Pre- and Postnatal Safe Sleep Knowledge and Planned as Compared to Actual Infant Sleep Practices

Paula Valino Ramos, BS
Pam Hoogerwerf, BS
Penny Smith, BSN, RNC-NIC
Carolyn Finley, MSN, RN, CNL
Morgan Swanson, BS
Uche Okoro, MBBS, DrPH
Charles Jennissen, MD

Our study objectives were to examine the safe sleep knowledge, attitudes and planned infant sleep practices of expectant mothers and how they were similar or different after their infant’s birth, and whether differences (if present) were associated with any demographic variables.

Study participants were surveyed at their 28-week prenatal and postnatal visits at the obstetric clinics of an academic tertiary medical facility from November 2019-February 2021. Those <18 years and non-English speakers/readers were excluded. After the study commenced, most mothers were not returning for in-person postnatal visits due to the COVID-19 pandemic. Thus, participants were contacted through text messaging encouraging them to take the follow-up survey on-line. Frequency and statistical analyses were performed using Microsoft SAS software, V.9.4.

355 women (44%) completed both the pre- and postnatal survey. Survey comparisons demonstrated that many participants increased their safe sleep knowledge. For example, of those who were unsure or thought it safe for a baby to sleep in a baby swing/bouncy seat in the house, about two-thirds (67/102, 66%) stated it was unsafe on the postnatal survey. In addition, many who planned sleep practices considered unsafe or were not sure prenatally reported utilizing safe sleep practices on their postnatal survey. For example, of those unsure or planned to place their infant not on their back (8% of total), nearly two-thirds (64%) reported putting their child to sleep on their back postnatally. Of those not sure or planned to use a crib bumper on the prenatal survey (17% of the total), only 12% were using one at their postnatal visit. Despite this, some reported they would be following safe sleep practices on their prenatal survey but then were not doing so postnatally. For example, of those stating they planned to have their infant sleep in the same room (88% of the total), 16% were actually sleeping in a different room from their baby. Similarly, 13% of those stating they would place their child on their back reported using some other position for sleep on postnatal survey. Certain demographics had higher proportions reporting this reversal for specific safe sleep practices. For example, Caucasians (19%) as compared to other races/ethnicities (5%) and those with incomes ?$75,000 (21%) as compared with those with less income (9%) had higher proportions stating their infant would sleep in the same room but then reported postnatally they were sleeping in a different room, P=0.0094 and P=0.0138, respectively.

Despite increases in safe sleep knowledge and many study participants following safer sleep practices than they had planned at their 28-week prenatal visit, there were also mothers who had planned on safe sleep practices who were not doing so after their baby’s birth. All expectant mothers should receive safe sleep education, but our study identified demographics for which targeted efforts and more effective interventions may be needed.

1. Participants will be able to name three safe sleep topic areas of which the knowledge of pregnant women increased the most from their 28-week prenatal visit to that postpartum.
2. They will be able to state three safe sleep practices that were followed by a much higher proportion postnatally than what respondents planned on their prenatal survey.
3. Attendees will be able to identify three demographic groups at increased risk for stating they planned on a specific safe sleep practice at their 28-week prenatal visit but then were not following that practice postpartum.