Alice Ernest expresses the opinion that the increase in BF has done more to
reduce deaths from SIDS than the back-to-sleep campaign.
I can't say what has had more effect where Alice is, but here where I live
the BF rate has been basically unchanged for 100 years, with nearly 100%
initiation rates and except for a short period (1960-70), continuation rates
have been uniformly high throughout the last century, with at least 40% of
mothers still BF at one year today.
Norwegian mothers were universally instructed to place babies prone for
sleep, until the early 1990's, about a year or two AFTER the back-to-sleep
thing started in the UK.  Deaths from SIDS were HALVED in the first year of
the campaign in Norway and have stayed at the new, dramatically lower level
ever since.  There seems little doubt that sleeping position has had an
advantageous effect.  This is a small country with just over 60 maternity
wards, all public and most of them the only ones in their areas, where
recommendations to HCPs from the national authorities are easily implemented
quickly.  We have been practically ordered to recommend sleeping in the
supine position from birth onward or risk disciplinary action from our
licensing bodies.
There are indications that co-sleeping has increased in the same time
period, without a concurrent rise in SIDS deaths.  But we don't really know
how many Norwegian mothers have slept with their babies, as this is not
something we have kept statistics on.  The BFHI here encouraged co-sleeping
as a way to make BF easier so we *think* there may be more of it going on
now than before, but we just don't know.  We don't know how many did it
before, or how many now.
It is worth noting that no one has ever raised doubts about the dangers of
waterbeds for infants (that is, we KNOW they are hazardous), nor of
co-sleeping on a sofa, as there has been shown to be a real risk of
squeezing the baby between an adult and the backrest of a sofa.  Gitte's
point about BF mothers never turning their backs on their babies is also a
good one.
No one has mentioned parental smoking as a risk either.  It has been shown
that babies who co-sleep with smokers are at increased risk for SIDS
compared to smokers' babies with their own beds, and this risk is further
increased greatly if the baby is artificially fed.
I don't find it confusing to distinguish between BF and artificial feeding,
nor between smoking and not smoking, and most parents don't either.
Babies shouldn't share beds with smokers, but smokers would do better by
their babies to at least breastfeed them to mitigate some of the dangers
their tobacco habit poses to their children.
But why should we use scare tactics to prevent all the other parents from
practicing safe co-sleeping?  For example, if a baby is apparently healthy
at one check-up and then dies a short time after having a DPT, HCPs don't
immediately start warning everyone not to immunize their children.  There is
no more reason to warn against safe co-sleeping practices.  We have a
responsibility to look at the evidence, as Heather Weil pointed out, and
parents are ultimately responsible for the choices they make for their
babies.  How sad that we don't share with them what they need to make those
choices well-informed ones.

Rachel Myr
Kristiansand, Norway, where the smell of almond macaroon pyramid cake
permeates my home today, and any of you who drop in for New Year's will be
gladly offered a taste!

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