The War on Bedsharing Continues

If you haven’t heard or seen yet, you probably will soon: news media reports that bedsharing comes with a five times greater risk of SIDS, even if the mother is a breastfeeding non-smoker.

Don’t believe it folks.

And I’m not just saying that because I’m sympathetic to breastfeeding and bedsharing. There is what appears to me to be an organized, and very persistent campaign against bedsharing going on in the Western world. I don’t quite understand it. I think it might partly be well-intentioned, because bedsharing does definitely increase the risk of sudden infant death, but only in certain circumstances – particularly if the mother smokes (probably the father too, but they haven’t collected much data about paternal smoking) and particularly in the context of parental alcohol or drug use ( and most likely, intoxication, not just a glass of wine). I think that some of the anti-bed-sharing lobby   thinks it’s too complicated to explain these things to parents, plus they think bedsharing is  abnormal and unneccessary. (You know, these researchers slept alone in their cots as babies and they’re all fine… sort of thing. Yeah, exception for their scientific tunnel vision.) So, they think it’s best to simply tell all parents to never bedshare, completely ignoring the biological and social absurdity of telling mothers to breastfed and then warning them to never sleep with their babies. Breastfeeding causes bedsharing, pure and simple. Not always perhaps. but very often. It’s biologically inevitable.

Back to the study. Discombobulated, perhaps, by recent evidence that has clarified that the risks of bedsharing are limited , and that breastfeeding protects against SIDS (a finding which some SIDS researchers did not accept in the past, and apparently some still don’t) several authors teamed up to to rehash and respin some of their old data, much of which uses poor, outdated definitions of things like co-sleeping and breastfeeding. How do I know? I’ve seen the peer reviews for this article. Journal articles have to be reviewed by academic peers to ensure high standards of scholarship. I actually have personal experience of this with regard to the one journal article I co-authored. I was unimpressed. The biases of the two reviewers were obvious. That is not to demean all peer reviewers. I do have some faith in the process, and I will acknowledge that the peer reviewers’ questioning of our findings – which they really just didn’t think could possibly be true (specifically, that many mothers of nightwaking babies idon’t think their baby has a “sleep problem”) – led to improvements in our article.  But just keep in mind that peer review is as imperfect and, at times, flawed as most human endeavours can be, even though it is often implied to be foolproof.

With respect to this article that supposedly found that bedsharing increased the risk of SIDS fivefold even if the mother didn’t smoke and did breastfeed,  3 of 4 reviewers did say it was excellent and made fairly cursory comments. One admitted to not being a statistical expert. But the dissenting, and more detailed review  was from Peter Blair, who, IMO, is by far the best SIDS epidemiologist in the world. I’ve interviewed him several times, and he’s pretty much the only SIDS epidemiologist I would trust for the truth about risk factors. He thoroughly trashes the study. Here’s a link to the peer reviews (Blair’s is the second, and by far the most painstakingly detailed). The authors’ response is there too. See how scientific publishing works!  http://m.bmjopen.bmj.com/content/3/5/e002299.reviewer-comments.pdf

By the way, notice that the article, didn’t make it into the main British Medical Journal, only BMJ open, an online journal that authors actually have to pay a fee to get into.

Hmm. I wonder why.

Oh and here is another rebuttal by some academics (who, obviously were not invited to be peer reviewers) whose work I trust http://bit.ly/11Tc76g

But don’t believe the news headlines you’re going to see and hear over the next few days.

PS. (Added 3 weeks later). A reader recently challenged me to back up my assertions that there is an “anti-bedsharing lobby” and that  some SIDS researchers have not wanted to accept that breastfeeding protects against SIDS. Fair enough.

Re: The so-called anti-bedsharing lobby. I think most people understand that I don’t mean that there is an organization (like the National Rifle Association or something) that campaigns against bedsharing. But there sure are a lot of researchers, health professionals and other advice-givers who are definitely against bed-sharing and who push their views quite aggressively. I also have the impression that they are talking to each other. For example, a number of years ago I had a conversation with a coroner and I asked, “What percentage of cases of overlying (parent rolling over onto a sleeping baby resulting in the baby’s death) that your office investigates are related to drugs and alcohol? ” “All of them,” he told me. Two years later this same coroner started saying that all bedsharing was always dangerous.  Then I noticed a number of coroners were saying this. I think anti-bedsharing people had been talking to them, or sending them their studies. I can’t prove this of course. But it is a matter of public record (just go look it up) that lots of people are campaigning to persuade parents that bedsharing is dangerous, and a bad choice for parents. I’d call that a lobby.

Re: Breastfeeding and SIDS. I have been writing about paying attention to research about SIDS (and many other things related to parenting) for almost 20 years. Admittedly, after some recent higher quality studies have come out, there is now much more acceptance of the idea that breastfeeding is protective against SIDS. However, 10 or so years ago, there was much less acceptance and a lot of researchers and official bodies would not say that breastfeeding was protective because, they said, the research was inconclusive. That was largely because a lot of older studies (including some of the ones rehashed in the BMJ online article) had poor definitions of breastfeeding. They would lump a baby who was nursed for two weeks in with babies who were exclusively breastfed for 4 months or more. Bad science.

That’s why I think some of the older studies were inconclusive. So I stand by the statement that, in the past that some researchers did not want to accept that breastfeeding was protective against SIDS. However, I’ve changed the wording slightly to make my meaning clearer. And I would still say that the authors of the article I’m critical of don’t seem to want to accept it.

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About uncommonjohn

I am one of Canada's top parenting writers. My areas of expertise and interest include debunking bad parenting advice (especially about sleep), self-regulation, fatherhood, child development, children's mental health, childbirth and breastfeeding.
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11 Responses to The War on Bedsharing Continues

  1. mcav75 says:

    I caught this news on the BBC today. It is fascinating how the news twists the facts until the are practically lies. By lumping in every incident of SIDS such as drug/alcohol/smoking related as well as couch and sofa sharing as if they are all just “bed sharing” without any other factors is extremely bad science.

    • Julia says:

      I saw the report on BBC Breakfast – I was not very impressed that both guests they had speaking seemed to be supporters of the study, and of the ‘thou shalt not co-sleep’ school.

      I would like to have seen a more balanced discussion.

  2. Heather says:

    Another good blog, John. Relying on media to give you accurate details about studies is not the best idea, especially when some “studies” have their own bias towards a specific conclusion.

  3. waggermama says:

    Reblogged this on Thames Valley Sling Babies and commented:
    I was just going to write about this, then realised someone better at writing has done the job for me. Please also see the UNICEF response here: http://www.unicef.org.uk/BabyFriendly/News-and-Research/News/UNICEF-UK-Baby-Friendly-Initiative-statement-on-new-bed-sharing-research/

  4. travelnole says:

    Reblogged this on Natural Birth and Parenting and commented:
    I was just working on a post about co-sleeping today during Alex’s afternoon nap, but since it’s not done yet I thought I’d lead with this reply to the new research saying that bed-sharing increases the risk of SIDS five-fold (maybe you’ve seen it). I haven’t done the thoughtful evaluation of the research that this blogger has but, like him, I’m not buying it. What do you think?

    My own co-sleeping post will be finished soon (tomorrow, maybe?).

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  6. nickysmiles says:

    John I am bedsharing and nursing my 3rd child so I am very much a proponent of this practice…but I also read a lot of research articles and have an eye for weak studies and a mind for critical review and I find your article leaving me skeptical. You make some claims that I would like to ask you to clarify. Would you mind answering a few questions?

    1) This statement: “… that breastfeeding protects against SIDS (a finding which some SIDS researchers have never wanted to accept)…” has me wanting to challenge you for clarification. What do you mean when you say that SIDS researchers don’t “want to accept” that breastfeeding reduces the risk of SIDS? Either breastfeeding does or it doesn’t reduce the risk of SIDS, good researchers are not supposed to “accept” their findings….the findings are the findings. What has led you to state that there is this bias among SIDS researchers? And if there is a bias…why is it there? What’s so wrong with breastfeeding such that the SIDS researchers wouldn’t want to bring themselves to “accept” that it could lessen SIDS rates?

    2) Who is the “anti-bed sharing lobby”? Specifically? The only anti-bed sharing pressure I have received is from my pediatrician who is trained by the APA to parrot the latest (and least legally vulnerable) medical advice to insure the physical safety (not mental health) of a baby. That’s it. I have yet to encounter an anti bed sharing “lobby” (that is if you don’t count my mother in law who neither bed shared nor nursed and at times has very little social filter).

    So my point is that I think you have some really excellent sound points to share but I would encourage you to be less biased and ‘frustrated’ at the enemy in your presentation. Your claims (without factual background statements) make you sound more biased than the SIDS researchers. I really WANT to take your information as gospel but I found myself eye-rolling halfway down the article. Too many people are writing emotionally charged articles with too little scientific data to support attachment parenting practices. And thus, people like me, (and more, importantly, like pediatricians) who have a lot of experience reading research articles become skeptical.

    • uncommonjohn says:

      Good questions and fair comments. Yes I am frustrated. I make no apology for that. But I’m not aware that I have ever called anyone the enemy.
      I am frustrated because I have observed a consistent and persistent push to promote the idea that bedsharing is dangerous willy-nilly (and the online journal article I am commenting on, in which a group of researchers decided to pool their old findings to make this exact point, is a prime example).
      Coroners are into it too. I don’t feel I need to cite examples. They are all over the place. There are enough “experts” in the anti-bedsharing category that I think of them as a lobby. But strictly speaking – no there is no formal anti-bedsharing organization that I am aware of.

      Re- breastfeeding. My statement that some researchers have never wanted to accept that idea that breastfeeding protects against SIDS is based on the fact that for years pro-breastfeeding people have said (and cited research) that breastfeeding is protective, but in the past I used to see that disputed. part of the reason that some SIDS researchers did not “accept” this was that findings were mixed. And that was primarily because some old epidemiological studies had very poor definitions of breastfed which, sometimes, put babies who were had been nursed for two weeks in the same category with those who were breastfed exclusively for four months. Some of those studies – and, I am going by memory on this (I don’t have time to look them up) did not find a protective impact of breastfeeding. However, now some better quality studies have been done, and there is much more general acceptance that breastfeeding is protective against SIDS. So, I could have worded that phrase a little differently to put it more clearly in the past tense.

      But I will revise a couple of wordings in the blog based on your feedback.

      So thanks for challenging me in a courteous way. I salute your intelligence and analytical skills.

      Regards,

      BTW. You and others might be surprised to know that I do not consider myself to be a promoter of attachment parenting practices, although my wife an I used a lot of them I see myself more as a defender of the essential needs of babies and the need, and right, of parents to interpret those needs and parent in ways that they believe will address those needs. Very often, when parents do that, IMO, they will find themselves doing things like co-sleeping, using slings, holding their babies alot, breastfeeding for a long time etc. But I am not a fan of set rules for parenting, and some expressions of attachment parenting philosophy seems to have a lot of what look like rules to me.

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  8. Bethany B. says:

    Re: breastfeeding becomes bed-sharing. Yes, yes it does. I was reluctant to start having my daughter sleep in our bed, but after the umpteenth 2am feeding where I nearly dropped her on the floor because I was – surprise, surprise – nodding off, and taking into consideration the number of pillows I needed to support her to prevent dropping her and the size of my breast as compared to her face when holding her in such a manner, I researched and decided that sitting up at 2am to breastfeed her was probably MORE dangerous than having her in our bed.

    What I found telling while researching it was that nobody in the anti-bed-sharing camp ever gives advice on how to avoid dropping your baby when you doze off during that 2am feeding, or keep from smothering her with your breast, or prevent her rolling between the support pillows and (the arm of the chair/wall/side of the bed/mom), they just tell you not to take baby to bed with you.

    • uncommonjohn says:

      Excellent points Bethany! One wonders if some of the deaths that occur when parents and babies sleep together on sofas have to do with the issues that you identify. I don’t know for sure, but I suspect that in some cases the parents may have been trying to avoid bedsharing, so they sat up on the sof and fell asleep, as breastfeeding pairs are wont to do.

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