Bedsharing and breastfeeding in the media - an analysis

This morning on Facebook the first thing I read was on one of the breastfeeding support pages I contribute to, from a mum who'd heard reports of the latest bedsharing research, published in the BMJ Open online, on the radio, worried about what she'd heard. I read the paper itself and the various articles about it, as well as a host of responses to it. A thread about the research on Mumsnet had over 300 posts last time I looked, and many of the articles have attracted numerous comments.

There's no question that reports of research in the mainstream media can have a massive impact on audiences. How could they not, with headlines and subheads like these: 'Bed-sharing newborns five times more likely to die suddenly than those who sleep in a cot, study shows' (Guardian), "Sudden infant death risk 'is five times higher if the baby sleeps in its parents' bed'" (Daily Mail), 'Parents should never allow babies to sleep in bed alongside them due to the risk of cot death, according to research which has prompted the Government to order an “urgent” review into official guidance.' (Telegraph), 'Bed-sharing "raises cot death risk fivefold" (BBC). The Mumsnet thread is full of people questioning their own behaviour in the light of the new research. The Facebook mum is not alone; all over the web there have been concerned parents, who've heard snippets on the radio or seen TV news items, wondering whether this new research can be believed.

There's a marked tendency in us to feel as though any 'new' report somehow trumps any previous research and this is certainly apparent in many of the comments on media reports - people believe that scientific research is a progression, and that each new finding is more reliable than the last, because it must build on what has gone before. That couldn't be further from the truth. The reality of scientific research is that it is much more complex a web than we might think. The research that is done depends on the interests of researchers, the availability of research funding grants, the whims of senior academics with preferred pet topics, the commercial aspirations of companies with cash, the declared aims of charitable organisations and many more variables. There are endless dead-ends, blind alleys and studies that contradict one another. And once the research is done there's the issue of making something of it, getting it noticed. Academic careers, the standing of institutions and future funding applications depend upon research reputations. Even when, as in this case, there is no suggestion of a conflict of interest among the authors, or of the funding for the study having come from a commercial interested party, there is still a need to publicise research, which is why editors and interested parties got a press release about this paper, which highlighted the most striking aspects of the research (as identified by the authors, or the press office?).

Another important point to make is that whatever the scientific ins and outs of the data presented in the paper, of which more below, researchers and academics are nonetheless able to draw their own subjective conclusions and have their own opinions about their research, based on their own experiences, culture and background, and this comes across strongly in the discussion/conclusions in the full paper. My feeling is that the paper's authors, while they may not have set out to provoke a media storm, nonetheless wanted to make a 'statement', and a recommendation that we reconsider the current UK guidelines is certainly that. (Several people I've talked to or seen comments from have thought, based on the reporting, that the guidelines are being or have already been changed to reflect this research - this is not true, although the BBC reports that the government have asked NICE to review their guidance in light of the findings.) I don't think the paper's authors have considered how their findings will be viewed by parents, or that they have much understanding or experience of our culture of parenting and infant feeding in the UK, although they do make some efforts to link their research to the UNICEF report on the cost savings associated with breastfeeding that I blogged about here.

Matters don't improve when the research is published. In the translation from the press release to finished articles, TV snippets, reports and local radio phone-ins much that is important is lost, and the discussions become less about what the research really shows, and more about the broad brushstrokes of an uninformed debate (much like the breastfeeding/bottle-feeding articles I regularly comment on).

Making sense of the crowded landscape of information requires time, an in-depth understanding of the subject in question and critical thinking, and the reality is that many of us rely on others to do this for us. (I am a non-fiction editor well used to reading and sifting large amounts of information, with a specialist interest in parenting and breastfeeding, and I still struggle at times to get to the heart of the matter.) Which is why I was delighted, having read the paper and some of the articles in the press, to find that UNICEF, Professor Helen Ball of ISIS online, and The Praeclarus Press, among others, had issued detailed statements that dig deeper into the research and expose some of its limitations. Professor Helen Ball also contributed to Radio 4s PM programme, where she discussed the findings with one of the paper's authors, Professor Bob Carpenter.

I've been interested in the whole media maelstrom from a breastfeeding perspective, because in peer support I'm often asked about sleep in the context of breastfeeding. Since studies suggest that co-sleeping and breastfeeding have an interdependent relationship, and we know that night feeds are important for maintaining mums' supply and on Radio 4 Professor Ball cited her own research that showed breastfeeding rates were twice as high among mothers who bedshared with their infants younger than three months, coupled with the fact that not breastfeeding increases the risk of SIDS, I've always believed, along with many others who work to support families, that black and white advice about bedsharing, as advocated by the authors of the paper, is inappropriate for breastfeeding mothers. I direct parents to UNICEFs leaflet Caring for Your Baby at Night and to Isis online for more information to help them make informed decisions. The NCT's page about bedsharing (cited by the authors of the BMJ study as evidence of 'a pro-bedsharing lobby', which I thought might be a clue as to their personal hang-ups on the subject) says that up to 50 per cent of parents admit to bedsharing on occasion. On the Mumsnet thread I mentioned above there were many contributions from mothers of infants who resorted to bedsharing as a practical solution to meet the needs of the whole family, and as the mother of three babies who breastfed frequently at night for many months I have been there myself.

So what of the relative risks for breastfeeding mothers who choose to co-sleep? Some interesting numbers can be extracted from the full paper. In the study, of 1,444 babies who died, 540 were breastfed (any breastfeeding - in this study even babies fed artificial milk at night in an attempt to get them to sleep longer would be in this group) and 940 were bottlefed. Of 1,405 babies who died (the exact numbers change slightly because of missing data), 1,091 had one or two parents that smoked. Of 1,422 babies who died, 607 had been put to sleep on their front (another criticism of the study is that it uses old data, including many babies who slept on their front). Overall, the rate of SIDS in the UK is approximately 3 in 10,000. Among breastfed babies, of parents who don't smoke and whose mothers have not had alcohol or illegal drugs, that is reduced to 1 in 10,000 for crib sleepers in parents' room and is 2 in 10,000 for co-sleepers. Breastfed babies thus have a lower than average risk of SIDS. In 2010 there were 254 unexplained deaths in England and Wales and 723,165 live births. (ONS). Given the above, it is easy to see why Professor Ball commented: '...both sleep locations for breastfed infants of non-smoking parents in the absence of alcohol experience very few SIDS deaths. It is curious, therefore, that the authors issued a press release to call attention only to this small difference in predicted SIDS rates for breastfed babies of non-smoking parents who bed-share compared to room-sharing – while ignoring the hugely inflated risks associated with hazardous bed-sharing environments. It appears as though the authors choose to target breastfeeding mothers in this way as they are a sub-group with strong opinions about the benefits of bed-sharing, even though the infants of these mothers contribute negligibly to UK SIDS rates.' Without wanting to overstate the case it seems that even in the conclusions of research papers there is an undercurrent that undermines breastfeeding and parenting behaviour that promotes it. Fascinatingly this chimes with something else I read today, the Alpha Parent's look at how societies can be 'gendered' - some of our problems with this research and the reporting of it may be able to be explained by 'masculine' traits in our culture.

Having a baby? Planning to breastfeed? Don't read the papers...

Two articles have been bothering me this week: Helen Rumbelow's 'Your mother-in-law was right: breastfed babies don't sleep through the night' in The Times and Anna White in the Telegraph: 'Is baby-led weaning a load of mush?'.

The two pieces had much in common despite their different subjects. Both were judgemental, short on facts, and failed to accurately represent the best research we currently have about infant feeding. Helen Rumbelow suggested that there was some sort of conspiracy going on: 'This is what your health visitor, midwife, baby sleep book, the NHS and the National Childbirth Trust [an easy target perhaps, in the wake of the Kirsty Allsopp/NCT stand off?] won't tell you: your mother-in-law was right'. She claims the 'news', that breastfed babies wake more often at night, has been 'hushed up' in an effort to persuade women that breast is best. The implication, although she doesn't state it specifically, is that if you are breastfeeding and suffering from sleep deprivation, the solution is obvious: give up breastfeeding. I've blogged before about how this isn't supportive of women who are breastfeeding and consider it important. They don't want to give up breastfeeding, they just need more sleep. There are other ways to achieve that than to give the baby artificial milk, and any good breastfeeding supporter will have a range of suggestions that may help (including, but not limited to: co-sleeping, sleeping apart from your partner so that they get an unbroken night and can support you in the evening/morning, getting help from family or friends so you can nap in the day...). Elizabeth Pantley's book The No-Cry Sleep Solution has many breastfeeding-friendly ways to gently encourage your baby to sleep longer stretches.

What annoyed me most about the article was not its undermining of breastfeeding (although I didn't like that either). No, what got to me more was the assumption that babies waking up at night was a bad thing, as opposed to something normal. This is backwards: we should be asking why artificially-fed babies sleep so soundly and considering whether that is really desirable. We know that breastfeeding has a protective effect on the incidence of SIDS; it is likely that the waking patterns of breastfed infants are part of the reason for that. (See Isis for sound information about normal infant sleep.) Rumbelow goes on to draw her own conclusions from what is admittedly interesting research; I take issue with her interpretation, however, which continues to undermine parents who've decided not to artificially feed or sleep train their babies. She glibly asserts that 'Once a baby is weaned onto solids at six months, it is developmentally ready to sleep through the night', and goes on to claim that 'the type of mother to breastfeed her kid in the UK gets her heart broken every time her baby cries at night. And she could totally get a better night's sleep if she just adopted a harder line.' From where I stand, on the front-line with breastfeeding mothers, the whole picture is a lot more complex than that. Breastfeeding is not just about food, for one thing; night-wakings are not all about nourishment, at any age - growth spurts, development, separation anxiety, the child's (and mother's) personality all play a part. The research is valuable, and I'd be interested to read more about it, but I don't think Rumbelow did it, or breastfeeding mothers, justice in her piece. About the only thing I could agree with was the idea (not her idea, but that of the researcher she spoke to) that the research could lead to parents being given a more realistic picture of what to expect from their breastfed baby's sleep habits.

Anna White in the Telegraph did a similar job of undermining those mothers who've decided to ditch the spoon and puree method of weaning in favour of baby-led weaning (BLW). It clearly doesn't matter that the evidence in favour of baby-led weaning is sound, or that health visitors are now recommending it to mothers. (I've been talking to mothers about BLW, breastfeeding and cow's milk this week myself; I mentioned this NHS booklet and Gill Rapley and Tracy Murkett's excellent books Baby-Led Weaning and Baby-Led Breastfeeding). No, for Anna White BLW is a 'craze' that has 'divided mothers'. Really? Or is that just the aim of this sniffy article?

Reading on, it becomes clear to anyone who has read anything about BLW that Anna White has missed the point, since she claims that 'you have the faff of preparing dinner for two and a finger-food buffet for one' - in fact, BLW is easier as the baby can just have bits of whatever you're having. Case in point - steak, homemade chips, grilled tomato and broccoli, followed by melon with blueberries and strawberries. Sounds good to me - and it would all be baby-friendly too. If you start BLW at six months, you can skip the 'smooth puree, one-taste-at-a-time, veg first' scenario completely (those guidelines applied to babies who, we now know, were starting solids earlier than they should have).

I think what I most objected to in the piece was the suggestion that by choosing the new 'fad' of BLW, parents were somehow caving in to their children in an unhealthy way: 'This early selection process gives children the freedom to turn their noses up at food making it difficult to later on enforce such rules as no greens, no pudding. Staple values end up in the bin once you hand over control on a plate.' I can only suggest that Ms White does a little more research, which suggests that breastfeeding, followed by BLW, gives you the best shot at raising a child who is comfortable eating a wide range of nutritious foods and can trust their own appetite. And I have to wonder, since it became clear at the end of the article that she has not yet had any experience of starting solids with her own children, whether her views might mellow with experience in the months ahead.

While writing the above I've had my attention drawn to a third article, this time in the Daily Mail - no surprise there - about the home birth shown on Nursing the Nation on ITV1. Journalist Kathryn Knight's piece, entitled 'Would you ask your neighbours round to watch you give birth? Natalie did, not to mention her four other children, mother, best friend and a TV crew!' Subtext: what will these crazy women get up to next? The tone echoes the articles already discussed, coming across as deeply critical of anyone who makes a choice outside a narrow range of the so-called normal. 'Most would see Natalie’s choice as bizarre. After all, mothers generally prefer this most private of events to take place in front of no one other than their partner and a medical professional.' That sounds to me more like Knight's personal view of the matter than a fact. The same personal feelings are to the fore when she writes 'It’s a brave woman indeed who seeks to share these most primal and unflattering images of herself with the nation.' Unflattering? The pictures that accompany the article are beautiful, as was the film! That this mother was willing to share the positive experience of her birth with others is a great thing; exposure to positive stories of pregnancy and birth is known to have an impact on women's own births. When they know what their bodies are capable of, fear, and its capacity to put a brake on the physiological process of birth, recedes. This is what the Positive Birth Movement is all about.

I remain disappointed in the mainstream press and its coverage of birth, breastfeeding and babyhood. I've complained before about the editors that commission this stuff - does it really sell newspapers? It certainly doesn't contribute much to the real and interesting debates that are taking place online, and in Positive Birth discussion groups, homebirth groups and breastfeeding support groups across the country. I'm glad to say it's not all doom and gloom this week - I've been somewhat cheered up by the launch of Birthrights, a new organisation that aims to protect women's human rights in childbirth. Do have a read of their website - there's stacks of important information there for anyone giving birth in the UK today.