The moment we realise we’re pregnant, many of us jump to preparing for baby’s arrival, researching and planning, and making sure we’re ready to tackle the newborn days.
We buy cribs, bassinets, swaddles sacks and more, to prepare for helping a newborn sleep.
We read and hear about safe sleep, such as always putting baby to sleep on her back.
We read about leaving loose blankets out of the crib and never putting a pillow or stuffed toys in bed with baby.
Baby’s Death Serves As A Warning That Mamas Need More Support
Many of us also research co-sleeping, or we end up co-sleeping even if we didn’t plan to, due to needing sleep even when baby won’t sleep out of our arms.
And no matter how many books we read, how much we prepare, most of us aren’t ready for the pure and utter fatigue that is the first few weeks and months of parenthood.
A Baby’s Death Leads To Bedsharing Warnings
Recently, a devastated mother took to social media to share the heartbreaking loss of her baby and to warn other parents to please get out of bed to feed or soothe their newborn.
Unfortunately, during breastfeeding in bed, Kristen Hoffman fell asleep and later woke to her son unconscious. Despite efforts to save him, his brain was deprived of oxygen for too long and he passed away.
It sounds straightforward: Don’t fall asleep with baby in bed, always get up to feed them. This is the safest way, right? If only it were that simple.
First and foremost, Hoffman isn’t a mama that’s done anything wrong. She isn’t a mama who took an unnecessary risk. She wasn’t lazy for not getting out of bed.
She was a new mama, she was tired, and she was simply feeding her baby. Her warning to other parents is heartfelt, and heartbreaking as she lost her baby.
However, can her warning help other parents?
Is Getting Out Of Bed For Every Feed The Safest Thing?
Before having a baby, many of us expect to wake every few hours, feed baby for 10-20 minutes, then place baby back to sleep in their cot and repeat the process again a few hours later.
In reality, many of us have newborns who feed every one to two hours in the early weeks. They may feed for 20-40 minutes and then, when we go to put them in their cot, they stir and simply won’t settle out of arms or unlatched.
When we look at the tragedy of Hoffman losing her precious son John, and her heartfelt warning, it seems as though the simplest solution is to get out of bed and feed baby will sitting upright. The glider, the couch or the not so comfortable rocking chair will surely keep us alert.
Unfortunately, fatigued parents can fall asleep anywhere. There are massive amounts of cute photos floating around with parents passed out on the couch or the nursing chair while feeding baby.
The level of new parent fatigue is something many never felt before parenthood, and even if they did, it wasn’t felt while also caring for a fragile newborn.
If you’re at risk for falling asleep while feeding, couches, gliders, etc. still pose a significant risk, more risk than bedsharing while following safety guidelines.
In 2016, the American Academy of Pediatrics (AAP) released new safe sleep guidelines. Lori Feldman-Winter, a co-author of the new recommendations said in a statement: “If you are feeding your baby and think that there’s even the slightest possibility that you may fall asleep, feed your baby on your bed, rather than a sofa or cushioned chair. If you do fall asleep, as soon as you wake up be sure to move the baby to his or her own bed.”
Where Is The Safest Place For Baby To Sleep?
The guidelines provided by the AAP say:
- Babies should sleep in the same room as their caregiver for at least six months, preferably until at least one year.
- Babies should always be placed on their backs to sleep (if they roll independently to their tummy, that’s fine, but don’t place them to sleep on their tummy).
- Babies should be placed in their cot/crib, bassinet, etc. with only a fitted sheet.
- There should be no loose blankets, stuffed animals, or pillows on baby’s sleep surface.
- Baby’s sleep surface should be firm.
- Sleep positioners should not be used.
- Babies should not be left in a swing, car seat, bouncy seat, etc. for unattended sleep (if you’re not in the room watching them, it's unsafe for them to sleep in these items).
- Do not put baby to sleep with a hat on or anything else which is covering or could cover baby’s head or face.
- Never sleep with baby on a couch, glider, water bed, or other surface which poses an entrapment and suffocation risk.
- Don’t expose baby to cigarette smoke.
Is Bedsharing Inherently Dangerous?
In short, no, it isn’t inherently dangerous. In long, it can be, just as cot/crib or other sleep surfaces can pose risks when safety measures aren’t taken.
UNICEF UK recognises that on any given night, at least 22% of British infants are bedsharing. For this reason, they produced a guideline to co-sleeping for healthcare professionals to help care providers educate families on safe sleep.
Many healthcare professionals took or are still taking the same approach as Hoffman in warning parents of the dangers of co-sleeping. Unfortunately, this approach doesn’t necessarily reduce risks, and in some situations (e.g. falling asleep on the couch) it actually increases risks.
Parents become concerned about the safety of having their baby in bed. While exhausted, they think they’re doing the safest thing by heading to the couch to feed baby.
Unfortunately, they’re so fatigued, they fall asleep on the couch which poses more risk of suffocation and entrapment than a bed.
With the guidelines from UNICEF UK, healthcare providers are able to educate parents about safe bedsharing should they find themselves fatigued, or if they make the decision to bedshare regularly, they can bedshare in the safest way possible.
The reality, many new mothers are unable to get adequate rest with never breastfeeding in bed. Many parents find themselves exhausted at 2am and make the choice to bedshare. Without planning ahead, spontaneous bedsharing can lead to unsafe situations such as:
- Sleeping on a non-firm mattress.
- Having loose and puffy blankets near baby.
- Falling asleep with baby near a pillow.
- Keeping baby dressed warmly from when she was in her cot.
- Having baby sleep next to a sibling, not next to just mother, with a pet, etc.
While most healthcare providers believe it’s safest for baby to sleep on their own separate surface, making sure parents are aware of safe bedsharing guidelines reduces the risk of last minute bedsharing errors. Even if a parent never plans to bedshare, it’s important they have the tools to make a safe decision at 2am.
What Are Safe Bedsharing Guidelines?
While it’s likely your local paediatrician advises against bedsharing, there are many healthcare professionals who research the safety of bedsharing and make bedsharing guidelines.
Professor James J. McKenna of Notre Dame’s Mother-Baby Behavioral Sleep Laboratory has spent decades researching bedsharing, co-sleeping (same room, close proximity but separate sleep surface), and infant sleep in general. His guidelines, as well as UNICEF UK’s are similar and include recommendations such as:
- Baby is placed on her back to sleep
- A firm mattress is used
- Only biological parents in bed, baby next to mother
- A bed free of entrapment or entanglement hazards
- Completely sober parents
- Breastfeeding mother/baby pairs.
Is Extreme Fatigue Dangerous For Bedsharing?
In addition to these guidelines, some sources also say overly fatigued parents shouldn’t bedshare. In Dr. Sears’ Do’s and Don’t’s for Cosleeping Safely, you will find:
“Don’t bedshare if: You are exhausted from sleep deprivation. This lessens your awareness of your baby and your arousability from sleep.”
This guideline makes a lot of sense considering how fatigue can impact our bodies. We know to never bedshare if we’re intoxicated. In fact, few parents would become intoxicated while being responsible for caring for their children. If a parent chooses to be intoxicated, a responsible parent ensures their children are under the care of a responsible and sober individual.
So, why would being fatigued be dangerous? Many studies have indicated that severe fatigue can be as dangerous as intoxication when it comes to tasks like driving. It’s a reasonable jump then, that extreme fatigue can impact our ability to safely care for our children.
What’s the safest solution to reduce the risk of another tragic situation? Perhaps it isn’t more safe sleep recommendations, but rather ensuring more mamas receive adequate support.
Why New Mamas Need More Support
Once upon a time, mothers gave birth surrounded by other women. They were expected to rest 30, 40 or 100 days. They fed baby while others ensured they ate, rested and healed from childbirth.
There was also an era when parents were expected to feed on a strict schedule and leave their babies to self soothe essentially from birth. While mothers likely got more rest, we realised this was far from ideal for many infants.
Cue our generation, where we know it’s best to answer our newborns cries as soon as possible. We know to feed on demand in the early days and months to ensure adequate milk supply. We know early rice cereal has risks and isn’t the answer to getting a five week old to sleep through the night.
We’re back to feeding and soothing our babies like the “once upon a time” generations above, except we don’t have the support they did. Few of us have several relatives and friends who don’t work full time and can devote days, weeks or even months to caring for us in the postnatal period.
Why Are New Mamas So Exhausted?
Many of us give birth in the hospital and go home after a few days of frequent waking due to vital sign checks (which isn’t to say aren't important, but simply that few of us get adequate rest while hospitalised). A third of women are going home to care for newborns while recovering from a c-section which is a major surgery.
We’re sent home already exhausted, healing, and with little support. We’re told about the latest prams, swings and diaper brands, but no one tells us how to prepare for, prevent and manage major fatigue.
What we now have are parents warned not to bedshare with little information about safe ways to manage feeding a baby when you’re overly fatigued.
As an experienced mama, certified postpartum doula, and parent educator, I would expect to be immune from the type of fatigue which can make caring for a child dangerous. Yet, after a long hospitalisation, waking several times a night to pump, and then bringing home a preemie attached to wires, I wasn’t immune.
I know the feeling of such fatigue that you feel your body move and react far slower than you need it to. I know the feeling of poor coordination which ultimately leads to a hospital stay. And as I read Hoffman’s warnings, as I read her tragedy, I realise how in so many circumstances there’s no real explanation for which situations will unfortunately lead to tragedy.
But what I do realise is this, with more support, no mama needs to be so fatigued she or her baby is put at risk.
Safe bedsharing guidelines are a wonderful start and solution in some circumstances, but perhaps the real solution is a culture shift which ensures mamas enter motherhood with adequate support to reduce devastating fatigue.