James J. McKenna is the world-renown expert in bedsharing and cosleeping, and his book, published in 2009 by Platypus Media, is a great read for all new parents, even pediatric care providers. Professor McKenna is the Chair in Anthropology at the University of Notre Dame. He also directs the Mother-Baby Behavioral Sleep Laboratory at the University, and has published extensively on infant sleep and #breastfeeding human behavior, with a special interest on how cultural factors influence health and wellbeing. The National Institutes of Child Health and Human Development fund his research.
When Dr. McKenna became a parent in 1978, he and his wife were both anthropologists, so as they poured through a plethora of #pregnancy and parenting books, they read through the pages with an anthropological mindset. They appreciated that the advice on infant sleeping was not consistent with what they knew to be true about sleeping arrangements and other primates. Further, they recognized that infant care recommendations were not even based on empirical laboratory or field studies on human efforts, or even cross-cultural insights as to how human babies actually lived.
Rather, the recommendations on the books of their time, were based on 70 to 80 year old cultural ideas, mostly reflecting social values of male physicians who had never even changed a diaper. Dr. McKenna described the "experts" of his time as "middle-aged men who preferred to define babies in terms of who they wanted the infants to become, rather than who they actually were - little creatures who are very much dependent physiologically, socially, and psychologically on the presence of the caregiver to an unprecedented degree of an unprecedented length of time compared with other animals" (p 19).
The more he and his wife delved into these areas, the more they discovered that the prevailing wisdom had no basis in science whatsoever, and this discovery changed his career. His book not only offers great testimony, scientific evidence as to why cosleeping is integral to optimal health and wellbeing of both momma and baby, but it also discussed quite candidly why the healthcare industry, even the government, continue to create controversy regarding the subject; "these are social judgements, not science" (p 55).
Western social values heavily emphasize infant self-sufficiency as early in life as is possible for infants. Understanding this helps make sense of why our culture assumes that early nighttime infant separation from the parents was the recommendation, without scientific testing, because it was simply believed that this would produce happy, confident, emotionally healthy, independent future adults and of course, also support energized parents content to live their nighttime lives separate from their babies and children. This was touted as teaching babies to self-soothe and ultimately, create independent children and ultimately, independent adults.
When we look at the mammal world, and among different cultures and in different eras of human history, it is clear that cosleeping is universal through time, and is practiced far and wide and in many different ways. Dr. McKenna shares that this knowledge intuitively spoke to him in that if something was so common, particularly throughout the entire animal kingdom, it must be beneficial and now his hunch is supported by extensive and rigorous scientific literature.
Bedsharing is not a one-size-fits-all though. We do need to educate parents in what is safe and what is not; we do not all live the same and nothing is entirely safe. Dr. McKenna's book, Sleeping with Your Baby, is intended to provide a balanced, comprehensive and holistic perspective on cosleeping and bedsharing, specifically while breastfeeding.
What is Cosleeping & Bedsharing?
Cosleeping is sleeping in close emotional and physical contact with one's parents, usually within arm's reach. Whether it is for protection, warmth, food, or comfort, humans and other mammals routinely sleep side by side, generation after generation. We cosleep when we cuddle, snuggle and snooze together close enough to detect and respond to each other - whether on the same surface or not, and when at least one adult is committed to the infant's wellbeing.
Bedsharing is what it seems, the sharing of space in the same bed. Cosleeping however, can refer to roomsharing or any situation in which parents and infants are within arm's reach but not necessarily sleeping on the same surface.
The challenge in healthcare, for at least the three decades I've worked with new families, is that many pediatric providers claim cosleeping is dangerous and should not be practiced. In fact, this is even part of the evaluation by Child Protective Services, whether the child has their own sleeping space. However, while not all forms of cosleeping spaces are safe, it is also true that not all forms of #cosleeping is dangerous.
Pediatric providers opposed to cosleeping will simply teach not to sleep with one's child, and they may even have strict scripts for their nurses in what they can and cannot say to their clients, but the reality is, even parents who have no intention of ever sleeping with their child, do in fact find themselves doing so at some point in their parenting experience because caring for a little one around the clock is challenging. Falling asleep with your little one in your arms eases that challenge. Parents often tell their pediatric provider what they want to hear to deter conflict, but are often doing otherwise. It behooves us then to teach all parents what safe and unsafe cosleeping looks like, no matter their intentions or our bias, because the reality is that most all babies end up cosleeping with their parent at some time or another.
It is true, shares MeKenna, that "we need to be very conscious of how we cosleep. If bedsharing, how we arrange bedding, other children, pets, and furniture must be done with care" (p 27). While a mother's body is safe, our sleeping environments have changed considerably through time and these variables need to be well appreciated.
Smoking is potentially the greatest risk, as are drugs and alcohol. Sleeping environments can be adapted though to allow for the greatest convenience for parents, as it is very supportive of the mother and child bond, as well as support breastfeeding. Now, and throughout history, cosleeping has been an important component of protecting the child's survival and wellbeing, and contributes to both short-term and long-term healthy development. But, when a single child demises in an unsafe sleeping arrangement, it can motivate the pediatric provider to attempt to prohibit any potential repeat of such travesty without being truly discerning, or even scientific.
To perpetuate to the public the idea that the mother's body, no matter what her intentions or motives, represents an inherent threat to her infant is not only scientifically unsupported, but immoral and far more dangers in the long run just as this is gravely immoral when obstetrical providers do it to women in labor, pretending the infant must be saved from the danger inherent to the mother's body. This undermines her belief in herself as a mother.
McKenna states, "I worry more and more about our society's willingness to overlook parental rights, acquired wisdom, and parental judgments in favor of an increasingly impersonal and inappropriate one-size-must-fit-all 'medical parenting science'" (p 29). There is not evidence that babies put to sleep in cribs are safe and the focus of research has not been to identify how cosleeping may be made safer. For many reasons, providers are hellbent on separating mothers from their babies in spite of mothers having shared beds with their little ones for most of human history, covering hundreds of thousands of years.
Why Might We Consider the Advantages of Bedsharing?
Human infants are born more helpless than any other animal species. Most mammals are born with 60 to 90% of their adult brain size, yet humans are born with just a quarter. They remain in a biologically dependent state for the longest period of time, so much so that the mother's body helps them to regulate their own body temperature, even heart rate and respirations. Momma's milk offers them antibodies to protect them from the environment, that they can't quite make on their own yet. They are so vulnerable, and so dependent, that they essentially move from the placenta to the breast to finish their gestation. Consider then that all primate infants biologically expect to be in close contact and proximity with their caregivers, so certainly this seems even more appropriate for human children.
Imagine, you're living many generations ago, a hunter and gatherer, and as you lay down to sleep in the wilderness, in your tent, you question if it is safe to lay your child down beside you. In spite of predators among the trees or the freezing temperatures late into the night, and in spite of needing to feed the child through the night from your breast, it is believed to be safer to separate the child from the mother, from any adult in fact, and to leave it to sleep alone in the wild. Even questioning how to feed and where the child may sleep was not even part of one's mindset just a few generations ago.
Consider too that animals sleep in close proximity, if not belly to belly, with their parents which minimizes their crying and in doing so, minimize their being heard by predators. We know as well that when human babies cry, they raise their own cortisol levels, their own stress hormones. Crying also decreases oxygenation and increases heart rate which in turn augments cortisol further. There is evidence that teaches that elevated levels of cortisol in infancy can cause physical changes in the brain, which prompt greater vulnerability to social attachment disorders. Crying consumes a great deal of energy as well, which could be better spent promoting growth and development.
The benefits are many, far too many to list here, but know too that the highest occurrence of SIDS occurs at 3 months of age, when babies start to sleep longer and deeper through the night. Breastfeeding and bedsharing is protective of this because milk doesn't allow for as deep of a sleep, so the infant wakes more frequently to nurse. Mother exhaled carbon dioxide stimulates breathing, and even the brain matures differently because of this contact. Bedsharing helps to regulate temperature, breathing and heart rate in the infant so again, this is innately protective. Mothers have less anxiety when they lay skin-to-skin with their infants as well, improving their ability to mother.
What Concerns Arise Regarding Bedsharing and Cosleeping?
Sudden Infant Death Syndrome (SIDS) was first cited in the literature in 1963 during the time when artificial human milk became the overwhelming norm and infants began sleeping in their own beds, in their own rooms, along with more and more mothers smoking before and after their pregnancies.
We now know that prone sleeping and smoking pose the greatest risks to the safety of sleeping babies. Babies who are fed infant formula die either from SIDS or from some other congenital abnormality or illness at higher numbers than those who are breastfed. We also know that babies who do not share rooms with their parents, but instead sleep alone in their own rooms are twice as likely to succumb to #SIDS. The closer babies sleep to their mother, the safer they are. Interestingly, in Asian cultures or tropical cultures, where cosleeping and breastfeeding (and low smoking rates) are the norms, SIDS is a foreign concept.
"Our culture's emphasis on independence, individualism and self-reliance has helped drive the ideology that babies should sleep alone," states McKenna (2007, p 32). Without any supportive evidence, this conclusion has essentially forced vulnerable babies to be separated from those that were intended to keep them safe.
How Does One Bedshare Safely with Their Little One?
Families will practice cosleeping and bedsharing differently, but McKenna recommends with confidence that babies should sleep in the same room as the parents for at least the first six months. Not all families should bedshare. This practice does require mindfulness.
Babies should sleep on their back. Sleep on a firm mattress with tight-fitting sheets. Baby's face should not be covered, or risk being covered, by pillows, blankets, stuffed animals, siblings or pets. The sleeping environment should be smoke-free, even nicotine-free. If momma smoked during pregnancy, or smokes now, she should avoid bedsharing and a smoking father, should not sleep with a bedsharing mother and child.
The greatest risk to bedsharing is not a parent rolling on top of the child and suffocating the child; rather, the greater risk is the child becoming strangled or becoming wedged or trapped between a wall or a piece of furniture and a mattress, or between the head frame, headboard or footboard and the mattress. Pull your bed away from the wall; don't assume pushing it against the wall will protect them. I did have a client wear a nightgown with a thin waist belt to bed and her child was strangled by the seemingly benign strap; the child did survive but there were marks on the little one's neck and significant freight in all.
If you are bedsharing or breastfeeding, the thermostat should be a bit lower because your own body heat will warm up your little one and excessive warmth increases their risk of SIDS. Don't overdress babies as well, no matter where they sleep. Light blankets are best and little sleeping suits are great options for infants.
Cosleeping should not occur on the couch, recliner, or any surface other than the bed with a firm mattress. Using a baby in a cradle or cosleeper beside the bed is a safe option when bedsharing isn't a safe option. No waterbeds. No folded mattresses. No alcohol. No drugs. And babies should not sleep in an adult bed when there is no adult in the bed.
Questions? Feel free to ask in the comment section below. This is a controversial topic, but one that is quite clear in the literature. This argument is not about being unclear on the evidence, but rather, social rule. The facts are that the closer the baby is to its mother when sleeping, the safer the child.