To co-sleep or not to co-sleep with infants is often a dilemma and cause for discussion among many new parents, but especially for those in the African American community. While many parents adopt the practice, others have various reasons for opting out—both often stemming from beliefs passed down through generations.
In 1996, when I gave birth to my eldest daughter, co-sleeping was a no-brainer for me. I was breastfeeding and found I could nurse every two to three hours and still get a little more sleep without worrying about making bottles. My then husband wasn’t completely on board with it, because he was afraid that he would roll over in his sleep and suffocate our daughter. His fears weren’t unfounded. According to a 2010 study by the Journal of the National Medical Association, African American infants are at higher risk for sudden infant death syndrome (SIDS) and accidental suffocation than other infants and are up to four times more likely to bed-share with their parents.
In 1996, when I gave birth to my eldest daughter, co-sleeping was a no-brainer for me.
I countered that fear by having her sleep next to me and inserted an adjustable “gate” at the edge of the bed so she wouldn’t fall out. I repeated the same practice with our youngest daughter and never thought much about it until the topic was brought up in an online parenting group. Curious about how things have changed in the two decades since I gave birth, I spoke with other African American parents and pediatricians, including a spokesperson from the American Academy of Pediatrics (AAP), who had a range of opinions.
What is co-sleeping?
Co-sleeping is defined in a few different ways. One example is a parent sharing a room with an infant or toddler but with different sleeping surfaces. Another is actually sleeping in the same bed as the infant or toddler, which is also called “bed-sharing.”
Dr. Daniel Roper, a pediatric resident physician in Columbus, Ohio, says, “If a parent ever brings up the topic of co-sleeping, I am very careful to clarify which situation they are talking about because it’s a very important distinction to make.” The clinic he works in is proactive in initiating safe sleep conversations with parents to reduce the risk of suffocation. “When a baby is discharged from the hospital’s newborn nursery or NICU, parents have been counseled and provided information for the ABCs of safe sleep: Babies should sleep Alone, on their Back, and in a Crib,” he states.
The AAP advises against co-sleeping (sharing a sleep surface), as it increases the risk of accidental suffocation and strangulation in bed (ASSB). These incidents are a component of the more widely known SIDS. Dr. Roper says there’s been an abundance of evidence that safe sleep practices have greatly reduced SIDS deaths. “When parents show up to the clinic, they watch a safe sleep video before they are even seen by a doctor. Every visit until the child is 12 months old consists of filling out a survey on an iPad and asking how they put their baby to sleep. That survey flags risky sleep practices and alerts us.”
Why we sleep with our babies
Deborah Raines, associate professor at the University at Buffalo School of Nursing, mentions in an article for the University of Buffalo family traditions and cultural and geographical influences may lead some mothers to place their newborn children in unsafe sleeping positions. A study from the 1990s also found that 25 percent of Blacks have been advised by healthcare providers to place their babies to sleep on their stomach, compared with 7 percent of whites who said they received similar advice. Raines explains why many new mothers of color don’t debate sleep preferences: “You go home from the hospital and your mother says, ‘Honey, I never put you to sleep that way.’ Chances are you’re going to listen to your mother.”
Such questions and concerns weren’t brought to my attention 25 years ago, and I’m not alone among mothers of color. Melisha B., 49, from South Carolina, says, “As a 22-year-old single mom, I chose co-sleeping with my newborn baby mostly from feeling the need to watch over my child. Stories of SIDS scared me, and as a sense of security, I believed having my baby sleep in bed with me was the best option for us both.”
“You go home from the hospital and your mother says, ‘Honey, I never put you to sleep that way.’ Chances are you’re going to listen to your mother.”
She says that when discussing the topic with older women in her family, she found that most of them co-slept with their children for the same reasons as she did, especially feeling the need to have their babies nearby to immediately care for them. “Some mentioned a bassinet or crib wasn’t available at the time, but having their child with them while sleeping turned out to be the best thing for them at the time. I’ve co-slept with all three of my babies up until ages three or four. The transition from my bed into their own was difficult at times but achievable when they realized I was nearby.”
Brittany H., 35, from Florida decided on a different approach when it came to co-sleeping with her daughter. She used a bassinet that was attached to her bed.
“I spent most of my time in the early weeks sleeping approximately two hours a night. I started co-sleeping at six weeks when I had to go back to work, using a bassinet. I thought this was the safest option that also increased sleep time,” she says. Her daughter’s father was against co-sleeping, but “he was getting at least seven hours of sleep a night (compared to my two). I argued that if I didn’t start getting more sleep I would have to take time off of my job, and we couldn’t afford that.”
Looking back on her upbringing, Brittany says her mother co-slept with her as a child and approved of her doing the same as long as she was taking safety precautions. “My friends with children were concerned but ultimately understood my plight.” While she believes Black parents are more open to co-sleeping with their children now as opposed to 20-30 years ago, she attributes it to online support communities that Black parents have created for themselves. “The Black Breastfeeding Moms group on Facebook is where I learned about co-sleeping and how to do it safely,” she says. “It’s where I went for support when I had questions or concerns. It gave me the confidence to try things like co-sleeping and breastfeeding, which are still frowned upon in the Black community.”
Like Melisha B., Brittany H. found transitioning her now four-year-old daughter to her own bed and room difficult. “While she goes to sleep in her own bed, she generally wanders into mine in the middle of the night. It’s been pretty unsuccessful.”
Doctors insist co-sleeping is dangerous
Despite tales that co-sleeping has worked for many parents, it’s hard to ignore professional advice against the practice.
In 2011, the Milwaukee Health Department ran an ad campaign against co-sleeping after yet another infant death in the city. In 2009, Milwaukee saw 5.4 white baby deaths versus 14.1 Black infant deaths. Two posters were made of a baby lying in a bed next to a large knife. One baby was white, the other baby Black. The ad’s tagline, which said “Your baby sleeping with you can be just as dangerous,” was designed to be shocking, according to then Milwaukee health commissioner Bevan Baker.
Dr. Elizabeth Murray, pediatric emergency medicine physician at the University of Rochester Medical Center and AAP spokesperson, is both personally and professionally adamant that sleeping with an infant is unsafe.
“Co-sleeping is incredibly dangerous. Babies can suffocate with a simple sheet covering their face. They can also get stuck up against a parent, which can lead to suffocation. About 1 in 1,000 babies die from unsafe sleeping conditions in the U.S. each year. It’s easy to think a parent will wake up or know their baby is too close, but unfortunately that’s not the case. We also see babies injured from falling out of bed if a parent rolls.”
What we now know more than ever is that parents create their infant’s reality.
Working the overnight shift, Dr. Murray has frequently encountered unresponsive babies who have died from co-sleeping. She says it’s common for a parent to wake up early in the morning, usually around 5 or 6 a.m., and realize their baby did not wake for the 3 a.m. feed. “They discover their baby isn’t breathing and is lifeless. It’s the overnight team in the emergency department that most often sees these cases. Unsafe sleep deaths are 100 percent preventable.”
She goes on to state that these tragedies are rarely covered in the news, so unsafe sleep deaths are something parents know little about. “The Back to Sleep campaign to prevent SIDS helped a great deal, but many still think when a baby dies in its sleep, we don’t know why. That simply isn’t the case. In my community, we have a rate of unsafe sleep deaths that’s higher than the national average. It’s also important to know babies still form wonderful attachments with their parents, and breastfeeding is not inhibited by them sleeping in their own safe space.”
How we can keep our babies safe during sleep
Dr. Murray recognizes there is a pretty strong societal feeling of “Hey, my parents did it this way and I turned out fine” in a lot of different situations and believes in personalized suggestions against the practice. Smoking parents, drinking parents, and the gestational age of babies all can be factors. “This is not SIDS. These are deaths by suffocation and can be prevented by ensuring babies sleep alone, on their back, without blankets, pillows, or toys.” She also adds that parents shouldn’t worry about children getting too cold, as there are wearable blankets or baby sleeping bags that are safe because they do not slip up and cover the baby’s face. “A good rule is that a baby needs one more layer than a parent is comfortable wearing. That means, even in winter, it’s not necessary to cover infants in blankets or keep the room temperature very high.” It’s also important to know that evidence of alcohol or drug use in relation to infant death can be grounds for criminal charges in many states.
Parents can have the best of both worlds
If a parent is still concerned about being nearby to hear a baby’s cries, there’s no need to move them into another room before you think they’re ready. “We actually recommend a baby’s crib be in the parents’ room for at least the first six months of life and ideally up to one year of age,” says Dr. Roper. “However, I think it’s important to recognize living situations vary, so I usually place most of my emphasis on the ABCs of safe sleep whether or not the crib is actually located in the same room or if parents are using a baby monitor.”
Dr. Murray sums it up for new parents who may still be on the fence: “What we now know more than ever is that parents create their infant’s reality. Any routine becomes a habit and what the child expects. There is really never a need to co-sleep as it does not offer any benefit to the child and will make it harder for them to learn to sleep in their own crib or bed. If a family chooses to co-sleep, it would be best to wait until the child is one year or older.”