4th mom

A closer look at the risks and the guidelines

Before having kids, I thought I’d be a textbook parent. Follow the doctor’s advice and have a healthy baby. Easy.

Then my daughter arrived. 

She needed to feed every couple of hours, around the clock. After eight weeks of only getting to sleep in little bits, I was a wreck. 

Then one night, I passed out while feeding her in a chair. I still don’t know how I didn’t drop her. It was scary. 

I’ve learned my experience is common.

This study found that 29% of parents have accidentally passed out with their babies. The context is usual while breastfeeding, or out of sheer exhaustion.

Baby books are clear: babies must sleep in a separate crib, on their backs, with no blankets or toys. The goal is to prevent accidental suffocation or sudden, unexplained death (a.k.a. SIDS).  

In the abstract, this advice makes complete sense. 

But any decision has risks. I realized that these guidelines needed to be considered in the context of my situation. 

For me, the trade-offs were the dangers of SIDS or accidentally smothering my baby versus the risks created by my sleep deprivation. 

What are the risks of co-sleeping and SIDS?

A meta–review of 63 sleep-related infant death studies breaks it down pretty well. Here are the topline takeaways:

Although they’re rare, sleep deaths are a real risk.

Out of the 3.6M babies born in the US in 2020, 3,356 (or roughly 0.09%) had sudden unexpected infant deaths.

Within this, 905 (or 27%) were a result of accidental suffocation or strangulation in bed, and 1,389 (41%) were a result of sudden infant death syndrome (SIDS).

To put these numbers in context, SIDS is the 3rd leading cause of infant deaths in the US, according to the CDC. Unintentional injuries, including suffocation, car accidents, falls, and drownings, among others, is the 4th.

Younger babies are at higher risk of SIDS.

90% of SIDS-related deaths happen in the first six months of a baby’s life, peaking at 1-4 months. This suggests that concerns about co-sleeping centers on young babies too small to roll over alone. 

There is a range internal and external SIDS risk factors.

Internal risks are baby vulnerabilities, including genetics (such as dehydrogenase deficiencies) or immature cardiorespiratory systems. 

External risks include over-bundling the baby, not placing the baby to sleep on its back, loose bedding, bed-sharing, or smoking or using illicit drugs around the baby. 

Studies (such as this one, this one, and this one) have tried to isolate the impact of bed-sharing from other risk factors – such as whether the parents smoke or use illegal drugs – with conflicting results.

The problem is that sample sizes are tiny and clean data is hard to get, so the meta-review found “data [did] not support a definitive conclusion” as to whether bed-sharing is safe in the absence of other risk factors.

Another challenge discussed in the research review is the variability in terms of how deaths are recorded. The age of the baby also matters.

From this, the meta-study recommended that babies sleep in the same room but not in the parent’s bed for at least the first six months. 

This advice probably works well for many parents. 

Being in the same room lets you hear every peep. While attending to the baby requires getting up out of bed. 

In our house, this was a recipe for me to get severely sleep deprived.

What are the risks of sleep exhaustion and accidental death?

I couldn’t find data on how parental sleep deprivation impacts the 4th leading cause of infant death – accidental injuries.

Maybe this is harder to quantify so it gets less attention? I’m not sure. (If you’ve found any research on this, please drop it in the comments.)

One study discussed how accidental bed-sharing makes a dangerous co-sleeping environment – like a chair – more likely.

Another study focused on looking at the parent’s motives for bedsharing, concluding, “it is important that circumstance and motivation are considered in assessments of bed-sharing safety.”

So what do parents do?

According to the national Listening to Mothers survey conducted by Childbirth Connection, nearly half of moms reported sleeping with their babies sometimes before the baby hits six months, with about 1 in 5 (18%) doing this all the time. 

_{Source: Listening to Mothers II survey}

Among women with three or more kids, nearly 4 in 10 (38%) said their babies slept with them often or always. 

Why would so many experienced moms co-sleep? 

Many babies get better REM sleep when sleeping with a parent. It also can help new moms get more rest because they can breastfeed or console their babies without getting up.

And parents – particularly those managing more kids – need to get sleep if they’re going to function and not, say, get in a car accident.   

You know yourself and your baby. 

Many experienced parents are strongly against co-sleeping because they know the risk doesn’t make sense for them.

Likewise, some experienced parents have realized the trade-offs make sense for their situation. Parents that choose to go this route can minimize their co-sleeping risk by following guidelines, such as La Leche League’s “Safe Sleep 7” checklist (full detail is in chapter 2 of the book Sweet Sleep: Nighttime and Naptime Strategies for the Breastfeeding Family): 

• Non-smoker
• Staying sober & unimpaired
• Breastfeeding
• A healthy, full-term baby
• Back sleeping
• Lightly dressed, not swaddled 
• On a firm surface with their head uncovered, free from cords/strings, cracks, heavy covers, or extra pillows / toys