Family Matters

Controversial Posters of Babies with Knives Aim to Reduce Co-Sleeping Deaths

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Milwaukee Health Department

Babies and knives are not generally a good combination. But in the case of a Milwaukee ad campaign against co-sleeping, the startling juxtaposition of a snoozing infant nestled next to a butcher’s cleaver seems to have served its purpose: it’s got people everywhere talking.

What they’re saying varies. Some are horrified by the image, which is plastered in bus shelters, and its accompanying text: “Your baby sleeping with you can be just as dangerous.” Others think it’s exactly the kind of eye-catching message needed to jolt a city that’s already racked up nine infant deaths this year attributed to unsafe sleep environments.

“The shock that people feel from looking at the ad can’t compare to the shock that poor mothers are feeling when they wake up with a dead baby next to them,” says Judith Bannon, executive director of Cribs for Kids, a nationwide program that provides a free Pack ‘n Play portable crib to any new mom whose baby doesn’t have a safe place to sleep. “Now that’s shock.”

Where a baby sleeps is among the most incendiary of parenting choices, ranking right up there with topics like breast-feeding and working vs. staying at home. The American Academy of Pediatrics (AAP) says babies should sleep on their backs in a crib devoid of fluffy bedding, pillows or crib bumpers. But plenty of moms, particularly those who breast-feed, prefer to plunk baby in bed with them.

In some cases, such as when parents are drunk or under the influence of drugs, sleeping in bed with an infant is verboten — and few would disagree with that. But some mothers of healthy infants say co-sleeping is the easiest way to get some shut-eye and bond with baby. Even the AAP has acknowledged the upsurge in interest, specifying exactly what sort of co-sleeping is condoned. In its recent policy on infant sleep, the group advises parents to practice “room-sharing without bed-sharing,” which has been shown to decrease the risk of SIDS, or sudden infant death syndrome, by up to 50%. Putting babies in a crib, bassinet or playpen near the parents’ bed, according to the policy, “removes the possibility of suffocation, strangulation and entrapment that might occur when the infant is sleeping in the adults’ bed.”

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In an article about the revised policy, Dr. Michael Goodstein, a neonatologist in York, Pa., and a member of the AAP task force that updated the guidelines, noted that some parents choose to ignore experts’ recommendations:

“There are some barriers to changing behavior, and we know not everyone is doing everything,” says Goodstein. “All we can do is help people understand why we make these recommendations and encourage their use. We don’t have sleep police out there.”

The numbers of parents putting their infants to sleep on their backs, for example, has dropped over the years; it now hovers around 75%.

Just as some parents don’t enforce the back-sleeping guidelines, which have been shown to dramatically reduce the risk of SIDS, others believe that co-sleeping, done correctly, can be good for both mom and baby. “You should make a publicity campaign on how to bed-share properly, because cave men sure as heck did not put their babies in cribs either!” commented Franny Max, who signed a petition to persuade Milwaukee health-department officials to retract the butcher-knife ad campaign. “Babies have been sleeping with mom and dad for millennia.”

Another signer, Jennifer Erickson, agreed. “Milwaukee needs to focus on educating parents on safe co-sleeping practices…co-sleeping is far from the equivalent to sleeping with a knife,” she wrote. “Give me a break.”

Some experts believe there are safe ways to co-sleep. James McKenna, a University of Notre Dame anthropologist who is a lightning rod in the pediatric community for his promotion of co-sleeping, has assembled guidelines that include back-sleeping on a firm mattress that is tightly wedged against the bedframe. He cautions against sleeping with a baby on a couch for fear the infant could slip into the space between the back and seat, and suggests moms with long hair should tie their locks back to prevent entanglement. “Safe co-sleeping with breastfeeding is…humankind’s oldest and most successful feeding and sleeping arrangement,” wrote McKenna in an email. “If mothers’ bodies were even remotely as dangerous as these city officials ignorantly and offensively suggest when comparing mothers to inert, unresponsive  metal axe cleavers, none of us humans would be here today to object.”

But Cribs for Kids’ Bannon says for bed-sharing to be safe, babies should sleep on a mattress on the floor with no blankets and no pillows, which is something most parents aren’t willing to do.

MORE: Go Ahead, Let Your Kids Climb into Bed With Mom and Dad

This isn’t the first time Cribs for Kids, which is listed as the contact number on the Milwaukee co-sleeping ad, has courted controversy. Earlier this year, the group sponsored billboards in low-income neighborhoods in Pittsburgh featuring a hearse containing a tiny coffin and the message, “Your baby belongs in a crib, not a casket.”

Before settling on that particular campaign, the group assembled focus groups. “We showed them ads with cute babies asleep on their backs in cribs, then we showed them the shocking one with the hearse,” says Bannon. “One man said, ‘Now that I would pay attention to.'”

In advertising, it seems, the soft-sell rarely works. That’s why Gary Mueller, the adman behind Milwaukee’s campaign, decided to go the outrageous route. Milwaukee has one of the nation’s worst infant-mortality rates, at 10.4 deaths for every 1,000 live births in 2009. For comparison, New York City’s rate in 2009 was 5.3, an all-time low.

Mueller, who volunteered for the campaign in his role as founder of Serve Marketing, a nonprofit ad agency, said he decided on the edgy approach because more traditional messages about the dangers of co-sleeping hadn’t been resonating. “There absolutely was a gasp when we first presented it to the health commissioner and the mayor,” says Mueller. He got the same reaction when he ran it by a group of inner-city mothers and grandmothers who live in the zip codes where infant deaths have largely been concentrated. “They gasped too, but every person said, ‘You have to put this message out.'”

If there was any residual doubt on the part of city officials, it seems to have been allayed by an announcement last week by the medical examiner: on the same day the campaign was unveiled, a 7-week-old baby was found dead after co-sleeping with a parent.

Bonnie Rochman is a reporter at TIME. Find her on Twitter at @brochman. You can also continue the discussion on TIME‘s Facebook page and on Twitter at @TIME.