by Heidi Green
February 09, 2011

Bedsharing was not something I came to lightly.

When my first child was born, I was well aware of the official recommendations for how my baby should sleep (on his back) and where he should sleep (in a crib, away from parents). I knew what his sleep environment should be like (no fluffy bedding, no pillows, no more than a light blanket). My husband and I arranged these things carefully while we awaited his arrival.

But life has a funny way of changing one’s plans. Our baby was a great sleeper—as along as he was close to his mom or dad. But when we put him—so carefully, so quietly—on his back, in a crib, away from us, he would stir within minutes.

Weeks passed, and we managed. But as I breastfed my son in the rocking chair my husband and I had so carefully chosen, I worried about the sleep that I was missing. Worse, I worried that I would fall asleep in that chair and lose my grip on the baby.

It seemed ludicrous, and possibly even dangerous, to spend so much energy coaxing the baby to sleep apart from me, then fight sleep myself to coax him back to sleep. Surely, generations of mothers have slept alongside their children. My son and I both slept better when he was next to me.

And so it began.

I started bringing my firstborn into bed with me, months after he was born. I curled protectively around him, so he could breastfeed whenever he was hungry. He was settled by my presence, and I could rest and check on him easily throughout the night. It was a practical and beneficial arrangement.

My baby is now approaching 8 years old. He gave up bedsharing (easily) long ago. But, still, as headlines claim that bedsharing puts children at risk for SIDS. I wonder: Why is bedsharing so controversial?

The latest case against bedsharing
The latest case against bedsharing comes from a team led by Carrie Shapiro-Mendoza, PhD. Based on data from 1984 through 2004, the team argues that infant mortality rates from “accidental suffocation and strangulation in bed” has quadrupled since 1984. However, the study has several serious flaws:

1. While the researchers purport to be focused on “accidental suffocation and strangulation in bed,” they write, “Beds, cribs and couches were reported as places where deaths attributed to accidental suffocation and strangulation in bed occurred.” It seems evident to me that the data can’t be used to talk about the relative safety of bedsharing if we mix up the data with couchsharing. Or cribsleeping.

2. In fact, the researchers have mixed up bedsharing data with other data, including, unknown data. The sleep surface—bed, crib, couch, etc.—is, in fact, unknown for 54.6 percent of the cases they attribute to accidental suffocation and strangulation in bed (ASSB). What’s more, they can identify the bed as the sleep surface in just 27.6 percent of the cases. (Cribs are 6.8 percent, sofas/couches/recliners are 10.0 percent, and other is 1.1 percent). So, roughly three-quarters of the cases of death they categorize as “in bed” did not or cannot be known to have occurred in bed.

3. Data were drawn from death certificates, which were often incomplete. More than half had no cause of death listed.

4. Co-sleeping or bedsharing was reported in 53.3 percent of the cases, but no definition was provided.

5. The total rate of sudden unexpected infant deaths seems to have remained stable between 1998 and 2004. The percentage attributed to SIDS dropped while the percentage attributed to ASSB increased; this could be a shift in classification rather than a change in cause of death.

6. The researchers acknowledge, “cause-of-death reporting practices may be inconsistent between medical certifiers.” This seems to be likely; see remarks by Maryann O’Hara, MD, MSt and Richard Harruff, MD, PhD and others for concerns related to such data.

7. The study is descriptive in nature. It can serve to identify patterns and trends but cannot show cause and effect.

Given the many holes in this study’s data, parents could no more conclude that bedsharing is dangerous than they could conclude that their infants’ sleeping is dangerous.

The case for bedsharing
The most recent national survey shows that roughly 50 percent of parents sleep in bed with their babies for all or part of the night, suggesting that messages such as, “don’t sleep with your baby” aren’t very helpful. If parents are going to bedshare, then maybe they need safety information, rather than denouncements of their behavior.

As James McKenna, PhD, head of the Mother-Baby Behavioral Sleep Laboratory at Notre Dame University, has observed: Bedsharing is not for everyone. However, saying that some parents may not be able to provide safe bedsharing environments for their children is not the same as saying that no parents should do so. In fact, McKenna concludes that when done safely, mother-infant bedsharing can improve nocturnal breastfeeding, extend the duration of breastfeeding, contribute to infant and maternal health and well-being, and even save infants’ lives.

McKenna finds that bedsharing “makes breastfeeding much easier to manage” and “practically doubles the amount of breastfeeding sessions,” while enabling mothers and infants to “spend more time asleep.” The increased exposure to maternal antibodies which comes from more nighttime feedings can improve infant health. Bedsharing also makes breastfeeding easier, which British researcher Helen Ball, PhD concludes, encourages mothers to breastfeed longer, leading to a reduced risk of breast cancer.

In addition, McKenna’s studies have found that infant responses to maternal smell, movement, and touch reduce infant crying and positively affect infant breathing, body temperature, absorption of calories, stress hormone levels, and oxygenation. It seems like babies are neurologically wired to expect and respond to that nocturnal interaction.

In Why babies should never sleep alone: A review of the co-sleeping controversy in relation to SIDS, bedsharing and breast feeding, McKenna cautions that “Bottle-feeding-bedsharing mother-infant dyads and breastfeeding-bedsharing mother-infant dyads are not the same!” It is a point of particular importance to McKenna, as indicated by his use of ALL CAPS when making it. (I’ve spared you the caps here, but feel no less strongly about it.) Breastfeeding mothers who choose to bedshare specifically for the purpose of nighttime nurturing will sleep with more awareness of their infant than those who bottle-feed (thus lack the physiological interplay of breastfeeding) or bedshare with no particular intent to cue into the infant’s nighttime needs. Supporting this idea, a study of more than 10,000 mother-infant dyads in Massachusetts and Ohio found that while breastfeeders were three times more likely to bedshare, there was no link between doing so and risk of infant death.

Parents should not bedshare with their infants if they are inebriated or desensitized by drugs, if they are overly exhausted, if they smoke, or if they are obese. McKenna also recommends that babies sleep alongside the mother in a crib or bassinet, rather than in the same bed, if they are bottle-fed rather than breastfed, since bottle-feeding dyads have not demonstrated the same level of sensitivities shown by breastfeeding dyads in his sleep studies.

Bedshare—safely
The American Academy of Pediatrics now recognizes the need for infants to sleep in close proximity to their parents. Their 2005 policy statement on SIDS calls for “the infant’s crib or bassinet [to] be placed in the parents’ bedroom,” stating that “when placed close to their bed, [this] will allow for more convenient breastfeeding and contact.”

Infants need their parents to be in close proximity. Co-sleeping—in which the infant sleeps within close proximity to the parents—is highly recommended. Beyond that, with bedsharing, parents will need to weigh the risks and benefits for their own families.

Health care providers should be able to supply information about how to bedshare safely. Also, because placing an infant to sleep in a crib offers no guarantee of safety, health care providers should be able to provide information about how to assess safety of cribs and other sleeping surfaces, as well as where to get information about frequent crib recalls.

May each of us make the decision that helps the whole family rest easy!

Heidi Green has been researching and writing about women’s and children health since she moved to Pittsburgh more than 10 years ago. She is also a children’s book reviewer in her spare time. She is mom to Ben, Katie, Sam, and Max.