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Durham University

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Infant sleep location on the post-natal ward

A research project of the Department of Anthropology, part of the Medical Anthropology research group.


Evolutionary medicine examines the incompatibility between the lifestyles and environments in which humans currently live, and the conditions under which human biology evolved. In a paediatric context it aims to apply an evolutionary understanding of infant development and care-giving practices to the amelioration of iatrogenic effects of bio-medically driven changes in infant care, and the discordance between parental care-giving instincts and culturally sanctioned practice in post-industrial societies. This study (funded by Babes in Arms) was an experiment in evolutionary medicine. We hypothesised that, despite recent alterations in maternity care practices, a proportion of breastfeeding failure remains a consequence of the restrictions imposed by the hospital environment.


The project is funded by the following grants.

  • R170208: Bedding-in on the postnatal ward (Pilot Study), Community Foundation, £2710.00, 2001-06-01 - 2001-09-30
  • Bedding-in On The Postnatal Ward (£144558.00 from Babes in Arms)


Our objective was to determine whether the introduction on unhindered mother-infant sleep contact on the 1st 2 nights of an infant’s life affects breastfeeding initiation and infant safety.


The study design was a randomised non-blinded trial analysed by intention to treat, and was conducted on the postnatal ward of the Royal Victoria Hospital, Newcastle-upon-Tyne. Sixty-four newly delivered mother-infant pairs with a prenatal intention to breastfeed participated; Inclusion criteria stipulated vaginal deliveries without the use of IM or IV opiate analgesics in the preceding 24 hours and that all mothers and infants were healthy. Mother-infant pairs were randomly allocated to one of 3 sleep conditions: Baby in bed with mother using standard cot-side; baby in side-car crib attached to mother’s bed; standard rooming-in with baby in stand-alone cot adjacent to mother’s bed. Video-recordings were made of the 1st 2 postnatal nights. The main outcome measures were observed breastfeeding frequency and potential risk to infants.


During 4-hour-long observation periods commencing 2 hours after each mother settled down for sleep, bed and crib mothers and infants breastfed more frequently than cot mothers and infants [median difference (95% CI): bed vs. cot =2.56 (0.72-4.41); crib vs. cot=2.52 (0.87-4.17); bed vs. crib (0.04 (-2.10-2.18)]. No infants were observed to experience any hazards, however bed infants were observed in more situations exhibiting potential risk than crib or cot infants [median difference (95% CI): bed vs. cot 0.13 (0.03-0.23); crib vs. cot 0.04 (-0.03-0.12); bed vs. crib (-0.03-0.21)]. No differences were observed in duration of maternal or infant sleep, frequency of visits and duration of assistance provided by staff; or in maternal rating of overall satisfaction with the post-natal experience.

Conclusion: Sleeping newborn babies in close proximity to their mothers on the post-natal ward (bedding-in) facilitates breastfeeding initiation in comparison with rooming-in. None of the 3 sleep conditions was associated with actual infant risk; although infrequent, more potential risk events occurred in the bed-group. The use of side-car cribs for bedding-in on the post-natal ward is an effective means of providing unhindered mother-infant sleep contact—simultaneously enhancing breastfeeding initiation and preserving infant safety.

Published Results

Journal Article

  • Tully, K.P. & Ball, H.L. (2013). Trade-offs underlying maternal breastfeeding decisions: a conceptual model. Maternal & Child Nutrition 9(1): 90-98.
  • McKenna, James J., Ball, Helen L. & Gettler, Lee T. (2007). Mother–Infant Cosleeping, Breastfeeding and Sudden Infant Death Syndrome: What Biological Anthropology Has Discovered About Normal Infant Sleep and Pediatric Sleep Medicine. American Journal of Physical Anthropology 134(S45): 133-161.
  • Ball, H.L., Ward-Platt, M.P., Heslop, E., Leech, S.J. & Brown, K.A. (2006). Randomised trial of infant sleep location on the postnatal ward. Archives of Disease in Childhood 91(12): 1005-1010.
  • Ball, H.L. (2006). Bed-sharing on the post-natal ward: breastfeeding and infant sleep safety. Paediatrics and Child Health 11(Suppl A): 43A-46A.

Newspaper/Magazine Article

  • Ward-Platt, M.P. & Ball, H.L. (2002). Rooming-in at the Hospital: Assessing the Practical Considerations. Mothering Magazine (US) Sept(114).

Chapter in book

  • Ball, H.L. & Russell, C.K. (2012). Night-time nurturing: an evolutionary perspective on breastfeeding and sleep. In Evolution, Early Experience and Human Development: From Research to Practice and Policy. Narváez, D., Panksepp, J., Schore, A. & Gleason, T. Oxford: Oxford University Press. 241-261.
  • Ball, H.L. (2008). Evolutionary Paediatrics: a case study in applying Darwinian Medicine. In Medicine and Evolution: Current Applications, Future Prospects. Elton, S. & O'Higgins, P. New York: Taylor & Francis. 127-152.
  • Ball, H.L. & Klingaman, K.P. (2007). Breastfeeding and mother-infant sleep proximity: implications for infant care. In Evolutionary Medicine and Health: New Perspectives. Trevathan, W., Smith, E.O. & McKenna, J.J. New York: Oxford University Press. 226-241.


From the Department of Anthropology

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Further information

For further information, please contact Prof Helen L. Ball.