Back in 2011, the University of the Sunshine Coast piloted a new program that aimed to prevent infant deaths associated with suffocation – and with good reason.
According to a new report that details the program’s success, Queensland has a 30 percent higher infant mortality rate than the rest of Australia, and Sudden Unexpected Death in Infancy (SUDI) is the leading category of death after the first four weeks of life.
SUDI is a broad term that includes sudden infant death syndrome (or SIDS) and fatal sleeping accidents.
SUDI relates to infants under 12 months who die suddenly and unexpectedly, typically during sleep and where the cause is not immediately apparent.
An infant’s vulnerability to SUDI includes smoke exposure, low birth weight, mothers under the age of 20, remote locations, social vulnerability and substance and alcohol use.
UniSC Professor of Nursing Jeanine Young said the report confirmed “that sleeping in unsafe circumstances was a factor in almost every death in this category between 2013 and 2016”.
The good news
Central to the USC’s program is the ‘Pēpi-Pod”, a portable infant bed which creates a zone of physical protection for a baby within a shared bed or “other risk location” such as a couch.
Professor Young said these purpose-designed sleep spaces “are supplied to expectant and new mothers along with personalised education about infant breathing and safe sleeping strategies”.
The new report, by the Queensland Paediatric Quality Council, the USC and the University of Auckland, is an analysis of the Pēpi-Pod research program.
The report’s key finding is a happy one: Queensland saw a 22 percent reduction in the state’s infant mortality rate from 2014 onwards – “which aligned with the program’s expansion into maternal and child health services across various geographic regions”.
In other words, as the program moved from a pilot to a broader reach, the mortality rate was seen to drop.
The report also found “an astounding 75 per cent reduction in the infant mortality rate in areas of the state’s west and far north with the highest level of community participation in the program”.
A causal relationship between the program and the reduction in deaths isn’t claimed but, as Professor Young observes, “the timelines and locations of infant mortality reductions indicated very strong associations”.
Funding issue
Given this apparent success, and “the very positive feedback from participant families and health care workers”, USC is seeking “immediate funding for statewide implementation to save more Queensland lives”.
The report asks that government funding be expanded over eight years, “alongside real-time evaluation of its effects on the health and safety of infants under six months old”.
Professor Young said that since the USC research finished in 2018, the Pēpi-Pod Program had continued only on an ad hoc basis in communities with support from non-government services or philanthropists.
“The potential benefits are enormous, given that Queensland recorded 15 fewer deaths a year during this study, compared to an average of more than 50 each year,” she said.
“The cost of this intervention – about $1.4 million a year – would be extremely modest compared with what our Australian society has said it is prepared to pay for each life saved.”
More than 900 Queensland families in priority areas have so far participated in the program.
Research has found a much higher SUDI rate in Aboriginal and Torres Strait Islander families.
Some questions
The New Daily sent Professor Young a number of questions by email. We assumed the program simply targeted parents who sleep in the same bed as their babies. It’s more complex than that.
Smoking seems to be a key issue in this program
The Pēpi-Pod Program specifically aims to decouple vulnerable babies who have been exposed to cigarette smoke and shared sleeping as the risk of shared sleeping with a smoker has been reported as between 10-33 times higher.
Infants who are exposed to cigarette smoking during pregnancy are more vulnerable to suffocation as they have a reduced arousal response as they have developed in a reduced-oxygen environment.
Cigarette smoking causes vasoconstriction of blood vessels leading to the placenta – reducing oxygen and nutrients – which is also why infants exposed to cigarette smoking are often born at a low birth weight and/or prematurely.
Isn’t shared sleeping risky?
Shared sleeping (on the same sleep surface) in and of itself is not necessarily dangerous, it is the context in which it occurs – we have been sharing sleep for thousands of years and many cultures around the world continue to do so.
Our Queensland Infant Care Practice Study (involving 3341 families) showed that 75 per cent of parents had brought their baby into bed at some point in the first three months of life.
This is a very common practice particularly for breastfeeding families, and shared sleeping is particularly valued infant care practice by our Aboriginal and Torres Strait Islander families.
Importantly, our study showed many families choose to share sleep but also that many families (57 per cent) may not intend to share sleep, but end up falling asleep with their baby.
So simply saying don’t bed-share is not effective in helping families create a safer sleep space.
However, shared sleeping is associated with an increased of sudden unexpected death in infancy in some circumstances. Evidence suggests that these hazardous circumstances for shared sleeping include:
- With parents who smoke
- With parents affected by alcohol, substances or sedating medication
- When an infant is less than three months
- When an infant was born preterm or with a low birth weight
- When sleeping with baby on couch/sofa.
Is the program targeted at Indigenous communities?
In Australia, in the first instance the program partnered with Aboriginal and Torres Strait Islander communities through non-government Aboriginal-controlled health services, and government maternal and child health services which provide maternity and child health care to families.
These communities had identified that interventions that were culturally respectful of infant care practices that were valued by First Nations families should be a priority.
Portable sleep spaces are not new to First Nations families – the Coolamon and woven baskets have been used by Australian Indigenous peoples, like the traditional porakaraka and the introduced Wahakura baskets used by Maori families in NZ.
While this program is very relevant to the First Nations community due to its cultural value of shared sleeping – also higher rates of smoking, higher rates of prematurity and low birth weight and poorer access to health services – education about protecting a baby’s airway as they sleep is relevant to every family of a new baby.
The language used in the education program equips parents with knowledge to protect babies and asks them to take a role in sharing their knowledge in their own social networks.
