1. Hudson-Barr, Diane PhD, RN

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Have you heard the story of the twins born in 1995 at a Massachusetts Hospital? The girls each weighed approximately 1000 g and were cared for in separate incubators. One of the infants was frequently agitated, and the nurse caring for her remembered reading about the use of cobedding in Europe. The nurse put the twins together in one crib, and almost immediately the agitated infant snuggled up to her sister, improving her oxygen saturation and respiratory status. As the infants continued to be cobedded over the next few weeks, the health of both girls improved.


Cobedding is the practice of swaddling infants together in the same bed. It was first reported in the 1940s, and has since been used sporadically as an intervention for multiple birth infants in the United States. For hospitalized infants in countries with limited health resources, cobedding is often the accepted practice for multiple birth infants. However, in the United States concerns about infection and the increased availability of resources have supported the use of separate beds for multiple birth infants. Anecdotal reports sparked an increased interest in cobedding, and some nurseries across the country have implemented the intervention. An increase in the multiple birth rate has also contributed to this increased interest in cobedding.


Cobedding promotes a continuation of the antenatal environment for the infants, and supports the continuation of interactive development and coregulation that occurred in utero (Boyd, 2001). Cobedding also supports the parents when infants are hospitalized, because both infants are in one place and the parents don't have to choose which infant to attend to. Other suggested benefits of cobedding include increased parent-infant attachment, improved parent-nurse communication, and decreased length of stay (Boyd, 2001).


Research on the benefits of cobedding is limited; however, research has shown that the practice is not associated with certain poor outcomes such as increased infection (Browne, 2000;Lutes & Altimier, 2000) or increased apnea or bradycardia episodes (Browne, 2000). In a descriptive study of over 200 multiples in 10 Colorado neonatal intensive care units, Browne (2000) observed significantly greater weight gain during the first month in infants cobedded when compared to those in individual incubators.


Although no research-based protocols are available, it has been my experience that units implementing cobedding usually require that the infants be clinically stable, infection-free, of similar size, and have the consent of the parents. Exclusion criteria usually include infants requiring continuous positive airway pressure, or those who need continuous intravenous therapy.


Cobedded infants are usually swaddled so their hands are free to reach their own face and the faces and bodies of their siblings. Some infants appear to dislike cobedding and will cry or kick during the experience. These infants may need time to settle into the position; they may not be in the position they occupied in utero (ultrasound data of the position of the infants can be helpful), or they may dislike the practice. Color-coding monitors and equipment for each infant can help to ensure that nursing care is correctly documented; name bands on each baby should help to prevent medication, feeding, or treatment errors.


In my opinion, cobedding multiple birth infants is a timely developmental nursing intervention. Birth siblings can continue to support each other as they did in utero, parents can be at one bedside in close contact with all of their infants when present in the hospital, and continuity of care is enhanced. Additional research to confirm the safety of the practice, as well as to determine the impact on growth parameters, length of stay, and family attachment is needed.


Research on benefits of cobedding is limited; however, the practice has not been associated with increased infection, increased apnea, or bradycardia episodes. One study found greater weight gain in cobedded infants.




1. Boyd, S. (2001). 'The way they were': Multiple gestation infants and co-bedding. Journal of Neonatal Nursing, 7( 3), 95-100. [Context Link]


2. Browne, J. V. (2000, January/February). Co-bedding plural birth infants: Experience of ten Colorado neonatal intensive care units. Paper presented at The Physical and Developmental Environment of the High-Risk Infant: Research & Science for Care and Caring. Clearwater Beach, FL. [Context Link]


3. Lutes, L. M., & Altimier, L. (2000, January/February). A comparison of growth parameters in higher-order multiple low birth weight infants co-bedded versus traditionally-bedded methods. Paper presented at The Physical and Developmental Environment of the High-Risk Infant: Research & Science for Care and Caring. Clearwater Beach, FL. [Context Link]