(Sigh. Is there any chance we'll ever have the option of doing proper quoting and threading when replying to a post via the Lactnet page? Oh, well, I've tried to sort the different strands as clearly as I could.)


(Pat Jacoby)
"<Well, I have a BIG problem with it.  It is conflating SIDS with overlaying.>

(Sarah Vaughan)
"It isn't even mentioning either, for goodness' sake. It's highlighting the fact that there is an increased risk there."

(Pat)
The poster reads:
"There were three in the bed and the little one said....nothing."    Underneath, it said: "Reduce the risk of Sudden Infant Death.  ...For more information on SIDS, call: "

I believe the "three in the bed" reference, with mention of "...if you have been drinking alcohol, or using drugs, implies Rolling Over.
On the other hand, smokers in the bed are associated with SIDS, not overlaying.  So there are two things being blurred together.  That is wrong.  

(Sarah)
I see what you mean, but I'm still not seeing why you think this is such a problem? 

This isn't an academic discourse, it's a public health poster. The message is meant to be that there are risks associated with bedsharing and that it's important to avoid the most risky behaviours. All three of the behaviours listed – alcohol, drug use, and being a smoker – do indeed increase the risk of bedsharing quite noticeably and should be avoided if bedsharing. The purpose is to get that message across to parents. In that context, is it really relevant that the three behaviours don't all increase risk via the same mechanism? I can't see why on earth it's 'unethical' to tell parents that all three of those factors increase bedsharing risk.

....

(Pat)
SIDS is a death of unexplained origin.  NOT a suffocation.  If is a terrible unexplained thing, so far.  But breastfeeding IS protective.  

(Sarah)
Sure. No-one here is disputing any of that. The point is that bedsharing has been found to be a risk factor for SIDS. (This applies amongst breastfeeders too – see the study I cited in the post to Lara.)

...

(Pat)
And, breastfeeding mothers don't roll over on their babies if they are sober and not under influence of drugs.

(Sarah)
I think it's very rare for sober unmedicated mothers to roll over on their babies regardless of how they feed, but that's not the only way babies can smother in an adult bed. We know that pillows, duvets, and entrapment in the bedframe/in a safety rail/between the bed and the wall are all potential causes of smothering, and that, although such deaths are rare, they still happen significantly more often in adult beds than in cots.

...

(Pat)
  Anyone else in the bed must be equally clean and sober.  And committed, as McKenna says.  No smokers in the bed.  Because of SIDS- not roll overs. 

(Sarah)
Pat, I'm honestly a bit puzzled as to what point you're trying to make here. You're saying (quite correctly) that it's important for bedsharers to be clean, sober, and non-smokers. How is this supposed to be an argument against a public health poster which makes the same points?

[...]

(Pat)
The poster is not even a small step in the right direction, in my opinion.  A MUCH better one is the UNICEF one, which says in part: "Some parents choose to sleep with their baby in bed and some fall asleep  with them during the night while feeding and comforting, whether they intend to or not.  Therefore it is very important to consider the following points." And it goes on to give sensible and familiar (to us) guidelines.  http://www.unicef.org.uk/BabyFriendly/Resources/Resources-for-parents/Caring-for-your-baby-at-night/

(Sarah)
I love that leaflet too, and it's my go-to resource for information on safe sleep - simple, fact-based, and gives good advice on bedsharing as safely as possible while still making the point that using a cot by the bed is even safer. 

But the difference here is that that is a leaflet, not a poster. They're different forms of media that need to be structured differently. A poster can't go into the same kind of detail that a leaflet can; it needs to have a relatively simple, eye-catching message. The message from this particular poster is 'There are risks involved in bedsharing; here are some important ones to avoid.'

What would you do differently if designing a poster? What slogan would you use?

...

(Pat)
So to make myself clear.  I think we do a great disservice to breastfeeding mothers when we add-in the spectre of SIDS when we warn-correctly about safe sleeping conditions.

(Sarah)
If you mean that we shouldn't be scaring them with “If you even try bedsharing your baby will DIIIIIEEEEEEEE OF SIDS”, then I quite agree. If you mean that we shouldn't even bring it up as a risk, I don't agree at all. Breastfed babies can die from SIDS as well, even though it's rarer, and parents typically want to decrease the risk as far as feasible. 

Whether we like it or not, considerable evidence now consistently points to bedsharing – even low-risk bedsharing – still being higher risk than by-the-bed cot-sleeping. Yes, I do think it is fair for mothers to know this – not in a 'RISK RISK RISK DOOM DOOM YOUR BABY WILL DIE IF YOU DO THIS' way, but as part of a sensible, realistic discussion about different risks and possible practical strategies to reduce them. This is exactly the line the UNICEF leaflet takes; it states clearly that the safest place to sleep is in a cot by the bed, but combines this with clear, non-judgemental advice on how to bedshare as safely as possible if you do do it, and a list of the risk factors that make it too high-risk to try.

[...]

(Pat)
  As Helen Ball said: "100 years of rapidly changing infant care fashions cannot alter several million years of evolutionarily derived infant physiology." 

When a particular factor has been shown to increase risk, advising parents of this isn't 'fashion'. It's evidence-based care. Sure, babies benefit from being close to their mothers at night – but the evidence does show that doing this by having them in our modern beds doesn't seem to be the best way of doing it.


Best wishes,

Sarah

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