As doulas, it is vital we help educate our clients about many infant care topics. This includes ensuring they understand the evidenced based information for safe sleep for babies. While different professionals and families have varying opinions, we must provide evidence to clients, not simply our opinions.
As doulas, we will often be the professional a client looks toward. As a professional, we have a responsibility to provide our clients with honest, evidenced-based answers to common questions.
However, as birth workers, we also understand that sleep and babies can be quite nuanced. The American Academy of Pediatrics says X and UNICEF UK says Y, while Dr. James Mckenna and anthropologists might say A. How do we know how to educate clients about safe sleep when there are clear guidelines at each organization, but variations between organizations?
Safe Sleep – Always Provide Clients With Current Recommendations For Their Location
If you are a doula in the United States, it is important you provide clients with current recommendations provided by the American Academy of Pediatrics, your local health departments, etc. If you are in the UK, be sure to provide information from NIH.
Currently, the American Academy of Pediatrics recommends:
- Back to sleep for every sleep.
- This includes infants with reflux as there is no evidence to support side or inclined sleep is safe.
- All babies should be placed on their back to sleep until one year of age. If a child rolls to their side or stomach on their own, that is fine. However, caregivers should not place them on their side or stomach.
- There should be no blankets, pillows, stuffed animals, etc., in the sleep surface with the baby.
- Use a firm, flat sleep surface.
- Inclined sleepers and wedges, baby loungers, swings, car seats not on their base, etc., are not safe sleep surfaces.
- It is recommended that babies sleep in the same room with their parents, but a different sleep surface, for ideally the first 6 months of life.
- “The AAP understands and respects that many parents choose to routinely bed share for a variety of reasons, including facilitation of breastfeeding, cultural preferences, and a belief that it is better and safer for their infant. However, on the basis of the evidence, the AAP is unable to recommend bed sharing under any circumstances.”
You can read these guidelines in depth in the AAP’s policy statement.
UNICEF UK has similar guidelines as the AAP. They often provide more in-depth information about how to discuss these with parents.
Is Bedsharing Inherently Dangerous?
As a doula, you are likely to navigate these questions. It is important to recognize that statistics show about 50-80% of parents at least occasionally bedshare, varying by region, culture, etc.
A healthy, term infant contact sleeping with their biological, lactating, parent is not inherently dangerous. It is likely a biological norm.
However, modern blankets, modern furniture, pillows, overheated homes, prescription medications, soft mattresses, pacifiers, bottle feeding, etc., are not necessarily natural. None of these things are inherently wrong for parenthood.
However, when we combine contact sleep with comfy mattresses, fluffy pillows, big blankets, prescription medications, bottle feeding, etc., we do create a situation with real risks.
There are typically two different approaches professional organizations make when providing public education regarding bedsharing. One approach, which is what the AAP uses, is to blanketly discourage any bedsharing with infants, especially newborns.
The other approach is to discourage bedsharing while recognizing that statistics show some parents will do so anyway. For that reason, providing some guidelines to reduce risk is also included. This is the approach UNICEF UK seems to take. Per the UNICEF link shared above:
“The authors found that many breastfeeding mothers and caregivers do sleep with their infants whether intentionally or unintentionally. They argue that the data supports policies to counsel parents and caregivers on safe sleep practices, including bed-sharing in non-hazardous circumstances, particularly in the absence of parental smoking, recent parental alcohol consumption, or sleeping next to an adult on a sofa. Further research with appropriate methodology is needed to drill down on actual rates of infant deaths, paying close attention to the definitions of deaths, the circumstances of the deaths, and confounding factors, in order to ensure we have the best information with which to derive public health policy.”
What Should Doulas Tell Clients About Co-Sleeping and Bedsharing?
It is important that you provide current recommendations for your region and only evidenced-based sources. One should never tell a client that it is safe to bedshare and they should do so.
However, if a client is interested in bedsharing, your language is important. One might say something along the lines of, “Well, currently the AAP advises against bedsharing. However, some researchers, such as Dr. James Mckenna, believe bedsharing is safe in some circumstances if both the parent and child meet the criteria. You might find it helpful to look at the AAP website and Dr. James Mckenna’s website to learn more and make the informed decision which works for you.”
Navigating Safe Sleep During Doula Shifts
As a doula, it is important you follow all current sleep guidelines. If parents request you do something which is not in-line with current guidelines you can say something such as, “I’m professionally bound to following current AAP guidelines. It is a liability for me to do anything else. During my shifts, I can only put baby to sleep in a flat bassinet, crib, or pack-n-play. This is not a judgement on any sleeping arrangements you choose during your time caring for baby. I’m simply required to follow current guidelines.”
This means you can only put baby to sleep on approved sleep surfaces without blankets, pillows, etc. If parents continue to ask questions, you can use the opportunity to educate them regarding safe sleep recommendations.
Some doulas have made informed decisions to bedshare with their own children. That is a personal choice which some are comfortable making. However, it is important you do not use that anecdotal experience in place of evidenced-based information. If clients would like information about bed-sharing, be sure to point them to sources such as Dr. James Mckenna.