New Zealand has one of the highest rates of sudden unexpected death in infancy (SUDI) in the OECD, with most deaths occurring during sleep and at night. Whilst recommendations for safe infant sleep are promoted to parents, there is little understanding of how parents make decisions as they interpret these population level recommendations at the individual level. The objective of this qualitative study was to explore how mothers made decisions in the night-time care of infants, in one suburb of Christchurch, New Zealand. An inductive qualitative design was used to explore the topic. Thirteen semi-structured interviews were held with mothers of infants aged less than 6 months old, living in a more socio-economically deprived suburb. Thematic analysis was used to search for emerging themes and these were analysed in the context of existing literature and concepts from appropriate critical social theories.
The study found that night-time infant care decision-making was complex. Mothers were dealing with competing tensions between keeping their babies safe from death, and meeting their immediate needs for food, comfort and sleep. Added to this were pressures from the dominant 'intensive mothering' ideology which holds mothers accountable for their infants' psychological and emotional wellbeing. In attempting to live up to the myth of intensive mothering, women individualized and privatized risk behaviours in ways that aligned with neoliberal rationalities. Part of being a 'good mother' was being seen to follow 'expert' advice around safe infant sleep practices. When the baby was settled and healthy, mothers were more likely to trust 'expert' advice and follow recommendations. However, on occasion and in unplanned ways, the needs of the baby and/or the mother, led mothers to act in ways that differed from 'expert' advice. Mothers mitigated risks in their own ways, and used intuition to protect their infants from perceived danger. Nonetheless, anxiety levels were high for some mothers, due, in part, to the knowledge that a baby could die despite their efforts. Anxiety levels are not helped by recommendations that leave no room for negotiating the complexity of night-time infant care, nor by prosecuting mothers whose infants die in unsafe sleep environments. Greater recognition needs to be given to the complex realities within which decisions are made. The use of empathy in individualizing population level public health recommendations may relieve maternal guilt and anxiety, and empower mothers.