Monday, October 12, 2009

Co-sleeping,Bedsharing, or putting baby to sleep in the nursery... Which do I choose?

Many a mothers, grandmothers, fathers, aunts, doctors,and pediatricians feel strongly about this topic : Bed sharing/ co-sleeping / baby sleeping in their own room. I asked on my Facebook what people thought of this. What guided them to make the decision that best suited their circumstances.

Let us first define for clarification what is :

Co-sleeping :Baby in the same room/ in a side car attached to the adult bed
Bed-sharing: Sleeping in the same bed as mother
Baby sleeping in their own room : Self explanatory

Here are some responses :

  • In the same room is Ok but I think in the same bed could be not safe. New mom's are so so tired and a little one could suffocate easily.
  • I couldn't imagine not sleeping with my little ones. I've co-slept with all three from birth. There are ways you position yourself to make it impossible to turn over.....and when nursing you are so in tune to your baby, you know when they are moving around and just roll over to nurse. Both mom and baby sleep better and babies are able to thrive. I think it's one of the most important things for mom and baby especially.
  • Well, one thing I do know is that once you let the baby sleep next to you in your bed, he will want to sleep that way well into his childhood, but then again, sleeping in the same room would also be conducive to baby waking up and parents putting the baby back to sleep in their bed.
  • we love sleeping with our baby!!! it's easier to breastfeed through out the night,u just put her on in the sideways position and fall asleep next to each other and she's more likely to stay asleep all night that way instead of in her crib..... i know i couldn't put my baby in a seperate room I wouldn't be able to sleep all night, even if she's in her crib beside my bed i don't sleep cause I keep peeking in to see if everything's ok!  but of course, i don't recommend sleeping with your baby if you know you move a lot and could possibly roll over your baby!
  • Co-sleeping if you have only a queen bed. Especially if you like a lot of space. Though I often found myself accidentally bed sharing because I would fall asleep while nursing and not wake till the next nursing session.

    I've heard so many people say  "I know a mom/dad who put their baby in their bed to sleep and rolled over on the baby" . Or you hear " There was this mom who was nursing her baby at night in her bed, and her breast smothered the baby and it died". While these accidents are sad and true and it certainly cannot be excluded that these things can happen when you bed share with your infant, how many incidents are there out there about a baby dying in their crib because the blanket that was not supposed to be there suffocated or overheated the baby, or the stuffed animals that don't belong in the crib to begin with, smothered the baby when they rolled over on it. Or the newborn infant that was put to sleep alone in his crib, crying his eyes out to no avail of getting their sleeping parents' attention and died in the middle of the night.These are accidents that occur but are conveniently not peddled around

    But now you must wonder, what do the statistics say? What does the current evidence available prove? All you hear from the American Academy of Pediatrics is, no bed sharing, bed sharing bad, bed sharing NO NO. Here are the facts - just the facts.

    Statistics taken from a friend's blog : 

    The Consumer Product Safety Commission (CPSC) and the Juvenile Product Manufacturers Association (JPMA, the crib manufacturers' lobby) recently launched a campaign to discourage parents from placing infants in adult beds or sleeping with them, based on data showing that infants have a very small risk of dying in adult beds.1,2 The CPSC implies that infants in adult beds are at greater risk than infants in cribs, but as we know, and as they know, babies also die in cribs. What we need to do is calculate the relative riskiness of an infant sleeping in an adult bed versus a crib. We can do that by dividing a measure of danger for each situation by the prevalence, or frequency, of that situation, and then comparing them. (Oddly, the CPSC never presents relative risks.) Using government figures, we can perform a rough calculation to show that infants are more than twice as safe in adult beds as in cribs. This is aside from the many other advantages of co-sleeping or bed sharing, such as increased breastfeeding and physiological regulation, the experience of having slept well, parents' feeling of assurance that their child is well and happy, the enhanced security of psychological attachment and family togetherness, and family enjoyment.3
    Let's begin by looking closely at the CPSC data. The anti-cosleeping campaign is based on a dataset that contains the 2,178 cases of unintentional mechanical suffocation of US infants under 13 months old for the period 1980 to 1997. CPSC-authored articles about these data reflect only the small portion of deaths that occurred in adult beds.4 However, these data also have been published with summaries of the cause-of-death codes on all 2,178 cases.5
    Of these 2,178 infant suffocation deaths, we are certain of only 139 occurring in an adult bed. For 102 of these, we know that a larger person (presumably a sleeping adult) was present, because the cause-of-death code is "overlain in a bed." That does not tell us exactly what caused the death-that is, whether the baby died and then was lain on, or died as a result of being lain on. We can assume that the 37 deaths involving water beds occurred in adult beds, since few child water beds exist. That gives us a total of 139 infant suffocation deaths known to have occurred in adult beds in these 18 years.
    The same data show that 428 infants died due to being in a crib. It is likely that there were preventable risk factors (such as using a crib in need of repair) involved in these crib-related deaths. But that doesn't change our calculations, because the deaths did occur. Similarly, our calculations do not change due to the preventable risk factors (such as intoxication) involved in adult-bed deaths (and other overlying). Note that advocates are raising public awareness to increase the safety of both these sleeping arrangements, with the hope that all these deaths will decrease.
    We can't use the other 739 bed- or bedding-related cases in our analysis, because the place of death is not specific enough; these deaths may have occurred in a large adult bed, a single-size adult bed, a child's bed, or a misused crib. Nor can we include the remaining 760 deaths, as we have no idea whether they took place in a sleep situation at all. We also know nothing about the presence or absence of an adult, although a nearby, aware caretaker could have prevented many of these deaths.
    So for only 567 (139 plus 428) of the deaths do we know whether they took place in an adult or infant bed. Thus, from 1980 to 1997, 75 percent of the mechanical suffocation deaths of US infants with a known place of occurrence took place in cribs, while 25 percent took place in adult beds.

    While it is tempting to make the observation that three times as many babies died in cribs as in adult beds, if three times as many babies were actually sleeping in cribs as in adult beds, the risk would be the same in either place. Based only on this crude death-certificate data, we do not know which is safer. We still need to know how many babies were actually in adult beds or cribs-that is, an estimate of how common co-sleeping was.
    To estimate co-sleeping prevalence, we can turn to the CDC's Pregnancy Risk Assessment Monitoring System (PRAMS).6 PRAMS has been surveying mothers of infants, usually between two and six months of age (but occasionally up to nine months), since 1988. Approximately 1,800 new mothers are sampled each year in each participating state. The sample is rigorously selected to represent essentially every birth in the state, and the response rates are high (70 to 80 percent). Most of the 100 or so PRAMS questions involve prenatal and well-baby care and stressors.
    States have the option of adding their own questions and have asked about co-sleeping. The basic question asked is, "How often does your new baby sleep in the same bed with you? Always; Sometimes; Never." (Some states add "Almost always.") PRAMS data, therefore, can be used to ascertain co-sleeping prevalence in participating states and may be the only data of this kind.
    From 1991 through 1999 (the most recent data available) we see that roughly 68 percent (100 percent minus the 23 to 43 percent who "never" co-slept) of babies in these states enjoyed co-sleeping at least some of the time. Data from the United Kingdom are similar: Helen Ball's Sleep Lab found that around 7 percent always co-slept, 40 percent did so for part of the night, and 33 percent never co--slept.6
    Now let's try to estimate a single co-sleeping prevalence rate from these data. Let's say that babies who "sometimes" co-sleep do so about half the time. Over all the years of this sample, around 42 percent of babies co-slept "sometimes." Let's also say that "always" or "almost always" means 90 percent of the time. Roughly 26 percent of infants co-slept "always" or "almost always." Adding "always/almost always" (90 percent of the time x 26 percent of babies) to "sometimes" (50 percent of the time x 42 percent of babies), we get 44 percent of babies ages two to nine months who were co-sleeping at any given time, presumably in an adult bed.
    Now we can use these figures based on CPSC and PRAMS data to calculate the riskiness of these two sleep arrangements, although it's important to understand the limitations of doing so. For example, these PRAMS data are from only five states (although more will be available in the future), while the CPSC data are from the entire US. The years in which the PRAMS co-sleeping data were collected are not the same as those covered by the CPSC dataset, although they overlap. The CPSC covers infants zero to thirteen months, while PRAMS asks about infants two to nine months. The CPSC collects demographic details such as state, income, race, and age of mother (as does PRAMS), as well as time of the death, but they are not easily available to do a more detailed analysis. One or both of these data sources lacks information on impairment of caretaker and other known sleep risk factors, exact sleeping and furniture arrangements during different times in the night, overcrowding and other motivation for co-sleeping or crib sleeping, clinical pathology findings, previous health of the infant, etc. Plus, a complete risk analysis should include all causes of infant deaths, including SIDS.
    Nonetheless, these data are important population-based sources of information on sleep risks that we would not have otherwise. So let's go ahead and use them to estimate a risk ratio for co-sleeping. We take the 25 percent of the suffocation risk in the CPSC data linked to being in an adult bed and divide it by the 44 percent of babies who were actually in adult beds. Then we divide that fraction by a similar fraction for cribs, i.e., 75 percent divided by 56 percent. (If we multiplied each of these fractions by an overall infant death rate, we would have the actual risk for each group.)
    This result shows that it was actually less than half (42 percent) as risky, or more than twice as safe, for an infant to be in an adult bed than in a crib. Based upon these calculations using the CPSC's own data, we can say that crib sleeping had a relative risk of 2.37 compared with sleeping in an adult bed.

    As we have read, bed sharing is not as un-safe as many deem it. However, when bed sharing, all the safety pre-cautions should be followed, such as, not smoking, or letting anyone sharing the bed smoke. Do not let the baby bed share with a person who is substantially obese, nor one who is taking any medications that cause sleepiness. Avoid loose bedding and fluffy puffy comforters as these may increase suffocation in the infant. Keep all pillows and pillow covers away from the infants face and body. (Yes, you can still sleep on a pillow)

    When a child is placed in their crib to sleep, this does not automatically exonerate them from all suffocation and SIDS incidents. Safety precautions should also be followed closely : Avoid covering the baby with a blanket. If room temperature is too cold, try either lowering the temperature or adding more layers to the baby's sleep-wear. A sleep sack is also a genius invention that allows you to "cover" your baby with a "blanket", so to speak, that will not even have the possibility of covering their face. I myself, co-slept with my daughter, she in her crib and I in my bed. I always put a blanket on her because the temperature was always very cold in the room. One night, for some reason I awoke to find the blanket on my daughter's face... in horror I quickly grabbed and pulled it off of her, and I swore to never use a blanket to cover her again! That was a close call and I hope it serves as a warning to all the moms reading this blog.

    Personally, I am against putting babies (especially under the age of one) to sleep alone in their room. There are so many benefits when you have your baby sleep next you to in a side car or on your bed. As was mentioned before, the baby's temperature and breathing pattern is regulated because the baby will mimic its mother's breathing. Many a moms note that when their babies sleep in their bed with them, even though they are in the deepest stage of sleep, they can feel and are keenly aware of any movement that the baby makes. Moms have this subconscious awareness of their baby. And because of this, it is implicated that babies can wake more easily from a prolonged apnea (episode when the breathing stops) which in turn, prevents and protects the baby from SIDS.Best of all, bed sharing, or having the baby in a side care attached to your bed, facilitates night time nursing, especially for moms with newborns that need all the sleep they can squeeze in.

    What's the conclusion of this article? Let the well-informed minds of each one of you make the decision based on facts, that best suites your situation.

    1 comment:

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