In a bid to cut Baltimore's high infant death rate, a new public health campaign is hammering home a message to prevent more loss: Babies should sleep alone on their backs in a crib.
Driving that message will be some poignant representatives: local mothers who have lost their children. Their faces will be on billboards and their voices will be in radio spots. There will be a video shown in maternity wards, some speaking and some door-knocking.
Dearea Matthews, one of the mothers involved in the B'More for Healthy Babies project, hopes her personal loss will give her message real impact. "I would have listened if it was a real mother talking," she said.
Matthews lost Charlie on Dec. 29. He didn't wake up that morning. His panicked father called 911 while his grandmother performed CPR. But after an hour at Johns Hopkins Hospital, doctors told them he was gone. He was just one month old.
Charlie had been sleeping in bed with his parents, just as his two siblings had done — and just as many other members of his extended family had done with their parents. Even Matthews' doctor told her his four kids had slept in bed with him.
Many mothers in Baltimore and elsewhere believe that is not just more convenient for nursing and needy infants, but safer because the infants are close should something go wrong.
But 27 infant deaths last year in Baltimore were tied to unsafe sleeping practices, statistics show. Babies who are not alone in a crib can be crushed by a sleeping parent or sibling, or suffocated by blankets or toys. On their bellies they can also more easily choke. Charlie's death remains unexplained, but health officials say sudden infant death syndrome, formerly known as crib death, is far less likely to happen to babies properly positioned for sleeping.
Statewide, the infant mortality rate has been dropping, hitting its lowest point last year. There were 7.2 infant deaths per 1,000 live births in Maryland in 2009, down from 8 the year before, according to state statistics.
But in Baltimore, the infant mortality rate was 13.5 per 1,000 live births. More than a fifth of the 128 deaths were caused by unsafe sleeping practices. Only low birth weight was responsible for more deaths.
The Baltimore City Health Department plans to address the birth-weight issue as part of its B'More for Healthy Babies project. But because sleep-related death is more easily preventable, it's first on the agenda.
And it's a stubborn problem. A recommendation from a federal task force led to a national Back to Sleep campaign launched in 1994. That campign is credited with a 50 percent decline in the number of SIDS deaths, but the National Center for Health Statistics reports that SIDS remains the third leading cause of infant death in the country behind birth defects and low birth weight.
That years-old campaign is no longer getting the attention it needs, said Cathy Church-Balin, director of the Business Development Center for Communication Programs at Johns Hopkins Bloomberg School of Public Health. She's helping Baltimore officials with materials for the new campaign.
"It only takes nine months to get a new generation that needs the information," she said. "The message bears repeating."
Frequently and loudly, added Dr. Avril Melissa Houston, assistant commissioner for maternal and child health at the city health department. The health of the entire city depends on babies getting a good start, she said.
And the city, and nation, are losing ground. In 1960, the United States had the 12th lowest infant mortality rate, but by 2004, the nation dropped to 29th — "a disturbing trend," she said. The goal, she said, is to reduce deaths in Baltimore by 30 percent in three years.
There are several private and university partners, including the Family League of Baltimore City. Dr. Gena O'Keefe, the group's director of healthy community initiatives, said the goal is achievable but the campaign needs to reach new mothers where they live — as well as their families, caregivers and others who have influence in a baby's life.
"It's about changing people's behavior," she said. "To do that, we have to get out there in their community."
In all, the campaign will use more than $7.5 million in federal, state and private sources. The money will pay for bus shelter and billboard ads that already are going up around the city. There also will be 700 radio spots during the next eight weeks. The overall campaign will be ongoing.
Youth workers will go door-to-door handing out information in three target neighborhoods: Upton/Druid Heights, Greenmount East and Patterson Park. And a video will be played for new mothers at eight area hospitals that delivery babies.
That video features Matthews and other mothers who have suffered a loss. Matthews believes that if she had heard such personal stories she would have paid more attention than she did to the brochure in her doctor's office and the fact sheet handed out at the hospital.
Matter-of-fact words delivered on paper by a clinician don't resonate at a time when new mothers are being inundated with other information about giving birth, feeding and other seemingly more pressing matters, Matthews said.
She had heard of safe sleep practices, and Charlie did have his own crib, as did her two other children. But she often left him in her bed if he fell asleep after eating.
"I thought it was better," said the 25-year-old North Baltimore mother. "I was afraid if he was in his crib he'd choke and he'd be alone. This way he'd be close. And he'd be comfortable near his mother."
After Charlie died, she wasn't sure she wanted to be part of the B'More for Healthy Babies campaign. Repeating the details of Charlie's last day to reporters and to rooms full of strangers, let alone seeing her burdened face on advertisements, seemed like it was too much.
She initially rebuffed the health department official who called. But after talking to her husband and minister, she came to believe she could save another mother from going through the same devastating loss.
"If I can help another mother realize this is real," she said. "That's all I want to do."