The safety of newborn infants in three sleep conditions on the post-natal ward

H.L. Ball, E. Heslop and S.J. Leech

Parent-Infant Sleep Lab, Department of Anthropology, University of Durham, Durham, UK

The issue of infant sleep location in the immediate postnatal period has implications for mother-infant bonding, maternal confisdence in care-giving, and breastfeeding initiation (see Heslop and Ball, this conference). In order to implement Baby-Friendly practices many UK hospitals are developing bedding-in policies to allow or encourage mothers and their neonates to remain in close physical contact both day and night. These policies may incorporate either the infant sleeping in the mother’s bed with the use of a removable cot-side attached to the mother’s bed, or the use of a 3-sided clip-on-crib that fastens to the side of the mother’s bed. Prior to this study neither of these options have been examined from the point of view of infant safety in comparison with the use of a stand-alone bassinette – the standard infant sleep location for the post-natal ward.

On the post-natal ward of the Royal Victoria Infirmary, Newcastle-upon-Tyne, England, infants were randomised into three conditions: bedding-in with cot side; bedding-in with clip on crib; rooming-in with stand-alone crib. Mothers were recruited ante-natally from breastfeeding workshops with the inclusion criteria: intention to breastfeed, non-smoker, normal delivery, no opiate analgesics in labour. Mothers and infants were videoed for 8 hours on each of the 1st and 2nd nights following delivery. Videos were coded using The Observer (Noldus Information Technology bv, The Netherlands) using a behavioral taxonomy developed on the basis of previous studies. We report here only on the infant safety data. Four categories of infant risk were considered: falling; suffocation; entrapment; and overheating, along with several modifiers regarding the nature of the risk.

We identified one potential risk associated with the use of the cot-side for bedding-in, and no risks associated with use of the clip-on crib. However, we found that infants in the stand-alone condition were more frequently observed in potentially unsafe scenarios (involving one or more risks) than infants in either of the bedding-in conditions. These cases all involved unanticipated bed-sharing by mother and infant. We conclude that intentional bedding-in on the post-natal ward poses no observable risks to newborn infants under the conditions of this study, however unanticipated bedding-in may compromise infant safety.

Paper presented at Measuring Behavior 2005 , 5^th International Conference on Methods and Techniques in Behavioral Research, 30 August - 2 September 2005, Wageningen, The Netherlands.

© 2005 Noldus Information Technology bv