Calls for uniformity in sleep advice for newborn twins

Photo: Getty Images
Photo: Getty Images 

The tragic deaths of six-week-old twin girls in Brisbane last week have thrown the spotlight on the lack of information and uniformity around safe sleep arrangements for multiples.

While details surrounding babies' deaths are being investigated by the coroner, police released a statement saying investigations suggest the babies were sleeping together throughout the night and were discovered unresponsive in the morning. Police are not treating the deaths as suspicious and have described them as a tragic accident.

While it is not known whether the girls were sharing a bed with an adult in this case, Professor of Nursing Jeanine Young, who sits on the Red Nose National Scientific Advisory Group says that inconsistency in state and hospital guidelines and health professional advice has left many parents to find their own practical solutions in caring for their babies.

"Many parents will bed-share with their baby whether they intend to, or not," Ms Young says.  "For parents to be able to make informed decisions all parents should be provided with clear and impartial information about benefits and risks to sharing a sleep surface using risk minimisation guidelines.

"Risk minimisation considers individual family circumstances and takes into account a baby's changing needs particularly during the early months of life. It neither promotes or discourages shared sleeping; it acknowledges shared sleeping will happen whether intended or not, and allows a conversation with parents about how to reduce risk in all environments a baby may be placed to sleep in."

Professor Young has authored risk minimisation approaches for shared sleeping for both Red Nose and the Australian College of Midwives.

In Australia twin pregnancies account for 1.6 per cent of pregnancies but 60 per cent of twin pregnancies require a NICU admission and each hospitals policy around sleeping the twins varies.

Registered nurse and PHD candidate, Philippa Mann from Western Sydney University is researching newborn co-bedding of twins in hospitals and homes in Australia, examining perceptions and practices and has found very few global studies on twin sleeping.  She says as a result there are no consistent guidelines.

"The study is looking at twin siblings and whether they share a bed or not rather than sleeping with a parent," Ms Mann says. "There is inconsistency of research which makes it difficult to get a clear understanding of benefits and risks, and therefore without that we can't develop accurate and appropriate guidelines."

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She says Australia does not have statistics regarding SIDS in twins and whether co-bedding impacts it.

Emerging research is suggesting most parents, particularly those with identical twins, are choosing to co-bed their twins for a range of reasons.  Sometimes it can come down to the cost and availability of cots as well as space.

"They can feel distressed at the idea of separating the babies and there can be confusion about whether to make the choice about the bond or following SIDS guidelines," she says.

Ms Mann has found significant inconsistency between hospitals and even within the same hospital and that families are being sent home with no discussion about what to do when they get home.

She says research has shown numerous benefits of co-bedding twins, including synchronising sleep/wake states, aiding transition from womb to the world and providing a calming presence, because they interact so much. 

"In utero there is a process of co-regulating, synchronising their heartrates and foetal movements," Ms Mann says.

Some studies have looked at the effects of co-bedding and apnoea and found they may be less frequent when they are with their twin.

Professor Young says that while a proportion of deaths occur in shared sleeping environments, mostly with other risk factors present, over half of sudden infant deaths are in situations where baby is sleeping alone either in an unsafe sleep position, on their tummy, or in an unsafe sleep environment.

Information on sleeping twins can be found at:

https://rednose.org.au/article/what-is-the-safest-way-to-sleep-twins

https://rednose.org.au/news/sleeping-twins-in-the-same-safe-cot