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Book Review
Sleeping with Your Baby: A Parent's Guide to Cosleeping

by James McKenna, PhD
Platypus Media, 2007
Softcover, 128 pages

Reviewed by Kathleen Whitfield
Los Angeles CA USA
From New Beginnings, Vol. 25 No. 4, 2008, pp. 34-35

After having their son in 1978, James McKenna and his wife, Joanne, both anthropologists, discovered something disconcerting about the baby care literature they came across. Few of the recommendations for "good parenting" seemed to reflect any scientific research. Nor did they consider the way people actually parented around the world.

In McKenna's book, Sleeping with Your Baby, he explains where many of the pronouncements on the proper way to feed and nurture babies come from.

The baby-care "experts" were "essentially middle-aged men who preferred to define babies in terms of who they wanted the infants to become rather than in terms of who they actually were -- little creatures who are very much dependent physiologically, socially, and psychologically on the presence of the caregiver to an unprecedented degree for an unprecedented length of time compared with other mammals.

McKenna, as director of the Mother-Baby Sleep Laboratory at the University of Notre Dame in Indiana, USA, spends his time researching how mothers and babies sleep. His decades of research, both at Notre Dame and at other institutions, concentrate on the biological reality of infant sleep and how proximity to the mother helps babies thrive. McKenna has also been in the forefront of questioning the logic of recommendations from medical groups that discourage bedsharing in all situations.

Sleeping with Your Baby is a book that addresses a number of issues regarding cosleeping and bedsharing with infants. It is divided into a three parts. In part one, he talks about the basics of cosleeping, and he offers a definition:

Cosleeping refers to the many different ways babies sleep in close emotional and physical contact with their parents, usually within arm's reach. Whether it is for protection, warmth, food, or comfort, humans and other mammals routinely sleep side by side, generation after generation.

He also differentiates between cosleeping and bedsharing. Cosleeping refers to general proximity and could mean simply sleeping in the same room as baby, while bedsharing refers to sleeping on the same surface as baby.

McKenna explains some history of cosleeping, as well as the history of pronouncements against it. He also talks about advantages. For one, it keeps babies from crying so much, and that's a good thing. He writes:

When babies, especially before they can verbalize their needs, do not have their needs met, they cry....Years ago it was learned that prolonged crying decreases oxygenation and increases heart rate, which in turn then augments cortisol....Some studies have suggested that elevated levels of cortisol in infancy can cause physical changes in the brain, prompting a greater vulnerability to social attachment disorders.

Cosleeping also promotes breastfeeding, as mothers and babies who sleep near each other breastfeed more frequently and for a longer duration of time.

Sleeping with Your Baby is at its best, however, when McKenna explains the problematic nature of cosleeping for medical professionals. Because infant deaths are sometimes linked to bedsharing, many in the medical community have adopted the attitude that it should never be recommended. McKenna finds this appalling. There's too much evidence of positive aspects of cosleeping for it to be discouraged because of the potential for tragedy.

Instead, McKenna focuses on identifying safe cosleeping practices. The reality is that there are groups whose babies are more at risk of death if they share a bed. Those include the babies of mothers who smoked during pregnancy and those whose parents had been drinking and cosleeping. Other children being in the bed also poses risks.

The simple admonition not to bedshare, without taking any other factors into account, is too simplistic, McKenna writes.

Such a simple message misrepresents the nature and quality of the mother-infant relationship by overly simplifying a complex and highly variable phenomenon. Simple negative messages ignore valid alternative public and professional positions including sound scientific data and perspectives refuting the validity and accuracy of such "simple" messages.

Telling mothers to never share a bed with a baby because some babies died while sleeping near adults is the equivalent, McKenna writes, of telling people never to drive with their babies because some babies died in cars.

After that, McKenna spends a lot of the book addressing safe cosleeping. Part two of his book is called "How to Cosleep."

This section is as exhaustive as the first. One caution about the book is that there's such an emphasis on dangerous aspects of bedsharing that McKenna could inadvertently be discouraging a practice he endorses.

There's a two-page section of the book, emphasized with pictures, titled "Do not bedshare." It provides list of potentially deadly circumstances, including overheated rooms, drug or alcohol use, waterbeds, and recliners. It also includes circumstances including having other children or pets in the home who are likely to climb into bed.

McKenna also spends a lot of time talking about entrapment, where infants suffocate when they become wedged between the bed and a wall or another piece of furniture. McKenna has pictures of a very realistic-looking doll shown entrapped in a variety of different places.

McKenna, an academic, writes well and his direct nature is appreciated, particularly when he talks about the riskiest of the risk factors:

I cannot emphasize enough that most babies in the US who die in adult beds become wedged between the mattress frame and a head- or footboard, between the mattress and a wall, or between the mattress and a nightstand.

All the information presented is very helpful to new and expecting parents, however, the organization seems weighted toward scary things that can happen to your baby if you bedshare. There are nearly as many pages devoted to lists of contraindications and risks of bedsharing than to the explanations of the benefits of cosleeping. The chapters on things to avoid while cosleeping are also more graphically pleasing. That might have been intentional in order to focus more on his new information within the book. Of the many books on sharing sleep with infants, none has as comprehensive or as detailed an analysis of the risk factors of bedsharing.

The third section of the book offers practical information in the form of frequently asked questions about cosleeping. In it, McKenna addresses such issues as "How will cosleeping affect my relationship with my partner?" and "Will my cosleeping get in the way of my children being independent?"

When he addresses these issues, McKenna's analytical and forceful writing style is reassuring, as he explains the differences between parenting recommendations that come from cultural factors as opposed to biological ones. When addressing the whole issue of independence and fostering it, McKenna writes:

Sometimes parents are under the mistaken impression that if they don't train their babies to sleep by themselves, somehow some developmental or social skill later in life will be kept from them, or they worry that their babies will never exhibit good sleep patterns as adults. In reality, there has never been a scientific study anywhere that has shown any benefit whatsoever to sleeping through the night at young ages, or even sleeping through the night as adults.

Sleeping with Your Baby, despite my concerns with some of the presentation, is a wonderfully comprehensive book, full of details and reasons for cosleeping. In addition to McKenna's well-referenced information, the book features introductions by Dr. William Sears as well as Cornell University (Ithaca, New York, USA) anthropologist Meredith Small, who wrote the popular book, Our Babies, Ourselves.

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