There's a strong belief that many of Minnesota's 60 to 90 sudden infant deaths each year are preventable.
Investigators are now learning that unsafe sleeping arrangements are fairly common with these deaths. In particular, they've discovered many situations where parents and babies co-sleep or bed-share.
Dakota County Medical Examiner Lindsey Thomas has suspected this for years, based on what she's seen in her morgue and from what she's gleaned by reviewing every infant death in the state since 2005.
"I have been personally so persuaded by the evidence that suggests that these infant deaths are largely due to unsafe sleep environment that I really want to get the message out," Thomas said.
Thomas found that in 2005, more than three-quarters of the state's 62 sudden infant deaths were associated with unsafe sleep environments. That link was even more dramatic the following year, when 92 percent of the 57 cases had at least one hazardous sleeping condition present at death.
Her numbers aren't ready yet for 2007 and 2008, but Thomas said a preliminary review shows that most of the cases involved a dangerous sleeping situation, and bed-sharing was often a factor.
SIDS is still thought to be responsible for at least some of the deaths. In fact it's possible that in all of the cases, there was some sort of developmental problem that made the babies more vulnerable to dying during sleep, whether they succumbed to SIDS or to the hazards of an unsafe bed.
"It doesn't take much to obstruct the airflow in an infant's nose and mouth, or to change that, to alter that," said Dr. Patrick Carolan, the medical director for the Minnesota SID Center at Children's Hospitals and Clinics of Minnesota.
Carolan said deep brain autopsies have shown slight differences between babies who die suddenly in their sleep and babies who die from other causes.
"For most babies it may not be an issue, because they have the ability to defend their airway, meaning they can turn, redirect their airway, take a breath of fresh air and compensate for those," he said. "But babies that are vulnerable to SIDS may not have the same finely tuned defense mechanisms."
In other words, some infant brains may not get the message that the oxygen supply is too low. Or if they do get the message, they may not be able to react to it.
The challenge is that researchers don't know which babies may harbor these vulnerabilities and which ones don't. So they recommend that parents remove anything from a baby's bed that might impede breathing, such as sleep surfaces that are too soft, or fluffy blankets, loose sheets, bumper pads and toys. Those objects can entrap an infant and suffocate them.
But the idea that it could be unsafe for adults and even siblings to sleep with babies isn't as well understood, and the theory doesn't sit well with some parents.
"I think there may be some assumptions being made," said Lysa Parker, cofounder of Attachment Parenting International.
Parker's group believes in the attachment theory -- that babies need to be physically close to their parents much of the time to develop emotionally.
Parker said investigators usually can't provide much more than circumstantial evidence to support their bed-sharing warnings.
"For instance, when a child dies in a crib, it's automatically assumed to be a SIDS death," Parker said. "When a child dies in a parent's bed it's often assumed to be a suffocation or overlying on the infant. Or sometimes the parent thinks they must have, but they don't really know. They just assume [they] must have rolled over on the infant."
Parker acknowledges there might be a slight risk to bed-sharing, but she said it's worth it because that early, close contact helps babies grow into well-adjusted people. She said as long as parents aren't obese, under the influence of drugs and alcohol or deep sleepers, bed-sharing can be done safely.
“I have to [share my story], because in doing that it's the only way I see fit to honor my son.”
"The baby's senses are stimulated during the bed-sharing experience," Parker said. "There's a cascade of sensory exchanges that go on between the mother and the baby through the night. And the baby can smell the mother. It can smell the mother's milk. It can feel the warmth of her body."
In fact, bed-sharing is believed to promote higher rates of breastfeeding, something public health officials encourage.
But there have been some cases when bed-sharing clearly resulted in an infant's death, and the situations didn't involve alcohol or an obese parent.
Lisa West was a 20-year-old mother who had never heard any warnings about sleeping with her baby. In fact, her pediatrician recommended it as a way to bond with her son. That was six years ago.
Two months ago, West, now 26, finally decided to share the story of how her four-month-old son, Dayton, died.
West put together a video of still photographs of her son set to music and posted it on the Internet.
"He was wonderful. He barely ever cried, only when he was hungry. He was just a go-with-the-flow kind of baby."
On the night Dayton died, West and her family were staying with relatives. She and her husband shared a bed with Dayton, just like they did at home. Around 2 a.m., the baby woke up hungry for his bottle.
"He stayed awake for about a half an hour after his bottle, just staring so intensely at me and just cooing and smiling," West said. "And then we went to sleep."
Around 7:45 the next morning she was startled out of a deep sleep.
"My mother-in-law was screaming that I was laying on top of the baby," West said. "I turned him over and his lips were blue. And I just immediately started doing CPR, and my mother-in-law called the ambulance and my husband was just screaming, 'What did you do? What did you do?"
"I ran him out to the ambulance and then we went to the hospital," West continued. "I don't know what they said. I don't know how they told us that he was dead. But they came in and obviously said that they couldn't help him."
West hasn't talked much about her child's death. But now she has decided to share her story publicly.
"I just feel like I don't have a choice, like I have to do that, because in doing that it's the only way I see fit to honor my son," West said. "And maybe one day when I go to heaven he'll say, you did a really good job mommy and look at all these babies that you saved. And maybe he won't be mad at me."
West has been invited to testify before Congress on behalf of a bill that's expected to be introduced soon, which would create a national database to track unexpected infant deaths.
Dr. Lindsey Thomas, Dakota County's medical examiner, said a national database could help investigators finally get to the bottom of what's causing many of these deaths.
She likens the situation to the debate over seat belts. When she was growing up, almost no one wore seat belts. But today, Thomas said parents wouldn't dream of putting their child in a car without a car seat because the data proves that it's safer.
"I think it's part of our kind of evolving view of how much safer do we want our children to be than we were? And what we didn't know then did hurt us," she said. "In fact, people did die because they weren't wearing their seat belt. And likewise, I think babies did die in unsafe sleep environments, and now we recognize that in a way that we didn't."
But until the science proves the risks beyond a doubt, many parents are left with sorting out the mixed messages on their own.