La Leche League is not honest about the risks of co-sleeping

image

One of the best ways to determine if a profession follows scientific evidence is to determine how it reacts to evidence that contradicts established practice.

Obstetricians were convinced that episiotomies prevented more serious tears, but when high quality evidence showed that to be wrong, the rate of episiotomy plummeted. Pediatricians routinely recommended placing infants to sleep on their stomach to reduce the risk of aspiration, but when high quality data showed that the prone position increased the risk of Sudden Infant Death Syndrome (SIDS), they changed their recommendations to placing infants on their backs and the SIDS rate dropped precipitously.

New, high quality evidence now shows that co-sleeping dramatically increases the risk of SIDS among breastfed infants under 3-4 months of age (Bed sharing when parents do not smoke: is there a risk of SIDS? An individual level analysis of five major case–control studies), and the La Leche League is in denial. They base their denial on a “white paper” that insists that the new evidence should be ignored.

The lactivists who wrote this white paper are supremely unqualified to pass judgement on scientific research: 2 are lay people who run parenting blogs, 1 is a nurse, and 2, including Darcia Narvaez, PhD, are an minor faculty in psychology departments. Not surprisingly, they have produced a piece of junk, but to understand why it is so disingenuous, we need to review the study it purports to critique.

The study in question, Bed sharing when parents do not smoke: is there a risk of SIDS? An individual level analysis of five major case–control studies, is remarkably rigorous. The authors set out to answer a very specific question: what is the risk of co-sleeping in breastfed babies whose parents do not smoke or drink?

They found:

…[T]he combined data have enabled the demonstration of increased relative risk associated with bed sharing when the baby is breastfed and neither parent smokes and no other risk factors are present (see figure 2 and table 2). The average risk is in the first 3 months and is 5.1 (2.3 to 11.4) times greater than if the baby is put to sleep supine on a cot in the parents’ room (table 3). This increased risk is unlikely to be due to chance (p=0.000059).

The data is quite robust as demonstrated by the following graph:

Co-sleeping risk of SIDS

The graph shows Adjusted ORs (AORs; log scale) for Sudden Infant Death Syndrome by age for bed sharing breast-fed infants, when neither parent smokes and both smoke versus comparable infants sleeping supine in the parents’ room. AORs are also adjusted for feeding, sleeping position when last left, where last slept, sex, race, and birth weight, mother’s age, parity, marital status, alcohol and drug use.

What is most remarkable is linear nature of the increased risk of SIDS with co-sleeping compared to the risk of SIDS if the baby is sleeping in the parents room, at every gestational age, and regardless of whether or not the parents smoke. Up until the age of 14-15 weeks, co-sleeping always increases the risk of SIDS death.

The authors go so far as to apply Hill’s criteria to their findings:

  • Assessment of bed sharing, in the absence of parental smoking alcohol and maternal drug use, as a causal risk for SIDS by Bradford Hill’s criteria31
  • Strength of association: Adjusted Odds Ratio (AOR) for bed sharing=2.7 (95% CI 1.4 to 5.3), p=0.0027, for breastfed infants with no other risk factors. AOR for the first 3 months of life=5.1 (2.3 to 11.4), p=0.00006. These AORs are moderately strong.
  • Consistent: Of more than 12 published studies, all but two small ones show, after multivariate adjustment, increased risk of SIDS associated with bed sharing, some combined with sofa sharing…
  • Temporally correct: Bed sharing always precedes SIDS.
  • Dose response: New Zealand study showed risk increased with duration of bed sharing. Not otherwise investigated.
  • Biologically plausible: Bed sharing risk is greatest to youngest infants who are most vulnerable.
  • Coherence: The proposition that bed sharing is causally related to SIDS is coherent with theories that respiratory obstruction, re-breathing expired gases, and thermal stress (or overheating), which may also give rise to the release of lethal toxins, are all mechanisms leading to SIDS, in the absence of smoking, alcohol or drugs. Infants placed prone are exposed to similar hazards.

The authors conclude:

… Our findings suggest that professionals and the literature should take a more definite stand against bed sharing, especially for babies under 3 months. If parents were made aware of the risks of sleeping with their baby, and room sharing were promoted, as ‘Back to Sleep’ was promoted 20 years ago, a substantial further reduction in SIDS rates could be achieved.

The white paper touted by the La Leche League condemns the findings of this study and attempts to mislead readers about what the study actually shows.

The authors share two graphs that show how various risk factors (such as infant position, parental smoking and bottle feeding) increase the risk of SIDS. That’s nice, but that’s not what the study is about. The study is specifically about the increased risk of co-sleeping in babies without any risk factors who are breastfed.

The authors insist:

Without consideration of [bedding and temperature], it is not possible to determine that one variable, such as bedsharing itself, is inherently responsible for risk remaining in this study

Really? Is there any reason to believe that the temperature of the bedroom and the blankets on the bed differ between women who breastfeed and those who don’t? Of course not.

The authors continue:

Instead of looking at how each of the variables in the dataset can contribute to risk of infants’ breathing or compromise arousal — the authors focus on whether the act of breastfeeding protects against all risk of SIDS.

Did these women even read the paper? It does not focus on whether breastfeeding prevents all cases of SIDS; it focuses SPECIFICALLY on whether co-sleeping increases the risk of SIDS in babies who are breastfed and finds that it increases the risk by a factor of 5.

The second issue pertains to the risk factors included and not included in the analysis…

Missing from the analysis are other known risk factors: specifically … environmental context (bedding) or infant vulnerability (prematurity)…

But is there any reason to believe that breastfeeding women are more likely to have inappropriate bedding? Is there any reason to believe that breastfeeding women are more likely to have babies who are premature? Of course not.

The lactivists end with this rousing call:

So, let’s stop going around in circles talking about secondary issues and focus on discussion on primary issue: decreasing the risk of SIDS events. If we want to decrease risk of SIDS events, then we must assure infants’ are in the best possible situation to support breathing and arousability.

Apparently they haven’t noticed but that’s EXACTLY what the authors of the original paper are doing. They are looking at an issue that has the potential to dramatically decrease SIDS among breastfed infants.

  • ObiWan Kenobi

    I’m so sick of hearing about “cosleeping” ..or as the rest of the world calls it “taking your infant into your bed, shoving a boob in their mouth and passing out.” Sure it may be *easier* on the parents, but it isn’t safe, however people go to extensive lengths to pretend it is, you honestly can’t get away from that mentality on parenting forums which have just become an echo chamber to validate each other’s laziness. “Oh people in other countries do it, I mean look at Japan!” “Oh it’s *so* *much* safer, I researched it online at “cosleepingmommyattachmentog.com” “I sleep frozen in the same position, so my baby would *never* suffocate” “My child is *so* independent because we “cosleep” “Mammals sleep with their young, so it’s *natural*” “Yada, Yada, yada…”attachment” parenting”… Meanwhile refusing to acknowledge the facts. “Cosleeping” is not safe, but as long as it shuts their kid up who gives a sh*t because “Momma needs *her* beauty sleep” Sure endanger your child’s life because you don’t have what it takes to establish and maintain a safe sleeping routine for your child. I mean, if you’re too feeble and weak to safeguard your child’s life, when they’re SLEEPING, you may want to reconsider the whole parenting thing. Makes you wonder what these people expected when they signed up to have an infant…Did they get home with their babies and “SURPRISE! BABIES DON’T SLEEP THROUGH THE NIGHT!” It’s laziness, it’s irresponsibility, it’s a cop out they desperately try to validate and justify, but facts are facts, but whatever helps *you* sleep at night, right? it’s ignorant, selfish and lazy behavior. Props to all of the parents out there who are strong enough to do the right thing for their babies, who have enough common sense to know you don’t just take an infant into your bed with you because you don’t want to deal with them, props to the late nighters, the rockers, the walkers, the singers and the talkers, props to the parents who have the guts to actually be a parent, props to the parents who don’t cop out at the expense of their child’s health…just so they can selfishly pass out and resume being a parent in the morning.. what you learn and earn is by far something that will never be achieved by parents who throw in the towel and give up on their children.

    • Nick Sanders

      Why are you digging up a 3 year old post for your giant ramble?

  • N

    Aaaaand here what the co-sleeping expert says.

    http://cosleeping.nd.edu

    James McKenna should know. Should he not? As he studied it….

    • ObiWan Kenobi

      “Experts”…Funny these “experts” haven’t rewritten the standard sleeping guidelines for infants and children…hmmm.

  • N
    • ObiWan Kenobi

      How long did you have to Googlr to find that?

  • N

    Here is the answer of a german pediatrician to he carpenter study. see page 5 for english response.

    http://kinderverstehen.de/images/SIDS_Stellungnahme_Carpenter_HRP_130613.pdf

  • Angela

    We need to start talking about safe co-sleeping and bedsharing, not admonishing it. I’m well aware of the risks and fear promulgated by the Back to Sleep campaign and public health organizations, and accordingly I bought an Arm’s Reach Co-sleeper for my baby to use. But you know what? My baby didn’t want to sleep anywhere but on me at night, chest to chest, for the first 3 months of his life. Now he’s sleeping to my side, sometimes on his tummy, sometimes on his side, and sometimes on his back. On a rare occasion, I can set him in the co-sleeper for an hour. I encourage Amy Tuteur to revisit this post and read some of the comments to the meta-analysis that she linked to. It is not just LLLI that has a problem with it!

    • A

      There isn’t such a thing as safe co-sleeping. There might be “safer co-sleeping” though.
      If you understand the risks associated with co-sleeping and decide to do it anyhow, it’s your choice. Like homebirth, it’s a much riskier choice but it will probably be okay most of the time.
      What you can’t do is try to deny that there is any risk at all in an effort to promote the practice, which is exactly what La Leche League did. That’s not okay.
      Also, authorities aren’t saying to put your baby on his back to sleep (if there are no health conditions that indicate otherwise) because they are trying to make you afraid of SIDS; they’re saying it because it’s simply the truth that other sleep positions quite increase the risk of SIDS.

  • Robert Jackson

    Cultivate these keys and apply them into your new sleeping routine and you will sleep better and more soundly than ever before
    Doctor I

  • Robert Jackson

    Hmm you have allured me y your information on risks of co-sleeping.

    James

  • Barbara amsel

    Your blogs have allured me a lot. I’ll again visit this great site to get more valuable stuff.

    Doctoacdadasdasdas

  • Nicole

    Dr Amy, these findings make me very fearful of co-sleeping; I’m wondering whether things like obesity, fatigue, bedding, Western bed, etc. have a direct correlation with these statistics. If they’re factored in, they’re very obscured or I’ve just missed them… Co-sleeping was never a parenting choice I had considered or planned on before giving birth to my daughter. I accepted the recommended advice of putting baby in same room for first six months, on back, etc. Then I met my daughter: I tried my utmost and failed. Without giving you the complete rundown of how things panned out when we brought her home, I’ll keep it simple and just say I now co-sleep out of necessity as, I see, do many of the women who have previously commented on your blog. I had no intention of doing so but nothing I did was successful in settling my daughter in her Moses basket. Finally, out of sheer exhaustion and some potentially very dangerous sleep deprived moments, I decided it’s actually safer to co-sleep in my situation.

    I would like to know your personal opinion on why many Asian countries – such as Japan, Singapore and Hong Kong – have the lowest infant mortality and SIDS rates ( http://www.indexmundi.com/map/?v=29 ) yet it is the cultural norm in these countries to bed share with babies; there is a jarring discrepancy here… I ended up buying an authentic Japanese futon, a tiny buckwheat pillow that has the dimensions of basically my head only, and a sleep suit to replace bedding. I also have a sleep monitor on her (Snuza) and sleep alone with her while partner is in our original bed. I guess my biggest concern is that a blanket ‘no’ to co-sleeping practices makes me very reluctant to do so, despite common sense telling me that it must have something inherently to do with our sleeping arrangements as Westerners. I think having micro-sleeps (as I was) on the couch and when I brought her into the bed (before I’d researched co-sleeping and hadn’t created a ‘safe’ environment) is actually more dangerous, but the campaigns against co-sleeping frighten me, as it gives the impression that there is some unknown element to co-sleeping in and of itself that makes it dangerous rather than, what I’d argue is rationally, a culmination of elements that make it risky… I am not attached to any ideology and just genuinely would be interested in your thoughts…

    • Young CC Prof

      Your link shows that Japan has a low infant mortality rate, but infant mortality has many causes other than SIDS or bed suffocation. In the USA, for example, premature birth is the leading cause of infant deaths. In fact, 2/3 of infant deaths in the USA occur in babies who were born prematurely, and other countries including Japan have fewer premature births.

      Also, even if you did have precise SIDS rates, possible SIDS deaths may be investigated differently in different countries, so it’s hard to compare SIDS rates internationally.

      We don’t know precisely what the risk of co-sleeping under different conditions. There isn’t enough data, and when sleeping deaths do occur, the folks involved may have some incentive to lie about how it happened!

      It does sound as if you took every possible precaution to reduce the risk of co-sleeping, only one adult and one child, low or on the floor surface to prevent falling off, very firm mattress, no thick blankets or pillows. About the only remaining risk is parent rolling over onto child. And I get that some babies just will not sleep except on someone, and there’s a limit to how long even the most devoted mother can go without sleep before becoming a hazard herself.

      So, a baby who will sleep in his own crib is still safer, but life and parenting about doing what works.

  • fan

    According to this study what are exactly the dangers of co sleeping? Thank you

    • yentavegan

      You are not alone in your difficulty to get a grip of the real results of this study. In a nut shell, Mothers who breastfeed and co-sleep have a higher occurrence of SIDS than mothers who breastfeed but do not co-sleep. I did not want to believe this study too. It meant that years of my life were wasted devoted to an ideal of mothering that frankly is not in the least significantly beneficial to children. Infact, some of what I was indoctrinated to believe is down right dangerous.

      • fan

        Thank you for your answer. I understand that the study says that for mums that breastfeed and cosleep the risks of SIDS is higher but does it says why??

        • Dr Kitty

          Because the medical establishment suspect that SIDS can encompass the phenomenon of being suffocated by bedclothes or a parent, which is obviously more common when co-sleeping.

  • vintner

    There is no exact right or wrong way, mums should support each other, Statistics will give you information, that you can use or not. If you have the one baby who is in the stats, then what would you say. My babies slept in a bassinet next to me and sometimes i fell asleep with them in our bed. Blessed with all four, healthy babies. They grow up and you wonder what all the fuss was about. As a parent of four teens, all I can say is enjoy them while they are babies and don’t get so wound up on ideology.

  • Curious

    This article has ruined my sleep for the last couple weeks. I stopped bringing my 11 week old into bed with me–a few weeks of sleep deprivation is worth not having my baby die! That said, I HAVE been wondering about possible confounding variables, bedding included. Doesn’t Japan have a high rate of bedsharing and a low rate of SIDS? Is this just propaganda that doesn’t actually prove anything (or is perhaps not even true) or is there something different about how the Japanese bed share? Anyone who can provide resources for answers will be greatly appreciated!

    I can’t wait for that 16 week mark to get back to easier napping! I bought a firm mattress to put on the floor in the baby’s room for the express purpose of safely napping together/dozing off for night time feedings (at least, I had thought it was safe, with no fluffy bedding & no high edges to roll off). My husband would never go for bringing the baby into our bed! Since I’ve stopped, naps are not as easy…

  • guesty
    • Eddie

      I get access denied. What’s there?

      • guesty

        Oops I think you need to register to see the forum – which probably wouldnt be a bad thing. There is a fair bit of woo on this board and its the most popular board in New Zealand… scary…

  • PoopDoc

    There are those who co bed because they find it easier than getting up at night to feed the baby. There are those who co bed because they feel closer to their baby. There are those who co bed because they just want to. The odds of SIDS are higher, but still a relatively low risk. So if a parent is informed they can have every right to take on that risk. “Professional” organizations who flat out lie to parents and say there is no increased risk sicken me. I suspect their tune would change if they were liable for the bad advice they dole out.

  • Sue

    I look at it this way: there are many many millions of healthy, well-adjusted people in the world who were raised without co-sleeping, and have gone on to raise their own healthy, well-adjusted children in a loving way, without co-sleeping.

    So, if co-sleeping is a choice that carries no benefit to a child’s well-being or development, and carries a risk, why persist in promoting it?

    Or, alternatively, why not accept that there are risks and push for cribs beside the parental bed?

    • Maya Markova

      Co-sleeping does have short term benefits. To be not so formal, many if not most if not all babies like it (similarly to other mammals of this age) and many mothers like to feel their baby by their side (apparently again some relic from our distant past).
      I have co-slept with both my babies because they wanted it, i.e. would not sleep elsewhere for hours. I realize now that I have subjected them to risk without even realizing it. In the books I had read, the only advice against co-sleeping was that “the child will refuse to sleep elsewhere” (if allowed to co-sleep even once).

      • In th eolden days of Old Wives Tales (my mother’s generation) the risks of “overlaying” meant that co-sleeping was number one on the list of things not to do. Everybody knew someone, or new of someone, who had lost a child that way. Don’t know when SIDS was named and identified, so accidental suffocation may not have been the cause, but I had it drummed in to me as Antigonos did.

  • HLBall

    A very small risk, multiplied by 5, is still a very small risk. Did you read the part of the paper where the authors indicated the predicted SIDS rate for a breastfed term infant who bedshared with non-smoking parents compared to roomsharing was a difference of approx. 1/10,000? The newspapers, and then you, were taken in by the press release issued by the author of this paper. Why, for instance, aren’t they (and you) raising awareness of the substantial risks associated with smoking or alcohol and bedsharing, rather than attacking breastfeeding mothers who contribute almost nothing to the SIDS rates.

    • A small risk multiplied by 5 is indeed still a small risk. But somebody ends up wishing they hadn’t taken it.

      We all take risks, wittingly and unwittingly, every day. Usually because they are unavoidable or the benefits stop us thinking to much about them. Taking them on the basis that bad things happen to other people isn’t great though.

      • thepragmatist

        Right here. When my guy was little, I would’ve done anything to lessen the anxiety about SIDS. He certainly didn’t sleep in my bed: I knew I was high risk (meds for one). But, I was equally afraid that he would succumb because he was a side-sleeping in his crib, and also would only nap in a moving swing. But he lived. Still I was constantly checking and listening because those first months are terrifying (at least to the anxiety prone!) and I don’t really understand anyone is can look at all the Coroner Reports out there and these studies and STILL want to put a baby in their bed, when they can easily put a crib RIGHT NEXT TO THE BED, and be within arm’s reach and know baby is safe. (And trust me, I agonized about my guy who would only sleep on his side, but I did some research and discovered that it was a much less increased risk than sleeping on his tummy, so I felt a bit more relaxed– even then, I was terrified of SIDs and so happy when we made it out of the SIDs zone. And now I enjoy sleeping with my boy! But he’s big and I feel safe to do so.

    • Amy Tuteur, MD

      And pretending that a small risk does not exist, as La Leche League is trying to do, is still a lie that keeps women from making an informed decision for themselves, right?

      • Karleen Gribble

        I think it has been made pretty clear that the study in question has some major flaws that call the proposition that there is any increased SIDS risk with cobedding dyads without other risk factors into serious question. We will only know as future research takes a closer look at how the sleep environment and SIDS interact- it’s not a simple issue to consider. It is premature to say that cobedding is inherently risky, and could well be dangerous. As discussed, it is entirely possible that instructions not to ever sleep with your baby actually increases infant deaths due to mothers falling asleep with their babies in manifestly unsafe environments. Depending upon the context, a large proportion of mothers will share a sleep surface with their baby- in Australia the last study that looked at this put the figure at 80%. Providing information about how to make cobedding as safe as it can be is important, just as it is important to provide information on how to make a cot a safe place for a baby.
        Amy I’d still be interested in seeing your response to the critiques, of Blair, Fleming and Ball as per the BMJ website- go for the substance rather than the soft target.

        • TamJ

          Flaws? Really? Even if “flaws” were a significant issue (which is questionable) in this study, it’s not only this study that demonstrates bedsharing to be a a concern, especially in infants under 4 months of age.

          McGarvey C, McDonnell M, Chong A, O’Regan M, Matthews T. National Sudden Infant Death Register, The Children’s Hospital, Temple Street, Dublin 1, Republic of Ireland. Factors relating to the infant’s last sleep environment in sudden infant death syndrome in the Republic of Ireland. Arch Dis Child. 2003 Dec;88(12):1058-64.

          Tappin D, Ecob R, Brooke H. Paediatric Epidemiology and Community Health (PEACH) Unit, Department of Child Health, University of Glasgow, Yorkhill, Scotland, UK Bedsharing, roomsharing, and sudden infant death syndrome in Scotland: a case-control study. J Pediatr. 2005 Jul;147(1):32-7

          R G Carpenter, L M Irgens, P S Blair, P D England, P Fleming, J Huber, G Jorch, P Schreuder Sudden unexplained infant death in 20 regions in
          Europe: case control study. Lancet 2004; 363: 185-91

          Lahr MB, Rosenberg KD, Lapidus JA. Bedsharing and maternal smoking in a population-based survey of new mothers. Pediatrics. 2005 Oct; 116(4):e530-42.

          E A Mitchell Department of Paediatrics, University of Auckland, Private Bag 92019, Auckland, New Zealand. Recommendations for sudden infant
          death syndrome prevention: a discussion document. Arch Dis Child. 2007 February; 92(2): 155–159.

          Ruys JH, de Jonge GA, Brand R, Engelberts AC, Semmekrot BA., Leiden University Medical Center, Reviuslaan 38, 2343 JR Oegstgeest, The
          Netherlands. Bed-sharing in the first four months of life: a risk factor for sudden infant death. Acta Paediatr. 2007 Oct;96(10):1399-403.

          Vennemann MM, Bajanowski T, Brinkmann B, Jorch G, Sauerland C, Mitchell EA; GeSID Study Group. Sleep environment risk factors for sudden infant
          death syndrome: the German Sudden Infant Death Syndrome Study. Pediatrics. 2009 Apr;123(4):1162-70.

          Cindie Carroll-Pankhurst and Edward A. Mortimer Jr Sudden Infant Death Syndrome, Bedsharing, Parental Weight, and Age at Death PEDIATRICS
          Vol. 107 No. 3 March 2001, pp. 530-536

          Lynne Hutchison B, Rea C, Stewart AW, Koelmeyer TD, Tipene-Leach DC, Mitchell EA. Sudden unexpected infant death in Auckland: a
          retrospective case review. Acta Paediatr. 2011 Aug;100(8):1108-12. doi 10.1111/j.1651-2227.2011.02221.x. Epub 2011 Mar 22.

          • Karleen Gribble

            But you see this is the problem. Studies have looked at SIDS and cosleeping and found that sharing a sleep surface with an infant increases the risk when the parents smoke, when they have consumed alcohol or other drugs and when they are not in a bed but on a sofa. That is what all those studies you cite found. No surprises there and no one questions it. Whether breastfed infants of non-smoking, non drug affected sleeping with their mother in an adult bed are at greater risk is the question. Beds are not an inherently safe environment, nor are cots. Context is important.

          • TamJ

            Please read the studies. Some level of context is definitely more important – which is why I only cited those studies that accounted for more than just shared sleep surface. I could have listed dozens more had I only been using the criteria you suggest.

          • TamJ

            With relevant excerpts:

            “Co-sleeping should be avoided in infants who are <20 weeks of age.”

            McGarvey C, McDonnell M, Chong A, O’Regan M, Matthews T. National Sudden Infant Death Register, The Children’s Hospital, Temple Street,
            Dublin 1, Republic of Ireland Factors
            relating to the infant’s last sleep environment in sudden infant death syndrome
            in the Republic of Ireland. Arch Dis Child. 2003 Dec;88(12):1058-64.

            “Sharing a sleep surface was associated with SIDS .. The association remained if mother did not
            smoke or the infant was breastfed … Bedsharing is associated with an increased risk of SIDS for infants <11 weeks of age.”

            Tappin D, Ecob R, Brooke H. Paediatric Epidemiology and Community Health (PEACH) Unit, Department of Child Health, University of Glasgow, Yorkhill, Scotland, UK Bedsharing, roomsharing, and sudden infant death syndrome in Scotland: a
            case-control study. J Pediatr. 2005 Jul;147(1):32-7.

            “For mothers who did not smoke during pregnancy, OR for bed-sharing was very small… and only
            significant during the first 8 weeks of life.” [One way to phrase this in a one sentence headline is: Co-sleeping with children under 2 months old was a
            significant risk factor for SIDS.]

            R G Carpenter, L M Irgens, P S Blair, P D England, P
            Fleming, J Huber, G Jorch, P Schreuder
            Sudden unexplained infant death in 20 regions in Europe: case control study. Lancet 2004; 363: 185-91

            “Epidemiologic evidence shows that there is little or no increased risk for SIDS among infants of nonsmoking mothers but increased risk among infants of smoking mothers and younger infants [<8-11 weeks of age] of nonsmoking mothers. It seems prudent to discourage bedsharing among all infants <3 months old. Young infants
            brought to bed to be breastfed should be returned to a crib when finished…[P]utting an infant of a nonsmoking mother to sleep in an adult bed
            should be delayed until 3 months of age.”

            Lahr MB, Rosenberg KD, Lapidus JA. Bedsharing and maternal smoking in a population-based survey of new mothers. Pediatrics. 2005 Oct; 116(4):e530-42.

            “Infants aged <12weeks born of non‐smokers are at
            increased risk of SIDS with bed sharing compared with infants of non‐smoking mothers not bed sharing.”

            E A Mitchell Department of Paediatrics, University of
            Auckland, Private Bag 92019, Auckland, New Zealand. Recommendations for sudden infant death
            syndrome prevention: a discussion document. Arch Dis Child. 2007 February; 92(2): 155–159.

            “Bed-sharing is a serious risk factor for sudden infant death for all babies of less than 4 months of age.”

            Ruys JH, de Jonge GA, Brand R, Engelberts AC, Semmekrot BA., Leiden University Medical Center, Reviuslaan 38, 2343 JR Oegstgeest, The
            Netherlands. Bed-sharing in the first four months of life: a risk factor for sudden infant death. Acta Paediatr. 2007 Oct;96(10):1399-403.

            “Bed sharing (especially for infants younger than 13 weeks… increased the risk for sudden infant death syndrome.”

            Vennemann MM, Bajanowski T, Brinkmann B, Jorch G, Sauerland C, Mitchell EA; GeSID Study Group. Sleep environment risk factors for sudden infant death syndrome: the German Sudden Infant Death Syndrome Study. Pediatrics. 2009 Apr;123(4):1162-70.

            “By demonstrating that among an urban population at high risk for SIDS, bedsharing is strongly
            associated with a younger age at death, independent of any other factors.”

            Cindie Carroll-Pankhurst and Edward A. Mortimer Jr Sudden Infant Death Syndrome, Bedsharing,
            Parental Weight, and Age at Death
            PEDIATRICS Vol. 107 No. 3 March 2001, pp. 530-536

            “[Y]ounger infants are at highest risk when faced with the environmental challenges of bedsharing….There was no evidence of diagnostic shift and the prevalence of bedsharing did not change over the decade. Conclusions: Bedsharing was associated with a high proportion of SUDI cases, especially in the youngest infants.”

            Lynne Hutchison B, Rea C, Stewart AW, Koelmeyer TD, Tipene-Leach DC, Mitchell EA. Sudden unexpected infant death in Auckland: a retrospective case review. Acta Paediatr. 2011 Aug;100(8):1108-12. doi: 10.1111/j.1651-2227.2011.02221.x. Epub 2011 Mar 22.

            “During 2000-2002, 1,064 infants died from [Accidental Suffocation and Strangulation in Bed],
            resulting in an ASSB mortality rate of 9.2 per 100,000 live births. Most ASSB deaths (71%) occurred before an infant reached 4 months old.”

            Carlberg MM, Shapiro-Mendoza CK, Goodman M. Matern Maternal and Infant Characteristics
            Associated With Accidental Suffocation and Strangulation in Bed in US Infants. Child Health J. 2011 Jul 17. [Epub ahead of print] PMID: 21769585

          • Karleen Gribble

            You need to read the whole of the paper to understand just what they looked at. For eg, McGarvey et al. did not consider drugs other than alcohol in their analysis and did not consider whether the infants were breastfed or not. And they don’t provide detail on how they determined the reference sleep for control infants (some studies underestimate the level of cobedding by how they define it) which means that they could have overestimated the risks of SIDS- we really don’t know. The devil is in the detail. Abstracts do not necessarily give a good indication of the research.

    • Eddie

      The risk of the lowest-risk group was 0.8/10,000 without co-sleeping, 2.3/10,000 with co-sleeping. That’s a difference of 1.5/10,000. As you say, a small — but significant — absolute increase. It’s important to understand what the risks actually are, and what increases those risks, so that people can make informed choices. Anyway, this isn’t an attack on breastfeeding mothers. This is an attack on the LLL, who only want to acknowledge facts that support their cause.

      I doubt there is much need to raise additional awareness of the substantial risks associated with smoking and drinking, as those risks are (at least in my experience) well publicized.

    • Sullivan ThePoop

      Are you feeling guilty about something that you are not sharing because no one is attacking breastfeeding mothers and those same breastfeeding mothers are contributing significantly to the SIDS rate if they are also cosleeping.

  • Guesteleh

    OT: Just read an article from back in March in the Guardian and didn’t know if Amy had seen it. I can’t link since I’m posting as a Guest.

    Experience: I didn’t know I was having twins

    ‘When I was pregnant with my son, I had felt so alienated and stressed whenever I came into contact with the medical profession that I decided not to involve the NHS again’

    • Hannah
    • HannahB

      How can someone write that and not realize how unbelievably self absorbed they sound? She basically says, “I kinda feel bad because my lack of prenatal care led to my twins staying in the NICU for six weeks with underdeveloped lungs…but not that bad, because it let me have a calm pregnancy.” Just….arggghhh these women frustrate me so much! I feel sorry for these twins, growing up with a mother who so clearly puts her feelings before their health and safety.

  • Karen in SC

    OT to the Certified Hamster Midwife: this book is right up your alley!:) A mouse midwife!

    http://www.amazon.com/Mama-Midwife-A-Birth-Adventure/dp/1480244104/ref=cm_cr_pr_product_top

    • Eddie

      The one 1-star review of that book is pretty appalling. I guess the book is bad because it shows use of castor oil — which I guess is superpowered (the reviewer says it “is not a toy”) — and ultrasound, where the reviewer says “Dopplers are ultrasound technology, very powerful as well, and the research does show that it is dangerous for babies and developing cells.”

      Sigh.

      I didn’t have the heart to rebut the ultrasound craziness in that review.

      • Certified Hamster Midwife

        sounds like that person is an unassisted childbirth proponent.

      • Victoria

        I thought the one star review was because the person objected to the midwife being in the spotlight, the references to the “super hero” etc. (agree!) and then I saw the rest. The author of course responded and disagreed but only with the super hero part. It wasn’t on my Amazon wish list anyway.

    • Certified Hamster Midwife

      I can’t wait to read the part where the midwife encourages the birthing mother to pick the weakest pup and gobble its head.

  • When I was nursing my daughter, I had very large breasts. If I did BF in bed at night, I often had too make sure my daughters nose was clear of the breast while she fed. I remember a couple of times I fell asleep while she nursed & woke up to snorts & gasps, because Of this. It scared the hell out of me & I made sure I stopped nursing in bed at night.

  • Karleen Gribble

    It appears to me that you haven’t gone over the methodology of the paper being discussed very carefully. In particular in imputing whether mothers had consumed alcohol or not because studies did not consider the issue of alcohol consumption. What do you think of the criticisms of this paper made by SIDS researchers in letters to the editor of the BMJ?

    • KarenJJ

      Do you believe that breastfeeding mothers would be drinking more alcohol than non-breastfeeding mothers?

      • Hannah

        The paper wasn’t comparing breastfeeding vs non-breastfeeding mothers- it was studying the risks of co-sleeping in mothers with no other risk factors. It’s known that having consumed alcohol makes co-sleeping riskier, so I think the suggestion is that, if this wasn’t properly controlled for then the risks may be inflated.

      • SporkParade

        Probably. Breastfeeding mothers who are worried about supply are advised to drink dark beer.

    • Captain Obvious

      Why stop there? Why not ask if these mothers live in a meth house? Do they smoke marijuana or K2? Do they have more visits to the ER per year for unexplained child injuries? Really?

      • Karleen Gribble

        You might like to have a closer look at the paper and the early response letters on the paper. You know the baseline for SIDS risk excluded male babies…they really were working hard to demonstrate that cobedding is dangerous- it appears to me that there was some serious massaging, or perhaps more accurately moulding, of the data.

        • Elizabeth Abraham

          Haven’t read the article, but I’d like to know if they state a reason for excluding male babies from the baseline.

          I had a preemie, and when DD was in NICU, it was explained to me that her prognosis was better because she was female – testosterone inhibits the development of lung surfactant in male babies, so they have more breathing problems.

          Is it possible that male babies were excluded from the baseline SIDS risk in order to make co-bedding look safer, rather than more dangerous?

          • Karleen Gribble

            Yes you are correct Elizabeth being male is a risk factor for SIDS. I would suggest that it is worth reading the paper for yourself and also the comments. http://bmjopen.bmj.com/content/3/5/e002299.full#responses

          • Courtney84

            Ill startbwith, I haven’t read the article or comments. However, I think the “soft” target of LLL is chosen because more expectant and new parents are listening to LLL than perusing the BMJ. It is flat out inappropriate when advocacy groups for breast feeding and/or NCB discount data that suggest risks because it doesn’t align with their teachings or philosophies.

          • Sullivan ThePoop

            If being male is a risk factor and they wanted to remove all risks factors, as stated, then that would be the reason to leave out male infants.

    • CanDoc

      Karleen – I agree, I don’t think this study is nearly as watertight as it is portrayed. Fortunately, there are real scientists providing real critical appraisal and perspective. It can provide new parents with information to help them make parenting and sleeping choices that work for them. The fact is that most of the world co-sleeps in one way or another, and there are many ways to make that as safe as possible. Unlike placenta-eating, cosleeping isn’t exactly a new idea that is the province of the crunchies.
      But like Dr. Amy, I take issue with the LLL position because it so so reactionary and emotional and driven by an agenda that is pro-breastfeeding rather than pro-infant-safety.
      (I apologise if this is a repeat comment – Disqus keeps eating my posts.)

      • Karleen Gribble

        Hmm, “remarkably rigorous” was how Amy described the study. And LLL provides information on “safe cosleeping.” As described by posters here, many mothers find themselves cosleeping by accident- they feed their babies in bed and fall asleep. The danger in saying “never sleep with your baby it is dangerous” is that mothers instead get up to breastfeed their baby and fall asleep in an environment that is manifestly dangerous (ie a chair or sofa). Blair and Fleming found that when the SIDS message in the UK was “Don’t ever sleep with your baby” that there was an increase in deaths in sofas and some of these mothers stated that they had fallen asleep by accident after taking in the message not to share a bed with your baby. It’s a complex issue, as articulated by Helen Ball and the truth is that older SIDS research simply doesn’t have the data to answer the questions that we are asking now about SIDS and the sleep environment simply because they didn’t know then what we know now.

        • Amy Tuteur, MD

          If you are a PhD researcher in infant feeding, you ought to know that being rigorous and being true are two different things. The first is describing methodology; the second validity. This is a remarkably rigorous study; that makes it more likely to be true, but does not prove it is true.

          • Karleen Gribble

            Indeed I do understand the difference and it is the questionable methodology that makes the description of the study as rigorous quite puzzling.

    • thepragmatist

      What about Coroner Reports from various regions where, when controlling for variables like smoking, it was found that a large percentage of deaths could be attributable to sleeping with mom or dad or siblings? The largest number of deaths here involve smoking and poverty. 🙁 But there was even a very public death of a baby while bedsharing in a hospital with mum, during breastfeeding. 🙁 I know this is the holy grail for many AP parents, but why not just side car a crib like so many people do?

  • Eddie

    By the way, I notice that the La Leche League tries to discourage pacifier use, although they seem to stop short of saying not to use one. They acknowledge that pacifiers are associated with a lowered SIDS risk, but then say that paci use will interfere with breast feeding and breast is best.

    So they’re not exactly consistent on that claim of, “If we want to decrease risk of SIDS events, then we must assure
    infants’ are in the best possible situation to support breathing and
    arousability.”

    • Amazed

      Breast beats all. What’s a living baby compared to breastfeeding!

      • LukesCook

        A non-breastfed baby is hardly worth saving. Just another obese, low IQ, sickly drain on society. What with all the c-section babies out there, it’s not like we need any more!

        • thepragmatist

          LOL! Alpha Parent, is that you??? 😉

          • SuperGDZ

            It’s irony!!! 😉

  • Antigonos CNM

    When I was a nursing student, 1964-1967, we were taught that babies should NEVER be allowed to sleep in the bed with the mother. The rationale, in those days was that a baby could be smothered, by pillows if not by Mom. This was later revised because “the baby would kick, etc. and wake the mother up” if he/she couldn’t breathe, but even so, in hospital at least, the rule was maintained.

    It seems it has only taken half a century to filter down, when it’s common sense basically. I was involved, btw, with a newborn infant death in hospital with a mother who had the baby sleeping in the bed with her, but it was never proved whether it was SIDS or deliberate [the mother had mental health issues which the family denied at the time, but became obvious when she attempted to kill her next baby 2 days after birth].

    • GiddyUpGo123

      Oh my god that’s awful! What a terrible experience for everyone …

  • GiddyUpGo123

    “If we want to decrease risk of SIDS events, then we must assure infants’
    are in the best possible situation to support breathing and
    arousability.”

    This is echoing something I heard a lactation consultant say back when I was trying to nurse my first baby. She insisted we should co-sleep because it helped encourage the baby to nurse through the night. I told her I was concerned about SIDS and she said, “Oh no, cosleeping protects babies from SIDS!” She then went on to tell me that the magical bond between mother and baby is such that if my baby stopped breathing while I slept I would immediately be aware of it no matter what stage of sleep I was in, and then in my sleep be able to rouse the baby by reaching out and giving him a little nudge. I don’t know what I thought about it at the time because I was so frazzled by new motherhood but now I think about how hard I slept during those precious couple of hours I managed to actually sleep at all, and I think if I was trying to cosleep and someone crept into my bedroom and actually took my baby while I slept I wouldn’t have noticed. In fact I probably would have slept until noon before I even realized he was gone.

    • Box of Salt

      “She insisted we should co-sleep because it helped encourage the baby to nurse through the night.”

      Why on earth would that be a good idea? Isn’t night time for sleeping, and daytime for eating, including nursing?

      • Dr Sarah

        For older babies, yes. I should think the lactation consultant was talking about newborns, who need to feed at night. Night feeds can also be important for getting a mother’s supply fully established.

        There was a small study done by Helen Ball (don’t have the reference to hand) randomising mothers and newborns on, I think, the second night of life, to different sleeping situations – a cot next to the bed, bedsharing, or a cot attached to the side of the bed with no fourth cot side between mother and baby. What they found was that mothers in both the second and third situations – i.e., the two situations where they could just reach out and pull their baby nearer to them without having to sit up and lift their baby over a cot side – nursed much more often during the night (which sounds very plausible to me – even small things feel impossible when it’s the middle of the night, you’re that tired and you’ve just been woken from sleep). But the really interesting bit is that the mothers in those two groups *also* went on to have much higher breastfeeding rates a few months down the line than the mothers who’d had to sit up and lift their babies over a cot side to nurse them on that second night. That little difference in terms of nursing frequency on that night at the beginning made a real long-term difference. It was only a small study and I don’t know if it was repeated, so it’s not definitive, but it’s still interesting.

    • auntbea

      I definitely remember waking up from a unintended sleep during which I had been completely unaware of the world, including the baby I was holding, for three hours.

  • fiftyfifty1

    There are a lot of stories posted here about severe sleep deprivation. Sleep deprivation so severe that women are choosing to co-sleep despite the risks, or are deciding not to risk it but then winding up falling asleep in a recliner or dropping their babies from their arms.
    Holy buckets, this level of sleep deprivation can’t be healthy! Is the goal of exclusive breastfeeding really worth this cost? That question is the elephant in the room. And I’m asking this as someone who has been there. I’ve fallen asleep and nearly dropped my newborn from a chair. I’ve woken up in a “near miss situation” with my body half-rolled/draped over my baby during co-sleeping after I had broken down and brought her into bed with me (and normally I consider myself a light sleeper who isn’t prone to rolling).
    I guess if I had to do it over again, I would chose “none of the above”. I would choose to have my husband cover one of the night feedings with a bottle of formula.

    • Eddie

      Unfortunately, there are some who believe that exclusive breast feeding is worth any cost. Several times, one or two links from this site I’ve found people sanctimoniously saying, “If you have a child, you have to be a grown up and do the right thing.” and then going on to say that this means EBF, no matter how tired you get, in some cases even if you have to stop taking meds for a while. There is just no room, in these people, for reality, for shades of grey. The world is black and white.

      Craziness.

      My littlest one’s first months are a blur, but I know I did bottle feeding at nights at least some of the time so my wife could sleep. Breast feeding was important to us, but exclusive breast feeding was not something we even considered. If someone had seriously pushed EBF, I would have looked at them as if they were saying we should live without electricity and running water. I didn’t want my wife to be in a foggy haze for months.

      • rh1985

        It’s crazy that they refuse to consider that the benefit the baby gets from having a mom who is psychologically/physically well from taking needed medication and getting the most sleep possible with a young baby may outweigh the benefit from breastmilk. I already feel crappy from lowering my meds to try and get pregnant and I’m not even all the way off yet. I didn’t fall asleep until 6am last night. There’s just no way I will be able to breastfeed if I get pregnant. I would stay off meds and pump if I had a sick preemie baby at the hospital but, the awful thing there is I wouldn’t have to be awake/alert to care for the baby. 🙁

    • FormerPhysicist

      In my case, I had to pump anyhow, so my husband did give a bottle some nights. But he needed to sleep too and that didn’t work too well for us. Plus, getting formula ready woke either of us up fairly completely and I could doze during side-lying nursing.

      My babies were all champion nursers and crappy sleepers. You only had to get a nipple near them for them to latch. Even at a day old. With consideration of our particular case, we chose to co-sleep.

      Your point is well-taken, though. I don’t think the goal of EBF is worth severe sleep-deprivation. But each family has to choose what works best for them, while considering the risks. Similar to those who risk a stomach-sleeping or propped up baby due to reflux issues.

    • AmyM

      Yep, that was one reason I was happy to formula feed. My husband and I took shifts—we figured out early on how to bottle feed both babies simultaneously, and that way each of us could get about a 5hr uninterrupted stretch of sleep each night. It didn’t work perfectly, and we were still sleep deprived, but it helped. The boys were around 3mos old when they dropped all but one overnight feeding, so we alternated nights…HUGE difference. Even still, after they finally slept all the way through (around 6mos), and we were both able to get full night’s sleep every night, it took a month for the fog to completely clear.

    • me

      I didn’t see bfing as having much to do with it. I guess I’ll never know, but I don’t see how a bottle of formula would have magically “cured” my kids’ apparent aversion to their cribs. If anything I figured it was a “wash” – I bf, reducing the risk of SIDS, but I co-slept, increasing it. I don’t know if that truly equalized the risks. Maybe someone knows the specific stats and can chime in…

  • BeatlesFan

    Forgive me if this is a really stupid question; I didn’t co-sleep with either of my kids and they are/were both bottlefed. I have read/heard most co-sleeping, breastfeeding moms say co-sleeping is convienient because they can simply stuff their boob into baby’s mouth and go back to sleep. In theory, this makes sense, but here comes the stupid question: what about changing the baby? I always changed my son at every nighttime feeding, and do the same now for my daughter. Do co-sleeping parents keep diapers and wipes beside the bed, and change the baby in bed? Or just skip the diaper changes until morning? How about burping? Does one stick the nipple in, fall asleep while baby nurses, and then wake up again to burp? If burping and changing is necessary, is it really any easier than doing all of it in another room? Probably a whole bunch of stupid in this question, but I am curious.

    • Charlotte

      One of my cosleeping friends keeps diapers and wipes next to the bed, so I’m assuming she does it in the middle of the night. I’m not really sure how many of the feelings are really as easy as they describe, or if it’s more bragging and the reality is nighttime breast feeding is as labor-intensive as daytime breastfeeding.

    • Anon

      We breastfed and room shared. I did everything in bed. Kept a changing pad and everything next to the bed, burp clothes, etc. Nothing about having the baby 1.5 ft away in a bassinet was harder than having baby in bed, because yeah, diapers and burping.

      Maybe that is why the crunchies always supposedly have kids with ten million “allergies”? Really they are gassy, have diaper rashes, and are miserable from not being burped or changed at night.

    • FormerPhysicist

      Mine never needed to burp much. I believe bf babies swallow less air (in general) and need burping less than bottle-fed.
      The diapers – we kept diapers and wipes near the bed and changed when we managed to.

    • slandy09

      We only had one bedroom and we kept all the diaper changing stuff in there, close to the bed. My husband was in charge of nighttime diaper changes, and she got changed pretty frequently at night during those days. So while we did get more sleep bed-sharing in those days, we were still pretty darn tired.

    • CarolynTheRed

      My daughter stopped peeing overnight really early, she’d wake up with a dry diaper every morning starting before 2 months. We stopped changing diapers overnight when we noticed most were dry. If she does one of her rare nighttime wettings, she’ll let us know.

    • Kristie

      My last baby wasn’t much of a night wetter, and never pooped at night once we got past the 1st week or so. When he slept with me, he’d really only fuss and root around without fully waking up, so most of the time I didn’t need to change him. If he was in his own bed, he’d be wide awake and downright hysterical, so then I usually did end up changing him before sitting down to nurse. He also nursed lying down like a champ, and wasn’t much of a burper. Of course, none of the rest of my kids were anything like that, and they required a lot more tending to at night, with burping, bouncing, re-swaddling, changing, etc.

    • Leica

      If I have to get out of my bed in the middle of night, my body says “Oh hey! You’re awake! Let’s go do something!”, and then I can’t get back to sleep. As long as I can stay in bed, I can go back to sleep readily. We use an Arm’s Reach cosleeper bassinet, so baby has a safe space, but it’s super convenient. I keep diapers and wipes in the end pockets. I can pull him into bed, nurse him side-lying, change diaper if needed and tuck him back into his bassinet. I drape him across my chest, pat his back a couple times and he burps. The cosleeper also helps him sleep well, because I wake up as soon as he gets restless, and I feed and settle him back down before he gets a chance to fully wake up. He was sleeping 6hr stretches by 8 weeks and at 4mo sleeps 8 hrs (8pm-4am, nurses for about 15min, then right back to sleep until 8 am).

      • FormerPhysicist

        Yes, ^^^ THIS. A better explanation than I have been giving, but also true for me/us.

      • LukesCook

        I’m impressed. I just know that if I’d been doing any diaper changing while half asleep and side-lying in bed in the dark we would have ended up doing midnight laundry as often as not.

    • kari

      We co slept for a while when the sleep deprivation got unbearable. Baby nursed and fell back to sleep, as did I. They didn’t burp unless they took a bottle, so it wasn’t necessary at night. We didn’t change baby unless it was a poopy diaper, or if it had a lot of pee. Once a night was usually enough after the first few weeks.

  • Laura

    OT: I know a young woman, primip, due in a couple of weeks with a “frank breech” baby. C/s was recommended if the baby did not turn. Is there any truth to claims that pelvic rocks or anything like that might help turn the baby?

    • CanDoc

      No. Only strong evidence is for external cephalic version, a procedure to manually turn the baby usually done by an OB. There is weak but compelling evidence for moxibustion (a type chinese medicine) for who-knows-what-reason. There are some purported positions and chiropractic medicine that may help, but the research either a) isn’t there, or b) isn’t robust.
      A cesarean section is a really lovely way to have a breech baby.

      • Laura

        Thank you, CanDoc.

      • An elective cesarean section (for a mom who prefers it) is a really lovely way to have a baby period. (breech or otherwise)

      • Kerlyssa

        How can research be both weak and compelling?

        • CanDoc

          Argh, Disqus keeps dropping my comments. Haha, terrible wording on my part! Weak = small number of studies/women. Compelling = in spite of this the numbers are statistically very significant and suggest effect that is due to more than just chance alone.

    • Antigonos CNM

      Brief answer: no. However, breech babies CAN turn, unaided, right up to the onset of labor [but usually don’t]

      The theories about ECV have gone full turn [no pun intended] during my career. ECV, and even internal version [using special elbow length sterile gloves, was almost routine when C/S posed considerable risks — i.e. before antibiotics — and then went out of favor. The reasons given were that, if a baby turned easily when ECV was done, there was a strong probability that the baby would also easily turn back into breech [must note that some breech presentations reflect either pelvic anatomical abnormalities in the mother, or placental insertion other than in the fundus], and if it was difficult to turn the baby externally, there was an increased danger of causing placental abruption. Now it has come back into favor, with ultrasound as a guide. Yet I’ve seen far more failures than successes, and it’s not without risk. By far the safest for the baby, and less painful, for the mother, method is C/S.

      A C/S for breech, if the mother’s next pregnancy is a vertex presentation, is a good reason to attempt VBAC, if no other contraindications are present.

  • Charlotte

    OT: Several people suggested I give negative feedback to my hospital about their Baby Friendly changes. I did, and I got a phone call from the director of the maternity ward apologizing for my bad experience and asking about how she could improve it for others. Enough parents have complained that they are trying to find a middle ground between what parents want and what the initiative says they must do. She agreed that not giving formula when requested was bad, but said that although they want to support parent’s wishes when it comes to their babies, the rule about not bathing for the first 6 hours was necessary no matter how much poo was on the baby because the baby needs to smell mom’s breast in order to breastfeed and bond (would a tiny amount of residual soap really interfere so dramatically that a baby would not be able to bond or eat at all?) She also said that it was important that mom and baby be kept together at all times so that it was not willing to change the rule about not allowing mom to send the baby out of the room for more than an hour. She said they cut the nurse to patient ratio to help out moms who had c-sections or who were too sick or injured to safely care for their babies but that was the best they could do. I told her the Baby Friendly changes were well-intentioned and were a result of women not having a say in what happened when they gave birth a long time ago, but that the pendulum had swung the other direction now and women still no longer have a choice, but are forced into making the opposite choice. She was literally stunned. She said she had never thought of it that way before and that it really gave her food for thought. A meeting about the mandatory baby rooming-in policy was coming up and she told me she would bring up my concerns and hopefully come up with a good solution.

    Another thing she mentioned really confirmed my suspicions about why they did all this. All of the other hospitals in my state are trying to get Baby Friendly Certified as well, and she said they want to keep up. But if so many parents are upset that they have to keep balancing what parents want with what the initiative demands, why would they want to do this?

    • ejohns313

      Oh my God. I did not know about the BFHI’s poop-cuddling provision. That’s hilarious.

      • Dr Kitty

        The actual BFHI goals say that hospitals should “allow” 24hr rooming in, not that it is mandatory against the mother’s wishes.

        Also, not washing the baby is NOT AT ALL part of BFHI.

        I gave birth in a UK hospital that has had BFHI certification for years.

        My kid was washed about an hour after she was born, and I could have given her to the midwives and taken a sleeping tablet the night after the birth (I chose not to).

        I don’t think the US hospitals are implementing the BFHI the way it is meant to be implemented, nor the way everyone else is.

        • Ceridwen

          The guidelines from the BabyFriendlyUSA website include this language:
          Of all randomly selected mothers with healthy term babies, at least 80% will report that since they came to their room after birth (or since they were able to respond to their babies in the case of cesarean birth), their infants have stayed with them in the same room day and night except for periods of up to an hour per day for facility procedures, unless there are justifiable reasons for a longer separation.

          Given that “justifiable reasons” isn’t defined so it’s hard to say whether it’s intended to include maternal request but I can understand why hospitals would think that it didn’t. The problem appears to lie at least as much with the BFHI itself as with the hospitals.

          • Dr Kitty

            BUT BFHI does allow for 20% of mothers with healthy, term babies NOT to have them 23/7, doesn’t it.
            We could contact UNICEF and see what they say.

    • Hannah

      You see this is what happens when well meaning and otherwise sensible initiatives are implemented by stupid people. I think that the original idea was that mother-baby contact should be prioritised over routine non-urgent hospital procedures (bathing etc), not that you shouldn’t wipe down a meconium covered baby, if the mother wants it. I have no idea where she got the smell thing from, or how not wiping off the poo would even follow from that (surely the poo would be more likely to mask the mothers scent than washing down with water would?). Maybe next time bring wet wipes, so you can at least wipe the baby down yourself, if needs be.

    • Eddie

      That’s awesome! It sounds like it was a productive conversation and that you successfully challenged her assumptions.

      About “no bath” — so in other words a small amount of residual soap would be more distracting to baby than the other … artifacts of birth that were present on a baby’s skin? I suppose this is possible, but then, wouldn’t using a specific soap fix that problem? Maybe?

      I imagine that hospitals see BFHI certification as a selling point, something they can advertise to drive business. And that being the only non-BFHI hospital in the state would make them look bad. Too many consumers are ignorant about what various certifications actually mean and would in fact respond to an ad saying, “Hospital X isn’t even baby friendly! Come to ours instead.” Hospitals have to take that into consideration. It’s an unfortunate reality.

      Again, it’s awesome that you followed up and that you reported back here. If I ever hear that the hospital where my wife delivered considers going BFHI, I’ll definitely contact them, as they currently have a very smart middle-ground that appears (to my lay eye) to be evidence-based rather than ideology-based.

      • BeatlesFan

        About “no bath” — so in other words a small amount of residual soap would be more distracting to baby than the other … artifacts of birth that were present on a baby’s skin? I suppose this is possible, but then, wouldn’t using a specific soap fix that problem? Maybe?

        That’s a good thought- they do make odorless soap, my husband uses it before he goes out hunting, as apparently white-tailed deer are not pleased with the scent of Irish Spring.

        Either way, if a baby is covered in blood, feces, or any other less than desirable substance, the mother sure as hell should be able to ask that the baby be hosed (or at least wiped) down quickly. In no other area of a hospital would one patient be expected to enjoy being covered in another patient’s excrement.

        • Charlotte

          They were allowed to towel her off, but weren’t allowed to wash her so she had poo in her ears, under her fingernails, and in her skin folds for 6 hours. It was beyond stupid.

          • GiddyUpGo123

            I have never heard of this, and I just can’t pick my jaw up off the floor. That is simply disgusting and it seems so unsanitary, I can’t believe a hospital where they generally sterilize everything would even consider such a revolting practice. And is there any science behind this idea or is it based entirely on woo? I just don’t even get how this idea gets into a hospital where people are supposed to be rational and, you know, *actually* educated. Med school educated. WTF?

          • Cascaritas

            Meconium burns skin. Is the person you talked to aware of that?

          • rh1985

            I’d be so tempted to tell them to bathe the baby or I’d be ####ing attempting to do it myself.

      • Antigonos CNM

        I think that, if I were having my kids nowadays, instead of 30+ years ago, I’d immediately mark any hospital advertising itself as “Baby Friendly” off my list.

        But of course, in the US, one chooses the hospital where one’s doctor has admitting privileges, so it’s not always one’s own choice — another problem.

        • rh1985

          I love my OBGYN (and she is totally supportive of me not breastfeeding which wins her major points) so I will be really annoyed if the hospital she delivers at is at all “baby friendly” at least they are not on the cursed list on the BFHI site.

    • Ceridwen

      I’m glad you contacted them about it and impressed that they are following up!

      I’d have been PISSED if they had refused to take the baby away during my postpartum stay in the hospital. I had 40 hours of labor and had hardly slept in 3 days by the time my baby was finally born and my husband and I both needed a chance to recharge. We had the nurses take the baby the entire night other than when she needed to be nursed the first night and for about half of the night the second night. When we went home with her we were rested up and able to handle the transition much better than if we’d been forced to keep her in the room with us the entire time.

      Good for you for standing up to these policies being implemented without thought for the needs of the parents.

      • Charlotte

        Believe me, I was! It was an emergency c-section after a failed induction so I had not slept for 36 hours prior to her birth. Then, the longest amount of consecutive sleep I got in the four days from birth to discharge was a little over an hour. I was falling asleep while people were talking to me. After several instances of me waking up to realize I had accidentally fallen asleep with my baby in my arms while sitting up, I felt like it was unsafe for me to hold her. Not having a well baby nursery is such a horrible idea. I know that birth experience isn’t everything, but it really is sad that the birth of my second daughter ranks pretty high on the list of most miserable times of my life. Sleep deprivation combined with harassment about formula feeding made for a pretty emotionally crushing combo when you’re going through it. After nearly losing my first baby to prematurity and losing my second to a miscarriage, all I wanted was a safe and uneventful birth.

    • Allie P

      Are you freaking kidding me? My newborn baby didn’t have to “find” my breast. We opened her mouth and stuck my nipple in. The L&D nurses showed me how. The idea that they wouldn’t bathe feces off a newborn because they are supposed to “find” your breast is ludicrous.

    • The Bofa on the Sofa

      Why does a sleeping baby have to be in the room with the mom? That makes no sense.

      • Bombshellrisa

        To save the hospital from having to pay a nurse to watch them in the well baby nursery! When I hear about this stuff, I always think its about saving money for the hospital, not about what is really best for patients

        • Eddie

          And when a marketable certification lines up with saving money, ka-ching! They get to save money and blame it on the patient / say it’s really for your own good.

          • PollyPocket

            That’s my theory about the 39-week induction policy (ban on “elective” inductions prior to) despite evidence that is conflicting at best.

            How much does a baby on a ventilator cost?

            How much does a stillbirth cost?

            Do the math, and it’s pretty obvious why so many hospitals consider inductions prior to 39 weeks “an unsustainable practice.”

          • Susan

            I can be cynical that way too but thinking about it I have been told that NICU is profitable and labor and delivery/OB is not.

          • Susan

            Though your theory works great for insurance companies!

    • BeatlesFan

      I seem to remember showering within 2 hours after the births of both of my children. Unless it’s part of the BFHI to not allow mom to shower/bathe for 6 hours after the birth as well, I can’t understand why the smell of soap on mom’s breast won’t confuse the baby, but the smell of soap on baby’s own skin will.
      Besides that, are there really newborns that are able to find a nipple and latch all on their own within a few hours of birth?

      • Wren

        My second child basically did find the nipple and latch on by herself just after birth. I held her and she rooted for the nipple, found it and latched. My son did nothing of the kind though. I swear she read a breastfeeding manual while in the womb, she was so easy to nurse. She didn’t seem bothered by me showering fairly soon after she was born either. I honestly don’t remember when she was bathed, but it was definitely over 6 hours after birth. She was wiped off before that, but not bathed.

    • PollyPocket

      The bathing thing is the silliest thing I’ve ever heard. In school we we taught to treat the baby as “biohazardous” until the first bath. Bathing could be delayed for things like airway, breathing, circulation, neurologic, and other deficits that were immediate threats to baby’s health and well being. But once baby was stable vernix was gone!

    • Antigonos CNM

      the rule about not bathing for the first 6 hours was necessary no matter how much poo was on the baby because the baby needs to smell mom’s breast in order to breastfeed and bond

      Oh fooey. If that were true, no adopted baby would ever bond with its adopted mother and vice versa, or any premie who spent its first days in NICU either. There is some evidence that the function of vernix is to protect the infant skin [I knew nurses who would use it on their faces as a face cream!] but one doesn’t have to scrub the baby, just get rid of excess and the residues of amniotic fluid and/or meconium [both of which are excellent media for bacteria to flourish in]

      More to the point, all this skin-to-skin business often results in a well-chilled baby, [who comes out of a warm womb wet and into a room whose ambient temperature is much lower] who shouldn’t be bathed until its body temperature has risen.

      • rh1985

        I don’t have a child yet (trying to have my first) but I really don’t get the skin to skin thing? I’d rather clean the baby off and wrap it in a blanket….

    • Antigonos CNM

      The comment about staffing is much more pertinent. As nurses’ salaries rise, the trend has been to have as few as possible tending patients, with a crew of aides and other underlings taking over a number of what were formerly nursing duties. This is one of the ways hospitals save money, and after all, healthy mothers postpartum don’t need lots of care [that’s the argument] while “sick” and post-op mothers generally can’t be taken care of by persons without nursing education. So force Mom to take over as much of her baby’s care as possible, even if she’s literally limp with exhaustion.

      What gets me is the lack of flexibility in all these programs, whether it is total rooming-in or limited access to the infants only at feeding times and keeping them in the nursery the rest of the time. Some women do want 24/7 with the baby, from the minute of birth onwards, some don’t, most fall in between, and don’t even feel the same way from day to day, depending on how they feel at a particular moment. Ditto the feeding policies, which vary with infant and mother. Is this such a difficult thing for hospitals to understand?

      • rh1985

        If I am going to be the one taking care of the baby 24/7 I’d rather go home, seriously… what is the point of the hospital if there is no rest/recovery time.

        • AmyM

          I can see your point, but for one thing: if you have a PPH, hours or days post-partum, you are best off in the hospital. Or if the baby is showing subtle signs of distress that most of us wouldn’t recognize….hopefully, in the obnoxious quest to breastfeed, a nurse might catch a baby “grunting”…I know I wouldn’t recognize the noise. I’ve heard of it, but I haven’t actually heard it.

    • rh1985

      The rule that the baby has to be with the mother 24/7 is idiotic. What about single moms, or mothers with other children that their partner MUST stay home with because they have no available childcare? If I were not going to be given the option to send the baby to the nursery and rest and recover, I’d rather just go and recover at my house where it’s nicer. I will definitely be checking about the hospital my OBGYN delivers at – its not on the dreadful baby friendly list but I will definitely be asking their policies about nurseries, formula (100% sure I won’t breastfeed for medical reasons), etc…

      • Eddie

        Smart. Hopefully as consumers ask these pointed questions, hospitals will begin to understand that there is an intelligent middle ground between BFHI and the overbearing paternalism of the US hospital system of so many decades ago.

    • PoopDoc

      This may sound like a silly question… What about women deliver in hospitals with the intent of placing their children? Why would you want to force them to room in if they do not wish to.

  • staceyjw

    They don’t know how to read.
    Or they are liars.

    • Eddie

      This is something we see all the time. Their ideology is so strong, such a foregone conclusion, that all other facts are bent to fit. More like lying to themselves than lying to others. This doesn’t excuse it, mind you, but I do draw a distinction between those who knowingly mislead others and those who lie to themselves and unwittingly mislead others. I judge more harshly those who knowingly mislead (such as by refusing to release information that you know is damning) than those who mislead themselves.

  • AmyM

    The “Red Wine and Applesauce” blog also has a post about this study this week. It comes across a lot like any study that suggests breastfeeding isn’t magic: people who wholeheartedly believe that [cosleeping, breastfeeding] not only works for them, but is BETTER and that all parents who are real parents should be doing it, will come up with a ton of reasons (some ridiculous, some plausible) about why that study sucks.

    I think there has been enough data showing that bedsharing can increase SIDS/suffocation deaths of young infants. However, that doesn’t mean people should never do it….just like formula feeding, if you do it right (clean water, clean bottles, right water to powder ratio), there isn’t much risk. A lot of people here talked about the blankets and other factors that should be considered when thinking about cosleeping…it can be done pretty safely, so if that is what works for some people, they should be taught the safest way to go about it.

    It wasn’t something I ever wanted to do, and with twins, a high bed with a space between the wall and the bed and (at the time) a dog who tended to sleep on the bed, it wasn’t safe. It was also winter in New England, and I didn’t want to go without blankets. Even when I tried to take a nap with them in the bed (on top of the covers, dog elsewhere), I was too paranoid and I couldn’t fall asleep…and they slept fine in a crib from the beginning, so clearly cosleeping was not the answer for me and my family.

    However, there are plenty of cases where that is the only way the mother/parents will get any sleep. If they follow the safety rules and reduce the risk factors as much as possible, odds are it will work out fine. It is not productive to demonize every study that shows the opposite of your ideology, and in some cases (like on MDC) that could lead to parents doing something unsafe, because their internet friends insisted it was all good.

    • The Bofa on the Sofa

      As I always say, “All else being equal…”

    • ejohns313

      Yeah, I read the Red Wine post. I noticed that the risk-benefit analysis closely mirrors the explanations many moms give for not breastfeeding (it’s just not working, abject misery isn’t worth a slightly lowered risk, sleep deprivation also is dangerous, etc.). But when parents who use formula make those same arguments, we’re lazy/defensive/making excuses/bad parents. It’s funny because 1. there are many more real barriers to breastfeeding than to crib-sleeping, and 2. the impact being discussed in connection to cosleeping is DEATH, not just short-term health outcomes.

  • guestk

    I suspect there are trade offs here. Crib sleeping may be the ideal but sleep deprived parents are also a potential danger. what is the relative risk of SIDS vs accidents from a sleep deprived parent?

    • Jessica

      Of course, sleep deprived parents are a danger to others, too: when driving or if they are in a career field where lives depend on them. A friend of mine is a pharmacist and when she returned from maternity leave she tripled her malpractice insurance because she was worried that she would make a mistake if she was too sleep deprived.

      • theadequatemother

        the risks of sleep deprivation in a high stakes job was one of the MAIN reasons I sleep trained my child early. The other main reason of course is that health sleep = healthy child.

        • me

          I tried sleep training. It didn’t work. But, despite our best efforts, kids don’t always do everything we want them to do, kids are like little people that way….

  • slandy09

    Bed-sharing was the only way anyone got sleep during the newborn days. We tried and tried to get her in the bassinett, but SCREAMED if we even got close to it. It didn’t help that the bassinett was at least 14 years old (a hand-me-down from the in-laws) and we were too poor to buy anything else. So, we took precautions to make bed-sharing safe. What helps is that if she’s sleeping next to me, I don’t move. Not even a millimeter. I guess it was because I was paranoid.

    Next child, we plan to buy a crib and side-car it with our bed. Hopefully, that works.

    • slandy09

      *but she screamed

    • anon

      Yep. I’ve had three who absolutely refused to sleep on their own in the beginning. With the first, my husband and I made ourselves utterly miserable and just didnt’ sleep for months, taking turns sitting up and holding her. With the second and third, I co-slept. It helps that my husband works midnights and I am in a queen bed by myself, but I still HATE it. The third baby will sleep on his own if he is on his tummy, which prompted me to ask my pediatrician, “which is worse, co-sleeping or tummy sleeping? Because getting zero sleep for the next six months is NOT an option.” And he agreed with that, thought long and hard, and said co-sleeping was safer. I was really, really hoping he would say tummy sleeping :/ and seriously: I really, really don’t like co-sleeping. it’s uncomfortable and nerve-wracking and I think it breeds bad sleep habits (my middle child is a horrible sleeper even now and she’s been out of my bed for close to two full years. My oldest is an absolute champ. I guess it could be coincidence, but I don’t think so), but truly, I will die and be dead if I expect him to sleep on his own. So we do it.

  • yentavegan

    I am an uneducated lay breastfeeding cheer leader, so please excuse my difficulty in understanding the data.
    Is there an increase of SIDS for breastfeeding co-sleepers over breastfeeding crib sleepers?
    Or is breastfed co-sleeping infants rate of SIDS the same or higher than non-breastfed co-sleeping infants?

    • Dr Kitty

      The study looked specifically at BREASTFED babies, and the co-sleepers fared worse from SIDS than the crib sleepers. The study didn’t assess bottle fed babies at all.

      • yentavegan

        thank you Dr. Kitty. So the data shows that there is an increase of SIDS in breastfed co-sleeping infants compared to breastfed crib sleeping infants, right?

        • fiftyfifty1

          Yep, you got it. Breastfed babies who are put to sleep in cribs or basinettes have a lower risk of SIDS than breastfed babies who co-sleep.

          • Susan

            Since we are using the term co-sleeper are those co-sleeper things ( like a portacrib attached to the bed ) ok? Mine are older and they ALL slept in the bed when babies. If I had known this then I of course would have changed to something else, but I suspect I would not have had as much sleep. Just curious about the consensus on those products which seem like a happy middle ground for breastfeeding mothers.

          • Sgaile-beairt

            the judgment of solomon….

            And the one woman said, O my lord, I and this woman dwell in one house; and I was delivered of a child with her in the house. And it came to pass the third day after that I was delivered, that this woman was delivered also: and we were together; there was no stranger with us in the house, save we two in the house. And this woman’s child died in the night; because she overlaid it.

      • Julia B

        The original article did look at bottle vs breastfeeding, but the graph Dr Amy used was only for breastfed infants. This is from the results section:

        “Table 1 shows that bottle feeding increases the risk of SIDS. When analysed as a single factor, the OR for bottle feeding is 2.9 (2.5 to 3.3); however, the multivariate AOR is 1.5 (1.2 to 1.8).”

        So there is a significant increase in risk of SIDS in bottle fed infants, which was almost attentuated in the adjusted model. This is because some of the risks for SIDS (younger maternal age, smoking) are also confounded with bottle feeding. The authors cited some Dutch figures showing that a national campaign to reduce co-sleeping was very effective (reduced from over 20% to under 3%), and over the same time period there was an increase in breastfeeding. I cannot see why La Leche League is promoting co-sleeping to improve breastfeeding rates since it is unlikely to be a critical strategy.

        I also wanted to mention that the authors of the study should be applauded for finally providing evidence about the risk of SIDS and bed-sharing. It was very interesting to read and just shocking the effect of maternal drinking and drug use on risk of SIDS. I was also interested to see that this study also found around a 10-fold risk of SIDS for front-sleepers, further confirming this as a risk factor.

        • Antigonos CNM

          During the era when I gave birth [1980-1983], putting infants to sleep on their tummies was still Gospel. Amazing they all survived. Amazing we all survived, since I expect a good many of us slept on our stomachs as well.
          My granddaughter demanded to be on her stomach as well, and my daughter became absolutely convinced she’d become a victim of SIDS, even with a baby monitor.

          Some babies simply haven’t read the book or refuse to admit the risk.

          • guestmama

            I wonder if there is a reason why some babies prefer tummy sleeping – ie, do some babies breathe easier in that position, and so tend seek it out?

            My youngest has a congenital airway defect (Laryngomalacia) and sleep apnea, and he breathes considerably better on his tummy. So much better, in fact, that his doctors instructed us to position him that way, because in their opinion he was less likely to die of SIDS while sleeping prone than from his airway anatomy sleeping supine. Even now, at 18 months, he still sleeps on his tummy/side with his neck thrown back to better open his airway.

            Since a lot of airway defects go undetected, especially the milder cases that still cause airway obstruction, I have to wonder how many of these babies who won’t sleep well on their backs actually breathe better in other positions. Congenital airway defects are actually quite common and under diagnosed – what impact might that have in SIDS/co-sleeping/crib studies?

  • Amy Tuteur, MD

    OT:

    You MUST check out these pictures from The Royal College of Midwives cake decorating contest! Can you imagine any other professional society doing something like this and then publicizing it?

    https://www.facebook.com/groups/199827500028384/permalink/606112059399924/

    • Victoria

      I should have known better. I clicked while eating.

    • Dr Kitty

      The placenta cake is very well done. Not appetising, mind you, but very well done.

  • Eddie

    Fascinating. When data supports their position, it is cause-and-effect. When data does not support their position, it is only an association and it has hidden confounders.

  • Amy Tuteur, MD

    What I find most interesting about La Leche League’s attempt to dismiss the evidence is that co-sleeping and breastfeeding are two separate things. Women aren’t deciding whether or not to breastfeed based on the safety of co-sleeping.

    Co-sleeping is an element of attachment parenting, so why does La Leche League feel the need to defend attachment parenting?

    • Jessica

      They are two separate things, but when AP-types talk about breastfeeding vs. bottle feeding, they specifically say, “Baby slept in bed with me and it was so easy to nurse in the middle of the night! Half the time I didn’t even wake up!” The ability to bed share makes breastfeeding more attractive to the woman who will be handling all of the nighttime feedings. If you have to get out of bed and sit in a chair and stay awake the entire time, well, you’ll be a sleep deprived zombie in no time.

      • I’d rather be a zombie for those few months than be the mother of a child who died of SIDS and wondering if there was anything I could have done to avoid it.

        • The Bofa on the Sofa

          Well, see, all you have to do is to deny that it could have been avoided.

      • guest

        don’t they get that it isn’t so either or? there are tons of ways to be lazy in those first months without risking falling asleep on your baby. nurse in bed, lying on one side, roll the baby onto your chest to burp, lean over and place in cot, fall asleep. it can be as little as a 15 minute disruption once per night if you are lucky. I honestly couldn’t sleep if the baby was too close because my mommy sense was too active.. probably keeping me from smothering the baby accidentally.

        • Anon

          This is what I did with both kids. 30 yr old bassinet my mom used for me next to bed. Pulled baby into bed, nursed (as someone said previously, I had to hold their heads and breast in specific ways for it to work), sat up to burp with various cloths (yay reflux), set baby back in bassinet. If you are really so exhausted you are going to drive off the road etc, you are also probably exhausted enough to fall right back to sleep despite baby protests of being in a bassinet.

          • me

            Well, not in my case. My car is much quieter than any of my kids… YMMV of course.

      • Awesomemom

        I managed doing all the night time feedings while bottle feeding and was tired but not a total zombie. Honestly I would prefer to be the tired mother of a living baby than the well rested mom of a dead baby.

        • me

          I believe that is known as the false choice fallacy. Not to mention that we aren’t simply talking about “tired”. “Tired” I can handle. The level of sleep deprivation that I endured while trying to achieve the ideal nearly caused a psychotic break. There is a reason sleep deprivation is such a commonly used method of torture. It works. Of course, some babies sleep in a crib without much of a fuss, some mothers are able to cope with less sleep than others. No, I wouldn’t recommend co-sleeping for everyone; it obviously has its risks. However when the choice is exhaustion, depression, suicidal thoughts, falling asleep with baby in couch/recliner, and nearly going off the road (more than once) while driving… yeah, at that point it might be something to consider. But I don’t expect someone who hasn’t BTDT to fully comprehend.

          • auntbea

            Yeah, when my husband found me swaying back and forth in the kitchen, staring at nothing, it was time for something to give. Fortunately, I find the floor comfy and mine was willing to start sleeping in the crib at about three weeks.

          • Awesomemom

            That is when you get a spouse or someone to help you get some sleep. My youngest was a terrible sleeper, a crazy amazing bad sleeper. I would get my husband the hell up and have him take over. Generally I didn’t because he was working and a heavy sleeper so by the time he woke up because of the baby I was already up and getting a bottle ready but for her I did. I have been there and done that and did not resort to bed sharing. My bed is not safe for babies to sleep in because it is a pillow top and is very high off the ground.

          • me

            You are assuming that help is readily available. When our first two children were babies my husband worked second shift and was often TDY, and was deployed while the second was still an infant. So, yes, sleeping in shifts or alternating nights is fine in theory. But not everyone has that luxury. And what seems to being missed in my posts is that my babies were not simply waking up due to hunger and then going back to sleep. Once I started co-sleeping they only woke 1-2 times per night to nurse. They were waking up *because* they were in a crib/bassinet and apparently *really* unhappy about that. So waking my husband to feed them is all fine and dandy, BUT then you still have to deal with the hours of someone-stuck-me-with-a-hatpin screaming while you (or your husband) try (and fail) to get them back into the crib. And even if you somehow manage to successfully get them in the crib and sleeping, twenty minutes later you get to repeat the whole process. Nightmarish.

            That being said, I don’t smoke, I don’t drink, I don’t do drugs (prescription, OTC, or otherwise), and I’m not obese. Same goes for my husband. Our mattress is a firm queen size – no pillow top/memory foam. We are okay with minimalist bedding and while my girls were co-sleeping we just put the mattress on the floor. I understand not everyone would be willing/able to meet those criteria. And if your kid sleeps okay in a crib/bassinet and/or you are functioning on the amount of sleep you are able to get, great! Keep on keepin’ on. But what was going on in my house was not a simple matter of “tired”. And you said it yourself – you weren’t a total zombie. I was. One that was having suicidal ideation at that. I’m not saying co-sleeping is without risk (and I agree with Dr Amy – LLL should be honest about the risks). What I am saying is that sometimes (and given the number of posters here who have stories similar to my own I’m guessing it’s not as uncommon as I once thought) despite our best efforts and intentions, things don’t work out the way we wanted them to. It’s true of childbirth, it’s true of bfing, and it’s true of crib sleeping. None of those “ideals” are worth driving oneself over the edge for.

          • What do we know about why babies cry? And the different kinds of crying? Or about different sleep patterns?

            I came back to these topics after years and years of not giving them much thought – and have been fascinated by the things that have changed. Babies should be carried constantly, crying causes brain damage, and bf for six months isn’t good enough.

            Are children who have more or less continuous physical contact for months or years at any advantage? Sleep patterns are very individual. I used to claim that being able to sleep well and heavily almost anywhere – waking up was more of a problem for me, so I worried about night feeds, but my recollection that it was not much of a problem in the event. My first daughter definitely knew how to cry, and I do remember some wretched evenings when she would cry inconsolably from 6 pm to 10. Colic was the official reason given, though with hindsight I doubt that. It was fairly rare for her to fuss at night, though – she would sleep quite happily in her crib in about four hour stretches. I know there are others who don’t, though and I can sympathise with anyone suffering from sleep deprivation because it really is a form of torture. As is worrying about SIDS. Being able to feed and soothe a child without waking properly does seem like a plus, and having the child close is reassuring. My own early conditioning and heavy sleeping would make me very nervous about a child in the same bed. Like homebirth, the risk is small, but, unlike homebirth, I can imagine taking this one – because the benefit of getting enough sleep is one I can understand.

      • CarolynTheRed

        The idea of sleeping through a feeding terrifies me, especially with a small baby. Somebody’s got to move unless I’m too close to the baby for my comfort, or the baby’s too mobile for my comfort. It’s also a little icky to me (sure it’s a baby, but I want to _know_ it’s just the baby)

      • S

        Here’s what i don’t understand — I didn’t sleep through feedings until my kid was around 6 to 8 months. Before then, i had to physically put him onto the boob. By that age, aren’t most babies able to sleep through the night without a feeding anyway?

        (That’s what our pediatricians told me. Now, _i_ can’t always sleep through the night without running downstairs and chugging an Ensure at 3 a.m., so i’ve been a big weenie and never put my kid to the test.)

        • Therese

          You don’t understand how other people might fall asleep or stay asleep more easily than you? Or how some babies might be easier to latch on than others?

          • S

            The latter. Can babies commonly latch on much earlier than that? I only have personal experience with the one kid, plus friends’ stories of a few more. (That is a sincere question, as was my original question about whether babies old enough to pop themselves on the boob are also generally old enough to sleep through the night.)

            I fall asleep easily, so actually i do find it difficult to imagine the first thing. =)

          • S

            Ack! No, no, i remember now. It wasn’t the latching. It took him that
            long to be able to pull up my shirt and get the boob out (I never wore
            nursing clothes). Sorry for all the dumb.

        • me

          I’m not sure. I didn’t night wean until after age one. Could my children have gotten thru the night without nursing sooner than that? From a medical/nutritional perspective, I’m sure they could have (no weight gain issues). For me it wasn’t necessarily about making night feedings easier (though that was an ancillary benefit – I slept with my top lifted up and by the time they were 3-4 mos old it was super easy to latch them on). It was about getting more than 2-3 hours of broken sleep each night. And avoiding hours of air-raid siren level screaming in between those bits of broken sleep.

      • FormerPhysicist

        I went to bed-sharing after falling asleep while nursing in the chair and dropping the baby (multiple times. 🙁 ) I only meant to lie down while nursing and not cosleep. I meant to put the baby back in her crib afterwards. But I *always* fell asleep. I really don’t do well on sleep-deprivation. So we took steps to make it as safe as possible (no blankets, no pillows, sidecar on the bed for when I woke enough to move the little one).

        • Susan

          That sounds like me! I came so close to dropping my youngest when I tried nursing him in the chair at night I went back to my granola head roots on the bed sharing thing. I’m glad I got away with it. Hope you didn’t have hard floors! I guess if I were young enough to be doing it again I would get a side car or bassinet in the room.

      • fiftyfifty1

        “you’ll be a sleep deprived zombie in no time.”
        Especially if you are struggling with low supply and/or low storage capacity and your baby feeds every 1.5-2 hours.

    • desiree

      La Leche says it’s a single issue organization, but they don’t do a great job of hiding their preference for AP-style parenting. This is what they say about co-sleeping: http://www.llli.org/faq/cosleep.html and here’s what they have to say about birth: http://www.llli.org/ba/nov99.html. I like their birth paper because they actually do a fairly good job of showing that epidurals don’t affect breastfeeding, then stating the opposite anyway in their conclusion.

      • Ceridwen

        I’m entertained that I had almost all of the epidural related interventions they mention in that article (all but restricted food/water) and yet none of the post-delivery complications they mention. Oh, and my daughter is a breastfeeding champ and has been from the start despite me having an epidural for >12 hours, having labor augmented with pitocin, and not getting to attempt to latch her until just over an hour had passed from her birth.

        The conclusions at the end of that article are incredibly disingenuous given the evidence they cite.

        • Leica

          Heck, I had a planned c-section, and my baby nurses like a champ. The OR nurse helped him latch while I was still on the table being stitched up.

        • desiree

          I had an epidural for 2 hours, then emergency c-section under triple the normal c-section under epidural dose (the anesthiologist said he needed it to work fast, hence my huge dose). My daughter came out bright eyed and nursed like a champ. I never even had pain, and she was my first. She went on to nurse for 2 years. It’s just an anecdote of course.

    • araikwao

      This is exactly what irritates me about the ABA (Australian Breastfeeding Association) here on the other side of the world. Co-sleeping hits the news, and the “expert commentary” in the media is someone from the ABA defending the practice! They are not the Australian Co-Sleeping Association, so why are they weighing in? If they want to normalise breastfeeding, then why align it with (what I perceive to be) more fringe-type parenting choices?? (I understand that most parents at some point will bed share out of desperation, I tried it a few times with #1 but it was not safe, helpful or appropriate for us, but this is different to all night, every night AP stuff.)

      • Eddie

        I imagine that the leadership of these groups want to maximize BF at all costs, which then leads directly to co-sleeping. Anything to get even a small increase in numbers. The kind of thinking that 79% BF is better than 78% BF, so any measure that makes even a tiny increase is worthwhile, no matter the cost or hassle or inconvenience, no matter how flimsy the evidence backing up that small increase. After all, think of the children!

        I gather from context that co-sleeping is associated with higher rates of BF than room-sharing. Of course, this does not mean cause-and-effect, but all-too-often, people desperate to Do Good Works ignore or are ignorant of that fact.

  • KarenJJ
    • KarenJJ

      Actually, reading that, I wonder if it occurred to them that the reason parents were bed-sharing to start with was because their babies were such frequent wakers at night.

  • Gene

    Keep in mind that there is a push to keep SIDS as a specific diagnosis where we do NOT know the cause of death. A baby who dies wrapped up in a comforter, pressed up against a pillow or crib bumper, or crushed under a sleeping parent died of MECHANICAL SUFFOCATION and not SIDS.

    • KarenJJ

      I wondered about that. The “SIDS” death I’ve personally heard of was a baby that had just started rolling and had rolled onto their tummy and gotten a foot caught in the cot railings and couldn’t get their head back to a good position to breathe well (I heard all this second hand so I’m not sure how correct it was).

    • theadequatemother

      Do babies that die of mechanical suffocation have indications on examination/ autopsy? Like adults do with broken scleral blood vessels and who knows what else?

    • mollyb

      Coroners often refer to deaths where mechanical suffocation is suspected but cannot be PROVEN (as if very often the case with young babies) as SIDS II (unexplained infant death where mechanical death is suspected). It is often very difficult to prove conclusively that a baby suffocated and that is why the term SIDS (or SIDS II) is used. ETA–I am not a coroner and if any one is and has a correction, I would appreciate it. I live in Milwaukee, WI which has a huge co-sleeping death crisis and I learned this information while researching this issue.

      • Laura

        I couldn’t get past “huge co-sleeping death crisis.” That is terrible! I am very sad to hear that, mollyb.

  • LukesCook

    Isn’t it more likely that bed-sharing infants will be sleeping with inappropriate bedding, ie whatever bedding their parents sleep with – pillows, duvets, etc? As far as I know a baby’s cot is supposed to have no bedding whatsoever other than a firm mattress, but I’m sure there aren’t that many bed-sharing parents who are going without pillows and blankets until their baby is weaned.

    • Amy Tuteur, MD

      As you point out, parents aren’t going without blankets and pillows, which would mean that if bedding is the proximate cause, bed sharing increases the risk of SIDS.

      • Karen in SC

        Also, deep pillow-top mattresses and memory foam mattresses are very popular.

      • FormerPhysicist

        Actually, I did go without blankets and pillows. PJs, socks, and a small fortune for our gas bill. But I doubt most parents will.

      • S

        My son and i slept on a mat on the floor. I didn’t own a bed for years, so this is normal for me but i suspect not for most people. I would sleep with my arm outstretched so as not to roll toward the baby and would wake up freezing and numb. Overall i was happy with the arrangement despite the physical discomfort (I can sleep through a lot of things), but i imagine a lot of people would be unable to sleep like that.

  • LynnetteHafkenIBCLC

    “Of more than 12 published studies, all but two small ones show … increased risk of SIDS associated with bed sharing, some combined with sofa sharing…”

    I’m interested in how sofa sharing factors into this research. It was my understanding that sofa sharing is always dangerous and shouldn’t be included as a form of bed sharing.

    • Amy Tuteur, MD

      Sofa sharing was not included as part of the bed sharing group.

    • me

      I wonder about that too. Seems the biggest risk is when parents are trying not to bed share, but failing (baby won’t sleep in crib/bassinet). I knew there was increased risk of SIDS associated with co-sleeping vs crib sleeping, but for me the choices weren’t co-sleeping vs crib sleeping; the choices were co-sleeping in a prepared adult bed vs be up all night with screaming baby then collapse in utter exhaustion with baby in arms on couch or recliner. I believe I made the safer choice. Maybe not the safest choice, but none of my kids allowed me to make the safest choice 😉

      • Chava

        This is what happened to us. My husband complained mightily about the gas bill the winter after my son was born, but we literally had no other choice. The second his swaddled bum would hit the crib he’d wake up and scream. And this wasn’t just “oh he’ll settle” he cried himself into puking a few times.

        Dr Amy, was there any considerations for say, using one of the co-sleepers? or sidecarring a crib? is that less risky?

        • chava

          was=were.

      • desiree

        That was us too. I sidecarred the crib even but she still wouldn’t sleep in that. So, I just put her between me and the sidecar crib, no blankets or pillows, and kept her at my head level (i was figuring that I’d be less likely to accidentally smother her with my face). Sometimes you’ve just gotta do the best you can with the hand you’re dealt.

        But I think La Leche could have address the reality of bedsharing without going so far as to claim that it’s equally as safe as crib sleeping. Maybe it is, if you’re super safe about it and meet every requirement. But maybe it’s not. Obviously though, they’re driven by ideology on this one and not science.

        • staceyjw

          I agree. What is so wrong about saying “yes, it increases SIDS”, but people can still to choose to do it? HB increases risk, as well as all kinds of other stuff. Why deny it?

          • me

            Exactly this! We’re parents. We’re human. We aren’t perfect. And trying to do everything in an “ideal” way leads to mega burnout and then guilt when (not if, but when) we fail to be perfect. There is nothing wrong with doing the best you can. I liken my situation to the whole bfing vs ffing argument – Yes, bfing is “best”, but the benefits are small (in developed nations) and fleeting. Sure, try it, if it works out, great! But if it doesn’t work out, don’t drive yourself crazy over it. The “risks” are small and fleeting (and FWIU one of the risks of ffing is an increased risk of SIDS… go figure). Yes, crib sleeping is “best”, but the benefits are small and fleeting. Sure, try it, if it works out, great! But if it doesn’t work out, don’t drive yourself crazy over it. The “risks” are small and fleeting.

            Understand that I am talking about mindful, responsible co-sleeping here, just as I am talking about mindful, responsible ffing. Either can be made more dangerous (sometimes exceedingly so) when done incorrectly.

      • Dr Kitty

        I had a bassinet beside the bed and I TRIED to get her into it after the night time feed. And she screamed. And screamed. And screamed.

        So she slept in that bassinet until 2am, when she woke for a feed, came into bed with me and then slept there until 6am when we got up.
        Until she was 3 months old and I put her in a cot in a different room.

        Next time (if it ever happens) I’ll skip the bassinet and just put the cot in our room.

        Co-sleeping wasn’t my preferred choice, it was a sanity saving measure and I did it for the shortest period of time I could.

      • Jessica

        I am one of those who avoided bed sharing (with two obese adults and two dogs in a bed quite high off the ground with major gaps between frame and mattress, I did not believe it was safe). So I nurse baby in the recliner in his nursery, and cannot count the number of times we’ve fallen asleep in it together. It’s never intentional, but it happens. Safe? No. Safer than our bed? Maybe…. I love breastfeeding, but I wish there was a better way to feed baby in the middle of the night and get sleep.

        • Dr Kitty

          Not safer than your bed. Chairs and sofas are more dangerous than beds.

          • Jessica

            I may well be rationalizing it, but our mattress is easily 3 to 3.5 feet off the ground, and the bed frame is wider than the mattress – roll off the bed, you hit the frame then the ground. Add in dogs, a softer mattress, and two obese adults, and well, it did seem that the specific recliner we have may be safer. It’s likely not. But I really have no other place to feed the kid in the middle of the night, and it feels like picking the least bad option.

          • Therese

            Obese chair sleeping is more dangerous than both skinny chair sleeping OR obese bed sharing. You’re lucky your child is still alive.

          • Jessica

            I am being quite serious here – what is the death rate for infants who co-sleep with parents in a bed vs. a sofa vs. a chair? To say something like “You’re lucky your child is still alive” implies a very high death rate or absolute risk, yet I have not seen the numbers to quantify that risk, especially compared to other sleep situations.

            I didn’t share my story to be shamed about being a bad mother and I’m trying very hard not to take your comment in that vein. Rather, I was pointing out how even someone who thoughtfully considered the risk of bed-sharing and opted out of it can end up making another risky (riskier) choice by accident. I never intended to co-sleep anywhere with my son, but the sleep deprivation with a young infant is brutal and it happened despite my best efforts.

          • Eddie

            The SIDS rates in the article being discussed are 0.08/1000 live-births for room-sharing, breast-fed, <3mo old babies where neither parent smoked. Bed-sharing increased that risk to 0.23/1000. For the sake of argument, and making up a number, let's say the risk of obese chair sleeping is ten times worse than co-sleeping. That would make the risk 2.3/1000. IMO, that doesn't exactly fall into "you're lucky your child is still alive" territory. Even if the risk were 100 times worse, at 2%, that doesn't fall into the "you're lucky…" category.

            I understood the point you were making in the correct context, and I believe most other people did as well, based on several other mothers making similar comments.

          • Jessica

            Thank you. I never took statistics in college (opted for Calculus instead) and could not make heads or tails out of the numbers Dr. Amy posted.

        • LukesCook

          I nursed in an upright chair in the nursery. I did fall asleep a couple of times, and woke a few minutes later (sleeping upright with a lolling head being VERY uncomfortable) in the same position. Maybe this was less safe than falling asleep in bed would have been. But the point is that it only happened a couple of times, for a few minutes at a time. Had I been lying in bed, I’m quite sure I would have fallen asleep EVERY time, and probably for a few hours rather than a few minutes.