Mothers' Instincts: Safe Sleep Guidelines Ignored

Despite mothers' knowledge of safe sleep guidelines for infants, many do not follow them. A study found that fewer than half of new mothers intend to follow the guidelines and then follow through on those intentions. This is a worrying trend, as safe sleep practices are crucial for preventing Sudden Unexpected Infant Death Syndrome (SIDS), a leading cause of death in babies. While mothers are aware of the recommendations, they often find them impractical and resort to non-recommended practices to help their infants sleep. This includes bed-sharing, using soft bedding, and holding or rocking infants to sleep. To address this issue, interventions are needed to educate parents about the risks and promote developmentally appropriate sleep strategies for infants.

Mothers find guidelines impractical, resorting to non-recommended practices to help infants sleep

A study by the American Academy of Pediatrics (AAP) has revealed that mothers often find safe sleep guidelines impractical and resort to non-recommended practices to help their infants sleep. While mothers are aware of the guidelines and acknowledge their importance, they find them difficult to follow in practice. This is concerning as it increases the risk of sudden infant death syndrome (SIDS) and sudden unexpected infant death (SUID).

The study surveyed 3,260 mothers of infants aged 2-6 months, finding that only 45% followed the recommendation to sleep in the same room but not the same bed as their baby. This is despite 59% of mothers intending to follow this recommendation. The study also found that 24.2% of mothers intended to share a bed with their babies at least some of the time, which is not recommended due to the risk of accidental suffocation or smothering.

Mothers who participated in the study reported using non-recommended practices such as holding or rocking their infants to sleep (80%) and feeding their infants to sleep (76%). They also used products not approved for infant sleep, such as car seats (56%), swings (48%), and infant carriers (40%). These practices may seem harmless but they can increase the risk of SUID.

The study highlights the need for better education and support for new mothers. Mothers may be unaware of the risks associated with non-recommended practices or may find it challenging to follow the guidelines due to exhaustion or the demands of their infant's sleep patterns. Interventions that teach parents about developmentally appropriate sleep patterns and strategies to promote infant sleep and self-soothing may help increase adherence to safe sleep guidelines.

It is important for healthcare providers to have open and non-judgmental conversations with mothers about safe sleep practices and to provide practical advice and support to help them follow these guidelines. By working together, we can help keep infants safe and reduce the risk of SIDS and SUID.

Mothers are more likely to follow guidelines when doctors clearly explain them

Mothers are more likely to follow safe sleep guidelines when doctors clearly explain them. This is because mothers are more likely to trust the advice of their doctors when it is clearly explained to them. When mothers are not given clear explanations, they are more likely to follow their instincts or the advice of others, which may not always be in line with safe sleep guidelines.

Doctors should clearly explain the risks associated with not following safe sleep guidelines, as this can help mothers make informed decisions about their baby's sleep arrangements and reduce the risk of Sudden Unexpected Infant Death Syndrome (SIDS).

Additionally, doctors should be aware of the cultural and social factors that may influence a mother's decision-making process. For example, women of color and women with less education are more likely to bedshare, as are those who intend to exclusively breastfeed. Doctors should take these factors into account when providing advice and work to build trust with mothers to ensure they are following safe sleep practices.

Clear and consistent communication between doctors and mothers is essential to ensuring that safe sleep guidelines are followed. By providing clear explanations and addressing cultural and social factors, doctors can help mothers make informed decisions about their baby's sleep arrangements and reduce the risk of SIDS.

Confusion over recommendations, with some contradicting previous advice

The American Academy of Pediatrics (AAP) has issued safe sleep guidelines, including the "Back to Sleep" recommendation, advising parents to place infants on their backs to sleep. This recommendation has been effective in reducing the incidence of SUID/SIDS. However, some mothers find it challenging to follow this advice due to their babies startling themselves awake when placed on their backs. In such cases, sleeping on the belly may seem more comfortable and convenient for the baby, contradicting previous advice.

Another point of confusion is the recommendation against bedsharing. While bedsharing is a common practice, especially in non-western and non-industrialized cultures, it has been linked to an increased risk of SUID/SIDS. The AAP and other organizations, such as the Consumer Product Safety Commission (CPSC) in the United States, have warned against bedsharing due to the risk of suffocation or strangulation. However, some mothers choose to bedshare to facilitate breastfeeding, monitor their babies, or for cultural reasons.

The conflicting information and recommendations can make it challenging for mothers to determine the safest sleep practices for their infants. Additionally, cultural and societal influences, as well as individual circumstances, play a role in mothers' decisions regarding safe sleep practices.

To address this confusion, healthcare providers should engage in culturally sensitive and informative conversations with families. They should provide clear guidance on safe sleep practices, taking into account individual family dynamics and circumstances. Educating parents about the risks associated with certain sleep practices and promoting developmentally appropriate sleep strategies for infants can help reduce the risk of SUID/SIDS.

Mothers find it hard to follow guidelines when exhausted from frequent night feeds

It is not uncommon for new mothers to feel exhausted from frequent night feeds, and this can make it difficult to follow safe sleep guidelines. Breastfeeding is a demanding task, and it is normal for mothers to feel tired and exhausted. Here are some reasons why mothers may find it challenging to adhere to safe sleep practices:

Physical Demands of Breastfeeding

Breastfeeding requires a significant amount of energy, with the body using about 25% of its energy to produce milk. This can result in a loss of around 1000 calories per day, which is a considerable amount for new mothers who are already adjusting to the demands of motherhood. The physical demands of breastfeeding can lead to breastfeeding fatigue, making it challenging for mothers to follow safe sleep guidelines.

Sleep Deprivation

The frequent night feeds can disrupt a mother's sleep, leading to sleep deprivation. Getting at least 5-6 hours of uninterrupted sleep is crucial for the body to function effectively. However, with a newborn, mothers often have to wake up multiple times during the night to feed, change, and soothe their babies. This disrupted sleep pattern can result in extreme fatigue, making it difficult to follow recommended safe sleep practices.

Hormonal Changes

Childbirth can cause fluctuations in thyroid levels, potentially leading to hyperthyroidism, which may cause insomnia and contribute to fatigue. Additionally, hormonal changes during breastfeeding can impact a mother's sleep patterns, energy levels, and overall well-being. These hormonal changes, combined with sleep deprivation, can make it challenging for mothers to consistently follow safe sleep guidelines.

Emotional and Mental Health

The early days of motherhood are emotionally and mentally demanding. Mothers may experience nursing aversion or irritability, especially during nighttime feeds, due to tiredness or feeling 'touched out'. This can lead to feelings of guilt or uncertainty about their ability to care for their baby. The stress of adjusting to new responsibilities and the pressure of meeting societal expectations of motherhood can further contribute to mental exhaustion.

Inadequate Support

Mothers who do not have adequate support systems may struggle to follow safe sleep guidelines. While partners or other caregivers can assist with some tasks, mothers are often the primary caregivers, especially when it comes to breastfeeding. The constant demands and lack of respite can lead to burnout and make it challenging to consistently adhere to safe sleep practices.

Unrealistic Expectations

The idealised expectations of motherhood and infant sleep can also contribute to mothers' difficulties in following safe sleep guidelines. The reality of frequent night feeds and sleep disruptions may not align with societal norms or advice from well-meaning friends and family. This misalignment can cause confusion, self-doubt, and a sense of failure, leading to a departure from recommended safe sleep practices.

While it is essential for mothers to be aware of and strive to follow safe sleep guidelines, it is also crucial to recognise the challenges they face. Providing support, accurate information, and realistic expectations can help mothers navigate the demands of motherhood and make informed decisions about their babies' sleep and feeding routines.

Some mothers believe their babies sleep better when bedsharing

There are several reasons why mothers may believe that their babies sleep better when bedsharing. Firstly, it is instinctual and traditional for mothers to sleep close to their babies, as it facilitates breastfeeding and provides a sense of protection and safety for both the mother and the child. This practice has been observed in various cultures around the world, including modern hunter-gatherer societies, where bed-sharing is universal. Additionally, bedsharing allows for skin-to-skin contact, which has been shown to reduce the risk of Sudden Infant Death Syndrome (SIDS) and promote neurodevelopmental maturity and normal respiratory breathing patterns.

Another reason for mothers' preference for bedsharing may be the convenience and ease it offers for nighttime feeding. When the baby is in the same bed, mothers don't have to get up or call out, reducing the disruption to their sleep. This can result in longer overall sleep for both the mother and the baby, which can have positive effects on the mother's daytime functioning and emotional regulation.

Furthermore, bedsharing can provide psychological benefits for both the mother and the baby. According to anthropological research, when adults and babies sleep together, their heart rates, brain waves, sleep states, oxygen levels, temperature, and breathing influence one another. This mutual influence suggests that the baby's growth and development are intended to occur most safely inside that biological system, near an adult's body, especially during the first few months of life. Additionally, bedsharing can promote REM (Rapid Eye Movement) sleep, which is important for synaptogenesis, the rapid growth of connections between neurons in newborns.

Lastly, bedsharing can foster a sense of closeness and bonding between the mother and the baby. By sleeping in close proximity, the baby can hear the mother's heartbeat and breathing, which can be soothing and calming. The baby may also feel the mother's warm breath, which stimulates their breathing and encourages them to take deeper breaths.

While there are perceived benefits to bedsharing, it is important to note that the American Academy of Pediatrics (AAP) and other medical organizations recommend against bedsharing due to the potential risks associated with it, including accidental suffocation or strangulation, and the increased risk of SIDS. However, some researchers and anthropologists, such as James McKenna, argue that bedsharing can be made safe by following certain precautions, such as placing the infant on their back, removing loose bedding, and ensuring a nonsmoking environment.

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