Randomised trial of infant sleep location on the postnatal ward

Helen L Ball ^1*, Martin P Ward Platt ², Emma Heslop ¹, Stephen J Leech ¹ and Kathleen A Brown ³

¹ Durham University, United Kingdom
² Royal Victoria Infirmary, United Kingdom
³ Royal Victorial Infirmary, United Kingdom

^* To whom correspondence should be addressed. E-mail: h.l.ball{at}durham.ac.uk.

Accepted 11 July 2006

Abstract

Objective: To determine whether postnatal mother- infant sleep proximity affects breastfeeding initiation and infant safety.

Design: Randomised non-blinded trial analysed by intention to treat.

Setting: Postnatal wards of the Royal Victoria Hospital (RVI), Newcastle-upon-Tyne.

Participants: 64 newly delivered mother-infant dyads with a prenatal intention to breastfeed (vaginal deliveries, no intra-muscular / intra-venous opiate analgesics in preceding 24 hours).

Intervention: Infants were randomly allocated to one of 3 sleep conditions: Baby in mother's bed with cot- side; baby in side-car crib attached to mother’s bed; baby in stand-alone cot adjacent to mother’s bed. Main outcome measures: Breastfeeding frequency and infant safety observed via night-time video-recordings.

Results: During standardised 4-hour observation periods bed and side-car crib infants breastfed more frequently than stand-alone cot infants [mean difference (95% CI): bed vs stand-alone cot =2.56 (0.72-4.41); side- car crib vs stand-alone cot =2.52 (0.87-4.17); bed vs. side-car crib = 0.04 (-2.10-2.18)]. No infants experienced adverse events, however bed infants were more frequently considered to be in potentially adverse situations [mean difference (95% CI): bed vs stand-alone cot 0.13 (0.03-0.23); side-car crib vs stand-alone cot 0.04 (-0.03-0.12); bed vs side-car crib 0.09 (-0.03- 0.21)]. No differences were observed in duration of maternal or infant sleep, frequency or duration of assistance provided by staff; or maternal rating of post- natal satisfaction.

Conclusion: Suckling frequency in the early post- partum period is a well known predictor of successful breastfeeding initiation. Sleeping newborn babies in close proximity to their mothers (bedding-in) facilitates frequent feeding in comparison with rooming- in. None of the 3 sleep conditions was associated with adverse events; although infrequent, potential risks may have occurred in the bed-group. Side-car cribs are effective in enhancing breastfeeding initiation and preserving infant safety on the post-natal ward.

Keywords: bedding-in, breastfeeding initiation, post-natal care, rooming-in, side-car crib

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