Thursday, December 29, 2011

The Co-Sleeping Controversy

This is a final I completed for my one of my college courses. We had to present an argumentative essay on a topic that related to sleep, and I chose co-sleeping. I know it is very long, but I did a lot of research for this paper. I am happy with how it turned out, and I did receive an A on the paper. If you have time, read through the essay and let me know your thoughts on co-sleeping.

The Co-sleeping Controversy and a Parent’s Ability to Receive a Good Night’s Sleep

A controversial anti-co-sleeping campaign was recently started in Milwaukee. As part of the campaign, a set of ads were released that depict two babies, one white and one black, each baby laying on a bed surrounded by fluffy blankets, peacefully sleeping. However, the ads take a sinister turn when you notice the butcher knife lying beside each baby. The headline reads, “Your baby sleeping with you can be just as dangerous.” (Herzog and Stephenson) The ads have caused quite a commotion among parents and health officials; with people on both sides arguing their points. The high rate of deaths associated with co-sleeping in Milwaukee are a cause for concern, yet these ads approach the subject by putting fear into parents. Stating that co-sleeping should never be done is closing the door on the possibility for new parents being able to receive more sleep. There is a difference between accidental or dangerous co-sleeping and intentional co-sleeping done by informed parents. Instead of focusing on the dangers of co-sleeping, new parents should be educated on both the benefits and the risks, as well as how to co-sleep safely, so they are able to make an informed decision that will help them achieve a better nights rest with a new baby. 
Co-sleeping is not a new practice, as it has been widely used by parents for years. However, the rates of co-sleeping declined when the “Back to Sleep” campaign began. The “Back to Sleep” campaign encouraged parents to never sleep with their infant, and to only lay their child flat on his or her back in a crib. The information that has been supplied to the general public is that any type of co-sleeping is unsafe, and that it raises the risk for Sudden Infant Death Syndrome (SIDS). While there are reasons to be cautious about the way a person chooses to co-sleep, there is no reason to conclude that intentional, safe co-sleeping poses a risk to the baby’s health. In fact, some research suggests that co-sleeping actually has both emotional and physical benefits for the baby, as well as the mother. 

With encouragement from pediatricians, nurses and health officials, many parents give up on the idea of co-sleeping and adopt other ways to attempt to obtain more sleep. One of the most widely used practices is to “sleep train” an infant, which means the parent basically leaves the child alone in the crib and comes back to check on the baby frequently, but usually does not pick the baby up.  This method of training a baby to sleep may be useful for some parents, but for others it does not help them receive a better nights rest. Although some sleep training methods do not specifically promote letting a baby cry, there are instances during the course of most sleep training programs when the infant is left to cry, which some believe helps the infant learn to self soothe. 

A study published in Neonatal Network found that letting a baby cry for prolonged periods of time can have significant physiological consequences. The study found that infants who cried experienced “increased heart rate and blood pressure, reduced oxygen level, elevated cerebral blood pressure, initiation of the stress response, depleted energy reserves and oxygen, interrupted mother-infant interaction, brain injury, and cardiac dysfunction.”  (Ludington-Hoe, Cong, and Hashemi 29-36) Some parents may be unaware of the physiological responses that infants have to crying; however, they may become distressed when their infant cries and becomes too upset. Even parents who adopt the sleep training method may find it hard to stick to it, especially when the baby cries profusely or when the baby awakes in the middle of the night to eat. Parents that are unhappy with the “sleep training” method may attempt co-sleeping, yet they are often warned against it and even reprimanded for trying it. 

When the “Back to Sleep” campaign was launched in 1994, parents across the country began placing their babies to sleep on their backs and no longer co-slept. ("NICHD") The campaign has been reignited several times over the last 17 years as new studies have been released that show the number of SIDS related deaths each year. Most new parents are sent home from the hospital with pamphlets from the “Back to Sleep” campaign, which does not address co-sleeping at all, except to dissuade parents from ever doing it. 

While the number of SIDS deaths every year is startling, the focus is far too often put on co-sleeping. The Consumer Product Safety Commission (CPSC) released a statement that said there were over 100 deaths related to co-sleeping between the years of 1999 and 2001. ("CPSC") The Juvenile Products Manufactures Association (JVMA) teamed up with the CPSC to further the “Back to Sleep” campaign after this report was released. This presented a large conflict of interest, as the JVMA is actually a manufacturer of cribs. The report further ignited the anti-co-sleeping messages that were being sent to parents. In addition, the report did not address the total number of crib related deaths for the years between 1999 and 2001. Babies can be at risk for suffocation from soft bedding and pillows in a crib or in an adult bed, so focusing solely on the deaths that occurred in adult beds makes it seem as though most deaths are related to co-sleeping. During the years of 1999 – 2001, there were about 2600 total deaths per year related to SIDS, which is a large number when compared to the deaths associated with co-sleeping. (Sears)

While the “Back to Sleep” campaign has been valuable, as it has taught parents safety measures that are important, it has also caused many people to believe co-sleeping is never an option. In their list of top 10 safe sleep practices, the campaign writers state that a baby should never sleep in the bed with his or her parents, as it is dangerous and increases the risk of SIDS. ("Eunice Kennedy Shriver National Institute of Child Health and Human Development") 

However, studies have been done on this very topic to discover if co-sleeping does increase the risk for SIDS. One such study, published in the British Medical Journal, did find that babies who co-slept appeared to have an increased risk of SIDS. Yet, when underlying factors were investigated, it seemed that the babies who did have a higher risk for SIDS were in a home that was overcrowded, the parents had been consuming alcohol, the parents were extremely tired, or the baby became trapped underneath a large blanket. (Blair, Fleming, and et al) Although it does not state this in the paper, these cases were most likely due to accidental co-sleeping. This is why it is highly important that parents learn the difference between accidental co-sleeping and intentional co-sleeping. 

In cases where the parents intentionally co-sleep, there is actually a decrease in the risk for SIDS. Although more studies need to be done to conclusively determine why infants have died during co-sleeping; from SIDS or suffocation, several early studies show promising findings for the benefits of co-sleeping. A study published in the Journal of Pediatrics found that mother arousals are heightened during co-sleeping. When paired with an earlier article that studied the stages of sleep during co-sleeping, the researchers suggested that “the observed changes in stage 3-4 sleep and arousals associated with bed sharing might be protective to infants at risk for SIDS because of a hypothesized arousal deficit. The responsivity of the mother to infant arousals during bed sharing might also be protective.” (Mosko, Richard, and McKenna 841-49) The researchers did note the importance of safe sleeping arrangements, yet they concluded that co-sleeping may decrease the risk for SIDS. Another study, published in the American Journal of Physical Anthropology, found that the mother’s breathing during co-sleeping could raise levels of CO2 to non-lethal levels, which could potentially stimulate the baby’s breathing. (Mosko, Richard, and et al 315-28) Although more research needs done, there is evidence that supports the claim that co-sleeping can decrease the risk for SIDS, if done safely. 

 New parents may be overwhelmed and exhausted during those first early weeks at home, which can make it easy for the parents to accidently fall asleep while holding the baby. These cases are most likely what leads to an increased risk of SIDS, whereas intentional and safe co-sleeping does not. While the risk of SIDS is the main danger that physicians and health agencies warn parents against when it comes to co-sleeping, what they fail to explain is the benefits of co-sleeping and how it can actually help both the parent and the infant receive a better night’s sleep. 

Research has been done to investigate what the benefits are for a mother and child that sleep together, and there have been interesting conclusions from the studies. One study, published in the Journal of Obstetric, Gynecologic, and Neonatal Nursing, examined women during the fourth week after giving birth. The researchers examined the sleeping patterns of the women, as well as the way the women fed their infants. Conclusions from the study showed that women who breastfed and co-slept received more hours per sleep each night, while mothers that bottle fed received less overall sleep, no matter what sleeping arrangement they had. (Quillin, and Glenn 580-88) This study shows that not only is co-sleeping beneficial in helping the new mother sleep more, but breastfeeding can also help new mothers receive a better nights rest. 

Professor James McKenna is a biological anthropologist who is the director of the Mother-Baby Behavioral Sleep Laboratory at the University of Notre Dame. He has conducted numerous studies on the risks and benefits of co-sleeping. Through his research, he has found that there are benefits for both the mother and the infant. His research has shown that babies who co-sleep have regular heart rhythms and fewer instances of pauses between breaths. (Gettler, and McKenna 42-51) This means that babies who co-sleep are generally sleeping physiologically safer, which decreases the risk of SIDS. Professor McKenna also conducted studies to find out if the mother continues to receive the same quality of sleep if she co-sleeps or sleeps alone. His study did find that the mothers who co-slept and breastfed their infants did wake more often throughout the night; however, the women also reported that they enjoyed the sleep they received, and they also received the same amount of sleep as breastfeeding mothers that slept alone. His overall conclusions from the study stated that 94 percent of co-sleeping mothers felt that they received enough sleep each night, while only 80 percent of mothers that slept alone were happy with the overall amount of sleep they received. (McKenna, and McDade 134-52)

Sleep is highly important for everyone, and new parents are especially affected by a lack of sleep. Many people believe that co-sleeping can inhibit the amount of time that the parents will actually be able to sleep. Some concerns have been expressed that state that new mothers may be too aware of the baby, and will not sleep well. While others are concerned that the mother will not be aware enough, and will become too used to the baby sleeping with her. Professor McKenna’s study, titled “Maternal Sleep and Arousals During Bedsharing With Infants,” found that women who co-slept had shorter durations of stages 1-2 and stages 3-4 sleep, yet they continued to receive the same amount of REM sleep as mothers who did not co-sleep. (Mosko, Richard, and McKenna 142-50) His overall conclusions from the study state that mothers do become more aware of their infants presence, and will be able to stay alert enough to monitor the infant’s status. Yet, the study also found that the rate for overall wakefulness at night was not increased in co-sleeping mothers, which dispels the myth that co-sleeping mothers will not receive a good night’s rest. While further research will help explain more about SIDS and co-sleeping, Professor McKenna’s research proves that health officials and agencies should not completely dismiss co-sleeping as an alternative way for parents to sleep. 

While Professor McKenna is an advocate of co-sleeping, he also explains that it is highly important to practice safe co-sleeping techniques. If new parents are educated on how to co-sleep safely, they will be able to receive a better night’s rest with their infant. However, if parents are not instructed how to co-sleep safely, it may result in the parents accidentally sleeping with the infant, which can be dangerous. A study published in the British Medical Journal, titled “Hazardous cosleeping environments and risk factors amenable to change: case-control study of SIDS in south west England,” found that many infants who died from SIDS were co-sleeping in an unsafe environment. The study found that most of the co-sleeping related deaths they analyzed could be attributed to parental use of drugs and alcohol, maternal cigarette use during pregnancy, a pillow used near the infant, or co-sleeping on a sofa. The researchers concluded that, “…specific advice needs to be given, particularly on use of alcohol and drugs before cosleeping and cosleeping on a sofa.” (Blair, Sidebotham, and et al) The message that needs to be sent to parents is how to co-sleep safely, and not to simply condemn co-sleeping completely. When parents are misinformed or not informed at all, it leads to an unsafe co-sleeping environment that can increase the risk for an accidental death occurring. 

Professor McKenna shares information on how to co-sleep safely through his articles and published studies. McKenna explains that to co-sleep safely, the parents should both agree on co-sleeping and both partners must be committed to following safety measures while co-sleeping. (McKenna) Parents should avoid having large blankets, pillows, or stuffed animals on the bed near the baby. Blankets that are used on the bed should be lightweight and never cover the baby’s head. The baby should be laid down on his or her back to sleep, and a baby should never be allowed to sleep on a waterbed. There are also other factors that can cause unsafe co-sleeping conditions, which include the parents smoking, or using alcohol and drugs. Parents should also not co-sleep if they are extremely fatigued or taking medications that could make them overly drowsy. If co-sleeping in the same bed is not an option, the mother can still remain as close as possible to the baby by using a co-sleeper that attaches to the side of the adult bed. Professor McKenna’s safe co-sleeping guidelines are the information that should be distributed to new parents, versus the pamphlets that simply state to never co-sleep with a baby. 
While the high rate of SIDS and suffocation related deaths are a cause for concern, the message being sent to parents is that they should never attempt to co-sleep, under any circumstances. This leaves parents without vital information that could not only help protect their baby, but also help them receive a better night’s rest. Instead of focusing on the dangers of co-sleeping and not supplying parents with information; health officials, agencies, physicians, and nurses should be educating parents on both the risks and benefits of co-sleeping. If new parents leave the hospital better informed about how to co-sleep safely, they will be less likely to accidentally fall asleep with their baby, which will decrease the likelihood of an accidental death occurring. If parents are educated and informed, they can make the decision that is best for their family, which will help everyone in the home achieve a better night’s sleep.  

Works Cited
Blair, Peter, Peter Fleming, et al. "Babies sleeping with parents: case-control study of factors influencing the risk for sudden infant death syndrome." British Medical Journal. 319. (1999): n. page. Web. 1 Dec. 2011. <>.

Blair, Peter, Peter Sidebotham, et al. "Hazardous cosleeping environments and risk factors amenable to change: case-control study of SIDS in south west England." British Medical Journal. n. page. Web. 12 Dec. 2011.

Chuong-Kim, Margaret. "Cry It Out: The Potential Dangers of Leaving Your Baby to Cry." Dr. Ben Kim.N.p., n.d. Web. 12 Dec 2011. <>.

"CPSC Cautions Caregivers about Hidden Hazards for Babies on Adult Beds." CPSC. CPSC, n.d. Web. 5 Dec 2011. <>. 

Gettler, Lee, and James McKenna. "The Science of Sharing Sleep." Mothering. Jan./Feb. 2009: 42-51. Web. 4 Dec. 2011.

Herzog, Karen, and Crocker Stephenson. "Ad Campaign Unveiled as Another Co-sleeping Death is
Announced." JS Online. Journal Sentinel, 9 Nov. 2011. Web. 5 Dec 2011. <>.

Ludington-Hoe, SM, X Cong, and F Hashemi. "Infant crying: nature, physiologic consequences, and select interventions.." Neonatal Network. 21.2 (2002): 29-36. Web. 12 Dec. 2011.

McKenna , James, and Thomas McDade . "Why Babies Should Never Sleep Alone: A Review of the
Cosleeping Controversy in Relationship to SIDS, Breastfeeding and Bedsharing." Pediatric Respiratory Reviews. 6. (2005): 134-52. Web. 5 Dec. 2011. 

McKenna, James. "Safe Cosleeping Guidelines." University of Notre Dame Mother-Baby Behavioral Sleep Laboratory. University of Notre Dame Mother-Baby Behavioral Sleep Laboratory, n.d. Web. 5 Dec 2011.<>.

Mosko, Sarah, Christopher Richard, and James McKenna. "Infant arousals during mother-infant bed
sharing: implications for infant sleep and sudden infant death syndrome research.." Pediatrics. 100.5 (1997): 841-49. Web. 12 Dec. 2011.

Mosko, S, C Richard, et al. "Maternal proximity and infant CO2 environment during bedsharing and
possible implications for SIDS research." American Journal of Physical Anthropology. 103.3 (1997): 315-28. Web. 12 Dec. 2011.

Mosko, Sarah, Christopher Richard, and James McKenna. "Maternal Sleep and Arousals With Bedsharing Infants." Sleep. 201.2 (1997): 142-50. Web. 5 Dec. 2011. 

"NICHD Back to Sleep Campaign." NICHD. NICHD, 18 Oct. 2011. Web. 5 Dec 2011 

Quillin, Stephanie, and L Glenn. "Interaction Between Feeding Method and Co-sleeping on Maternal-
Newborn Sleep." Journal of Obstetric, Gynecologic, & Neonatal Nursing. 33.5 (2004): 580-88. Web. 5 Dec. 2011. 

"Safe Sleep for Your Baby: Reduce the Risk of Sudden Infant Death Syndrome (SIDS)--General Outreach." Eunice Kennedy Shriver National Institute of Child Health and Human Development,. NICHD, 2005. Web. 5 Dec 2011.

Sears, William. "SIDS: the Latest Research on How Sleeping With your Baby is Safe." Ask Dr.Sears. N.p n.d. Web. 1 Dec 2011.

1 comment:

  1. Hi, my name is Heather! Please email me when you can, I have a question about your blog!



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