Pod Talk

Pod Talk 14: Clear to land

Wed, 10 Dec 2025 04:41:02 GMT

Learning from pilots

Tēnā koutou

This post is in response to a coroner's report on the death of a young baby where parents felt the concern about jaundice was the priority and could not recall safe sleep conversations, although they had been documented as had. In the coroner's words, "T he challenge is to ensure the underlying reason for safe sleep advice is communicated to all parents and caregivers in a way that is heard and understood. " Our safety messages must not just be sent, but also received. They must land .

Why messages may not land

For many families, safe sleep information arrives among dozens of competing worries: pregnancy concerns, birth issues, newborn feeding, crying, jaundice checks, healing, lack of sleep, family stress, cultural expectations, other health messages, and more. Attention goes to whatever feels most pressing, understandable, and relevant.

A baby’s biggest SUDI risk is the hidden vulnerability in their “wake-up” response to low oxygen — something that happens inside that can’t be seen — but needs protection on the outside. Safe sleep messages may float above parents, heard perhaps but not anchored. They haven’t yet touched down in their understanding. We can say everything right, but it may not register as important or urgent. This is an engagement issue, not an acceptance one. Safe sleep messages don’t protect babies unless they land .

Landing a plane is like landing a message

Pilots prepare for landing in three key ways: they line up the plane long before the runway, slow it down because nothing can land at full speed, and then touch down smoothly — no jolts or surprises. These three principles can guide us, too, when helping a protective idea for preventing SUDI to land with families.

1. Line It Up (Name the vulnerability)

We line up a protective idea by lining up the conversation around the baby’s hidden vulnerability — making it visible and simple to grasp. Start with the core message, without detail: “ Young babies have a hidden vulnerability in their ‘wake-up’ system. They need extra protection for breathing that parents can provide. ” This plants the seeds for both importance (about breathing) and confidence (I can do something), perceptions that are predictive of action. Gently expand:

“ This vulnerability is greater for some babies than others, but present for all.”
“Some babies don't respond as quickly or fully when oxygen drops. Parents can’t see this. Babies can’t signal it. But it changes the level of protection babies need.”

2. Slow It Down (Personalise it)

A plane can’t land at full speed — neither can an idea. Slowing the moment allows the idea to land emotionally (on feelings) and spiritually (on beliefs), not just verbally (on words). Families need time to see how a message relates to their baby , not just babies in general. “ Let’s talk about your baby and what this vulnerability means … ” When families feel the message is about their child, their attention shifts. Protection becomes personal, not theoretical. The value of keeping their baby safe becomes felt, not simply heard.

3. Touch Down Smoothly (Show the protection)

Touchdown happens when families feel able to act. Whether it’s keeping the face clear, placing baby face-up, or using a wahakura or Pēpi-Pod when bedsharing, engagement happens when families understand the purpose: “ This protects my baby’s breathing through a critical stage of development. ” They take in what feels important, personal and doable. When parents understand the “why,” then “what to do” becomes obvious. “ Here’s a simple way you can give that extra protection at home. ”

The most effective moments in engagement come when we connect these three ideas: name the hidden vulnerability, personalise it, and show the protection needed.

Which idea needs to land?

In SUDI prevention, we are not trying to land all the messages — that leads to overwhelm. From one core idea — " protect breathing " — everything else flows: face-up, face-clear, smokefree, vapefree, wahakura, Pēpi-Pod, firm surface, no pillows ... When families grasp this one idea, safe sleep behaviours make sense. And if they don’t, behaviours may seem optional, negotiable, “nice if possible” or even forgotten. So the message that must land is: ' protect breathing ' where the baby’s invisible vulnerability is the reason and the family’s power to protect is the reassurance. That’s the psychological anchor point that changes decisions.

The single most powerful way to help the idea land

Always bring the conversation back to protecting this baby’s breathing. Not safety rules. Not checklists. Not vague general advice.

Back to personalised protection of this baby’s hidden vulnerability to low oxygen. When this connection forms, families often shift from knowing to commitment. You’re likely to hear:

“Now I understand why this matters.”
“Now I get why my baby needs this extra protection.”
“Now the Pēpi-Pod makes sense.”

That moment — when understanding finally lands — is the heart of SUDI prevention.

Mā te wā, Stephanie

Pod Talk 13: Why are we still feeding the ducks?

Mon, 21 Jul 2025 01:11:50 GMT

When resources are limited, evidence must guide our decisions.

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Would you feed bread to the ducks if it was your last loaf, your only piece, with hungry children waiting in line?

How would you decide who gets bread and who misses out? In this analogy, bread represents the fundamentals of life. When bread is plentiful, feeding the ducks might seem harmless, playful, kind. But when children miss out on their breakfast toast because the ducks got the last of the bread, we must ask: 'Are we making good decisions, and what responsibility takes priority when the bread is running low?' In this story, 'bread' is the in-bed sleeper: a simple, low-cost intervention that can save a baby’s life. But when there aren't enough to go around, who gets one, and who misses out?

What research is telling us

Last week, a paper was published in the Journal of Paediatrics and Child Health titled ‘Who is supplied with in-bed sleepers (Pēpi-Pod and wahakura) for reducing SUDI in New Zealand?’ ( link ) It reports that 65% of infants most in need of in-bed sleepers - those at highest SUDI risk - are missing out. Yet, enough in-bed sleepers were available for all priority babies in the study group. The paper concludes: “In-bed sleepers need to be used by high-risk infants when bed sharing, if SUDI rates are to be lowered.” This is the single most effective action we can take - based on current evidence.

A baby who missed out

This morning, I read a coroner’s report about Baby K - a young pēpi exposed to nicotine during pregnancy, who bed shared without protection, and who might still be here if a Pēpi-Pod or wahakura had been available, and used , that night. We will never know for sure, but his death is a stark reminder of what is at stake if in-bed sleepers are not prioritised to those who need them most. Baby K is not an isolated case, but now the norm in New Zealand. Most SUDI pēpi are born early, small or nicotine-exposed (tobacco or vaping), bedsharing at the time of death, less than 5 months old, and have no in-bed sleeper available.

From abundance to scarcity

The study above examined a time of relative abundance (2019–2021), when over 7,000 Pēpi-Pods and an estimated 2,000 wahakura were distributed each year. Yet even in that context of plenty, only a third reached babies with clear biological risk . In 2025 we face a different reality. Supply is half what it was during the study period - enough for only half of our priority pēpi. But even this reduced number is comparable to the early programme years (2010–2016), when infant deaths fell by 30%. Back then, we did more with less . So how do we do it again?

Facing the ethical tensions

It’s unlikely that health teams are deliberately diverting in-bed sleepers from babies at highest SUDI risk. It is likely that decisions are being shaped by competing values, assumptions, or uncertainties that unintentionally leave high-risk babies unprotected. These tensions - about vulnerability, priority and the hard calls that must be made to align our actions with evidence - may require uncomfortable conversations. However, if we are to save lives, they are conversations we must have.

Not all vulnerabilities are equal

We may be confused about what is meant by 'high risk' for SUDI as vulnerability comes in many forms - social, environmental, biological. And not all vulnerabilities carry the same SUDI risk. In-bed sleepers were designed for pēpi with biological vulnerability - those born small, early or nicotine-exposed. Vulnerable on the inside . These pēpi are at highest risk for SUDI because they have reduced ability to respond to suffocation risk, and that vulnerability follows them into every sleep.

Yes, in-bed sleepers may offer value to whānau in terms of convenience, cultural relevance, peace of mind or where there is hardship. But when these benefits are prioritized over the protection of biologically-vulnerable babies, we lose sight of the core purpose of in-bed sleepers .

Compassion guided by evidence

It may feel deeply unfair to withhold an in-bed sleeper from a struggling young mama with no safe place for her pēpi - especially when accessing other supports like a cot or bassinet can be difficult. That feeling is compassion. We care. And it is also compassion to reserve in-bed sleepers for babies who need them most, because unlike traditional infant beds, only in-bed sleepers reduce the dangerously high SUDI risk caused by smoking and bedsharing . When our compassion is guided by evidence, we resolve ethical tensions and direct in-bed sleepers to where they may make the difference between life and death for a biologically-vulnerable pēpi.

What must change in 2025

We are way off course with using in-bed sleepers to reduce sudden infant death. There is an urgent need to align our decisions with the best available evidence, and do more with less as we have before . In 2025, with reduced supply, our responsibility is clearer than ever. We must prioritise biological risk for who gets in-bed sleepers, and the saving of lives as our purpose. There are two simple criteria:

smoking in pregnancy (or vaping)
born < 37 weeks or <2500 grams

If we do not make this shift in thinking and practice, our efforts will drift further off course, and more babies like Baby K will quietly miss out.

In memory of baby K

I dedicate this blog to Baby K and to his whānau - with deep respect for their loss, and with hope that their story will sharpen our focus. We can’t change what happened for Baby K, but we can choose differently for the babies who come next. We have the knowledge. We have the tools. We have the responsibility. This blog is a call to prioritise biological risk when deciding where we direct our diminishing supplies of Pēpi-Pod and wahakura because they are not just support, but a vital opportunity for survival.

Mā te wā, Stephanie

Pod Talk 12: Apples are not oranges, but both are fruit.

Mon, 20 Jan 2025 23:23:49 GMT

What can happen when we see apples and oranges as just fruit.

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As the saying goes, we should not compare apples to oranges. This means we need to be cautious about comparing completely different things as if they are the same. An apple is an apple with its specific 'apple' look, satisfying crunch and sweet to tart flavour, depending on the variety. An orange is an orange with its own colour name for goodness sake, juicy tangy insides and tidy pre-packaged segments. Both are 'fruit' and both are good for us. We may prefer one over the other based on taste, convenience or what we want to put in the pie, but they are both a type of fruit with their own points of difference.

It is the high level of Vitamin C that sets an orange apart from an apple, in the nutritional sense. If Vitamin C is what you want to fight your cold, you will get 12 times the dose from eating an orange compared to eating an apple of similar size. If you do not have a cold, and do not need a Vitamin C boost, just a crunchy healthy snack on your walk, then it is probably the apple you will reach for. So, our preferences may depend on the problem we are wanting to solve.

The apple and orange analogy is relevant to infant beds. A cot is a cot - large, heavy, not portable, with legs and rails, suitable for younger and older infants. A bassinet is a bassinet - smaller, not so portable, lighter-weight, with legs and no rails, suitable only for younger infants. A Moses basket is a Moses basket - similar to a bassinet, but with no legs, woven and with carry handles. These are all types of infant bed and are considered 'safe sleep devices' in SUDI prevention circles. Then there are Pēpi-Pod and wahakura, also infant beds, also 'safe sleep devices'; compact, no legs, suitable only for younger babies, able to be brought into the adult bed for safer bed-sharing. Different.

So, do these various infant bed types offer pēpi the same things? Yes, if we are talking about a smokefree, breastfed, full-term 2-week old pēpi. Any of the above bed types will meet that baby's needs in the early months. No, if we are talking about an 8 month old pēpi where bed size matters so a cot would be most suitable. And when we have a new-born infant exposed to smoking in pregnancy or born at 34 weeks, what is the problem to be solved that will influence our choice then? What distinctive feature of the various infant bed options will we go looking for?

Of the various infant bed options above, only Pēpi-Pod or wahakura were designed to be brought into the adult bed to make bed-sharing safer for the more vulnerable child. That is the feature that sets them apart . Rather than needing a boost of Vitamin C when we have a cold, the SUDI-vulnerable pēpi needs a boost of protection when bedsharing. Pēpi-Pod and wahakura offer this - a bed within a bed. They were introduced, not to be yet another infant bed option for families, but to solve a problem; specifically, to break the link that escalates SUDI risk during bedsharing, f or babies weakened by smoking in pregnancy, or prematurity. Just as apples and oranges are both fruit, Pēpi-Pod and bassinet are both infant beds, but they, too, are not the same thing and should not be compared as if they are.

For this reason, we now refer to the Pēpi-Pod and wahakura category of infant bed as in-bed sleeper to highlight their protective point of difference. Not 'sleep spaces' nor 'safe sleep devices' as these terms are general infant bed terms. In-bed sleepers. We encourage you to use this term and to preserve your supplies of in-bed sleepers specifically for issue to those pēpi who need a boost to their protection that an in-bed sleeper can offer, and a cot or bassinet cannot. Infants smoke-exposed in pregnancy, born before 37 weeks gestation, or weighing <2500gms - t hese are the priority pēpi for in-bed sleepers.

Prevention programmes are only effective if they are able to influence key risk and protective factors that have a causal relationship with the problems being addressed, in our case SUDI. Harm from smoking in pregnancy escalates SUDI risk when exposed infants bedshare, and in-bed sleepers can mitigate that escalated risk . Currently, we have 73% of 1500 records in our database reporting distribution of Pēpi-Pod to lower risk, smokefree infants, and just 27% to smoke-exposed infants urgently needing a boost in protection. This pattern needs to reverse , especially in these times of funding cuts and austerity that demand more accurate targeting to need of a limited resource.

So how can we do this? How can you do this in your service? We must do this if we are committed to boosting protection for the pēpi most needing it. I would love to hear your ideas, plans, ways we may be able assist you to reorientate in-bed sleeper supply. For our part, we have developed a sample document ' Policy and procedure guide: Supply of in-bed sleepers ' that may be useful to some. Comments always welcome.

Mā te wā, Stephanie

Pod Talk 11: Stuck in difficult places

Thu, 07 Nov 2024 03:04:24 GMT

When we are unable to change a situation we want to change

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Most of us have a story of a child, pet or ourselves getting stuck in a difficult place, like the image above. Our then 4 year old once got stuck in quicksand on a family holiday at Pohara Beach, Golden Bay. We raced against the incoming tide to get him unstuck and back on dry sand, by lying on a raft of tree branches and hauling him in. It was scary.

More scary though was when he was 3, and he dissappeard one evening when getting off a train in Sydney - down that gap between train and platform. I was right behind, carrying his baby sister and our bags, and had no idea where he had gone. He literally was there and then he was not. Thankfully, a person on the deserted platform saw him fall. Thankfully, too he was wearing dungarees so I lay on the platform and hauled him up by the straps. Very traumatic for all.

Not traumatic, though, just plain embarassing, was the time I fell through the perished webbing of a folding chair at a group picnic for my husband's work. I was stuck there for some time because everyone was laughing so much and taking photos. I was very very stuck!

Being stuck. Being stuck i n a difficult place can leave one feeling many things - powerless, helpless, shame, fear, frustration - even if there may be a funny side. The stories above are about being physically stuck, but there are so many other kinds of stuck. We can become stuck in our ways, our beliefs, our viewpoints, our attitudes, our knowledge, our perspectives, and so much more. Being stuck means being unable to change a situation that we want to change . We may need help from others to become unstuck, or we may need to think differently about our predicament.

Are we stuck in SUDI prevention? I ask this because in the past 5 months I have received 8 reports from coroners on their findings of the sudden deaths of infants aged between 5 weeks and 5 months and a new theme is emerging. Most infants were healthy full-term infants. All eight were exposed to multiple well-known SUDI risks that included, smoking in pregnancy, smoking in households, side and prone placement for sleep, soft pillows as mattresses, use of pillows and tri-pillows, loose bedding. Seven of the eight infants were routinely bedsharing (one was on a couch) with parents and / or siblings, therein escalating risk. This picture of vulnerability is not new.

The new theme , though, is that most families had been offered a sleep space and most either declined the offer or accepted but did not use. Research suggests that had these eight infants been sleeping in a bed designed for babies, they likely would not have died. This is a here-and-now reality check. These are the circumstances of babies dying currently in Aoteoroa. This is one place where prevention may be stuck. Statistics NZ data also suggest we are stuck. They show no overall change to infant death rates from 2019 despite the focused resources and effort.

What is hea rtening about the above is that the reduction in deaths that immediately followed the introduction of portable sleep spaces in 2011, has been maintained. Holding a change is itself an achievement. There are far more protected children now. Comparing post-perinatal (7-364 days) mortality rates before and since access to sleep spaces, an estimater 570 lives have been saved .

Pause for a moment ... and imagine these 570 children all in one group.

Also good is that a known seven of the more vulnerable infants discussed above received a wahakura or Pēpi-Pod sleep space, often both. This is evidence of reaching more vulnerable babies, even though the opportunity to protect was not taken up by families.

Where might we be stuck? We may be stuck in our communication, our perceptions of a family's priorities, values, understandings, preferences, pressures. We may be stuck in our ways of delivering information. We may miss the need to personalise our listening; miss the need to personalise both infant risk and family care responses. We may be stuck in thinking that information is education. It is not. Education, from the Latin educere , means to lead forth, go beyond, change. We may need to find new ways to foster understanding of vulnerability and answer the why, who and when questions.

Getting unstuck . All interventions need to be kept fresh. In 2025 we will introduce the cloud/kapua coloured version of Pēpi-Pod sleep space. A comment from a young woman who was offered a fibre version of a Pēpi-Pod sleep space has helped me get unstuck about perceptions of attractiveness or 'the look of it' .

" I like the look of it (fibre version). I'd use this one. I wouldn't use the other one."

Research, too, tells us that looking good matters in a product, even more than function for many people. Although we have decided not to pursue a fibre option, for many reasons, we can offer a coloured version of Pēpi-Pod sleep space which, with its more modern look, may have more appeal for some, and therefore remove potential barriers to use. We are listening and we will learn. Different thinking brings different results.

To get unstuck is not comfortable. In being transparent, we designed the Pēpi-Pod sleep space to be functionally supportive of key experiences for healthy infant brain development - closeness, connection, responsiveness - windows for reassurance. As for looking good, we include attractive and quality natural fibre bedding and believe that a sleep space becomes beautiful when a baby is placed in one. To many, these features are attractive, but not to all. While the windows may be lost in a coloured version of sleep space, the low sides and portability still support closeness, connection, and responsiveness of infant and parent.

So what will you do to help change a situation we all want to see changed - more families understanding why their baby is vulnerable to SUDI, accepting and using a sleep space as a tool for protection, and feeling empowered by doing so. We do not want to stay stuck in a difficult place for too long.

Mā te wā, Stephanie

Pod Talk 10: Impossible decisions

Fri, 24 May 2024 10:42:45 GMT

A 1:38 a.m. email from Moana in Sydney last Wednesday

Tēnā koutou

About once a week we get a direct request to supply a Pēpi-Pod sleep space to a family. Usually the email is written before the sun rises. Usually the baby is just a few days old. Usually the request is urgent. Usually there is no context except that deduced.

On Wednesday 22 May, Moana (not her real name) sent this email from her Sydney address at 1:38 am. This time there is context. Moana is keen for me to share this, so Pod Talk 10 is written by Moana. No comment from me. To respect her courage and vulnerability, please share Moana's experience in your networks, as is her wish.

Message 1

Hi, I’ve just had a baby and would like to purchase a Pēpi-Pod. I was given one when I was pregnant in New Zealand, but wasn’t able to bring it with me to Australia. I found it so helpful with our first baby, and was wondering how I could purchase one and have it sent to Australia. If you can help me out, that would be much appreciated.

Message 2
Thank you for getting back to me and for your generosity. Can I say that what really made me contact you is that our family nearly experienced a tragedy due to not practising safe sleeping. I didn’t want to share it because I was afraid of being judged. But I feel prompted to share this with you.

We had purchased a bassinet for our son to sleep in, but as soon as we placed him inside, he would cry and fuss. Mind you, he is currently 5 days old. This has happened for the last three nights. Due to lack of sleep and misjudgment, he slept in my arms after burping him, knowing that he wouldn’t sleep in his bassinet. I fell asleep. If I had not woken up when I did, we would have lost him because his airways were blocked. I’ve never been so scared in my life to see how easy and silly it was to make that decision that could have ended tragically.

That is what prompted me to think about what I did with my last baby and how we slept, and it was having her in the Pēpi-Pod. Having our baby in our bed is what I loved - closeness. But also her being protected at the same time. As I had mentioned before, I was too scared to share my experience because I didn’t want to be labeled as a bad mother, but I know that my experience can help other parents and their families.

And to think that I would even have done that (fall asleep with him in my arms) because I’ve been taught what to do and what not to do. But it happened so fast. I have not been able to sleep since last night with that fear of seeing my son pale and unresponsive; thinking that it could happen again.

I will be seeking help, but I just want to express how grateful I am that we have these initiatives that help promote safe sleeping. I will forever be an advocate for safe sleeping and protection of infant breathing. I hope that you understand the impact this will forever have in my life.

Message 3

I have no problem with you sharing my experience. Thank you for allowing a safe space for me to share my experience with you.

Mā te wā, Stephanie and Moana

Pod Talk 9: A cruel way to learn

Tue, 26 Mar 2024 21:55:30 GMT

What life jackets, hands, seat belts, umbrellas and crutches have in common with Pēpi-Pod and wahakura

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During periods of vulnerability most people take extra care. On the water we don a life jacket, during Covid, a mask. In a car or plane we buckle-up. When it rains we put up an umbrella. If we break a leg, we lean on the support of a crutch. We hold a child's hand when near hazards.

The period of vulnerability is usually time-limited, and while the 'extra care' may sometimes be inconvenient, annoying even, we tolerate it because it is not forever. The boat trip ends. The plane lands. The sun comes out. The leg heals. Some of us, or sometimes, though, we don't take that extra care, or not for long enough. We weigh things up and accept some risk, believing that 'she'll be right'. And usually 'she' is, but sometimes 'she' is not.

In the same way that life-jackets, seat-belts, masks, hands, umbrellas and crutches are tools for managing vulnerable periods in life, so too are Pēpi-Pod and wahakura. They are extra care for babies who carry an extra burden of SUDI risk. The simple little baby beds offer sanctuary from that extra risk during a period of developmental vulnerability - the first 4 months. However, this period is not as short-term as a flight, a rain shower, or a boat trip.

There are an estimated 600 or more individual sleep events that need that 'extra care', spread over 120 or so days. We may protect some of those sleeps, most of them even, but perhaps not all of them? We may become reinforced in our decision to accept some risk when nothing bad has happened from an occasional lapse - yet. For example, if a mother falls asleep feeding her baby, and nothing 'bad' happened, then she may feel less concern and more confident to continue sleeping with her baby, and use the 'extra care' sleep space less or not at all. The looming possible tragedy is hidden from her.

Since September 2023, I have received 5 Coroner reports that are the stimuli for this post. They describe the context of death for 5 children, three aged 5 weeks and two aged 9 weeks. All five carried that extra burden of risk. All five slept in a Pēpi-Pod or wahakura in their early days. All five were found lifeless, sleeping not in their sleep space, but beside a sleeping carer, two on a couch and three in an adult bed. One distraught mother repeatedly said ' sorry ' over the phone to her midwife for not putting her baby in the Pēpi-Pod that sleep. What a cruel way to learn about vulnerability and protection.

How can the loss of these children and the anguish of their families change something in us? How do we enable appropriate concern in parents (not fear) about the escalating hazard from ' young baby + smoking in pregnancy + bed-sharing '? This is the 'triple risk' scenario. Feeling appropriate concern is essential to taking 'extra care' throughout the length of the vulnerable period. Fear, on the other hand is likely to cause resistance; is not helpful.

This recent article about sleep-related decision-making by parents of more vulnerable babies, reported that, in order to acknowledge and plan for risk situations " parents valued credible, trusted sources, and understanding how and when safer sleep practices protect babies.' They want to know! And they want it personalised for their baby.

As best you can, your conversations with parents need to leave families enabled. That means parents:

feel concern about accidental suffocation during sleep,
believe their particular baby needs extra care when sleeping, in the form of a sleep space,
believe they can make a vital difference by using the sleep space, that they have considerable control
feel that the benefits outweigh the disadvantages , that it's worth it and they want to .

You, and the sleep space, act as cues to action.

May you be supported in your conversations by the analogies above of tools to protect in vulnerable times, the stories of where 'she'll be right' failed babies , and evidence that over 60,000 New Zealand babies have enjoyed the protection of Pēpi-Pod and wahakura. During that time, infant death rates of young babies (7-91 days) (all causes and not just SUDI) have reduced by 25% for Māori pēpi and 21% overall (Source Statistics NZ). It's worth it.

Mā te wā, Stephanie

Pod Talk 8: Lessons from a pressure cooker

Mon, 12 Feb 2024 22:55:55 GMT

Systems don't move, even in small ways, without pressure

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Once upon a time I taught chemistry. Oh how a life can go off on a tangent! But chemistry taught me some general principles. One such lesson is the relationship between heat, volume and pressure . If you change one, the others will either go up or down. For example, when you turn up the heat, you will turn up the pressure if the volume stays the same. And if you do that in a pressure cooker, it will eventually blow up and make a terrible mess! Because a pot is a pot, and its volume stays the same, so you have to 'let off some steam' to reduce pressure and prevent an explosion.

Nowadays, pressure cookers are much less scary than the ones from childhood, and it is quite rare to have to scrape your dinner off the walls and ceiling of your kitchen! Cooking food with pressure speeds up the process, saves energy, and improves the result. This is where the analogy makes sense for safe sleep work. We need a pressure cooker approach to protection. We need to turn up the heat in every conversation we have, so as to speed up the process for protecting more vulnerable pēpi, save energy in whānau by avoiding all that grief, and improve survival outcomes to at least the same as other pēpi.

Information from coroners on the deaths of 64 pēpi reported here in 2022, is a good place to start for identifying where to focus . It is with:

pēpi who are Māori
pēpi who are exposed to smoking in pregnancy
pēpi who do not have a wahakura or Pēpi-Pod, and, if older, a cot available
pēpi whose mama decline smokefree support

These factors identified about 70% of all deaths. If we turn up the heat on our efforts for this group of pēpi, we will put pressure on the system as a whole and speed up prevention.

As individuals, we do the bit we can do. No one can do it all. For some it may be turning up the heat on addressing social concerns , such as overcrowding where there is simply no room for a cot, and so bed-sharing is seen as a solution. For others, it may be cultural concerns such as teasing apart the values conflict between bed-sharing and smoking. Many in this network have opportunities to turn up the heat on health concerns from smoking in pregnancy, so that accepting smokefree support becomes a priority. And, while all that effort is building pressure in the system, there is the work of access concerns to get every vulnerable new-born an infant bed for safer bed sharing, and a cot for their 'next stage'.

As pressure rises from all this collective effort across the system,

so does the pressure on you to have that difficult conversation, to help resolve that value conflict, to personalise vulnerability.
so does the pressure on whānau to devalue smoking, to use the sleep space they have accepted, to embrace smokefree support.

We are not working in isolation. We are the team - from policy makers to professionals to parents. It is not that we don't do enough already, it is how we do that enough, that we do it with common purpose and a sense of urgency. Together, our bits of effort help turn up the heat to the point where the system needs to ' let off steam ' in the form of more lives saved, sooner rather than later. That is what we should see when we take a pressure cooker approach to preventing sudden infant death.

Mā te wā, Stephanie

Pod Talk 7: Upside down and back to front

Fri, 15 Dec 2023 01:39:21 GMT

Upside down and back to front

This clock face is all wrong.

That will be immediately obvious t o most of us who are old enough to know about analogue clocks. Those 'upside down' and 'back to front' numbers catch our attention , are worthy of comment. The clock itself is not wrong. It is the right way up, standing on its stumpy little legs, waiting to crash into someone's sleep with its clanging alarm. It is just the face that is wrong; it is the face that makes it harder for the clock to do what it is meant to do - tell us the time, set an alarm, and sound an alarm to alert us.

We have a si milar situation with baby faces in New Zealand. Too many babies are sleeping upside down (prone) due to a concerning sleep position shift from back to front in some families. It is over 30 years since we learned to move babies from front to back (prone to supine position) when sleeping. This finding has been heralded as the greatest paediatric breakthrough of our time, such has been the impact around the world on lives saved; such is the power to protect of this simple infant care practice.

So why is it that 30% of sudden infant deaths reported in this Ministry of Health SUDI report , published in 2022, were of babies not placed on their backs for what was to be their last sleep? Placing babies on their sides and tummies was twice as common for babies who died as it is in the general infant population. And right there is another fact that must disturb us in this network, because that 15% of babies born each year represents 9000 babies; 9000 babies exposed to a well-established and easily prevented risk for sudden infant death. Had all babies in the above report been placed in their backs, 19 may still be with us.

This statistic of 9000 should send alarm bells through our prevention work for the following reasons, too, described in research and confirmed in the SUDI report. Because prone sleeping interacts with other risks, babies who sleep on their backs have all these advantages over babies who do not: it is

easier to breathe (arouse, alarm, startle, reboot)
easier to alert a parent if there is a problem or need
easier to stay in a safe position , stay protected
easier to maintain a clear face
easier to avoid escalating risk if also exposed to smoking in pregnancy
easier to avoid escalating risk from also bed sharing
easier to avoid escalating risk from also being winter
easier to avoid escalating risk from also being premature
easier to avoid escalating risk for babies unaccustomed to prone sleeping
easier to avoid escalating risk if also sleeping in a room distant from a main carer
easier to avoid escalating risk from also having too many bedding/clothing layers

Returning to the alarm clock analogy, babies need to be able to sound an alarm and alert their parents when they meet a breathing challenge. They need to be the right way up in order to have all the survival advantages listed above. The right way up for a baby to sleep is facing the stars. This is our work. We are the team entrusted to preventing preventable deaths. We need to reverse the back to front positioning practice, before it takes hold; we need to engage our families to help spread understanding of why ' on the back' makes it easier for babies to breathe.

This post is my Christmas gift to you - reimagining an Aotearoa where all pēpi sleep the right way up - facing the stars, and imagining the 1 in 5 SUDI deaths that may not happen in 2024 as a result of our collective action.

Mā te wā, Stephanie

Pod Talk 6: It matters where you grow

Wed, 08 Nov 2023 21:49:10 GMT

It's spring! Let's talk soil.

No, this is not a gardening post that you have stumbled on. But it is a lesson from spring .

Nature holds so much wisdom and clarity if only we notice and consult her. Last summer, nature made it very clear where in our garden we should plant the chilli peppers, and what to feed the blueberries. Hopefully, we are now in for a very 'hot' summer that is loaded with antioxidants and phytoflavinoids. Thank you, nature, for the lesson and the produce.

So what is spring teaching us through the image above? For me, spring is telling us loud and clear - t upu whakamiharo - i t matters where you grow . It makes a difference to how you turn out . When the growing conditions are good, as they are in the middle of the seedling tray, the new plants emerge healthy and strong. If conditions are unfavourable, as in the outer compartments of the tray, then seedlings emerge weak and vulnerable, some not at all.

When I first saw this image of the seedlings some years ago, it made a powerful impact on me as an analogy for promoting placental health . So much so that we built a whole programme around it that you can download here - It matters where you grow . And we created a talk card to encourage conversations with whānau that join the dots between healthy placenta - healthy baby - safe sleep.

Just as healthy soil grows healthy plants, healthy placentae grow health pēpi . Soil and placenta are the starting places of care for the life that will emerge from each. In te reo Māori, whēnua, we know, means both placenta and land. The term has deep cultural significance for Māori. There is ritual around disposal of whēnua to honour its essential role in a baby's life, and the value of interconnectedness of people with the land.

While parents and whānau may know whēnua is 'important', they may not understand how, why or what conditions may support or challenge its work. For example, they may know that smoking is 'not good' for a baby, but they may not know that it makes the whēnua work harder to get oxygen and nutrients to the baby; that the whēnua may not last the full 9 months.

If you have been trained in midwifery, nursing, medicine or any other health science, you will know that the whēnua is a short-term organ with long-term effects for the life it is charged with protecting. You will have in-depth knowledge and understanding about its function in nurturing a baby from implantation to delivery. You will know what conditions may influence where an embryo implants and what that means for the baby and pregnancy. You will know the short and long-term consequences of an overworked whēnua .

Your knowledge gives you an advantage that those of us who are non-experts do not have. You understand the interconnectedness of the many components of this wonderfully complex organ.

Which brings me back to soil. Analogies, metaphors and stories can make learning about complex concepts easier for those of us without expert knowledge. And safer, as they externalise issues and enable a more objective perspective. The human brain remembers the gist of your explanations more easily than the details. The natural world is rich with lessons that we can translate into meaningful moments of insight for families. Starting with whēnua because all work to improve placental health is safe sleep work, too.

So get creative. Look around you for images that might support you to make a particular point, and learn from how people respond. It will make your conversations fresh and surprising, and, hopefully, insightful and enabling.

Mā te wā, Stephanie

Pod Talk 5: See patterns not problems

Tue, 17 Oct 2023 03:20:46 GMT

When we influence patterns, we influence the system

As humans, we prefer things clear and simple over confusing and complex. We try to make the confusing and complex clear and simple. But what if there was another way to view complexity, to work within it, because the context of safe sleep work is complex.

Babies are complex. Families are complex. Relationships are complex. Cultures are complex. Factors such as poverty, health, trauma, experience, gender, education and more, all play their part, too. In the next few posts, we'll discuss complexity and what it means for our work to protect our pēpi.

In a nutshell, complex means there is no straight pathway to results and many factors work together and against each other for influence. We cannot control things, order things, predict things, but we can observe things, try things, learn things. At its heart, complexity is held together by the interconnectedness of a myriad of individual components or factors. There is a constant to and fro of influence from these interactions.

Think of a jigsaw puzzle where individual pieces need each other, learn from each other, in order to make the whole. The 'whole' is more than the sum of its parts, as Aristotle so famously observed more than 2000 years ago. For example, conversation is more than a collection of words, family more than a collection of people, traffic more than a collection of vehicles.

Before we race in to make things better, first we must take note of what is already there. Because strengthening existing perspectives and values are the levers for change in complex circumstances. Look and listen for patterns hidden from easy view such as signs of emerging confidence, or clues as to a dominant influence, or personal value. These patterns may hide in feelings and beliefs more than words and actions, so use your ears!

From patterns you get insights that reveal the levers for strengthening influence. Perhaps start more sentences with "I've noticed that ..." , " What you've shown me is ...", "How you feel about ... suggests ... is important to you".

From a complexity viewpoint, your safe sleep work is a process , not a package of actions. Remember to look for those patterns.

Mā te wā, Stephanie

Pod Talk 4: The business of opportunities

Tue, 19 Sep 2023 08:47:44 GMT

For a child, opportunities lost or gained last a lifetime

Tēnā koutou,

Sometimes coroners report the death of a baby while bedsharing where there is a wahakura or Pēpi-Pod available, but not used that sleep. There is no blame implied in sharing this fact. None. Many factors influence parental decisions, especially in relation to infant sleep. To me, though, this is a double tragedy, the lost child and the lost opportunity to protect. Neither can be got back and the anguish and suffering of that is unimaginable.

This concerns me, must concern us, must make us reflect on our practice. For we, in this network, are in the business of creating opportunities . We must seek to understand our part in why people may know, but not do the protective thing. A Pēpi-Pod, for example, is only an opportunity until it is used.

For a baby, opportunities lost or gained last a lifetime. Time matters more when development is most rapid. The needs of a child are urgent . This is biological relativity and applies to any rapidly developing system. Our work is to open windows of opportunity for increasing protection while leaving families aware , not fearful; empowered , not judged; clear not muddled; believed in , not doubted; enabled not hindered.

This is skilled work, for such opportunities lie in our communication of safe sleep information, our korero and listing ears, as well as in the infant beds themselves. So how acknowledging are we of what is going well for a family, because this may be the confidence boost they need to engage? How honest are we with parents about their babies vulnerability, because this may be the fuel of their motivation to protect? How attuned are we to underpinning feelings and beliefs, because therein may hide barriers to uptake? How trusting are we of parents' influence as role models and peer communicators, because this may be key to their participation and self-worth .

Opportunities - creating them, offering them, passing them to families who feel enabled by them. This is the business of safe sleep work.

Mā te wā, Stephanie

Pod Talk 3: The smallest version

Wed, 06 Sep 2023 01:49:25 GMT

The smallest version you can do this week

Tēnā koutou,

For years, I have had grand ideas about two projects and have not got very far with either. There has been lots of thinking, talking, learning, excuses, huff and puff, but nothing to show for it. Yet both I have pulled off this week! I give credit to a comment from my daughter - "What's the smallest version of that project that you could complete this week?" Wow! That comment has been a game changer. So much so that I just had to share it with you.

The first project was the ' Infant Survival Watch '. We relied heavily on this when leading SUDI prevention work, and not supporting you similarly weighed heavily on me. That simple shift in thinking to ' the smallest version ' and ' this week ' cleared away all the obstacles and left me feeling free as a bird.

So much so, that I was energised for the second project. I have gone past blog post no 1 of Apr 2022 and resurrected the Pod Talk posts to bring you numbers 2 ( Keep Watch ) and 3 ( The smallest version ). As you will see, these, too, are a ' small version ' and easily completed ' this week ', but they mean we can be back in touch, having conversations and feeling connected in our safe sleep work.

In the depths of overwhelm , change and 'too much to do' we can be held back from doing what we know will have impact simply by thinking we have to do the big and fancy version. What if we did the smallest version of that vision that we could do this week ? What might that mean for our influence in the world?

Mā te wā, Stephanie

Pod Talk 2. Keep watch

Tue, 05 Sep 2023 03:01:37 GMT

Keep a close eye on the survival rates of our babies.

Tēnā koutou,

Being seen. Sudden infant deaths happen silently, often at night, scattered through communities. Because they do not happen as a group tragedy, they too easily go unnoticed. Not by us, though. Not by the teams in this network. And not if we make them visible as a group. This post is to launch our Infant Survival Watch so that you have updated and timely information with which to fuel your interventions.

Survival picture. First, though, a picture of the current survival chances of New Zealand babies. In 2022 there were 57531 live births and 207 deaths of babies under one year. Eighty-four babies (40%) died in their first week. The remaining 123 babies were in the post-perinatal (PPN) age when more deaths are considered preventable. Seventy-seven were between 7-91 days and 45 between 92-364 days. How many of those 77 babies had a better chance at survival because they had an in-bed-capable sleep space? What might that number be if the answer was 'All of them'?

Our Infant Survival Watch will monitor PPN mortality rates by region and ethnicity across each quarter. It will provide a timely context for monitoring how well we are tracking with the twin goals of improved survival and equality for New Zealand babies.

Mā te wā, Stephanie

Pod Talk 1. Big puddle

stephaniecowan@changeforourchildren.nz (Stephanie Cowan) — Thu, 28 Apr 2022 03:48:16 GMT

A river without banks is a big puddle

Tēnā koutou,

We have started up Pod Talk again, as a forum for sharing updates and stories related to the work of protecting babies as they sleep. It is a simple way to connect with you as a network, and connect you to each other through what is shared.

Why are we doing this mahi (work)?

Access to portable baby beds, known as sleep spaces, is now not our main objective. Their use by vulnerable infants when in risk locations, is. These are two very different objectives. Access is important, but, as we have learned, it is not enough. While the supply of portable baby beds has doubled in recent years, post-perinatal mortality has increased, and, sadly, some babies have died where there was a sleep space available, but not used for ‘that sleep’.

A river without banks is a big puddle

Similarly, an intervention without monitoring lacks direction. We need timely feedback from data to make course adjustments and stay on track. This first issue is to remind all services that from July 1st, 2021, we will only be supplying goods to partner agencies. Partners are those agencies who understand and accept our refreshed ‘terms of supply’, made for quality reasons, and share our commitment to the collection of clinically relevant programme data with which to steer their services towards real change for our children.

Mā te wā, Stephanie