It’s among the most heartrending moments in a job that has many: Telling a mother she accidentally smothered her infant.
That’s what Muscogee County Deputy Coroner Elizabeth Allison has had to do, more than once, while also telling the bereft parent she cannot hold the dead baby, one last time, because the body’s now evidence in a death investigation, and must be secured for an autopsy.
“There’s so much emotion, and the mother’s in absolute shock,” Allison said. “In all honesty, I’ve had a mother say, ‘Oh my God, I killed my baby!’”
One of three deputies under Coroner Buddy Bryan, Allison represents the coroner’s office on Muscogee County’s Child Fatality Review Committee, which annually reviews child deaths from the previous year, and files a report with the state.
That committee found an alarming portion of the 2018 fatalities were “Sudden Unexpected Infant Deaths” (SUIDs) associated with “co-sleeping.”
SUID means the abrupt death of a baby less than a year old, with no cause that’s immediately obvious without further investigation.
When associated with co-sleeping, it means a parent or other caregiver fell asleep with an infant who suffocated, sometimes under the weight of the other person’s body, sometimes in the crook of an armchair, sometimes smothered by a pillow or loose bedding.
Unlike other fatalities the committee reviews, these are entirely preventable, and that’s a message some people are missing, members say.
County child fatality review committees were established by Georgia law in 1990, tasked with annually reviewing evidence in the deaths of those 17 or younger, and reporting their findings to the Georgia Bureau of Investigation, with the aim of recommending measures to prevent such deaths.
Besides Allison, the Columbus committee includes Assistant District Attorney Robin King, the chair; victim advocates Nikki Smith and Alexis Henderson, each a committee secretary; and a public health nurse, a mental health representative, a law enforcement officer, a child advocate, and others.
They meet each month to sift through cases, discuss the evidence and decide what factors led to each child’s death.
They do not have to review every child fatality, as some infants are born with so many afflictions they never leave the hospital, and the cause of death is obvious. No autopsy is necessary.
Of 27 child deaths in Columbus in 2018, eight needed no review, leaving 19 for the committee to examine, King said. Of those, three were sudden unexplained infant deaths associated with co-sleeping and a fourth was clearly an accidental death caused by co-sleeping.
“We look at these 19 deaths, and four of them are associated with co-sleeping,” King said. “And so in essence, over 20 percent of these deaths were preventable by not co-sleeping with the children, particularly the infants.”
This is not just a problem in Columbus, but across the country.
According to the Centers for Disease Control, the United States in 2017 had 3,600 SUIDs. About 1,400 were classified as Sudden Infant Death Syndrome, 1,300 as of undetermined cause, and around 900 as accidental suffocation or strangulation in bed.
SIDS is an apparently healthy infant’s abrupt death that remains unexplained after a thorough investigation. It is categorized as a subset of SUID.
An investigation and autopsy may determine that a sudden unexplained infant death was caused by suffocation, when the circumstances fit. Sometimes the circumstances include family customs in putting babies to bed, and those are hard to overcome.
“Our numbers just reflect a problem that’s nationwide, and it’s so preventable,” King said. “We can’t prevent chronic asthma attacks…. The medical deaths, we can’t prevent those. Homicides, those are a separate issue.”
Here’s a breakdown of Columbus’ other child fatalities last year:
- One child was killed in a homicide, a 3-year-old shot with his father.
- Five were medical or natural causes.
- Three were SUIDs.
- Two were car crashes.
- Two were undetermined.
- One was an accident.
- One was a drowning.
Hospitals regularly teach new mothers the sleep risks for infants, with nurses emphasizing that newborns should be placed on their backs on a firm surface clear of pillows, plush toys and bedclothes.
If face down, the baby’s breathing may be blocked. If the sleeping surface sinks, the child may suffocate in the depression. Any clutter, or anything that might tangle around the baby’s neck, may lead to asphyxiation.
Nurses at Piedmont Columbus Regional start giving new parents such advice right after delivery, when the mothers are recovering in what the hospital calls its “mother-baby unit,” said Kristin Hinton, clinical manager for the pediatric emergency department.
“That education starts there for the two to three days that they’re in the hospital,” said Hinton, adding nurses start talking about it when they see mothers in bed with their infants. “That real-time education is important.”
Is it effective?
“I do believe in some cases, it is,” Hinton said. Sometimes elders in a family have other ideas about childcare, because people decades ago didn’t know what doctors know now, she said: “We didn’t have the research.”
The mothers also get handouts detailing safe infant sleep practices when they’re discharged, she said.
Another risk some parents don’t anticipate comes from sitting in a chair while cuddling a baby. That’s expected, with nursing mothers, but it’s not safe if the mother starts dozing off.
Said Allison: “A new mother’s nursing a child. She’s tired. She falls asleep. The baby suffocates in between her breast and her arm. It does happen, which is very unfortunate.”
The safety tips can be condensed into the ABCs of safe sleep, she said: “The ABCs are ‘baby Alone on their Back and in their Crib’ — no stuffed animals, no blankets, no adult comforters.”
Henderson said some families think a baby is safe on a couch with pillows to buffer the infant from the adults, but the pillows could suffocate the child.
Such dangers long ago led to the hospital instructions new mothers get. King said she has children in their 20s, and she got safe sleep instructions at their births.
Based on extensive research, the American Academy of Pediatrics updated its recommendations for safe sleep practices in 2016, widely publicizing its findings.
Yet the fatalities continue.
Those who do the fatality review say what they’re up against is no secret.
It’s partly a generational influence, the assurance from elders that these newborns’ parents and grandparents were put to bed on their bellies, and they were just fine.
“The thing that we’re finding mostly is that we can educate these parents and grandparents, but once they get home, they go by what great-grandma says, which is, ‘Well, I put your mama on her belly, when she was a baby,’ and they don’t see any harm in it,” Allison said.
Another impediment is the fashion of adorning a baby’s crib with fluffy accoutrements.
Henderson, a child of the 1990s, said that’s an issue with her generation:
“The ‘90s babies are starting to create their own families … and it’s all over Pinterest and Google and these magazines to decorate your baby’s crib and have all these nice teddy bears and these cute hats, and they don’t realize all that’s unsafe in a baby’s crib.”
A third wall to educating the public goes back to that agonizing moment when Allison has to tell a mother she smothered her infant:
No one wants to think about that.
“It’s something people just want to brush under the rug,” the deputy coroner said. “They don’t even want to talk about it, because you’re talking about infants. Who wants to think about a baby dying?”
To further emphasize safe sleep practices, the nonprofit Safe Kids Columbus is hosting “Safe Sleep Classes” at 4 p.m. Oct. 15, Nov. 12 and Dec. 17 at 615 19th St., across from the John B. Amos Cancer Center.
Each hour-long class is free, said Pam Fair of Safe Kids Columbus. Anyone interested may call 706-321-6720.
The program is intended for women who are in or close to their third trimester of pregnancy.
Each participant who qualifies for Medicaid can get a free portable play pen with a bassinet, commonly called a “Pack N Play,” which is safe for putting a baby to bed in the mother’s room. Fair said the priority will be providing those to parents who don’t already have one.
Safe Kids Columbus formed a “Safe Sleep Committee” this year to promote safe sleeping for children. It includes representatives from Piedmont Columbus Regional, the health department, the coroner’s office and childcare specialists.
Fair said the committee started the safe sleep classes and has asked pediatricians to re-emphasize the dangers of unsafe infant sleep with their patients.
Social media’s another tool. Allison said she regularly uses Facebook to post warnings about the sleep risks infants face.
“Even if we can make a change in one home out of five, I feel like we’re doing something,” she said.
Other messaging is more basic, like a onesie given new parents, with three words on the front:
“This Side Up.”