I have touched upon co-sleeping in previous posts but it definitely deserves a post on its own. I want you all to have all the facts to be able to make your choices & safely sleep however you need to in order to get the rest you all need!
"When done safely, mother-infant cosleeping saves infants lives and contributes to infant and maternal health and well being. Merely having an infant sleeping in a room with a committed adult caregiver (cosleeping) reduces the chances of an infant dying from SIDS or from an accident by one half!" - Dr James McKenna *4
It is important to say that Co-Sleeping is an umbrella term that can and has included: room-sharing, bed-sharing, & couch/chair-sharing. Oftentimes, when cases of SIDS or SUIDs occur in co-sleeping situations, it isn't specified in which of these specific situations it occurred. For the remainder of the post, I will use co-sleeping to discuss bed-sharing in particular.
Why we sleep together
According to Dr James Mckenna, a professor of anthropology and the director of the Mother-Baby Behavioral Sleep Laboratory at the University of Notre Dame, "human infants are still born the most neurologically immature primate of all, with only 25% of their brain volume." This is an extremely unique characteristic and we continue to develop through constant contact and closeness to our mothers.*4
In other words, this is most likely the reasoning behind why, even if we didn't want to share a bed with our babies, they end up in our beds anyways no matter the amount of times we've heard how dangerous it is to co-sleep. Dr Mckenna states that infants cry less and sleep more when sleeping with their mothers because it makes them...happy! While some amazing infant-mother responses occur as well. Just being close to mom and her smell, movement and touch has been proven to reduce crying and regulate the baby's "breathing, body temperature, absorption of calories, stress hormone levels, immune status, and oxygenation."*4
Dr Mckenna states that it is good for an infant to sleep next to their mothers, unless it is practiced dangerously.*4 I will go into this below.
Safe Co-sleeping & what it looks like
I have stated this thousands of times and I will say it here as well - Babies should sleep in a clear, empty sleep space. This is easy to do in a crib, bassinet, sidecar style crib or basket. But I can't feel good about just telling families to do that when the majority of families also bed share or co-sleep for many reasons for some, most or all of the night (cultural choices, just being tired, etc). What I can do is make sure families know how to make bed-sharing safer whether you fall asleep on accident or choose to co-sleep full time. The Lullaby Trust's tried and true advice on safe co-sleeping with your baby is:
Keep pillows, sheets, blankets away from your baby or any other items that could obstruct your baby’s breathing or cause them to overheat. A high proportion of infants who die as a result of SIDS are found with their head covered by loose bedding.
Follow their other safer sleep advice to reduce the risk of SIDS such as sleeping baby on their back.
Avoid letting pets or other children in the bed
Make sure baby won’t fall out of bed or get trapped between the mattress and the wall*1
When not to co-sleep
Co-sleep isn't always a great idea. If it isn't sustainable, mom isn't getting any rest, baby isn't getting any rest, baby bottle feeds either breastmilk or even more so formula (more on this later!). There are also instances where it can be very dangerous:
Either you or your partner smokes (even if you do not smoke in the bedroom)
Either you or your partner has drunk alcohol or taken drugs (including medications that may make you drowsy)
You are extremely tired
Your baby was born premature (37 weeks or less)
Your baby was born at a low weight (2.5kg or 5½ lbs or less)
Never sleep on a sofa or armchair with your baby, this can increase the risk of SIDS by 50 times
You should never sleep together with your baby if any of the above points apply to you or your partner.*1
Breastfeeding mothers have a completely different way of sleeping with their babies and this is fundamental. The natural position is to make a c shape around the infant. The infants head is tucked under mom's arm so baby's face is aligned with the breast and baby's head isn't close to the pillow (see photo below!). The baby naturally lays onto their back once they've finished suckling, so there is little to no worry that baby will roll onto their stomachs.
Breast feeding and co-sleeping almost go hand in hand. Mothers provide the sleep hormones for baby through their milk and sleep cycles become in sync. Infants suckle often throughout the night and the proximity of mom allows for mom to rest while baby gets the nutrition they need. Breastmilk is easily digestible and frequent night feedings is known to help prevent SIDS.
So positive aspects from breast-sleeping are:
The baby will most likely always lay on their back
Mom and baby tend to face each other
Mom and baby are easily awoken if/when necessary
Baby's head is below the pillow, across from breast
Sleep cycles and cortisol levels are in sync *3
Just to reinforce this, here is an important finding from Dr James McKenna and Dr Helen Ball - "For breastfeeding mothers, bedsharing makes breastfeeding much easier to manage and practically doubles the amount of breastfeeding sessions while permitting both mothers and infants to spend more time asleep. The increased exposure to mother’s antibodies which comes with more frequent nighttime breastfeeding can potentially, per any given infant, reduce infant illness. And because co-sleeping in the form of bedsharing makes breastfeeding easier for mothers, it encourages them to breastfeed for a greater number of months, according to Dr. Helen Ball’s studies at the University of Durham, therein potentially reducing the mothers chances of breast cancer." *4
We also need to consider those babies that are formula fed.
You may be asking, why is formula feeding not safe for co-sleeping?
Formula, that is made of cows milk, is higher in protein and for this reason babies tend to sleep deeper, longer stretches. This poses a threat to the infants well-being and safety as they may be in such a deep state of sleep that they do not wake in case of danger.*2 Therefore, it is strongly recommended that bed-sharing not happen if you are formula feeding with cow's milk formula. Why is this?
First let's think about the cows milk and the behavior of cows after giving birth. Generally, the mother cow can feed the newborn and leave them to sleep on their own. Calves are extremely mature when they are born - they can stand quickly after birth, they can sleep on their own, they begin to follow their mother to graze, etc. Like I said before, cows milk is made to be high in protein and fat allowing for longer stretches between feedings so the mother can be gone for long periods of time. Human infants are extremely immature when they are born and are vulnerable in the first years of life with high dependency. Infants are biologically wired to need to wake frequently for safety and for feedings. If a human infant is given the milk of a cow, it may behave like mom is not present and potentially not wake when it should.*2
These potentially dangerous aspects also tend to happen when co-sleeping with a bottle fed or formula fed infant:
Mothers tend to put their infant on a pillow
The likelihood that the baby sleep on their tummy is higher
Sleep cycles may not be in sync
Both mother and baby sleep may be deeper, making it hard to wake.
The combination of these factors highly increases the risk of SUIDs or SIDS.*3
Scared to Co-sleep in bed so we sleep...
It is so important to maximize family sleep in the first months of your baby's arrival. And this is a hard task in most cases! Because we have heard so many times how dangerous it is to sleep with our little ones, if we do end up in bed together, we are terrified and cannot sleep with them next to us. I hope that you have pulled some pointers from above if you do end up deciding to share a bed with your little one and this has made you feel a little bit more confident in your decisions. However, if you are like me (a light sleeper anyways!) then maybe co-sleeping just isn't for you! It is so important to consider how tired you are during those night feedings. If you do feel like you are going to fall asleep while feeding your little one and you do not want to feed in bed, I suggest you lay a yoga mat or something of the sort on the floor next to your little one's crib in case you do fall asleep. Please, under no circumstances, sleep with your baby in a chair or on the couch.
We are co-sleeping & want to continue to do so, but how can we night wean or just get more sleep?
Finding a balance to keep sleeping together but encourage a little bit more independent sleeping is a great option. There is no blanket answer to this but gentle strategies could include gradually stretching sleep intervals, working on how the little one falls asleep in the first place, and general sleep basics to help with the process. Just send me a note for more info! This can even be a precursor to ending co-sleeping as a first baby step.
We are stuck co-sleeping - how do we stop?
You have been sleeping with your little one, who is now a toddler (which feels like sleeping with a drunk octopus looking for its car keys) and you feel like the situation isn't sustainable for your family any longer. You would like maybe to have your space back to be intimate with your partner or just don't want to be hit in the face by flying tentacles. I get that! There are so many gentle ways to move your little one from your sleep space into their own sleep space but so many different aspects go into this move! I wish there was a blanket answer that I could just give you on the fly but each child is different, each family situation is different and both of those aspects need to be considered and respected before making the leap.
When should we stop?
You know your family best and what is realistic. We need to consider sleep associations and the future first and foremost. Some questions you need to ask yourself - Will your child always need someone next to them to fall asleep? Do you want to be co-sleeping well into their teens? Do you want your child to be able to go to sleep overs with friends or to their grandparent's house? How can you see that happening if they need to you sleep with them? Maybe once you have night-weaned is the time to make the transition? Maybe you'd like to continue night feeding but would like your own space while keeping baby in the same room? There are so many options and strategies that can be adapted to your parenting style and created to sustain a secure bond with your child while creating independent sleepers!
Please send me an email or give me a call and I would love to help walk you through different ideas and then eventually make a transition!
Dr Melissa Bartick: Bedsharing & Breastfeeding -- Horne, R. S., et al. (2004). "Comparison of evoked arousability in breast and formula fed infants." Arch Dis Child 89(1): 22‐25.
McKenna, McDade 2005 Ped Resp Rev; Ball 2006 Hum Nat 17(3