Co Sleeping

I was listening to the news yesterday (Thurs Sept 30, 2010) and heard that the South Australian Coroner put out a statement saying "The message to be drawn from these five tragic deaths is that the risk of sudden, unexplained death in infancy is greatly increased where a child sleeps in the same bed with one or more parents or other adults, whether the mechanism of death is asphyxia due to overlaying, bedding or otherwise," (The Herald Sun, http://www.heraldsun.com.au/news/national/adults-sleeping-with-babies-increases-risk-of-sudden-and-unexplained-infant-death/story-e6frf7l6-1225932398204). When I heard this I felt so sad and frustrated that people were so misinformed. There was criticism of this statement by certain doctors, though I cannot find the reference for it. The criticism basically said that most parents will sleep with their babies even if its jsut a nap. What this statement is doing is making it more dangerous as people won't be aware of how to sleep safely with their babies and children.
I couldn't agree more. Before I had even reached puberty I was already bombarded with how to make your baby sleep safely in a cot. Never a mention of co sleeping. However as my eldest was born a few days before 37wks, we weren't quite ready with a cot mattress and the like. I had a bassinet and washed it madly when I went into labour, but it rained before I got home with my newborn. The only place for her to sleep that first night was with us in bed- and it felt like the most logical place for her to be. It was only due to luck and wide reading that I happened across some very sensible tips for safe co sleeping, half of which are exactly the same as the recommendations for cot sleeping! Imagine if I hadn't come across these tips, and so had no idea how to make our bed safe for our baby whom I had birthed barely 5 hours earlier?
 
Dr Sarah Buckley, an GP living in Queensland has written a book called Gentle Birth, Gentle Mothering. I love it and recommend it to everyone who is pregnant, or thinking about it. It really is quite fabulous. In it, she has "10 Tips for Safe Seeping". I will only list them, if you wish for elaboration then I strongly suggest looking at her website http://www.sarahbuckley.com/ or even better- buy the book!
1. Put your baby on the back or side to sleep
2. Keep your baby's head uncovered during sleep
3. Avoid entrapment hazards
4. Avoid strangulation hazards
5. Dress your baby appropriately for the room temperature
6. Keep your baby smoke and drug free
7. Do not put your baby to sleep alone in an adult bed
8. Ensure that older babies in cots/cribs cannot fall out
9. Do not put your baby to sleep on a sofa or chair
10. Breastfeed your baby.

The thing that I have often heard when there has been a co sleeping death, is that the adult and baby fell asleep on the lounge together. This is completely unsafe and should never be done. I know I nearly did a few times with my eldest, but knowing how unsafe it was I made myself put us both to bed, in bed. A baby needs to sleep on a firm mattress cot, bed, floor, wherever. A waterbed is not safe for a baby.

Dr William Sears is a very vocal advocate of co sleeping, and is given credit for coining the term "attachment parenting" which is very popular. He has written an article about co sleeping, which can be found at http://www.askdrsears.com/html/10/t102200.asp In this article he looks at some research and says the following

"In fact, one independent researcher examined the CPSC's data and came to the opposite conclusion than did the CPSC - this data supports the conclusion that sleeping with your baby is actually SAFER than not sleeping with your baby (see Mothering Magazine Sept/Oct 2002)..... The number of parents that bring their babies into their bed at 4 am is probably quite high. Some studies have shown that over half of parents bring their baby into bed with them at least part of the night. And the number that sleep with their infants the whole night is probably considerable as well. In fact, in most countries around the world sleeping with your baby is the norm, not the exception. And what is the incidence of SIDS in these countries? During the 1990s, in Japan the rate was only one tenth of the U.S. rate, and in Hong Kong, it was only 3% of the U.S. rate. These are just two examples. Some countries do have a higher rate of SIDS, depending on how SIDS is defined........... The September/October 2002 issue of Mothering Magazine presents research done throughout the whole world on the issue of safe sleep. Numerous studies are presented by experts of excellent reputation. And what is the magazine's conclusion based on all this research? That not only is sleeping with your baby safe, but it is actually much safer than having your baby sleep in a crib. Research shows that infants who sleep in a crib are twice as likely to suffer a sleep related fatality (including SIDS) than infants who sleep in bed with their parents"

In the same article Dr Sears also gives some safe co sleeping tips:

  • Take precautions to prevent baby from rolling out of bed, even though it is unlikely when baby is sleeping next to mother. Like heat-seeking missiles, babies automatically gravitate toward a warm body. Yet, to be safe, place baby between mother and a guardrail or push the mattress flush against the wall and position baby between mother and the wall. Guardrails enclosed with plastic mesh are safer than those with slats, which can entrap baby's limbs or head. Be sure the guardrail is flush against the mattress so there is no crevice that baby could sink into.

  • Place baby adjacent to mother, rather than between mother and father. Mothers we have interviewed on the subject of sharing sleep feel they are so physically and mentally aware of their baby's presence even while sleeping, that it's extremely unlikely they would roll over onto their baby. Some fathers, on the other hand, may not enjoy the same sensitivity of baby's presence while asleep; so it is possible they might roll over on or throw out an arm onto baby. After a few months of sleep-sharing, most dads seem to develop a keen awareness of their baby's presence.

  • Place baby to sleep on his back.

  • Use a large bed, preferably a queen-size or king-size. A king-size bed may wind up being your most useful piece of "baby furniture." If you only have a cozy double bed, use the money that you would ordinarily spend on a fancy crib and other less necessary baby furniture and treat yourselves to a safe and comfortable king-size bed.

  • Some parents and babies sleep better if baby is still in touching and hearing distance, but not in the same bed. For them, a bedside co-sleeper is a safe option.

Here are some things to avoid:

  • Do not sleep with your baby if:

    1. You are under the influence of any drug (such as alcohol or tranquilizing medications) that diminishes your sensitivity to your baby's presence. If you are drunk or drugged, these chemicals lessen your arousability from sleep.

    2. You are extremely obese. Obesity itself may cause sleep apnea in the mother, in addition to the smothering danger of pendulous breasts and large fat rolls.

    3. You are exhausted from sleep deprivation. This lessens your awareness of your baby and your arousability from sleep.

    4. You are breastfeeding a baby on a cushiony surface, such as a waterbed or couch. An exhausted mother could fall asleep breastfeeding and roll over on the baby.

    5. You are the child's baby-sitter. A baby-sitter's awareness and arousability is unlikely to be as acute as a mother's.

  • Don't allow older siblings to sleep with a baby under nine months. Sleeping children do not have the same awareness of tiny babies as do parents, and too small or too crowded a bed space is an unsafe sleeping arrangement for a tiny baby.

  • Don't fall asleep with baby on a couch. Baby may get wedged between the back of the couch and the larger person's body, or baby's head may become buried in cushion crevices or soft cushions.

  • Do not sleep with baby on a free-floating, wavy waterbed or similar "sinky" surface in which baby could suffocate.

  • Don't overheat or overbundle baby. Be particularly aware of overbundling if baby is sleeping with a parent. Other warm bodies are an added heat source.

  • Don't wear lingerie with string ties longer than eight inches. Ditto for dangling jewelry. Baby may get caught in these entrapments.

  • Avoid pungent hair sprays, deodorants, and perfumes. Not only will these camouflage the natural maternal smells that baby is used to and attracted to, but foreign odors may irritate and clog baby's tiny nasal passages. Reserve these enticements for sleeping alone with your spouse.

Obviously I co sleep with my babies. Happily. Safely. My eldest now sleeps on her own bed that my husband made for her that fits between our bed and the wall. She can touch me easily and sneak into our bed if she needs to, but it is 'her bed' and usually prefers to sleep there. When we have tried to move her into her own bed and/ or room in the past she would get frightened and lonely and I would spend a lot of time going in and out of her bed/room comforting her and helping her back to sleep, much like a newborn. It didn't last for long as I was exhausted. But a few months ago we gave this option a try and it has worked out well. Babies are designed to be close to their parents ALL the time. Think back to the beginnings of the human species, there is no way a baby would have survived sleeping on their own for the whole night, this blueprint hasn't changed and separate sleeping is not the norm in most parts of the world. I did try to put my eldest in her own cot in the early with but I am the kind of person who crashes into walls if not fully awake, and she just would not sleep in her cot. I tried it for day sleeps as well, and it was a dismal failure for us. I tried her sleeping next to us in the pram as no bassinet or cot could possibly have squeezed into that tiny room. I did not get a wink of sleep. Upon reflection of this I realised that I could tell by the sounds she was making if I needed to become more awake and feed her back to sleep or she was just working through her day during sleep. When next to me I could not see her, I was not in tune with her sleep rhythm and I was all out of whack.

Research has shown that when a mother and baby co sleep within touching distance, their sleep cycles becomes in sync and so the mother will start to stir at the same time as her baby. It's totally true and still happens to this day, though I am getting better at denying the truth of needing to wake up at 6 am. But it is a conscious denial, and I am awake enough to be aware of what my children are doing. I am typically a pretty sound sleeper, once I even slept through a fire truck roaring past my bedroom window with lights and sirens blaring and me only asleep for 10 min! I will sleep through many things, but all my baby has to do is wriggle and snort and I am aware of it and stirring to gather more information.

For those who are thinking "Great! So if I co sleep with my baby I am not going to get a wink of sleep!" but research has again shown that mothers who co sleep get at least as many hours of sleep as do those who sleep separately. While my eldest was/is not a fabulous and easy sleeper, the exhaustion didn't last for long, and I know that it was the best way for us. She would stir, hungry again, and I would stir without completely waking, feed her and slip straight back to sleep without having to do anything more than roll over and move my shirt, if that. In contrast with a separately sleeping baby which requires a mother (or father if bottle fed) to physically get out of bed and wake up enough to not walk into too many walls, pick up the baby, settle them enough to feed and sit somewhere comfortable enough to feed for who knows how long, then settle the baby back to sleep, and get back into bed and to sleep. Typical problem here is that by now the mother is usually wide awake and cant go back to sleep for an hour or 2, by which time a newborn may be waking again. Or, even worse, mother has fallen asleep on the lounge with her baby and this is not safe, as discussed earlier.

All the technical and safety bits aside, it is so lovely to snuggle up to snooze with your little baby. It feels so right. You and your baby can touch and reassure each other with no more effort than lifting a hand. You get to feel that delightfully soft warm skin even more and there are so many wonderful moments that would never happen otherwise. It is also another way for babies and children to be close to working parents. My husband works a long day away from home, and it is not unusual that our girls don't get to see (awake) him for a day or two if unlucky. However, if our youngest stirs in the night he is there. So even if there isn't conscious interaction between them, she will often stir in the night and pat his arm or back a few times and go back to sleep. Or in the mornings it is far more common that our youngest wakes us all up, and will cuddle up with her father, pat his face, give him kisses or laugh at his funny pyjamas. I can tell you, it's a lovely way to wake up in the morning. You can't be grumpy when you were woken up with wet baby kisses, even if it is 530 am.

We have never had any trouble with our girls sneaking out of bed as commonly happens when children make the cot to bed transition. After all, they were exactly where they wanted to be- with us. Nor could they get out of bed without us knowing. Nothing could happen to our babies without us knowing about it, which is exactly what nature intended.

Co sleeping can be a wonderful thing, when done safely. It is cozy, loving, and pracitcal. I urge all parents to become informed about co sleeping before making any decisions about sleeping arrangements. If it isn't right for your family then you have weighed up all the information and made a careful, considered, informed choice.

 

Addit: I wish to add that 4 months after writing this article, my eldest just decided one day that she wanted to sleep in her own bed, in her own room. I honestly didn't expect it to happen, as mentioned earlier we have been there before. But this time she decided on her own with no prompting or persuasion by anyone else. She has slept every night in her own bed very happily for the last few weeks since deciding. So for those who think that co sleeping children "will be 10 and still sleeping in my bed!" or have had people say it to them, I put this example to you for another side of it. The transition was everything we hoped for- smooth, easy, of her own choice, in her own time, and just no big deal. 4 years of co sleeping to help my high needs, uneasy sleeper feel safe and comfortable in her own sleeping space. She has had her night time needs met, and can move forward with no baggage about sleeping. It's really nice to see that what we worked towards and hoped for has completely paid off. If we had a chance to change things I wouldn't, not a thing.

Elimination Communication

Many people people will be thinking "who the what now?" but bear with me! When my youngest was a baby in early 2009 I wrote an artcile about Elimination Communication for Grass Roots magazine, who kindly publsihed it later that year. A copy is below.

For a magazine focused on self-sufficiency I cannot imagine a topic more useful for parents of babies than Elimination Communication. The concept has many names given to it by westerners trying to describe what is common knowledge among many other cultures around the world. Infant Potty Training, Elimination Communication, Elimination Timing, Nappy Free, are some and I am sure there are others too. The concept is very basic- babies know when they need to wee or poo, and use body language to communicate this need with us. All we need to do is learn to trust our selves and our babies and respond. All around the world this is a common practice, and it’s not just the parents that catch the wees/ poos but grandparents and siblings too.

I need to be clear that this is NOT early toilet training as was advocated by some parenting ‘experts’ in early-mid last century. These ‘experts’ told parents that a baby of mere months old should be made to use the potty or toilet, even if it meant strapping that poor baby or child to the potty/ toilet so they couldn’t get off it. No human touch, or companionship, no gentle communication between baby and parent/carer about a simple and basic function of every living creature. Current parenting experts seem to take the stand that babies are incapable of communicating these needs, and the medical system teaches that babies under 2 years cannot control their bowel or bladder. But if that’s the case how is it that I was trying to find undies small enough to fit my not yet 2 yr old daughter who was continent day and night? And if the babies can’t communicate their needs why was I able to know when my daughter needed to wee in usually enough time to take her to an appropriate receptacle?

Another thing many people don’t seem to know is that babies don’t wee or poo in deep sleep. We co slept with our daughter and so when she started to wake so did I, and I would catch the wee usually. If I didn’t wake up fast enough, or she was especially tired and only slightly stirred then I would miss that wee. It was no big deal though as she slept on a woollen under blanket with a flannelette rug over top of it. Easy to wash in the morning and we would simply put a cloth nappy over top of it for the rest of the night. We had nighttime dryness long before daytime.

Part of the idea of Elimination Communication is that if we never teach our babies to ignore their bodies needs and communications by making them wee their pants and sit in it for who knows how long, then you wont have to teach them what they used to know when it comes time to toilet train at 2-3 yrs old. And who likes sitting with a wet and pooey bottom for possibly hours? How is that respectful? As adults we would be shocked and humiliated if someone told us that we were not able to know something so fundamental, and so had to wear a bulky cloth, or worse a chemical filled plastic wrapper, wee and poo in our pants and sit in it for up to a couple of hours. So why do we do this to our babies? To then teach them a couple of years later that this is wrong and dirty, that wees and poos must suddenly go somewhere else. No wonder toilet training can be tough.

Cues

There are different types of cues or ways of knowing that a baby needs to go. These include body language, sounds, pattern of day, and intuition. Their cues do change sometimes. Hers certainly did. But that’s part of parenting, keeping up with the changes as they grow and develop.

Body Language- We have all seen a baby get that far away look and a few minutes later smell their need for a new nappy. What a lot of people don’t do is see the far away look and take the baby to an appropriate place, catch the wee/poo, and return to what they were doing with little mess or fuss. Some babies pull their mouth to one side and wriggle a bit, others grimace a certain way, others kick their legs more or faster, others go completely still. My daughter used to hold her breath for a few seconds before she did a wee when she was 5-8 months old. I got pretty quick at moving then.

Sounds- Some babies cry and squawk a bit when they need to go, some fart a few time and then do a poo, it can be anything. The best bit is you can teach them to associate a certain sound with wee/ poos. Then when you think they need to go but they are a bit slow starting, you can give them this cue and as often as not they will go. It can also be a way when older to reassure them that this is an ok place to go. I still use the cue with my daughter who is 2 and a half if she is going somewhere a bit different and is unsure if its ok. I chose to use the words ‘wees’ or ‘poos’, although the very good mothers of many other cultures seem to prefer the ‘psssss’ sound. It’s up to you really.

Pattern of Day- Some babies don’t cue very strongly and so it is easier or more reliable if parents notice when they tend to go and provide opportunities. For example I could always rely on catching a wee within 10 minutes of waking, even if I missed every other wee that day. Some babies wee every 10 or 15 minutes during the first hour after waking, other go during a feed. It’s so individual.

Intuition- Sometimes you just know they need to go. Don’t think about it, don’t question it- just take them. You will be surprised how often you are right. As often as not I would catch a wee or poo simply because I found myself stopping whatever I was doing looking at her and thinking about her wees. Unfortunately, there were too many times when I doubted myself, and her, and we both got wet.  


Starting Out

So how to start out? Some books say that if you start after 4 months it’s not really going to work. Personally I think its possible at any age, though it might require more effort than if starting with a younger baby. It is possible to start from birth. My babies seem to poo so frequently as young babies that I wait a month or so. The first thing to do is decide what cue sound you wish to use. Then keep your baby as bare bottomed as possible and whenever you notice them going, or have just gone, use the cue sound. Watch, watch, watch and watch some more. But don’t forget to listen and trust your instincts. Soon enough you will begin to notice trends and patterns that are individual to your baby. Once you feel you are not noticing a lot of new cues, take the leap of faith and just go for it. The first time I did it I had been dithering for a few days and in the end I grabbed a plastic container, took her nappy off and held it under her while she had a feed, as she always seemed to wee during a feed when she was little. Sure enough she did a little wee in the bowl. I was very excited and pleased. I don’t think I caught any more that day or the day after, but slowly and surely I got the hang of it and caught more and more. That’s the best bit- the more you do it, the better you get at it, the more obviously they tell you about it, so you do it more and so on ad infinitum. Just like breastfeeding.

It also seems that some babies go on a strike, if you will, around 8 months. We certainly did. It lasted about 3-4 months during which I did get quite frustrated at times. Usually when she would hold on to her wee despite my cues and patience and encouragement, and as soon as we settled back into whatever we were doing she would wee, usually on both of us. At this time she was striking on lots of things that we had previously done- basically everything except her breastfeeds- and I was struggling to figure out what she was doing, when, where or why. However that stage passed, for which I was very grateful, and we got back on track and using Elimination Communication helped me get back in tune with her and reconnect with her.

It may seem like a lot of effort, and to begin with it was. But it was worth it to me. My daughter never had nappy rash after the first bad bout that pushed me into Elimination Communication. Toilet training never happened. It was a very easy and gentle progression. Now wees and poos are just something we do, we can talk about them much as we talk about what’s for lunch and why we eat fruit and vegetables, but they are no big deal. Don’t get me wrong; we had good days and bad days. I was pleased if I caught 80% of the wees for the day. Of course if we were getting on the bus, or at the library or something I would put her in a nappy and if I could take her to the toilet I would, but I didn’t pay as close attention when she had a nappy on, so for me it worked best with no nappy. I know of others who have their baby in a nappy between times, but still catch most of the wees. By the time she was 2 yrs she only had a nappy on when she wanted to pretend to be a little baby (I was quite pregnant with our second at this time) and it usually only stayed on for 10-30 minutes, never wet or dirty. Now I’m starting with my baby, though she is more complicated than her sister as she has spina bifida and so may not have the same control and sensation that most people do. But to me its even more important to use Elimination Communication if she might have difficulty with toilet training and continence- if I never teach her to ignore what sensation she has, then it will be easier for her to figure out how to control it. Only time will tell if I am right.

Addit: I am using nappies mostly for my youngest, though she goes on the potty almost every morning, and where possible after her day sleep. Sometimes she asks to go to the toilet and usually does something. If she adamantly refuses to sit on the potty I don't make a big deal of it either. She is still in nappies, and the time is not right for us to help her into full time continence yet, but she is still connected to her body and what it feels like when she needs to go, so it should be ok.

We were talking with her (new) Occupational Therapist recently who asked about her bowel and bladder. When I described what we were doing with her we were met with absolute approval. We were told that we couldn't have done anything better for her, and there isn't anything else the O.T could suggest to help at this point in time either. It was very gratifying, as some people have politely and quietly thought I was crazy. While I never asked for or needed anyone elses permission to follow my intuition, it was nice to have a health professionals complete approval nonetheless.


More information can be found on Dr Sarah J Buckleys website, address given above, also google any of the names for the concept given above.

 

 
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