Salm Ward, T. (2014). Reasons for Mother–Infant Bed-Sharing: A Systematic Narrative Synthesis of the Literature and Implications for Future Research. Maternal and Child Health Journal, 19(3), 675-690.

Objective: Mother–infant bed-sharing has been a common practice for centuries. Understanding the reasons parents choose to bed-share can help tailor safe sleep education. The purpose of this article was to systematically review the international literature on: (1) reasons parents bed-share, (2) the cultural context of bed-sharing, and (3) implications for interventions and future research.Design: Systematic literature review using the narrative synthesis methodVariables Measured, Instruments Used:A systematic review of the international research and gray literature was conducted using the narrative synthesis method.

1. Review questions were: “What are the reasons parents bed-share with their infants?” and “What is the cultural context of these reasons?” Given the availability of both qualitative and quantitative literature regarding this phenomenon, a narrative synthesis approach was chosen to facilitate a systematic and transparent method for reviewing both quantitative and qualitative literature.
2. PubMed, CINAHL, and PsycINFO were searched from August to September 2013 using the terms: “infant,” “sleep,” “bed shar*,” “co sleep*,” “sleep location,” “sleep practices,” and “sleep arrangements,” alone or in combination, and Google Scholar was searched using the terms: “bed share,” “bed sharing,” “co sleep,” and “co sleeping.”
3. Additional articles were identified based on the author’s past work, and from reference lists of selected articles.

Participants

• N= 43 (Journal Articles)
• Participant ages: N/A
• Location: Research conducted in Athens, GA
• Eligibility: Titles and abstracts were reviewed for the following inclusion criteria: (1) referred to bed-sharing with infants less than 12 months of age; (2) provided reasons for caregiver-infant bed-sharing; and (3) published between 1990 and 2013. Studies were excluded if they examined bed-sharing in disorders such as epilepsy or breathing disorders, or among multi-gestational infants.
• SES: N/A

Limitations:

1. Because of the nature of qualitative data as a unique view, it cannot be “replicated, added to another or transferred.
2. In this synthesis, only one author determined eligibility and extracted data, which can increase the potential for errors.
3. This analysis was unable to determine quality of the findings related to reasons for bed-sharing, which in turn, limits the strength of the evidence presented in this narrative synthesis.
4. In thematic analysis, it can be difficult for readers to understand how and at what stage themes were identified.
5. Themes were not stratified by demographic characteristics other than race/ethnicity; for example, age, educational level, or socioeconomic status.

Finding(s):10 Reasons for bed-sharing themes were found

1. Breastfeeding: Breastfeeding was the most commonly-cited reason for bed-sharing.Bed-sharing was an easy and convenient way to manage frequent nighttime feedings
2. Comforting- mother or infant:Bed-sharing provided comfort to mothers and infants. Mothers reported feeling emotionally comforted, reassured and secure when bed-sharing. They reported a preference for sleeping with their infants.
3. Better/more sleep—infant or mother: Bed-sharing was used as a strategy to improve infant sleep. Infants who bed-shared were perceived to fall asleep “more quickly,” have higher quality or “better” sleep, and higher quantity or “longer” sleep. Mothers reported bed-sharing to “settle” the infant to sleep
4. Monitoring: Bed-sharing was a method to more closely monitor the infant. Monitoring referred to being able to hear, feel or see the infant’s: (1) breathing (2) body temperature or (3) to generally sense a problem or change in status. Parents felt they could immediately assist their infant if there was a problem
5. Bonding or attachment: Bed-sharing was thought to promote bonding between mother and infant,especially when the mother was working outside the home. It also allowed fathers to spend more time with the infant
6. Environmental reasons: Environmental reasons included: (1) no crib, (2) for protection, and (3) for warmth. Parents did not have a crib for financial reasons, because they had no space for a crib, or because another child was using it.
7. Crying: Bed-sharing also occurred in response to infant crying. Bed-sharing infants reportedly cried less.
8. Cultural or familial tradition- Cultural tradition included references to practices by “our culture” (or “our racial/ethnic group”); for example, among Pacific Islander, Indian, Mexican, Aboriginal, and Hmong families, especially as a way to preserve a sense of culture when living in a foreign land.Bed-sharing was also described as a familial tradition, in which parents bed-shared with their own parents (or grandparents), or with previous children.
9. Disagree with danger- Disagreement and skepticism about the dangers of bed-sharing were expressed. Risks of infant death were minimized by parents because they felt the risks did not pertain to them, for example, because they were “light” sleepers or they would “never” roll onto their infant.
10. Maternal instinct- Bed-sharing was seen as a maternal instinct or “natural,” “normal,” or just feeling “right.”