family tools
choose a tool resource directory
find a practitioner parenting toolbox product safety media reviews family fun guide send an e-card family astrology

community features choose a feature birth stories find a Mothering friend live chat mothers' writing group teen voices

	ask the experts sarah j. buckley

Sarah J. Buckley GP, MD
Pregnancy and Birth, Family Planning, Co-sleeping

• Co-sleeping - mattress advice and cosleeping information
• Trying to conceive at 44
• Napping problems with co-sleeping
• Conceiving soon after giving birth

I'm 30 weeks pregnant with my first child and am hoping to have a natural birth. I'm also keen to co-sleep with our baby. Are there any special baby mattresses you would recommend that will protect the baby from being covered in the blankets or rolled on? I also have encountered some opposition from my family, and wonder if you could provide me with some information to support my choice.

Congratulations on your pregnancy, and it's great that you are making plans for natural birth and co-sleeping with your baby. You are also very wise to look at safety considerations around sleeping with your baby in an adult bed.

Through human history, and still around the world, almost all mothers have co-slept with their babies because it is safe,intuitive and it is what we are designed to do. Co-sleeping will bring you and your baby into the same sleep cycle, so that you will both will be in light sleep together, about every 1 1/2 to 2 hours. While in light sleep, you may feed and attend to your baby, and your baby, if next to you, will be stimulated by your movements (and viceversa), although often neither of you will actually wake up. This stimulation will keep your baby from dropping into a very heavy sleep, which is not normal, and may even be dangerous, in a smallbaby. Co-sleeping will also give your baby more of your nourishing breast milk, with less effort on your part; he/she will cry less and both of you will get more time asleep, and less time walking the corridor. And of course it's instinctive, it's fun, and your baby will be so nice to cuddle at night!

You can also be reassured by overnight video studies of co-sleeping mothers and babies, which show that co-sleeping mothers, even in deep sleep, are aware of their baby's position, and move when necessary to avoid over-laying. At no time in these studies did co-sleeping mothers impede the breathing of their babies, who had higher average oxygen levels than solitary sleeping babies. Co-sleeping mothers and babies will almost always sleep facing each other, with the baby lying on the side or back. This is much safer for the baby than lying on the front, which increases the risks of SIDS. This information is summarised by James McKenna, who conducted these sleep-lab studies, at www.naturalchild.com /james_mckenna/, and also see his lovely article for Mothering Breastfeeding & Bedsharing Still Useful (and Important) After All These Years

There are many ways to co-sleep, and you can decide what will work best for you and your baby. Co-sleeping- which has been used to describe sleeping arrangements where the baby is in the same room as the mother- can mean having a cot or crib in your room, having a bassinet or special'co-sleeper' right next to the bed (eg see www.armsreach.com) and/or having your baby right next to you, on the same surface, which is called bed-sharing. Co-sleeping has been shown to protect against SIDS,probably because the mother's breathing signals help to remind her baby to keep breathing after the pause (or apnea) that small babies naturally have when asleep.

Co-sleeping is not dangerous, and may even protect babies from sudden death (SIDS). Places like Japan and HongKong, where co-sleeping is the norm, have some of the lowest SIDS ratesin the world. However, our soft western-style bedding has some suffocation hazards that you need to be aware of if you are going to bring your baby into your bed. These are summarised in my article "Ten Tips for Safe Sleeping" at www. naturalparenting.com.au

In brief, if you bed-share you need to use a firm mattress, with no extra pillows or bedding. Sheets and blankets are preferred to duvets/doonas/comforters, which can easilyend up over the baby's head. Dress your baby in one layer if you are bed-sharing (or less, if you prefer to be skin-to-skin with your baby),and do not over heat the bedroom, as over heating is a risk factor forSIDS. You also need to ensure that your baby won't fall out of bed, but guard rails are not recommended, because a baby can become trapped between rail and bed. Head and foot-boards are hazardous for the same reason, as is the gap between a bed and wall. A baby can become wedged and suffocate in any gap that is more than 1" or two fingers-breadth. The safest design for bed-sharing, in my opinion, is the brilliant Humanity and Infant Family Bed Top Co-sleeping Device, which protects baby from falling out without gaps www. humanityinfantandherbal.com/HTML/fambed.html Another option is to have a firm mattress on the floor.

Co-sleeping mothers (and their partners, if they will sleep next to the baby) also need to be reasonably alert, i.e. not affected by alcohol or drugs, and not so exhausted that they cannot respond to their baby in the night. Mothers who smoke, or who smoked during pregnancy, are not advised to bed-share,as their babies are at much higher risk of SIDS in this case

Also, do not leave any baby under 1 in an adult bed alone; donot sleep a baby next to an older child; and keep pets out of the bedroom. Do not sleep with your baby on a sofa or chair, a bean bag or a waterbed, which are all hazardous for the baby. If you are bottle-feeding, it is recommended that you put your baby back in the cot, because you and your baby are less likely to sleep in the safe face-to-face position.

One more comment; no matter where your baby sleeps, he/she is likely to need a lot of attention at night. Life with your new baby will be easier if you can rest, and hopefully catchup with sleep, as much as possible in daylight hours. My rule of thumb, when my nights were very busy, was that I needed to be in bed for 12 hours at night, eg 8pm to 8am- plus my afternoon rest. I suggest that you plan to keep your life simple, and don't expect to do anything much except enjoy, and care for, your baby and yourself in the early months.

Thanks again for your question, and I hope you and your baby have a wonderful time sleeping together.

MoreResources
More information about safe co-sleeping at www.mothering.com/articles/new_baby/sleep/safety- checklist.html
UNICEF brochure on safe bed-sharing at www. babyfriendly.org.uk/pdfs/sharingbedleaflet.pdf
I share more of my thoughts about co-sleeping at www.womenofspirit.asn.au/sarahjbuckley.html#mothering
Mothering issue number 114, dedicated to the safety of co-sleeping, all online at www .mothering.com/articles/new_baby/sleep/sleep.html

My 7month old son has slept in our bed since the day he was born. I feel a deep instinct to share sleep with him. He has a difficult timesleeping alone, though, and I wonder if you have some insight for me. I can lay down and nurse him to sleep. When I get up, he will stay asleep, but only for a short time. During the day he will take naps in a swing or a hammock that rocks, but only for 30-45 minutes. If I lay down with him, he'll sleep for 2 hours. I'd like him to be well rested, but I don't always want to lay down for 2 hours during the day!

Your son is fortunate to have a warm and sensitive mother, and he is indeed blessed by your willingness to follow your mothering instincts.

In reply to your question, I can offer you 3 ways of looking at your situation. These are; the biological needsof your baby; his individual needs and personality; and your own needs.

Firstly, your son has a biological need for your presence. If you consider that our forebears include over 100,000 generations of hunter-gatherers living in the wild, around 500 generations of agriculturalists and only 10 generations of industrialists, you will appreciate that our babies have developed an inbuilt biological need- a genetically encoded expectation, if you like- to be in the presence of a care-giver, without whom they would have been in danger of death from predators in the wild. Your presence still signals safety for your son, and his protests at being left alone are actually his well-developed survival instincts.

You may also be interested to know that our Western cultural practice of sleeping our babies in isolation (day and/ornight) is highly unusual, even today. For example, in Bali, babies are not put down, but are always carried until they reach 6 months and Japanese children sleep with their parents until they are teenagers. Extended family arrangements in traditional cultures mean that there are many hands to help; mothers would not be expected, as they are in our culture, to provide all of the continuous contact that babies require in the first year.

Secondly, babies have their own personalities and some babies are more flexible than others, in terms of their biological needs. Many babies of your son's age would tolerate separation during daytime sleep (and some will beexpecting this, if they sleep separately at night), and there are of course many ‘methods' (eg controlled crying) designed to stretch our baby's biological capacities so that they conform to our social expectations, eg of sleeping alone through the night. Some babies who have less flexibility may be labelled difficult or high needs, but their protests are, I believe, actually a very healthy expression of their biological needs. Note that our babies' ability to adapt to cultural norms does not mean that there is no harm from these practices. On the contrary, I believe that when we stretch our babies' biological needs too far in our quest for‘independence' in our babies, we can interfere with the development of trust, which is a baby's first developmental task.

Thirdly, you have your own needs. Raising a baby in isolation is difficult- if you were living the life of your foremothers, your son's need for security and physical contact would be automatically met within your group or family. I am guessing that you have tried various things, and your son has not accepted them as a substitute for your presence. He is obviously a smart and sensitive boy!

The good news is that, like his other genetically encoded expectations, his need for you at sleep time is likely to become looser with time. You will also get increasing amounts of feedback from him, in terms of his strong sense of security and well-developed attachment to you, which will help you to trust that you are doing the right thing in your mothering, despite social norms.

I also believe that every mother deserves an afternoon rest- at least an hour with our feet up- and your son is gently encouraging you to do this. Could you make this an enjoyable habit, taking some time out with your son to catch up on sleep and/or a good book, diary, drawing pencils, food, cup of tea, music, essential oils, etc? Personally, I have been taking an afternoon rest for more than 10 years, and find that, especially when I have busy nights with my little ones, it gives me nourishment and the reserves I need for the rest of the day. Cuddling up together (and breastfeeding) also gives you more of the love hormone, oxytocin, which enhances your pleasure in, and devotion towards, your son.

If you really do need to be awake and upright at times, I suggest that you find ways to keep your son near you, egin a crib or other safe sleeping surface that you can move around with your activities. A mattress on the floor is ideal, as long asthe area is safe for him when he awakes. Also please note that it is not safe to leave a baby under 1 unsupervised on an adult bed, because of entrapment and other hazards.

On a personal note, my 4th baby Maia has been, like your son, very sensitive to my presence at sleep times. She wouldn't sleep more than 20 minutes in the day without me next to her, and would waken, even from a deep sleep, if Igot up in the night. She has gradually loosened her attachment to me, and is a very secure and bold nearly-4-year-old, but still has an extra need, compared to my other children, to be ‘in touch' with me at sleep time.

Books that may support and inspire you include:
"Our Babies Ourselves" by Meredith F Small
"Touching- The Human Significance of the Skin" by Ashley Montague
"Loving Mama-Essays on Natural Parenting and Motherhood" -Ed Tiffany Palisi
"The Continuum Concept" by Jean Liedloff

My husbandand I just had baby four months ago. We want to have another
one very soon. Are there any special considerations we should take in regard to my health and our baby's health with pregnancies very close together?

Ordinarily I would not recommend spacing children more closely that 2 ½ to 3 years. The reasons for this, as below, include the baby's physical and emotional health, the mother's physical and emotional health, and the impact on siblings.

Pregnancy and birth require a large investment of the mother's resources. On a physical level, a mother donates a lot of nutrients to the baby in her womb, and this investment continues while she is breastfeeding. If she conceives before she has had the chance to replenish her supplies, her next baby may not have adequate levels of nutrition for optimal growth. Studies have suggested that the mother's nutritional state at conception has a more powerful effect on the baby's health than her nutritional state later in the pregnancy.

Because of these factors, babies born after short inter-pregnancy intervals (especially under 6 to 8 months, but even up to 18 months between pregnancies) are more likely to be premature and small for dates. Both of these factors increase the risk of stillbirth and early death. Closely spaced children are also likely to receive less breast milk, which will further disadvantage their health and development. The World Health Organisation recommends that infants be breastfed for at least 2 years, for optimal nutrition. (However it is possible to continue breastfeeding during pregnancy and beyond- see resources for more information.)

Our babies also require a lot of physical contact- carrying, holding, breastfeeding, especially in the first year of life. If the mother is pregnant or has given birth to another sibling during this time, the older child is much less likely to get his/her need for closeness met.

When children are closely spaced, there will also be competition for emotional nourishment from the mother and/or other carer. This is especially true when there is no extended family orother individuals who are available to meet the important emotional needs of very young children. Sibling rivalry is likely to be more intense among closely spaced children. Again, I believe that a spacing of at least 2 ½ to 3 years is ideal for children's long-term emotional development.

The physical depletion caused by closely spaced pregnancies can also affect the mother's health and survival. In developing countries, a mother who has closely-spaced pregnancies is at increased risk of hemorrhage, premature labour, infection, anemia and death. In these countries, mothers are encouraged to space "three to five (years) to stay alive",for the health and survival of both mother and baby. These risks may be lessened when the mother has access to good nourishment, but lower levels of nutrients can still affect health and energy levels.

Childbearing is also a huge emotional task. Mothers whose children are closely spaced have an even greater task, and will need a lot of support to meet the needs of their children.

Having said all of that, I am also aware that there are some circumstances where close spacing will be chosen by the parents. If you have considered all of the above, and still wish to space your family closely, I advise you to work hard on your preconception nutrition, which is, as above, a vital factor in having a healthy pregnancy and a healthy baby.

Usually I advocate at least 3 months of an optimal diet (for both parents) before conceiving- you can read my recommendations for preconception care in a previous question asked by a mother wishing to conceive again at age 44. In your situation, make sure you eat good amounts of quality food, andfocus especially on high-protein foods such as meat, eggs, fish,dairy products, nuts, seeds and legumes/beans.

You can chooseto take a preconception nutritional supplement (usually a prenatal supplement is appropriate), or (my preference) boost your diet with whole food supplements such as nutritional yeast (sprinkled on food),spirulina (stirred into water or juice), barley grass powder (withwater or juice), kelp (in cooking), parsley (raw in salads, soupsetc), black strap molasses (dissolved with milk or milkshake), and sesame seeds/tahini (sesame seed paste- in salads and sandwiches), all preferably organic.

You can continue these during pregnancy, although you will probably want to cut back on leafy and root vegetables (including barley grass and possibly spirulina- check with your taste buds and discuss with your care provider), which are high in natural plant toxins, in the first 3 months. It is safer to limit your parsley intake throughout pregnancy- see "Protecting Your Baby to Be" in Resources for more about natural plant toxins in early pregnancy.

Specific nutrients that are more likely to be depleted with a short inter-pregnancy interval include

• Iron -found in meat, especially organ meat, shellfish, fresh and dried fruit and spirulina and parsley. You can boost your iron intake by cooking in cast iron pots. You may also want to consider taking a tonic, such a floradix, but don't take this at the same time as zinc or calcium supplements.
• Zinc, found in meat, poultry, fish, nuts and seeds, especially cashews, sesame and pepitos. Depletion in zinc may cause low birth weight and prematurity.
• Folate, found in green leafy vegetables as well as in yeast extracts, organ meats and wholegrains. It would be wise to consider taking a 400 microgram folate supplement, beginning 3 months before conception, to prevent birth defects such as spina bifida.
• Chromium, found inyeast, egg, shellfish and eggs. Depletion in chromium can contribute to poor blood sugar control in pregnancy.

I also recommend that you follow your body's dietary cravings and preferences, if they are healthy, which is how all of our ancestors obtained a healthy diet.

There are other precautions that apply to anyone who is planning to conceive which are listed in the excellent Australian Better Babies books (see www.fertility.com.au or, in the US, the book "Healthy Parents, Better Babies; A Couple's Guide to Natural Preconception Health Care" (by the same authors, available fromAmazon.), also summarised in the preconception chapter of my upcoming book "Ecstatic Birth." These include avoiding alcohol, cigarettes,coffee, x-ray and other sources of radiation, overheating (eg hotbaths), household chemicals, marijuana and other recreational drugs,and analgesic and prescription drugs unless absolutely necessary. These precautions are most critical during the first 3 months of pregnancy, when the baby's organ systems are developing.

Wishing you a healthy, happy family.

Resources
Adventures in Tandem Nursing: Breastfeeding during Pregnancy and Beyond. Hilary Dervin Flower. Published by La Leche League International, 2003.

The risk of maternal nutritional depletion and poor outcomes increases in early or closely spaced pregnancies by Janet C King J Nutr. 2003 May;133(5 Suppl 2):1732S-1736S. Available online at www.nutrition.org

Healthy Parents, Better Babies, Francesca Naish and Janette Roberts. The Crossing Press,Calif, 1999.

Protecting Your Baby to Be—Preventing Birth Defects in the First Three Months of Pregnancy. by Margie Profet, Little Brown, London 1995. My summary of some of her findings in the Q&A at www.midwiferytoday.com/enews/enews0511.asp