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Infant sleep location on the post-natal ward
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.
- 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.
- 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
From other departments
For further information, please contact Prof Helen L. Ball.