On the first day of September in 2007, Renée Walker woke up with her two toddlers and her 4-month-old, Tayiana, in a friend’s apartment, on an air mattress she and her children all shared while bouncing among homes in the Sacramento area.
Walker had woken up early, excited because she’d be feeding Tayiana her first warm bowl of Cream of Wheat. She headed to the kitchen, leaving the infant in bed with her siblings. As she prepared the meal, she cooed to Tayiana in her usual way, expecting groggy baby babble in response.
“As I’m pulling the cereal down I look into the room and I’m saying, ‘Tay Tay, wake up,’” Walker said. “And I looked at her, and she did not look herself. I dropped the cereal, I ran to the room.
“I just jumped on the air bed – the air bed moved and she just stayed. She was gone.”
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Walker is among dozens of African American women in Sacramento County who have lost their children to sudden unexpected infant death in recent years. Black babies in Sacramento County were about five times more likely to die in their sleep than white babies between 2010 and 2015, according to a Sacramento Bee review of California death certificates. They were about seven times more likely to die in their sleep than Latino babies. No Asian babies died during sleep in Sacramento County during that period.
Between 2010 and 2015, nearly half of the 79 infants who died during sleep were African American, the analysis found. During that same time period, African Americans made up just 11 percent of the child population.
Across California, black babies also are much more likely to die in their sleep than white, Latino and Asian babies, according to the U.S. Centers for Disease Control and Prevention.
These “sudden unexpected infant deaths,” as medical groups have coined them, occur during sleep and often without witnesses. Though for decades such deaths were considered random and unpreventable, doctors have changed their tune in the last decade, noting that most of the deaths occur in unsafe sleeping environments.
Public health officials now recommend that parents lay babies down alone, on their backs, in cribs bare of anything except a tightly fitted sheet to reduce the risk of sudden unexpected infant death. Though the guidelines are clear, they haven’t made their way to many of Sacramento’s African American families, said Dr. Ethan Cutts, a Kaiser Permanente pediatrician.
Cutts is one of two dozen community leaders taking part in a special committee spearheading Sacramento County’s effort to address mortality rates among African American children that for decades have outpaced child death rates for other racial and ethnic groups. Sleep-related deaths are among the key factors driving that disparity, according to both The Bee’s review and a 2012 county study.
Often without realizing it, families are putting babies down in an unsafe environment, Cutts said. That could mean on a mattress shared by multiple children and adults who might roll over the baby, in a room with smoky air that hurts the baby’s lungs, or even in a chair or car seat if mom can’t afford a crib.
Over the next four years, the committee will use millions in county funds to launch an educational campaign, through hospitals, churches and clinics, to prevent parents from putting infants to sleep in adult beds, laying them down in bedding that could suffocate or strangle them, or “overdressing” them in a manner that dangerously elevates temperature.
“(People) may not have an understanding of what it means to sleep safe,” Cutts said. “We have decades of cultural feeling about (sudden infant death) that think it’s unpreventable. Now we’re having to change generations of feeling ... and that’s difficult.”
The bed-sharing debate
When an infant dies suddenly and unexpectedly, medical examiners usually classify it as a sudden unexpected infant death. They also may use the term sudden infant death syndrome, or SIDS, which is a specific type of sudden death that does not have an identifiable cause. Because there’s no test to determine whether an infant died of accidental suffocation vs. SIDS, death certificates often list the cause of death as “SUID,” but with a contributing factor such as “co-sleeping” or “lying prone” (face-down).
Between 2010 and 2015, 36 black infants died in their sleep in Sacramento County. In 16 of those cases, the coroner noted in the death certificate that the baby was sleeping with an adult or sibling. In eight cases, the baby was put to sleep on his or her stomach or was found underneath a pillow. Twelve cases had no contributing factors marked.
Nationwide, leading public health groups, including the American Academy of Pediatrics, now cite parents sharing a bed with their children as a major risk factor for infant sleep-related deaths. Cutts agrees, saying it’s really just a problem of physics.
“(Infants) are lying next to their parents, who weigh a lot more,” Cutts said. “The beds are very soft, and they slip into that ‘black hole’ that’s created by the parent – a gravity well. They can’t breathe and start to suffocate. The body tells them to move, but they don’t know how to do that yet.”
Despite the warnings, significant numbers of women across racial groups continue to sleep with their babies held close. A 2013 study from the U.S Department of Health and Human Services found that about 40 percent of both black and Asian women always or often share a bed with their infant.
Yet, in The Bee analysis, no Asian babies died of sleep deaths between 2010 and 2015.
I just jumped on the air bed – the air bed moved and she just stayed. She was gone.
Renée Walker, who has lost two babies to sleep-related deaths
James McKenna, director of the Mother-Baby Behavioral Sleep Laboratory at the University of Notre Dame, is among a vocal subset of experts who cite similar statistics in arguing against a blanket condemnation of bed-sharing. It is an age-old, universal practice that can be done safely, McKenna said – but only if certain guidelines are followed.
“It isn’t really an issue of the bed-sharing,” he said. “No group has increased more in their bed-sharing behavior than whites, and their (mortality) rates are going down. It’s the condition in which it’s occurring that’s killing the babies.”
One reason African American babies are at higher risk while bed-sharing is that they are more likely than other racial groups to have been born prematurely, said Dr. Terri Major-Kincade, a Texas neonatologist who does outreach to African American mothers through March of Dimes.
Many premature babies begin life with lower lung capacity and a vulnerability to infection, Major-Kincade said. They also have a less developed ability to wake up during a sleep apnea, when they stop breathing temporarily. Those conditions make black babies more likely to die regardless of where they are sleeping, she said.
She tells all of the moms she works with not to share the bed, but she gets especially worried when moms take premature babies back home without a crib.
“People think, ‘OK, I’m just going to put my baby next to me, and I’ll know, it’ll be OK,’ ” she said. “It’s not going to be OK. Our babies are going home smaller and smaller.”
Another factor, according to McKenna, is that breast-feeding remains less common among African Americans than other racial groups.
“We’ve found that breast-feeding mothers are more highly sensitized to the behaviors of their babies than formula-fed babies,” he said. “It’s just a result of the biological process of breast-feeding, and the baby alerting the mother that it’s ready to feed.”
That frequent checking in can be what keeps a mother from rolling on her baby, or what helps a baby wake up during apnea, McKenna said. Bottle-fed babies, on the other hand, have lengthier, deeper sleep periods because formula keeps them full for longer.
McKenna does not recommend bed-sharing for formula-fed babies, nor for babies who were born prematurely or at a low birth weight. He warns against co-sleeping on sofas and recliners. And he was among several experts who advise against bed-sharing if adults have used drugs or alcohol.
Still, McKenna said, safe-sleeping classes should include information on what types of families can co-sleep and how to minimize the risks.
“Who are the babies that live? And what are the conditions under which they are bed-sharing?” he said. “This is not a subject where you just say either do it or don’t.”
Keeping baby close
As it presses forward with its education campaign, Sacramento County is adhering to the stricter guidelines adopted by the American Academy of Pediatrics, which recommends parents share a room with their infant, but never a bed.
“If there is any wiggle room, people will exploit it,” Cutts said. “The message is very clear. This is unsafe, and you have to realize you’re taking a risk.”
An estimated $600,000 of the county’s $26 million plan to reduce black child deaths will address safe sleeping practices through billboards, radio announcements and neighborhood fliers. Other funding will increase the county staff positions dedicated to home visits to educate new moms about safe sleep.
About $2.5 million of the county funding will go toward construction and staffing of two new family resource centers – one in south Sacramento and one in Arden – where social workers can hold safe-sleeping workshops.
The idea is to build on some of the programs the county already runs, expanding resources and targeting neighborhoods where infant mortality rates are especially high.
In the past, the information about sleep death has not been consistently and reliably transmitted, Cutts said, and safe-sleeping workshops have come and gone with county budget slashes.
“We’ve had these programs where we try to do a lot of education,” Cutts said. “But then the funding dries up, and new babies are born and they don’t get the education. As soon as we stop the education, the deaths go back up.”
A lot of us sleep with our babies under us or by us. We’re scared to leave them alone.
Robin Evans, Sacramento mother of three
The county is looking to capitalize on programs such as one that unfolded on a recent weekday at a community center in Meadowview. A half dozen mothers, a father and grandmother watched a staffer demonstrate how to safely prepare a crib and lay a baby down, then practiced with a doll.
At the end of the session, attendees were given free Pack ’n Play Play Yards to use as cribs. The county is also giving out free Pack ’n Plays, which cost about $50 apiece, through maternity wards at area hospitals.
Robin Evans, a mother of three, said she had heard about the workshop from a friend and was curious. She said she had been sleeping with her 5-month-old son, Mekhi, since bringing him home from the hospital, and had no idea it could pose a risk.
“I did all my kids on their back, but they were with me,” Evans said. “My whole family had done it, with all their kids. ... A lot of us sleep with our babies under us or by us. We’re scared to leave them alone.”
Evans lives near the center in Meadowview, a community familiar with poverty and violence. Neighborhoods with high rates of crime tend to be hotspots for infant sleep death in Sacramento County. During the five years covered in The Bee’s review, infant sleep deaths were highest in the 95823 ZIP code in south Sacramento and the 95821 ZIP code near north Arden Arcade.
Paula Birdsong, who runs an infant mortality prevention program at Center of Praise Ministries in midtown Sacramento, said bed-sharing is an instinctive practice for many young black women living in violent neighborhoods or transient circumstances.
“Some of them are not sure about other people in the home, and they’re not sure if anyone will try and take their baby, try and harm their baby,” she said. “That is a reality that some of our moms are facing ... that’s why they want to keep their babies as close as possible.”
Young African American mothers also tend to trust family members more than their doctors or the county, she said. Unfortunately, those family members aren’t always passing down updated information about safe sleep.
“Most people will say, ‘my grandma did this, my mom did this,’ ” she said. “That’s the thing we have to try to combat. It was very common for a long time for people to do that. We have learned through the information we have now that that was a huge gamble.”
In hopes of bridging that trust gap, the county also is looking to expand the reach of groups with a proven track record of working with African American mothers. That includes Sacramento Building Healthy Communities, one of seven community programs slated to get $120,000 annually over the next three years as part of the county initiative. Healthy Communities partners with a range of programs, including Black Mothers United, which pairs struggling black mothers with a personal advocate.
Renée Walker, who lost her first baby on the air mattress in 2007, turned to Black Mothers United for help when she became pregnant again in 2015. She had lost another child to sleep death in the intervening years, this time while she, her two toddlers and her newborn were sharing one bed in a motel room.
The program helped her connect with support and services for the birth of Jeremih Chess Jr., now 4 months old. In concert with Black Mothers United, Walker devotes some of her time to telling her story of loss at schools and churches. It’s hard to recount the deaths, she said, but she wants women like her to know what can happen if they don’t get help.
“If you don’t love yourself, do it for that baby,” Walker tells them. “Be resourceful, be informational. Don’t be close-minded; don’t be fearful.”