Sunday, May 12, 2013

Supporting Mothers, Supporting their decisions

“New father, huh?  Not getting any sleep, are ya?”
“Actually, I’m getting pretty good sleep.  My wife co-sleeps with the baby, so the baby just wakes up to nurse, then goes back to sleep.  Everyone sleeps better. ”
“Oh………   (confused look)….Um, ….OK.  (uncomfortable silience)…Uh,… see ya ‘round.”
I can’t say how many times that conversation has happened.  Each time we have a new baby, people expect us to have a nightmare of a time sleeping at night for at least weeks after the birth.  It seems like everyone expects problems with what can be a normal, loving, and bonding part of our human lives, and when the relatively easy experience of my family comes up, it’s as if we had said that drugging our baby with heroin made it sleep through the night better.  Newsflash, everyone:  Co-sleeping is an option which is often easy, healthy, and safe – in fact, co-sleeping is still the norm in most of the world outside of our Western culture, and has been the norm for millions of years.  However, it seems that moms are often discouraged from co-sleeping - either subtly or not so subtly.
I know this is a contentious issue, and I encourage everyone to look into the relevant data.  If it were just about me- about whether or not I was getting a good night’s sleep as a father of a new baby, then it really wouldn’t matter much.  But there is much more at stake here - mothers need support, both in help with family work as well as support in making informed decisions free from pressure (especially factually false pressure). 
 It’s already known that babies and mothers who co-sleep also show better sleep coordination, less stress, and many other benefits1, including emotional security that, according to recent studies, helps them their whole lives2.    Mothers who co-sleep are much more likely to breast-feed, and breastfeeding has been shown in multiple studies to benefit us all by producing healthier babies and happier moms3. 
These are important, but there is another important topic that looks like it is being ignored – the possible psychological benefits such as attachment, comfort, and particularly, reduced post partum depression (PPD).  In Western countries, PPD affects a whopping 10-20% of mothers.  Just a quick reality check here – every 1% is 50,000 women every year in the United States.    If the rates of PPD were brought down to that reported in regions where co-sleeping is more common, then hundreds of thousands of our wives, mothers, and sisters would be spared the dark pit of depression, and perhaps some of the suicides and cases of impaired infant care associated with PPD would be prevented.  
But is there any way to reduce PPD?  As mentioned above, we don’t have sufficient research yet, but there are reasons to suspect that increased co-sleeping could help where it is appropriate4.  For one thing, co-sleeping has been shown to make successful breast-feeding more likely, which is known to reduce the likelihood of PPD.  There is another possible reason as well.
For at least millions of years, a baby that was not with its mother at night may well be lost or worse, and the only hope for survival was to cry in terror for mom.  That terror could well be as natural a response as the rooting or grasping reflexes, and it has saved millions of our Ancestor’s lives, or we wouldn’t have it as babies.  As a result, for many babies, sleeping in a distant room could well be forcing a child to experience terror night after night. 
What about the mom’s perspective?  For our Ancestors for millions of years, a birth was followed by co-sleeping, unless the baby was dead or lost.  Infant mortality and stillbirth were facts of life, and it seems plausible to me that millions of years of evolution have resulted in some mental response in the mother when the mother’s body tells her brain that the baby is dead or lost. 
Why is co-sleeping so strongly discouraged?  We all can see that it is the crib industry that advertises so heavily to discourage co-sleeping (such as the recent “safe babies” advertising campaign by JPMA), and the same crib group says that co-sleeping in unsafe on their webpage5.   A little math shows that every 10% of mothers the advertising convinces to use a crib instead of co-sleeping is worth around 50 million dollars in increased sales6.
Oh, that advertising is to help with safety, right?  Maybe not.  The numbers show that co-sleeping likely decreases the deaths from SIDS7, which were 2,000 a year in the United States8.   So if co-sleeping would decrease that by just half, then that’s 1,000 babies saved.  Oh, but doesn’t co-sleeping lead to smothering deaths?   Most of these are from improper sleep arrangements, and even if all of them were real, that still overshadowed by the much larger numbers that occur with crib use (half of 2,000 is much larger than a few dozen). 
Am I blowing this out of proportion?  I hope so, but the more I investigate the more concern I have. 
For me, the embrace of my infants has melted my heart in a way that is impossible to describe.  Just as importantly, I’ve seen how depression can destroy one’s world.  Even the thought of mental harm to anyone’s baby or any mother brings me to tears.  If we can help babies and spare some moms from PPD by co-sleeping, how could we morally fail to do so?  At the very least, we need to find out, based on controlled research, and we need to talk about this issue openly as a society.
This mother’s day, I hope we can agree to bring PPD into the open, as a serious problem affecting us all.  I hope we can pledge to prioritize (and fund) research on PPD and co-sleeping, free from industry influence, putting the interests of mothers and babies first.  I hope we can support all mothers in making informed and guilt-free decisions about what sleeping arrangements work best for them.
In hope, I wish everyone (especially all mothers) a Happy Mother’s Day-

Jon Cleland Host
1.      “Sleep and Psychosomatic Medicine” Pandi-Perumal S.R, Rocco R Ruoti, Milton Kramer, 2007,
2.      Crawford, M. "Parenting practices in the Basque Country: Implications of infant and child-hood sleeping location for personality development", Ethos, 1994, 22, 1: 42–82.
3.      Gartner LM, et al. (2005). "Breastfeeding and the use of human milk [policy statement]". Pediatrics 115 (2): 496–506.
4.      Yes, of course there are factors that need to be taken into account when deciding whether or not to co-sleep.  For instance, babies are not safe co-sleeping with mothers who are using any drugs (including alcohol or tobacco), or are obese.  It’s interesting that obesity and drug use are conditions that were not present in our Pleistocene past.
6.      With 5 million births per year in the United States, if half of those need cribs (the others have cribs from older siblings, etc.), and cribs cost around $100 to $400, plus the crib bedding at $60 to $300, plus other accessories, let’s conservatively say $200. 
5,000,000 x 0.5 x 200 = 500 million dollars every year.
So if their advertising causes just 10% of mothers to use cribs instead of co-sleeping, that’s 50 million dollars in increased sales.
Correct me if I’m wrong on those numbers.  Does anyone have the actual yearly sales of the crib industry?
7.      P. S. Blair, P. J. Fleming, D. Bensley, et al., “Where Should Babies Sleep – Along or With Parents? Factors Influencing the Risk Of SIDS in the CESDI Study,” British Medical Journal 319 (1999): 1457-1462