[CG] Guidance for Midwives - Infant Bed Sharing Whilst in Hospital

Bed sharing is defined as babies “sharing a bed with their mother either to breast feed or receive comfort”. Co-sleeping is where “the mother and baby share a bed and either mother or baby is asleep”¹. In practice bed sharing often leads to co-sleeping. Co-sleeping is associated with a greater incidence of Sudden Infant Death Syndrome (SIDS) in the first 12 weeks of a baby’s life.^2,3 Therefore neither practice can be recommended.⁴
Scottish Executive Guidance for parent’s states:⁵

“The safest place for your baby to sleep is in a cot in your room for the first 6 months. While it’s lovely to have your baby for a cuddle or a feed, it’s safest to put your baby back in the cot before you go to sleep, especially in the first 3 months”.

Guidance for staff

All health care professionals should aim to ensure that women and their families are able to make a fully informed choice with regards to bed sharing/co-sleeping. It is therefore our responsibility to ensure that they have been provided with the necessary written and verbal information, to allow them to do so. This process will have commenced in the antenatal period.

As part of routine postnatal care women will be issued with a copy of the Reduce the Risk of cot death leaflet⁵ on admission to the postnatal ward or as soon as possible post birth. (Leaflets placed in each cot.) The information contained in the document should be discussed and a note of this action detailed in the case record.

Despite the provision of clear evidence based information some women and their families will choose to disregard the recommendations made. As professionals we must accept the choice made by the families concerned and continue to provide care in a supportive environment. It is essential that the choice made by the woman with regards to bed sharing/co-sleeping is clearly documented in the midwifery case record.

It is recognised however that bed sharing is occasionally necessary⁶. It is essential therefore that staff share current recommended best practice with parents and acknowledge the additional surveillance required if bed-sharing occurs⁷. For example the routine drawing of curtains completely around bed space – obscuring vision – should be discouraged.

Examples of when a woman requires to remain in bed with supervision whilst feeding/comforting her baby may include:

• continuing to experience the effects of a general anaesthetic
• immobility following regional anaesthesia
• having a clinical condition which affects level of consciousness or ability to respond normally to the baby
• disability that would severely affect mobility or sensory awareness
• baby is requiring frequent feeding and where supervision is possible.

On the occasions that short term bed-sharing is deemed clinically necessary by the midwife, the woman will require to be supervised individually by a competent adult –this may be husband, partner or member of staff – who have had the risks explained. There have been several incidents reported, where the baby has fallen from the bed (or chair) and sustained injury. Whilst we can never completely remove all risk it is important that both midwives and parents take steps to minimize the potential of harm.

Prior to discharge from hospital, the ward midwife should reiterate the recommendations made by the Scottish Executive around bed sharing and co-sleeping in the home. Staff should ensure that women have a copy of the Reduce the Risk of Cot Death leaflet or, provide a replacement.