State officials struck a nerve last week when they cautioned parents against sleeping in the same bed with their babies after the suffocation deaths of five Maine infants since early January. Recent research has further fanned the controversy, both in the U.S. and abroad, over whether parents should sleep with their newborns.
To Marleina Schwenk Ford, an Ellsworth mother of three, Friday’s warning was an unhelpful vilification of a common practice and a laying of blame at the feet of grieving parents. Ford believes “co-sleeping” — or more specifically “bed sharing” — can promote bonding and better rest for parents and baby, if planned for and practiced safely.
Many health experts, including the American Academy of Pediatrics, insist there’s no such thing as safe co-sleeping.
“It’s awful when a baby dies, it just is,” Ford said. “Nobody wants to see that happen. But it seems like when the baby’s alone in the crib and it dies it’s a tragedy. But if it happens to be in bed with the parents, it’s their fault and they should have known better. It’s an awful thing to say to somebody.”
The babies, who ranged in age from 1 to 3½ months, died from positional asphyxia, according to Chief Medical Examiner Dr. Mark Flomenbaum and Maine Attorney General Janet Mills. Positional asphyxia can occur when the airway becomes obstructed because of the position of the neck or body.
All of the deaths were ruled accidental. Four involved bed sharing and one resulted from “inappropriate sleep environment,” according to the attorney general’s office. While babies are at greater risk while bed sharing if a parent is under the influence of alcohol or drugs, investigations of the deaths found no evidence that substance use was a factor.
The attorney general’s office released no other details about the deaths.
Both Mills and Flomenbaum cautioned parents against sharing a bed with young children. The safest place for babies to sleep is in a crib or bassinet in the same room as parents, according to the pediatrics academy.
While that may be true, parents must be educated about how to bed-share safely, Ford said.
It’s one thing to succumb to exhaustion and fall asleep with an infant in a pile of comforters and fluffy pillows that can obstruct breathing, she said. And parents should never share a bed with a baby while under the influence of alcohol or medication. But planning ahead to make Mom and Dad’s bed safer — such as by using a firm mattress and removing dangerous bedding — reduces the risk, whether parents co-sleep regularly or only occasionally as an inevitable part of raising a newborn, she said.
Jessica Begley, a mother and certified infant and child sleep consultant who lives in Gray, disagrees. She refuses to work with parents who insist on sharing a bed with their babies.
“I hear all the time, ‘I’m doing so safely,’” Begley said. “The truth is it’s not as safe as a crib.”
Ten to 15 babies die as a result of unsafe sleeping circumstances in Maine every year, according to the Maine Center for Disease Control and Prevention. Babies should sleep on their backs during naps and at night, rather than on their sides or stomachs, the academy recommends. Infants also should sleep without stuffed animals, pillows or other items that can stifle breathing.
A May 2013 study published in the British Medical Journal Open found that babies under 3 months who shared a bed with their parents were five times more likely than babies who slept separately to die from sudden infant death syndrome. The study, which reviewed data from five previous studies, did not differentiate between deaths from SIDS and asphyxiation.
The findings garnered attention because they reflected babies thought to be at low risk —- their parents didn’t smoke and hadn’t been drinking alcohol or taking drugs, factors known to increase the danger to infants while bed sharing. The authors urged health providers to take a more definitive stand against the practice.
Some parents co-sleep by choice, while others resort to it in desperation to get everyone some rest, Begley said. Inadequate maternity leave policies in the U.S. also often leave mothers without sufficient time to recuperate after birth, leaving them exhausted throughout the day and more likely to fall asleep with their babies in bed, she said.
A resurgence of “attachment parenting” also means many moms and dads “think they need to be as close to the baby as possible,” Begley said.
Many of the benefits parents seek by snuggling next to their babies at night can be achieved by placing a crib or cradle next to the bed, she said. Begley, who’s also a certified lactation counselor, suggests that option to mothers who find it easier to breast feed with baby close by.
Ford tried that herself with her first two children, opting for a special “co-sleeper” apparatus with her third child that kept her daughter within arm’s reach next to the bed. But not all families have the money or space to set up special sleeping arrangements in their bedroom, she said.
A blanket policy against co-sleeping, like the one advocated by Maine’s attorney general and medical examiner, actually can endanger babies, she said. Exhausted but well-meaning parents instead fall asleep on a sofa or chair, which poses even greater risks because infants can become trapped, Ford said.
A British parenting charity, the National Childbirth Trust, echoed that concern in reacting to the BMJ study in 2013.
“It could lead to an increased likelihood that a parent or carer inadvertently falls asleep while holding the baby, in a chair or on a sofa, which is much less safe for the infant,” Rosemary Dodds, its senior policy adviser, told the Guardian newspaper.
Ford also said she has heard stories of sleep-deprived parents who make multiple trips a night to a nursery down the hall and end up tripping or falling with their babies in their arms, she said.
“If you are going to co-sleep — and people are going to — how to do so safely is important,” she said.