Monday
Nov142011
Fun with Analogies: Co-Sleeping and Knives, Car Travel and Guns
Monday, November 14, 2011
The City of Milwaukee Health Department wants to tell you that co-sleeping is like letting your baby sleep with a sharp knife . They are sharing this news via two new posters (one with a black baby one with a white baby) that tell parents that babies can die when sleeping in adult beds and that warn parents to always put their baby to sleep on its back in a crib. They also give a phone number for people to call if they cannot afford a crib.
I've been over this before. Statistically, co-sleeping is as dangerous as traveling by car (really, read the stats). But the health authorities ignore that. When I wrote about this previously, I said:
But since the City of Milwaukee likes its analogies in visual format, I thought I would help them out by creating an equivalent poster with the message that taking your baby in the car is just like giving your baby a loaded gun to play with.
The idea that crib sleeping is always a perfectly acceptable alternative to co-sleeping is laden with as much societal and cultural baggage as the assumption that walking is always a perfectly acceptable alternative to travel by car. Sometimes it might be, but often it simply isn't. Health authorities need to stop scaring and shaming parents and instead teach them about the pros and cons of different sleep options and about the things that they can do to make their chosen sleep environment as safe as possible.
More info: Co-Sleeping Safety
I've been over this before. Statistically, co-sleeping is as dangerous as traveling by car (really, read the stats). But the health authorities ignore that. When I wrote about this previously, I said:
Cars are convenient. People like cars. Peoples lives would be changed significantly and we would have to drastically change our habits to give up cars.
Bed sharing is convenient. Parents and babies like co-sleeping. Parents would be more tired, breastfeeding rates would be reduced, and parents would be less responsive to their infants at night if they had to give up bed sharing.
Bed sharing is a reality. Parents do it. Banning it or discouraging it is as ridiculous as trying to ban or discourage car travel.
If people stopped traveling by car except when it was really necessary, there would probably be more accidents and more deaths because the roads would be full of inexperienced drivers. And when parents are generally discouraged from sleeping with their babies and then bring them into bed when really desperate, there are more accidents, more deaths.
The Ontario coroner should stop telling people not to bed share and instead tell them how to make bed sharing safer. Public health agencies don’t tell people not to travel by car, instead they tell them to use seatbealts, use car seats, drive the speed limit, don’t use cell phones while driving, etc. Address the conditions that make bed sharing unsafe. But don’t tell people not to do it. Because they will. And they will do it unsafely.
But since the City of Milwaukee likes its analogies in visual format, I thought I would help them out by creating an equivalent poster with the message that taking your baby in the car is just like giving your baby a loaded gun to play with.
The idea that crib sleeping is always a perfectly acceptable alternative to co-sleeping is laden with as much societal and cultural baggage as the assumption that walking is always a perfectly acceptable alternative to travel by car. Sometimes it might be, but often it simply isn't. Health authorities need to stop scaring and shaming parents and instead teach them about the pros and cons of different sleep options and about the things that they can do to make their chosen sleep environment as safe as possible.
More info: Co-Sleeping Safety
Reader Comments (135)
just in a crib? while they were at it, couldn't they at least bring up the dangers of venetian blind strings, heavy art and weak nails, overly fluffy comforters, and smothery stuffed animals? used/thrift cribs with too-wide slats? mattresses that don't fit tightly?
the knife ad made me laugh, but yours is great, too. ;^)
Wow. That's an extreme image! You're smart to point out that people are going to co-sleep regardless, and I think the car analogy is poignant.
None of these campaigns seem to address the reasons people co-sleep in the first place. Sure, some people adopt co-sleeping as part of their initial parenting plan (and since they plan for it from the beginning, are probably more likely to know how to do it safely). But if someone is co-sleeping because they are too physically exhausted to listen to a baby in a crib scream any longer, have to work in three hours and simply HAVE to sleep, or have tried everything they can think of and get a baby to sleep anywhere else, then telling them "always put your baby to sleep on his back, in a crib" isn't really all that helpful. What if you can afford a crib, but can't afford trying to function on no sleep?
Well said.
I really think they should just be more specific. Co-sleeping with your baby is like putting them to sleep with a knife IF you are a crystal meth addict, a narcoleptic, a drunken lout, a Restless Legs Syndrome sufferer or Charlie Sheen. Who is all of the above.
Oh you said it so well! That campaign is so freaking ridiculous! It's a weird subverted agenda they are trying to push and I'm so happy to hear your voice speaking with such eloquence about the nonsensical aspects of it all. Your image and poster is great!
It's too bad babies can't read those posters, they don't seem to get it that in the modern era, they aren't supposed to want to be close to their parents at night, that it's actually dangerous :P
I tried "on his back in a crib" for 17 months with my first and was a walking zombie until one night I pulled the mattress OUT of his crib and slept on it with him on the floor of his room (oh wait, but I wasn't actually supposed to RESPOND to his waking, at least, that's what my pediatrician told me, I guess it was my fault he wasn't sleeping well after all.) After that, if he wanted to sleep with us, we let him. If we'd done it sooner, we'd all have gotten a lot more rest.
Ha!
It is very important to note that Milwaukee has an extremely high infant mortality rate, higher than that of many developing countries. 10-15% of those deaths in 2010 were attributed to unsafe sleep environments. It could be argued (as you've done here) that they are going about it in the wrong way, but at least they are trying to do something. And it's much easier for billboards, soundbites, etc. to have a short, clear message. You can't blame them for trying to tackle a huge, huge issue in their city.
It would be interesting to know what the formula-feeding rates in Milwaukee are.
Seriously? This is fear-mongering at its highest.
I am deeply offended by the knife ad. Obviously they're going for a shock effect. It irritates me when I read about how "bad" co-sleeping is presumed to be by the authorities. In many cases they state facts that have little to do with co-sleeping itself... like, parents who are intoxicated and passed out with an infant on a couch or putting heavy bedsheets on an infant. To me, these are not specific issues to co-sleeping.
People seem to forget that we don't know what causes SIDS...while there was a correlation between stomach sleeping and SIDS one does not cause the other (just ask the number of parents who lost their babies to SIDS who never co-slept or slept on their stomachs). Not to mention that these articles never address the other risk factors associated with SIDS research (low birth rate, parents who smoke, etc).
http://city.milwaukee.gov/breastfeeding
it doesnt give exact % but it says the rates for breastfeeding are MUCH lower
Thank you for this! I live in the metro Milwaukee area, and I have coslept with both of my girls. I am currently nursing my 13 month old. I am very disappointed about the message that they are sending to the women in Milwaukee. They should be teaching women how to safely cosleep.
Thanks for finding that! I'm not surprised.
Perhaps, given the studies that link breastfeeding with decreased SIDS rates, instead of attacking co-sleeping, Milwaukee should work on increasing breastfeeding.
From what I read off the site they are also trying to increase breastfeeding in the area. I dont know about any of you other cosleeping mamas...but when me and my little one tuck it at night "yes" in the same bed....i dont have a whole bunch of fluffy pillows, or fluffy blankets...and my child does NOT sleep on their stomach as this picture so clearly depicts.....I have one arm above my childs head and my knees are tucked up underneath his, my other arm is used to make sure the blanket we have is situated quite far from his face....but maybe thats just me
Wow. Just wow.
Did you see on the Milwaukee gov't website that parents who can't afford a crib may be provided with a Pack n'Play? Are they even regulated items?
Man who brought the knife to a gun fight.
I do not mean to defend this campaign but I am trying to figure out what they were thinking when they decided on this campaign. Perhaps, it wasn't totally directed at co-sleeping but directed at parents who use a regular bed for their baby because they do not have a crib or room for one. As a social worker and maternal child nurse I have seen families that have limited beds for many family members so their baby may be sleeping wherever there is space available.
My response to such a campaign would be to educate parents about safe sleeping for infants, this should be included along with feeding options and help with breast feeding, bathing and general baby care. Nurses try to give new parents a lot of information before leaving the hospital...car seat safety has been on the agenda for many years now...safe infant sleep should be put on that agenda as well but not with a poster like the one used in Milwaukee.
I think that social and healthcare family workers try to be non-judgmental but this kind of poster to me is directed at the lower socioeconomic population and it speaks volumes...lets use scare techniques rather than education.
Thanks Annie for this thought provoking post. There is still so much to be done in maternal and child care.
thank you for your constant vigilance, insight and critical discourse on all matters relating to conscientious parenting! your articles are so thoughtful and so articulate! i never believed in bed sharing until i had my now 5 month breastfed daughter - she is in a co-sleeper now, but those first few months of bed sharing were so beautiful and so important to my sanity, her security, and our success as a breastfeeding pair. i cried after i took her into my bed, thinking i was doing something wrong. then i realized that mother knows best. thank you soooo much for your site!
Is Milwaulke having a huge problem with babies dying while co-sleeping? I don't know what the stats are, but I would think they were going for shock factor with these ads just like all public service ads are. Just playing Devils Advocate, but if they are having a huge problem with this, then maybe that's why they started this campaign. By the way, I am currently cosleeping. Have at one point or another with all of my children.
Thanks! I really did laugh out loud!
Your ad is particularly apt cause from the way it looks to me, that kid isn't strapped into the car seat correctly either. If s/he is rear-facing, the harness strap should be at or below shoulder level (looks like they're above from the way it goes up over the left shoulder), the harness straps should be tightened more and the chest clip straightened, and no after market products (head cushion) should be used. Just sayin'.
And if s/he is forward-facing, she's too young.
WORD.
Hear, hear. Those ads are so offensive. Cheap shock tactics and fear-mongering. What is healthy about this North-American notion of leaving a tiny little baby in a room all by him or herself, feeling abandoned and alone. Babies need to be held. Period.
I agree that what they're doing is utterly ridiculous, but I think I know why. Co-sleeping *can* be dangerous, but only when other factors come into play - drugs, alcohol, smoking. Telling people not to drink, smoke or do drugs is rather like banging your head against a brick wall. Telling people not to co-sleep is new and shiny and could, overall, actually save lives when the boring old drink/smoke/drugs ads have failed.
It's using a mallet to knock in a drawing pin - whoo! Analogy! - but you can kind of get the intention behind it.
I don't co-sleep because I have a BMI of 32 and suspected sleep apnoea. I feel that, because of that, I am probably higher risk when it comes to doing some harm while co-sleeping. Nobody has ever told me that's a problem, but to me it makes sense that it would be. There's your trouble, as you say - just not enough information.
Milwaukee has a major issue with babies dying and it isn't from co-sleeping - they should focus on THIS, which has been identified as a crisis so major my understanding is the CDC has gotten involved: http://www.cuph.org/projects/ses-and-race/ "Infant mortality and poor birth outcomes are major public health issues in the United States that disproportionately affect African American families. Among 42 reporting states for the years 2003 to 2005, Wisconsin had the second highest African-American infant mortality rate at 16.4 deaths per 1,000 live births, approximately 3 times the rate for Wisconsin whites.1 The City of Milwaukee, home for over half (63%) of the African-American population in Wisconsin, experiences similar racial disparities.2 Between 2003 and 2007, Milwaukee’s African-American infants were 3 times more likely to die within their first year of life than white infants, with infant mortality rates of 16.2 and 5.1, respectively.2 These racial disparities have remained consistent over the past 15 years.3 In 2007, the leading cause of African-American infant deaths in the City of Milwaukee was disorders related to low birth weight and preterm birth.2 From 1993 to 2006, African-American women were 3 times more likely to have low birth weight and preterm infants than white women.3 In a study examining health outcomes in the City of Milwaukee by socioeconomic status (SES), the authors found that health disparities existed among all SES groups; in particular, the Lower SES group was 1.9 times more at risk than the Upper SES group of experiencing an infant death, with IMRs of 14.5 and 7.7, respectively.4"
Love your ad! And of course I agree, education on safe co-sleeping (and while we're at it properly defining co-sleeping and bed-sharing) is the right way to go about this.
Just to add a data point, I have a BMI of, I don't know, way over 32, and have bed-shared with no worries. I don't have sleep apnoea, though.
See my comments below. Milwaukee has crisis level racial disparities for infant mortality. While I appreciate their efforts to do something, this campaign is not going to address the true underlying issues, which have nothing to do with co-sleeping.
I think that's pretty typical of how bed-sharing looks. It is the safe way after all.
This info is very interesting...the disparity of death rates related to SES would make sense based on the low birth weight and pre-term birth. We are discussing a complicated issue here which is not necessarily related to co-sleeping but a whole myriad of factors that lead to an infant's death in the first year of life.
This is still not an excuse for Milwaukee's poster campaign.
Hmmm, so they should make their PSA's more like if you don't eat an apple a day it's like eating a knife? Get to work on that PSA for Milwaukee ;). Someone must think that this is why all these babies are dying and then threw a whole lot of money at it. PSA's are meant to be shocking and catch people's eye. While it's an absurd analogy and instead of offering free cribs they should be offering education it's not entirely a bad thing to warn people about the possible dangers. And again, I do co-sleep, but I don't drink, do drugs, and I'm a pretty light sleeper. I do think someone's heart was in the right place here. Maybe someone who lost a child to co-sleeping?
Co-sleeping is actually much SAFER than driving. Ie: the number of children under 1 who die in car accidents in the US each year is much higher than the number of who die from co-sleeping deaths.
Death under 1 year is also associated most highly with pre-term delivery, lack of pre-natal care, and low birth weight.
Want to help the babies of f Milwaukee? Give their teenage mothers mandatory sex ed, free contraceptives, free pre-natal and materal health care, breastfeeding support and substance abuse counselling ( including smoking cessation help). I promise you you will save more babies.
But that costs more than scary posters.
I have Restkless leg syndrome and have co-slept peacefully with my daughter for over 2 years. RLS is not a contraindication for co-sleeping.
In Ontario, they only classify a death as SIDS if it happened in what they consider to be a safe sleep environment (on back in a crib with nothing but a fitted sheet and no smokers in the house) and they have no other explanation for it (i.e. no medical conditions). No bed sharing death would ever be called SIDS because they assume that bed sharing is dangerous and it is therefore the cause of death.
Jenny:
I hope you will express your disappointment to the officials in Milwaukee. They need to hear from people who live there that this is not okay.
100% agree with this. But... plenty of teenage mums are doing a brilliant job, and plenty of mothers in their twenties don't seem to be. How do you identify at-risk households, and how do you help people who refuse help?
Monica:
Even if they do have a big problem with co-sleeping deaths, I don't think this is the way to approach it. If they had a huge problem with fatal car accidents, they wouldn't warn people not to drive. They would remind people to wear seatbelts, not drink and drive, obey the speed limit, etc.
Becca:
I've never seen an infant sleep campaign that focuses on not drinking, smoking or doing drugs if you are sharing a bed with your baby.
Grrrr.....
It's one thing to do put together so inflammatory as a baby sleeping with a knife, but they photographed the baby in an UNSAFE co-sleeping environment as it was. All those fluffy pillows, that comforter. Sigh.
The Milwaukee Health Department should check the statistics. They have it backward. Cosleeping is safer than sleeping alone. They should start with this article from drmomma.org called "How the Stats Stack Up: Cosleeping is Twice as Safe" http://www.drmomma.org/2009/09/how-stats-really-stack-up-cosleeping-is.html
I agree that someone's heart is probably in the right place, but they obviously didn't do their research. My guess is that it isn't a parent who lost a child to co-sleeping. It is probably a public health official/coroner who sees the dead babies and whose own baby slept happily in a nice crib.
I think health departments all over the country must have just gone to a conference where they hammered co-sleeping as the evil of all evils. Pittsburgh's health dept is trying to get all the home visiting agencies to have a *NO CO-SLEEPING POLICY* where all mothers are told co-sleeping is NOT ALLOWED. Apparently, Pittsburgh has the highest infant mortality rate in the nation, among African-Americans. And the numbers they are trumpeting as the reason for this anti-cosleeping binge? 20 "sleep-related" deaths. There are 15,000 babies born in Pittsburgh every year. THIS IS NOT A PUBLIC HEALTH EMERGENCY. Not to mention the fact that the "sleep-related deaths" include several incidents that have nothing to do with co-sleeping (babies on couches, etc). They don't give detailed enough information about the causes of those deaths, and then jump on co-sleeping as the boogeyman.
I would bet my life that none of those 20 deaths were to breastfed infants intentionally sleeping with their mothers.
I work in a community-based doula agency, and our clients are exclusively very low income and generally medically under-served. I see the community first-hand. As a previous poster said, these deaths are not caused by co-sleeping, and berating mothers about co-sleeping is not going to change anything. The root cause is poverty and racism, and until that is addressed, there will be an enormous chasm of mistrust and misunderstanding between the do-gooders who have no clue, and the people they are trying to "help."
No, but then why would they bother making them? We've heard the alcohol/drugs/tobacco message so many times now that we're immune to it, even when it's tied in with more emotive images. Cigarette packets in this country have pictures of ICU babies, corpses and tar-laden lungs on them, and yet people still buy them.
Our local authority has that policy, too. The health visitor, who attends all accidental child deaths in the area, said that she does not agree with the policy, and that every single SIDS case she attended had smoking paraphernalia in plain sight at the time of the visit.
Funny how I raised my kids to ages 4 and 6 with co-sleeping and we're all alive today.
Want to talk about dangers in childhood? Howe about....artificial food colouring in candy...or a regular diet of fast food. Driving them every where, even to a playdate walking distance from your house. Or shall we talk about how essential it is sending a 3 year old to full day Kindergarten because that is the only place where they will learn?
Pff....
I have four kids, and I did modified co-sleeping with the younger two. My husband and I had spearate rooms at the time because he worked the night shift, so I brought the baby to my bed any time she woke after 3 am. I am a heavy sleeper in the first part of the night, so I wanted that rule for safety. I had a firm bed and kept the house warm so I only needed blankets on my feet. In other words, I did just what you ar talking about: I mad co-sleeping safer and did it anyway.
I do think that part of our cultural paranoia on this issue grows from our shrinking family size. Urging parents to endure the sleepless nights of infancy in the worst way possible is something we culturally tolerate because we expect people to only have one or two infants. If the cultural norm were still large families, and multiple infancies took up twenty years of the parent's life, it would be much harder to convince them that good parents were willing to wake every hour for a back-sleeping crib baby "for the baby's safety."
Funny ad. I think they're trying to do the right thing. People who believe something advocate for it, so they're not dumb or doing a disservice; they're actually trying to do a service. According to their stats it's dangerous, so that's why they're advocating against it. I'm sure that, with training and thoughtfulness, it's super safe to cosleep. Also, Annie's stats in another page say that under 9 kids die per 100,000 from sleeping with an adult. I don't know how that is per incident, but I can guess that the odds are still amazingly low for any particular incident, so the overwhelming good bet is that the baby will survive.
Simply repeating weird stats like "Hey, I had 6 kids and they're all alive" or "out of all kids very few died" doesn't really say anything. Neither of course does "Sleeping in a big bed is like sleeping with a knife." I wish someone could dig up real information, or explain how the kids die. To that end I looked at the study you quote from the coroner of Ontario, and it looks like the main objection is unsafe sleeping environment, which mainly means anything that a baby could fit into or get suffocated by, like the gaps between a bed and wall, big heavy bedding, etc. Totally doesn't seem like they're targeting co-sleepers, just the unsafe sleeping environment. I guess most of the under 12 month deaths happen in an unsafe environment. Obviously the parents who have a safe environment aren't in those stats, and neither are those with an unsafe environment but whose children survived (and so many more did survive than died). Anyway, the message is sleep safely because babies die by getting suffocated in beds.
In the meantime, I don't know why everyone is so against a group of people who are trying to do a good thing, according to their best knowledge. If you can do it safely then advocate that, but why always jump on the people who are trying to do good?
I'm against these ads because I think scare tactics and telling people they "should never" are not an effective way to get a message across. As someone said above, people still smoke even knowing the consequences. People will look at these ads and say, "Pfft, as if. I'm not a careless parent. I'm going to do what I want." The message is just way over the top. Now, an ad campaign that said, "Co-sleeping is beneficial to mothers and babies. Learn how to do it safely," would probably get a lot more people to change their sleeping environments to make it safe.