Co-sleeping, a controversial practice that is gaining followers despite the risk to the baby

Lluisa has had a rural house on the outskirts of Barcelona for more than two decades: a bucolic place, on the edge of a stream, where many families with small children go.

Oliver Thansan
Oliver Thansan
20 March 2023 Monday 23:07
21 Reads
Co-sleeping, a controversial practice that is gaining followers despite the risk to the baby

Lluisa has had a rural house on the outskirts of Barcelona for more than two decades: a bucolic place, on the edge of a stream, where many families with small children go. But in recent years he has detected a change that calls his attention: "When I ask them if they need a crib, most parents now tell me 'no': that they 'college', that is, they sleep in the bed with their children, and they do not need it. While before the crib was a requirement, today there are few families that ask for it”.

The crib, that object that seems essential for upbringing, is going out of style. “Sleep with your son. In this way, you do not need a bassinet or cribs, or walkie-talkies ”, writes the psychologist Rosa Jové, in her latest book Sustainable parenting (La Esfera de los Libros).

Since she published Sleep Without Tears, an editorial and ideological response to the best-seller Go to sleep, child, by Dr. Estivill, Jové has become one of the most fervent defenders of parents and children sleeping together as a matter of course. She is also a benchmark in Spain for natural or "attachment" parenting. This style, increasingly in vogue in our parts, has co-sleeping as one of its pillars (along with prolonged and on-demand breastfeeding, natural childbirth and constant physical closeness with the baby).

Jové's thesis is very similar to that of American anthropologist James McKenna, whose studies on mother-infant sleep are a constant in the bibliography of natural parenting. McKenna considers 'harvesting' to be the 'natural' way of sleeping: this is how our species, a mammal, has done it for most of its history.

For an "overwhelming majority" of mothers and children, he maintains, it is a practice that is not even questioned: "In most of southern Europe, Asia, Africa, America and South America, mothers and babies routinely share a bed" , he writes in his book Safe Infant Sleep: Expert Answers to Your Co-sleeping Questions (Platypus Media). The book is almost 300 pages long but does not specify in which parts of “southern Europe” 'harvesting' is an unquestionable practice.

Co-sleeping advocates maintain that separate sleeping is a recent thing, a byproduct of the industrialized world. A society, where, writes McKenna, “mothers have the dubious luxury of asking themselves two basic questions: how am I going to feed my baby? Where is she going to sleep?

For him, the answer to both dilemmas is one: combine breastfeeding and co-sleeping. In fact, he has coined a term (breastsleeping), which would be "breastfeeding while sleeping". "There is no such thing as infant sleep, there is no breastfeeding, there is only breastsleeping," he says in one of his countless articles in defense of co-sleeping. The increasingly ubiquitous message is this: 'harvesting' and suckling are two interrelated, almost symbiotic practices. And by doing so, it is responding to the physiological and affective needs of the creatures.

Before these arguments, who dares not to 'harvest'? Exercising a practice that for many mothers seems to be synonymous with full happiness. At least, on social media: "We slept cuddled up and at two months, we slept fantastically all night." "Yessslecho-power!". "Four months of happy co-sleeping and even when she wants." "Since she was born, I sleep in a corner, but I love watching her while she sleeps." “Luckily we have evolved and returned to this primitive instinct. It is wonderful". “I fall in love every day. With a 2-year-old girl and expecting a baby girl in June. We will sleep in a herd, all together.”

It would seem that the world sleeps happily if these comments are heeded, taken from the Instagram of the midwife and popularizer Laia Casadevall, from a post titled: "Do you know why I love co-sleeping?" There do not seem to be sleep disorders that, according to the Spanish Association of Pediatrics, affect 30% of children under five years of age, but rather mothers who "fall in love every day" with their offspring thanks to co-sleeping.

In the current imaginary, with a strong presence of attachment influencers on social networks, buts to co-sleeping almost do not exist. Like lactation, no discussion is allowed. And if these buts are mentioned, it is done almost on tiptoe. Without leaving Casadevall's post —which has almost one hundred thousand followers—, although he mentions a “safe bed-sleeping” and “Unicef's safety recommendations”, he does not delve into it.

The "UNICEF safety recommendations", collected in different publications, from 2006 to 2021, are these: it is recommended to share the room with the baby "for at least the first 6 months", since this helps with breastfeeding and protects babies from sudden death. But it is also specified that: "The safest place for a baby to sleep is in a crib attached to your bed." Adult beds, they point out, from the United Nations organization for children, "are not designed for the safety of babies."

The American Academy of Pediatrics also advises sharing a room with your baby, but not a bed, for the first six months of life. Recommendations (updated 2022) to reduce sleep-related deaths include: “Share a room, close to parents' bed, but on a separate surface, designed for children, ideally for the first six months of life". This separate sleeping surface, designed for children, would be equivalent to… a cot.

A key recommendation is that the baby sleep on his back: in fact, the American Academy of Pediatrics was the one who, in 1992, recommended this position as the safest to put them to bed and reduce the risk of sudden infant death. This simple rule meant a substantial decrease in the incidence of this syndrome but, as the Academy itself explains: "The sleep-related infant mortality rate has remained stagnant since the 2000s." One of the causes of risk is "an unsafe sleeping environment", which includes sharing a bed with parents in the first months of life.

The Spanish Association of Pediatrics (AEP) reiterates that "in the entire history of humanity, children have slept with their parents" and that this practice facilitates breastfeeding, which, they emphasize, has a protective effect against sudden death syndrome. of the infant However, this entity also ensures that "the safest way for infants under six months to sleep is in their crib, face up, near their parents' bed."

The recommendations of the AEP are in line with those of Unicef, which adds that, if you opt for co-sleeping, either intentionally or spontaneously, you must keep the pillows away from the baby, make sure that the bedding does not cover neither head nor face and prevent him from falling or getting trapped between the mattress and the wall. It is also not recommended to leave it alone in an adult's bed. Under no circumstances is it recommended to 'collect' if drugs, tranquilizers or alcohol have been used, if you are a smoker or if the baby is underweight. Likewise, it is urged to avoid putting yourself "in a position in which the mother can fall asleep with her baby on a sofa or armchair."

The notion that co-sleeping can pose a risk is not to everyone's taste. In polarized times, with the so-called mother wars in the background, this issue uncovers heated debates. In his book, James McKenna lashes out at the American Academy of Pediatrics for what he calls "their anti-sleeping crusade." Other disseminators simply ignore the recommendations not to sleep with a baby under six months and limit themselves to listing the aforementioned tips for safe co-sleeping.

In the networks, in general, the inconveniences of co-sleeping are overlooked or minimized: “What is done to avoid crushing them? I don't have children but I toss and turn in bed more than a merry-go-round and I would be very afraid of literally killing him”, asks a follower in the aforementioned post by midwife Laia Casadevall. The answer is given by another follower: “Don't worry, when you're a mother, you'll see. The protective instinct that you have for your baby [will] make you watch out even if you are asleep.”

At the academic level, there is also controversy, and a striking zeal on the part of some sectors, linked to activism (the promotion of breastfeeding), for co-sleeping to be practiced. The reasoning of organizations such as IHAN-Spain (Initiative for the Humanization of Assistance to Birth and Breastfeeding, linked to Unicef), is that this practice encourages exclusive breastfeeding and, as this is a protective factor against sudden infant death , there is a positive balance between benefit and risk.

In Spain, a 2012 article in the Revista Pediatría de Atención Primaria, (entitled: Co-sleeping favors the practice of breastfeeding and does not increase the risk of sudden infant death), argued that when properly practiced, "avoiding risk factors" , co-sleeping “is not related to sudden infant death”, which was described as “extremely rare”. The text, signed by several authors, branded most of the studies on this subject as "not very rigorous".

The article was answered in the same medium by two infant sleep specialists: pediatricians Ramón Ugarte and Gonzalo Pin. In it they pointed out that "referring to sudden infant death as a "very rare" entity does not seem very accurate, due to its fatal consequences" and that "not because it is anthropologically natural" co-sleeping should be considered as something safe. Without denying that this practice facilitates breastfeeding, they pointed out that 'harvesting' is not a “sine qua non condition” to guarantee it. They also noted the lack of mention in the article of the recommendations, both from UNICEF and the AAP, that, at least during the first six months of life: "The safest place for the baby is in his crib, next to his parents' bed