The first few weeks of my son’s life were filled with ups and downs and a fair amount of crying – both his and mine. The intense psychological transformation to motherhood and the plunge in my hormone levels post-birth conspired to make me a less stable version of my former self.
I noticed, in particular, a sense of dread unfurling up from the pit of my stomach as the afternoon wore on. I knew night was coming. And I didn’t know how I could manage to survive another one.
We had a co-sleeper bassinet carefully anchored to one side of our bed and a crib in the nursery, adjusted to the appropriate newborn height. The crib mattress fit the crib snugly and was encased in single fitted sheet made of organic cotton with rainbow-coloured polka dots.
My wife and I had spent countless hours carefully selecting these items, then more hours putting everything together and preparing the nursery for our baby. The night I managed to fit a decorative, brightly-coloured bedskirt under the rungs of the crib, I woke up several hours later and had my first contraction.
Our son’s arrival was the culmination of years of effort, multiple sperm donors and fertility specialists, two rounds of IVF and many, many thousands of dollars in savings, gifts and credit card debt.
We were not the kind of people interested in taking any risk, no matter how tiny, with our infant. He would sleep flat on his back, on a firm surface, at a safe distance from us, his parents.
Except he refused.
On those long, dark nights after nursing him to sleep, I’d rise from the recliner and attempt to lift him over the crib’s top rail and down onto the cool mattress — but once he got there, in fact usually before, he would rouse and start rooting around for my nipple again, then grunt into a full-blown squeal until I pulled him back up to me, latched him on and returned to the chair to start the whole thing over again.
After a few rounds of this, my eyelids began sliding shut as soon as his, and I’d wake later with a start, terrified that I’d wedge him against the armrest somehow and kill him.
One night, my wife entered the nursery when I didn’t come back to bed and found the baby sleeping against my thigh. He had slid all the way down there in his sleep, and in mine.
“This isn’t safe,” my wife observed, logically. “Just come get in bed.”
So we did. I chucked the pillows to the ground, kicked the covers down below my feet, and like human mothers have done for many thousands of years, I laid on my side, rested my head on my shoulder and nursed my baby to sleep.
When I woke up the next morning, he was fine. So was I – in fact, I felt much better than I had since before my labour began. I’d gotten several solid hours of rest.
Finally, the clouds had parted, allowing a thin ray of light to shine through. If I could sleep at night while I nursed him, then maybe this whole motherhood thing was possible.
The American Academy of Pediatrics takes a firm stance against bed-sharing.
It turns out that my wife was right about the chair. It’s up to 67 times more dangerous to sleep with a baby on a soft surface like an armchair or sofa, according to the American Academy of Pediatrics (AAP).
In the newly-revised guidelines it released in July, the AAP reiterated the importance of placing babies on their backs to sleep, and doubled down on the recommendation against bed-sharing that had kept me trying to stay awake in that chair all those nights.
Admitting that this mode of infant sleep has been the norm for most of human history, the guidelines state:
“The AAP understands and respects that many parents choose to routinely bed share for a variety of reasons, including facilitation of breastfeeding, cultural preferences, and belief that it is better and safer for their infant. However, based on the evidence, we are unable to recommend bed sharing under any circumstances.”
Note that while the AAP does not condone bed-sharing, which is what I was doing lying on my side and nursing my baby to sleep, they do recommend co-sleeping, or room-sharing, for at least the first six months. This was what we had attempted to do with the co-sleeper, where the baby sleeps nearby but on a separate surface.
“The reality that parents quickly learn when they’re breastfeeding is that something’s gotta give in the first few weeks.”
- Diana West, lactation consultant
My baby did not want a separate surface, however. He wanted to be able to reach my breast with his mouth.
While I sometimes felt like a failure, or like I must be going crazy, during those first weeks of my son’s life, there is also research to back up my experience.
In a study published in September in the journal Biology, which received a great deal of media attention for its proposed mathematical formula of getting a baby to sleep, researchers also found that babies’ heart rates increased most at the moment of “detachment from the mother.”
This sounded precisely like my children. As infants, they would happily nurse to sleep and lay cuddled against me all night long, nursing on and off, but the moment I peeled their sticky little bodies off of me to try to put them down, or even just to get up to pee, it was game over. They seemed hardwired to sleep beside another human.
The AAP continues to recommend room-sharing for the first six months because it is associated with a lower risk of SIDS, and because it facilitates breastfeeding, which is also associated with a lower risk of SIDS, in spite of a 2017 study finding that parents were up to four times more likely to bring babies into the bed when they were sharing a room.
Of her failed attempts to get her daughter to stay in her co-sleeper, a friend of mine once told me, “she can smell me. I know it.”
Bed-sharing is much more common than people let on
I felt like the AAP guidelines contradicted themselves, and this was before the 2022 updates increased the breastfeeding recommendation to two years from one. If the baby is in the room, and the baby is breastfeeding, odds are that the baby will end up in the bed at some point.
Repeatedly, studies have borne this out.
Professor Helen Ball is the head of the Durham Infancy and Sleep Centre in the UK. The sleep centre formerly known as the sleep lab, is where Ball and her colleagues in the department of anthropology have spent over 20 years studying infants’ sleep.
“We did a prevalence survey in the UK and found that about 50% of all babies in the first three months were spending some time in bed with their parents,” Ball tells HuffPost.
That was in 2004. Subsequent surveys have reproduced similar results, she said, with higher breastfeeding rates correlating with higher rates of bed-sharin
“All of those people were doing it... with no information about what might be safe and unsafe. They were just told not to do it.”
- Helen Ball, head of the Durham Infancy and Sleep Centre in Durham, England
Even in the US, bed sharing is a frequent, yet unspoken, occurrence.
In a 2015 study, 61.4% of respondents from 14 states reported bed-sharing with an infant, with 37% saying they did so “rarely or sometimes,” and 24.4% reported “often or always.”
“It seems to me that we were massively under-acknowledging the amount of bed-sharing that happens in Western countries,” said Ball. “Therefore, that meant that all of those people... were doing it with no information about what might be safe and unsafe. They were just told not to do it.”
Data shows that bed-sharing increases the risk of SIDS, but it’s a little more nuanced than that
While I knew that bed-sharing was the most instinctual thing for me and my son to do — and I had several new mom friends at the time doing the same — I was never convinced that it was safest. Just because something feels natural doesn’t mean it offers the best odds of survival, does it?
The truth is that about 3,400 infants under age one die every year in the US, according to the Centers for Disease Control and Prevention. These deaths are labeled under Sudden Unexpected Infant Deaths, and the CDC breaks them down into three categories: Sudden Infant Death Syndrome (SIDS), unknown cause, and accidental suffocation or strangulation in bed.
In 2020, 41% of these deaths were categorised as SIDS, 32% as unknown, and 27% as accidental suffocation or strangulation.
The rate of SIDS waned significantly in the 1990s, after the AAP came out with its safe sleep recommendations, and the Safe to Sleep campaign blanketed the country in public safety messages. But the rates of unexplained suffocation or strangulation deaths have held steady over the past few decades, even rising slightly — though this may have to do with how the deaths are classified more than their cause, which in many cases is unknown.
While many of the deaths — such as those from SIDS — were not preventable, what if some of them were? 3,400 is a lot of shattered families.
Emily Oster, an economist and author, examines and contextualises the risk of bed-sharing in her bestselling book Cribsheet. Using data from a 2013 meta-analysis (a study of studies) published in the British Medical Journal, Oster shows that the risk of infant death increases significantly when bed-sharing occurs with an infant who is bottle-fed, whose parent smokes, or when a parent has been drinking.
While it remains quite small, the risk of SIDS does increase for a baby who bed-shares, even in the absence of these factors, going from 0.08 deaths per 1,000 births to 0.22 deaths per 1,000 births. This is significantly lower than the overall infant mortality rate of 5 deaths per 1,000 births. Oster explains in the book, “A perhaps more useful way to say this is that among families with no other risk factors, roughly 7,100 of them would have to avoid co-sleeping to prevent one death.”
The question is, is it feasible or realistic to keep that many babies out of their parents’ beds, all night, every night, for the first year of their lives? And, perhaps more urgently, how do the AAP guidelines limit what paediatricians are able to say to their patients?
“To tell people just don’t do something that nature tells them to do, it is not only not going to be successful, they’re going to go underground.”
- Diana West
Dr Jill Wright, a paediatrician at UNC health, tells HuffPost that she sticks to the AAP guidelines when talking to families about infant sleep.
“I have had that happen to a patient, to an infant, and it’s a tragedy – a preventable tragedy,” said Wright.
“There is good evidence that bed-sharing can increase the risk of infant death,” she says, adding that “there are a lot of things that further increase the risk.”
As to the idea of safer bed-sharing, Wright reiterated that the AAP “said no bed-sharing under any circumstances,” and that she would advise families to “have that safe surface easily accessible in the parents’ room.”
Other American doctors quoted in the media implore parents not to bed-share, saying that there is “no reason” to do so.
As Dr John Cox in Ohio recently told a local TV news station, “I know moms are tired, and you’re nursing frequently, and you’re feeding frequently throughout the nighttime. You can easily have that bassinet right in your room right next to you, so when you’re done, you put that baby there so you can get the proper rest.”
But you can only get rest if the baby remains asleep. Otherwise you’re just lying there listening to them cry, wondering what on earth you’re supposed to do next.
“The reality that parents quickly learn when they’re breastfeeding is that something’s gotta give in the first few weeks,” Diana West, an international board certified lactation consultant and the author of Sweet Sleep, tells HuffPost.
Some parents turn to infant formula or attempt to sleep-train their babies. And some of us bring the baby into the bed.
The UK has a different approach in educating parents about safe sleep
The UK offers a model for a way to discuss sleep safety while acknowledging the utility, and the prevalence, of bed-sharing. Ball calls it a “risk minimisation strategy.”
West likens it to teaching safer sex instead of abstinence only. “To tell people just don’t do something that nature tells them to do, it is not only not going to be successful, they’re going to go underground.”
The UK guidelines, released in 2019, speak of a “clear sleep space,” acknowledging that bed-sharing – whether planned or unplanned – is common, but that it is much more dangerous on a sofa or armchair.
The guidelines advise people not to bed-share with an infant if the baby was preterm or low birth weight, if the parents drink or use drugs, or if either parent smokes – in addition to the general safe sleep advice that says to put babies on their backs, without any bedding or other objects and making sure the room doesn’t get overheated. They also recommend that bed-sharing parents should keep pets and other children out of the bed, and prevent the baby from falling or getting trapped between the mattress and the wall.
“Parents are very happy about the change in the [UK] guidelines,” says Ball. “They don’t have to hide their behaviour anymore. They don’t feel judged. They don’t feel stigmatised,” she said.
The Lullaby Trust, Unicef UK’s Baby Friendly Initiative and the Baby Sleep Info Source collaborated to write these safer sleep guidelines for the UK. Previous guidelines, written by the Department of Health and the Lullaby Trust, included this sentence: “The safest place for a baby to sleep is in a cot by your
bed.”
International organisations like La Leche League and the Academy of Breastfeeding Medicine also offer guidelines for safer bed-sharing. The latter’s website states: “All parents should be educated on safe bed-sharing, with the understanding that bed-sharing is very common, and when bed-sharing is unplanned, it carries a higher risk than planned bed-sharing.”
My daughter was born when my son was four years old. I set up the co-sleeper for her and put her down there on her first night home. When she woke, however, I nursed her back to sleep against my curled body — the shape that Ball said she watched all the mothers take in her sleep lab.
During her first year of life, she spent most of her nighttime hours in the bed beside me – but not once did I fall asleep with her in the armchair or on the couch. I nursed her for 21 months. There’s no way to know whether all this prevented her death or put her at risk.
But I never told my paediatrician where she slept.