” I wanted some external validation and I called a lady I knew who was also a primatologist and she had her first child in her late 30’s and early 40s. I remember doing field work and she was there with her young son. I respected her opinion on a lot of things, so I called her and asked her: When you had your first child where did he sleep? And her friend said: “Oh he sleeps with us, he always slept with us.”
Helen Ball is Professor of Anthropology , and Director of the Parent-Infant Sleep Lab at Durham University, UK — and Chair of the Scientific Committee for the Lullaby Trust (UK SIDS Charity).
Background: Helen grew up in a small village in East Yorkshire area in the UK. She has one brother and one sister and she is the oldest. It was a typical British family upbringing. Her Dad worked and her mom stayed home. It was a happy childhood which Helen says was a bit sheltered because of the rural area where she lived. When she turned 16 she got an intense thirst to travel and see life beyond the community in which she lived in. She started visiting Europe and the States and attended University of Massachusetts in Amherst and did her PhD research in Puerto Rico.
Current work: In her childhood years, Helen thought she wanted to be a pediatrician so she applied to medical school. She was accepted but did not get the qualifications needed in High School to go to medical school so she ended up studying human biology in a different University.
She then discovered anthropology as part of that degree which made her want to pursue a Masters in PhD in anthropology and at that time she was a primatologist and she was studying primate behavior – that is what she went to Puerto Rico to do.
When Helen was hired at Durham in the anthropology department, she was hired as a primatologist. At that time, she had a 1 year old and had her second daughter 3 years later. This is when the realization of being a primatologist conflicted with motherhood. Her field work was thousands of miles away and it required long stretches of behavioral observation that she just could not really sustain.
It was at this juncture that she realized she would need to switch her research focus and do something closer to home. She was familiar with some of the research of Dr. James McKenna on mother/infant sleep behavior. Helen thought that this was something she could do as this was the same kind of training she already had. She was familiar with this and said to herself: I can study moms and babies sleep behavior at night. This is how her next career venture all began.
How did she manage field study with a 1 year old: Helen returned to Puerto Rico with her husband in the summer to see if it was feasible to continue to do field work. He would stay with her daughter in the day. Helen would take the boat to the Island that would have the primate colony. She would leave at 7:00 am and not come back until 7:00 pm. She managed to collect the data but she had lost the enthusiasm for it as she realized she was missing so much of her daughter’s daily life. Helen said that the work she was doing did not justify being away from her family for so many hours, so she decided she would look for something else.
How long has Helen been working in the Lab: She started studying infant/sleep in 1995 and she managed to persuade the University to build the sleep lab in 1999, so almost 20 years now.
Her children: Helen has 2 daughters, ages 24 and 20 years old. She did breastfeed both of her babies and tells us that it was a very important experience for her and it really formed a lot of her thinking about the research that she did in the early days.
When I asked Helen how she managed the early days of mothering, she said that she brought her babies in her bed with her from Day 1. She recognizes that she was fortunate to be with the medical practice that she was in. She gave birth in a small hospital in Down East Maine, a hospital that was quite innovative for its time because she attended a practice that had an obstetrician and a midwife in partnership. You got to see each one during your pregnancy and then you got to decided which one you wanted to be with you during your labor.
I opted for the midwife who was a lady that was nearing the retirement age. When Helen left the hospital, she Midwife patted Helen on the shoulder and said “don’t forget to take her to bed with you, my dear.”
Her personal experience with bed sharing: The midwife affirmed to Helen what she had already decided she was going to do anyway. Her anthropological training led her to think that this seemed like the obvious way to cope with your baby at night and to feed your baby at night. Helen had read books like the Continuum Concept, by Jean Liedloff and read James Mckenna’s early research on bed sharing. She remembered what she learned and this is what felt right for her. She still needed some external validation. Helen called a lady she knew who was also a anthropologist and a primatologist. This woman had her first child in her late 30’s and early 40s. Helen remembers doing field work and she was there with her young son. Helen respected her opinion on a lot of things, so called her and asked her: When you had your first child where did he sleep? And her friend said: “Oh he sleeps with us, he always slept with us.” Helen said: I went thank you very much, that is all I wanted to know! She just needed some validation from a mother who she respected.
Helen states that it is rare in the animal kingdom for the young to be separated from the mother. When this does happen in the Ape community it is because the mother has died. Other mothers usually do not nurse babies other than their own so the new ape does not fare very well if its mother dies, so it is quite a tragic outcome.
Goals in mind for breastfeeding: She had no fixed idea as to how long she was going to breastfeed but was going to do it as long as they wanted to. She did have difficulties because she was working both times. With her oldest daughter she went back to work when she was 1 week old as part time lecturer in the classroom. Helen hired someone who would come to her office and hold her while she taught. She was able to be there and she could feed her whenever she needed to and she breastfed her for 1 year.
With her second daughter, she had off for 5 months. She was very fortunate because the University had a nursery that was just a short walk from her office. They phoned her every time she needed feeding and then go back to work again. She breastfed her for 14 months. She did not really pump because she slept with her babies at night and could breastfeed them during the day.
We then talked about concerns that society seems to have on babies who co-sleep and breastfeed throughout the night will become very dependent on their moms and may have psychological issues.
Both her daughters are quite independent – Helen’s experience with psychological issues is that there were no issues. When they come home, they still come to bed to have a cuddle and tell her about their lives. This established a very close relationship that she enjoys now. While Helen understands others have heightened fears and concerns, she never really did.
Sleep Lab: Behavioral Sleep Lab – Interested in creating an environment in which one or both parents come into the lab and sleep as normally as they possible can. It was set up like a nice hotel room with kitchen a TV and nice big bedroom and bathroom and perhaps a crib, depending on what kind of studies they were doing.
The only difference is that these rooms are equipped with cameras on the ceiling and an infrared light so that they can film in the dark. They have physiological monitor cables that run from the room next door which is the monitoring room to the bedroom and some of the studies we put the parents or babies or both up to these respiration censors, heart rate monitors in order to ascertain the different sleep stages.
The studies have evolved over time. The first question that Helen wanted to answer was whether parents actually slept with their babies. Everyone said that no one slept with their babies so how are you going to find anyone to study. She found out that nobody does that and found out that this was a hidden behavior and they were not talking about it. If they were not talking about it, then it had all sorts of implications for safety. She wanted to first uncover what was happening and then she found out that parents were bed sharing. About 50% of parents that they interviewed said that they did not call themselves bed sharers. Then if we asked if they had ever fallen asleep with their babies in their bed and they said Oh yes! that often happens. They just did not call it bed sharing because they were not sleeping with their babies all night, every night. Bed sharing was something that they did by accident or it was something they did occasionally, or something that happened once in a while or their babies started off somewhere in a crib and then came into the bed partway through the night to be fed and then wound up staying there.
For all of those reasons, they felt as though the baby had really slept in the crib, although most of the time they stayed in the bed with mom and dad.
Why were people not talking about sleeping with their babies? Was it because they were afraid of what other people might think? Helen said yes, they were afraid of being censored both by Health Professionals and by other parents. They thought they were going to be told off for doing something that they shouldn’t be doing, and by other parents. That feelings from other parents had a lot to do with this idea of having a good baby because good babies sleep through the night and don’t disturb you.
Bringing your baby into bed was kind of a signifier that your baby did not sleep all night and you would have to come up with another strategy to cope with the sleep disruption.
Did you also want to study whether or not moms or parents had better sleep when their babies were with them. Yes Helen said – We wanted to know what the impact bed sharing was for the baby and how they coped with sleep disturbance. This also evolved into being interested in understanding how moms understand infant/sleep development. There is a lot of misinformation out there about what babies sleep development actually looks like. This idea that babies should be sleeping through the night at 3 months old and if they are not then you need to do something to fix that. There are a lot of public perceptions on infant sleep that is based on old fashioned ideas about babies and what parenting is all about.
Safety of co-sleeping and bed sharing: What did you use to think or believe before you started studying moms and what has changed, if anything as a result of your studies as far as recommendations you make.
One thing that became more apparent the more research she did is how capable babies are in ensuring that they are not in hazardous situation. For example:
What happens when babies are in beds with moms and dads is that the covers move around a lot and if a baby is flat on the mattress at moms breast height then the covers go over the babies face fairly frequently and the covers get removed fairly frequently and the interesting thing is that half the time babies are the ones removing the covers. We also found that babies are quite adept at getting their parents to move when they get too close.
Helen shared the story about a dad who turned over and got too close to the baby and the baby just stuck his arms and legs in the middle of the dads back and the dad jumped. Infants are active agents in ensuring their own safety this was a real eye opener in some of the research.
Other safety issues: Swaddling babies – Helen shares her very firm opinion about bed sharing babies and swaddling. She says they must always have their arms and legs free from being swaddled because this is part of their own defense mechanisms to help themselves. This is one of the ways in which they maintain their own safety. Babies are much more vulnerable if they are bed sharing and are swaddled.
Concerns about when the weather gets cold: Parents who are bringing their babies in bed need to think about not putting any more layers on the baby than they have on themselves. Just a single layer of pajamas. If the baby is by itself, harder to maintain thermal regulation so then it is going to need more layers. Where no one is going to be attending to it and by itself, then sleep sacks are a good idea, but not a bed sharing baby in a sleep sack because it is another layer than the parents are wearing and that is likely to be too much.
Pillows: Keep them away from babies. The instinctual position that breastfeeding moms get into when they sleep with their babies is to keep their pillows up above their shoulders with their arm up above the baby and the baby is down underneath the moms arm at the level of her breast. This way the baby never comes anywhere near the pillows.
Occasionally we see they put babies up at face height or between parents pilows and this is much more hazardous. Breastfed babies seem to always be placed flat on the mattress on their back and this is going to be fine.
Moms natural instincts: Moms have micro arousals quite frequently during the night. They come out of deep sleep, to check on their baby. They feel where its face is, they put their arm on chest to make sure its breathing, they check on their temperature and they go back to sleep. They do this multiple times through out the night while she is mostly asleep. If she is doing this instinctively, and the baby is stirring or she detects a problem she is going to wake up. Those are the occasions that she thinks she woke up before the baby, but she was really aroused and alerted to something ahead of time that has caused her to wake up.
Sudden Infant Death Syndrome (SIDS): The data they have in UK now helps to make this clear. There are some circumstances that make bed sharing and co-sleeping hazardous that increase the chance of a baby dying both by accident or unexpectedly or for no explained reason ( which is the definition of SIDS).
This includes situations like sleeping with babies on a sofa, baby sleeping with smokers or if baby was smoke exposed during pregnancy. This would also include sleeping with a premature or low birth weight baby who is particularly vulnerable and can’t do these self defense things themselves or sleeping with a baby if you have been under the influence of alcohol or medication.
In the UK, 90% of SIDS deaths that occur while co-sleeping occur during hazardous conditions. This to me suggests that for all other co-sleeping babies that the risks are relatively low.
Question: Through the studies that you have done, is one the results affirming and confirming to parents who are already co-sleeping and/or are you working towards changing things and using the results of your studies to strongly encourage parents to sleep with their babies.
Answer: I think whether or not parents sleep with their babies is a matter of their personal choice but I think they should be making informed choices, so they should know what the risks are and have that information available to them before they make those choices. What Helen hopes her research does is contribute to that information they need in order to make that choice. I have never recommended to anyone that they should bed share or co-sleep with their baby, but I have explained that it is a strategy that some parents use in order to be able to cope with nighttime feeding and to sleep with their infants related sleep disruption. I think it is important that health care professionals have this conversation with parents. That they tell them that it is likely that ( particularly if they are a breastfeeding mom) it is likely that at some point they will fall asleep with their baby because 70 – 80% of breastfeeding moms have reported that they have slept with their baby and they need to be prepared for that. They need to know how to make their beds safe with their baby. If they find that happens to them. They need to know what to avoid in terms of their own behavior. I don’t advocate promoting co-sleeping or bed sharing to parents but I advocate giving them information to helping them make their own decisions.
How are you best disseminating this information: One of the things that happened when research got out to public domain was that they would begin getting inundated with queries from parents and health professionals about all sorts of issues about infant sleep.
We decided to get some funding and work with some of the organizations in the UK that support parents to create a website and put all this information on the site. We created the infant sleep info resource website which is our best effort to amass all this researched information and evidence about where babies sleep, how babies sleep, what the evidence says about the risks, so that parents who want to can inform themselves and health professionals can go to get the most up to date information.
Two pieces of information that you have learned that you would like new parents to know about infant sleeping:
Every baby is different. Their sleep development is different. Don’t compare your babies sleep with someone else’s babies sleep. It is not helpful. Your baby will start sleeping through the night when your baby is ready to start sleeping during the night.
While nighttime sleep disruptions that infants cause can be hugely difficult to cope with when you are going through this, it is important to remember that in the grand scheme of things that it lasts such a short period of time. The sleep is different when you are going through things and to enjoy those night wakings with their baby because they are really memorable times in your child’s life that you will miss when they are gone.
In your studies, are you finding that babies who are waking up at night, is it mostly for food or other reasons?
Since the babies that she studies are between 0 and 4 months old they are waking for food. It is definitely breastfeeding related.
Crying it out: This subject is the focus of the next research project she hopes to be conducting. How parents make decisions about how they are going to cope with infant related sleep disruptions. Why do some parents figure out that the most effective strategy is to just bring their baby to bed and just feed baby when their baby wakes and cope with it that way, While other parents feel that the baby has a problem and they needs to fix the problem with sleep training or with medication or some other intervention is the most appropriate way for them to address that issue. These are the topics that she hopes to be studying.
With regards to sleep training and crying it out, it is a consequence of Western cultural perceptions about what infants ought to be doing. If you look around the world and in other cultures, they don’t think their babies need to be taught how to sleep, babies just they just sleep. They just sleep when they need to sleep. The problem that we have in today’s society is that babies sleep doesn’t easily conform with mothers sleep schedules. The big issue in the United States is that some moms have very little maternity leave. It is less of an issue in the UK because we have fairly good maternity leave.
There are still families who do follow the sleep training route, because they think that is what they are suppose to do. They are told by their moms and aunts that they need to do the tough love thing and let them cry it out and it’ll learn to sleep through the night. As far as I know, the studies that have demonstrated that sleep training works and that babies do start to sleep through the night, don’t apply to babies under 6 months of age. The ones that do start sleeping through the night, they don’t stay that way. Sooner or late they start waking up again and than you either have to do it again or accept the fact that your baby is not going to conform to your expectations.
Helen’s approach when talking to parents is to try and adjust their expectations of what their baby is going to be doing, rather than try to fix their baby.
I shared what I tell parents which is: This is what your baby is doing and now it is your job to try and figure out how to work within the situation rather than try and control it.
The Continuum Concept, by Jean Liedloff
Sleeping with Your Baby: A Parent’s Guide to Cosleeping Paperback – January 1, 2007, James McKenna
Lori J. Isenstadt, IBCLC
Lori Jill Isenstadt, IBCLC is a huge breastfeeding supporter. She has spent much of her adult life working in the maternal health field. Once she became turned on to birth and became a childbirth educator, there was no stopping her love of working with families during their childbearing years. Lori became a Birth doula and a Postpartum doula and soon became a lactation consultant. She has been helping moms and babies with breastfeeding for over 25 years. Lori founded her private practice, All About Breastfeeding where she meets with moms one on one to help solve their breastfeeding challenges. She is an international speaker, book author and the host of the popular itunes podcast, All About Breastfeeding, the place where the girls hang out. Lori is the owner of the All About Mothering membership site. – allaboutmothering.com/offer You can reach Lori by email at: [email protected] or contact her via her website: allaboutbreastfeeding.biz/contact
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