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Category: Sleep

Safe Co-Sleeping

Safe Co-Sleeping

Unfortunately, there is a very sad article making the rounds on Facebook and several of my news feeds at the moment about a 7 week old baby who tragically died while bed-sharing with his mother. I don’t want to minimise this terrible loss in any way whatsoever, and I completely understand this mother’s desire to share what happened to her child with others as a way of trying to prevent such a tragedy from occurring again (and I can’t even imagine her heartbreak she must be feeling).  However, a lot of the information in this article is not evidence based, and it’s piling a whole lot of fear onto the words “bed sharing”, which isn’t helping when there’s already so much fear and misinformation out there in the first place. (I’ll put a link to this article at the bottom of this post so you can read it for yourself if you want).

First, the article doesn’t mention if this mum made a deliberate choice to co-sleep with her baby, and had therefore baby-proofed her sleep environment with that in mind, or if instead she had accidentally fallen asleep with her baby in her bed. We know that accidentally falling asleep with a baby in an unsafe sleep environment is much more dangerous than making the sleeping environment safe, and planning on sleeping with your baby in your bed. The mum doesn’t say that she was co-sleeping or bed sharing. She says that she fell asleep with her baby, and the baby slipped off the breast.  These are two very different scenarios.

We don’t know if this mum was exclusively breastfeeding or not. The recommendations we do have make it very clear that co-sleeping should only be done in an exclusively breastfeeding relationship. Even one or two bottles of artificial baby milk a day can put babies into a deeper sleeping pattern that is harder for them to rouse from, and it also weakens the mum’s instinctual awareness of her baby in bed with her.

Waking up repeatedly to breastfeed a baby and accidentally passing out from exhaustion in a chair or on a couch is actually much more dangerous for your baby than deliberately planning on co-sleeping safely with them.  There are hormones released during breastfeeding which are designed to help both you and your baby to fall asleep, so it’s very common to nod off while breastfeeding. It’s better to plan for this occurrence to happen in a safe environment, rather than fighting against sleep (and most likely losing the battle) propped up in a chair or on a couch.

Also, the title of the article itself makes it sound like *breastfeeding* was the reason that this baby died, when actually it wasn’t the breastfeeding, it was unplanned bed sharing. In reality, all the evidence we have tells us that exclusively breastfeeding is some of the best protection we have against Sudden Infant Death Syndrome (SIDS).

The article keeps linking to a parents.com article as evidence, saying things like “experts have found…”. Unfortunately, parents.com are not experts on co-sleeping, bed sharing or breastfeeding. Professor Helen Ball and Dr. James McKenna are experts on co-sleeping.

And finally, we need to remember that co-sleeping is not a “trend”. Parents aren’t doing this because it’s cool. They’re doing this because it’s the biological norm for our human species, and the way that we’re supposed to feed our human babies. It’s also the best way to get more sleep as an exhausted new parent, IF you’re exclusively breastfeeding, and IF you make the sleeping environment safe.

So how do you safely co-sleep?

In a nutshell: you need to be exclusively breastfeeding, make sure the mattress is firm and not something you sink into, and that any cracks between the headboard and wall are packed with rolled up towels or clothing so there are no gaps. Duvets and pillows need to be kept well away from the baby (including snoozepods and snugglers and sleep positioners), and the baby should zipped into a sleep sack rather than swaddled, with their head uncovered (and their arms free) The temperature of the room should be about 18 degrees Celsius, and the baby should be dressed appropriately so that they don’t overheat. The baby needs to have been born at term, and should be placed on his/her back to sleep. And obviously, mum and dad both need to be nonsmokers and sober.

Want better evidence than my word alone? Professor Helen Ball’s research from Durham University is one of the best places to start. She has a fantastic website you can visit which talks more about where babies sleep, and how to make their sleeping environment safe.

La Leche League has a check-list you can use as well, called The Safe Sleep 7.  La Leche League also has great article called Safe Sleep and the Breastfed Baby.

Dr. James McKenna, director of the Mother-Baby Sleep Laboratory at the University of Notre Dame, also has an excellent guideline on how to make the sleeping environment safe.

And finally, if you are an exhausted new parent who is combination feeding (i.e. breastmilk and artificial baby milk) and wanting to co-sleep but unable to do so because of these guidelines, putting the baby in a side-car cot that attaches next to the bed (so that they have their own separate sleeping environment while still being very close to you) is a good option, or else a bassinet close to your bed. You could also look into using a baby box in your bed with you, which research from Finland is supporting (although if you’re going to use a baby box, there shouldn’t be any extra padding, blankets, bumpers or pillows with the baby, just a baby and a zippered sleep-sack).

(And finally, the article in question can be found here.)

Sleep and “Self-Soothing” Roundup

Sleep and “Self-Soothing” Roundup

There is so much conflicting information out there on sleep, and so many messages you’ll hear on why having your baby “sleep through the night” is the holy grail of parenting and that if your baby isn’t hitting this milestone by (insert whatever age you like here), it’s a disaster or they’re not a good baby or you’re not a good mother or you’re allowing them to create bad habits etc. etc.  But the truth is that every baby is unique, sleep needs vary tremendously between kiddos, and learning to “sleep through the night” is a developmental milestone that you can’t really force a baby to hit before they’re ready, just like you can’t force them to sit up or crawl before they’re ready. Also, it’s important to remember that even as adults we wake up several times in a night (because we’re thirsty, or hot, or cold, or have to use the toilet, or had a bad dream, or heard a loud noise, or are stressed about something, or uncomfortable, or or or…), but the difference is that as adults we have learned to roll over, self-soothe and go back to sleep. Babies are still learning this skill.  It takes years for them to fully master it, and until they do, they often still need our help, input and reassurance to fall back asleep. Meeting a baby’s needs is not “creating bad habits”; it’s being responsive and attentive to the baby’s needs, which in the long run will create more security and independence.

Strangely enough, discussing sleep and self-soothing is a very “controversial” topic. On parenting boards and facebook groups and public forums, there are strong advocates for sleep training, using either “controlled crying”, “gradual extinction” or “crying-it-out” (CIO) methods as a way of teaching a baby to sleep through the night. There are equally strong advocates against these methods. Because every parent is exhausted (EXHAUSTED!), there is an unending market for books, sleep gurus and training methods as desperate parents (understandably) look for ways to get more sleep. And not surprisingly, the message you get from mainstream sources, news articles and “how to get your baby to sleep” books suggest that a baby who isn’t sleeping through the night by (insert whatever age you like here) is a problem that needs to be fixed. But what I am more interested in looking at is the actual science behind these differing approaches. Research into sleep, such as what Professor Helen Ball at the University of Durham is doing through the Infant Sleep and Information Source, is still a relatively new field, but there is a growing body of evidence which is beginning to refute the claims of the many (insanely popular) sleep experts and authors and gurus who recommend this or that sleep training technique.  The following is a round-up of some of these articles.   

First, Sarah Ockwell Smith has a great article on realistic sleep expectations for babies. As you can see, there is A LOT of normal variation in this, and even if one baby is ready to sleep through the night at 8 months, another baby might not be ready to do so at all. Each kiddo is unique and has different needs. 

Sarah Ockwell Smith also has a good article on what’s really happening when you teach a baby to “self-soothe”. Unfortunately, sleep training methods don’t really teach our babies to self-soothe. This is a developmental skill which they can only learn with time and maturity. Instead, it teaches a baby to stop signaling her distress. Babies are smart and they very quickly learn that if crying doesn’t bring a response, it would be better to conserve their energy instead and not use a method that doesn’t work. A study done in 2012 by Middlemiss et. al. monitored the cortisol levels (i.e. stress levels) in 25 mom+baby pairs and found that at the beginning of the study, the mom and baby were synchronised in their stress response, meaning that when the baby was stressed and signaled this to the mother, the mother responded to this with a rising cortisol level of her own. In other words, if baby was distressed, mom was distressed, and their cortisol levels were in sync. By Day 3 of the study, after using a gradual extinction sleep training method, the researchers found that the baby was no longer exhibiting stressed behaviour, but the baby was still distressed (as demonstrated by high cortisol levels). Meanwhile, because the baby was no longer signaling its distress, the mom’s cortisol levels had decreased, indicating that she was no longer in sync with her baby (at least in terms of cortisol levels).

Calm Family wrote a very detailed response to the BBC One’s recent airing of Panorama, Sleepless Britain, which addresses many of the ways “sleep issues” are portrayed in the media.

The Analytical Armadillo, another IBCLC blogger, has also written a good analysis on what happens during self-soothing, and that even though it works (and it does work), it’s not necessarily harmless.

Evolutionary Parenting looks at the science behind exposing our kids to stress, and what’s actually going on neurochemically in their brains when this happens. 

Uncommonjohn also looks at the science behind self-soothing

The Milk Meg writes about the many reasons our babies wake so frequently in the night.  

And while this doesn’t actually get into the science behind it, Mama Bean Parenting documents quite…succinctly…the many, many, many messages we receive in our society which tell us that a baby that doesn’t sleep through the night is a “problem”.

Finally, Dr. Sears has some good suggestions on ways to get more sleep without using CIO methods, as does Dr. Jay Gordon in this article. The Milk Meg also has some ideas on ways to gently night-wean breastfeeding babies.

And one final disclaimer, since I know this is an incredibly sensitive subject for many parents. I understand the desperate need, the overwhelming desire, to somehow find a way to get more sleep! We’ve all been there. Many of us are still “there”.  Parenting is exhausting, and waking frequently with our babies in the night is not at all conducive to our modern lifestyles. I absolutely get it. And I have many clients and friends who have used sleep training methods, sometimes with very good results–hell, I’ve attempted a few of these methods myself with my first son out of sheer desperation (but wasn’t able to follow through with them). I am in no way judging the reasons why parents might turn to these methods, and I have nothing but empathy for the desperate exhaustion that makes these methods seem like the only answer. Getting more sleep is a positive thing for everyone involved, and allows us to be better parents, and in our bleary, sleep-deprived states figuring out how to get more sleep seems all-consuming and anything promising a quick fix seems like mana from heaven. But it’s important that we as parents do careful research and make informed decisions before deciding on a parenting course of action. Our media and society is saturated with messages about sleep and ways to “fix” it, and nearly all of these messages usually recommend some form of sleep training. That is one side of the debate. All of the articles I have posted here are the other side. It’s important to understand both sides before making an informed choice.

As a midwife, asking “Is your baby waking regularly and feeding regularly?” is a much more supportive and useful question for new parents instead of “Is your baby sleeping through the night?”. Most likely, a normal and healthy baby who’s feeding regularly and growing well will NOT be sleeping through the night, so rather than make parents feel like there’s something wrong, it’s much better to emphasise what’s absolutely right about this scenario. And then look for other ways to support exhausted parents to sneak a bit more sleep into their lives.