Opening talk at ISEMPH2016
Maternal-infant sleep ecology​ by Helen Ball

Commentary by Andrew F. Read, Penn State

Terrific opening talk at the ISEMPH meeting just now. Helen Ball, from the University of Durham, UK, talked about her work on what she calls maternal-infant sleep ecology. It’s a fascinating area, and not just because of the considerable conflict between the sleep needs of mothers and newborns. I’ve always thought that the very vulnerability the players involved (I hesitate to call mother and baby ‘patients’) make early childcare one of the areas of medicine most prone to old wives tales, snake-oil salesmen, and worse physicians with strong data-free opinions (eminence-based medicine). In addition, as Helen argued, it’s an area ripe for viewing through the evolutionary perspective. Human newborns are, like so much of the human condition, a mish-mash of traits resulting from descent with modification. We come from lineages producing precocial infants that can follow mum in the world – but we are born way too early for our brain development and so are secondarily altruistic. Moreover, our weird newborn state is now being delivered in an even weirder adult setting—the modern industry world—a classic case if evolutionary mismatch if ever there was.

So there is a clash of evolved infant biology and culturally determined patterns of nighttime care. Helen argued that different societies handle reconciling mother and offspring sleep needs in different ways. Indeed, her work shows that true even within the UK; a generation ago, to get baby to sleep, mothers moved their babies to formula milk as soon as they could. Today, many mothers instead sleep with their babies, so baby can feed when it wants. Looming over this new behavior is Sudden Infant Death Syndrome – fear of which drives the health advice that you should never sleep with your baby. Helen’s work shows that in fact for most mothers, it’s very unlikely they will kill their babies. Mothers adopt safe positions, babies feed when they want and so feed more frequently, breast feeding continues for longer, and both sleep better. Where there are SIDS risk factors (smoking, drinking), putting baby in a sidecar attached to the bed, or even in a transparent plastic box a mattress in bed next to mum can still improve things.

Impressively, Helen’s work has led to policy changes in the UK (NHS Trusts, NICE) and beyond (UNICEF). The changes can be summarized as shifting advice from ‘Make sure mums don’t sleep with their baby’ to ‘Empower families to make informed choices about co-sleeping with babies’. It must be enormously satisfying to have your research move from outputs (scientific papers) to outcomes (improved heath outcomes). I am so envious.

Did an evolutionary perspective help here? Is this one of the few examples where an evolutionary perspective has directly improved human well being? Helen argued it did. I am less sure. There is no doubt the evolutionary perspective makes clear why there is so much conflict in the first place. But did it suggest solutions? What Helen and her group actually did was to get in and ask mums what they were doing and why, make detail observations of what was happening at night, and measure health outcomes. It seems to me that approach is a main flavor of evidence-based medicine. It doesn’t need evolutionary motivation. But perhaps that’s it. Realizing that evolution has produced the hopeless human newborn, and that that evolutionary compromise is now arriving in a world poorly suited for it, Helen was driven to actually go out and look. She chose to study the natural history of mother-newborn sleep, not to accept the wisdom firmly handed out by grandmothers and the health care establishment. I can’t help wonder if this is another example of the evolutionary perspective giving permission to think previously unthinkable things. That’s not something unique to ev med folk of course. But the ev med framework sure makes it easier to see when orthodox beliefs just don’t make much sense.