This ad and others are part of an anti co-sleeping campaign in Milwaukee, Wis. launched in Fall 2011. The campaign responds to Milwaukee’s staggeringly high infant mortality rates and aims to reduce those numbers by 2017.

The city suffers from some of the worst infant mortality rates in the world. Milwaukee ranks seventh worst among 53 of the largest cities in the U.S.

The disparities between African American and white infant mortality rates are even more startling. African American infant death is nearly three times that of the white community’s. [Retrieved from: http://www.jsonline.com/news/milwaukee/milwaukee-infant-mortality-rate-drops-overall-but-disparity-worsens-sp54t7f-148680905.html]

Angela Lang, RN, IBCLC, ANLC and co-chair of the Milwaukee County Breastfeeding Coalition (MCBC) serves on the Fetal Infant Mortality Review (FIMR) through the Racine Public Health Department.

FIMR is designed to learn what can be done to prevent fetal and infant deaths from occurring. FIMR is part of the National Infant Mortality Review.

“If we knew why Milwaukee’s infant mortality rates are so high, we would have solved the problem,” Lang explains.

But it isn’t a coincidence that all of Milwaukee’s infant deaths in 2009 and into 2010 shared one common factor: all of the babies were formula-fed, as reported by Fox 6 News Milwaukee.

Co-existence

In Wenda Trevathan, Euclid O. Smith and James McKenna’s Evolutionary Medicine,  we learn that “Infants and mothers sleeping within arms reach (co-sleeping) with nighttime breast-feeding represents the evolutionary stable sleeping arrangement…”

In fact, “Co-sleeping may facilitate a unique sensory bridge within the mother-infant dyad that maximizes the chances of optimal development…” [Trevathan, Wenda, Euclid O. Smith, and James McKenna.Evolutionary Medicine. New York: Oxford University Press, 1999. 54. Print.]

As a mother who safely bed shares and breastfeeds, I find Milwaukee’s anti co-sleeping ads insulting. But insulting already breastfeeding and bed sharing families is the least of our worries.

Lang says denouncing co-sleeping altogether does a disservice to mothers in general and the way we naturally feed our babies. She agrees it’s part of our physiology to fall asleep while breastfeeding.

Instead of respecting biology, the anti co-sleeping campaign instills a sense of fear in mothers.

“Because women are so afraid of falling asleep with their babies, they fall asleep in rocking chairs or other places that are far more dangerous to sleep with your baby,” Lang explains.

In its Guideline on Co-Sleeping and Breastfeeding, The Academy of Breastfeeding Medicine concludes, “There is currently not enough evidence to support routine recommendations against co-sleeping.”

The American Academy of Pediatrics suggests room sharing but not bed sharing in SIDS and Other Sleep-Related Infant Deaths: Expansion of Recommendations for a Safe Infant Sleeping Environment technical report.

And in Changing Concepts of Sudden Infant Death Syndrome: Implications for Infant Sleeping Environment and Sleep Position the AAP offers suggestions on how to safely co-sleep and bed share with an infant.

Instead of denouncing co-sleeping or bed-sharing, Milwaukee should focus its efforts on breastfeeding support and safe co-sleeping education.

Breastfeeding itself is protective against Sudden Infant Death Syndrome (SIDS).

However, it is important to note that breastfeeding alone will not protect infants from co-sleeping related deaths. Parents under the influence of alcohol or other drugs should never sleep with an infant. No one should smoke around children. Siblings should not sleep with infants. For other safe co-sleeping guidelines visit: http://kellymom.com/parenting/nighttime/familybed/.

In the article Bedsharing Promotes Breastfeeding, James J. McKenna, Sarah S. Mosko and Christopher A. Richard state that “routinely bed sharing infants breastfed approximately three times longer during the night than infants who routinely slept separately.”

If breastfeeding and bed sharing interlace, can one exist without the other?

Intervention

Lang highlights MCBC’s important collaboration with the African American Breastfeeding Network which serves to address breastfeeding disparities, increase breastfeeding awareness, build community allies and de-normalize formula use.

Lang says the African American population has around a 30 percent breastfeeding initiation rate compared to an overall 75 percent breastfeeding initiation rate. These dramatically low breastfeeding rates are linked to high infant mortality.

The numbers call for increased breastfeeding awareness and support within the community.

In 2011, Lang started working at Wheaton Franciscan Healthcare St. Francis, a Baby-Friendly designated hospital in Wisconsin.

Studies have found that implementation of the Baby Friendly Hospital Initiative’s Ten Steps to Successful Breastfeeding is an effective strategy to increase breastfeeding initiation rates in the US hospital setting.

Lang says the biggest contrast between Baby-Friendly facilities and other hospitals is that Baby-Friendly designated hospitals support women in their choice to breastfeed.

“There is a misconception that we try to force everyone to breastfeed,” she says.

In Wisconsin, over 80 percent of mothers initiate breastfeeding but that number plummets to about 16 percent exclusively breastfeeding at six months because too often, mothers are faced with Institutional and Cultural Booby Traps.

When Lang’s first son was born, she experienced pressure from medical staff to feed her baby formula.

“I needed to be an advocate for him against the medical professionals,” she explains.

Wheaton Franciscan recently completed their audit and Lang says that the hospital’s staff does a good job of implementing Baby-Friendly guidelines.

But Wheaton operates under different challenges.

“We don’t own our doctors,” Lang says. “So we can’t enforce trainings for pediatricians, obstetricians and neonatologists.”

That becomes a struggle especially when physicians practice at other locations not Baby-Friendly designated. Inconsistency and unfamiliarity with breastfeeding protocols means trouble for medical staff and ultimately mom and baby.

Public health concern

The AAP released a policy statement last year stating that “infant nutrition should be considered a public health issue and not only a lifestyle choice.”

Over one third of adult Americans are obese but
breastfeeding offers a 30 percent decrease in obesity over a lifetime, Lang says.“If you stop and think about that number, it is unbelievable,” she says.

The United States Lactation Consultant Association (USLCA) recently released a statement for Healthy Weight Week stating that “for the first time in years… obesity and extreme obesity among low-income preschoolers decreased slightly between 2003 and 2010.”

USLCA attributes the lower obesity rates to increased breastfeeding rates.

“…During the study period, the number of low-income mothers breastfeeding their babies increased by more than 10 percent,” the statement includes.

Like the AAP states, breastfeeding is clearly a public health issue; it affects all aspects of the community.

As MCBC and other advocacy groups and individuals continue their mission to normalize breastfeeding, our communities will gradually improve general health outcomes.

Lang was recently chosen by the Wisconsin Association of Lactation Consultants to extend her public health service. This summer, she will travel to Uganda to assist Josephine, an ILCA partner, with breastfeeding trainings.

Lang is also a recent graduate of the Union Institute and University/Health Children Maternal Child Health: Lactation Consulting Program.

Corrections made 3-25: Lang serves on the Fetal Infant Mortality Review (FIMR) through the Racine Public Health Department, not the Milwaukee Public Health Department. She also works at Wheaton Franciscan Hospital St. Francis, not Elmbrook.