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
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<http://www.bmj.com/content/319/7223/1457.short>.
Blair, Peter, Peter Sidebotham, et al. "Hazardous cosleeping
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your Baby is Safe." Ask Dr.Sears.
N.p n.d. Web. 1 Dec
2011.
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