:Tēnā koutou

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