Unless you have been living under a rock, you have heard that the Fisher-Price Rock ‘n Play was recently recalled.
…A reclining baby sleeper that rocks, vibrates, and plays music, it developed a cult following among sleep-deprived parents and has been the subject of thousands of glowing reviews.
But recently, the product has come under scrutiny for safety concerns. It’s been linked to at least 32 infant deaths, and on April 12, Mattel, which owns Fisher-Price, announced it would recall all of its Rock ’n Plays. The company is advising that “consumers should immediately stop using the product.”
“Infant fatalities have occurred in Rock ’n Play Sleepers, after the infants rolled from their back to their stomach or side while unrestrained, or under other circumstances,” a joint warning from Fisher-Price and the Consumer Product Safety Commission reads.
Pediatricians warned about this problem for years, yet were largely ignored:
[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]How many babies have to die each year just so we can keep lactation professionals happy: 10, 50, a hundred?[/pullquote]
“As a pediatrician and parent consumer, I believe it is irresponsible to promote the Rock ’n Play Sleeper as a safe, overnight sleeping option for infants. By continuing to do so, you are putting babies at risk,” pediatrician Natasha Burgert wrote in an open letter to the company in 2015. “I am asking you to consider re-marketing the Rock ’n Play Sleeper as a comfortable, portable infant seat; to be used for observed play, and as a temporary place for brief rest.”
But finally, the US government acted:
“We cannot put any more children’s lives at risk by keeping these dangerous products on the shelves,” Dr. Rachel Moon of the AAP said in a statement. “The Rock ’n Play inclined sleeper should be removed from the market immediately. It does not meet the AAP’s recommendations for a safe sleep environment for any baby.”
Now consider this:
Routine skin to skin care as currently practiced by most hospitals causes more deaths each year than the Rock ‘n Play did in a decade.
How? Through Sudden Unexpected Postnatal Collapse.
As a paper from December 2017 explains:
This sudden collapse occurs in apparently healthy term newborns soon after birth, commonly during initial skin-to-skin contact or the initial breastfeeding session…
International data show an incidence of 0.026 to 0.05 per 1,000 live births. In Australia, the reported incidence is 0.05 per 1,000 live births >37 weeks’ gestation per year. A twofold difference in the reported incidence in Australia, compared with New South Wales (0.1/1,000 live births) suggests reluctance on the part of clinicians to report cases. Failure to investigate cases by autopsy leaves parents uninformed about the cause of death and without relevant information that may affect future pregnancies.
So from 25 to 50 or more infants per million infants die each year of this condition. In the US, with 4 million births per year, that means anywhere from 100 to 200 infant die each and every year in a misguided effort to promote breastfeeding.
How do hundreds of otherwise health babies die in the hospital, often on the day of birth?
The peak incidence of SUPC is within the first 2 hours after birth, typically, the time when the mother first places the newborn skin to skin and also breastfeeds for the first time. Although many risk factors have been identified, prone positioning, first-time mother, unsupervised first attempt at breastfeeding, and parental distraction, including smartphones, appear to be primary among them.
In a recent report involving 26 cases of SUPC, 15 of the infants were positioned prone during skin-to-skin contact, 18 were born to primiparous mothers, 13 occurred during unsupervised breastfeeding within the first 2 hours after birth, and 3 cases occurred during maternal use of a cellular smartphone. Some of these (situational) risk factors are easily modifiable.
Although SUPC events are relatively rare, the clinical outcomes for these infants are devastating, with many infants dying either at the time of the event or after a prolonged hospital course. Those who survive are at risk for hypoxic-ischemic encephalopathy, which is often severe, with seizures occurring as early as 6 hours after the period of asphyxia. Despite prompt hypothermia treatment, SUPC survivors may suffer severe neurodevelopmental disabilities.
Compounding these completely preventable tragedies is the fact that the evidence that skin to skin care provides any benefits for term infants is non-existent.
Skin to skin care was originally developed as a substitute for incubators in the care of premature infants in low resource settings. It has only been studied in preterm infants.
So why has it become “standard of care” for term babies? According to the American Academy of Pediatrics paper Safe Sleep and Skin-to-Skin Care in the Neonatal Period for Healthy Term Newborns, the evidence on the benefits of skin to skin care for term infants is this:
Although not specifically studied in full-term infants, it is likely that these infants also benefit in similar ways.
In other words, there is NO EVIDENCE it has any benefits for term babies, including the benefit claimed by lactation professionals of promoting breastfeeding success.
The AAP acknowledge that skin to skin care carries a risk of death. How can we prevent these deaths? They’re not sure.
Several authors have suggested mechanisms for standardizing the procedure of immediate postnatal SSC to prevent sentinel events; however, none of the checklists or procedures developed have been proven to reduce the risk. Frequent and repetitive assessments, including observation of newborn breathing, activity, color, tone, and position, may avert positions that obstruct breathing or events leading to sudden collapse. In addition, continuous monitoring by trained staff members and the use of checklists may improve safety.35 Some have suggested continuous pulse oximetry; however, there is no evidence that this practice would improve safety, and it may be impractical. Given the occurrence of events in the first few hours of life, it is prudent to consider staffing the delivery unit to permit continuous staff observation with frequent recording of neonatal vital signs.
But I know exactly how we can prevent these deaths:
Stop promoting skin to skin care!
Lactation professionals will howl, but honestly, how many babies have to die each year just so we can keep lactation professionals happy: 10, 50, a hundred?
I agree with the authors of this paper: Sudden Unexpected Postnatal Collapse: One Newborn Death is One Too Many.
Skin to skin care is more deadly than the Fisher-Price Rock ‘n Play. The government mandated that Fisher-Price recall its defective product. It should do no less to protect newborns from lactation professionals; hospitals should end the deadly practice of mandated skin to skin care.
“It is likely?” That’s all we have for a sweeping policy of mandatory skin to skin for term infants? It is LIKELY?
It is likely that I’m pissed.
I can’t access this full text, but it doesn’t sound like that paper actually shows that skin-to-skin is causing increased incidence of SUPC versus moms who didn’t do it, just that it’s occurred during skin-to-skin, which is a thing a lot of mothers are doing during that time frame so it makes sense that cases would occur during this activity that lots of people are doing during the postnatal period. Before telling women they can’t hold their babies after birth or that a certain position is required or prohibited, including telling them that skin to skin is definitively good or definitively bad–as currently it hasn’t been properly studied, sounds like more research is needed. And it sounds like what’s really necessary is closer staff supervision during this risky time to catch early warning signs of problems.
Do you have more papers discussing this situation? I’m trying to read about it but PUBMED only shows studies, really poor studies, talking in favor of STS.
My son was a micro-preemie.
We did skin-to-skin with him starting when he was 8 days old (and the risk of brain bleeds from positioning mistakes was gone) until he was around 31 weeks and thermoregulating on his own (which we’ve been told is weirdly advanced).
Once he was mature enough to be held in a cradle hold, he really preferred it. My husband, our son and I are those people who are always warm so Spawn would often be stuck to my or my husband’s chest due to both of us sweating when it was time to remove him.
The NICU had a protocol for moms of less premature babies to do skin-to-skin – but they certainly didn’t push it because while most kids do well some kids would just crash.
I was pretty blunt in my proto-birth plan that I wanted to be handed a dried off baby who had received his antibiotic eye drops as at a minimum and ideally his Vit K and HepB shots. I’ve gotten enough amniotic fluid on me from cow births to know that I do not like the feeling of it. Protecting my kid’s eyes from newborn conjunctivitis is more important to me than pretending I want a slimy kid popped on my chest.
I used my rock-n-play knock-off, (it didn’t play music or vibrate or anything) it was basically a rocking cradle, for my son only during the day, he would take brief naps in it, but never prolonged sleeping. I never left him in it unattended. When I had to go to the bathroom or the kitchen etc. I either put him in his crib, bassinet, or on his play mat. Once he was able to start trying to sit up or roll over, about 4 months old I put it away and stopped using it. I will do the same for my daughter, As for skin-to-skin, it was not a priority for us, we kept forgetting and we never laid down, but always sat in a semi-reclined position. I would use my phone at night when holding my son and rocking him back to sleep to keep myself awake. I think the biggest problem with promoting skin-to-skin is that it pushed on exhausted parents who, though they are excited and happy to finally meet their child, they are in much need of sleep as well. For some reason the welfare of the mother is often ignored in favor of the infant, there are exceptions, but usually they are forced to do skin-to-skin for a minimum of 30 min. I lasted about five before I handed him off to my husband because my arms were tired and felt heavy. I seriously wonder what happened to common sense when it comes to parenting these days.
I put a ‘But Please Can We Not?’ on my birth plan but we will see how that goes. It is not like I can stop them, particularly if baby is still bungee corded to my undelivered placenta.
I will say that I was told that I can wear whatever I want as long as I don’t mind it getting stained so I am going in with a layered sports bra and tank top and if a nurse tries to undress me my husband has been instructed to raise a fuss.
That’s what I wore and was comfortable. Nothing was permanently stained either. They can’t take it off if you are attached to all the monitors and I didn’t care if they had to cut off my clothes if it was an emergency. I just hate hospital gowns!
I hate the hospital gown too. A nurse tried to explain to me how to keep baby’s mouth clean with glyceryn and, in an attempt to look at my nipple she raised those shitty flaps that covered my boobs without even asking. I wore a bra because as I can’t stand the feeling of heavy breasts hanging but still, it felt like I was some cow and she was checking my udder. No dignity or autonomy allowed for mums. Oh, and I was in the nursery with a bunch of people staring through the window.
That is actually my oddly specific nightmare. I am a weird touchy puritan about nudity and the idea that suddenly it is totally fine for a stranger to expose and lay hands upon previously private portions of my own personal body without my express consent is horrifying to me. I don’t even wear tops with visible cleavage ffs.
It’s not being puritan at all-it’s completely understandable. Any patient in a hospital is going to feel vulnerable in the first place, and even more so giving birth-if anything, care givers should be even more aware of vulnerability and be very conscious of the need to ask for consent prior to anything, even if its touching that is needed for treatment (like sewing bits up). Just because its something they see every day doesn’t mean that you have to lie there exposed to everyone and anyone and have everyone and anyone groping you.
I dislike the way in which nursing staff use your given name automatically-I don’t know if its the same everywhere, but the last couple times I’ve been a patient (both surgical), you’re expected to answer to your first name while they still expect to be called ‘nurse’. Using first names enforces a degree of intimacy that I’m not comfortable with, especially if its someone helping me onto a bedpan. If you prefer to have people use your first name, fine, but it shouldn’t be a default position. I don’t think its respectful or professional. When I was a real doctor (as in, seeing patients) I always addressed them as Mr or Mrs, and it was only those who said to call them by their first name that I did so.
And silly names for parts of one’s anatomy. I had a nurse come in and ask me how my “hoo-ha” was that morning. I asked her to send in a nurse who was able to use correct anatomical terms, since if she was not able to use the correct term, there was no way I trusted her ability to perform an accurate assessment.
After I had my first, the nurses kept coming in asking to check my “bottom” and I only figured out WAY later they meant my perineum. I guess I figured they had some reason they wanted to check that? IDK why they couldn’t have just said what they were actually doing.
I’ve absolutely no doubt that the lactation industry will respond to this by victim-blaming, and push for the banning of smart phones in hospital as that is obviously the main cause of SUPC as it distracts mothers from their real job of caring for their baby….
I’ve needed my phone to stay awake many times while holding my babies. Better than falling asleep and dropping them!
With regard to safe sleeping environments and cradles, we’ve been through this before, repeatedly. Roger Byard in Australia produced a load of evidence about the dangers of automated rocking cradles and chairs-I remember seeing one of his research videos years ago, he had very young infants in an automated rocking cradle and the angle of the swing caused the baby to roll face first into the angle between the base and the side, and would have led to asphyxiation (obviously being in a research environment, parent and researchers were on hand). Basically, you should never leave your baby alone and unsupervised in an automated cradle or chair. Just one of his many papers on this:
https://adc.bmj.com/content/archdischild/71/6/497.full.pdf
And drop side cribs and bumbos and nap nannies and bumper pads…all killed far fewer and over the course of many more years.
Is skin-to-skin being promoted before the baby has had all the gunk cleaned off them, and before they get the first checkup, APGAR assessment, etc?
It is in the hospital where I will be delivering. They deliver the baby directly onto your bare chest where they remain until either they have breastfed, two hours have elapsed, or there is a medical issues requiring intervention. During this time two nurses are supposed to be assigned to you and the baby to encourage latching. I assume the APGAR is done with the baby on your body but the rest of the baby checks and vit K and eye goop etc are delayed until right before you are being transported to recovery. Hep B is done on day 2
The other preggos on my hospital tour nodded approvingly during this description but honestly it sounds pretty barbaric to me. like you give the big final push, congrats you did it, now its parenting time, have you fed your baby yet because we have two people here staring at you until you latch on your baby.
“CONGRATS, YOU’RE IN THE MARINES NOW! MARINES ARE NOT ALLOWED TO FORMULA-FEED WITHOUT PERMISSION!” (in Gunnery Sgt Hartman’s voice)
What if parents WANTS the baby to be checked over, washed etc before trying to feed it? And what if she’s formula feeding?
I refuse skin to skin. I find the idea disgusting and uncomfortable. I instructed that my babies exit my vagina, be taken to a warming table, suctioned, wiped, assessed, weighed, cleared, and then swaddled and handed to me. I then kept them upright for several hours (they’re gunky and congested at birth) and their faces visible at alm times.
…I also eff and would give the first bottle within 30 minutes of birth, but after everything was settled.
In my sacred birth plan I put down that I will not be able to relax at all until I know the assessments are good and I am not surrounded by strangers. If bonding the goal then the quickest path is to do the medical stuff and then GTFO.
Unless “Bonding” is code for “Immediate breastfeeding” in which case good freaking luck.
Dang, that does sound barbaric. Forced two hours of skin to skin. At least, you have two nurses to hopefully catch the baby if you fall asleep. I loved holding my babies, but I was exhausted and needed to eat too. I even waited to feed my first until after I ate. Someone delivered take out for me shortly after delivery and I hadn’t eaten in over a day. Had no trouble with latching or bonding.
I think you can leave or at least put the baby down earlier if you nurse successfully. They are baby friendly and one of the metrics is that babies attempt to nurse within an hour of birth so I assumed that is where all this nonsense was coming from.
I put a bullet point in my birth plan that it was more important to me that my husband get the baby ASAP and I wouldn’t be nursing anyway so I figure if we do a handoff once I have agency and then one one of us busts out a nursette of RTF that should communicate pretty well our parenting philosophy.
FWIW – (was NOT a BFHI facility) My husband held baby before I did and it helped his bond with baby and certainly didn’t hurt my bond. I also requested someone else take baby after about 10 minutes of nursing/skin to skin because I was so tired/drugged I didn’t feel safe holding her. Again no harm done. And we gave baby a bottle of RTF (which she pounded) after my attempt with breastfeeding. And we sent baby to the nursery every night so I could get the sleep I needed to recover.
I definitely recommend having things in your birth plan ahead of time and figure out your allies on the nursing team, etc right away. I was really up front in my birth plan and with everyone that I interacted with and things went quite smoothly.
That does seem barbaric and also reckless. Best place for baby after birth is the warmer.
Or at least getting the placenta out first doesn’t seem like too big an ask.
And also: my baby has a father. I have been carrying her for nine months, and am likely going to be pretty wiped. Maybe giving him first dibs isn’t like the worst idea.
Teenage abuse survivor here, being bare chested and stared at for two hours sounds really &$@&dy triggering to me.
On the bare chest? This sounds so uncomfortable. I wouldn’t want to be completely naked, especially for such paternalistic reason. I was kinda naked for my c section but thank god no one tried to latch him to my boobs in the OR. I was also under a paper sheet.
That sounds horrible!
It’s really a matter of point of view though. My understanding of this policy, beyond the breastfeeding promotion aspect, was that it’s a reaction to women being upset at giving birth, and then their baby being immediately whisked away for various medical interventions, leaving the new mother alone to deal with the aftermath of birth wondering where the baby she was supposed to get out of this disappeared to.
I mean, you can really see the two sides to this – some people will be “I am alone without my baby :(” and others will be “Oh thank goodness some alone time while I need this rest”.
Like, I read it more as you give the big final push, congrats you did it, here’s the fruit of your labors – enjoy it in peace while you’re stuck here two hours anyway because we need to make sure you don’t hemorrhage.
I’m also not that bothered by the bare chest aspect – I certainly wasn’t worrying about hygiene at that point of the process.
The immediate breastfeeding aspect I’ll agree is more pressure than just being given the baby, but I think it’s probably separable from the rest of the process – if we successfully reduce the breastfeeding pressure overall, the policy could become “you can try and breastfeed now but also do it later if you prefer; your milk will likely come in either way”. However, again in my experience it wasn’t two people staring at me until I latched my baby, it was two people actively trying to help and show me how to latch said baby. Which comes with its own awkwardness, so, not necessarily going against your point there.
To be fair I didn’t actually have my baby with me for the full two hours because he had breathing issues so they took him away for an hour or so. Maybe I would have found it annoying to have the baby the whole time but I don’t think so.
In retrospect I do have issues with how I was expected to parent immediately, but for me this materialized in the day after the birth, where I could have done with a lot more rest and a lot fewer caring for baby and nurses coming in for one reason or another; those first two hours after giving birth I had no issue with and would do again.
That is the problem with one size fits all healthcare right? What works for one person might not be the choice for another. There are so many women who are so different from me and I want them to be happy and fulfilled with their experience in as much as anyone can be fulfilled emotionally by a medical event.
What I hate is that I feel rushed and steamrolled, like I am nothing but a cipher for someone else’s vision of motherhood. I am supposed to perform the role of mother instantaneously and with an audience before I even have time to process what is happening and this is supposed to be fine and normal to my sensibilities because a stranger tells me that this is what I should want.
Yes, this!
I liked having the baby put to lie on my chest while still getting stitched up from the CS; it’s not like I had a lot of other things to do anyway at the time. But after a few minutes of patting, kissing, and wondering whether the somewhat wrinkly baby face will suddenly seem beautiful once some hormones kick in, it got a bit uncomfortable and it was great to be able to hand LO off to his dad, who cuddled him wrapped in a blankie.
Why make this about X minutes minimum instead of just doing what works for the individual case? It’s not like there are so many tricky options to cover…
Yeah, I’m trying to figure out that step that goes from, “allow skin-to-skin right after birth if that’s what mom wants” to “require 2 hrs of skin-to-skin, unless breastfeeding.”
With all my kids I held them until I was ready to give them up, then they got weighed, wiped off, assessed, and swaddled up, then I held them again for a while or dad did. I appreciated being able to do that. Though when I had retained placenta after baby #2 and my midwife was elbow-deep pulling it out, it would have been nice if someone had suggested I give the kid to dad temporarily.
Another perhaps minor point re the hygiene thing: so, baby gets plopped, all wet and, um, goopy, on your chest. If it’s anything like the hospital where I delivered my three, the nurses then spend the next several days telling you to hurry up and take a shower (which I was all in favor of! I love showers! I love feeling clean!)–but while simultaneously refusing to take care of the baby so you can shower AND telling you that you mustn’t leave the baby unattended in your private room while you take a shower in the attached bathroom, through whose door the baby’s bassinet won’t fit. *facepalm*
It took me something like two and a half days to get a shower the first time around because of DH’s schedule and he apparently needing to be there while I showered. If I had been covered in birth goo for those two days on top of the gross postpartum sweatiness/two-days-sans-shower yuck, I just might’ve gone round the bend.
I did not do skin to skin with my kids. No one mentioned it and I didn’t ask to. My first was immediately put on my belly and then wiped off. I really appreciated that because I had to push for a very long time and that told me he was okay. My second was wiped off and wrapped up then handed to me. I held them for a bit, this was probably when the nurse assessed their APGAR (both got perfect scores) and then they were weighed, checked, and whatever else they do. It wasn’t like they were gone, since the warmer was just a couple feet away. I got them back diapered and swaddled and we were happy.
In my hospital, baby was placed on me immediately after birth, and stayed there while placenta was delivered and cord clamped. Then it got taken away, cleaned, wrapped and put into the warmer, and placed on me for breastfeeding after I was stitched up. Leaving uncleaned baby on bare skin for two hours sounds like a nightmare!
Actually, placing baby on me immediately after delivery sounds yucky now, but at that moment I didn’t mind because it was for a brief period and I was quite high on endorphins or whatever those hormones are which come in immediately after birth, it was quite a cathartic feeling.
You betcha! Gross, isn’t it. They tried to make me do it, but I couldn’t hold her as I was in too much pain having my clitoral artery stitched up while the nurse frantically tried to get a line in me for pain meds. ‘Cuz god forbid they ‘medicalize’ birth by routinely putting in a line just in case they need it.
They didn’t put a line in you when you were first admitted?
Yup! My daughter was a 37 weeker and was born with all the cheesy crap still all over her skin. Which ended up all over my chest during skin to skin. Good times! That stuff does NOT come off easily. 🙂
Yes, I got a lecture when I refused too. It also took them an hour to do any kind of medical care such as weighing her and putting the eye gunk on her. They didn’t wash her for 24 hours either. Next time, I am going to request that they do all of that right away except for the bath.
The whole BFHI should be recalled.