Co-sleeping in New Zealand

There is a war being fought in New Zealand bedrooms, and the bullets are made of bullshit.

Recently, a coroner described an epidemic of co-sleeping with infants being killed by the practice. Reportedly, between 55 and 60 babies have died per year due to unsafe sleeping practices. The coroner’s report related to a sick, premature baby who was in the same bed as his mother, a smoker. He was formula fed, and she had consumed both a bottle of wine and cannabis before going to bed. The coroner commented: “I have to repeat comments made in the past that it [co-sleeping] is becoming almost like an epidemic.”

The fundamental problem with co-sleeping is that it happens a lot in what are called socially chaotic households. The parents that are drug users and alcoholics, the parents who don’t care enough for their babies, the parents who pass out on the sofa with their babies on top of them, and the families who are in otherwise extreme circumstances through no fault of their own. It’s quite obvious to any thinking person that careful co-sleeping is not the same as lying in bed with somebody who is passed out drunk. What is not obvious is whether it poses any increased risk over, say, room sharing, the current recommended practice. (We need to take a moment here to clarify that co-sleeping can mean sharing a room or sharing a bed. Here, we are talking about bed sharing.)

The most recent New Zealand study was a meta analysis of five prior studies, and was published in May 2013. It aimed to get to the bottom of the matter: “To resolve uncertainty as to the risk of Sudden Infant Death Syndrome (SIDS) associated with sleeping in bed with your baby if neither parent smokes and the baby is breastfed.” Bravo! The study found that bed sharing for non-smoking, alcohol and drug free parents does indeed increase risk of SIDS from 0.08 / 1000 live births to 0.23 / 1000 live births.

Now, these are tiny numbers, and here is a danger (this is where the bullshit bullets fly in the other direction). I could ask all my friends who are parents and find they’d all had no problem bed sharing. That’s great, but anecdotal evidence doesn’t make it safe. Many practices are both unsafe and probably won’t cause harm. Don’t wear a seat belt? You’ll probably be fine. Don’t wear sunscreen? Ditto. But these unsafe practices have an associated probability of harm. With co-sleeping, do I want to gamble on a 1 in 700 chance of killing my baby? No, I don’t want to do that. So these tiny numbers are a concern.

However, there are obvious problems with this study. The first is in assuming information about the circumstances of death is accurate. It’s not reasonable to assume that parents will tell the truth about how their baby died. There are strong disincentives against honesty in cases like this. The second is that the study did not account for other factors such as obesity, sickness, and legal medications. This may seem like nit picking, but the study found a 243-fold increase in risk with alcohol, drugs and smoking, so it is reasonable to consider that factors not controlled for may constitute a substantial portion of the remaining risk. The third problem is that the researchers imputed values. As one reviewer put it:

“Maternal alcohol consumption prior to the last sleep was collected but only for 38.7 per cent of the mothers in the study…. Imputing values from a group of five studies, three of which did not even ask the question, is surely making unreasonable equivalence assumptions across studies conducted in different countries with different cultures in different time periods.”

To my mind, this is a flawed study. It is resonably clear that co-sleeping is dangerous if you or your partner are drunk or stoned, or smokers. It is not at all clear that careful co-sleeping is hazardous.

But… why take the risk at all? Well, a generation or two ago, we put babies in nurseries and left them to cry. We fed them on a timetable and we considered them to be machines that need discipline and strict management. Today, many of these ideas still hold sway, but in general we practice a kinder form of child rearing. It is certainly easier to settle a child if they are close at hand. Arguably, it is also more natural. Babies have been held, swaddled in their parents clothes for thousands of years (of course, babies also used to die all the time). Nevertheless, babies want and need this natural closeness. They settle more easily and display less distress.

Sarah and I feel that it is important for our baby Zia to feel loved and to feel close to us. We are not prepared to compromise that for the sake of bad science, given that other studies have found no risk. So we do bed share, and we do get lectures about how we are harming our child. However, we do also maintain a rigid space in the bed that is just Zia’s space, and we feel that this provides a level of safety we are comfortable with.

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