Cosleeping Safety and the Milwaukee Billboards

I’ve started looking into cosleeping in the wake of the Milwaukee anti-cosleeping billboards. I said to a friend recently that there’s something fucked up in Milwaukee to have caused all of their recent deaths, so that’s where I started in my research: what the fuck is happening in Milwaukee?

I started with the 2010 City of Milawukee Fetal Infant Mortality Review (FIMR) Report.

It’s immediately apparent that Milwaukee has an abysmal infant death rate, which is sharply divided by race and location. That report breaks out two zipcodes, their racial makeup, and their death rate for 2008. One zip code is 97.6% white with an infant death rate of zero. The other zipcode is 94.9% black with an infant death rate of 17.6, which is a shockingly high number. 73% of Milwaukee infant deaths are caused by complications of prematurity and congenital abnormalities. 18% are attributed to “SIDS, overlay, accidental suffocation”. SIDS is a really tricky diagnosis to research, because it has different definitions and is inconsistently applied, but I’m setting that aside for now.

For the deaths in the “SIDS, overlay, accidental suffocation category”, there are several “risk factors” that have been identified as being present in these kinds of deaths. (It’s important to note that “risk factor” doesn’t mean that factor caused the death, just that those factors were present.) The risk factors present in the Milwaukee deaths were 1) pillows, blankets, soft things present with the baby 2) bedsharing 3) secondhand smoke 4) baby placed prone or on side 5) baby was born prematurely 6) alcohol or drug abuse by caregiver 7) baby sleeping on a couch, chair, carseat, or swing. The average number of these risk factors present in each death was four. I can’t tell from the report quite how these risk factors tended to occur together.

There are several scenarios I’m worried about with an alarmist campaign like this:

  • Will parents who bedshare, smoke, and have soft things in bed with baby stop bedsharing but continue to put smokey soft things in a crib, not doing much to reduce overall death?
  • Will parents who’ve been bedsharing without any other risk factors avoid bedsharing now, depriving them of the benefits of bedsharing without any decrease in deaths?
  • Will parents not learn about how to safely bedshare and then do it unsafely when they fall asleep from exhaustion or take the baby to their bed out of desperation (which happens at some point or another for almost all parents)?

I’ve never understood the general panic over cosleeping. I mean, “crib sleeping” isn’t safe, either. For safe crib sleeping (or, I like to say “isolation sleeping”) you have to follow a long list of safety guidelines:

  • Make sure your crib has a Consumer Product Safety Commission label or a Juvenile Products Manufacturer’s Association (JPMA) label and that your crib has not been recalled and that the bars are no more than 2-3/8 inches apart.
  • Only use a mattress designed for your crib. Check that the mattress fits the crib perfectly.
  • Do not accept hand-me-down cribs or buy secondhand cribs.
  • Don’t use loose-fitting mattress protectors.
  • Don’t put pillows, stuffed animals, toys, or bumper pads in the crib.
  • Don’t place the crib near a heater, against a window, near any dangling cords from windows, or near large furniture.
  • Use a baby monitor if you are not sitting right nearby while your baby is in the crib.
  • Make sure there are no missing, loose or broken parts or improperly installed screws, brackets or other hardware on the crib or the mattress support.  Check the stability and hardware on the crib often. Check for loose threads and strings, holes and tears. Make sure there is no cracked or peeling paint, splinters or rough edges.

Huh. It’s almost like cribs aren’t really a safe place for babies to sleep. How come I haven’t seen any alarmist billboards about the dangers of crib sleeping? Safely bedsharing actually involves many of the same warnings: keep pillows and soft bedding away from baby, have a firm mattress, don’t have gaps between the mattress and the wall/headboard, etc. Why can’t we just let parents know the basic guidelines of safe bedsharing? A huge campaign was launched in 1994 to educate parents to put babies to sleep on their backs, and the campaign is credited with reducing the SIDS rate by 50%. Maybe it’s time for a safe cosleeping campaign.

The reality of bedsharing is that as almost 70% of American parents cosleep with their baby at some point. Why? Because there are strong benefits of cosleeping, both for the children and for the parents.

  • Babies sleep better and enjoy going to sleep more.
  • Mothers sleep better.
  • Breastfeeding is easier, rates are higher, and duration is longer.
  • Cosleeping fosters independence in older babies and children.
  • Cosleeping has positive effects on the child’s overall emotional health.
  • It is parenting. Many parents prefer to keep relating to their children during sleep.

For additional reading about these benefits, visit peaceful parenting, Natural Parents Network, and PhD in Parenting.

Instead of listening to alarmist news reports, I recommend that you listen to the research of Dr James McKenna from the Mother-Baby Behavioral Sleep Lab at the University of Notre Dame. The Sleep Lab is a research and teaching laboratory that researches the safety, physiological, and psychological consequences of parent-child sleep choices. Digging into their published articles is a goldmine, but you can learn a lot just by checking out their website:

  • “Mother-infant cosleeping with breastfeeding is humankind’s oldest and most successful sleeping arrangement.” The Western practices of formula-feeding and moving sleeping babies away from their parents and off of their backs is responsible for the SIDS epidemic. Likewise, mothers suffocating their babies while sleeping is also a Western problem that requires more explanation than simply blaming bedsharing alone.
  • Infants require continual proximity and contact with a caregiver’s body for their nutritional needs (breastfeeding) and also to promote proper functioning of their body temperature, immune system, heart rate, breathing, organ development, and central nervous system as well as their psychological and emotional development. For older children, cosleeping contributes to their “independence, social competence, feeling of high self esteem, strong sexual identities, good comportment…in school, [and] ability to handle stress…”
  • “Sleeping through the night” is a completely emotionally, socially, and biologically inappropriate activity for babies. McKenna calls it “scientifically bogus”. Babies should wake frequently in the night to breastfeed, staying in the kind of “lighter sleep” for which they are designed.
  • A breastfeeding mother is more physiologically and mentally in tune to her baby’s movements and sounds than a formula-feeding mother, and the breastfeeding baby is more physiologically tuned to her. The baby and mother in a breastfeeding dyad spend more time in “lighter sleep” that makes them more responsive to one another. Almost all bedsharing deaths involve non-breastfeeding babies.
  • Bedsharing deaths are overwhelmingly associated with other independent risk factors, notably: baby placed on ou stomach in an adult bed with no supervision, lack of breastfeeding, baby placed on top of a pillow, maternal smoking, and drug and alcohol use. This was shown in the Milwaukee report, as well, where an average of four risk factors were present.
  • If you aren’t comfortable with bedsharing, or if you’re formula feeding or otherwise can’t make the safest bedsharing environment, remember that cosleeping by having the baby in a crib or bassinet in the room with you gets the job done, too. The idea is to have the baby within sensory range of a parent. This kind of “separate surface” cosleeping is non-controversial and recommended by everyone.

The facts about formula-feeding really interested me. McKenna’s research on that was verified for a Fox6 news report. All the cosleeping deaths in Milwaukee in 2009 and 2010 up until the report were of formula-feeding babies. In the FIMR from Milwaukee, why isn’t formula-feeding listed as a “risk factor”? The Fox6 report talks about a woman who accidentally killed her 6 day old infant while sleeping with her while drunk. Why is that a “cosleeping death”?!

What’s clear to me is that Milwaukee has a serious infant death problem that highlights their larger problems of racial and income-based disparities. Why are 73% of babies dying from issues with prematurity or birth defects? And why are those deaths clustered in certain zipcodes? Putting scary images on billboards that point the finger of blame at individual parents is a lot easier than addressing economic inequalities or a failing health care system. In the Fox6 news report, Anna Benton of the Milwaukee Health Department says,

“I really don’t think that this is a problem of any specific cultural group. And I guess I don’t feel it’s the place of the health department to distinguish between different types of people.”

But shouldn’t it be the job of the health department to determine the real reasons for these deaths and to address the most important factors? In Milwaukee (and elsewhere), cosleeping deaths occur mostly in poor, black families living in what Pat McManus of the Black Health Coalition of Wisconsin calls “chaotic homes.” Addressing poverty in black communities and the substance abuse, poor health care, and difficult child-rearing choices that accompanies poverty are much harder to do than just creating mean billboards.

Members of The Milwaukee Health Department are not doing their jobs. They are cowards who are ignoring the real needs of their communities.

In conclusion, this quote from the Sleep Lab site stood out to me as the bottom line on the anti-cosleeping mania in which Milwaukee is currently leading the pack:

“Unfortunately, the rhetoric against bedsharing parents has turned very ugly, very vitriolic, negatively judgmental and condemnatory, and indeed, nothing less than threatening, of any and all bedsharing parents even when risks are minimized; and the zeal and imprecise language which is being used by many technicians involved in what is considered “safe infant sleep” campaigns is over simplified to the point that it is inaccurate, misleading, and inappropriate, and is itself dangerous on many different levels, both politically and scientifically.”