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 Wisconsin. 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; professionals are and will be afraid to talk about it. Nonetheless, a mother’s basic need for feeding and responding to her infant’s needs will continue to be met. Parents and professionals must be fully informed with accessible information and free to ask questions and dialogue about safe strategies. We seek to avoid situations where efforts to comply with rules result in more unsafe situations.
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 solutions that are highly unlikely to affect parental decisions that deny strong biological, intellectual, and empathic responses to their infants. Those of us who raise our children in the culture of breastfeeding and safe bedsharing we 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 a meaningful discussion and response to 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, not action based on decisions of a few.
Safe Sleep Environment
Without a doubt, an unsafe sleep environment is not appropriate 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; a paternalistic approach that ignores a variety of motivations for engaging in bedsharing. We believe in and support parents. We encourage a response to safe sleep that educates and empowers parents.
Looking at Data
In the 2010 City of Milwaukee Fetal Infant Mortality Review (FIMR) Report, bedsharing is identified as a risk factor in the same category as true causes of death by overlay and suffocation. If these bedsharing situations followed safe guidelines, should not the infant deaths be logically attributed to SIDS, just as they would if the infant were in a crib?
Page 17 shows that of 90 SIDS, overlay, asphyxiation deaths, 85 involved multiple risk factors. Bedsharing, indicated as a risk factor and being prevalent in 70% of the 90 deaths, was not the only identifiable risk factor. Five deaths for which there was only one risk factor are indicative of relatively “clear,” isolated causes of death. Even ifwe assume that bedsharing were the only risk factor in these five deaths, as this report does not identify accompanying risk factors such as obesity, other people in the bed, siblings in the bed, or bed structure, no one can be sure that these five deaths would have occurred in “safe” bedsharing conditions based on the API Safe Infant Sleep guidelines.
Assume we accepted that bedsharing was the single risk factor in the five deaths attributable to a single risk factor. Deaths attributed solely to bedsharing may then be reported at 0.05% – the lowest of all sleep-related risks. Technically, these deaths might be attributed to SIDS-bedsharing barring any additional and previously unidentified risk factors.
API agrees with an objective to strive for no infant or child deaths, certainly preventable ones. Zero tolerance is noble and we should aim for it, but when we break it all down, it must be analyzed on par with other sleep conditions and environments, knowing there is an uncontrolled element to SIDS that eludes all. When we look clear-eyed at the data, bedsharing may not be the boogeyman after all. In missing critical data and clear analysis, we are less able to achieve our common goals of keeping children alive, safe and thriving within their families.
More risk factors must be identified. Cause of death and risk factors need to be isolated for full information. Bedsharing does not equate to overlaying and it does not equate to SIDS.
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, just 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 they found that at some point in the night, the mothers feel 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 variation and sets parents up for overwhelming challenges in safely meeting 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 so exhausted ultimately desensitizing the parent to the child’s need for loving responsiveness. The baby is deprived of emotional and physical support and 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 frightening messages that only confuse parents. Eliminating smoking, breastfeeding, roomsharing are all known practices that 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 message and questioning its validity. We hope those involved with the campaign messaging 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 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 take back their rights 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