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Be Well: Why Do Babies Die In Their Sleep?

Amanda Saucedo with her newborn Benjamin and older son. [photo: Courtesy Amanda Saucedo]

by Sarah Jane Tribble

It's been nearly two years and Amanda Saucedo still can't stop asking herself the same question: How exactly did her baby die in her arms?

She recalls bringing 30-day-old Benny into bed to nurse him.  They fell asleep. Hours later, Saucedo woke and called 911.

"Do you need police, fire, ambulance?” the operator asked.

“Ambulance,” Saucedo answered.

Then the operator asked: “How old is the person, what's going on with them?”

“I woke up and my baby isn't breathing and he's blue,” Saucedo said, adding moments later: “He’s gone. He’s gone.”

Saucedo, who provided a copy of the 911 tape for this story, requested the public record in her search for answers. As the call continues, Saucedo tells the operator between sobs that this happens to other people.

“Not me,” she says.

Saucedo had researched how to raise Benjamin well, decideding to do a water birth, nurse him and, ultimately, co-sleep with him after reading about the benefits of being close.

Now, after his death, Saucedo is intent on understanding exactly what went wrong.  Understanding why babies die in their sleep has been a question for parents, medical professionals and those who work in the justice system for decades.

Nationwide, about 25 percent of babies less than a year old who die, do so from "accidental suffocation or strangulation in bed," according to the U.S. Centers for Disease Control and Prevention. 

In Lorain County, where Saucedo lives, officials believe nearly all babies who die in the home die from sleep-related deaths. In Cuyahoga County, officials also say sleep-related deaths are the main reason babies die in the home. During the past decade, about 20 babies have died annually because of sleep-related causes.

In the past, Cuyahoga County Investigator Cindie Carroll-Pankhurst says she would face "push-back" when talking to community groups.

“I was told things like, ‘You've never had any children.  You don't know.  No one would ever roll over on their baby.  Why are you coming into the community and saying bad things about this community and how they take care of their babies?’”

 Carroll-Pankhurst says.

County medical examiners have not always consistently collected data about infant deaths. Carroll-Pankhurst says many of those incidents that may have been caused by unsafe sleep were classified generically as Sudden Infant Death Syndrome – SIDS. 

But in 2014, Ohio began requiring that specific information be collected during death investigations.

We're sorting them out better,” Caroll-Pankhurst says. “And the more we're able to do that the better the data will be not just in Cuyahoga County but across the country so that we can push that much harder on the recommendations and how to reach audiences that may be harder to reach.” 

At University Hospital's Rainbow Babies and Children's Hospital, which sits within blocks of some of Cleveland's high infant mortality neighborhoods, 

Dr. Lolita McDavid talks with a young mother whose four-day-old baby is in for a routine examination.

McDavid checks the baby's heart beat and pulse, and addresses the mother directly: “So, what I want, I want to know that the baby is sleeping in her own place?

The mother answers with a smile: “Yes, she has a bassinet.'”

McDavid says: “A bassinet? Fabulous and it's on a flat surface? Nothing else in the bassinet except her in a sleeper? “

Again, the mother smiles and says: “Nothing, yeah, and a cover over her.”

With a firm look, the doctor states: “And she doesn't need a cover, OK.?”

McDavid, who is part of Cuyahoga County’s child fatality review board, is taking the safe-sleep message a step further than the "Back to Sleep" campaign that saturated the media in the 1990s. The medical community now says it's not enough to simply put the baby face up. 

Instead, the baby needs to be alone, on the back and in a crib.

McDavid explains this to the mother: “We call it A-B-C – Alone, on her back and in a crib. Pack-and-play and bassinet are wonderful.”

But medical researchers also warn: This is a complicated topic.

There is no debate in the medical community as to whether parents should put babies down to sleep safely on their back. There is also agreement that babies have died from extra bedding as well as when sleeping with an adult or other children, But some medical experts say that doesn’t mean there are not other causes of death while sleeping.

Investigators call these cases "true SIDS." SIDS is officially definedas the death of an infant younger than one year of age that remains unexplained after a complete investigation. For example, the county medical examiner says Cuyahoga County tagged one case of SIDS in each of the past two years.

Dr. Richard Goldstein, who directs the Robert's Program on Sudden Unexpected Death in Pediatrics at Boston Children's Hospital, says researchers are looking into other possible causes. They are asking whether there are biological reasons making some babies more prone to die in their sleep. 

“I hope we discover important things where we can respond to the terrible pain that these people feel and must live with that comes really from not knowing and not having an answer,” Goldstein says.

Goldstein's group is reviewing Amanda Saucedo's case.  She sent Baby Benny's medical records and the coroner's report there after his death.

On a recent morning, at the new home she shares with her mother, Saucedo talked about Ben's death and the questions that she still has. 

"I knew that babies died while bed sharing but I didn't think that it happened just like everybody else that says things to me now. They assume that it happens when the mom is drunk or high or overweight. But that's just not the case, it happens to good moms."

A copy of the coroner's report shows that Ben's death was determined to be positional suffocation due to unsafe sleep. It notes that Ben was bedsharing with an adult. 

The coroner noted “manner” of death was an accident.