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The Importance of Safe Bedsharing Education

Our bed, stripped of all fluff.

I recently attended a conference, and I was excited to see on the agenda that there would be a presentation from my state’s health department on the topic of safe infant sleep. I was really looking forward to hearing some new and exciting evidence-based information regarding safe infant sleep. I’m sure you could imagine my disappointment when the speakers regurgitated the same old information that the only safe sleep environment is in a crib. I was further disappointed when they also shared with us their “Infant Safe Sleep Recommendations,” which did not even include information about how breastfeeding may be protective against SIDS. But they did recommended a pacifier. Ugh. (I don’t have anything against pacifiers, I was just disappointed that this made the list, but breastfeeding didn’t). The most disappointing thing of all was that they were strongly (strongly!) against bedsharing, yet they told us within the first five minutes of their presentation that the bedsharing portion result of their study have not yet been evaluated.

My head was flooded with questions for the presenters, but I only wanted to choose one question. I was really wondering about the lack of breastfeeding information in their safe sleep recommendations, and since we were at a conference specific to Native Americans, I also wondered if they had information tailored towards the Native American community (my co-worker asked about this – I knew she would). The most pressing question on my mind, though, was that since they believe bedsharing is so dangerous, did they educate parents about how to bedshare safely?

Their answer: no.

Their reason: they don’t want to give mixed messages.

My interpretation of this answer is that they intend to put a stop to the practice of bedsharing completely. Unfortunately for them, they appear to be working against nature, and they are definitely working against culture. These are two very powerful forces, and I am not convinced that some marketing strategies from the state’s health department will be able to change both nature and culture.

The speakers were obviously well educated in the subject of infant sleep and why parents choose to co-sleep. However, I feel that their strategy of withholding information is standing in the way of the very topic they are promoting: safe infant sleep. To me, the predicament is similar to teaching teenagers about safe sex. Should we teach them how to do it safely? Or should we just tell them not to do it at all? I feel that people should have all available information, and then let THEM decide the safest and best route.

Research shows that bedsharing rates are increasing. This article says, “bedsharing appears to be widespread and strongly influenced by cultural factors.” This report says that nearly 50% of their survey respondents report bedsharing at some point over the past two weeks. 50 percent in just two weeks! Some reports say around 75% of parents share a bed at some point (this research came from Oregon and Manitoba, Canada). I can only assume that if the respondents in that survey have a state health department like mine, they did not receive any information about how to bedshare safely. How in the world is withholding this information keeping any baby safe? According to the speaker from the health department, infants are 20 times more likely to die of suffocation on a surface other than a crib (they were referring to this article from Pediatrics). Although they felt that this research was reason enough to not offer safe bedsharing information, I guess I saw it from a different point of view. This research screams out to me that parents desperately need safe bedsharing information.

We used bedrails to provide an extra layer of protection against rolling.

Because the United States is made up of many different cultures, I think it is imperative to provide safe bedsharing information to every family who has an infant. Obviously, you can include this information alongside safe crib-sleeping information. However, by not providing safe bedsharing information, infants are suffering. Research shows that co-sleeping is more common among non-white, lower income families, and younger parents. I really feel that withholding information is condescending, as if these families are too stupid to understand the information and make informed decisions. Furthermore, safe cribs, safe mattresses, and other accessories cost money. Some families share a bed out of necessity. I find it so irresponsible that these families are not given proper information about safe bedsharing.

Research shows that bedsharing has health benefits such as prolonged breastfeeding rates. Bedsharing can help mothers and babies get more sleep because a mother can sleep while breastfeeding or respond to the baby immediately. Research also shows that just being near a caregiver can affect a baby’s physiological functions. Despite these benefits, there are certain risk factors that can make it dangerous such as a caregiver who smokes, a caregiver who is overweight, too many blankets and pillows, gaps between headboards and walls, and  a bedsharer’s drug or alcohol consumption. In fact, most of the risk factors overlap with the SIDS/safe crib-sleeping information. Some health agencies’ recommendations on safe sleep even leave off the critical advice to never “co-sleep” on a couch or other similar piece of furniture. Some parents have heard the advice against bedsharing, but no one ever told them that sleeping on a couch with your infant is dangerous. They opt for the couch instead of the bed because they have only heard that bedsharing is dangerous.

Several researchers have pointed out that underlying factors such as maternal smoking or alcohol consumption by the caregivers appear to be risk factors for “SIDS” in bedsharing deaths, not necessarily bedsharing itself. A local fox station out of Milwakee linked local bedsharing deaths to lack of breastfeeding (not a scientific study, but an interesting correlation). They even consulted James McKenna for their article.

Aside from the reasons why parents choose to co-sleep or why parents are forced to co-sleep, some co-sleep by accident. I speak from experience when I say that breastfeeding can make a mother very sleepy. A mother may very much want to put her baby a crib to sleep, but she falls asleep while breastfeeding. If this mother has information about safe bedsharing, she could intentionally make her sleep environment as safe as possible in the case that she falls asleep while breastfeeding. Between the ages of 2.5 months to 6 months, my baby was up every 45 minutes to 1 hour all night long. Would I have really kept breastfeeding if I had to get up out of bed every 45 minutes, stayed awake to breastfeed, and then placed the baby back in the crib? Sometimes my baby wouldn’t even unlatch for up to an hour. Crib sleeping was completely unrealistic in my situation.

I feel that anyone who believes that 100% crib sleeping is feasible for 100% of the population is nothing short of naïve. What about the baby who continues to cry alone in the crib? At what point will a parent’s frustration level overcome her sensibilities? I know a child who suffers from shaken-baby syndrome. Apparently her dad couldn’t handle the crying anymore. Parents need safe tools at their disposal to handle sleeplessness and frustration. If a parent decides to take their baby into their bed so they can get some sleep and relief from the crying, they should know how to do this safely.

In answering my question about if the health department includes safe bedsharing information with their safe sleep information, the speaker finished her answer by saying that if a parent tells his or her doctor that they are bedsharing no matter what, then the doctor can offer safe bedsharing advice. There are several problems with this strategy. First of all, bedsharing has become such a dirty secret that many parents will not even tell their doctor. Second, doctors might not even know what how to make bedsharing safe. If the information is not provided to the public, there is a good chance that the doctors also do not have this information. I told a doctor and a nurse practitioner that I was bedsharing with my baby, and neither offered safe bedsharing advice. The doctor told me to put the baby in the crib, and the nurse practitioner told me to put my 2.5 month old in a crib, shut the door, and don’t check on him. There was absolutely nothing about this advice that was helpful to my situation (and I would also consider the nurse practitioner’s advice downright dangerous).

According to some experts, medical professionals get very little training when it comes to sleep issues in babies and children.  They simply don’t know what to do about the situations parents present them with. In my experience, the typical advice is to just let them cry or give them solid foods. Neither piece of advice is often helpful nor healthful. Parents are left to their own devices when it comes to getting their children to sleep, and they are typically making these decisions, exhausted, in the middle of the night.

In doing research on this topic of educating parents about safe co-sleeping practices, I could not find any information on what happens when you DO give parents safe bedsharing information. I’d be curious to find out if anyone has even studied that it is better to simply tell parents to put babies in cribs and leave it at that. I can’t imagine that withholding information about how to prevent deaths in a bed is better than giving a person information on steps to take to make the sleep environment – any sleep environment – safer.  If we know that up to nearly 75% of the population shares a bed with their infant, why in the world would we not tell them how to do it safely?

Public health information about how to prevent SIDS in cribs has been widely available for years, yet information about safe bedsharing is tucked away in just a few books and is becoming more widely available on the internet. Arguably, the research comparing crib safety to bedsharing safety doesn’t really compare because the research itself and the health professionals providing safe sleep information are skewing the results. It doesn’t surprise me that infant deaths occur in unsafe bedsharing environments, just as it does not surprise me that deaths occur in unsafe crib environments. If safe bedsharing advice was as widely distributed as safe crib sleeping advice, maybe the rate of bedsharing deaths would decrease.

I encourage everyone to pass on safe bedsharing information to everyone they know who provides care for an infant. You can find safe sleep guidelines on the following websites:

James McKenna

Dr. Sears

API International

I previously posted about the importance of safe co-sleeping and how it happened with us. My experience is probably why I feel so passionately about this subject. I was uninformed, and figuring out how to share my bed as safely as possible finally gave me the opportunity to relax, get some rest, and enjoy my baby.

The crib: According to gavin, a fun place to play but a scary place to sleep.
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Published in Sleep