Safe Bed-Sharing; Do Childbirth Educators Have a Responsibility to Cover This Topic?

safe bed-sharing.jpgChildbirth educators are often faced with the challenge of covering topics during class that envoke passionate discussion and strong feelings amongst both families and researchers. Circumcision and vaccinations are two such topics that easily come to mind and that I believe fall into this category.  I pride myself on sharing evidence and best practice with my childbirth education class families and I appreciate that Lamaze International supports such efforts.

Safe sleep information can be confusing for parents, often with mixed messages coming from their baby's health care provider, their social community, their family and even their childbirth educator.  When I ask during class where parents intend for their newborn to sleep, most are planning for their new babies to sleep in their own sleeping space in the parents' room.  When I inquire where the baby is actually sleeping when I attend the class reunions, normally held when the babies are between four and eight weeks old, the responses are mostly that babies are bed-sharing with the parents for all or some of the night.

The reality is that many parents will find themselves bed-sharing with their babies at some point, as they navigate the challenging early days and weeks of parenting a newborn.  For this reason, I feel it is my responsibility to be sure and cover the topic of safe bed-sharing, so that parents understand that if they find themselves bed-sharing with their infants, they know how to do it safely.  

Melissa Bartick, MD, MSc, wrote an extremely well written piece, "Should the AAP Sleep Alone" on the Academy of Breastfeeding' Medicine's blog "Breastfeeding Medicine" two years ago, that I often share when asked why I cover safe bed-sharing in my classes.  It is important for educators to be able to explain why their class content may differ from recommendations from the American Academy of Pediatrics, whose stance is that bed-sharing is not an acceptable or safe choice for families.

Dr. Bartick addresses how the message to never sleep with a baby may have backfired and in fact increased the risk of infant death when parents sleep with their babies on sofas and recliners, in order to avoid bed-sharing which they have learned is always an unsafe sleep environment.

The message publicly shared in the United States is not consisent with the information that families in other developed countries receive. Dr. Bartick informs us that Canada, Australia and Great Britain approach this issue from a different perspective and offer another message. These countries acknowledge that bed-sharing is likely to happen and health care providers offer information on how to reduce risks to the infant if bed-sharing will occur.

U.S. pediatricians who wish to fall in line with the AAP's stance have little room to discuss safe bed-sharing and all the benefits and risks of many different sleep options with the families they see, despite the reality that parents are most likely bed-sharing at least some of the time with their new babies. Bed-sharing has been happening since the beginning of time. Does insisting that a new baby sleep in their own space fight the innate need for a parent and young infant to remain close both during the day as well as during sleep?  Dr. Bartick questions whether parents have concerns about disclosing that they bed-share in order to avoid criticism from professionals?

The research on this topic is not black and white either, and there are many confounding pieces of information that were not independently evaluated when this topic had been researched in the past.  One such example is not examing deaths of infants in a parents' bed vs on the couch with a parent.  Are current AAP recommendations  based on research that was not properly conducted? Is it time for funding to be designated to cover this topic thoroughly and soundly?

For all these reasons and more, I feel it is my ethical responsibility to acknowledge that some (many?) families in my classes wiil choose to bed-share at least some of the time and that these families deserve to be provided with accurate information on the benefits and risks of how to bed-share safely so they can make an informed choice about what feels right for their family.

I urge to you hop over to read Dr. Bartick's piece on Breastfeeding Medicine blog and then check out Science & Sensibility's coverage of this topic.  We have discussed bed-sharing and safe sleep before and provided resources and expert opinion for educators to use in class.

What do you share about safe infant sleep in your classes?  Do you cover bed-sharing?  How do you share best practice with the families you work with?  Can you share your perspective?

Image courtsey of Verity Worthington.

2 Comments

I cover this in my childbirth education classes!

September 14, 2016 05:23 AM by Emily

As you say, the majority of parents end up doing some kind of bedsharing, especially if they're breastfeeding - Best they do it safely.

The medical and public health community in the U.S. harms families with their blanket statements against co-sleeping. 

Bed-Sharing Info

September 21, 2016 11:28 AM by Linda J. Middlekauff, RN, BSN, LCCE

Thank you, Sharon, for this interesting article and the resources as well.  After attending a conference which included Dr. James McKenna, I began to cover the topic of bed-sharing in every class series.  I agree that since many parents will use bed-sharing to some degree that it's our responsibility as birth educators to present the info about safe bed-sharing.  I begin the discussion with asking my students where babies in their own families of origin slept most of the time.  For those who remember, I've had a mixture of responsed including bassinett near the parents' bed, a Moses basket in the bed, in the parents' bed & in a crib exclusively.  We actually usually have a very interesting discussion from there after which I mention the guidelines given in their class packet for that class.  It takes only about 10 - 15 minutes, & I've really enjoyed including this in my class on newborn topics.

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