Dr. James McKenna's Letter to the Editor:
The following letter to the editor was written by API Advisory Board member Dr. James McKenna in response to an article published in an Iowa newspaper The Des Moines Register on February 22, 2003
Dr. Hein's analysis of bedsharing deaths (Krantz, 2/24/03 One-Third of SIDS babies shared adult beds)) reflects a serious cultural bias and apparently a refusal to address the actual causes of why the infants died in the beds... and his perspective reflects a degree of simplicity that ultimately distorts a true understanding of differential outcomes, both positive and negative, associated with different "types' of mother-infant co-sleeping in the form of bedsharing. My guess is that the data he uses to infer negative universal principles emerge primarily from high risk, inner city populations, for which multiple risk factors for SIDS abound. Indeed, this interpretation of bedsharing in general is not consistent with other epidemiological facts. For example, when bedsharing occurs in conjunction with breast feeding amongst mothers who do not smoke, and who know basic sleep environment safety, SIDS and infant deaths not only are not increased but are reduced! Breast fed, bedsharing babies, cared for by mothers who do not smoke, are under-represented in SIDS populations worldwide, according to the SIDS Global Task Force data.
The paper I refer to was published two years ago (Early Human Development). The authors describe data showing that the highest bed sharing cultures around the world have the lowest SIDS rates. It is important to point out that the bedsharing occurred absent of maternal smoking and absent of the prone infant sleep position. But this is exactly my point here. Bedsharing has never been shown to be an independent risk factor for SIDS or unexpected death and it is not thought of by experts as being a uniform or coherent practice. How one "does it" makes all the difference. In almost every instance where babies die some specific other primary risk factor is associated with the death as, for example, the infant was sleeping prone, or the mother was a smoker, took drugs, or the mattress was too soft, or the mother or father was unaware that the baby was there, or a young sibling was sleeping in the bed next to the infant, and there are others. It is also possible that there were no risk factors but that the baby died from SIDS.
Perhaps Dr. Hein included in that sample of "bedsharing deaths" babies that were sleeping with their parents on couches -which is not "bedsharing" and is known to be extremely dangerous. If these babies died in a crib, the explanation of the death would not have indicted "crib sleeping" or crib sleeping in a "solitary" and unsupervised context, but rather most likely he would have emphasized the specific risk factors associated with the crib death, or perhaps he would have described these deaths as a pure SIDS. He seems to exclude the possibility that any bedsharing deaths are a pure SID, which is inappropriate.
Dr. Hein's statistics show clearly that for Iowa apparently solitary crib deaths constitute the majority of Iowa's infant deaths. Will he also argue therefore that while babies should not bedshare, they mustn't also sleep in cribs? Ironically, if Dr. Hein were to use evidence-based medical science at very least he should be recommending that no infants sleep in a room by themselves. According to two major epidemiological studies, one from Great Britain and one from New Zealand, infants sleeping alone in a room in cribs were twice as likely to die from SIDS as infants who slept in the same rooms with their mothers, and/or were in and out of their mothers bed all night!
Dr. Hein also under-reported the number of parents in the United States who bedshare. He described how bedsharing behavior has doubled in the nineties (moved from 5 to 12.2 percent of parents) but this figure only refers to the number of parents who sleep in bed with their babies, all night, every night. What is left out, which increases this figure significantly, are the numbers of parents who sleep with their infants for half the night--who relocate their infants from their cribs after the first feed. When one includes partial or "half-the-night" bedsharing the percentage of contemporary parents bedsharing reaches between 40-60% and the number is increasing. With over 72% of mothers leaving the hospital breast feeding--our culture has changed as regards infant sleeping arrangements. As our articles in Pediatrics reveal bedsharing and breast feeding as our mutually reinforcing--When mothers make a decision to breast feed, even without realizing it, they likely are making a decision to sleep with their baby, so powerful is the biology that underlies the need for babies to be physically close to their mothers to promote easier and more efficient sleep and breast feeding behavior.
It is true that beds did not evolve, but mother-infant co-sleeping with breastfeeding surely did and for only one reason: for the protection and well being of both mothers and their infants.
Dr. Hein can serve an important role in helping our culture in making this transition, as breastfeeding becomes our new norm. He and his colleagues can help to educate parents as to how to bedshare safely--just as we seem to be willing to help parents place their infants safely in safe cribs. But to imply that all and every kind of bedsharing ought to be banned because unfortunately some parents to not have the means or knowledge or capability to do it safely is not only inappropriate and wrong, but it deprives parents and infants of their rights to become informed to make choices that are only theirs to make. Bedsharing is not pathological and inherently dangerous behavior. It is normal human behavior.
In his final report of Iowa infant deaths, I would hope that Dr. Hein will exhibit the same level of preciseness and detail for explaining how and why babies die in bedsharing contexts--that he will use to explain how babies die in cribs or die sleeping alone. If we must--we might want to get rid of dangerous beds in order to preserve the inherent protectiveness of the mother-infant co-sleeping and feeding relationship. But it is one thing to identify hidden dangers potentially associated with bedsharing, its altogether a different issue to assume as Dr. Hein seems to that is the mother herself who is the hidden danger.
Finally, Dr, Hein may which to choose that only hazards associated with crib and solitary infant sleep are worth solving, but parents may wish to solve other problems--to choose to solve problems and eliminate hazards associated with bedsharing. It is their right to do so.
We now know what adverse social and physical circumstances make bedsharing dangerous, so by all means, let Dr. Heim begin in Iowa as we have here in Indiana, to promote safe sleep brochures which include information about safe cosleeping and bedsharing. Not to do so will seriously limit access to an entire new generation of parents, most of whom breast feed, and who like millions of human beings everywhere have discovered both the short and long term benefits of sleeping with infants and children.
James McKenna Ph.D.
Professor of Anthropology Director, Mother-baby Behavioral Sleep Laboratory
SIDS Global Task Force Education Committee
University of Notre Dame
Notre Dame, Indiana 46556