Crane, Tamsyn-resized

Tamsyn Crane

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When our son was born in January, there was no question about where he would spend his first night in the world, and many nights thereafter. Just like his big sister before him, he sleeps in the crook of my arm in our bed. With instant access to milk, he can latch on and off without much disruption to anybody’s sleep (how amazing that must be—to have your favourite food available instantly throughout the night). While I could happily recommend co-sleeping, I am not here to sell the benefits of it. So why, when the midwives, health visitors, and my GP ask about where my baby sleeps, do I lie?

My default answer has always been ‘we have a side-sleeper cot’. This is true; we have one. But it is unassembled in the corner of the room, waiting for the time when our baby boy is bigger and more active and four in a bed becomes too much for our king-size (our eldest always joins us at some point in the night too).

So why do I not explain that my husband and I (both intelligent healthcare professionals) have done our research, weighed up the risks and benefits, and have made an informed choice? We know the safe co‑sleeping guidelines, possibly better than they do. Because I know what they will (likely) say. That ‘the safest place for an infant to sleep for the first 6 months is in a cot in your bedroom’. But, like most things, it is far more complicated than that.

Most parents I know have had their babies and children in bed with them at some point. They wouldn’t readily share this information, until I tell them that we bed-share too. In fact, a 2004 study of parents in England revealed that around 50% of babies had slept in their parents’ bed by the time they were 3 months old.1 It is not unusual, but it is still taboo.

Co-sleeping often occurs unintentionally when new, wrung-out parents—emotional and suffering from torture levels of sleep-deprivation—crash out with their baby in their bed or, more dangerously, on a sofa. We don’t always consider that, in the interests of everyone getting more sleep and to help to establish exclusive breastfeeding, bed-sharing can be undertaken safely—if a few golden rules are followed.

There is some evidence of an association between co-sleeping and sudden infant death syndrome (SIDS), but it has not been shown to be causative,2 and the studies are largely not robust enough to be significant. But I don’t have the words for a full critical appraisal of the evidence in this column.

In brief: the 2015 update to the NICE guideline on postnatal care specifically recommends discussing co-sleeping and the association with SIDS—but it also states that ‘the evidence does not allow us to say that co‑sleeping causes SIDS’.2 NICE’s definition of co-sleeping doesn’t distinguish between bed-sharing or co-sleeping on a sofa or chair, and it is recognised that co-sleeping can be intentional or unintentional. So how do we convey this complex message to parents, particularly those without a scientific background?

As the ‘fountains of knowledge’ for mums and dads, who are floundering with this mysterious tiny creature that has turned their lives upside down, we should discuss co-sleeping and advise parents ‘if you are going to do it, make sure that you do it safely’.

There are some excellent resources available; I highly recommend the Baby Sleep Information Source (previously known as Infant Sleep Information Source), and UNICEF UK has some good advice for healthcare professionals on how to be conscientious when talking about co-sleeping safely.3

But when you have your next 6‑week check appointment, please mention co-sleeping—and in return, I promise that the next time a doctor/nurse/midwife/hairdresser asks me ‘where does he sleep?’ I will tell the truth. And I won’t even mention the half-built cot.

Tamsyn Crane

 

References

  1. Blair P, Ball H. The prevalence and characteristics associated with parent–infant bed‑sharing in England. Arch Dis Child 2004; 89: 1106–1110.
  2. NICE. Postnatal care up to 8 weeks after birth. NICE Clinical Guideline 37. NICE, 2015. Available at: www.nice.org.uk/cg37
  3. UNICEF UK, Baby Sleep Info Source, The Lullaby Trust. Co-sleeping and SIDS: a guide for health professionals. UNICEF UK, 2016. Available at: www.unicef.org.uk/babyfriendly/wp-content/uploads/sites/2/2016/07/Co-sleeping-and-SIDS-A-Guide-for-Health-Professionals.pdf