Why we cosleep with our infant and you (perhaps) should too

The feeling of a soft little one gradually melting into my arms is lovely, and I wouldn't soon give up rocking my baby to sleep. That said, shifting from foot to foot in the dark several hundred times night after night can get repetitive. So tonight, as I was rocking little Peregrine, I set myself an intellectual challenge. I was going to simultaneously count how many times I shifted from foot to foot and plan out this blog post. It turned out that after only 564 rocks he woke up and demanded to be nursed, but I will write what I planned anyway.

Peregrine is now almost two months old, and we've slept with him in our bed with us from the very beginning, as we did with both his older sisters. I can hear the million voices crying out in horror, but hold on and let me explain why. The benefits, I hope are obvious (snuggles, not needing to wake up to nurse the baby, baby sleeping better, family bonding, etc.) but most people (in the US anyway) don't sleep in the same bed as their baby, don't feel allowed to, because the public health advice is that it can cause the infant to strangle or suffocate.

Zero day old Peregrine cosleeping (don't tell the nurses)

Our three children were born in Germany, Denmark and Wisconsin, respectively, and we have learned to be quite skeptical of official advice and cultural mandates that vary wildly from place to place. Advice regarding infant suffocation risk certainly depends on where one lives. When we told our Japanese friends how strongly Americans are cautioned against cosleeping, they were surprised and amused. In Japan, apparently, the official advice and common practice is for the baby to sleep between the mother and father, like Lancelot's sword (misplaced cultural reference, I know.) Our German friend warned us strongly against letting our cat near our baby, as a smothering would surely ensue.

Tigerlily and Flopper, dressed for Halloween

As an American scientist with a professional interest in early mortality, and with kids, I of course looked up the science upon which the American advice is based. The most common reference regarding the risks of cosleeping is:
Blair et al. (1999). Babies sleeping with parents: case-control study of factors influencing the risk of the sudden infant death syndrome. British Medical Journal. 319, 1457-1462.
There are more recent papers on this conducted in several countries, and as far as I can see none of them have basically contradicted Blair et al.'s clearly stated "Key messsages" (sic):

Key messsages

• Cosleeping with an infant on a sofa was associated with a particularly high risk of sudden infant death syndrome
• Sharing a room with the parents was associated with a lower risk
• There was no increased risk associated with bed sharing when the infant was placed back in his or her cot
• Among parents who do not smoke or infants older than 14 weeks there was no association between infants being found in the parental bed and an increased risk of sudden infant death syndrome
• The risk linked with bed sharing among younger infants seems to be associated with recent parental consumption of alcohol, overcrowded housing conditions, extreme parental tiredness, and the infant being under a duvet

Now, my wife and I do not smoke, do not drink, are not sleeping on a sofa, do not put the baby under a duvet, do not have overcrowded housing conditions and are merely very, rather than extremely, tired. As this 2016 study makes clear, cosleeping is often associated with overcrowding because people in poverty don't have the money for an extra room or an extra bed. Poverty increases the risk of almost all causes of death, especially infant deaths, and much of the risk from cosleeping may actually be risk from poverty. Our baby is under 14 weeks, but according to Blair et al.'s findings, without these other risk factors (particularly smoking), there is no increased risk associated with cosleeping, even for neonates.

Not child endangerment (with Tigerlily)

Other studies have added parental obesity and extreme youth as risk factors. I am certainly overweight by the standard definition, but not obese. We are not particularly young parents. But still, if there is any risk at all of rolling over onto the baby, wouldn't it be safer to have him in a crib in another room? Emphatically, disastrously, not. Blair et al. write, "There was an increased risk for ... infants who slept in a separate room from their parents." Their estimate, that having the baby sleep in another room increases risk by about ten times, has been revised by more recent research to increasing risk by about half. Long story short, having the baby in a separate room is dangerous, while having him in our bed with us presents no documented risk compared to a good modern crib.

This presents two obvious questions: How should parents who aren't trained in interpreting regression tables make this decision? And, why is the official US advice (which resembles that in several other countries) what it is?
My interpretation, based on Blair et al., and the studies that have followed from their work: Always sleep in the same room as the baby. (Shockingly, this has only now become the advice from the American Academy of Pediatrics)  Never sleep on the couch with the baby (they tend to roll into the cracks, and this is truly dangerous). Don't cosleep with a baby under 14 weeks old if you are a smoker, are under the influence, are obese, are overcrowded (which is associated with poverty and all its ills), or are otherwise difficult to wake. If those risk factors don't apply to you, there are hundreds of hours of baby snuggling available to you, and you can decide to take them or leave the baby in a proper crib in your room. Quitting smoking is astoundingly good for your children's survival, even if you don't smoke inside the home.

Now why is the official advice a simple, "Never cosleep," or starker versions thereof? Because official advice has to be short and simple to be effective. My paragraph of advice, above, is 150 words. "Never cosleep" is two. "Don't live in poverty," would be great, if people were given the opportunity of escaping. People are, on the whole, really bad at following complex advice, and really good at finding reasons why things don't apply to them. Have my wife and I really never used a duvet with a baby? Questionable. Am I really overweight rather than obese? I haven't weighed myself in over a year. How tired is "extremely?" Have I ever fallen asleep on the couch with a baby? Certainly. You see, it gets messy, and it is easier for officialdom to just say, "No."

Baby Kestrel sleeping on the couch with Big Sister. Closely supervised.

So my message to you, should you be in the position of choosing where to sleep your baby is to make an informed decision. Good slogans are rarely good advice, and extensive snuggles are one of the things babies need most.

This baby (Kestrel) is not asleep. A desk drawer is not a proper crib.

Unsolicited parenting advice

I have decided to share with you one of the big points of baby raising that Iris and I learned by hard experience.

We have a million books on baby care, Iris reads a bunch of "mommy blogs," and we know lot of people with babies; we felt quite confident in our baby skills before our first daughter was born. For the most part that confidence was justified, but there was one thing we just had no idea about. Once we figured it out, it transformed our parenting experience: helping a baby fart. One hears all about midnight feedings and how to deal with diaper rashes, but we had no idea it was necessary to help a baby fart. She would be crying inconsolably, and we would be going crazy trying everything we could think of to sooth her, and then at 3 or 4 or 5AM, she would finally fart, and immediately fall asleep. This happened repeatedly for weeks, maybe months, until we figured out that belly massage, light pressure on the belly, or alternatively pushing her knees up toward her belly would squeeze the fart out. With practice one can feel exactly where the gas bubble is and guide it up and around and down and out. We got good at this, and could make her fart almost immediately, bypassing the hours of gas pains and ear pains. 

P.S.  Another thing I found very useful, when woken up for the 14th time that night, was to have a posted list of things to try to help the baby. It seems like it would easy to remember to check the diaper, but when sleep deprived enough this can be quite hard. So here it is:

Belly Massage

Milk

Temperature

Wrap

Rock

Light

Sing/Hum

Diaper

Clean skin

Nose

In almost every case where she wasn't actually sick, one of those was it. Print it poster size and put it near a nightlight.

37 weeks

It is an obvious yet remarkable fact that a fetus, near the end of pregnancy, could as easily be a newborn baby. Whether through natural birth or c-section, removing the full term fetus from the mother is all that is necessary to transform it into a baby. One remarkable thing about this is that a baby is an air-breathing animal much like any other, and a fetus does all its gas exchange through a tube attached to its circulatory system through its belly button. I can’t easily imagine keeping a tortoise alive by sticking a tube into its belly, nor do I imagine one would have much luck doing so with an adult human, or even a child. But somehow it works for the fetus.

Another thing that is striking about the fetus being a nearly complete baby is that it is a nearly complete baby entirely inside the belly of the mother, upside-down, often with its head inside her pelvis. I don’t know about you, but I could not function for very long with a nearly full sized baby inside me and a skull in the middle of my pelvis. I think I wouldn’t last five minutes, but apparently this situation can go for weeks with little danger, and bearable discomfort, to possessor of either pelvis or skull.

A tremendous amount is now known about ontogenesis, the process by which a single egg grows and develops into a whole person. We have studied it on the scale of molecules, cells, tissues, organs and whole individuals and from the perspectives of physiology, genetics and evolution. There are still vast areas we know almost nothing about, but we can largely reject the hypothesis that there is magic involved. Never the less, things can feel like magic even when reason rejects it. This whole process, of self-directed growth of a single cell into a person, makes it easy to understand why spirits, gods and humunculi are so often invoked.

Focus

We turned the living room into a seminar room for the night, all the couches and chairs facing the blank white west wall, onto which we projected my PowerPoint slides. The audience was diverse: in addition to a dozen adults from several professions, I spoke to two little girls (neither of which understand English), an eight month old baby and a big old shaggy dog who curled up by my feet. Before I had gotten through my introductory slide the dog was snoring loudly under the table I was using as a podium, one of the little girls was raising her hand wanting to go to the bathroom, and the baby was waving at me with both hands and saying, "bob bob bob bob bob bob bob bob." As I described the success of my laboratory experiments to date, the dog woke up and began snuffling in the trashcan next to me, and at some point one of the little girls came and tried to sit behind the podium. Despite these disruptions (or perhaps because of them?) the presentation went well, the assembled nonexperts seemed to think the presentation clear and convincing, and their comments, while helpful, require only minor changes to the talk.

I hope that the distinguished scientists I am to present to on Wednesday will be somewhat more decorous. If they are not, it may give me an unfair advantage over the other applicants.