Who else is bed-sharing with their babies?

04 Aug, 2019

Research on bedsharing in the UK shows that at least half of all parents will bed-share with their baby, whilst in Canada and America its closer to 75% of families. Although we may not know it, we are probably following what our bodies have evolved to do, to ensure the survival of our race.

“The physiology of prolonged mother–infant contact provides support for the beneficial effects of bed-sharing—research data associates enhanced breast-milk production, increased prevalence and duration of breastfeeding, improved cardiorespiratory stability and oxygenation, better thermoregulation, and fewer episodes of crying with regular mother–infant body contact” (Trevathan & McKenna, 1994).

How can you beat that? Mother Nature always knows best.

I will now go into some studies of bed-sharing practices around the world. Most of these parents don’t plan to bed-share with their babies before birth, but once the babies born all those plans go out the door and they end up bedsharing. What health professionals should do is know that most parents are likely to bedshare at some point even if they don’t plan to so the best thing they can do is spread the education of what good bedsharing so parents who do end up bed-sharing in the near future can do it properly.

North Tees, UK.

In this Research Article by Ball, H.L, ‘Reasons to bed-share: why parents sleep with their infants’, Journal of reproductive and Infant Psychology, 20 (4), (2002), a study was performed of 253 families in North Tees in the UK. The mothers were asked to provide sleep diaries on 7 consecutive days and interviews were conducted at the end of the first and third month of age. While the study explored reasons for bedsharing, it came up with valuable information on the prevalence of bedsharing “47.4% of the babies in the sample bed-shared with their parents at least once, for all or part of the night, during their first-month sleep-diary week”. The percentage who bedshared and started later in this period was greater “ With the inclusion of parental reporting of ‘ever bed-sharing’ at interviews the proportion of the sample that had bed-shared by the time their baby was 4 months of age was 70% (176/253).” Incidentally, the most common reason given for bed-sharing was the ease of breastfeeding their baby at night.

NHS, UK

Similarly, in the Infant Feeding Survey 2005 by Boiling, K., Grant, C., Hamlyn, B., in The Information Centre for Health and Social Care, the NHS performed a study on infant feeding, breastfeeding vs bottle feeding, rates of maternal smoking etc. But incidentally, they also found that the rates of bedsharing were quite prevalent “Around half (49%) of all mothers allowed their baby to sleep in the parental bed at least occasionally, with 11% adopting this practice on a regular basis. Co-sleeping was particularly associated with breastfeeding mothers - 61% of breastfeeding mothers allowed their baby to sleep with them at least occasionally compared with 38% of mothers giving only formula milk.”.

Manitoba, Canada

In another study of 293 families in Manitoba Canada called “Maternal Bedsharing practices, experiences and awareness of risks” in the Journal of Obstetic, Gynecologic and Neonatal Nursing, results showed that “72% reported that they bedshared with their baby on either a regular or an occasional basis. Mothers who breastfed were twice as likely to have bedshared. Approximately 13% of respondents who had bedshared reported an experience(s) with bedsharing in which they had rolled onto or partway onto their infant.”

Oregon, Canada

I found this study by Lahr, M.B., Rosenberg, K.D., Lapidus, J.A., ‘Bedsharing and maternal smoking in a population-based survey of new mothers’ in Pediatrics 2005 particularly interesting. They open with “Some studies have found that bedsharing is associated with SIDS, but, to date, there is only strong evidence for a risk among infants of smoking mothers and some evidence of a risk among young infants of nonsmoking mothers. Despite the lack of convincing scientific evidence, bedsharing with nonsmoking mothers remains controversial. In some states, nonsmoking mothers are currently being told that they should not bedshare with their infants, and mothers of infants who died of SIDS are told that they caused the death of their infant because they bedshared.”

Their study’s objective is to determine whether advice given to smoking mothers is different to that given to non-smoking mothers on bedsharing. If smoking is directly correlated to higher risk of SIDS when co-sleeping then surely the advice then to non-smoking mothers should be different and tailored to their situation. While this is what any rational person would think, unfortunately public health messaging has not yet caught up…. The study concluded that “In Oregon, if not elsewhere, the message that smoking mothers should not bedshare is not being disseminated effectively. Because it is not known whether the risk caused by smoking is associated with prenatal smoking, postpartum smoking, or both, bedsharing among either prenatal or postpartum smokers should be strongly discouraged. Much more public and private effort must be made to inform smoking mothers, in culturally competent ways, of the very significant risks of mixing bedsharing and smoking. Public health practitioners need to find new ways to inform mothers and providers that smoking mothers should not bedshare and that putting an infant of a nonsmoking mother to sleep in an adult bed should be delayed until 3 months of age.”

Anyway, back to the prevalence of bedsharing. It found that in this study in Oregon, 35.2% reported bedsharing frequently (always: 20.5%; almost always: 14.7%) and 64.8% infrequently (sometimes: 41.4%; never: 23.4%). Bedsharing among postpartum smoking mothers was not statistically different from among nonsmoking mothers.

Hong Kong

Study in Hong Kong of Childcare practices and cot death in the New Zealand Medical Journal 1996 found that parents regularly share their bed with their babies, as opposed to just occasionally. Hong Kong also has a very low rate of SIDS, at 0.3 in every 1000 live births, which is much lower than most Western countries. In this particular study of 100 mothers, results should that “81% babies slept in the parents room. 32% shared a bed with parents but only a third were described as being "in direct contact". Only 9% of infants were still breast feeding by 4 weeks of age. 78% of babies slept on their backs, 18% on their sides and 3% on the fronts. Sheepskins were not used and 56/58 described underbedding as firm or moderately firm. At the time of birth only 3% of mothers smoked.”

I also found this comparison chart of SIDS and neonatal risk of death across lots of countries. https://www.ispid.org/fileadmin/user_upload/textfiles/articles/CPR17_Hauck_SIDS_Trends.pdf

Japan

Similarly, in Japan, where bedsharing is very normal among most families, bed-sharing every night, a study by Fukumizo, Kohyama and Hayes called ‘Sleep-related nighttime crying (yonaki) in Japan: a community based study’ was conducted and published in Pediatrics. It compared Japanese and Amercian children, and they found that 59% of Japanese children aged six months - four years slept in their parents bed at least 3 times a week.

Cross-cultural study

Another study ‘Parental behaviours and sleep outcomes in infants and toddlers: a cross- cultural comparison’ shows the huge difference in bed-sharing between traditional ‘Eastern’ cultures ( by East I mean countries in Asia, Africa, and South America) and those in ‘Western’ cultures (by West I mean the USA, the UK, parts of Europe, more developed countries). This study involved parents of 29,287 infants and toddlers completing a survey based on the Brief Infant Sleep questionnaire. The families were from Australia, Canada, China, Hong Kong, India, Indonesia, Korea, Japan, Malaysia, New Zealand, Philippines, Singapore, Taiwan, Thailand, United Kingdom, United States and Vietnam. The results showed that “For predominantly-Caucasian, the most common behavior occurring at bedtime is falling asleep independently in own crib/bed (57%), compared to just 4% of those children living in predominantly-Asian regions.” In fact the study found that the best predictor of infant sleep outcomes was parental behaviour - all the more reason to arm parents with all the knowledge to make informed decisions about their sleeping practices.

United States of America

While rates are low in ‘Western’ countries, it is growing. A study was conducted in the United States from 1993 - 2000 with 1000 interviews covering 8452 night-time caregivers. It was published in the Pediatric Adolescent Medicine journal in 2003 and found that 45% of infants spent at least some portion of the night on an adult bed in the last two weeks - between 1993 - 2000, the proportion of infants sharing a bed with a parent/caregiver increased from 5.5% to 12.8%. More than 90% of infants who usually slept on an adult bed shared it with their parents.

The factors that increased the likelihood of routine bed-sharing are:

Maternal age is less than 18 years old
Maternal race or ethnicity is black, asian or ‘other’ as opposed to caucasian.
Household income less than 20,000
Living in the southern states rather than midwest
Infant is less than 8 weeks old
Living in mid-atlantic compared to midwest
Baby was born with low birthweight or pre-term

While bed-sharing rates are increasing in western countries and remain high in other parts of the world, a study of 14 families with called “Breastfeeding, co-sleeping and dental health advice” found that that only half of the mothers tell their healthcare provider e.g. doctor, midwife etc that they are bedsharing because they fear that they will be told off and frowned upon, so they do this in secret - increasing the risk that they are not properly educated on what good bed-sharing looks like.

Parents need to be as informed as possible and their many choices embraced by health professionals so that they can be educated and not doing things in secret and potentially getting it wrong. The cost of this is too high for health care professionals to be holding onto rigid ideas that have no convincing evidence - it’s time to accept that cultural practices and evolutionary drives play a huge role in how we parent, and informed decisions and education of parents is the key to keeping babies safe and secure.

Research

Reasons to Bedshare - why parents sleep with their infants http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.500.3574&rep=rep1&type=pdf

Infant Feeding Survey 2005

https://digital.nhs.uk/data-and-information/publications/statistical/infant-feeding-survey/infant-feeding-survey-2005-main-report

Maternal bedsharing practices, experiences and awareness of risks

https://www.ncbi.nlm.nih.gov/pubmed/18507598

Bedsharing and maternal smoking in a population based study of new mothers

https://www.ncbi.nlm.nih.gov/pubmed/16199682

Childcare practice and cot death in Hong Kong

https://www.ncbi.nlm.nih.gov/pubmed/8649671

Sleep related night time crying (yonaki) in Japan: a community based study

https://www.ncbi.nlm.nih.gov/pubmed/15866855