Three in a bed

Recently I came across a paper on bed sharing and breastfeeding by Helen Ball and colleagues which cited my research with Dr Amy Brown on the effect of early parenting routines on breastfeeding. I was therefore keen to read the paper – despite my ever growing to do list! The paper reports on follow up data from participants from the NECOT trial. This paper explored the link between breastfeeding duration and bed sharing frequency in women who had indicated at least some prenatal intention to breastfeed. It seemed timely to write a blog post on this because this week is Safer Sleep Week.

Through my experiences as a trained La Leche League breastfeeding peer supporter I have talked to breastfeeding mothers and found that they bed share with their infants, intentionally or unintentionally, often through sheer exhaustion. Having a young infant is tiring and involves a lot of night feeds. When you are exclusively breastfeeding you are solely responsible for feeding your infant – no-one else can get up in the night and take over for you as they can if you are bottle, mix feeding, or expressing. Breastfed infants may also be more likely to wake more frequently in early infancy because breast milk is more easily digested and so they will be hungry more often. Therefore breastfeeding mothers may be very tired and wish to bring their infant into bed with them and try to maximise their sleep (or at least reduce their sleep deprivation) or they may be so tired that they unintentionally fall asleep while feeding their infant.

We know the reasons why breastfeeding mothers might bed share with their infants. We also know that this is an important topic for many reasons. Firstly, there are health benefits of breastfeeding for a longer duration for both the mother and child, yet many women struggle to continue to breastfeed.  Secondly, we also know that a large number of mothers bed share with their infants (for example in this study only 15 out of 807 mothers reported never sharing a bed with their infant in the first six months). The NICE guidelines published in 2014 conclude that there is a statistical association between bed sharing and Sudden Infant Death Syndrome (SIDS), meaning that where bed sharing there may be an increase in cases of SIDS – although this does not mean that bed sharing causes SIDS. Many have argued that the association can be explained by examples of ‘unsafe’ bed sharing practices and that bed sharing safely does not carry an increased risk. ‘Unsafe’ bed sharing practices have been recognised in the guidance as the parent being a smoker or consuming alcohol, drugs, or medications and the infant being pre-term and/or low birth weight. Finally, we also know that there is a link between bed sharing and breastfeeding duration. The authors of the study aimed to identify which mothers were likely to bed share with their babies so that in future mothers who are more likely to do so can receive information to encourage safe practices.

In the study the authors found that more women who bed-shared frequently were still breastfeeding at 6 months (which is the World Health Organisation recommendation for exclusive breastfeeding) compared to those who never/rarely bed shared or only bed shared on an intermittent basis. A strong pre-natal intention to breastfeed was reported by those who subsequently went on to bed share often in comparison with those who did so less frequently. The authors conclude that providing advice to breastfeeding mothers on bed sharing safely is crucial to minimise the risk of SIDS but to maximise the benefits of breastfeeding to mother and child.

Photo by Bronia Arnott. All rights reserved.

Overall the study was well designed, but not without limitations. There was only a single item intention question to assess prenatal intention to breastfeed and since this is a strong predictor of bed sharing the results would have been more robust had the authors included a number of items assessing breastfeeding intention. Typically in studies of psychological constructs, such as intentions, researchers would include several questions relating to that construct and then use the average of the scores across all of the questions in the results. The argument is that doing this is a more accurate assessment of the construct, in this case intention to breastfeed, than a single item and therefore the results are more reliable. This seems particularly important if this was to be used as a screening tool to provide mothers-to-be with information about safe bed sharing pre-natally. There was also a lot of missing data in relation to bed sharing (192/870 dyads provided insufficient data to be classified into one of the three categories) so this limits the representativeness of the findings. Further, the classification of bed sharing frequency is such that those who bed share for as little as one hour per week for at least 3 or 4 weeks in a month (therefore a minimum of 3 hours per month) are described as ‘often’ sleeping with their infant, which doesn’t seem particularly frequent to me, and I would like to have known more about the maximum numbers of hours these dyads were bed sharing for. Finally, this data was collected back in 2008-2010 but the NICE guidance was updated in 2014 and it would be useful to explore the same question in a current sample of mothers and infants.

My takeaway message from this paper was that mothers who bed share are likely to breastfeed for longer, and this has health benefits for both the mother and the child. Since many mothers seem to be bed sharing and because bed sharing promotes health through increasing breastfeeding duration, the authors feel that mothers should be given further guidance on ‘unsafe’ bed sharing practices to avoid to minimise risk. For now the current guidance and information about bed sharing safely is summarised on the NCT website for parents and parents-to-be.

 

 

 

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