Sleep With Me, Baby
I never decided to sleep with my baby. Like many people who eventually sleep with their kids, specific sets of circumstances just seemed to demand it. Initially, it was while travelling with my now 1-year-old son. It was easier for him to be comfortable with strange surroundings if, when he opened his eyes at 3 or 7 a.m., he would at least feel, see and smell his parents.As Brendan got older and began teething, he started waking regularly in the middle of the night, and we'd bring him from his crib into bed with us; I'd nurse him and we'd all sleep together the rest of the night. Then later, at 10 months, he got a cold that left him waking in his crib three times a night, thirsty and struggling to breathe through a clogged nose. That's when co-sleeping started in earnest. We made up the futon in the study and took turns sleeping with him. (All three of us in one bed was a little crowded.) Now this half night in his crib, and half night with one or both parents is routine. He wakes once or twice during the night, nurses and falls back asleep.Many people who consciously plan or eventually choose co-sleeping find that nights with their children are filled with unique, intimate moments of communication, interaction and affection -- moments that leave babies and parents feeling more bonded, more connected, than if they had they spent the night apart. Sometimes after Brendan wakes during the night I massage him to help him relax and get back to sleep while he -- who incessantly motors about all day -- lies still. On one recent early morning I whispered a story to him recounting our visit earlier that day to a local farm, with animal noises and all. He quietly looked at me and at the ceiling, smiled slightly at the noises and fell back asleep. When he's awake for good -- anytime after 5 a.m. -- he usually announces this by crawling up my chest and planting a slobbery open-mouth kiss on my mouth before he goes charging off on all fours to attack the clock radio.But these aren't the kinds of shared-bed moments that make headlines. Last September, news reports featured the Consumer Product Safety Commission's recommendations that parents keep babies sleep out of adult beds. In May and October of this past year, Pediatrics magazine published articles warning of the dangers of children sharing beds with adults.The people behind these recommendations are immersed in the details of very different moments when children sleep with adults. Catastrophic moments.Sitting at his desk at Care House, a new, home-like facility designed to address the needs of child crime victims, Sgt. Thomas Flanders is as unequivocal as the poster that hangs behind him: "Babies belong in baby beds," it says, and he says so, too. Flanders heads the Infant Death Investigation Unit and sits on the Child Death Review Team, which was formed in 1996 to investigate and analyze why local children die and what, if anything, can be done to prevent those deaths."I would not advocate sleeping with an infant under any circumstances," he said. "I am absolutely against it and I can give you 22 reasons why."That's the number of cases in which the coroner's office has ruled that babies died of "overlay asphyxiation" -- or smothering as a result of someone laying on top of them -- over the past four years in my county. Flanders is as adamant on this point as his stories are horrifying.One couple, he recalled, was out drinking all night and came home to a crying baby. They wanted the child to be quiet so they put they baby in bed between them. When they woke up the next morning, there was no baby there. They started pulling off the covers and found the child: rolled up in a sheet at the bottom of the bed, smothered, dead.Another man who weighed well over 300 pounds was sleeping on a couch with a baby. He slept on the outside, thinking he was protecting the baby from rolling off. He rolled on to the baby, trapping the child between the seat and the back of the couch, smothering the baby to death."I've got a whole closet full of pictures of dead babies," Flanders said, pointing to a door in his office. As far as he's concerned they all testify to one thing: "Bed sharing contributes to killing babies," he said."Six minutes," Flanders emphasized -- six minutes of deep sleep on top of your baby is all it takes to kill the child. "Would you bet the life of your child that you wouldn't roll over on it and stay asleep for six minutes? I wouldn't," said Flanders.I couldn't answer the question that Flanders asked because it assumed that it would be physically possible to sleep on top of my child for six minutes. I can't believe that one minute would be possible. The night after I talked to Flanders and heard horrible descriptions of child deaths, I climbed into the futon to nurse and sleep with my baby as confident as ever that I posed absolutely no risk to him. Quite the opposite -- he was still congested and I wanted to be close to monitor his breathing and his temperature and to hold him upright when he coughed.When I told Dr. James McKenna, a biological anthropologist who specializes in the physiology of mother-baby sleep, of my comfort level, even after hearing grizzly police reports, he wasn't surprised. He said simply: "That's because he wasn't talking about you."McKenna, who directs the Mother-Baby Behavioral Sleep Laboratory at the University of Notre Dame, has spent hundreds of hours watching mothers and babies sleep together. It has been his field of study for 18 years and he has published between 40 and 50 peer-reviewed papers on the physiology of mother-baby sleep.In his lab, women and their babies have been hooked up to monitors that can measure their level of sleep and McKenna has found that, even in the deepest stages of sleep, mothers (sober, healthy mothers on safe sleeping surfaces) arouse in response to their babies within 15 seconds at the most. Further, research has demonstrated just how dramatically a newborn reacts to having its air supply cut off. In a cruel experiment done in the early '70s, which McKenna said would not be done today, a newborn baby's nostrils were stuffed with cotton while cellophane was held over its mouth for 20 seconds. The baby arched its head and put its arms straight out like a board and exerted considerable physical response. In a write up about the experiment, McKenna said, it was advised to have two nurses to hold the baby down because of the strength of its reaction."This is not a passive protoplasmic blob willing to have its air supply taken away," he said. "Newborns are capable of very robust and vigorous activities."Given this intense infant reaction, when a baby is suffocated by an adult in bed it implies two things, either a) there is something wrong with the adult who was sleeping with the child -- in addition to drug and alcohol use, obesity and depression can also contribute to adult lack of sensitivity to infants -- or b) the child was smothered intentionally.Katie Allison Granju, a published author on parenting issues, also discussed sensitivity to a sleeping child in an online article at Breastfeeding.com. "Parents who enjoy a family bed and doctors who advocate its use point out that the same internal signals that prevent a sleeping adult from rolling out of bed and injuring herself will also prevent a parent rolling on top of her infant." Again, this assumes a sober adult on a safe sleeping surface. Ask any co-sleeping parent and they'll likely say what I would: I've never fallen out of bed, and Iâve never woken up with so much as a hand or limb on top of my baby, let alone my whole body."These are unbelievably extreme conditions under which babies are dying," McKenna said of the overlying child deaths that police and coroners investigate. Many of the tragedies that occur involve "young, smoking mothers who are from incredibly depressed, challenged and disenfranchised communities." He understands how exposure to these cases can color the perspectives of those who work with them, but they are taking situations that are "inherently pathological and they are using them to ascribe generalizations to all situations," he said.Just as babies die in cribs because of unsafe conditions in those cribs, babies can die in beds because of unsafe conditions there. With cribs, though, the scientific community is eager to define and address the conditions that create the danger, said McKenna. But with co-sleeping, those conditions aren't discussed. The Consumer Product Safety Commission's recent report is an example of this, he said."In the vast majority of the cases cited in the two studies," he said of the data from which the CPSC developed conclusions, "these babies confronted their final hazard while sleeping alone. Yet they didn't conclude that the parent should be sleeping close to the child. Why wasn't that argued? Because it would never have occurred to them."With the crib, they go after the dangerous condition. With an adult bed, they don't discuss the conditions. They see the problems as unsolvable and inevitable. The act itself is the problem."Enter cultural bias, which is strong enough to overwhelm both science and common sense. Linda Smith, a local lactation consultant who has been a childbirth educator for 22 years, says the Western cultural taboo against co-sleeping can be traced to late 1800s England. "It happened at about the same time that doctors starting telling moms how to feed babies -- to do it on a schedule. The whole idea was to be more scientific -- to regulate the body like a little machine."When Western nations like Great Britain, the United States, New Zealand and Australia began adopting this more scientific approach to child rearing --scheduled feedings and naps, children sleeping in separate beds and rooms --they were departing from a global and historical norm. Two researchers, Herbert Barry and L.M. Paxson of the University of Pittsburgh, looked at the 173 societies for which sleeping information is available in the anthropological record. They found that 76 had a mother and infant sharing a bed, 42 shared a room but not the same sleeping surface, and the remaining 55 shared a room with the bed unspecified. No societies routinely put their infants in a separate room.This research was reported on in the book Childhood by Melvin Konner. A companion volume to a PBS series of the same name, the book gives a broad view of child rearing practices -- a perspective that makes our own cultural biases all the more obvious. When the author and others involved in this PBS series shared information about Western infant sleep practices with people in other cultures, isolated sleeping was frequently seen as neglectful, cruel even --as was the practice of letting babies cry without comforting them. The idea of pushing an infant to be independent, even if just while sleeping, frequently invokes pity -- for both the parent and the child -- among people of other cultures. And it's not just non-industrialized cultures. In Japan, the historic practice of the mother sleeping with children still stands as the cultural norm.But things could be changing in the United States. The La Leche League is one organization that has challenged the current norm and promoted co-sleeping as a means of enhancing breast feeding. Many co-sleeping families have read The Family Bed, published in 1987, and survey research in the '80s indicated a rise in American parents sleeping with their children. In spite of all the advice against it, particularly among doctors, 45 percent of parents from one Case Western Reserve School of Medicine survey said they allow their children in their bed, even if just for part of the night.McKenna saw evidence of this change recently in one of the introductory anthropology courses that he teaches. He asked the class of 100-plus students how many remembered sleeping with their parents. A full 60 percent raised their hands. McKenna said he was amazed at the change compared to even 10 years ago.Many contemporary American parents describe their decision to co-sleep as something that just felt instinctual -- it felt like the best, perhaps the only, way to monitor and protect their child during the night. This instinctual response is becoming increasingly tested by science.Linda Bradford, a nurse and midwife, lived through what most new mothers live in fear of during their child's first year of life: Her daughter, her first-born, died in her crib in the spring of 1968. She wasn't quite four months old. The death was diagnosed as SIDS -- Sudden Infant Death Syndrome.When she later gave birth to two sons, who are now 28 and 25 years old, she vowed to stay by their side through the night. "I breastfed and slept with my babies," she said. "I spent every minute I could with them." Like many women who have done this, she finds the idea of the mother's body "being some kind of gigantic wooden rolling pin" ridiculous.Bradford's response cannot be dismissed as an emotional reaction to a tragedy. Ever since SIDS statistics were compiled, researchers have been trying to determine why Western countries have the highest rates of these tragic deaths and why places like Japan have the lowest. While SIDS can happen to a baby in bed with her parents, SIDS rates are very low in places where co-sleeping is common.In his sleep research, McKenna found that babies who bedshare spend less time in the deepest level of sleep, but more time sleeping overall. They arouse more frequently, and breastfeed more frequently. This pattern -- while not maintaining the Western ideal of having a baby sleep through the night at a young age -- may be the most adaptive and beneficial sleep pattern, McKenna said, and may contribute to the child surviving its first year.Numerous cases where parents have saved their children because they were sleeping with them have also been reported. When I asked McKenna if he had ever heard of co-sleeping parents recording close calls -- like that they had woken up lying on their baby -- he said he hadn't. "What you are more likely to hear is 'Iâm so glad I was sleeping with my baby -- he had protracted sleep apnea and he was turning blue.â I can't tell you how many times babies have been saved by the fact that a parent was sleeping with them."We have, then, as polarized a debate as is possible. One group of thoughtful people who have done a lot of homework, the Child Death Review Team, is about to tell us that to sleep with our babies is to risk those babies' lives. Another group of thoughtful people, dedicated to breastfeeding and backed by a bevy of scientific research, says that to sleep with babies will allow you to better care for and respond to your baby's needs, will lessen the likelihood of SIDS and will provide long-term psychological benefits.The problem with the first group of people is this: They didn't study co-sleeping. They studied child deaths. If co-sleeping had been studied it's possible that results would show more babies have been saved than killed by the practice. In fact, if they looked only at co-sleeping -- at families who consciously chose co-sleeping for breastfeeding convenience and its other benefits to their children -- they would not likely find any deaths due to "overlay asphyxiation."But could it be that co-sleeping, when done safely, is the best situation for a child? And could isolated sleeping introduce other risks? Bed sharing has been practiced long enough, and by enough people, to begin to study its long-term effects, and the studies are coming out positive. A 1994 study of middle class English children has shown that the children who never slept in their parentsâ bed tended to be harder to control, have more temper tantrums, and to simply be less happy overall. The study also found that those children were more fearful than their co-sleeping peers.Another study based on surveying college-age subjects found that young adults who slept with their parents when they were children had higher self esteem, experienced less anxiety and greater comfort with physical contact and affection. Ironically, since separate sleeping is encouraged to make a child more independent, another study found that solitary sleepers were rated as being more dependent on their parents than co-sleepers. The largest study to date -- of 1,400 subjects in Chicago and New York -- found a positive correlation between having co-slept as a child and having a greater feeling of satisfaction with life.McKenna believes that these results will continue to be reinforced as ongoing studies are completed, and that this research, combined with the fact that the largest immigrant groups coming to the United States are from co-sleeping cultures, could lay the groundwork for an eventual cultural shift on this issue. In the meantime, though, parents are left with conflicting advice. Their only option is to look into the research on this issue, just touched upon here, and make their own decisions.After I had my baby, nurses, midwives and lactation consultants were eager to tell me to trust my instincts, which struck me as rather vague advice at the time. But I found that by doing so, I was instantly bucking Western conventions by always comforting Brendan when he cried, letting him nurse on demand and then, finally, sleeping with him -- even though the conventional child care books said never to bring baby into the parental bed.The result of all this rule breaking? A very happy baby and happy, albeit somewhat tired, parents who have come to this conclusion: co-sleeping has enriched their lives and risked no one's.Marrianne McMullen is the editor and co-publisher of Impact Weekly, where this story originally appeared.