>> I also strongly encourage those mothers NOT to fall asleep while
>> nursing in bed because of the dangers involved (overlay, falling off
>> the bed, overheat, entrapment between headboard and mattress).

These are all legitimate hypothetical problems, but there is an
enormous field trial of sleep patterns going on right now (6 billion
plus) and has been since the beginning of time.  It makes sense to
evaluate the epidemiological evidence to find out which risks play out
to make a real difference in infant mortality.  It is one thing to
propose a possible risk, and another to look at the results and
determine what's really happening.  Otherwise we may miss the real
risks.  Let's take a very brief look at what has been presented so far
(a quick commentary on what's been reported in Lactnet this week):

As Rachel Myr pointed out, the study in which 64 infants died was not a
co-sleeping study, but a bed study.  However, co-sleeping is a
variable, since adults rarely sleep in infant cribs.  The babies who
died in their cribs--nearly 100% of the deaths--were invariably
sleeping without their mothers.

So, we have, in the U.S., some 2500 SIDS deaths, of which approximately
64 occurred in non-cribs, either with or without their mother.  It
looks as though 97% of SIDS deaths occur in infant cribs.  Of the 3%
that are left, an unknown number were co-sleeping.  Of the ones which
were co-sleeping, did the deaths occur in spite of the protection
offered by co-sleeping?

The logical conclusion would be that the risk of sleeping in non-cribs
are negligible compared with the far greater risk of sleeping in cribs.
  If we further subdivided the non-crib deaths into those with mom and
those without, we might have an even clearer picture of co-sleeping's
ability to protect infants against the risk of SIDS.

If co-sleeping offered no protection, the percentage of babies dying
alone would be 50%, rather than almost 100%.  If co-sleeping were
indeed a risk factor, as has been believed in popular culture, the
percentages would be approximately reversed.

The problem with the data so far is that we probably (and this should
be measured) have more babies sleeping alone in this country than
co-sleeping, and if indeed it is riskier to sleep alone, this is
skewing the data.  And no matter how powerful the protection of
co-sleeping is, there are other variables that are also important.  To
what extent can co-sleeping protect against the pro-SIDS effects of
formula feeding, cigarette smoking, certain viruses, specific genetic
vulnerability, and other variables we haven't yet opened our eyes to,
some of which may be terribly obvious in retrospect?

A rigorous epidemiological survey on the risks of sleeping alone is
indeed needed, if we are to continue to support the practice of
separating infants from their mothers and putting them into infant
cribs.  This is a situation in which the assumptions of culture have
influenced the direction of scientific inquiry.

In the unlikely event that it would be shown that co-sleeping had no
protective effect, we could then focus on other important sequelae,
such as the influence that different sleeping arrangements have on the
occurrence and persistence of normal feeding (breastfeeding) and the
development of the child and family.  If co-sleeping did nothing more
than promote higher rates of breastfeeding and longer duration, it
would behoove health professionals to encourage the practice.  In the
extremely unlikely event that co-sleeping was actually showed
epidemiologically to carry a higher risk, this risk would still have to
be quantitatively measured against co-sleeping's positive effect on
breastfeeding (which saves lives) before we could legitimately decide
not to encourage it.

Arly  Helm, MS, IBCLC

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