Sharing beds and sharing information with parents – Guest post by Emma Pickett, IBCLC

Photo with thanks to @tir_torresphotography

Emma is an International Board Certified Lactation Consultant and is listed on our Nurturing Birth directory – she has been working in breastfeeding support since 2005

Why is it that a double bed (preferably king-size) is the norm for married couples when it comes to sleeping?

Certainly some co-habiting couples choose other arrangements but generally we accept that couples who love each other usually want to sleep in close proximity. It’s not simply about sex because couples who each have double beds in separate rooms can do that too but we assume SHARING the bed is the expectation.

We expect people who love each other to want to be close at night time. It’s warm. It’s loving. It’s reassuring. It’s comforting.

And we’re talking about adults here who are quite grown-up and have had a handle on this sleeping business for a while.

But yet when it comes to teeny tiny new babies, we’re not entirely sure they’re allowed to have the same needs and desires.

These are teeny babies who don’t even realise they are separate entities from their mothers. Like any primate, they regulate their heart rate and respiratory rate when they are near their parents. Their stress hormones reduce. They also do a better job of keeping warm near someone else because babies have a big surface area for their body size.

They usually need to feed regularly through the night.

And if their needs aren’t meant, they can make a very loud noise that wakes everybody else up too.

But still we get messages that sharing a sleeping space with a baby is ‘accidental parenting’ and even ‘dangerous’.

Some parents are getting these messages from their healthcare professionals directly. I spoke to a trainee breastfeeding counsellor this week who wondered if she was ‘allowed’ to talk about co-sleeping. It’s an area she’s nervous about. I’ve also spoken to parents who do bed share but were keeping it a secret and overtly lying when asked about sleeping arrangements by people who were supposed to be supporting them.

Why are people nervous?

It’s true that in the presence of some risk factors, sharing a sleeping space with a new baby (particularly a very small or premature one) can raise some issues. And to be fair to healthcare professionals, they often get taught about the worst case scenario. We know that smoking is a problem. If a mum smoked in pregnancy, if she does now, if her partner does now (and smoking doesn’t have to happen around the baby), then co-sleeping is a riskier activity.

We also know that the use of drugs and alcohol alongside co-sleeping can be a problem.

We also know that when families don’t breastfeed, there are greater risks to bed sharing.

So if those risk factors are not present, if a baby is breastfed and parents are aware of how to create a safe sleeping space (the book ‘Sweet Sleep’ published by La Leche League is great for this), we can genuinely feel more relaxed.

Japan is a country where co-sleeping is the norm, maternal smoking rates are very low and rates of exclusive breastfeeding are high.

As SIDS researcher James McKenna describes:

“Japan [has] one of the lowest SIDS rates in the world (between .2 and .3 babies per 1000 live births compared with approximately .5 per 1000 infants for the US). The Japan SIDS Family Organization reported that SIDS rates continue to decline in Japan as maternal smoking approaches practically 0, and exclusive breastfeeding reaches around 70-75 % … One report shows that as bed sharing and breastfeeding increased and as maternal smoking decreased, SIDS rates decreased. This suggests yet again that it is not necessarily bed sharing, but how it is practiced, that can be dangerous.”

Some surveys in the UK suggest that bed sharing among breastfeeding families can also reach these levels but without cultural acceptance, parents may not be getting the information they need to help them to create the safest environment possible.

Why else are people nervous?

Because they think they ‘shouldn’t do it’, not for safety reasons, but because it makes their own lives harder and reduces their own sleep in the long term. It’s not what ‘you’re supposed to do’.

New parents genuinely worry that they will ‘never be able to get their baby out of their bed’. Or ‘the baby won’t sleep as well’. Or they won’t sleep as well.

These worries come from powerful messages from older generations and a lot of popular baby care books. They have ‘failed’ if a baby comes into their bed. They have ‘succeeded’ if a baby sleeps separately in a different space. They are ‘being naughty’ when a baby comes into their bed and everyone falls asleep together.

First off, it’s important to note that when safe co-sleeping happens, everyone gets better sleep. Research by Quillin and Glenn in 2004 concluded that: “More sleep was obtained when breastfeeding mothers slept with the newborn. Methods or devices that allow breastfeeding mothers and newborns to sleep next to each other in complete safety need to be developed.” It might be that babies and mothers sometimes rouse each other at night but it appears that good quality deeper sleep happens when mothers have their sleep cycles in greater sync with baby. It’s also important to note that a baby sometimes rousing (which isn’t the same as full waking) may have protective properties against SIDS.

What seems to happen if parents feel they shouldn’t bed share is that breastfeeding mums are deprived of that vital life skill – learning how to breastfeed lying down. I’ve spoken to mums who are actually scared to do it. They are scared of falling asleep (which is what nature assumes you will do as mums also receive the sleep-inducing oxytocin when they breastfeed). Rather than responding to what is happening, by creating a safer sleep space, they often go and sit up somewhere.

I know mums leaving the bedroom, flicking on lights (even though they sort of know that doesn’t help sleep patterns) AND moving to sofas. And in the years I’ve been supporting breastfeeding mums, plenty of them are then STILL falling asleep on these sofas.

I’ve talked to mums who’ve fallen asleep in rocking chairs, armchairs, sitting up in bed. The baby was in their arms and sometimes on a breastfeeding pillow and a while later the mums comes to a start to realise they’ve fallen asleep while feeding. I’ve spoken to mums who woke as baby was rolling out of position and mums who didn’t and woke up to find the baby where they shouldn’t be. I think I get these ‘confessions’ because I’m not the health visitor or the midwife or the GP.

And every time I speak to a mum who says she was ‘told’ not to co-sleep, I feel like screaming.

Because a safe bed sharing space is the preference in every bit of research over falling asleep with a baby on a sofa.

If you want to be scared about something, be scared about falling asleep sitting up while feeding.

It’s not going to be as safe as when a mum learns to breastfeeding lying down according to all the guidelines. When a mum lies next to her baby, she takes up that protective side lying position. She’s thought about her bedding and baby’s clothing. And when baby has finished, they roll onto to their back (on the safe mattress where the nearby environment has been carefully considered).

The ‘Sweet Sleep’ book talks about assuming bed sharing might happen even if you weren’t expecting it to. We know that the majority of breastfeeding parents do end up bed sharing in some form so that seems like a safe assumption.

We buy infant car seats because of the teeny risk something might happen. Why not create a safe bed sharing space on the teeny chance that happens too?

As a breastfeeding supporter, I know that mums who sleep near baby are more likely to breastfeed for as long as they want to. Research from this year led by Professor Helen Ball concluded that, “Significantly, more women who bed-shared frequently were breastfeeding at 6 months than those who intermittently or rarely/never bed-shared.” It might be that those who are passionate about making breastfeeding work are more likely to breastfeed but the link is there.

In my own story, I started out being one of the mums who ‘thought they shouldn’t’. That lasted less than a week when it was clear my first child felt otherwise.

When mums do have reasons to not want to bed share and they still desperately want to breastfeed, what can help them to make it work?

They may still benefit from learning how to breastfeed lying down. They then may use strategies to ensure baby gets back to their own sleeping space. I know one mum who held a ping pong ball under the arm that supported her head while she fed as she found she was kept awake by holding onto it!

These might be the mums that benefit from more support in the day to allow them to nap or support in the evening to allow them to go to bed when baby does (or even before baby does in some cases). These are mums that need to know that keeping baby as close as possible and sleeping in the same room is still the aim for at least the first six months, even if they are not going to be bed sharing.

Our job as lactation consultants, breastfeeding supporters and doulas is to give families the best information and support them to come up with solutions that fit their own situations. We are the ones who sometimes have the time to talk about sleep choices in much more detail and we mustn’t shy away from having honest conversations with parents. Parents need to feel they can talk about what is really happening at night. They can then get the right information to make the choices right for them. At night, we don’t always end up making conscious choices so we need to create the safest environment possible to fit all the options. Talking about bedsharing is nothing we should be nervous about.

Baby Sleeping Through the Night?

I was just scrolling through my junk emails this evening and came across one from the retailer Next – “Baby milestones – Celebrate their memorable moments and more”. The main image is of the most adorable baby wearing a long sleeved vest emblazoned with “I slept through the night”. It made me want to cry.

Today was the third day of the Nurturing Birth Doula Course with a fabulous group of women on their way to becoming doulas. We were looking at many aspects of postnatal care, but particularly at the pressures new mothers face. One question I hear time and time again in my work with new mothers, from their mummy friends, relatives and even well-meaning strangers is “Is your baby sleeping through the night?” It is as if that is the holy grail of parenting – anything other than sleeping through the night represents MUMMY FAILURE! And we can’t be seen to be failing – we have to be getting it right all the time. So, what does “sleeping through the night” mean?

When I had my first baby almost fourteen years ago I thought sleeping through the night meant putting my baby down after his early evening feed and then not seeing him til morning. Something I had read, or heard, led me to believe that all babies will magically sleep for an unbroken 12 or so hours. Fantastic. Turns out that wasn’t what other people thought sleeping through to mean, nor was it what my baby did! When I started teaching baby massage groups I started asking mothers what they thought sleeping through the night meant. The range of answers was extraordinary. The vast majority viewed sleeping through as a baby going for an uninterrupted stint of about 7 or 8 hours – usually from about 11pm, so an approximation of an adult’s normal night. For some it was as short as four or five hours e.g. midnight to 5am, and one woman even told me that sleeping through meant her baby sleeping approximately 8 hours, but waking a couple of times to feed! It made me realise that a lot of women were potentially beating themselves up over something unnecessarily.

So, why the focus on sleeping through? Is it because we are concerned about our babies getting enough sleep? Or is it because sleep deprivation is so tough to deal with? Would it be easier if we recognised how babies sleep and adapted our lifestyle to suit for what is, after all, a temporary period in their and our lives? Babies don’t sleep in the same way as adults – they don’t develop circadian rhythms until at least 2-3 months old, and they are evolved to sleep much lighter, with the exception of one deep stint of sleep, which often occurs after cluster-feeding.

The specially-designed breastmilk which comes through at that early evening feed is designed to promote a deeper sleep – the composition of breastmilk changes across a 24-hour period, and even contains hormones designed to help the baby to settle. If a mother were to permit herself to go to bed around the same time as her baby she might benefit from one longer stretch of sleep before the baby goes in to the more regular waking pattern that often occurs through the rest of the night, which is totally normal. A recent study undertaken at Swansea University studied 6-12month old babies and discovered that the majority still wake up during the night and, contrary to popular belief, not just because they are hungry. Humans wake during the night – for a pee, for a drink, for a cuddle, because we are too hot, too cold or because we had a disturbing dream.

Perhaps Next should change the design of their baby vest to “I sleep like a baby” with a note on the back to explain “ I wake regularly at night, but enjoy daytime naps”. And perhaps there should be a design for mothers that says “My baby sleeps like a baby, so come and feed me, clean my house and watch him/her whilst I have a daytime nap!” And perhaps there could be a design for partners/doulas that says “She sleeps with her baby so I’ll be cooking her a meal, tidying her house and watching her little one so she can catch up on some zzzz!”

For sleep-deprived parents, or those who need more feeding support, then visit the Nurturing Birth Directory and search for doulas, night support or feeding www.nurturingbirthdirectory.com

For more information about becoming a doula visit www.nurturingbirth.co.uk

The myth of the “late” baby

A big shout out to the gorgeous @coral.atkinson who shared this photograph of her pregnant belly on Instagram yesterday in the hope that it is the last she posts before the arrival of her third baby. She says, “Today I reached my due date, I was an emotional wreck all morning, gutted that even third time around I couldn’t have a baby before that milestone. I feel like hiding away in a darkened room.”

There is something very wrong with our medical system if women feel like failures if they haven’t birthed their babies by a due date, commonly known as an EDD (Estimated Delivery Date). Crucially, we need to recognize that the date is an estimation, a guess date – plucked from somewhere in the range of 37 and 42 weeks, those dates being the point at which pregnancy is considered full term. Other countries choose different dates – France has long considered 41 weeks to be the guess date for birth, and that sits far better with us given that 65% of women will sail past their UK EDD without the first sign of a twinge or show.

Babies arrive in their own sweet time – women gestate for different lengths of time – and are rarely “late”. Babies are born when their bodies, and particularly their respiratory systems, have matured. Research last year finally proved what people had believed for a long time, that components in the surfactant produced by the baby’s lungs enter the mother’s system and triggers the labour process to start. It is a beautiful symbiosis between mother and baby – two bodies working together. The process doesn’t need to be kick-started unless there is a medical reason for induction and there is little evidence to show that the stretch and sweep which is so routinely offered to mothers as they pass 40 weeks does anything beneficial at all.

So, how could we make that time at the end of pregnancy easier? What would make women feel better about themselves and more positive towards their babies? Would it help if this pressure to perform by a particular date was removed? Could we give women a due window, an estimated due month or a best-before date for birth? Is there a way that we could nurture, support and empower women in these last days and weeks to feel that they are right where they need to be, without the emotive words “overdue” and “late” hanging over their heads? If you’ve got any brilliant ideas about how we can change the current state of play we would love to know!

We send all our best wishes and birthing vibes to Coral as she heads towards the birth date and hope, for her sake, that Baby Three decides to come soon!

For more information about Nurturing Birth doula courses visit www.nurturingbirth.co.uk

To find doula support or any other pregnancy/birth/postnatal/feeding services visit www.nurturingbirthdirectory.com