Safe Sleep Day is on December 4 to help ensure babies sleep safely this summer. A safe sleeping advisor tells Nursing Review that nurses often have special opportunities to ask the questions that can make a difference to vulnerable families.
Safe Sleep Day on December 4 heralds the annual focus on promoting safe sleeping for babies and taking action to reduce the risk of sudden unexpected baby deaths.
To protect babies at risk of sudden unexpected deaths, nurses need to be ready to ask the uncomfortable questions about smoking and bed sharing, says a safe sleeping advisor.
Jeanine Tamati-Paratene (Kai Tahu, Te Atiawa) is a regional advisor for Whakawhetū, a government-funded SUDI (Sudden Unexpected Death in Infancy) prevention programme for Māori. Ministry of Health statistics indicate that 60 per cent of the 40–60 SUDI each year are Māori, with the combination of high smoking rates amongst mothers and bed sharing meaning Māori babies are especially vulnerable.
Tamati-Paratene says nurses should never feel uncomfortable asking mothers and whānau about quitting, as smoking during pregnancy and smoking in the baby's home is the biggest risk factor for SUDI. Or to be afraid to just ask a few more questions – and check for themselves if on a home visit – to be doubly sure that vulnerable smoking families have a baby bed; just in case the family feels too embarrassed or scared to tell the Tamariki Ora or Plunket nurse that they are bed sharing without one.
Whakawhetū facilitates the annual Safe Sleep Day, held on 4 December this year, and works with communities and District Health Boards to help reduce SUDI, provide policy advice, and share evidence-based information and resources to the health sector and Māori communities through regional workshops and online training. A primary focus for Whakawhetū has been promoting the use of wahakura (flax woven baskets) for babies to enable safer bed sharing and reduce the risk of accidental suffocation.
“Safe Sleep Day is held annually in December just before the summer 'silly season' when people can drink more and go to sleep with their babies,” says Tamati-Paratene. "If you look at the stats, a lot of SUDI happen in the middle of winter, when it’s cold and you bring your baby into bed, and they also happen at the peak of summer when people may not be making the best of decisions through maybe alcohol or drugs or simply not getting enough sleep. So we specifically have Safe Sleep Day at this time of year to keep people's awareness up and to be extra vigilant with our pēpi."
Tamati-Paratene says Safe Sleep Day also gives an opportunity to reinforce the message of what is safe sleep.
"Culturally, for Māori in particular, bed sharing is just what we've always done – we've always slept with our pēpi. It hasn't been a traditional practice to put your baby in a separate bed on the other side of the room."
Complicating the issue is the very high level of Māori women smoking. Tamati-Paratene says unfortunately 40–50 per cent of Māori women are still smoking during pregnancy and in some regions it's even higher.
She says if a woman hasn't smoked in pregnancy, breastfeeds her baby, lives in a smokefree home and is a sober mum, then even if she bed shares with her baby, the risks of her baby passing away from SUDI is very, very slim. And even if she doesn't breastfeed, as long as she hasn't smoked in pregnancy and lives in a smokefree home, the chances are still very, very small. Scaremongering about bed sharing should not be the major focus, believes Tamati-Paratene.
"The biggest risk factor is when that baby has come from a mum who has smoked during her pregnancy and then comes into a home where there is smoking.
"That's our biggest challenge in this whole safe sleep korero – supporting our women to give quitting a go and if we can't get them before they are hapu, then while they're pregnant. That becomes all of our mission really. It sits with whānau and it sits with our doctors, nurses and our midwives.
"It's something I don't believe we are doing all that effectively all the time," says Tamati-Paratene, who has previously worked with Smokefree Nurses Aotearoa managing the 'What smokers **itals**really** want' project.
"I'm not a nurse but I know how awesome they are." She also knows that those in the health workforce don't always feel confident to start those ABC conversations (i.e. Ask about smoking, give Brief advice and strongly encourage Cessation support).
Tamati-Paratene says having worked in health promotion for nearly 20 years she also knows how tough it can be to get inside people's front doors and believes Plunket and Tamariki Ora nurses – despite some of the really hard stuff they have to do – have an "awesome privilege and opportunity" to talk with whānau directly.
She advises nurses visiting a potentially vulnerable whānau to be non-judgemental and open-minded about each family's individual situation.
Informing mothers about the greatest risk factors for SUDI may also help them make good decisions about bed sharing rather than "just feeling terrified (by scary SUDI statistics) and hiding it from their Tamariki Ora or Plunket nurse".
"Some whānau don't tell the truth if they are asked whether their baby has their own baby bed. They will say 'oh no I've got a cot or a bassinet' and they get the tick in the Plunket book but actually there isn't a baby bed for a lot of those whānau, especially in our most vulnerable whānau."
She says a friend of hers, who did have a cot for her baby, was surprised when the visiting Plunket nurse just ticked the box and didn't come and have a look to check whether her cot was set up right during the nearly hour-long visit.
"I think sometimes it is not about being judgey or nosy but trusting the gut feeling and not being afraid to ask a few more questions."
Tamati-Paratene says nurses should treat time with families as a real opportunity to really support them in a practical way.
"If there is one thing you can do is never, ever be afraid or uncomfortable asking somebody (about quitting). Because they feel uncomfortable too… but they (really) want you to ask.
The more times that nurses and others ask and offer support the more likely it is that smokers will stop eventually, despite some of the hardships that might be happening in their lives.
Tamati-Paratene says a focus for Whakawhetū in the past 18 months has been its regional Protecting Our Mokopuna seminarsthat are attended by whānau, local community leaders and health professionals and are led by the 'godfathers' of SUDI – Hastings GP David Tipene-Leach and paediatrics professor Ed Mitchell.
The online training is a 'buffer' to back-up the seminars for those who can't attend and is intended for both families and health professionals with the online workshop accredited by the Midwifery Council as professional development training.
The final Protecting Our Mokopuna seminar of the year was held at Manurewa Marae on 4 December to mark Safe Sleep Day. There have also been "weave-offs" held in communities, including two held at Te Wānanga o Aotearoa's Auckland and Northland campuses on Safe Sleep Day to give all whānau an opportunity to try weaving.
Safe bed sharing options make mark?
Portable safe sleeping baskets and pods for babies, along with safe sleeping programmes, have been linked to a recent drop in infant mortality.
Earlier this year safe sleep advocate and Hastings GP David Tipene-Leach addressed a Whakawhetū Mokopuna Ora Conference about the collaborative work of the Māori SIDS (Sudden Infant Death Syndrome) Prevention Team, Whakawhetū, Change for our Children and various district health boards that led to the Safe Sleep Programme. The programme includes health promotion, family education and the supply of a safe sleep baby bed to families at high risk of SUDI (Sudden Unexpected Death in Infancy).
The latest infant death statistics to be released by Statistics New Zealand showed a 19 per cent decrease in the infant death rate for Māori in 2012 compared with the previous five-year period (2007–2011) but rates for other ethnic groups did not show change. The drop in Māori baby death rates was also reflected in the SUDI deaths of Māori infants, which dropped from 41 in 2011 to 19 in 2012. The lowest SUDI rate between 2000–2012 for Māori was 34 in 2007 and it peaked at 54 in 2000*.
"We have not introduced a new vaccine, we have not stopped smoking and we have not reduced poverty," Tipene-Leach told the conference. "The only change in New Zealand for deprived families with infants in the last five years is the introduction of 11,000 pēpi-pods, 1,000 wahakura and 500 waikawa."
*Statistics New Zealand points out that infant death numbers are small so rates can fluctuate markedly from year to year and small numbers should be interpreted with caution.
Wahakura: a traditional response to a contemporary problem
The woven wahakura baby bed is a kaupapa Māori solution to a Māori issue, says Jeanine Tamati-Paratene. It was developed by the Nukutere Weavers' Collective in Gisborne and around 1,000 of the woven sleeping baskets have been made and given to families to enable safe bed-sharing. "The wahakura still encourages breastfeeding and it still encourages the kaitiaki of the baby, be it mum, nana, papa or aunty, to have baby close to them when they sleep,” says Tamati-Paratene.
"But it just keeps baby safe whether mum has smoked in pregnancy or not and whether she has had a drink or not. It is something physical that can keep that baby safe and we know that if Māori have the opportunity to be offered a wahakura they will take it over a pēpi-pod any day as it is kaupapa Māori and a taonga that has been created by hand for them and their pēpi."
But wahakura also require talented weavers and supply doesn't always match demand, but she says Whakawhetū supports as many communities as possible to make as many as they possibly can and have been working on establishing and strengthening relationships with master weavers around the region to be wahakura champions. "It's a traditional solution to a contemporary problem."
The pēpi-pod sleep space
The Christchurch earthquakes helped launch the pēpi-pod as a low-cost, readily available and portable, safe sleeping bed for babies and families affected by the quakes.
The pod (a plastic box and bedding pack) is seen by its developers, Change for our Children, as a 'sister' to the woven wahakura promoted by Whakawhetū.
Since the quakes the plastic pod and safety education has been offered to thousands of families of babies at increased risk of accidental suffocation. Change for our Children says the pods are not for all babies but a public health response to the higher risk of sudden infant death for babies who are more vulnerable due to exposure to smoking, especially in pregnancy, being born before 37 weeks or weighing less than 2,500 grams, or in family environments where use of alcohol and drugs are prevalent. It says these babies have a predisposing vulnerability to hypoxic challenges. Places of heightened risk for babies include in, or on, an adult bed, on a couch, in makeshift situations or when sleeping away from home.