_detail.asp?item=608

allgrownup said...

I'm glad to have found out about the swaddling, we won't be doing that anymore. And I'll stop worrying so much about her side sleep position and or sheets & blankets.

Cave Mother said...

Liz - thanks for the link. Very sensible response from UNICEF.

Anonymous said...

nya - this must be why my crazy scottish MIL sent my husband an email this morning saying we will kill the baby if we sleep with her. sigh.

Lisa - edenwild said...

I want to know what percentage of the SIDS babies were co-sleeping in a cot and how many were bed sharing safely. Those would be interesting statistics.

Cave Mother said...

Lisa - in this study, co-sleeping means bedsharing or co-sleeping on a sofa or chair. It does not include a cot in the same room as the parents. I doubt they would even have counted a bedside cot as co-sleeping.

allgrownup said...

I've tagged you for a book thingy on my blog, and neglected to tell you for 3 days, sorry:-) you don't have to play x

sarah said...

what never seems to get mentioned is the research one NZ man did into SIDS in relation to toxicity of mattresses. He pretty much proved this was a significant causant.

There are special mattress covers you can get for cots and also for adult bed mattresses which greatly reduce the likelihood of SIDS.

Melodie said...

Ack. I RT'ed a comment on twitter today about UNICEF standing by its support of bed sharing. At least I think that's what it said....I made the error of not actually reading the link but thought it sounded great. I think I've learned my lesson! :(

Chante @ My Natural Motherhood Journey said...

I hadn't heard about this yet. Thank you so much for posting it and reminding us to always look at the studies with a cautious and weary eye.