Dear Lactnetters,

As an RN who has seen infants injured due to unsafe sleeping conditions, an IBCLC, and a mother who co-slept with all of her babies, I feel I may be able speak from experience seeing both sides of this argument. Sorry for the wordiness of this post. 

Large cultural changes can be difficult for a society to accept all at once. I agree with Dr. McKenna, breastfeeding and co-sleeping are normal human activities and they go hand in hand. The longer a mother breastfeeds, the more likely she is to co-sleep. The more a mother sleeps with her infant, the longer she is likely to breastfeed, which is something we all want to see, longer and more positive breastfeeding experiences for mothers and babies.


Lately though, I'm wondering if the co-sleeping debate is too much for our society to handle right now. Perhaps we need to implement breastfeeding first and help to make it more of a cultural norm, and next begin to work on the prejudice our society has again co-sleeping. Perhaps I'm wrong. It's been known to happen before. 

I believe that in general, Europe is probably a generation ahead of us in the USA, in their thinking about breastfeeding and bed-sharing. There is an understanding of the difference between safe bed-sharing and unsafe bed-sharing. They educate their patients on the differences. I would love to see the same thing in the US, but we are still often debating about the benefits of breastfeeding and promoting it as a cultural norm here in the medical community. We have a long way to go to tackle this issue and educate our HCP's. I've had RN's and MD's tell me that breastfeeding isn't any healthier, or they don't care about it, or they don't have time for it, etc. We may first need to tackle this issue, and then the co-sleeping will be easier to discuss. But instead we stick to the party line - never sleep with your baby. So instead mother's stay up late breastfeeding their infants in a rocking chair, and then fall asleep and drop the infant. Or fall asleep on
 a couch with the infant, who then is suffocated in the couch and we blame the mother for the infant's injury. 

In my never to be humble opinion, there is a lot of hysteria, pseudo-science, and misinformation about co-sleeping in the US, and the majority of the medical community is at least a generation away from listening to anything rational on the subject. It actually reminds me more than a little, of the way in which mothers in the 1950's were blamed for their children's autism "because they didn't bond with their babies." In the same way, I sometimes see parents blamed in this culture when their infants die of SIDS while in the same room as them when they may very well have died the same way if they were sleeping in a crib, but are blamed, perhaps erroneously and then spend the rest of their lives wracked with guilt. Before we do that to parents, we better we really sure that what we are saying is correct. Perhaps when breastfeeding becomes more normal in our society again, people will be more willing to listen to the facts instead of hysteria. 

Cultures in which co-sleeping is more frequent and the rate of smoking is low such as Japan and the Netherlands have the very lowest rates of SIDS in the world. If co-sleeping causes SIDS, why are their SIDS rates so low?

Not that I'm against putting infants to sleep on their backs (which they naturally do when they fall asleep breastfeeding), however the reality is that Back to Sleep actually cannot conclusively prove that it has reduced the rate of SIDS. Before you respond that I'm an idiot. One thing I'd like to point out is that this whole program is based on a correlation of data, and not any actual clinical studies. What that means is that during a ten year period, this country began to see a drop in SIDS at the same time we began telling parents to put their infants to sleep on their backs. So maybe those two things are related, but you have to admit that's not exactly science to just make that assumption. Especially, when during that same period of time, maternal smoking and drinking also declined and breastfeeding rates increased. Was the drop in SIDS rates related to supine sleep, breastfeeding, decreased smoking, some or all of these factors? Truthfully, we
 have no idea because that would necessitate a randomized-control, large scale study that was never done. And if I can also point out, during this time in which SIDS declined, co-sleeping increased also in this country. But "everyone knows" that back to sleep reduces SIDS right?

I'm also annoyed by studies that show infant's may have lower rates of SIDS when they use a pacifier are used to promote pacifier use. Because the infant supposed does more sucking at night and keeps it in light REM sleep longer. However, when infants co-sleep and breastfeed, they do the same thing. Good grief. All other mammals sleep with their infants, maternal-infant co-sleeping has been the norm throughout evolutionary history, it's what we are biologically drive to do, and it's possible that it may be protective against SIDS. Again, it would seem that perhaps the wiser thing to do would be to do more randomized clinical studies regarding breastfeeding and safe co-sleeping practices to see if their is an increase or decrease in the rate of SIDS.

Anyway, as someone who also has seen infants die from unsafe sleep practices, I also think a wiser approach would be to begin talking to parents about the difference between safe and unsafe co-sleeping practices. A soft adult bed, high off the ground is less safe than a firm mattress on the floor, such as the majority of people sleep on in other countries such as Japan. Sleeping with your infant is unsafe if you are drinking, smoking, using drugs, sleeping on a couch, etc. We know these things contribute to injuries and suffocation in infants. 

I had a patient last week who told me that her first child died at 4 months (too old to be in a rocking cradle) because they had him in a cradle in their room and he rolled over and fell out of the cradle and died of a head injury. These were parents that had a 6th grade education level, the infant should not have been in a cradle after it was rolling over, the parents were doing what they were told by their MD, to room-share, but not bed-share. But they could have benefited from additional education about safe-sleep. The main problem is that this is the type of "co-sleeping" that most HCP's see and results in infant injuries. They do not see the 99% of breastfeeding, loving parents who safely sleep with their babies. They see the people who don't really want to sleep with their baby but can't afford a crib, are on drugs, smoking, or neglecting their infants and then become very opposed to the idea of co-sleeping because they see the when it goes
 horribly wrong. Unfortunately, just like all other aspects of parenting, parents who have many social problems are at a higher risk for parenting problems and their kids are at higher risk, too. We can reduce those risks through improved education and support of these vulnerable populations, but we may never be able to completely mitigate them. And just trying to address this problem with a simple, "Never sleep with your baby," over-simplifies a very complex problem.

As a mother who co-slept, in my opinion, I was always keenly aware of where my breastfed infant was, even while asleep. We took our bed apart and just put our mattress on the floor for years, so we could sleep with our infants with no worries about injuries and yet I could "sleep through the night" because even when my baby woke to eat, I could continue to sleep, making ever aspect of nighttime parenting easy and stress-free. As a parent, I would love it if all breastfeeding mothers read Dr. Sears,"Nighttime Parenting" book. He stresses that infants must be sleeping safely, but there are many options, and the one in which parents and infants are happiest and get the most sleep is the one that right for your family.

Recently, there was a similar discussion on this forum in which an LC in the UK complained about a public health campaign about safe sleep that implied that co-sleeping is dangerous. Ah, if only we were at that point. It would be nice if we could have a rational conversation about this in this country. But we have posters instead that say, "Put your baby in a crib, not a casket."

Oh boy. Well, there's my rant for the day. Thanks for listening.

Tricia Shamblin, RN, IBCLC

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