What I find particularly disturbing about this campaign is that by focusing on scaring people from co-sleeping the City of Milwaukee Health Department abdicates taking on the real issues contributing to infant deaths in their area. "Co-sleeping" is a easy scapegoat. Issues such as low rates of breastfeeding, alcohol and drug abuse, smoking, economic stress, poor pre-natal care, specifics of unsafe sleeping conditions, and lack of real support for mothers (especially single mothers) are swept aside. Instead, we get a one-size fits all blanket statement "Co-sleeping in a bed with your baby is as dangerous as your baby sleeping with a butcher's knife" = only a crazy, irresponsible parent would do that!
Really? This is the best solution they can come up with? How is this scare-tactic approach going to help mothers (and fathers) confronting the constant and relentless needs of their helpless infants? And it certainly does not aid the cause of increasing breastfeeding rates (which is a major public health concern) because breastfeeding success is intimately intertwined with infant nighttime needs. Simply put, babies are designed to breastfeed and they are also designed to wake frequently at night to nurse; this provides the best insurance for their growth and survival. Our babies are designed to sleep near their mothers.
Despite public health campaigns that promote crib sleeping for infants and malign bed-sharing, many mothers and babies end of sharing sleep at some point. This study investigates where babies in the U.S. really end up sleeping. When health care and government agencies fail to consider the very real needs of mothers and infants during the night, demonize bed-sharing and fail to educate parents about safe sleep conditions for bed-sharing they inadvertently put babies in greater danger. Desperate mothers in their attempt to avoid bed-sharing may accidentally fall asleep in far more dangerous places with their infants like arm chairs, rockers or sofas (which would still labeled as "co-sleeping" by our state agencies even though it's the very thing these moms are trying to avoid.)
Talk about co-sleeping invariably triggers strong emotional responses in people. In preparing to write this blog I got swept away reading people's emotion laden responses to this issue. When a baby dies, this is a heartbreaking tragedy; people rightly want to prevent this from happening. And when it comes to where babies sleep, people have strong feelings, partially from wanting to protect babies and partly from believing they know the "right way" that infants should sleep. I noticed people can be pretty judgmental about the whole thing.
The truth is we can't prevent all infant deaths - there is no absolute guarantee in any situation be it in an adult bed, a crib, a bassinet or a playpen. A mother whose infant dies in a crib is just as devastated as the mother whose baby dies in her arms or next to her. Each mother is going to wonder if she could have done something differently so that her baby could still be here. Each mother is doing her best to do the right thing. Somehow, though, society likes to point a more judgmental finger at the "co-sleeping" mom. I am not understanding the reason for this - this attitude is distinctly biased.
What would really be helpful for parents in order to decide where is the best and safest place for their infant to sleep is a good hard look at the science behind infant sleep and nighttime needs. And to give parents more accurate statistical risks of co-sleeping. We really aren't there yet as a society; misinformation abounds from popular parenting magazines and books to advice from medical caregivers. New parents are bombarded with messages that their infants should be "sleeping through the night" and often have absolutely no awareness of how normal and beneficial it is for babies to wake frequently at night. Babies wake at night frequently to nurse and to be near their mothers. This is normal. Really. And an honest and realistic discussion about what constitutes normal infant sleep and how families can meet their infant's needs is desperately needed.
Does this mean that mothers and babies have to bed-share? No. There are lots of possible sleeping arrangements, but many families are probably going to bed-share at some point even if it's just out of desperation to finally get some sleep one night. That's why anti-bed-sharing campaigns are not helpful and can even cause the very problems they are trying to stop. According to the health campaigns, this is a health issue, not a moral one, so let's really take a good look at the facts and reality. The issue is to prevent infant death by providing a safe sleeping environment. So, let's make sure sleep conditions are safe, but we also need to acknowledge the reality of infant nighttime needs.
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| Photo and sculpture: JeanetteRansing (Flickr) |
With statements like this, "Infants may be brought into bed for nursing or comforting, but should be returned to their own safe space to sleep when the parent is ready to return to sleep," I have to truly wonder whether any of the staff at the Milwaukee Health Department are even parents who have ever cared for an infant. That statement just seems out of touch and unrealistic. The mother is the one who actually has to interact and care for her infant night after night after night after night; this care work is exhausting. Do you really think she isn't going to pass out from exhaustion at some point? Let's get real. Guidelines have got to be realistic and they've got to work. Since mothers will probably sleep with their infants at some point, let make sure everyone knows what the parameters are for safe co-sleeping or bed-sharing. That's being realistic.
And one of the ways we can make sharing sleep more safe in addition to spelling out the specifics of safe bed-sharing is by promoting, supporting and protecting breastfeeding. We really need to do more to make sure mothers and infants are able to breastfeed successfully and support this symbiotic and essential relationship. Breastfeeding is one of the major contributing factors towards preventing infant death.
In this Fox News story, "Is Sleeping with Your Infant Right or Wrong?", we see the Milwaukee Health Department's prior approach before the baby and knife photos with the same campaign using a headstone for the headboard bearing the same message - uh, it didn't really work the first round and if they are not addressing the real concerns (like not breastfeeding and how to safely meet an infant's needs) then I really don't see how it's going to have more success this time. The idea of making bed-sharing illegal strikes me as a truly frightening prospect; and warped, too - yeah, that's right, make breastfeeding next to impossible, continue policies that perpetuate a complete lack of support for families and then prosecute them when they are just trying to meet their baby's needs. Scary.
Families need support. Mothers especially need support. They need help making breastfeeding a success with public health and social policies that truly make nursing their infants possible. Not scare tactics, but real information and support services to help them make the decisions that are in the best interest of their family.
To simply admonish parents not to sleep with their infants, ever, under any circumstances, is unrealistic, quite possibly unethical, and does not provide the optimum in nutrition and sleep physiology. Morgan et al. JOGNN 2006; 35: 685-691Amen.
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