Safe co-sleeping for all babies: Do infant safer sleep boxes provide a safe and beneficial sleep environment for infants?

This study evaluates the efficacy of providing an ‘infant safer sleep box’ (ISSB) compared to a standalone cot in the same room to reduce the occurrence of modifiable risk factors associated with SIDS whilst bed-sharing, by providing observational data of mother-infant dyads using ISSBs in the parent-infant sleep lab. The present study recruited 11 mother-infant dyads who attended the parent-infant sleep lab for two overnight observations. A randomised crossover study design was used to compare the influence of allocating an infant safer sleep box (ISSB) and a standalone cot in the same room on night-time behaviour. Infant safer sleep boxes, modelled on New Zealand’s pēpi-pod are aiming to engage parents with safe sleep advice and provide a safe sleep space for infants. Participants were either allocated a standalone cot on the first night and an ISSB on the second night or vice versa. The study aimed to (1) collect observational data relating to the use of infant safer sleep boxes, (2) compare the effects of allocating an ISSB or a standalone cot on night-time caregiving and (3) to understand if ISSBs can provide a safe sleep environment for infants. The study population consisted of 10 exclusively breastfeeding infants and one formula feeding infant. The average age of infants was 15 weeks with a range of 4-19 weeks and 80% of participants reported bed-sharing at least once a week. None of the sample reported currently smoking or smoking in pregnancy. On nights allocated an ISSB the study population showed a significantly greater number of looking and touching events (p=.024) and increased maternal proximity (p=.008) in comparison to nights when their infants were settled in a standalone cot in the same room. Results also indicated that allocating an ISSB may be influential in increasing the frequency and duration of breastfeeding, reduce the occurrence of head covering events and create a safer sleep environment compared to a standalone cot in the same room for a preponderance of the study population. This study contributes to the growing understanding of portable sleep enablers as safe sleep spaces for infants who are contraindicated to bed-sharing. This study has indicated that using an ISSB did not interfere with normal infant care and may enhance parental monitoring and awareness of infants

THE UK BIRTH CENTRE POSTNATAL EXPERIENCE: ROOM FOR IMPROVEMENT?

Introduction: Postnatal care is one of the most neglected areas of maternity care and inadequate postnatal care has consequences for maternal recovery, breastfeeding initiation and continuation, and parent-infant relationships. Little is known about the experience of in-patient postnatal care for those giving birth within an alongside midwife-led unit in the UK. Evolutionary medicine has been used in the past to develop interventions to support evolved maternal-infant biology within clinical postnatal settings. This research aimed to trial an evolutionary-informed intervention (an in-bed bassinet), to improve parent-infant closeness, to facilitate responsive parent-infant care and to understand the experiences of families receiving postnatal care within a UK alongside midwife-led unit. Methods: Families (n=33) who gave birth to their first infant in an alongside birth centre in the North East of England were randomly allocated either an in-bed bassinet or a standalone bassinet for their in-patient postnatal stay. Video was used to observe caregiver-infant interactions throughout the postnatal stay and assess the influence of bassinet allocation on breastfeeding, parent-infant contact, maternal sleep, and staff presence. Of those who participated, analysable data for 31 participants was collected. Following participation semi-structured interviews were conducted with a subsample of participants (n=25) to understand the acceptability of the bassinet and gather feedback on their postnatal experiences. Results: There were no statistically significant differences between those allocated an in-bed bassinet versus a standalone bassinet for breastfeeding duration, frequency, or rate per hour. Mothers who were allocated an in-bed bassinet touched their infants significantly more than those allocated a standalone bassinet (p = 0.04), there was no significant difference in maternal or other caregiver holding, maternal sleep or staff presence. Regression analyses indicated that breastfeeding duration throughout the analysed period was associated with time spent in any bassinet (b=-0.213 (95%CI -0.40, -0.03)), prenatal intention to breastfeed (b=39.185 (95% CI 3.158, 75.213)) and maternal education (b=49.757 (95%CI 2.158, 97.357)). Reponses to the intervention were influenced by families need for rest, recovery, responsiveness, and safety throughout the postnatal period. Both bassinets influenced these themes in different ways, depending on maternal condition following birth and parental values. Overall families appreciated that the in-bed bassinet facilitated responsiveness and allowed them to closely observe their infants. The bassinets did present difficulties with parental rest and unique safety concerns. Conclusion: The results of this research indicate that the postnatal environment at the study site was hindering maternal postpartum recovery and breastfeeding initiation. Based on the results of the present study this thesis proposes the concept of ‘midwife-led postnatal care’ that upholds the philosophy of midwife-led care throughout the entire peripartum period

Digital health tools to support parents with parent-infant sleep and mental well-being

Digital technology is increasingly important in people’s lives, particularly for new parents as it allows them to access information, stay connected to peers and offers them seductive solutions for improving infant sleep and parental well-being. Digital technology has been developed to support parents in the following four ways: (1) providing digital information on infant sleep, (2) offering targeted support for night-time care, (3) managing infant sleep and (4) monitoring infant sleep and safety. Evidence on the effectiveness of these strategies is varied and there are concerns regarding the reliability of information, use of personal data, commercial exploitation of parents, and the effects of replacing caregiver presence with digital technology

Piloting Eyes on the Baby: A Multiagency Training and Implementation Intervention Linking Sudden Unexpected Infant Death Prevention and Safeguarding

We describe the coproduction, pilot implementation, and user evaluation of an evidence-based training intervention addressing prevention of Sudden Unexpected Deaths in Infancy (SUDI) for the multiagency workforce supporting vulnerable families with babies in a northern English county. We aimed in this pilot study to improve knowledge, skills, and engagement of professionals and support staff providing services for vulnerable families with increased risk of SUDI. The training intervention was co-produced by the academic team and the project Steering Committee which comprised senior leaders from the local authority, health and care sectors, and third-sector organisations, and rolled out to multiagency teams between November 2022 and March 2023. Evaluation data were collected using a post-training questionnaire, followed up by the Normalisation Process Theory (NPT) NoMAD survey issued at two time-points post-training, and interviews with stakeholders. The evaluation, conducted from January to May 2023, aimed to assess how well the multiagency workforce accepted SUDI prevention as part of their remit and incorporated SUDI prevention activities into their everyday work. Most multiagency professionals and support staff were enthusiastic about the training and their role in SUDI prevention. Fewer health professionals completed the training than expected. Forty percent (397/993) of invited staff completed the training. Our results revealed initial lack of knowledge and confidence around SUDI prevention and targeted provision for vulnerable families which improved following the Eyes on the Baby training. The proportion of nonhealth professionals rating their knowledge of SUDI prevention as good or excellent increased significantly from 28% before training to 57% afterwards. Self-rated confidence in discussing SUDI prevention with families increased significantly from 71% to 97%. Health professionals’ ratings increased significantly for knowledge from 62% to 96%, and confidence from 85% to 100%. Use of NPT allowed us to identify that by the time of evaluation, the earliest adopters were cognitively involved with the programme and engaged in collective action, while later adopters had not yet reached this stage. We conclude that effective implementation of multiagency working for SUDI prevention can be accomplished by providing clear training and guidance for all staff who have regular or opportunistic contact with vulnerable families. Our next step is to evaluate the sustainability of MAW SUDI prevention over the medium to long term and assess the responses of recipient families to this approach

Multiagency approaches to preventing sudden unexpected death in infancy (SUDI): a review and analysis of UK policies

Background Recent reviews of sudden unexpected deaths in infancy (SUDI) in England recommend a multiagency working (MAW) approach to prevention but lack clear guidance around how this might be implemented.Aims In England, local authorities commission and oversee public health services. This review examines how local authority policies address implementation of MAW for SUDI prevention to understand local variations and identify strengths and weaknesses.Methods Using a comprehensive list of all metropolitan, county, unitary councils and London boroughs in England, we systematically searched local authority websites for relevant published documents and submitted freedom of information (FOI) requests where policies or guidance for SUDI prevention had not been sourced online. We extracted data from documents using a standardised form to summarise policy contents which were then collated, described and appraised.Findings We searched the websites of 152 council and London boroughs, identifying 36 relevant policies and guidelines for staff. We submitted 116 FOI requests which yielded 64 responses including six valid documents: 45% (52/116) of local authorities did not respond. Seventeen councils shared the same guidance under safeguarding partnerships; removal of duplicates resulted in 26 unique documents. Only 15% (4/26) of the documents included a detailed plan for how MAW approaches were to be implemented despite 73% (19/26) of the documents mentioning the importance of engaging the MAW in raising awareness of safe sleep for babies with vulnerable families. Five areas of variation were identified across policies: (1) scope, (2) responsibilities, (3) training, (4) implementation and (5) evaluation.Conclusions There are discrepancies between local authorities in England in whether and how MAW for SUDI prevention is carried out. Strengths and weaknesses of approaches are identified to inform future development of MAW for SUDI prevention

The impact of breastfeeding on mother-baby sleep -- addressing popular myths

Does breastfeeding affect sleep, and does sleep affect breastfeeding? The answers to both these questions are largely ‘Yes’, however much of the relevant research is recent, and evidence-based information on the relationship between breastfeeding and sleep has not been part of the training of many clinicians or health professionals. This means that myths and misperceptions about this topic are rarely challenged and can undermine the breastfeeding goals of many new mothers. In this article, we examine twelve myths or misperceptions and the assumptions on which they are based and share the research evidence with which they can be challenged

Piloting Eyes on the Baby: A Multiagency Training and Implementation Intervention Linking Sudden Unexpected Infant Death Prevention and Safeguarding

We describe the coproduction, pilot implementation, and user evaluation of an evidence-based training intervention addressing prevention of Sudden Unexpected Deaths in Infancy (SUDI) for the multiagency workforce supporting vulnerable families with babies in a northern English county. We aimed in this pilot study to improve knowledge, skills, and engagement of professionals and support staff providing services for vulnerable families with increased risk of SUDI. The training intervention was co-produced by the academic team and the project Steering Committee which comprised senior leaders from the local authority, health and care sectors, and third-sector organisations, and rolled out to multiagency teams between November 2022 and March 2023. Evaluation data were collected using a post-training questionnaire, followed up by the Normalisation Process Theory (NPT) NoMAD survey issued at two time-points post-training, and interviews with stakeholders. The evaluation, conducted from January to May 2023, aimed to assess how well the multiagency workforce accepted SUDI prevention as part of their remit and incorporated SUDI prevention activities into their everyday work. Most multiagency professionals and support staff were enthusiastic about the training and their role in SUDI prevention. Fewer health professionals completed the training than expected. Forty percent (397/993) of invited staff completed the training. Our results revealed initial lack of knowledge and confidence around SUDI prevention and targeted provision for vulnerable families which improved following the Eyes on the Baby training. The proportion of nonhealth professionals rating their knowledge of SUDI prevention as good or excellent increased significantly from 28% before training to 57% afterwards. Self-rated confidence in discussing SUDI prevention with families increased significantly from 71% to 97%. Health professionals’ ratings increased significantly for knowledge from 62% to 96%, and confidence from 85% to 100%. Use of NPT allowed us to identify that by the time of evaluation, the earliest adopters were cognitively involved with the programme and engaged in collective action, while later adopters had not yet reached this stage. We conclude that effective implementation of multiagency working for SUDI prevention can be accomplished by providing clear training and guidance for all staff who have regular or opportunistic contact with vulnerable families. Our next step is to evaluate the sustainability of MAW SUDI prevention over the medium to long term and assess the responses of recipient families to this approach