Hi Kathleen and interested others,

Re: Sudden Infant Death Syndrome (SIDS) risk reduction and infant sleep location: Moving the discussion forward

In this article we are saying: a simple rule for infant sleep position was very effective in reducing SIDS deaths; but it doesn't follow that a simple rule for infant sleep location will do the same. Prone/supine placement is something we do TO our babies, sleep-sharing is part of a relationship we have with them — for many parents sleep-sharing reflects an important personal or cultural belief about the nature of infancy. Such beliefs are important and should be respected, not over-ridden. Bed-sharing is not what SIDS parlance calls a 'simple modifiable risk factor' -- it is a far more complicated behaviour than that (which we discuss at length in the article). It is being inappropriately addressed, therefore, in the part of public health strategy that aims to reduce infant mortality (what in UK is now called Safeguarding). Evidence that the strategies being employed are inappropriate can be seen in that they are rejected or ignored by parents, cause confusion and frustration among health professionals, and that there is a huge appetite for different strategies/information.

In places outside the US this issue is being tackled differently than by fear mongering and prohibition, by identifying and tackling things that make sleep sharing hazardous, and seeking alternative options if hazards cannot be removed. The mothers Kathleen mentions are terrified because US safe sleep messages are very blunt instruments that intend to use fear as a motivational force for compliance. We are beginning to see them creep into use in the UK, which was the impetus for this article.

What can IBCLCs do? Produce your own guidelines as a professional organisation that you can use to help women work through (pre and postnatally) to assess their own INDIVIDUAL situation regarding sleep sharing. Help them to put risks in context and to decide what they are and are not comfortable with. Offer options and alternative strategies for those who need them. Recognise that these might be temporary options to help them cope when they are vulnerable (e.g. when sleep deprived, or during postpartum weeks) or long-term options if they are smokers or have other permanent contra-indications etc. But also recognise that the vast majority of infants and mothers you work with are not at high risk, or even at any measurable risk. The 'no bedsharing' campaigns are aimed at a very different demographic where sleep sharing is ad-hoc and coalesces with many other factors to increase an infant's mortality risk. The terrified breastfeeding mothers who daren't feed their babies in bed for fear of accidentally falling asleep are the collateral damage of unsophisticated infant mortality reduction campaigns that are seeking a presumed easy fix (eliminated sleep sharing) rather than tackling the real factors underlying infant mortality.

Still couldn't say it succinctly :) but I hope what I am saying is now intelligible!
Helen

Professor Helen Ball
Director of Postgraduate Studies, Sleep Lab Director,
Department of of Anthropology, Durham University,
Dawson Building, South Road, Durham DH1 3LE, UK
T:0191 334 1602 F:0191 334 1615 E:[log in to unmask]
www.dur.ac.uk/anthropology; www.dur.ac.uk/sleep.lab
__________________________
Infant Sleep Information Source
www.isisonline.org.uk
__________________________


From: Kathleen Bruce <[log in to unmask]<mailto:[log in to unmask]>>
Date: Mon, 20 Aug 2012 20:45:50 -0400
To: Prof Helen Ball <[log in to unmask]<mailto:[log in to unmask]>>, Lactation Information and Discussion <[log in to unmask]<mailto:[log in to unmask]>>
Subject: Safe sleep

Hi Helen. I am not sure I understand what you are saying in your very erudite discussion. Can you speak more to what you would recommend to IBCLCs who deal with the moms who are 2 days out and who are sleep deprived and terrified that they will bump up against mortality in a very real and horrifying way. Thank you. Just confused....

--
Kathleen B. Bruce RN, BSN,  IBCLC
Lactnet "originator" and listmom
[log in to unmask]<mailto:[log in to unmask]>
http://www.etsy.com/shop/HeritageWoolSamplers
Lactation Resources of Vermont, Inc.
www.kbbspin.org<http://www.kbbspin.org>


             ***********************************************

Archives: http://community.lsoft.com/archives/LACTNET.html
To reach list owners: [log in to unmask]
Mail all list management commands to: [log in to unmask]
COMMANDS:
1. To temporarily stop your subscription write in the body of an email: set lactnet nomail
2. To start it again: set lactnet mail
3. To unsubscribe: unsubscribe lactnet
4. To get a comprehensive list of rules and directions: get lactnet welcome