Infant sleep location on the postnatal ward
RCT of mother-infant sleep proximity on the post-natal ward: an experiment in evolutionary medicine
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. 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.
Results: 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.