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 Study Shows Sleeping with Baby is Safe, Sleeping With Baby and Drugs is Not
Source: The Guardian by Sarah Boseley Date: 10/19/09
It seems like the most natural thing in the world to bring your baby into bed with you and give this tiny scrap of humanity all the closeness, comfort and reassurance you can. Mothers who do it know it quietens a fretful baby, and
allows
them to breastfeed without having to stumble out of bed into the
shocking chill of the early hours in a half-dazed, sleep-deprived state
of resentment.
But
we must not do it, say authoritative bodies including the Department of
Health and a leading charity. We must go against our instincts because
we are risking our baby's lives. Bedsharing is a risk for cot death.
The
Foundation for the Study of Infant Deaths (FSID) and the department say
categorically that the safest place for a baby is in a cot in the
parents' bedroom. Babies must sleep alone. Breastfeeding mothers should
wake up, get up in the cold grey dawn, pick them up, settle in a
comfortable armchair, feed them and then put them back in the cot and
hope they won't wail piteously for long.
This
message was strongly repeated by the foundation on the publication of a
study this week by the British Medical Journal which FSID itself
funded. "Latest findings by researchers from Bristol University . . .
confirm that 'the safest place for a baby to sleep is in its own cot'.
This four-year study . . . found that in half of all unexpected deaths
of children in the south-west of England, babies had died sleeping with
a parent or carer," said FSID's press release.
What
is worrying, the release went on, is that 25% of mothers in a survey
"were not persuaded that bedsharing can increase the risk of cot death".
But
anyone who read the full paper, by a very experienced and
well-respected team from Bristol and Warwick Universities, would be
hard pushed to believe it either.
Yes
– the study found that 54% of cot deaths occurred while the baby was
co-sleeping with a parent. But although the risk was strong if they had
crashed out on the sofa, it was only significant among those in a bed
if the parent had drunk more than two units of alcohol or had been
taking drugs.
This
is a serious, heavyweight piece of research by a team with impeccable
credentials who have been working in this field for 20 years. They
looked at all sudden unexplained infant deaths (Sids – often referred
to as cot deaths) in the south-west of England between the start of
2003 and the end of 2006. After campaigns in the 90s on the dangers of
putting babies to sleep on their fronts, the number of cot deaths has
dropped dramatically – by half. But there were still enough deaths (79)
in this study to make their conclusions valid.
Peter
Fleming, professor of infant health and developmental physiology in
Bristol, one of the study authors, was appalled by the
misinterpretation, as he sees it, of the paper in the media this week.
"I really felt quite uncomfortable about it," he told the Guardian
yesterday.
"My
view is that the positive message of this study is that it says don't
drink or take drugs and don't smoke, particularly for breastfeeding
mothers. We did not find any increased risk from bedsharing. It is a
very different message from the one the media picked up."
You
can say that half the deaths occurred while babies slept with their
parents. You could also say that half the deaths occurred while babies
were alone in their cots, he says, but: "I don't see anybody saying,
'Don't put your baby in a cot.'"
Fleming
has a particular reason for worry. The study showed that sleeping with
the baby on a sofa really is a risk. Yet seven of the parents whose
baby died say they had gone to the sofa to feed, aware that bedsharing
is said to be dangerous, and had fallen asleep.
"Any
advice to discourage bedsharing may carry with it the danger of tired
parents feeding their baby on a sofa, which carries a much greater risk
than co-sleeping in the parents' bed," says the paper. "Anecdotally,
two of the families of Sids infants who had co-slept on a sofa informed
us that they had been advised against bringing the baby into bed but
had not realised the risks from falling asleep on the sofa."
But
despite Fleming's concern, the FSID was sticking to the line agreed
with the Department of Health yesterday: "The safest place for an
infant to sleep is in a cot beside the parents' bed." It pointed out
that the same sentence appears in Fleming's paper, but did not mention
what follows next: "Based on evidence from research into Sids it is
questionable whether advice to avoid bedsharing is generalisable and
whether such a simplistic approach would do no harm. Parents of young
infants need to feed them during the night, sometimes several times,
and if we demonise the parents' bed we may be in danger of the sofa
being chosen. A better approach may be to warn parents of the specific
circumstances that put infants at risk."
Joyce
Epstein, director of FSID, says this is too complicated. "If you can
get people's attention for more than three seconds you would like to
give the whole story every time, but at what point do you lose
everybody?" she says. From their perspective, the simple direct message
– put your baby to sleep in a cot near the bed, not in the bed, is the
key.
The
new study, she says, is just one study (although in a Lancet 2006 paper
the Bristol team also found a link to drink and drugs). George Haycock,
professor emeritus of paediatrics at St George's hospital in London,
who is FSID's scientific advisor, points to nine previous studies that
have looked at co-sleeping and cot death and concluded that sharing a
bed is risky.
"You
can't say there is no risk," says Haycock, even if it is small for
non-smokers. And he is tacitly critical of the "breastfeeding lobby"
for defending bedsharing, when there is no concrete proof that it
increases the numbers of women who breastfeed.
But
Fleming says this study breaks new ground. Nobody in the past has
gathered reliable information about drug-taking. "The advantage of this
study is that because we did a death-scene evaluation, three to four
hours after the baby died, we were able to look at all sorts of factors
which in the past we couldn't look at." When the researchers talked to
the parents, offering sympathy without blame and the possibility of
explanations for their tragic loss, the parents told them everything,
including what they had drunk and what drugs they took the night
before. "People are very willing to share that information with you at
that time," he says. "You get the real picture."
The
paper adds that the findings may explain some of the quirky cultural
associations between co-sleeping and Sids. Among black African
populations in the United States and Maori and Aboriginal people, where
babies commonly sleep with their parents, cot deaths are high, yet in
other bedsharing communities, such as Japan, Hong Kong and among the
Bangladeshi and other Asian peoples of the UK, deaths are low. The
difference is in their smoking, drinking and drug habits.
FSID's
raison d'etre is to eliminate sudden unexpected infant deaths and that
is what they believe their advice on putting babies in cots, on their
backs, "feet to foot", on a firm mattress with no pillow, will help do.
But other organisations think there may be real benefits to taking your
baby into your bed. The National Childbirth Trust (NCT), the country's
leading parenting organisation (and champions of breastfeeding), openly
defends bedsharing.
"The
study shows that risks for babies whose parents did not smoke or
consume alcohol or drugs but who did share their bed with their baby
were not different from that for babies in a separate cot," says its
head of research Mary Newburn in a statement responding to the BMJ
publication.
The
NCT's position is a response to the real world of its members. "Many
parents share their bed with their baby when they are young and this
can be done safely," says Newburn. "It is clear from surveys that
around half of parents sleep with their babies at some point in the
first six months, and around a quarter do so routinely, so we need to
help them to do this in the safest way possible."
Rosie
Dodds, NCT senior public policy officer, says they understand FSID's
position. "They are really worried about the number of babies dying and
want everybody to be as safe as possible," she says. "But there are
likely to be advantages to babies sharing a bed with parents." Although
she acknowledges that there is no scientific evidence establishing that
bedsharing increases breastfeeding, there is an association, and
breastfeeding on its own has been shown to lower the risk of cot death.
Deborah
Jackson, author of Three In A Bed, says she thinks we are, in the UK,
"fixated on the bad aspects of sharing a bed with the baby", which is
strange because "the history of bedsharing or shared sleeping places
with the baby is as old as humanity itself".
Her
research, together with her own experiences of bedsharing with her
three children, have persuaded her it is profoundly beneficial for both
mother and child. The mother is aware of her baby as she is sleeping
and reacts to her. "[Once] I was asleep," says Jackson. "[One of my
children] was sleeping next to me. I suddenly sat up in the night and
held her over the bed and she was sick," she says. Somehow she had
known the baby was about to be unwell.
But
there are clear dangers if the mother has been drinking or taking
drugs. "All the things that make it good can make it really dangerous
if you are not incredibly sensible. That's true of everything in
parenting," she says.
Cot
death is devastating and everybody is on the same side – they want to
see fewer tragic families who have lost their babies. But there is
clearly not one single road that everybody can march down together. In
the end, a single prohibitive message for parents may even be
counter-productive. This may be one of those cases where the public
should be given credit for their intelligence and allowed to make up
their minds on the basis of rather fuller information.
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