Infants are “effectively being killed” by the practice of co-sleeping

There has been a lot of focus in the New Zealand media lately about the practice of co-sleeping, and the occurrence of infant deaths as a result. I know this, despite not owning a TV and avoiding the newspaper in my hormonal state, because people keep telling me, upon learning that we co-sleep, “Oh, but did you hear that they’re finding now it’s actually really dangerous?”

It has been interesting, reading the recent articles, as well as other articles from around the world in recent years.

It is important to note that New Zealand parents, upon the birth of their child, are given information on Sudden Unexpected Death in Infancy (SUDI) or Sudden Infant Death Syndrome (SIDS). Most parents are given a pamphlet distributed by Change For Our Children, which provides a list of the factors which make a baby more vulnerable to sudden death. These are:

  • Exposure to tobacco, both during and after pregnancy
  • Born before 36 weeks gestation
  • Weighing less than 2500 grams at birth
  • Not breastfed

Being unwell is also said to weaken a baby’s drive to breathe. Parents are also advised to sleep their baby face up and face clear, on a firm mattress with no adult bedding, no pillows, and no soft toys. If there is alcohol, drugs or partying around the baby, parents are told to ensure a sober person is with the baby.

The recent focus on bed-sharing in the media has been spurred by the fifty-five to sixty deaths of infants that have occurred during the night as said infant slept in the same bed as another person each year for the past four years (NZ Herald, ‘Co-sleeping baby deaths ‘like an epidemic,’ says coroner‘).

The death of Ivan Karaitiana in September 2011, at four months old, is one recent example that has been used in this campaign against bed-sharing and co-sleeping. Bed-sharing is being named as the culprit in little Ivan’s death, which has been ruled as SUDI. However, in reading the recent details of his death, it is clear that there were more prominent risk factors involved,

“[Ivan] was 6 ½ weeks premature and weighed 4lb 8oz (2.04kg) when he was born at Hutt Hospital…Cherie slept with Ivan in the double bed where they would normally top and tail, and his siblings slept in bunk beds…On the night before he died, Ms Karaitiana fed him formula and put him to bed, covered by a polar fleece baby blanket and a larger mink blanket.”
(NZ Herald, ‘Co-sleeping baby deaths ‘like an epidemic,’ says coroner‘ bold effects added by me)

Not only did Ivan have a very low birth weight, he was premature, so his lung function was potentially not as developed as it would have been, had he been full term. This is a known risk factor for SUDI. Further to that, he was not exclusively breastfed, providing the potential for the suppression of hormones which allow the mother to mimic her baby’s sleeping patterns. He was also covered by adult bedding, which placed the baby at risk for suffocation. The article also mentions that Ivan’s two older siblings also slept in the same room, as they had moved in with their grandfather due to financial difficulties.

Almost as an afterthought, right at the end of  the quoted article, the reporter adds, “[Ivan’s mother] had drunk a bottle of wine and smoked cannabis before going to bed“. Any baby, whether in the adult’s bed or not, is arguably placed in danger when their caregiver has consumed an entire bottle of wine and taken drugs.

Five month old Roretana Holland died of Sudden Infant Death Syndrome (now commonly synonymous with SUDI) in July 2010, while sharing a bed with his four year old sibling. The coroner was reported to have said that Roretana’s death was “another tragedy involving co-sleeping arrangements for infants as well as other matters highlighted by the pathologist” (The Dominion Post, ‘Infant died in bed with sibling‘), though it is important to note that this is not a direct quote of the coroner. However, closer reading of the article which details the coroner’s findings reveal again that bed-sharing, as attachment parents use it, was not the most prominent problem,

“The baby, one of four children aged under-five, co-slept with his four-year-old sister. All four children shared the same bedroom because they relied on a single oil heater for warmth. “Bedding consisted of a duvet cover acting as a mattress protector with a sheet over the top with a queen sized mink blanket (this was an unzipped sleeping bag). The children each had their own pillow.” On the night Roretana died he was given formula and pureed food before being put to bed at 7pm… Dr Kerry Thornbury of the Ora Toa Cannons Creek Medical Centre said the baby had been developing well, though had suffered skin infections, which were treated with Penicillin. There had been some concern about possible family violence but attempts to engage the Tamariki Well child nurse had been unsuccessful. The coroner’s decision stated that the mother had smoked throughout her pregnancy and drank alcohol, though gave up the latter when she found out she was pregnant after two months.”
(The Dominion Post, ‘Infant died in bed with sibling‘, bold effects added by me)

Roretana was not sleeping next to his exclusively breastfeeding, teetotaling, drug-free, healthy weight mother. He was sleeping with a very young sibling, out of necessity due to poverty. He was not sleeping on a firm, safe matress, but on a duvet cover, with adult bedding keeping him warm. The article seems to suggest that he may have been using a pillow, and if he wasn’t, his head was certainly next to a pillow, as his sibling used one. He was not exclusively breastfed, he was at least given formula at night, and was already being fed solids. He was not in perfect health, and was taking antibiotics. There is speculation that there may have been family violence in his household. And, perhaps most significantly, he had been exposed to tobacco from the time his mother had been pregnant with him.

The death of three month old ‘Baby N’ in June 2010 is being used as another example of why parents should not share their bed with their baby, despite it being clear that co-sleeping was one of several significant risk factors involved in his death,

“[Baby N] was born prematurely in Wellington Hospital in March last year, weighing just 785 gramsExposure to tobacco smoke and sleeping in the same bed as his parents against medical advice, on top of a premature birth also likely contributed…After being readmitted to Hawke’s Bay Regional Hospital with vomiting and lethargy he was discharged but died at home later that night. Staff at the hospital were concerned about his parents smoking, and that they shared a bed with the baby. Mr Devonport said asphyxiation caused by Sudden Unexpected Infant Death  was the main cause of death. ”[But Baby N] should have slept in his own cot, appropriately positioned with his face clear, and preferably with an apnoea alarm attached.””
(The Dominion Post, ‘Baby died needlessly, coroner finds‘)

Baby N was born prematurely, and very underweight. Guidelines given to New Zealand parents suggest that babies born under 2500 grams are at a higher risk for SUDI. Baby N was less than half of this weight. He had also been exposed to tobacco, and had been in hospital that day with vomiting and lethargy, where concerns had been raised about the safety of co-sleeping for this particular baby. This was a baby known to have been very at risk of SUDI, and he should not have been in bed with his parents. But this does not automatically prove that co-sleeping for healthy babies of a normal weight is dangerous.

Kompton Renata Joseph’s 2009 death, at the age of one month, is particularly frustrating for the coroner involved, as his parents admitted to co-sleeping with their new baby at the time of Kompton’s inquest. But, as in the cases above, co-sleeping does not appear to be the whole problem.

“Kompton Renata Joseph, aged one month, was found dead in his parents’ bed after they woke in the morning…About 5am parents Lesley and Kirsty Joseph went to bed after drinking bourbon mixers with Mr Joseph’s brother, Lance. Ms Joseph began to feed the baby in bed but then fell asleep. When she woke about 9am she found the baby lying in the bed between her and her husband, with a “purple face”. An autopsy found Kompton died of sudden unexplained death in infants, or Sudi.”
(The Dominion Post, ‘Sleeping with baby earns coroner’s ire‘)

The parents had both been drinking alcohol. Kompton appears to have been breastfed, but if his mother was consuming a fair amount of alcohol on a regular basis, I do wonder whether this may have effected him. Certainly, he was not in a safe environment with both of his caregivers being under the influence of central-nervous-system depressants.

Interestingly, it is the same coroner who looked into Kompton’s death, as Ivan’s. In the article detailing Kompton’s death, the said coroner, Wallace Bain,  is quoted as having blamed co-sleeping for the death of the baby, “The country needs to get serious, but I’m not sure how long it will take to get the message through. It is an absolute no-no.” (The Dominion Post, ‘Sleeping with baby earns coroner’s ire‘) I can understand why Bain may be getting frustrated at the regular occurence of infant deaths. But I would argue that co-sleeping is not the problem.

Deliberate co-sleeping can be just as safe as any other sleeping arrangement. According to The Womanly Art of Breastfeeding, studies have shown that a breastfeeding mother will naturally sleep facing her baby, with her lower elbow forward and her legs curled up underneath the baby. A sober, breastfeeding mother of a healthy weight will not roll over onto her baby. A later blog will discuss how to safely co-sleep, but rest assured it does not involve tobacco, alcohol, pillows and adult bedding, nor does it involve sleeping with a baby who is known to be vulnerable to sudden death.

In all four of the deaths discussed above, the parents were users of tobacco and/or alcohol. In two of the four deaths, the co-sleeping was acknowledged to have occurred because of financial difficulties. At least two of the four babies were formula fed. Where birth weight is provided, it is under 2500 grams, and both of these babies were premature. Co-sleeping itself is not the danger, it is co-sleeping coupled with known risk factors that proves to be a danger to babies.

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