I feel like the topic of bed sharing is an ongoing topic of discussion on social media. It is mixed camps of course – some for, some against. The same issue presents in the literature. There doesn’t appear to be much of a grey area – yet when we look at statistics, many parents practice bed sharing despite having knowledge of the risks. So should there be a grey area to explore this more in-depth with each individual case? I really think there needs to be, so those who are choosing to bed share anyways can do so as safely as possible.
I thought it might be helpful to discuss bed sharing a bit, what data we have, and current guidelines. But also my personal experience and shifting perspectives.
Disclaimer: this is not medical advice. This blog is for informational purposes only. For advice regarding your own health and the health of your family, please see your trusted healthcare provider. My views and opinions are my own.
Wait, what is bed sharing?
You might not be familiar with the term if you are just pregnant with your first child and haven’t attended a prenatal education class of some sort (where this topic is usually briefly covered).
There are two terms you may hear in a prenatal education course – room and bed sharing.
Room sharing is supported by current recommendations until at least 6 months and involves sleeping in the same room as your infant.
Bed sharing would be also room sharing, except you are also sharing a sleeping surface (whereas, in room sharing your baby is sleeping in your room on their own safe sleep surface). So generally, this would be having your baby sleep on your bed with you – but there can be many risks to this, and this is why it is an important topic to discuss today.
Current Statistics and Debates Around Bed Sharing
Keep in mind – this is a reported number. With studies we always have to think that there is 1) some proponent of the population not reported because studies are never ‘all inclusive’ as much as we try to make them representative; and 2) that some women may not disclose this information because of things like fear of judgment (yes, even with a survey). So these numbers could, hypothetically, be larger. Just important to keep in mind.
These numbers do not reflect a majority, but they do reflect a large percentage and this was 5+ years ago, so these numbers could very well be different today. In either direction (though more recent studies point to them remaining stable or increasing in many countries).
There were certain sociodemographic characteristics associated with increased reporting of bed sharing – younger mothers, lower income, and those who rent were more likely to report it frequently. Notably, those without a healthcare provider reported higher rates/frequency as well.
Another common factor with increased frequency was breastfeeding, and this was a commonly reported reason to bed share. The other popular reason was to promote sleep for mom and baby. However, parents may choose to bed share for a handful of other reasons – if you click on any of the studies I’ve shared, many share long lists of reasons parents reference as to why they might. And reasons are various and often influenced by their own and their baby’s individual circumstances.
Other studies have demonstrated that bed-sharing is not really a black and white issue. It is often a culturally important practice for example, so this factor cannot be overlooked. Parents may also use it to encourage sleep (as we see above) or to settle a baby, and the decision is not often made ‘lightly’ or without risk consideration.
There are certainly risks to bed sharing and we must not overlook this, especially when done with certain more high risk infants or in unsafe environments. Risk considerations exist around the risk for the head being covered; the thermal environment or infant temperature; risk for hypoxia or SIDS; frequent waking; and the risk if the mother smokes (or uses substances).
Some studies have highlighted potential benefits to safe bed sharing practices such as increased duration of breastfeeding, which boasts in itself a myriad of other benefits. I bold safe because there is a big difference between what is considered a safer bed sharing option and what is not and the risks/benefits associated with each.
Current Recommendations in Canada and the US
Both do promote “room sharing” for the first 6 months, which is significantly different from bed sharing as I explained above.
I’ve posted previously about SIDS and the related safe sleep recommendations to reduce the risk here, and I’ve also had Cayla Solomon, paediatric sleep consultant of Sleeping Beauties, on the podcast to speak on this topic. These might be good to review re: safe sleep recommendations, as well as the Canadian and American resources I’ve shared two paragraphs above.
The authorities highlight the major risks of unsafe bed sharing practices – which include the risks I’ve mentioned above, as a reason why they do not support bed sharing.
If there are risks and it is not recommended, why are people still doing it?
Well, that is exactly the question that needs to be answered. It is important to look at why bed sharing is practiced frequently when current recommendations and guidance in many countries do not encourage it.
An excellent nursing article by Bunch and Hutson (2020) calls for more statements to be made by larger, respected organizations around mother & child health about this topic. More research is needed about risk and benefits – particularly of safe vs unsafe bed sharing, as most of the studies focus on safety of sleeping alone and the associated risk reduction. They importantly note that we need to explore this topic more and adopt a less black and white policy scheme when it comes to bed-sharing because it doesn’t consider the complex realities of each family. We must consider things like parent choice, lifestyle and culture when developing care plans for new families.
Some people may not be able to bed share safely and they should be counselled appropriately about this. But each case needs to be considered on a case-by-case basis, and risk/benefit factor analysis completed for each family.
Families need to be supported in their new parenting journey – and the fact that we are providing the guidance of not to bed share at all, yet it is still being done, points to the idea that a blanket statement simply is not appropriate in this situation. As healthcare professionals – we need to do better because many of my nurse colleagues still report seeing many bed sharing associated deaths in practice and this is not acceptable.
But I think we can see that telling people “no don’t do that because x, y, z risk” doesn’t necessarily work in this situation. We see this in many other healthcare situations as well – we could tell people never to eat sweets, or to smoke cigarettes, or to do dangerous risk-taking actions like jump from a plane or go bungee jumping, but some will weigh their risk/benefits and still decide to pursue their preferred option.
We need to be studying the motivation behind why these actions are taken (which, as can be seen from existing studies, is starting to be done), but we also need to be speaking directly to the main stakeholders in this situation – parents – and trying to understand their lived experience. Education seems to bare little influence on the decision to bed share (based on the Stats Canada information), so does that suggest that some potential benefits may outweigh risks for parents? Why is this? We need to look at this and try to understand so that we can cater our health teaching and policy toward an overall safer and more supportive environment for parents.
Parents should not feel afraid to speak to their healthcare provider about their child’s sleep. This to me, suggests that we as healthcare professionals, are approaching the way we speak and counsel around these topics the wrong way. This needs to be addressed.
My Experience and Perspectives
I want to make it clear, I am not saying that baby sleeping on their own surface isn’t the safest option – it absolutely is.
What I am highlighting here is that, despite people knowing this, they are choosing to bed share. So perhaps the best option isn’t always the best for each individual case. Perhaps it isn’t feasible for a period of time. Perhaps families are complex units and we cannot simply say “no don’t do that” with a blanket statement and (whether intentionally or not) shame those who do. Each family unit is so different – I am sure each of us sees that when we compare our family to our parents, or to our friends. One size fits all doesn’t work in most parenting situations, so I don’t find it ridiculous to think it doesn’t work here either.
Many who I’ve spoken to, are choosing to learn how to bed share safely any way they can, because it is what works best for their family at this time in their trajectory. Their reasons are various and complex. I think we need to work better at understanding the “why”, and promoting safety in these situations. We have to remember that people will make their own decisions with the information we give them, that is informed choice. But no matter their decision, we can try and promote as much safety as possible within their scenario. That is our duty – not to shame, but to try and understand, empathize, and support.
From my own experience, I felt the struggle here. I felt the pain of a change in perspective – because change never comes without discomfort of some sort.
As a new nurse and an expecting mom for the first time, I thought: ‘my baby will sleep in her own crib because this is the safest thing’. When I had my baby, and she went through a period of just not sleeping at all, which led to my husband and I not sleeping at all, I had to change my perspectives. I had to because we could not mentally or physically survive when all of us were not sleeping. I am sure some would say oh your husband could sleep in the basement; or take turns waking up; but sometimes it doesn’t work that way. We tried. We tried so hard to keep going and change shifts, but it wasn’t working. My husband had to return to work and him not sleeping then became a safety hazard, as he works with machinery. Our reasons were complex and unique to us – but we ended up speaking to our care provider about the issue. “What do we do? I know that she should sleep in her bassinet but she isn’t sleeping and we aren’t either. I don’t feel safe.”
With the help and guidance of our provider, we did bed share – for us, it was for a period of time because that is what worked for our family. It was not a perfect solution for us either, but at least everyone was getting some sleep so it was significantly better than continuously trying all night to lay a baby down in a bassinet just to have her shoot back up, wide awake. We were so lucky to have guidance about how we could make our space as safe as possible – because this information can be hard to find on your own and it is really beneficial to have guidance around this.
Through this experience, I learned a few things. First of all, I continued to recognize that the recommendations were correct – the safest option remained the baby being in her own sleep space. I will still continue to promote this and the current Canadian recommendations on safe sleep.
But, I also learned that in some circumstances – it remained the safest option but not necessarily the best one for the family, parent(s), or baby at the time. I learned that sleep is complex and that families are too and when we bring 2 complex concepts together.. well, it becomes hard to navigate. I learned that we need to look at these situations with a more open and empathetic perspective – sometimes people understand very well the risks, but we as healthcare professionals fail to understand their values, cultural practices, beliefs or needs.
During our no sleep period, I came very close on multiple occasions to falling asleep holding my baby in a chair, which is a significant risk. I remember also once dozing off during this period with her on the couch, only for about a second. Hugely risky. I cried when I woke up from my 1 second doze off because I knew that something terrible could have happened.
I was distressed, sleep deprived, and worried about my family’s safety. I was scared to address the topic as a healthcare professional with another healthcare professional in fear of judgment. But we were so lucky to be met with empathy, and we were supported to make our situation as safe as possible – so we did bed share, for a time. Like I said, it wasn’t our ideal but it was worked for us at that time. It helped us get through a particularly challenging period, and then we went back to putting our baby down in her bassinet (and I know this isn’t the path that every family takes – and that is why it is so important to assess each situation independently).
She’d still end up in our bed for parts of the night, I won’t lie. We continued to practice the guidance provided to us for safety. Until about 9 months when she decided she was happier in her own space, and I heaved a sigh of relief because we both got our own spaces back and I felt like I was once again following the guidance. I shouldn’t have had to feel like that, but the fear of judgment from others made me feel that way.
So – I think that the recommendations remain appropriate, but that our approach to counselling and teaching around safe sleep needs to change. I think we need to approach the topic differently, provide guidance/support at more frequent intervals, and most importantly, we need to include families perspectives and values within our guidance, on a case by case basis.
Parents should not feel fearful to bring the topic of sleep up to their provider! That is not ok.
For those who can and need to (or want to follow their cultural practices) – we should also be able to provide non-judgmental counselling around this. A black and white stance does nothing but create fear in parents to address their concerns with their provider. We can provide this education – the facts and the recommendations – while also trying to understand a family’s context and provide the best support we can within the confines of this context. I truly believe this is possible, but we need to put in work to do this.
We need more research and more guidelines. Information that is easily available to parents. We know parents are bed sharing despite recommendations, so we should be providing them with guidance for these situations. That doesn’t mean we have to stop educating and promoting the safest option – it just means we need to be a bit more open and supportive to each family’s needs. Resources are needed, otherwise unsafe practices will prevail and there will be despair.
So, lets do better and work together with families to see how we can best support safe sleep without making anyone feel as if they cannot talk about sleep to us.
As always, thanks for reading.