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Twin infants often spend their first days or weeks in neonatal units, where decisions about their care can deeply affect families. This study explored how Australian neonatal units approach “twin co-bedding”, placing twin infants together on a shared safe surface. Researchers from Western Sydney University investigated policies, staff experiences, and beliefs about this practice. The results show wide differences in how hospitals manage twin co-bedding and reveal a need for clear, evidence-based guidelines to support both families and healthcare workers.
Twin co-bedding is sometimes used to help twins stay close to each other after birth, which may support bonding, comfort, and regulation. However, practices differ widely, and not all hospitals have policies or education programs to guide staff. This study looked closely at how neonatal healthcare workers view and apply twin co-bedding in daily care, and how these variations affect families of twins.
The mixed-method study gathered data from 21 neonatal units and 17 healthcare workers across Australia. It combined surveys, focus groups, and interviews. While most units practiced twin co-bedding occasionally or regularly, only about a quarter had written policies. Researchers found that the decision to co-bed often depended on staff experience, available space, or equipment rather than standard guidelines. This lack of consistency left many healthcare workers unsure of best practices and families uncertain about what to expect.
Four main themes emerged:
Policy-Driven Practitioners in a Policy Vacuum – Many staff members wanted policies to guide safe co-bedding but worked in hospitals without clear rules.
Evidence, Knowledge, and Education – Without formal training or guidelines, staff relied on general safe-sleep advice and personal judgment.
Personal Beliefs and Practice Observations – Some staff believed co-bedding comforted and stabilized twins, while others worried about infection or safety risks.
“The Parent Owns That Baby” – Being Family-Centered – Staff emphasized the importance of parental choice but noted that parents sometimes feared judgment if they preferred co-bedding. The fear is caused by absence of official guidance and the mixed attitudes among staff.
Overall, the study revealed that decisions about twin co-bedding were often guided by individual beliefs rather than uniform evidence or education. While some staff supported the practice as nurturing and family-centered, others hesitated due to unclear safety information. The absence of consistent policies created uncertainty and confusion for both caregivers and parents. Inconsistent or missing policies led to unequal care practices, meaning that even twins within the same hospital could receive different approaches to cobedding depending on staff, shift, or setting.
The authors concluded that neonatal healthcare workers are policy-driven professionals who value clear, evidence-based instructions to provide safe and family-centered care. The study calls for national guidelines and better staff education to ensure that twin families receive consistent support. More research is also needed to identify both the benefits and potential risks of twin co-bedding, helping hospitals make informed decisions that strengthen family wellbeing.
In the meantime, improving open communication between healthcare workers and parents may help families feel more confident and supported in their choices about caring for their twins.
Paper available at: Neonatal Twin Cobedding: A Mixed Method Study of Policy, Practice and Staff Perceptions in Australia - Mann - Journal of Advanced Nursing - Wiley Online Library
Full list of authors: Mann, P.; Foster, J.; Psaila, K.; Schmied, V.
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