API Response to the Milwaukee Anti-Bedsharing Campaign
API's response to the Milwaukee Anti-Bedsharing Campaign and the report aired today on NBC's The Today Show and on ABC news:
Our hearts are broken at the loss of precious lives in Milwaukee. API is moved by and shares this passion to definitively halt similar ongoing sleep-related tragedies. We also agree and support information that would discourage bedsharing for those who are not healthy/safe candidates. Still, to say that no parent should ever have the baby in bed is as detrimental as saying that all babies should be in bed with their parents. While the Milwaukee anti-bedsharing campaign has generated a lot of controversy and interest, we persist in calling for facts that accurately describe the reality and continue to insist that when safe alternatives are dismissed, greater tragedy may result.
API is concerned that parents will be afraid to talk about bedsharing; and that professionals will be reluctant to talk about it. While the debate continues, the reality is mothers will still be responding to their instinct to meet their children's needs by breastfeeding at night, in their beds. They should be supported to make it a safe environment. Parents and professionals must be fully informed, be free to ask questions, and willing to discuss safe strategies. We urge policy makers to avoid setting parents up -- where parents' efforts to meet children's needs and fulfill an edict to not be in an adult bed run into conflict and result in many dangerous sleep environments.
Parents' reasons for bedsharing are varied; in a popular poll more than 45% of American parents report that they have had their infant sleep with them at some point. A provocative ad and the gift of a playpen are poor solutions, unlikely to affect parents' strong biological, intellectual, and emotional responses to their infants. Those of us who raise our children in the culture of breastfeeding and safe bedsharing cannot imagine this basic human instinct as taboo. It is a basic, human biological right for a baby and a healthy mother to be in close proximity.
As the campaign has already become news, we hope the momentum of this controversy will have the positive benefit of meaningful discussion as well as much needed information, support, and resources.
What is urgently needed:
- Education about safe sleep environments;
- Better and clear data, analysis, and transparency in information;
- Communication and conversation for viable solutions based on good data as well as parent and infant behavior; and
- Broad participation, rather than action based on dictates of a few and those who stand to benefit for reasons other than infant wellbeing.
Safe Sleep Environment
Without a doubt, an unsafe sleep environment is dangerous for an infant. API educational material guidelines clearly state that mothers who are bedsharing are advised to breastfeed, not smoke or take other drugs or alcohol (or sleep with a partner who does these things), or be obese. Creating a safe sleep environment includes firm mattresses, the space free of any potential entrapment. A firm futon or mattress on the floor, or a side-car sleeper are safe sleeping arrangements that breastfeeding mothers have used for centuries.
The current argument against educating about creating a safe sleep environment is that parents cannot learn. This is a paternalistic approach that ignores the variety of motivations for engaging in bedsharing. We encourage a response to concerns about infant sleep that educates and empowers parents.
Looking at Data
The 2010 City of Milwaukee Fetal Infant Mortality Review (FIMR) shows that during the years 2005-2008 there were 478 infant deaths. Of six broad categories of causes, "SIDS, Overlay and Accidental Suffocation" was identified as the third highest cause and accounted for 90 deaths representing 18% of the total.
Charts on pages 17-18 of this review show the prevalence of the following seven risk factors identified in the 90 deaths: pillows, bumpers, blankets, quilts; bedsharing; second hand smoke; prone sleep position; prematurity; adult alcohol or drug use; and sleeping on couch, car seat, sofa or swing.
Data collected and reported about infant deaths is improving, but remains incomplete and inaccurate. Better data will provide for more effective public-health campaigns. We note that all except five of these 90 deaths involved more than one of the risk factors above and 70% of the deaths identified "bedsharing" as one among multiple risk factors.
We advocate the following clarifications in order to identify the true risks, prevalence and causes of death so that work may begin to address these factors and further reduce further needless tragedy.
We advocate that infant sleep risks be clarified and risk-taking motives understood so that the public-health responses and campaigns are more effective.
We advocate that a shared bed be identified as a sleep location and not as a risk factor.
Even with cribs, environmental conditions determine the relative safety of the location. When the location of death becomes the default risk factor, the actual risks are obscured and the failure to address them may limit the effectiveness of public-health campaigns as a result. Crib-sleeping SIDS campaigns have successfully targeted risk factors and avoided confusion with the sleep location.
Despite the fact that cribs are the location of the majority of (and sometimes even the direct cause of) infant sleep-related deaths, parents have never been warned to avoid cribs. Because cribs are deemed sleep locations and not risks, campaigns have successfully focused on safety education. As a result of correctly targeting the actual risk factors, cribs SIDS have dramatically declined.
We advocate extending the list of risk factors when bedsharing to include: adult obesity; multiple persons in a shared bed; bed structure safety; infant sleeping beside someone other than mother; and mother not breastfeeding.
We advocate greater understanding of and sensitivity to parental motives that can lead to unsafe infant sleep.
We cannot assume that cribs are inherently safer in every case than shared beds and employ free crib programs on a belief that families wanted but could not afford to purchase a crib and that these families are aware of and will follow the crib sleeping safety guidelines. We are unaware of the evidence that supports these assumptions.
API supports initiatives that aim to eliminate preventable infant sleep-related deaths. Though the unfortunate reality is that preventable deaths do occur and will continue to occur in a variety of safe and unsafe sleep locations, we know improvements are possible.
When we engage parents as trusted allies in the health and wellbeing of their children, we will come closer to achieving our common goals of keeping children alive, safe and thriving within their families.
Communicating with Parents
The frightening image used in the Milwaukee campaign against bedsharing perfectly illustrates a fear-based campaign, a campaign that does not help parents know what to do, and not even what not to do. In this case what not to do may be interpreted widely. It is a simple and shocking picture and suitably controversial to grab attention. Dr. Kathleen Kendall-Tackett, who has conducted research on the harm of these kinds of anti-bedsharing campaigns, reports that they potentially create dangerous situations with a message that terrifies rather than educates parents. She found even though mothers hear the message to not bedshare, they misinterpret what they hear:
The findings indicate that almost 60% of mothers bedshare and that this occurs throughout the first year. These findings also indicate that 25% of mothers are falling asleep with their infants in dangerous sleep locations, such as chairs, sofas or recliners. Journal of Clinical Lactation Vol. 1, Fall 2010
Most of the mothers in Dr. Kendall-Tackett's survey were breastfeeding mothers, and she found that at some point in the night, the mothers fell asleep with their babies. Along with current safe sleep strategies she strongly recommends:
Safe–sleep campaigns should include information on safe bedsharing. In absence of this information, parents are likely to continue bedsharing, but may do so in unsafe ways...
Consequences and Alternatives
The Milwaukee campaign uses a simplistic approach that ignores human nature and sets parents up for unsafe practices as they meet their baby's needs in the middle of the night. Parents feel forced to go against their instincts, turning to practices also known to harm infants. Confining their infant to the crib, letting their baby "cry it out," and engaging in sleep-training methods create stress in the baby. Even worse, parents become confused, irritated and exhausted, ultimately desensitizing the parent to the child's need for loving responsiveness. The baby is deprived of emotional and physical support, and is at risk for harm. The history of parenting has shown that sometimes we move to a so-called strategy, only to find that we have created the potential for something worse, perhaps in this case, the potential for more SIDS deaths. We need to move forward with certain knowledge, being very careful before issuing blanket edicts with unknown outcomes that go against a natural, instinctual, and beneficial human behavior practiced for thousands of years.
API understands the great disparity in bedsharing among Milwaukee communities and yes, there are cases were families should not be bedsharing. In every case, however, parents can be educated and empowered in their love for their children, to make their own decisions. Milwaukee and other health departments can better spend their dollars to reduce infant deaths on good prenatal care, breastfeeding promotion, nutrition counseling and good parenting education instead of on frightening messages that only confuse parents. Breastfeeding, roomsharing, and eliminating smoking are all practices that are known to significantly decrease the chances of SIDS.
The encouraging news is that so many of the comments coming from parents in blogs, Facebook, and on the ABC website show that they are seeing through this anti-bedsharing message and questioning its validity. We hope those involved with the campaign will take this feedback to heart.
We encourage all parents to write to their local TV stations, newspapers, facebook pages, and other media to question these campaigns and advocate for safe, complete messages based on sound research. Come to this task full of compassion for the campaign directors, as we believe they too have the infant's best interests at heart. As compassionate parents ourselves, we have the tools to engage effectively. We continue patiently and persistently on our course of best action as we do in our daily parenting.
For its part, API is actively advocating for complete data collection on infant mortality rates, having a standard for death certificate questionnaires that ask the right questions and delineate types of deaths, be they SIDS, suffocations, overlay, complications of prematurity, etc. The results should clearly indicate how this information compares to infant deaths that continue to take place in cribs.
Your continued support is vital to this effort. The factors involved in this bedsharing debate are greater than a well-intentioned public health effort. Strong financial interests, conflicts of interest, and lack of data transparency and clarity must not be a part of the processes that effect public health decisions, especially to the prospect of greater harm.
Only a grassroots, empowered public will make a difference in saving lives, empowering parents to recognize their right and responsibility to raise their children in a loving, connected and healthy environment.
You are invited to review and use these valuable resources:
- Jim McKenna, PhD: cosleeping.nd.edu
- Dr. Bill Sears: askdrsears.com/news/latest-news/dr-sears-addresses-recent-co-sleeping-concerns
- API 2010 Appeal for Support: attachmentparenting.org/news/2010appealforsupport.php
- API Safe Sleep Resources, Free Downloadable Brochures, Position Paper, Letters, and Principle: attachmentparenting.org/infantsleepsafety/
API resources are available for your use and we invite you to share your concerns with:
Bevan Baker, Commissioner of Health
Milwaukee Health Department
Frank P. Zeidler Municipal Building
841 North Broadway, 3rd Floor
Milwaukee, WI 53202-3653
No email available
Milwaukee Journal Sentinel Letters to the Editor
200 word limit
Write: Letters to the editor, Milwaukee Journal Sentinel,
P.O. Box 371, Milwaukee, WI 53201-0371
Other major outlets
Your local newspaper
Consider donating to API's efforts in support of parents at: Give today to help keep babies safe! or mail to: API, P.O. Box 4615, Alpharetta, GA 30023. Questions? 800-850-8320
Attachment Parenting International