My second baby slept in bed with me, all night, every night, from the time we took her home from the hospital until she was 3 months old. At first, I was almost too terrified to fall asleep, for fear that I would roll over and suffocate her.
After all, nearly all major medical organizations warn against bedsharing, on the grounds that it increases the chances of Sudden Infant Death Syndrome (SIDS).
“The safest place for your baby to sleep is in the room where you sleep, but not in your bed. Place the baby’s crib or bassinet near your bed (within arm’s reach). This makes it easier to breastfeed and to bond with your baby,” according the The American Academy of Pediatrics.
Statements like these sound definitive. But, in fact, considerable scientific controversy surrounds the role of bedsharing in SIDS.
Prominent researchers like James McKenna, for example, advocate bedsharing as a way to make breastfeeding easier on mothers. McKenna claims that bedsharing in the absence of other hazards, a practice he terms “breastsleeping”, does not increase the risk of SIDS, and makes it easier for women to maintain their milk supply and to practice extended breastfeeding.
No one disputes that bedsharing is unsafe under the following circumstances:
- if the mother smokes, drinks heavily, or abuses other drugs
- if the baby was born with a low birth weight or prematurely
- if the baby is co-sleeping with someone on a chair or couch, or with a sibling
- if the baby is bottle-fed instead of breastfed
Instead, the debate boils down to two questions:
- Whether bedsharing is always unsafe, or only unsafe when other risk factors for SIDS–like alcohol or drug abuse, smoking, and bottle feeding–are present.
- Whether bedsharing is unsafe on normal sleep surfaces, like a mattress, or only on other surfaces, like sofas and rocking chairs.
Here’s my take on the evidence, and why I ultimately felt comfortable sharing my bed with my daughter.
1. When no other major risk factors for SIDs are present, the absolute risk while bedsharing is very low.
In 2006, a large review of SIDS research found that bedsharing was clearly dangerous if the baby’s mother smoked, drank excessively, or abused drugs; whether bedsharing raised the risk of SIDs when these other factors were not present was unclear. It seemed possible that bedsharing might be risky for very young infants, under 8 weeks of age.
Following up on this review, in 2013, Robert Carpenter of the London School of Medical Statistics led a meta-analysis of 5 case-control studies.
(Because randomized controlled trials are infeasible for something like SIDS, researchers must rely on observational and case-control studies. Case-control studies typically interview parents to compare the circumstances and characteristics of infants who died from SIDS (cases) with those of similar infants who did not die from SIDS (controls). Factors found more often, statistically, among cases than controls are assumed to influence the risk of SIDS)
Carpenter’s goal was to assess the independent risk associated with bedsharing–whether bedsharing increased the chances of SIDS even under “ideal” circumstances: a baby sleeping next to only a breastfeeding mother who does not smoke, drink, or abuse drugs.
For infants under 3 months of age, Carpenter found a 5-fold increase in relative risk for bedsharing, even under “ideal” circumstances, when compared to sharing only a room. Despite the increase in relative risk, the absolute risk of SIDS for this population remained very low: roughly 2 out of 10,000, a rate substantially lower than the 9 out of a 10,000 for the US as a whole.
2. But for infants 3 months and older, case-control studies find no increased risk of SIDS, in the absence of other risk factors. Carpenter found no evidence that bedsharing alone raised the risk of SIDS after the age of 3 months. An additional 2014 meta-analysis of 2 case-control studies, led by Peter Blair, actually found a reduced risk of SIDS for infants older than 3 months who shared a bed with their mothers.
Why was Blair’s meta-analysis one of the few to find a significantly reduced risk for older infants? Perhaps because his was one of the few studies to carefully distinguish co-sleeping on a mattress from co-sleeping a sofa or chair. This matters because co-sleeping on sofas and chairs is a large and undisputed risk factor for SIDS. Co-sleeping on a couch or chair raised the odds of SIDs 18-fold, in Blair’s research.
(Blair also found no statistical increase in risk for infants younger than 3 months. But, the there was a trend towards a higher risk, which approached statistical significance. Considering this fact, and that numerous studies find that bedsharing with very young infants, especially before 8 weeks, slightly increases the risk of SIDS, I am inclined to chalk up this null finding to inadequate statistical power.)
3. Bedsharing, on its own, has far less of an impact than other risk factors for SIDS. Surprising, isn’t it? Considering that not bedsharing, along with putting your baby to sleep on its back, is the focus of so much SIDS advice given to parents. But bedsharing on its own is in fact far less risky than stomach sleeping or having the misfortune of being the third child, and only slightly more risky than having your baby sleep in a separate room. And how often are we parents warned against having our babies sleep in a separate room?
But let me stress again that bedsharing significantly heighten the risk of SIDS when other dangers are present, like maternal smoking, alcohol or drug abuse, prematurity or low birth weight, and bottle feeding. Bedsharing with a mom who smokes is far worse than just the combined risk of having a mom who smokes and having a mom who bedshares. Bedsharing makes having a mom who smokes or abuses drugs many times more risky than it would be otherwise.
This makes sense. Sleeping next to an impaired adult who could easily roll over on a baby is extremely dangerous. No one who smokes, abuses drugs or alcohol, or who does not breastfeed should ever share a bed with a baby.
Some Concluding Thoughts…
Bedsharing worked for me, but is clearly not for everyone. Not everyone can sleep comfortably with their baby, and, as many mothers report, infants who share a bed may wake up more often than infants who sleep in a crib.
For me, the decision came down to a potential slight increase in the risk of SIDS in the early months versus the collateral risks of severe sleep deprivation.
When my first child, a boy, was a newborn, I did not bedshare. During those early months, I could barely perform even the most routine tasks, like going to the grocery store or holding up my end of a casual conversation. Every time I drove a car, I felt like I was putting my life–and the lives of everyone else on the road–at risk.
As out of it as I was, I constantly worried that I would trip and fall while carrying my son, or fall asleep while holding him on a sofa or chair–a huge risk factor for SIDS.
So, with my second child, a girl, I bedshared from the day I brought her home from the hospital. Bedsharing while she was a newborn kept me sane and comparatively–very low expectations here–well-rested.
When my newborn daughter woke up in the middle of the night for the umpteenth time, I just rolled over, latched her on, and fell back asleep. This was so much easier than having to wake up fully, stand up, pick her up from her crib, struggle stay awake until she was done breastfeeding, and then put her back down in her crib–assuming that all this movement did not startle her back awake.
By planning to bedshare–as opposed to bedsharing haphazardly, sometimes unintentionally, and frequently out of sheer desperation–I was able to follow the best guidelines on making our sleep environment as safe as possible. I removed all blankets and extra pillows, and had no one but me with my daughter in the bed.
Given the evidence, do I think I slightly increased my daughter’s chances of SIDS? Perhaps. But sometimes when we try to reduce the risk of a rare but horrible outcome like SIDS to zero, we unintentionally raise the risk of others, such as severe sleep deprivation, postpartum depression, and car accidents.
After all, life is risky. Crossing the street is risky. Riding a bike is risky. Getting in a car is risky. Yet, I plan on my children doing every one of those things, often.
As parents, we have to weigh the risks and benefits of every decision. This is why, as parents, we need to understand the actual risks involved in the choices we make for our children.