Erica Neser – Only in last century or so has anyone debated where babies should sleep. The overwhelming majority of people OUTSIDE Western culture accept that babies sleep with their parents – this is seen as natural and expected.
So how did it come about that most ‘sleep experts’ nowadays believe that babies should be trained to sleep through at the earliest possible age?
Factors influencing modern sleep ideologies
In the late 1800’s it was believed that frequent feeding caused all kinds of diseases, and thus it seemed sensible to ban all night feeds.
“It is improper and pernicious to keep infants continually at the breast; and it would be less hurtful, nay even judicious, to let them cry for a few nights, rather than to fill them incessantly with milk, which readily turns sour in the stomach, weakens the digestive organs, and ultimately generates scrofulus affections (a form of tuberculosis).” (Enquire Within Upon Everything, 1882)2
The notion of human beings being ‘born in sin,’ fear of spoiling babies and children by showing them affection or touching them, and the fear of exposing babies to sex, all contributed to the idea that babies should be kept away from their parents, especially at night.
The Church tried to prohibit mothers from sleeping with their babies, citing the danger of ‘overlaying.’ This was based on the fact that many starving, destitute mothers confessed to their priests that they had smothered their babies deliberately because they were unable to take care of them.
Modern Western societies came to value individualism, independence and self-discipline with strong prominence given to the father’s role as authoritarian or disciplinarian – intimacy and closeness to children were thought to undermine this role. Emphasis on the romantic nature of the marital relationship to the exclusion of children also emerged at this time, which further pushed the babies out of the parental bed and bedroom.
Parents relied more and more on external authorities for advice on pregnancy, birth, baby-care, breastfeeding and childrearing. Medical doctors dismissed parents’ intuitive sense of what feels right and issued strict instructions to parents. And one must remember that medical authorities at that time (and today, more often than not) did not have a very sophisticated understanding of the complexities of physiology, neurology or psychology, or any special training in baby sleep issues.
Sleep research in laboratories (studying ‘normal sleep’ cycles and patterns) started in the 1950’s – when fewer than 9% of newborns were still breastfed by the time they went home from hospital. The formula-fed baby, sleeping alone, was the NORM at the time, and the results were then translated into statements such as “all babies should…”
Advice was based on moral values (“all babies should…”) rather than physiological needs, which led to unrealistic expectations, which are still with us today.
Seen from a cultural point of view, a baby’s biologically appropriate response (protesting when separated from the mother) came to be regarded as naughty, deficient, and in need of corrective treatment.
Advice from this era still pervades modern thinking, and parents are often admonished that they are spoiling their baby by ‘allowing’ her into the parental bed or by feeding on demand.
Some examples of modern ‘sleep training’ advice: 3
- “…I refer to ignoring of all crying or extinction as the preferred solution to help your child sleep better because I think this works best for the 20% of babies who have extreme fussiness/colic…”
- “…to prevent the development of sleep problems, buy a crib tent. You may have to use duct tape to keep the child from getting to the zipper. Parents are often reluctant … because they imagine their child will feel like a caged zoo animal, restricted, or abandoned. Of course there will be some protest crying for a few days.”
- “… going to your child at night … produces sleep fragmentation, destroys sleep continuity, and creates insomnia in your child.”
- “To establish regular naps, no longer than an hour [of crying], but …there is no time limit at night.”
- “We are leaving him alone to forget the expectation to be picked up.”
- “First, however, you’ll need earplugs in order to ignore the banging, crying, or yelling.”
Parents become convinced that ‘what feels right’ (i.e. responding to their baby) is dangerous, harmful and naïve – and again parents are told to do ‘as the doctor orders’ because ‘doctor knows best’.
Definitions
Co-sleeping and bed-sharing are not interchangeable terms but are often used as such.
- Co-sleeping: within arm’s reach of each other (mother and baby can sense each other i.e. see, hear, smell, touch each other)
- Bed-sharing: on the same surface (in the same bed) – therefore this is one form of co-sleeping
Co-sleeping & SIDS
In 2001, 2236 babies died of SIDS in the USA. 64 of these babies were sleeping in their parents’ bed (2,8%), while 2172 of them were sleeping in cots (97,2%).
And yet, American Academy of Pediatrics recommended in 2001 that babies do not sleep in their parents’ bed because sleeping in a cot is safer. This recommendation has since been revised following an outcry from health professionals.
As James McKenna & Lee Gettler put it: “… untested cultural assumptions rather than biological truths far too easily can appear credible and come to underlie public health policies and recommendations, cascading at times into unforeseen but nonetheless disastrous recommendations or practices.”4
How co-sleeping protects babies against SIDS:
- By promoting breastfeeding, which decreases the risk
- The mother exhales CO2 on her baby, which helps regulate the baby’s breathing pace
- Stimulation provided by movement of the mother’s chest
- Synchronous breathing patterns
- Fewer obstructive apneas than solitary sleeping babies
- More regular breathing
Guidelines to safe bedsharing
- Baby MUST sleep on her back (NOT on her tummy)
- Firm surface – not a sofa or water bed
- Tightly fitting bedding
- Consider strangulation risk if mother has very long hair or strings on pajamas
- Baby should not be over-wrapped
- No spaces between bed & wall where the baby can become wedged
- Bedsharing is appropriate for a committed adult (i.e. parent or grandparent), not just anyone!
- Baby should not sleep alone on adult bed
- Avoid extra pillows and heavy duvets
- Avoid if you and/or your partner are smokers (co-sleeping is considered safe, but bedsharing not)
- Avoid when using medication which makes you drowsy
- Avoid when extremely fatigued (over and above the normal parental fatigue)
- Avoid when using alcohol and/or drugs
- Avoid toddler sleeping next to the baby
- Avoid if the mother is extremely obese
- Avoid if your lifestyle is very chaotic (apart from the normal chaos of having children)
“Night awakenings constitute a problem only for parents who expect their children to sleep through the night… Co-sleeping with nighttime breastfeeding remains clinically significant and potentially lifesaving”.5
Co-sleeping and nighttime breastfeeding
- Co-sleeping doubles the number of feeds at night
- It triples total duration of feeding at night
- Co-sleeping babies have shorter intervals between feeds
Now you may exclaim: “In that case, there is no way she’s sleeping in my bed!”
BUT, consider the following facts…
How co-sleeping benefits you
- Bonding – growing mutual attachment
- Helps prevent the return of fertility (higher prolactin levels; suppresses ovulation)
- More sleep in total
- Synchronised sleep cycles (waking naturally at the same time as your baby, which means you will feel less groggy)
- More satisfaction with the amount of sleep
- Increased ability to interpret your baby’s cues
- The quality of your sleep may be improved by breastfeeding at night (due to release of hormones such as prolactin and oxytocin, which may assist you in falling sleep again)
How co-sleeping specifically benefits breastfeeding
- Increased milk supply
- Increased duration of your breastfeeding relationship
- Baby can consume a significant portion of her total feed during the night
- Breast refusal is often not an issue at night (“dreamfeed”)
- Relief of engorgement
- Feeds while bedsharing are often experienced as less stressful than day feeds
- Day feeds are often initiated by the mother; when bedsharing, the feed is initiated by the baby – this is truly demand feeding
- When introducing solids, the volume of breastmilk consumed during the day decreases, but when co-sleeping, the nighttime breastmilk consumption remains the same.
How co-sleeping benefits your baby
- More efficient energy use
- Lower blood pressure
- Increased growth
- Less stress
- More stable temperature
- More sleep in total
- Less crying
- More light sleep, less deep sleep (this is protective!)
- Your baby is reassured immediately upon waking vs. waking in alarm state (crying) when sleeping alone
- Bonding – growing mutual attachment
You are not alone…
Outside of Western society, sleeping close to the baby is the routine arrangement, and separate sleep is considered abnormal. Even in Western society, up to 70% of all parents and babies sleep together for at least part of the night, if not all night.
Points to ponder…
- Richard Ferber, well-known advocate of “controlled crying” and author of Solve your Child’s Sleep
- Problems, has now repudiated his stance on sleep training.
- 60 years of advocating sleep training has failed miserably, since 62% of modern adults still struggle to fall asleep.
- Children who co-slept as babies are “easier to control”, happier, less likely to throw tantrums, less anxious as adults, more comfortable with physical affection & touch, higher self-esteem, more independent, more satisfied with life in general. 6
“Babies are too important to be left alone with nobody watching them.” (Mother from Vietnam, where SIDS is unknown and all babies co-sleep)
“A human infant is biologically designed to sleep next to its mother’s body and to breastfeed intermittently throughout the night, at least for the first year of its life.”7
1 Quoted in Three in a bed by Deborah Jackson, p. 132.
2 Quoted in Three in a bed by Deborah Jackson, p. 142.
3 Healthy Sleep Habits, Happy Child by Marc Weissbluth, 2003, p. 103-324.
4 Textbook of Human Lactation by Hale & Hartmann, p. 273.
5 J. McKenna, Mothering magazine, Sept/Oct 2002.
6 Textbook of Human Lactation by Hale & Hartmann, p.294-5.
7 Textbook of Human Lactation by Hale & Hartmann p. 271.
Erica Neser is the author of Sleep Guide for Babies and Toddlers (Protea Books, 2006)
“Nature, if she be not interrupted, will do the whole business perfectly well; and there seems to be nothing left for a Nurse [or parent] to do, but to keep the child sweet and clean, and to tumble and toss it about a good deal, and keep it in good Humour.” (William Cadogan, Essay on the Nursing and Management of Children, 1748)1
Erica is also a Birth Doula ~ Breastfeeding Consultant ~ CPR Instructor ~ Bereavement Counsellor