These archives contain posts from the UK Midwives and Consumers email list, a discussion group for people interested in midwifery in the UK. All are welcome to join the group. Posts in these archives express the views of the individual authors, and not those of the Association of Radical Midwives.
16 February 2004
UNICEF statement on mother-infant bed sharing
Following the recent publication of a study in the Lancet (1) on Sudden Infant Death among bed-sharing babies and a subsequent meeting at the National Patient Safety Agency to consider guidance on bed-sharing, the UNICEF UK Baby Friendly Initiative has issued the following statement:
In recognition of the fact that mother-infant bed-sharing appears to be associated
with longer and more successful breastfeeding, the UNICEF UK Baby Friendly Initiative
has for some time been working to help health professionals enable breastfeeding
mothers to share a bed with their baby whilst maintaining the safest possible
environment. A sample bed-sharing policy has been developed for hospitals and
a leaflet for parents produced with the Foundation for the Study of Infant Deaths
(FSID). Both documents are designed to promote safety while protecting breastfeeding,
by educating health professionals and parents on the
benefits and contra-indications to bed sharing and the safety issues related
to it. UNICEF has also been urging NHS trusts to acknowledge the need to provide
training for health professionals on all aspects of bed-sharing, including effective
communication to parents of key messages appropriate to their needs and circumstances.
The Lancet paper suggested a slight increase in the risk of sudden infant death among babies of non-smoking mothers who bed-shared all night in the first eight weeks of life. This was followed by a large amount of publicity and media coverage advising against bed sharing.
At present, the UNICEF UK Baby Friendly Initiative is unable to support blanket recommendations against bed sharing in the early weeks for the following reasons:
There is some controversy as to whether the results of the Lancet study clearly
and unambiguously indicate an increased risk of bed sharing with non-smoking
parents in the absence of other known risk factors. There is serious disagreement
among the study authors about the statistical methods employed, the significance
of the findings and their implications for parents. Similar concerns have also
been raised about a forthcoming Scottish study on the same subject. Until these
issues are resolved, it remains inappropriate to give advice to parents based
on the results of this study.
There is concern that simply advising parents against bed sharing without giving
practical information about how to cope with a
very young baby at night may increase risk. Breastfed babies often feed frequently
and for long periods in the first few weeks after delivery. Breastfeeding can
also have a soporific effect on the mother (this is nature's way of allowing
her to rest). If mothers feel that they must not bed share there is a least
a theoretical risk that they will sit on a sofa or chair and fall asleep there,
putting their babies in far more danger than if they had shared a bed. There
is an additional concern that the sleep deprivation caused by sitting up for
large parts of the night will drive mothers to eventually either ignore the
recommendation and take their baby into bed when they are excessively tired
(a known risk factor) or to give up breastfeeding.
Bottle fed babies are significantly more likely to suffer infections and respiratory
illness both of which put young babies at
risk (2). There is evidence that bottle-fed babies are not as easily roused
from sleep as those who are breastfed which again could put babies at risk (3).
The health benefits of breastfeeding to mothers and babies are considered so
great that targets for increasing breastfeeding have been set in the UK and
health professionals all over the country are working hard to achieve them.
There is anecdotal evidence that health professionals may simply advise parents
against bed sharing if they perceive it to be banned or discouraged at an institutional
or national level. This means that parents are denied a full discussion about
important topics such as the benefits, contraindications and safety issues.
Parents may also be less likely to raise the subject for fear of disapproval.
Nevertheless, recent research conducted in the UK (4) indicates that while all-night
bed sharing is relatively unusual, it is very common for parents to take their
baby into bed for shorter periods at night, particularly for breastfeeding,
comforting and settling babies.
It is therefore essential that the benefits, risks and alternatives to bed
sharing are carefully weighed and that parents be given full
information appropriate to their needs in order to encourage safe practice and
to protect breastfeeding. The UNICEF UK Baby Friendly Initiative recommends
that:
Health professionals should ensure that parents are given full information
about this issue in the antenatal and early postnatal
period. Community staff should reinforce the information once mothers and babies
are at home. The UNICEF/FSID leaflet 'Sharing a bed with your baby' is designed
to support this.
All NHS Trusts should develop guidelines for staff in order to ensure safe
and appropriate practice both in hospital and at home.
a.. Trusts should provide all relevant health care staff with adequate education
to allow them to discuss this issue with all parents
as appropriate to their needs.UNICEF recommends that discussions with parents
about bed sharing should address the following factors:
The circumstances under which co-sleeping should be discouraged (parental
smoking, alcohol or drug consumption, excessive
tiredness, inappropriate sleep surfaces such as sofas, etc)
the use of bed sharing as a care strategy for breastfeeding mothers and babies
the additional risk of accidents if a baby sleeps in an adult bed, coupled with support to avoid or minimise these risks
UNICEF has suggested to the Royal College of Midwives and the Community Practitioners' and Health Visitors' Association that talks continue to ensure that adequate guidance on bed sharing be available to health professionals, including the issue of effective risk assessment for all mothers and babies.
All interested parties have agreed that the joint UNICEF/FSID leaflet 'Sharing a bed with your baby' provides clear, comprehensive and evidence-based information for parents and that it should continue to be used. UNICEF will continue to monitor research developments to ensure that the leaflet remains evidence-based.
UNICEF further recommends that all future research into infant death and sleeping environments should unambiguously record data on all important factors, which must include the baby's sleep surface, maternal and paternal smoking status, alcohol and drug consumption and infant feeding method. These factors should be recorded at the time of infant death (rather than relying on data for other periods such as feeding method at delivery or smoking status during pregnancy) and the results should be adjusted to control for them.
1. Carpenter RG et al (2004). Sudden unexplained infant death in
20 regions in Europe: case control study. Lancet 363: 185-91 [Full
text]
2. Standing Committee on Nutrition of the British Paediatric
Association (1994). Is breastfeeding beneficial in the UK? Arch Dis Child
71: 376-380.
3. Horne RSC et al (2004). Comparison of evoked arousability in
breast and formula fed infants. Arch. Dis. Child 89: 22-25 [Abstract]
4. Blair PS, Ball HL (2004). The prevalence and characteristics
associated with parent-infant bed-sharing in England. Arch Dis Child. in
press.
My local hospital has decided to withdraw co-sleeping advice from baby packs and actively discourage parents from doing this as they are saying it's unsafe.
I'm a member of NCT and on the AN/PN forum and as an NCT branch we are trying
to decide how to respond. I wondered if anyone has any references that I may
use to support both sides of the arguement.
Thankyou
Bev
Recommend googling James McKenna, also the CESDI 1999 which found co-sleeping protective against SIDS when neither parent smoked. Also afaik the recent cases of 'overlaying' led the coroner to urge hospitals to review policies on observing new mothers who were medicated for pain, *not* to stop co-sleeping entirely. UNICEF have a leaflet...
Can't give any refs *against* co-sleeping apart from the CESDI study which found co-sleeping with parents who smoke to be a huge risk-factor in SIDS. I'd google them meself but my brain hurts already.
Tracy
The UNICEF booklet is called 'sharing a bed with your baby' and is (according
to the website) included in the 'Baby Welcome' packs - which your hosp probably
hands out !!!
Barbara
I wonder if this decision was taken in the light of the recent research published
in the Lancet by the Foundation for the Study of Infant Death?This research
was given a lot of publicity. It says that no baby under the
age of (I think) 8 weeks should sleep with its mother.
The research was very flawed (not least in my opinion because I discovered that the FSID is sponsored by Cow and Gate). UNICEF have provided a very good critique and maintain that babies should continue to sleep with their mothers because of the benefit in terms of establishing breast-feeding.
yes, and as I recall, the research itself did _not_ prove that under 8 weeks was dangerous, it was only the press release that said that! because they had (v suspiciously) pulled out the wrong statistics, from before they'd been corrected for other variables. and this was corrected later but of course the wrong information had already had lots of publicity by then.
I took a call today from parents of a breastfed baby who was waking twice in
the night to feed, at 15 weeks. This essentially
normal behaviour was regarded by them as aberrant, because they had read that
babies 'should not' do this. They had put the baby in a separate room to try
to stop this (babies are safer sharing a room) and they had left the babyto
cry for up to 40 minutes before 'giving in'.
I feel sad that our society removes us so far from our instincts that situations like this happen (to both parents and babies...) Or it might just be my instincts...but after ds was born I couldn't imagine anything but sleeping with him in our bed. DH had been nervous about the idea beforehand, afraid that he might roll on baby and hurt/smother him, but as soon as ds was born he knew such a thing couldn't happen.
Both our bodies were far too aware of ds to make this a danger- even when our
brains were asleep (not as much as we might have liked for those first few weeks)
our bodies kept our baby safe. I remember waking out of a dead sleep one night,
having sat the baby up because he was snuffly and having a hard time breathing,
but none of this consciously decided. My body just did it and then my mind woke
and said "Oh..well good. Baby is ok" Anyway, cosleeping made night
feedings so much easier- I didn't have to get up and go anywhere, and ds didn't
have to start crying and fully wake to be fed. He could just rustle around
a bit and then latch on, and we could both go back to sleep. I wish more parents
knew this was a viable option, and felt empowered to do it.
-Ginny
LW updated July 2, 2004