Parents overlaying infants – fact or fiction?

Co-sleeping (in the sense of bedsharing) advocates tend to pooh-pooh the idea that overlaying is a realistic hazard while sharing a bed with the baby, especially if you do it “safely”. Here’s James McKenna, the anthropologist who researches the physiological effects of bedsharing (but has, so far, not managed to prove any conclusive SIDS risk reduction as a result), on the subject:

In the worldwide ethnographic record, mothers accidentally suffocating their babies during the night is virtually unheard of, except among western industrialized nations, but here there are in the overwhelming number of cases, explanations of the deaths that require reference to dangerous circumstances and not to the act itself….

…While there is evidence that accidental suffocation can and does occur in bed-sharing situations, in the overwhelming number of cases (sometimes in 100% of them) in which a real overlay by an adult occurs, extremely unsafe sleeping condition or conditions can be identified including situations where adults are not aware that the infant was in the bed, or an adult sleeping partners who are drunk or desensitized by drugs, or indifferent to the presence of the baby.

It’s certainly true that under certain circumstances which constitute unsafe cosleeping – parents under the influence of drugs or alcohol, shared sleep on unsafe surfaces such as waterbeds or sofas – the chance of death from overlaying is far higher than in a safe cosleeping situation. I would also postulate that despite his physiological findings about cosleeping dyads, mothers who are fast asleep may still not be entirely “aware that the infant was in the bed”. But to claim that historically, no infants were ever overlain until the advent of western industrialized nations is complete rubbish.

Overlaying has been known at least since Biblical times (see I Kings 3:19 – remember the story about Solomon’s judgement between the two women and the baby? That’s what happened to the dead baby, according to the Bible). In fact, babies who died suddenly and unexpectedly were assumed until recent times to have been overlain – as cosleeping was common (and not only with parents). Undoubtedly, the overwhelming majority past events of infants dying in their sleep were actually SIDS, deliberate infanticide, or deaths as a result of undiagnosed congenital problems. But people attributed these deaths to overlaying, presumably, because such cases were known to happen (and they may not have been always wrong, mind – see this late 19th century cohort of infants in Dundee, Scotland). It’s also very hard to estimate deaths by overlaying (or SIDS deaths, for that matter) in tribal populations whose living membership may not exceed several hundreds or thousands at any given time, record keeping is scant, and where infant mortality (regardless of cause) is extremely common. Even in modern times and places, it’s often hard to discriminate between a SIDS death and an overlaying one; the coroner usually goes by the death scene investigation and the results of the autopsy (which may be negative in both cases). Ardent cosleepers often squawk that deaths from SIDS in adult beds are often misattributed to overlaying. Other than the preponderance of physical evidence, though, there is no way to determine this.

It’s certainly a stretch to say that every instance of infant overlay will cause the infant to die; After all, SIDS/SUDI death rates are measured per 10,000 population. But to pretend that it never happens, and when it does, it’s the fault of unsafe cosleeping, is equally a stretch (See my similar post on head covering as a SIDS risk factor).

A recent study in the Journal of Obstetric, Gynecologic, and Neonatal Nursing by Ateah et al helps shed some light on whether overlaying happens only when parents are under the influence or sleeping in unsafe conditions. Named “Maternal bedsharing practices, experiences, and awareness of risks”, the study’s aim was to determine the extent and experiences of bedsharing among mothers and their infants in the province of Manitoba, Canada, and the mothers’ knowledge of the accompanying risks.

Questionnaires were sent to all mothers giving birth in Manitoba in a given month (all 1,122 of them) when their babies were 3 months old; 293 of the mothers (26%) filled out and returned it. The questionnaire, besides collecting demographic data about the mothers and babies (age, baby’s gender, socioeconomic status, education, etc.), also asked about the mothers’ attitudes toward bedsharing and their agreement or disagreement with statements about the risks of bedsharing, and also – what is pertinent to this blogpost – whether they had, to their knowledge, rolled on to their infant in their sleep.

It’s interesting to note that the cohort who responded to the questionnaire was of higher socioeconomic status than the general population: nearly two thirds (66.2%) had completed higher education, the majority (over 90%) were married/partnered, and over 2/3 were at home with the baby at the time (either SAHMs or on maternity leave). Exceptions aside, this is not the demographic normally given to using illicit drugs or drinking to excess. Smoking was apparently not assessed. Over 2/3 also reported they were breastfeeding their infants, either exclusively or along with formula.

Among this high-status cohort, 42.7% shared a bed with their infant on a regular basis, and an additional nearly 30% slept with them occasionally. Ergo, almost 3/4 of the sample slept with their babies at one point or another. Of those who did, nearly 1 in 7 (13%) reported at least one incident involving someone rolling over fully or partially onto the baby while asleep. Comments offered included the following:

• “Yes, I’ve rolled onto my baby in my sleep. I woke myself up when I felt her. She didn’t move or cry. Thank goodness I’m a very light sleeper.”

• “Have found that my hand was partly covering the [baby’s] face as my initial intention was just to help hold pacifier in mouth . . . .”

• “With my second child, I woke up on top of her and the scary thing was that she wasn’t crying.”

• “Once I had him not on my arm, beside me. And I wasn’t aware and fell asleep hard andalmost rolled on him but [someone else] woke me up.”

• “I have not rolled onto my baby but my husband has. We had noticed a few times when
she was less than 1 month old, when we woke she was under the covers and very hot.”

• “I have slept with my baby maybe twice and both times he would wake me when he
moves. Once I turned over to find that he had rolled slightly and a pillow was on top of
him. No more co-sleeping after that. ”

• “Yes, being a new mom is very exhausting, and I will occasionally fall asleep during
feedings, she will move or fuss if I am ‘squishing’ her. ”

While the events described did not cause the infants involved any harm, and in fact, some of the infants managed to alert the person who overlay them that they had to move, it’s clear that overlaying isn’t just some rare-to-nonexistent piece of fiction that some anti-bedsharing people (say, crib manufacturers) made up for their own personal gain, or something that only happens to mothers compromised by drugs or alcohol. Even if we assume the 74% of non-responders had no such events happen among them (something I find highly unlikely), there would still be an occurrence rate of roughly 1 in 40 parents (~2.5%) who experienced overlaying their infants. Just because in all the cases mentioned, the babies were not harmed (either because the mother, the baby, or a third person sensed something was wrong and prevented it), does not mean this will happen in every instance. So while death from overlaying on an adult bed is probably not a common event by any means, claiming it’s an impossibility or can only happen when a parent is compromised is, also, probably not likely, either.

Mind you, one of the rules for “safe cosleeping” also states you shouldn’t sleep with your baby if you’re “overly fatigued”. I’ve never quite understood how a parent is supposed to assess this correctly (indeed, the overly fatigued state, ironically, may hinder this assessment), nor have I ever actually heard any ideological cosleeper remove themselves from a bedsharing situation as a result. Maybe that’s why the authors of this study also agree that the safest sleeping environment for a small baby is on a sleeping surface adjacent to the parents’ bed, and state:

Since not all risk factors associated with bedsharing can be controlled, such as the level of caregiver exhaustion and infant overheating, recommendations for safe bedsharing
cannot be provided.

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7 Responses

  1. “Mind you, one of the rules for “safe cosleeping” also states you shouldn’t sleep with your baby if you’re “overly fatigued”. ”

    Uh…when is a new parent NOT “overly fatigued”?

  2. With my first child it was drilled into our heads not to fall asleep with the baby in arms. She is 23 years old. And when my Son came along (10 years old) the Lactation consultant told us we must sleep with the baby to help withbreast feeding . She told me no Mother rolls on her child unless she is on cold medicine or drugs and/or Alcohol. We did sleep with him until he was about 5 years old.

    I think after reading your article I would have to say there is not enough evidence to say that cosleeping is as safe as crib sleeping. However, there are more danerous child rearing practices such as anti vax and various homebirth situations. My new advice to hard core homebirths is “why don’t you rent an RV, make it your own space and deliver in the RV close to the hospital.” Not a perfect choice for me but I think a little safer choice for them. Cause they are going to homebirth and I am going to clean up the mess when they do finally come into the hospital.

    But back to bed sharing. I think we have had 2 cases of demise due to bed sharing at my hospital. Both cases were unsafe situations like sleeping on the couch with the baby.

  3. I’ve always found it very difficult to sleep with a baby. My first-born also found it difficult to sleep with us (!), but our second-born doesn’t care much where she sleeps; however, I don’t sleep well with an infant. It is very difficult to hold/position the baby beside you and get any sleep yourself. I’m always interested in why/how co-sleepers can get any sleep with their infants at all. Not only is it uncomfortable at times, but I wake up constantly making sure the baby is free of limbs and blankets and pillows. Every sigh wakes me. Every movement wakes her. How can anyone sleep that way? If I want to roll over on my stomach and turn my head left, I *have* to sleep that way; I won’t sleep any other way. If the baby’s in the way … either she or I is going to lose out on some sleep! There’s something about the (co-sleeping) parents’ sleep habits that is quite intriguing here, I think.

  4. Angela – I found that when I fell asleep in bed while nursing my babies (yes, it happened on occasion), I woke up all stiff from trying not to crush them. When they were oldre and came to our bed if they were sick, I had that to contend with plus getting kicked in sensitive places all night long! 😆

  5. I’d say it is a fact and a very real risk. The New Zealand report of a coroners hearing below shows two cases of overlaying in a short time period, but judging from the comments in the second, related article they are likely to be classed as SIDS rather than the true cause which was that overlaying did occur and caused the death of the infants, with a 50% of SIDS cases being associated with bed sharing.

    “Mums sob as joint inquest held: Mothers’ sobs filled courtroom 7 at Wellington District Court as inquests were held on how their babies died in bed, possibly because of “unsafe sleeping environments”, a pathologist said. In four of the seven cases the babies were sharing a bed with others. Three were in bassinets, but face-down, which probably caused them to suffocate. Wellington coroner Garry Evans, who has condemned bed-sharing as a deadly practice in at least 15 other cases during the past eight years, reserved his findings. He told the families yesterday that the inquests were not a witch-hunt. “There is no suggestion these babies received anything except tender loving care. We are simply here to see what contributed to their deaths.” Judy-Anne Tito, who accidentally smothered her son Nephi, said she knew it was risky sleeping with her tiny twins “but it was the only way they would settle…..”.

    “Dangers of sharing bed with babies not clear: More consistent messages about the dangers of bedsharing with babies are needed, child health experts say. Auckland University professor of child health research Evan Mitchell said bedsharing absolutely increased risk of babies dying from sudden infant death syndrome (Sids). “About 50 percent of the deaths are occurring in a bedsharing situations,” he told Radio New Zealand….”

  6. oh my God…why did I read those links???

  7. Thanks for putting Rational Moms on your blogroll. I am reading this article with utter fascination, as I recently have given over to co-sleeping myself. We kept our son in his own bassinet until he was three months old and rarely napped with him. Now he is six months old, and we grew tired of putting him down in his crib over and over, only to have him wake up, so we started actually co-sleeping with him. I want to write an article about this for Rational Moms, actually.

    I lived in Japan when I was young, and moms there routinely co-sleep. I was very paranoid about the safety issues (which seems warranted I realize, after reading your links), so I put a flat, firm mattress on the floor of the nursury, dressed the baby in a sleep sack, and we keep all bedding far away from his face. I am a very light sleeper and don’t move at all while sleeping with him. I have sacrificed some comfort and ability to move around, but it seems to work just fine for me. I also sleep alone with the baby in his room, and my husband sleeps in our bedroom. This has obvious implications for my marriage, but we are okay with it for now.

    Our apartment is very cold, although we live in sunny Los Angeles. The funny part about living in a warm place is that often the heating systems just aren’t too great, so the winter is always drafty and cold. We are of course going to get a space heater and do some weather stripping in the baby’s room, which should help. But the baby is much warmer next to me.

    And bottom line: kid just doesn’t like the crib. You can argue that I need to train him, and my argument back to you will be please, please, come over to my place and try it. I’d like to see it! He wakes up without a warm body next to him. Our pediatrician said sleep training would work best after six months. By that time, we were already co-sleeping. We tried the training and it seemed to be working. But then the baby was sick, or teething, and now we’re about to travel. So there is always something that legitimately delays further sleep training or makes us have to completely back track.

    I do not deny that this practice puts a dent in my normal routine, but I do enjoy having the baby next to me. It has also helped me to monitor his breathing, since he has been sick on and off since mid November and tends to get croup. He’s had two attacks in the last month! So despite the lack of utter comfort, it makes me more comfortable to be able to hear him.

    And he sleeps better, so ultimately, so do I.

    I don’t know how people sleep with a tiny newborn. Our first attempts when my son was very little caused me to think that babies are just terrible bedmates. He was a loud breather, wriggled around a lot, and then wet the bed. Who needs that? But after three months, it did work out better for us to share a bed.

    Last thing I would say: I would just never roll over, but that’s just me. And I only know that from trying co-sleeping. So whenever I read claims that it simply cannot happen, I am somewhat skeptical. I was very timid about trying co-sleeping because I would have to kill myself if anything happened to the baby. But as it turns out, I just don’t move while sleeping.

    On the emotional side, it is very, very nice, seems “natural,” feels right, and all that. I will really cherish these times with our son.

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