For years, new parents were bombarded with confusing messages about how their babies should sleep. Health visitors, midwives, parenting books, online forums and family members all seemed to say something different, especially when it came to bed sharing or ‘co-sleeping’.
Transforming our understanding
Professor Helen Ball and her colleagues at Durham University’s Durham Infancy and Sleep Centre (DISC) set out to change that. Their research has played a major part in transforming understanding of infant sleep, challenging concerns about bed sharing and emphasising the benefits of such close proximity for breastfeeding. This work has helped reshape both national and international guidance around co-sleeping.
Training tools developed from DISC’s research, which were part-funded by the Economic and Social Research Council (ESRC), have educated thousands of healthcare professionals, influencing how they advise parents about baby sleep.
DISC’s research has played a role in almost halving the number of sudden infant death syndrome (SIDS) cases since 2005, according to the Office for National Statistics. It has done this by contributing to safer sleep policies and practices, and providing parents with clearer guidance on how to reduce the risks.
Navigating advice on co-sleeping
From the 1990s to 2014, parents were advised against co-sleeping with their babies due to SIDS concerns. However, Professor Ball’s research revealed more than half of UK parents were rejecting this guidance and sharing a bed with their newborn at some stage.
Interviews with families and practitioners also highlighted cultural differences in sleep practices. For instance, a study in Bradford revealed families with Pakistani heritage often bed-shared yet had lower SIDS rates.
At the time, healthcare professionals, such as midwives and health visitors, received no formal training on co-sleeping and instead relied on personal experience and word of mouth.
It was clear the guidance was causing confusion and anxiety, says Professor Ball. She explains:
Health professionals were advising against bed sharing, but the evidence was not clear cut. Meanwhile, many mothers were bed sharing for various reasons, such as making nighttime breastfeeding easier, but feeling stigmatised over it. There was an urgent need for more nuanced, evidence-based advice on co-sleeping and how it could be made safer.
Link between bed sharing and breastfeeding
The research team began by studying where babies actually slept at night, observing mothers and babies in their homes, in hospital and at DISC’s sleep lab.
A distinctive pattern emerged in breastfeeding mothers who bed shared. Professor Ball explains:
They put their baby on its back at breast height and curl their body around with their arm above the baby’s head and their knees underneath its feet. This position means they can’t roll onto the baby and protects it from any bed partners getting too close. It happens so often, it’s got to be instinctive.
The researchers also found that when hospitals followed existing advice and placed newborns in separate cots, mothers often missed subtle signs that their babies wanted to feed. However, use of a ‘sidecar crib’ attached directly to the bed, without any barrier between the mattresses, resulted in more frequent and longer breastfeeding sessions due to closer mother-baby contact.
Advice for parents and healthcare professionals
In 2011, using ESRC funding, the team launched the Baby Sleep Info Source (BASIS), a website that draws on DISC research to provide evidence-based and easily accessible baby sleep guidance. BASIS is currently recommended as a go-to resource for parents by dozens of NHS trusts across the UK, NHS Scotland and UNICEF UK Baby Friendly Initiative.
BASIS also sparked a wider programme of training and outreach. In 2018, with further ESRC funding, the DISC team created an online programme for healthcare practitioners, with webinars on normal infant sleep, as well as sleep safety. Since its launch in 2020, more than 4,000 practitioners have completed one or both programmes.
Feedback has been overwhelmingly positive, with 99.6% saying they learned new information and 98.6% feeling more confident answering parents’ questions. As a webinar participant noted:
I knew the recommendations for reducing SIDS but couldn’t explain the ‘why’. I can now. The old recommendations about not bed sharing were still in my mind and I had a lot of doubts how to address this topic with parents and staff but I now have the confidence to talk about it.
In addition, the DISC team provided training to NHS trusts, local authority public health teams, Scottish Government, parent support charities, and breastfeeding support organisations, as well as overseas healthcare professionals spanning the globe.
Shaping national and international guidance
DISC research helped shift national and international guidance away from never co-sleeping to advice on how to make it as safe as possible. Its findings played a major role the National Institute for Health and Care Excellence’s recommendation that parent-infant co-sleeping be recognised as a common nighttime caregiving strategy in the UK. The team also worked with The Lullaby Trust, UNICEF UK and Public Health England to co-create new UK-wide safer sleep guidance in 2018.
The team’s research findings into using side-car cribs in maternity wards led to NHS trusts recommending the practice, and directly influenced the UNICEF UK Baby-Friendly Initiative guidance to health professionals on co-sleeping.
Next steps: Eyes on the Baby
Today, SIDS is rare in families who follow standard safer sleep guidance, but deaths still cluster in the most disadvantaged communities, where parents may be living in poverty, overcrowded housing or temporary accommodation.
Many of these families have little contact with traditional health services. However, they often have regular interactions with other professionals, such as:
- housing officers
- drug and alcohol workers
- domestic violence support staff
- ambulance crews
- police
To reach these parents, Professor Ball and her team have developed the Eyes on the Baby project. To date, the programme has trained more than 3,000 multiagency workers to spot dangerous sleep situations and start conversations about safer alternatives.
A North East Ambulance Service paramedic who undertook the training explains:
It will allow us to recognise unsafe practices in people’s homes and engage in a conversation to help the families recognise and improve unsafe practices.