This newsletter touches on SIDS. If you have been affected by it, you may want to skip this newsletter and head to this page instead.
It is the elephant in the room in many conversations I have with mothers who breastfeed: how do you sleep when your child wakes up at night? My answer is: I sleep with my baby next to me.
Depending on whom I talk to, there is a look of worry, surprise, or simple acknowledgment, as if we were sharing a guilty secret.
I mean, think about it: if you decide to breastfeed, and you breastfeed on demand, and your child wakes up at night, can you imagine getting out of bed every time and sitting up to feed the baby?
That is what I did when Lorenzo, my first son, was born four years ago. During our pre-birthing classes, we had done a first aid for infants course. The message was loud and clear: “Never bedshare because your baby may die.”
Reducing the chances of SIDS
The advice was probably not delivered in the most nuanced of ways (which is a problem in and of itself, but I’ll come back to it later). However, it is based on a real worry: it is estimated that around half of SIDS (sudden infant death syndrome) deaths occur while co-sleeping.
Let me unpack this. SIDS is the sudden and unexplained death of a baby younger than 1 year old, which is diagnosed if the baby’s death remains unexplained. It is unclear what the causes of SIDS are, although there are some known risk factors, including premature birth or low-weight at birth, sleeping on soft surfaces such as sofas or with fluffy pillows or toys, and parents who smoke. Removing some of these risks lowers the chances of SIDS.
But during my prenatal first aid class in Italy, there was no talk of risks; there was only a fear of bedsharing that was passed on to us.
“I have started hating nights,” I told Nacho when Lorenzo was three weeks old. I simply couldn’t take it anymore: waking up, sitting up, and trying to stay awake while feeding Lorenzo for long periods. I tried reading to stay awake but I couldn’t, I was exhausted.
One night, I fell asleep and woke up when Lorenzo was sliding out of my arms. Thankfully, I had a pillow that supported his head and I was on a futon on the floor. But I was scared of falling asleep again and so I lay down and instinctively moved into what I now know is an evolutionary position — one that mothers have developed over the years to protect their babies.
Changing guidelines on bedsharing
It looks like a shell: I lie on one side, arching my body around my baby, with my knees pulled up to touch the baby’s feet, and my arm around the baby’s head.
And it turns out that this position is not what creates more risk of SIDS. On the contrary: breastfeeding (like using a dummy) is associated with lower chances of SIDS because the baby is occupied sucking. (Interestingly, research suggests that bedsharing may partially explain the reduced risk of sleep-related death in breastfed infants.) Moreover, the higher risks of co-sleeping are associated with sleeping on sofas or armchairs where the infant can get trapped in soft surfaces. Bedsharing is only one form of co-sleeping and it can be done safely.
But, depending on where you are based, the guidelines on bedsharing you may have heard can differ radically.
In the UK, Spain and Norway, guidelines now tend to highlight how to create a safe bed environment in order to bedshare without creating risk for the baby. In Japan, bedsharing is so intrinsic to the culture that it is common for families to share a bed until the children are ten or older. In the United States, guidelines have slowly evolved. The American Academy of Paediatrics still says that they cannot recommend bedsharing under any circumstance, although the Academy of Breastfeeding Medicine recommends bedsharing and offers guidelines on how to do it safely.
How to reduce harm
Cecília Tomori, an anthropologist and public health scholar at John Hopkins who is internationally recognised for her expertise on breastfeeding, infant sleep, and maternal child health, says that we need to take one step back and understand that babies’ sleep evolved in extreme proximity to their mothers, and that breastfeeding relies on this closeness.
“If we recognise that breastfeeding and sleeping are interconnected, and we understand that babies actually wake up frequently, and they need care and they need to be fed and they need to be close and also, the chances are people will fall asleep while they are breastfeeding, then we can help people prepare for that scenario,” Tomori told me in an interview.
So instead of banning bedsharing outright, we can instead create an environment that is the least likely to potentially cause harm. For example, we can start by looking at the surfaces where we may fall asleep while breastfeeding.
The Lullaby Trust, a UK-based organisation that works to reduce SIDS, offers some very clear, research-based guidelines, which you can find here.
The most important things to take into account is to keep the baby on its back, and to be on a clear, hard mattress with no extra pillows or sheets around.
By following these guidelines, and understanding why they are there and what the real risks are, we can also avoid falling prey to marketing of gadgets that make false promises — from monitors to bassinets that claim to reduce SIDS.
If I had received this information at the time, I may have put myself in a sleeping bag and would have definitely let go of the duvet in the bed (which I anyway put below my waist and made sure to have warmer clothes in my top half). I may have felt less guilty and I could have avoided more risk too.
Also, with the right information, we can avoid re-victimising parents who lost their children because of SIDS. For example, in the United States, where the rates of Black babies who die from SIDS are higher than for the rest of the population, because of a complex interplay of reasons that go back to inequalities, there are often headlines that simply put the blame on Black parents “not getting the message”.
Next week I’ll be looking more deeply at breastfeeding and sleeping, with a chat with Dr Cecília Tomori. Many of you have said you are interested in more Q&As, so this will be the first of many. If you have any direct questions, feel free to send them to me and we can direct them to Dr Tomori in the comment section below this piece, on the website. Also, do let me know if you also had doubts about bedsharing, and if you went ahead with it or not.
What I’ve been reading
This piece in The Hechinger Report shows how children of colour in the United States receive less attention, which is critical, in their early years. This is true for diagnoses of autism and other disorders, but even for antibiotics and other early interventions. This persistent lack of intervention is partly a result of systemic racism and can “play a pivotal — and long-overlooked — role in shaping educational inequities years, even decades, after children start school.” Reporter Sarah Carr takes an in-depth look at the other factors that may play a role in fewer early interventions — from the distrust that families of colour may have of predominantly white medical staff, to lack of services in lower-income areas.
What I’ve been watching
In this TED Talk, Japanese architect Takaharu Tezuka talks about a really cool kindergarten he co-designed outside of Tokyo. He was inspired by his own daughter and son, and designed the school with his wife, Yui, putting kids at the centre. Fuji Kindergarten has a circular structure, mainly built around a low, circular roof. The circular structure keeps the children moving — they cover 4,000 metres a day on average! They built around the trees that were already on the land, adding safety nets around them, which the kids now use as a hammock. There are no separations between classes, because children can wander about. Eventually they make it back to their own space because the structure is circular. “Don’t control them, don’t protect them too much, and that makes them learn how to live in this world,” says Tezuka. I found this video thanks to Isabelle Hau, who has an interesting newsletter on early childhood education.
Who’s been inspiring me
I came across the incredible story of Vivian Maier, a Chicago nanny who became known after her death in 2009 for her incredibly honest street pictures. Maier left behind more than 100,000 images, in hundreds of boxes of negatives and undeveloped rolls of film, which were auctioned and discovered by chance after she died in poverty. A secretive person, Maier used to take the children she minded for walks into some of the city’s poorest areas. She portrayed people and captured scenes of people living in poverty and of children playing and working. There is a film that was produced about her life that I look forward to watching.
What members have been saying
Thanks to Jodi for sending an incredibly touching and honest response to the newsletter I sent out last week talking about how overwhelmed I was. “This is all so familiar. The frustration of wanting to do something and having a wee one with a different plan. The not buying new clothes but also not actually having anything that fits your current body shape,” he wrote. “I’m ‘just’ the partner and didn’t even have a kid grow inside me and yet [it’s] lead to significant body changes. The lack of sleep / poor sleep, lead to more snacking and a lot less physical exercise. I gained 10kg in the first year, and almost 5 more the second. but refused to get new clothes until I physically couldn’t get into my pants anymore and my shirt buttons just wouldn’t reach the holes on the other side!” Thanks Jodi, I will be coming back to body image and “bouncing back” culture soon.
In the meantime, keep the comments coming.
With love and care,
📣 The First 1,000 Days is edited by community member and friend, Shaun Lavelle.