Journal of Community Health

, Volume 43, Issue 3, pp 488–495 | Cite as

Infant Safe Sleep: A Survey of the Knowledge, Attitudes, and Behaviors of Obstetric Physicians

  • Nichole L. HodgesEmail author
  • Sarah E. Anderson
  • Lara B. McKenzie
  • Mira L. Katz
Original Paper


Obstetricians may be a pregnant woman’s primary professional source of information about her infant prior to the birth, but infant safe sleep knowledge, attitudes and behaviors of this population are unknown. This study explores obstetric physicians’ knowledge, attitudes, and behaviors related to Sudden Infant Death Syndrome and infant safe sleep and identifies barriers as well as enabling and/or reinforcing factors associated with providing infant safe sleep education in the prenatal environment. A cross-sectional survey was conducted with obstetric physicians who provide prenatal healthcare to women in Ohio. Surveys were sent to all licensed physicians included in the registry of the State Medical Board of Ohio with “obstetrics,” “obstetrics and gynecology,” or “maternal and fetal medicine” as their primary specialty (n = 1771). The response rate was 30%, with 418 physicians included in the analysis. Many participants were knowledgeable about infant safe sleep recommendations; however, only 55% indicated that it was important for obstetric physicians to discuss Sudden Infant Death Syndrome and/or infant safe sleep with prenatal patients. Many participants (70%) perceived barriers to providing infant safe sleep education, however most (82%) indicated interest in doing so. Participants’ knowledge and attitudes were significant predictors of whether they discuss this topic with patients. Obstetric physicians can influence the infant safe sleep decisions that women make. Improving obstetricians’ knowledge and attitudes about infant safe sleep and supporting physicians who wish to provide education on this topic may help to ensure that women are receiving frequent and consistent infant safe sleep messaging throughout the prenatal period.


Infant safe sleep Obstetricians Prenatal education Sudden infant death syndrome (SIDS) Sudden unexpected infant death (SUID) 



A research Grant to support this study was provided by the Center for Injury Research and Policy at Nationwide Children’s Hospital through Grant # 1R49 CE002106. Author Nichole L. Hodges also received research support from The Ohio State University College of Public Health. The contents are solely the responsibility of the authors and do not necessarily represent the views of the funding agencies.

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest relevant to this study.


  1. 1.
    Centers for Disease Control and Prevention. (2017). Sudden unexpected infant deaths and sudden infant death syndrome: About SUID and SIDS. Retrieved July 29, 2017, from
  2. 2.
    Centers for Disease Control and Prevention. (2017). Sudden unexpected infant deaths and sudden infant death syndrome: Data and statistics. Retrieved March 7, 2016, from
  3. 3.
    Moon, R. Y. & American Academy of Pediatrics Task Force On Sudden Infant Death Syndrome. (2016). SIDS and other sleep-related infant deaths: Evidence base for 2016 updated recommendations for a safe infant sleeping environment. Pediatrics, 138(5), e20162940. Scholar
  4. 4.
    Hauck, F. R., Moore, C. M., Herman, S. M., Donovan, M., Kalelkar, M., Christoffel, K. K., et al. (2002). The contribution of prone sleeping position to the racial disparity in sudden infant death syndrome: the Chicago Infant Mortality Study. Pediatrics, 110(4), 772–780.CrossRefPubMedGoogle Scholar
  5. 5.
    Hauck, F. R., Tanabe, K. O., & Moon, R. Y. (2011). Racial and ethnic disparities in infant mortality. Seminars in Perinatology, 35(4), 209–220. Scholar
  6. 6.
    Centers for Disease Control and Prevention. CDC WONDER (Wide-Ranging Online Data for Epidemiologic Research). Retrieved July 29, 2017, from
  7. 7.
    Centers for Disease Control and Prevention National Center for Health Statistics. Infant mortality rates by state. 2015. Retrieved July 29, 2017, from
  8. 8.
    Ohio Department of Health, & Ohio Children’s Trust Fund. Ohio child fatality review sixteenth annual report. 2016. Retrieved July 29, 2017, from
  9. 9.
    American Academy of Pediatrics Task Force on Sudden Infant Death Syndrome. (2016). SIDS and other sleep-related infant deaths: Updated 2016 recommendations for a safe infant sleeping environment. Pediatrics, 138(5), e20162938. Scholar
  10. 10.
    Colson, E. R., & Joslin, S. C. (2002). Changing nursery practice gets inner-city infants in the supine position for sleep. Archives of Pediatric and Adolescent Medicine, 156(7), 717–720.CrossRefGoogle Scholar
  11. 11.
    Gelfer, P., Cameron, R., Masters, K., & Kennedy, K. A. (2013). Integrating “Back to Sleep” recommendations into neonatal ICU practice. Pediatrics, 131(4), e1264-1270. Scholar
  12. 12.
    Vernacchio, L., Corwin, M. J., Lesko, S. M., Vezina, R. M., Hunt, C. E., Hoffman, H. J., et al. (2003). Sleep position of low birth weight infants. Pediatrics, 111(3), 633–640.CrossRefPubMedGoogle Scholar
  13. 13.
    Zachry, A. H., & Kitzmann, K. M. (2010). Disparities in sleep position awareness and compliance. Southern Medical Journal, 103(4), 311–315. Scholar
  14. 14.
    Moon, R. Y., Kington, M., Oden, R., Iglesias, J., & Hauck, F. R. (2007). Physician recommendations regarding SIDS risk reduction: A national survey of pediatricians and family physicians. Clinical Pediatrics (Phila), 46(9), 791–800. Scholar
  15. 15.
    Eron, N. B., Dygert, K. M., Squillace, C., Webster, N. J., Andrianos, A., Crockett, E. G., et al. (2011). The physician’s role in reducing SIDS. Health Promotion and Practice, 12(3), 370–378. Scholar
  16. 16.
    Moon, R. Y., Gingras, J. L., & Erwin, R. (2002). Physician beliefs and practices regarding SIDS and SIDS risk reduction. Clinical Pediatrics (Phila), 41(6), 391–395. Scholar
  17. 17.
    Thornhill-Scott, F., Dong, F., Redmond, M., & Ablah, E. (2017). Physician practices regarding SIDS in Kansas. Clinical Pediatrics (Phila), 56(8), 759–765. Scholar
  18. 18.
    American Academy of Pediatrics Task Force on Sudden Infant Death Syndrome, & Moon, R. Y. (2011). SIDS and other sleep-related infant deaths: Expansion of recommendations for a safe infant sleeping environment. Pediatrics, 128(5), 1030–1039. Scholar
  19. 19.
    Lauritsen, J. M., & Bruus, M. (2008). EpiData Entry (Version 3.1): A comprehensive tool for validated entry and documentation of data. Odense: The EpiData Association.Google Scholar
  20. 20.
    American Association for Public Opinion Research. (2015). Standard Definitions: Final Dispositions of Case Codes and Outcome Rates for Surveys (8th edn.). Retrieved March 3, 2016, from
  21. 21.
    Tracy, E. E., Haas, S., & Lauria, M. R. (2012). Newborn care and safety: The black box of obstetric practices and residency training. Obstetrics and Gynecology, 120(3), 643–646. Scholar
  22. 22.
    Norton, P. J., & Grellner, K. W. (2011). A retrospective study on infant bed-sharing in a clinical practice population. Maternal and Child Health Journal, 15(4), 507–513. Scholar
  23. 23.
    Lu, M. C., Prentice, J., Yu, S. M., Inkelas, M., Lange, L. O., & Halfon, N. (2003). Childbirth education classes: Sociodemographic disparities in attendance and the association of attendance with breastfeeding initiation. Maternal and Child Health Journal, 7(2), 87–93.CrossRefPubMedGoogle Scholar
  24. 24.
    McCoy, R. C., Hunt, C. E., Lesko, S. M., Vezina, R., Corwin, M. J., Willinger, M., et al. (2004). Frequency of bed sharing and its relationship to breastfeeding. Journal of Developmental and Behavioral Pediatrics, 25(3), 141–149.CrossRefPubMedGoogle Scholar
  25. 25.
    Ohio General Assembly. Ohio General Assembly Archives. Amended Substitute Senate Bill Number 276. 130th General Assembly. Retrieved August 27, 2017, from
  26. 26.
    Colson, E. R., Levenson, S., Rybin, D., Calianos, C., Margolis, A., Colton, T., et al. (2006). Barriers to following the supine sleep recommendation among mothers at four centers for the Women, Infants, and Children Program. Pediatrics, 118(2), e243–e250. Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2017

Authors and Affiliations

  1. 1.Center for Injury Research and Policy of the Research Institute at Nationwide Children’s HospitalColumbusUSA
  2. 2.The Ohio State University College of Public HealthColumbusUSA
  3. 3.The Ohio State University College of MedicineColumbusUSA

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