Tuesday, October 30, 2012

MiM Mail: Did you co-sleep?

Hi MiM,

When I had my first son I read a lot and had all sorts of plans for
how it would go and what type of mother I would be.  Co-sleeping did
not fit into that plan.  I knew that the American Academy of
Pediatrics
did not recommend co-sleeping and that it may increase the
risk of SIDS.  So into the crib he went.  I didn't intend to co-sleep
with my second son either, but once my sleepless baby boy arrived I
ended up doing whatever worked to get the most sleep.  He naps in his
crib or bassinet but spends a good portion of the night in bed with
me.  I still worry about safety risks and I definitely worry about the
process of breaking this habit at some point.  My question is, as
educated physicians and mothers, how many of you have opted to
co-sleep with your children and for how long?  How do those of you in
pediatrics or family medicine address this with your patients?  I'm
not really looking for advice necessarily, but I think this is an
interesting discussion point.  I found out after talking to other moms
that this is a lot more common than I realized!  This may be somewhat
regional also.  I live near a very liberal, somewhat "hippy" town
where baby-wearing, cloth diapering, and making your own baby food are
often the norm.

I am a PA in dermatology and the mother of 2 boys - 22 months and 5
weeks old.  I love following MiM!

E

26 comments:

  1. I did cosleep with both of my kids. It worked out really well for me. I had an Arms Reach Cosleeper for the second time around and really liked it. I treasure all of that extra cozy cuddle time and extra sleep to this day.

    I think there are some simple and proven ways to make cosleeping safer. Don't do it on a couch, with an intoxicated adult, with big pillows, etc.

    Anyway, I am a firm believer in "Whatever gets you through the night", within reason!

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  2. I coslept for 9months with each of my daughters. I had the pack'n'play w/ the bassinet next to my side with DD1 but she wouldn't sleep well so she slept with me or in the swing dragged into our room until I slept poorly and she was sleeping so well when I was not home and she was in the pack'n'play for my husband, so her pack'n'play in her room she went. With DD2 my husband built a co-sleeper and the swing was set up in the bedroom... well, she slept in the co-sleeper once, but hey, it made my bed wider. At 9months she again slept better on nights I was not home so to her crib she went and slept 930p-9a like magic.

    There are studies (quality I cannot attest to but you know we all want to support our positions) suggesting the sleep patterns and positions for co-sleeping breastfeeding mothers is different than formula feeding mothers. We have a king sized bed and I never pulled blankets/sheets above my waist. I don't drink alcohol nor smoke. I kept my body pillow behind my back so I was always on my side or mostly on my side facing kiddo with my body curled around her so she couldn't scoot up or down. Survival of the children requires survival of the parents and sleep is a requirement in my book, so whatever works.

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  3. I used a mini cosleeper, which allowed me to keep the baby next to me but I felt safe that I wouldn't suffocate her. My first daughter was a really loud sleeper so I couldn't fall asleep with her next to me in the cosleeper... so we went for the crib fairly early. My second was quieter and stayed in the cosleeper a really long time... until she was able to climb out herself and it became a safety risk.

    As much as I loved being able to see my baby during the night, we all sleep so much better in our own beds. I was so scared that every creak of the bed would wake her up. Plus the alarm, of course.

    These days I only allow the kids in the bed on rare occasions, because they just want to climb on me and that's not that amenable to either of us sleeping.

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  4. I am a family doc and co-slept most of the night with my daughter until she was around a year (she started off the night in her crib and then came back to bed with me if she woke up). I wasn't planning on it, but it really came down to whatever got us through the night so I could function at work the next day. I also found it helped her with the daytime separation as she got to snuggle with me at night. The eventual transition to her sleeping all night in her crib was not too bad and I am happy to say that at 3 years old, she is a very good sleeper who rarely comes into my bed. You just have to be smart about it. I tell my patients to make sure they have a firm mattress, no blankets or at the most a light one and don't co-sleep if they have had alcohol or other sedatives like cold medication or are a smokers as this significantly raise the risks. I also make sure they are between baby and floor (I had a patient whose daughter rolled off the bed because she fell asleep while nursing and had her on the outside of the bed).

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  5. I'm also a family doc. I co-slept with my son until 6 months. It was NEVER in my plan. But then when I was in the hospital, he wouldn't sleep in the bassinet. He WOULD in my arms. I got caught the first night with him in bed with me. It seemed so natural. When we got home, I tried to put him in the bassinet, and he wouldn't have it. So we co-slept. When I had overnight call, he co-slept with my husband. I slept on my left side, he had his head on my arm, face to face, all night long. I did it wrong, I guess, I used blankets and pillows. But he was never in danger because he was always 2" from my face with my arms shielding him. Everyone gave me hell (except, ironically, my pediatrician), but even my Mom gave in and agreed after she saw how hard it was to have him sleep. I got all the lectures about him never sleeping alone. And I just told myself, "This is what works, we'll do it as long as it works." And at 6 months, he started getting restless in bed. We moved him to his crib and he goes there now, falling asleep on his own. It worked well for us. It's not for everyone, but I still miss him at night. At the risk of sounding like a hippie non-doctor, Do what feels right to you. It's rare that that is wrong.

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  6. We did not co-sleep. My daughter went to the crib in her own room on her second night home. It worked out great for us because I did very few feedings over night (she slept for 7 straight hours her first night home and was sleeping 12 hours by 1 month) and my husband went and got her and brought her to me when she did need a night time feed. We had plenty of contact time during the day (she ate 60 minutes out of 90 during the day), so it was nice to have some quiet sleep at night.

    All of which is to say, whatever works. I don't know if she slept through the night early because that was her nature or because she was sleeping alone in a room with little to wake her. I lean toward nature. I was still exhausted all the time, which means either I'm a wimp or I can't imagine how anyone else functions.

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  7. I am a pediatrician and I co-slept with both my kids when they were infants. Co-sleeping allowed me to survive the crazy, difficult newborn stage. Having said that, the risk of rolling over the infant was real and I was ultra careful when I co-slept. Co-sleeping required a lot of work to make it safe--or safer. First, my baby and I were the only things on the bed (no husband or other children). There were no pillows, blankets, stuffed animals, etc. I made sure the mattress was firm and the sheet fitted. I dressed in 2 layers of fitted clothes for warmth--no blankets. Baby was dressed in a sleepsack. The bed was not positioned against a wall to prevent Baby from being wedged between the bed and the wall. I didn't take any meds/drinks that made me drowsy. I turned the ceiling fan on to make sure Baby was not overheated. I slept when Baby was nursing in the middle of the night but it was pretty darn hard to roll over her when she was in the crook of my elbow. I usually woke up after she was done nursing and moved her to the other side of the bed. Once she started to roll over, I transitioned her to the crib. Both my kids slept through the night at 4-5 months and transitioned to the crib well.

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  9. I do give parents the spiel about no co-sleeping, and what factors can decrease the risk if they choose to co-sleep, but honestly, parents will do what they want anyway. Also as a parent I know how hard it is for a breast-feeding mom not to co-sleep. I did with my kids, and I do realize that a lot of it when the baby is older becomes comfort nursing rather than being hungry. I just can't think in the middle of the night too well when the baby is screaming. It was easiest not to co-sleep when I stopped breastfeeding, actually. So I would just be aware of the recommendations and then make your decisions according to what you feel best.

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  10. We had the Arms Reach cosleeper for both my kids. They both started out the nights there but always ended up in bed w/me nursing during the night. As a working mom, it was a good way for me to get more sleep and to get my kids to sleep, neither of whom were very good sleepers until they were about 12-18 months old. I also lived in a hippy-dippy community where there was a lot of babywearing, cosleeping, cloth diapering and a active attachment parenting group (which I didn't join). The transition to cribs happened relatively smoothly for us, though it was a bit harder the 2nd time. Since my kids were sharing a room we put the crib in our room to get #2 used to sleeping there and then eventually moved it & him into the other bedroom w/his sister.

    Like another commenter said, cosleeping has risk to it but can be made safer. Lots of people do it and I wish we could have a more nuanced dialogue about it without mothers feeling pressured or guilty.

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  11. A good summary of the research done regarding the risks of bedsharing is here, http://www.isisonline.org.uk/hcp/where_babies_sleep/parents_bed/ - this information is connected to a professor at Durham University in the UK. My understanding is that much of the research suggests that there are safe ways to do it, as some have mentioned above. It seems almost always when a baby death occurs in a bedsharing situation there are one or more other risk factors/safety issues that often get ignored for the sake of authorities continuing to say "bedsharing is unsafe, don't do it" rather than, "don't bedshare if you smoke/take certain meds/are obese/have a soft mattress and tons of blankets around/etc"). There has even been research that in some jurisdiction(s), can't remember where, that after the PSA's went out about "never sleep with your baby" they actually had more problems, because women would instead try to nurse their baby on a couch hoping not to fall asleep (but then did anyway, and the couch is much more dangerous).

    I was at a recent talk, never realized that the reason it is unsafe for smokers to bedshare with an infant (even if they only ever smoke outside etc), is that even hours after smoking they will exhale carbon monoxide - not a good thing for a tiny baby nearby to inhale!

    Never even thought about it before my daughter was born or for the first few months afterwards - when I went back to work at 8 months (Canadian - self-employed physicians don't get the much-mentioned "1 year paid mat leave" but colleagues were accepting of 8 months), my daughter seemed to want more attention from me at night and started not sleeping as well/nursing a lot in the night such that occasionally co-sleeping/bedsharing was the only way I survived.

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  12. Officially, we didn't co-sleep. It was January, and we felt that it was too cold to go without blankets. And I don't sleep at all without a pillow, so I kind of figured there was no point, if we were going to do it safely. In reality, there were times that I was so desperate for sleep that we did bring our daughter into our bed for a couple of hours. It made me really nervous though.

    My current pediatrician has no problem with it if it's done safely, but the first pediatrician we saw totally scolded us for doing it. Though, she didn't have children of her own, so I'm fairly certain that she had no comprehension of what it's like those first couple of weeks with a newborn.

    After 5 months or so, the noise my husband and I made when we came to bed or got up to go to the bathroom at night started waking our baby up very frequently, so we moved her to a crib in her own room. We all slept much better after that.

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  13. I'm sorry, I haven't read all the responses. We def co-slept. With both babies, on our chests. The obvious stuff that other mentioned - no alcohol, sleeping pills, pillows, loose bedding, etc.

    I have to say that I had one episode where my son rolled off me and I woke up with him tucked kind of under my breast. I was *exhausted* (no other state in those first few weeks) . I've always though of myself as a really light sleeper (pathologically light), so this freaked me out. He was off my chest and a little under me. I'm not sure if I could have smothered him. I don't think so, but it was enough for me to start trying to transition him sooner into the crib.

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  14. Yes, co-slept with two kids. No guilt about this - read a ton of the literature (incl the full AAP statement and its sources - and, honestly, it's a lot more nuanced than the party line acts like it is), and avoided all red flags - slept on firm mattress on floor away from walls, no blankets above waist (at least for first 6mo), one small firm pillow kept high up, noone else in bed besides me + baby + husband (for 2nd kid, older was transitioned out of bed WELL before new baby arrived, and knew it was NOT OK to crawl in bed with us and stuck to this without fail), no alcohol/sedating meds/smoking/etc, not obese, breastfed frequently in the night. Seems to me the research argues this situation is at least as safe if not safer than a crib (certainly than a crib in another room).

    No problem transitioning out, at least with first (2nd is only 8mo now and still cosleeping). Night nursed probably longer than many would have wanted to in part b/c was intern when she was 1yo and night time cuddle time was important to me, but night weaned at the very end of that year during a 2 week night float block pretty uneventfully. Moved to toddler mattress on floor next to our mattress at that time. Not that long after, she started asking to move to her own room - but we only had one bedroom, so she couldn't. The week we got a second bedroom she announced she was sleeping in there now - and did so immediately. Has ever since.

    I would do it this way again without hesitation.

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  15. yep. coslept, but only after about five months. but i also babywore. extended breastfed. made my own baby food. so maybe i'm a hippy.
    pregnant with baby number 2 and plan to do it all again- maybe some modifications to the cosleeping this time, though, since we'll have a 3 year old and he's not supposed to be in the bed too.

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  16. I cosleep as well.

    I just felt that unless you have a miracle baby that sleeps through from an early age, breastfeeding is not compatible with crib-sleeping. Babies get lonely at night!

    For me it was better to set the room up for the inevitable bedsharing rather than take the baby into an unsuitable bed in a state of exhaustion. I rigged up an IKEA crib as a co-sleeper and used it until baby was able to stand up. Now she starts in the crib and comes into bed (the crib is still lashed to the bed as a barrier on one side, and I have a toddler bed rail on the other side. Single mom, so noone else in the bed. I do use blankets, but didn't for the first few months.

    She is now night-weaned, so I don't feed her during the night, just a pacifier and a little backrub, maybe a drink of water, and she goes back to sleep.

    I think that conscious, on-purpose co-sleeping is totally different to just falling asleep with the baby on you.

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  17. My colleague, friend, mentor is a leading researcher in safe sleep practices/SIDS prevention. I had my breast fed babies separate but proximal (in our room next to our bed but in their own space), placed to sleep on their backs on a firm surface, etc. Risking SIDS isn't worth the risk. This pediatrician mom couldn't do it any other way.

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  18. Yes, we did co-sleep but it was different with each kid.

    #1, when hubby and I were both residents I worked really hard at making sure our son would sleep in his crib. It was necessary for when I had overnight call, etc. Plus, at the end of intern year I was all about following the AAP guidelines, both as a physician and a new mom. (I laugh sometimes, thinking back at the advice I gave parents before I had kids.) We did start co-sleeping occasionally by accident at first, when I was so exhausted we fell asleep together after nursing.

    #2, out of residency, took a nice maternity leave before entering practice. Co-slept at night with my daughter because it made nursing and surviving with two kids so much easier. Napped in the crib, and transitioned her to crib at night at 3 months easily. She actually preferred it.

    #3, oh boy. Total chaos with 3 kids. Didn't even try the crib at night and after about 7 months he started refusing the crib for his naps. he co-slept for 2 years, until I weaned. It's been a long process getting him into his own bed but at 3 1/2 he starts every night in his own bed.

    We almost always wake up with at least one kid in our room. I keep a toddler mattress on the floor but the younger one often crawl in bed. I cherish this snuggly time (my husband doesn't, oh well). It won't last forever.

    I tell parents the official AAP recommendations, SIDS prevention, etc. But I also discuss the reality that a lot of parents do co-sleep and go through safe co-sleeping practices.

    It's just like sex-ed with teenagers. Encourage them not to, but teach them how to be safe about it because you know a lot of them are going to anyway. I think that is our responsibility as doctors. We need to educate every chance we get. We're all only human. No one should be expected to follow every rule to the letter OR to conform to a culture different from their own. So, I try to help people make well-informed decisions in as non-judgmental a way as possible.

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  19. Thanks everyone for the great comments and helpful information. It is interesting to see that this is not an uncommon practice, even among those in the medical field. It does sound like those of you that co-slept made every attempt to minimize the risks. We've actually starting putting our little guy in his crib at night now - partially because he is finally sleeping longer stretches, and partially because all his grunting was disrupting my husband. Fingers crossed this one is a good sleeper!
    E

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  20. I went back to work when my son was 7 weeks old. The only way I could get enough sleep and still function at work was to co-sleep. But when I started to co-sleep, I felt like it was right for me. I really needed the extra cuddle time co-sleep provided. With the second baby, we started to co-sleep right away.

    I also did a lot of research and felt comfortable with the precautions we took.

    But I am also crunchy despite being an MD.

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  21. I co-slept with my exclusively breastfed baby. It was just too hard getting in and out of bed for nighttime nursing. Once I returned to residency (he was over 9 months), nighttime nursing became one of my favorite times of the day. 1 week into an exhausting rotation I learned 1. Baby Zo was comfort nursing and 2. that I could not continue to safely nurse all night on top of working 12-16 hours. He had to go. It took 2 frazzled weeks of modified, graduated sleep training and our 13 month old is now sleeping solidly through the night.

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  22. I co-slept with both my kids, now 7 and 9, exclusively for three months. After that, periodically during night nursing to get more sleep and spend more time with them as a resident. Worked for me.

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  23. Being a full time student and a mother, it was just easier for me to put my dd next me in the middle of the night and breastfeed her to sleep. No stress trying to fight her to sleep in her own crib, we have a big bed why not. We have been co-sleeping with our parents/care givers for thousands of years. It provides them comfort and stability during their first few years of their life. I wasn't born in the US, so we didn't have the luxury of having our own room from day one, the youngest slept with my mom, and the others slept next to one another.
    I didn't put my dd on our bed the first few months just because she was so little I didn't want to risk SIDS. Once she put a little weight and that was it for us bye bye cuddling with hubby now we all cuddle together. She naps on her bed now ( she is 27 months old).

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  24. No way, no how, not up for debate. In no way did my comfort or desire for cuddles equate a risk to my son's life. He was in his bassinet 2 feet away from the adult bed from the get-go. Worked perfectly.

    Newborn babies have no experience whatsoever of anything except being crammed into a tight dark womb. Everything about the outside world is unique to them; sleeping wedged against a parent versus sleeping in their own bed are equally foreign. I think any supposed feelings of loneliness or fear are projections from adults onto the baby.

    To be honest all this self-righteous "I co-slept the right way" sound like defensive backpedaling by people who are acknowledging there's an increased risk. It's a lot more enjoyable to hold a baby on your lap in a moving car; perhaps he would enjoy the ride more too, and he'd certainly sleep better. However I doubt a post where someone cheerfully admitted they didn't use a carseat would not elicit the same chorus of nudge-nudge-wink-wink agreement as this cosleeping debate.

    I am actually surprised anyone who has ever handled a SIDS case could even consider it. I've taken the ER calls from the medics; I've autopsied a SIDS baby; and I've had friends who have lost their children from accidental suffocation. Dispassionate reading of the medical literature aside, it was these experiences that made it crystal-clear that any increased risk to my baby's life was not to be entertained, even for a wistful second.

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  25. I co-slept (at least some of the time) with all of my 5 kids and I always talk about safe co-sleeping with all new parents. I also had a home birth, my 5th, so I guess I'm not mainstream anyway. I'm a family physician and I firmly believe in attachement parenting. My kids are already 12-26 years old, and I'm very happy of how they turned out. I like to believe that co-sleeping has a part in this.

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