In the past five years, 22 babies died in Dane County in unsafe sleep conditions. The county has delivered its call to action: "Share the room, not the bed." The message is appearing this month on billboards, buses and radio. 

We believe the message begs urgent questions. Safe Conversations for Safe Sleep: Real people, real life was formed to call out questions in the public interest and connect critical dots.    

Did 22 babies die in Dane County simply because of where they slept? 

Empirical evidence suggests not. “Mothers all over the world sleep with or next to their babies,” says anthropologist sleep expert James McKenna, Ph.D., University of Notre Dame. “Even in the U.S., approximately half of American parents sleep with their children either all or part of the night.” The Academy of Breastfeeding Medicine states, “Some form of parent-child co-sleeping provides physical protection for the infant ... and extends the duration of breastfeeding, thus improving the chances of survival.” Breastfeeding in bed also enhances survival of recovering and exhausted mothers. 

Sudden unexpected infant deaths happen within a cluster of factors, including: prematurity, formula-feeding, respiratory illness, sleep surfaces permitting entrapment (chair, water bed, sofa), sleeping with an adult who is obese, sleep-disordered, or taking awareness-altering substances, smoking in the home, and housing/environmental burdens. 

Why do African-American babies die at a rate double that of non-African-American babies? Are sudden infant deaths linked to other inequities? 

Political, social and environmental health inequities are directly linked to the risk factors listed above.  For example, a 2014 landmark study shows people of color are exposed to 38 percent higher levels of air pollution compared to whites — Wisconsin came in ninth in the U.S. for air pollution disparities. Air pollution contributes to respiratory and other illnesses and may compound effects of  formula-feeding. In 2011 the surgeon general warned, “The risk of hospitalization for lower respiratory tract disease in the first year of life is more than 250 percent higher among babies who are formula-fed than in those who are exclusively breastfed at least four months. Furthermore ... sudden infant death syndrome is 56 percent higher among infants who are never breastfed.”

Most African-American mothers choose to formula-feed or don't sustain breastfeeding. Why? Based on interviews with African-American women, the Joint Center for Political and Economic Studies Health Policy Institute lists barriers: commercial and media promotion of bottle-feeding as the norm; fear of pain or ridicule for breastfeeding in public; disruptive hospital routines after birth; lack of health care provider knowledge and encouragement; lack of peer mentoring and role models; lack of timely home visits; and maternal economic difficulties, including short maternity leave and workplace obstacles. A new U.N. report shows the U.S. is one of only three countries in the world (alongside Papua New Guinea and Oman) that doesn't offer monetary support to new mothers, and working mothers get shorter unpaid maternity leave than in any other Western country.

 Why do mothers in Dane County bed-share, despite being told it's wrong? 

  • Most new parents know the feeling of extreme fatigue and the desperate need for sleep. They notice that their crying baby finally stops crying when she's brought into bed with them. 
  • To keep their jobs, many women return to work when their babies are 6 to 8 weeks old. Infants who breastfeed make up for lost time with mom by frequent nighttime feedings. Mothers who need to be fit for work by morning bed-share through the night. 
  • Some working moms who formula-feed say sleeping with their babies is what makes them feel “connected.” Secure attachment is the foundation of emotional and relational wellness. 

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  • Premature babies have underdeveloped regulatory and sensory systems and need close physical contact to self-regulate. When placed on his back alone in a crib, a preemie can become dysregulated and unable to calm, waking every time his mother puts him down.

Then there was the Madison mother who followed all the rules but one morning found her baby blue in his crib. Hospital specialists said her baby became sick from bed-bug pesticides sprayed by her landlord. Home again, she sleeps with her baby nightly in order to sleep at all. 

"Share the room, not the bed" applies in some specific circumstances, but the emphasis on where a baby sleeps deflects public attention away from critical inequities and contributors to infant death. At the same time, it denies breastfeeding and parenting realities, while inviting secrecy, mother-blaming and legal action. In Dane County, infants can be removed from homes where safe-sleep guidelines are disobeyed, and legislation was introduced in Wisconsin last year to criminalize bed-sharing in defined instances. This direction undermines trust, honest communication, and relationship-based services that empower practitioners to guide and equip parents successfully  through real-life situations.  

Our coalition calls for a bigger-picture campaign message: “Safe, supported mothers make safer babies!”

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Safe Conversations for Safe Sleep: Real people, real life: Anne Altshuler, RN, MS, lactation consultant, La Leche League leader; Ingrid Andersson, RN, MSN, nurse-midwife; Hannah Bernard-Donals, CPM, licensed midwife; Adria Cannon, lactation consultant; Erin Curtis, M.D., addiction psychiatry; Anne Eglash, M.D., family medicine, lactation consultant; Janna Hack, LCSW, infant mental health consultant; Tehmina Islam, CPM, licensed midwife; Jill Mallory, M.D., family medicine, lactation consultant; Traci Martinez, recruiter, freelance writer; Merta Maaneb de Macedo, RN, MSN; Rep. Melissa Agard Sargent, Wisconsin Assembly District 48; Emily Shier, MS Ed., certified doula; Lailah Shima, integral coach; Cathy Szudy, RN, MSN, lactation consultant, nurse-midwife; Heidi M. Wegleitner, county supervisor, housing rights attorney. 

The primary authors of this piece are Ingrid Andersson, Anne Altshuler, Erin Curtis, Janna Hack, and Heidi Wegleitner.