Safe Sleep is an investigative series examining what risk factors were present in more than 1,300 incidents of infant death over an 11-year span in Canada.
Annie Game initially thought it was funny when her son Jonathan suggested she and her partner should take a grandparenting course.
"I started laughing because I had a baby, right? So I know what it's about," said Game, who lives in Markdale, Ont.
Though she was laughing, Jonathan, who together with his wife, Kit Stanley, was expecting twin girls, was serious.
New parents, and even experienced ones like 69-year-old Game, are bombarded with information on baby care. Often, it doesn't reflect best practices, especially when it comes to safe sleep for infants.
That was a particular area of angst for Jonathan Game, and part of the reason he suggested the course to his mother.
"We weren't sure what those guidelines were. We had a general idea. But we felt that we would need to be monitoring closely, because you're a new parent, and you want to make sure that you're supporting them the best that you can," said Jonathan. "And without the information, we didn't want to make a wrong turn."
A recent CBC News investigation found that in 476 incidents of infant death from across five provinces and three territories between 2009 and 2019, 61 per cent of infants were bed sharing. In 77 per cent of cases, the infant had been sleeping on a surface not recommended as safe by health officials, such as an adult bed and a couch.
While they don't always know the cause of these deaths, experts believe there are specific, modifiable factors that put newborns at risk.
Class teaches new best practices on infant care
With the girls arriving in about eight weeks, Annie Game attended the three-hour grandparent course called Baby Care for Grandparents Workshop, over Zoom. The course, which costs $80 for two people, has enrolment capped at eight people, and often fills up quickly each month.
While working with new parents, Kerry Grier discovered there was a need for a grandparent course.
Grier, who is the lead instructor and a patient education specialist at Sunnybrook Hospital in Toronto, found there were unnecessary disagreements and different ideas about best practices for baby care.
She found some grandparents were giving outdated information to their family and that they could be a barrier to new parents despite their well-meaning attempt to help.
"It's a bit of a roadblock to the parents," Grier explained.
For example, Grier said, "A grandmother would walk into a room and there'd be a baby lying on his back. And the grandmother would panic because she had been told that babies should be on their tummies or on their sides. We now know that it's best for babies to be on their backs when they sleep."
Placing infants on their back to sleep is one of the main ways to prevent infant death during sleep. Health Canada also recommends placing a baby to sleep alone on an appropriate sleep surface, like in a crib or bassinet, without any bumper pads or other items as clutter.
That was information Game didn't hear when she was a new mother.
"It's an evolution," Game said. "[An] evolution of ideas based on research, which I think is helpful for everyone."
This was one of the topics Game was interested in learning about in the workshop. For many new parents and grandparents, safe sleep practices are the main way to decrease the risk of Sudden Infant Death Syndrome or SIDS.
SIDS is defined as "the sudden death, during sleep, of an infant less than one year of age, which remains unexplained after a thorough case investigation, including the performance of a complete autopsy, an examination of the death scene and a review of the clinical history," according to Health Canada.
Images in ads, social media play a role, researcher says
Back in Game's day, there was little known about SIDS, let alone what to do to prevent it.
"We knew [SIDS] existed and people were scared of it, but there really wasn't the research done to tell us how to respond to that. So I think that was certainly something that was very interesting to talk about," she said.
Grier became a first-time grandmother around the time she selected content for the course. She included safe sleep practices because it was a topic participants wanted to talk about.
Since switching to Zoom, due to COVID, they have had grandparents from the United States and Australia.
Sleep statements and promotional material can play a pivotal role in educating those providing care to babies. But traditional and social media often feature images of babies in unsafe sleep environments. These images have the potential to influence decisions about safe sleep practices.
"If you go on the internet and if you Google 'sleeping baby,' you will see babies sleeping in all sorts of unsafe sleep places," said Dr. Rachel Moon, a professor of pediatrics at the University of Virginia School of Medicine and a well-known SIDS researcher.
"On Facebook, Instagram, there are all of these pictures that parents take of their babies sleeping with somebody on the couch. 'Oh, isn't this cute?' Well, it is cute, but it's also very, very dangerous. The couch is one of the most dangerous places for the baby to sleep, and particularly with somebody else or by themselves."
Some advertisers also choose photographs for their product packaging showing babies in sleep positions not recommended as safe. Moon said a walk down the supermarket aisle makes that clear.
"There were boxes of baby wipes by a very well-known manufacturer, and they had a picture of a baby sleeping on the stomach on their box. So it's all over and it's all around us," said Moon.
These pictures "create this idea that this is normative behavior. This is what people are doing and that this is OK to do. So that all needs to change as well."
'A real desire for real evidence-based information'
In Nova Scotia, researchers at Dalhousie University, in collaboration with the IWK, are working toward making changes in how and when new mothers receive evidence-based information on infant care.
Dr. Justine Dol developed Essential Coaching for Every Mother as part of her PhD dissertation while studying at Dalhousie. She describes it as "a postnatal text message intervention focused on increasing Mom's self-advocacy, their confidence, as well as feelings of social support while decreasing anxiety and depression."
They recruited expecting mothers from across the province who were planning to deliver their babies at the IWK. The six-week program sent twice-daily text messages for the first two weeks and then a daily message for the remaining six weeks.
Dol was in the late stage of her pregnancy while she was developing the messages and testing them. She said this gave her an opportunity to test the process by sending the messages to herself, not only as a researcher, but as a first-time mom.
"When you're pregnant, you have a lot of interactions with health-care providers who are able to answer your questions. It was definitely a lot harder to find information, reliable information, about what to do in the postpartum period," said Dol. "There was often misinformation."
Dol said she has had lots of interest in the program, including from fathers-to-be.
"I think the fact that there is such a big interest indicates that there is a real desire for real evidence-based information during the postpartum period."
Back in Ontario, the twins arrived in August and the Game family has grown.
"Love them to bits. It's a great, big, new family," Game said. "It's wonderful."
She said she felt empowered after taking the course and has already recommended it to other grandparents-to-be.
"Once you see those babies, everybody's focus is on them," she said. "They're the vulnerable ones. They're the ones that need the support."