Co-Sleeping:some rationality and common sense

  • By Robin Barker
  • 11 Mar, 2017

Is sharing your bed with your baby as contentious as journalist and mother, Jacinta Tynan claims in a recent article – Co-sleeping can be a great thing.?

http://www.news.com.au/lifestyle/parenting/babies/opinion-cosleeping-can-be-a-great-thing/news-story/429ac132132edaa373893ad0bc689d08

Tynan, clothed in the hair-shirt of co-sleeping martyrdom, claims that sharing beds with babies and children is not only contentious but a ‘sure-fire lightening rod for parental judgement and disapproval.’

She writes that ‘it’s regarded as the genesis of dependent, needy children at best, with a potential to kill them at worst’.

To support this statement, she cherry-picks a case from the UK where a judge recently removed two children from a mother ostensibly for sharing a bed with her children. Certainly, the reporting of the case emphasised the bed-sharing aspects however tucked away in the fine print was the disclosure that the children were being physically abused.

Babies are never removed from parents simply on the basis of bed-sharing. Social workers do not prowl suburban streets waiting to pounce on parents who are sleeping with their children.

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Tynan doesn’t say exactly who she’s referring to when she states that co-sleeping is considered ‘weak and mollycoddling, making a rod for our own backs by raising children who can’t cope without us’.

If co-sleeping is as contentious as Tynan thinks it is I suggest the contention mostly comes from extended family members or online mothers’ groups where baby sleep issues tend to be battlefields of opposing views driven by feeling and emotion rather than rationality and common sense.

Most health professionals understand that it’s up to parents to make their own decisions about where their babies sleep.
This includes the first six months when health professionals, unlike journalists writing about their own experiences, have a duty of care to alert parents to the safety aspects of co-sleeping during this time.

We certainly never ‘push new mums to get their babies into their own rooms pronto’. For obvious reasons, the ‘the holy grail of sleeping through the night’ is something many mothers seek out, which I respect and understand, however most of us spend our working days explaining why ‘sleeping through the night’ is largely driven by the baby and can happen anytime between eight weeks and three years.

Don't rush me. I'll let you know when I'm ready to sleep through the night

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On the assumption that everyone is as eager to enjoy the benefits of the family bed as Tynan is, she theorises that it’s ‘generations of cultural conditioning that co-sleeping is bad parenting’ which deters parents from sharing their beds with their children. She doesn’t seem to consider the possibility that most of the time the decision has nothing to do with cultural conditioning but more to do with comfort, personal space, better sleep and some adult down-time.

It may come a surprise for Tynan to know that the idea of down-the-corridor-with-the-door-shut is heaven for many parents. This does not make them bad parents. Nor does it turn their toddlers/children into maladjusted, unattached axe murderers.

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Co-sleeping: most definitely not everyone's cup of tea

Mothers who find the realty of co-sleeping off-putting – ‘not their cup of tea’ - could be forgiven for thinking that it’s a far riskier proposition to admit to not co-sleeping when confronted with the zealous promotion of the co-sleeping cheer squad, for example, the Australian Breastfeeding Association, Professor James McKenna, Dr William Sears, Dr Jack Newman et al.

The ‘bad parenting’ label Tynan claims she and like-minded mothers are saddled with also hovers over everything the co-sleeping promoters serve up.
For example:

  • Claims of superior outcomes on later-life development, mental health, self-esteem and social skills plus a higher disposition toward showing affection.
  • The strong implication that the quality of attachment (an enduring emotional bond between two people) between parent and child is superior to that of separate-sleeping mothers and babies.
  • That the decision of where baby sleeps has lifelong consequences – positive from co-sleeping, neutral or negative from solitary sleeping.

  • The language used in co-sleeping promotion is soft-edged and warm (sensory, closeness, natural, sensitive, warm, intuitive, harmonious, tender, baby-centred).
  • The language used to describe separate sleeping is hard-edged and brittle (the baggage of a control mind-set, solitary, distant, structure, rigid, tough, mother-centred).

In summary:
The co-sleeping perspective strongly implies that any other arrangement is a second-best compromise as is the quality of mothering by those who choose ‘solitary’ sleeping over co-sleeping.

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             A word about the research

It might be of comfort for mothers to know that the research cited to back up claims of positive lifelong consequences attributed to co-sleeping is based on qualitative behavioural science studies, which are far from definitive and clear-cut.

These studies run risks of bias and are often interpreted in the light of the health professional’s strongly-held beliefs.
The studies often involve self-reporting, which is notoriously unreliable.
Replicating them is difficult and the use of the words ‘suggest’ and ‘may’ when drawing conclusions is common.
Depending on your point of view, for every study of human behaviour that shows one thing, another can usually be found to show the opposite.

Studies into human behaviour are important and have been instrumental in challenging many of our cherished beliefs, however this doesn’t mean they shouldn’t be looked at with a critical eye.

Analysing research is highly technical and something few people have the expertise to do.
Using ‘research shows’ to emphasise and/or promote a point of view, doesn’t mean a great deal without close examination of the studies involved.

I acknowledge that I am as guilty as anyone of throwing in the 'research shows' phrase - it's difficult to resist -  however I do endeavour to reserve it for research that provides definitive and clear-cut  conclusions, for example, immunisation and the recommendations for the safe-sleeping of babies.

Claims that certain behaviours, such as co-sleeping, will influence how children function all the way from babyhood through to adolescence and adulthood should be taken with a big grain of salt.

In summary:
A baby’s later-life outcome cannot be reliably predicted from a single experience such as co-sleeping and it is mischievous to try to convince parents that it does.

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           Co-sleeping: a bird's eye view

Having been professionally involved with families, babies and toddlers for decades I have a critical bird’s eye view of the history behind the pendulum-swinging advice on where baby should sleep.

In industrial societies (as opposed to traditional societies) sleeping babies and toddlers separately rather than with their parents has always been a combination of long-held ideas about baby discipline that have been difficult to shift, safety concerns, class, and personal choice as the standard of living improved and more space became available.

This remained the case until the 1980s when there was a big swing away from what was viewed as the rigid and prescriptive advice of the time that had been inherited from the Victorian era and beyond.
The growing body of research into human behaviour, particularly emotional, social and psychological development, as well as breastfeeding research, was a massive contribution to the big swing away from structure and routines.

This was largely positive. It gave mothers more options, encouraged health professionals to be more flexible, rethought inhumane policies and considered the needs of babies in ways that had been lacking in the past.

However, some of the emerging theories (for example, what came to be known as ‘attachment parenting’ and its various off-shoots such as the family bed and the continuum concept) were based on extreme positions, personal opinion and subjective interpretations of the evidence supporting them.
Rather than freeing mothers up to follow their instinctive urges, this pathway to baby heaven caused a considerable number of them as much grief as trying to follow rigid versions of the routine approach.

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             Co-sleeping and discipline

There’s no doubt that co-sleeping has been frowned upon down the ages for irrational disciplinary reasons. Until relatively recently notions about spoiling baby and turning him into a little tyrant who ruled the home were widespread.
Excessive crying was often viewed as naughtiness and a manipulative attention-seeking ploy ( if I cry for long enough they’ll pick me up ).

There was a feeling – that still persists – that baby had to be sorted (turned into a well-behaved little human) by the first three months so he wouldn’t turn into a juvenile delinquent and give his parents hell.

Baby-care booklets from the early part of last century used blunt language that is unheard of today:
‘Regrets and heart-burnings on the parent’s part in after-years will not make amends for giving baby a bad start.’
‘All the wonders of modern medical science cannot wipe out a first year of bad handling’

‘Some fathers object to the infants (newborns) being allowed to cry, but how else can they be trained? And unless they are properly trained they will become a source of incessant trouble.’

And (the clincher)

Recipe for Healthy Baby
WAKE BABY,
if necessary, in order to feed him REGULARLY
by the clock.
He must have NO NIGHT FEEDS after 10pm
He must SLEEP ALONE
Keep him OUT in the FRESH AIR as much as possible
Give him BOILED WATER daily
Give him SUN KICKS daily
Get up wind after feeding
Do NOT give a DUMMY

Our Babies, 1931, Office of the Director-General of Public Health, Sydney.

This advice should be put in the context of the times when the infant death rate was 103/1000 babies. Most deaths were preventable deaths caused by poverty, a general low standard of living, ignorance often due to a lack of education, poor hygiene and food, dirty water, doorstep milk and unsafe homes, furniture and baby equipment. The well-meaning but rigid advice of the era, aimed primarily at saving lives as much as teaching baby how to behave, contributed to the dramatic drop in the infant mortality rate to 27/1000 in the early 1940s as, of course, did the improvements in all aspects of obstetric and paediatric care and the general standard of living.

The dramatic decrease in infant deaths over the first half of the last century meant that an emotional, social and psychological approach more in tune with parents’ and babies’ needs slowly emerged in the second half of last century coming to full flower in the 1980s and 1990s. Co-sleeping was a big part of the swing away from routine and structure. It was offered up as the preferred choice for committed, caring parents who were told that ‘sharing sleep’ was a crucial part of ensuring optimum child development outcomes.

It must be noted that generations of pre-war babies, war babies (I am one) and early baby boomers, many of whose mothers followed the rigid advice system, have grown up into well-balanced, useful adults firmly attached to their mothers, with happy memories of their very stable childhoods.

It takes more to bend the twig than petty squabbles about the minutiae of child-care advice in the first three years.

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             Co-sleeping and safety

Safety concerns have frequently been behind what now seem like cruel and irrational policies of the past.

For example, banning or severely restricting parents from visiting their sick children. This persisted until the 1970s long after the original reason of fear of infectious diseases – scarlet fever, pertussis, influenza, cholera, diphtheria – being introduced into hospital wards by visitors had clearly passed.
The policy went back to the mid-1800s when the causes of infection were not properly understood, there was no immunisation or antibiotics and rarely any handwashing let alone hygienically clean surroundings.

Forbidding parents to see their sick children in hospital also carried a large component of 'it's better for parents not to see their children as parents upset their children too much'.
Demonstrating an appalling ignorance of infant and child emotional development it was believed that the silent child was 'good' and the crying child 'badly behaved'.

James Robertson's and John Bowlby's 1952 film, A  child goes to hospital , was a breakthrough in demonstrating the cruelty of the restrictions, however it took another twenty years before free visiting was the norm in paediatric hospitals.
https://www.youtube.com/watch?v=s14Q-_Bxc_U

Similarly, keeping newborns in nurseries away from visitors and, apart from feeding times their mothers as well, was also related to infection fears dating back to times when it was safer for mothers to have their babies in the street than in maternity hospitals. In varying degrees of latitude, this practice also persisted until the 1970s, the beginning of the slow march towards the flexibility and suite of options that is now available to women giving birth.

As Tynan suggests, the outlawing of co-sleeping several hundred years ago, based on the premise that mothers were purposefully overlaying their babies as a form of infanticide, has probably contributed to negative ramifications for co-sleeping down the centuries – even perhaps until the 1980s.
(Goodness knows how the co-sleeping law was policed, or how many mothers took a blind bit of notice of it).

Records of infant deaths in the 19th and early 20th centuries show that the high numbers of infant deaths which persisted until the 1920s/30s were more down to congenital abnormalities, diseases, infection, failure-to-thrive, neglect, ignorance, and infanticide by drowning rather than being overlaid by their mothers.

Nevertheless, there have always been risks associated with co-sleeping.
For example, the baby becoming trapped by the bedframe, headboard or footboard or getting stuck between the bed and the wall. Other risks include falling off the bed. Suffocation by pillows, blankets or quilts were also risks as was lying face down or being rolled on by an adult.

During the 1980s/90s co-sleeping was encouraged by breastfeeding promoters, midwives, many early childhood health professionals of varying disciplines, adherents of what is known as ‘attachment parenting’ and a mixed bag of others – anthropologists, psychologists, academics, mothers who loved it - extolling the rewards and joys of traditional-style mothering, a lá the baby-wearing !Kung of the Kalahari Desert or the Yequana Indians, whose firmly-attached babies, unlike the babies of Western mothers, never cried.

My recall as a hands-on practitioner during this period was rather than co-sleeping being frowned upon it was embraced by all and sundry, including health professionals like myself who found it a nice painless option for crying babies, breastfeeding difficulties, and sleep problems in older babies for parents who were open to the idea.

As the 90s progressed, casualty staff in paediatric hospitals were reporting small but significant numbers of fatal sleep accidents related to bed-sharing. Reports described the deaths as Sudden Infant Death Syndrome (SIDS, cause unknown) or as fatal sleep accidents when the cause was obviously down to the factors described above.

Around this time, additional risk factors such as cigarette smoking, obesity, parental drug and alcohol consumption, pets or siblings in the bed, squashy mattresses, doonas, waterbeds and pillows, which all had potentially serious negative effects on co-sleeping, were only just starting to be clearly identified.

The big breakthrough in SIDS research came in the early 1990s with the firm recommendation to sleep babies on their backs and not their tummies.
As tummy-sleeping was very common (a great way to help babies get to sleep) and had been standard practice for decades there was a lot resistance to the idea from health professionals and mothers, however as unequivocal statistical evidence mounted to support the recommendation, back-sleeping became a no-brainer. Other risk factors included cigarette smoking and any covering over babies’ heads and faces.

As we moved into the new millennium, the recommendations and risk factors firmed up as a more accurate picture emerged. Guidelines for co-sleeping, along with guidelines for separate sleeping, now include a list of precautions and advice on how to do it safely, which has been tweaked at various times according to the research.
https://rednose.com.au/article/sharing-a-sleep-surface-with-a-baby

Co-sleeping has never been on the official list of recommendations as a protection against SIDS or Sudden Unexpected Deaths in Infancy (SUDI) because the research supporting its inclusion is weak to nil.
Nevertheless, it is recognised that there is much to recommend co-sleeping if the guidelines for safe co-sleeping are followed.

Throughout the 00s, many health professionals and institutions continued to strongly support breastfeeding and co-sleeping as significant factors in protecting babies from SIDS. Maternity hospitals encouraged mothers to keep their babies beside them in their beds and to continue the practice at home.
The Baby Friendly Initiative - https://www.midwives.org.au/baby-friendly-health-initiative-bfhi - launched in 1991 encouraged prolonged skin-to-skin contact and bed-sharing.
(Unlike co-sleeping, bed-sharing in this context refers to breastfeeding in bed but not necessarily sleeping with the baby following the feed).

Following a series of global infant deaths and near deaths while bed-sharing in maternity hospitals – in Australia one death in 2005 and another in 2008 – the practice of co-sleeping in maternity hospitals was ceased. Since then, mothers are asked to put their babies in their cots beside their beds after feeding.
This has nothing to do with ‘cultural conditioning’ but is a rational, commonsense change in policy to prevent tragedies.

The recommendations following extensive research into SIDS in the last 25 years has resulted in the most significant benefit for the welfare of healthy babies in my professional lifetime. Deaths from SIDS (unknown cause) has dropped by 85%. As a health professional who regularly witnessed the distressing event of the death of a healthy baby this is an incredible statistic.
The whole body of research and all the recommendations has contributed to this but placing babies on their backs instead of their tummies or sides has been a major factor.

Deaths from SIDS has fallen so dramatically that it is now a sub-group under Sudden Unexpected Deaths in Infants (SUDI), which covers all deaths from known and unknown causes.

The reason for the recommendation against co-sleeping for the first six months is for the following reason:
Even when it is carried out as advised and the numerous identified risk factors are factored out, there remains a greater risk of SUDI than if the baby is placed to sleep in a separate cot in the same room as the parents.

Certainly, the numbers are minuscule but the avoidable death of even one baby is a tragic event.

The idea that the philosophy behind this advice is, as Tynan puts it, ‘that sleeping mothers are potentially deadly to their nearby babies’ is offensive to conscientious health professionals who have a duty of care to fully inform the mothers they see, and the long line of dedicated researchers who have made such a remarkable contribution to the welfare of babies in the last 30 years.

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In summary

  • Co-sleeping has not been a major factor in reducing the risks of Sudden Infant Death Syndrome (SIDS - death by an unknown cause).
  • Many things coming together have contributed to the dramatic fall in SIDS deaths but placing babies on their backs to sleep has been a highly significant factor.
  • Until the safe sleeping recommendations emerged, co-sleeping was an identified Sudden Unexpected Death in Infancy risk (SUDI – death by a known cause – in the case of co-sleeping, death by a fatal sleep accident).
  • While co-sleeping promoters (professionals and lay people) now accept that the recommendations must be followed if co-sleeping is to be done safely, many are still loath to accept that sleeping baby separately in the same room as the parents is the safest option in the first six months.
  • Apart from the first six months when there is a duty of care to inform parents of the safest sleeping place for their babies, health professionals don’t care where parents sleep their babies. It’s none of our business unless parents seek help in which case health professionals try to tailor their advice to suit the family.

  • A baby’s subsequent later-life outcomes cannot be reliably predicted from a single experience such as co-sleeping but, obviously, if parents love it they should be reassured that the view that 'co-sleeping is bad parenting' is not widespread. There is no cultural conspiracy to get children out of their parents' beds. Most people don't care.
  • If, on the other hand, parents find that co-sleeping involves a degree of discomfort and irritation they can't handle, they shouldn't feel they have to put up with it on the premise it will make them better parents (read mothers). Nor will it make their babies grow up to be better people.

  • Hopefully, Tynan’s article telling of the cruelty dealt out to co-sleeping mothers is exaggerated overstatement. If it isn’t then grandparents should learn to refrain from comment and mothers should do their own thing and let other mothers do their thing without harassment and name-calling.
    Which, in my experience, is actually what does happen most of the time.
As far as baby-care goes: be nice, be kind, teach them to read, teach them so swim, leave your mobile at home when you go to the park, and try not to get too sanctimonious and hot under the collar about things that don’t matter.

Bookshelf

Bruer John T, Ph.D, The Myth of the First Three Years , Free Press 2005, USA.

Hardyment Christina, Dream Babies, Childcare advice from John Locke to Gina Ford, Frances Lincoln 2007, United Kingdom

Jackson Deborah, Three in a Bed, Bloomsbury Publishing PLC; Revised ed 2003, United Kingdom.

Jean Liedloff, The Continuum Concept. Arkana, London, 1989



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