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.
