Like every mom, Miranda Halladay remembers every detail of the day her first baby was born.
Despite the blistering heat, she put in a full day at the family winery, a searing backache at day's end a sign that labour had begun.
By suppertime, Ms. Halladay was admitted to the regional hospital in Penticton, B.C., and, just after midnight last July 26, Rex was born. He weighed a healthy seven pounds 10 ounces, had an "extremely good cry" and the only abnormality noted was a dimple on his bum.
"It was a textbook birth and Rex was a textbook child - absolutely perfect," Ms. Halladay said proudly.
But three hours later, Rex was brain dead. Swaddled and left alone in the hospital bed with his exhausted mother. The newborn was asphyxiated when Ms. Halladay rolled on top of the child.
Ms. Halladay, who is expecting a second child in a matter of days, decided to tell her story, one drenched in tears, heartache and sorrow, to warn of the dangers of bed-sharing with young children.
"We want everyone to learn from our horrible experience, so no one else will have to suffer from such a preventable tragedy."
Bed-sharing, or co-sleeping as it is known in academic circles, is one of the most fiercely debated issues in family medicine. For decades, pediatricians have warned against the practice, while proponents have branded it as essential to bonding and breast-feeding.
Most parents have shared the bed with children at some point, though many are loath to admit it.
"Co-sleeping is a hidden phenomenon," said Sandra Woods, a community pediatrician in Val d'Or, Que. "The practice is widespread, but it's only now coming out of the closet."
Dr. Woods learned how controversial the subject could be when she wrote an academic paper on the safety of co-sleeping. During the peer-review process for the paper, the responses were detailed and passionate. Almost four years later, that research has morphed into a set of guidelines to be published in the fall by the Canadian Paediatric Society.
The U.S. Consumer Product Safety Commission condemns the practice of co-sleeping, saying it is dangerous, while the American Academy of Pediatrics expresses reservation. Unlike their U.S. counterparts who condemn co-sleeping outright, Canadian pediatricians take a pragmatic approach.
"Our main idea is to accept the notion that co-sleeping exists - rather than pretend it doesn't - and try to make the practice as safe as possible," Dr. Woods said.
Rather than a sweeping condemnation, the document will set out conditions for parents sleeping with their children.
The baby should always sleep on his back, on a hard surface: no waterbeds, no makeshift beds made of cushions or pillows, and no sleeping on the couch or in the Laz-E-Boy. The baby should be covered by no more than a thin blanket: no swaddling, no comforters and no pillows. And there should be no space between the bed and the wall, where a baby can fall.
"What you want to do is eliminate any possibility of entrapment or suffocation," Dr. Woods said.
According to the guidelines, a parent must also be in the proper state of mind to sleep safely with a child. The parent should not have consumed any drugs or alcohol or be excessively tired. And a parent who smokes should not practise co-sleeping, nor should a parent of a child with serious respiratory problems.
"As a rule, if you are afraid of not waking up, the baby shouldn't be in bed with you," said Aurore Côté, a specialist in respiratory medicine at Montreal Children's Hospital and one of the world's foremost authorities on infant-sleeping environments.
While she would not comment directly on the Halladay case, Dr. Côté said she is asked frequently by health-care professionals whether newborn babies should sleep with their mothers.
"My recommendation is always the same: The baby should be in a crib beside the bed. Many mothers have had long labours, many have received medication and most have slept poorly in the weeks leading up to the birth. Under these conditions, bed-sharing is never advisable."
There are no national statistics on the dangers of co-sleeping. But Dr. Côté is completing an exhaustive study based on Quebec data. Her preliminary findings show there were more than 435 infant deaths in the province from 1991 to 2000.
At least 81 of those deaths were due to "unsafe sleeping environments," including sudden infant-death syndrome and co-sleeping deaths. The preliminary data show that 17 of the deaths were due to "unsafe bed-sharing."
This suggests that like Rex, eight to 10 babies die every year in Canada due to bed-sharing - most in the first six weeks of their lives.
A large percentage of these deaths occur in unfamiliar circumstances, such as visiting friends or family and resorting to makeshift beds.
"The numbers are high and the way these poor babies die is awful," Dr. Côté said. Yet, she refuses to condemn co-sleeping, saying the debate is misplaced. "What we should be focusing on is not the practice of bed-sharing but the unsafe practice of bed-sharing."
A child who sleeps on his back and shares a good bed with a sober parent who is not exhausted is in virtually no danger. There is strong evidence that such children are at far less risk of SIDS - a condition that despite a dramatic drop in numbers still claims far more babies than co-sleeping does.
"We can't ignore that there are definite advantages to co-sleeping," Dr. Woods said. Notably, babies who sleep with their mothers breast-feed longer - and better - and are less likely to cry.
"The physical contact is also good for mother and child," she said, adding that she and her husband shared a bed with their boy until he was about 20 months old.
One of the main concerns of parents (usually the father) about co-sleeping is the wrench it throws into their sex lives. "A baby in the bed can be a barrier method in the true sense of the word," Dr. Woods said with a chuckle.
But she said that is just one of many adjustments new parents have to make and is an issue couples need to discuss openly between themselves and with their pediatricians.
"What we want, above all, is for people to come out of the closet about co-sleeping, so their physicians can offer support and medically sound advice," Dr. Woods said.
Ms. Halladay desperately wishes she had received adequate support and advice before and after Rex's birth. "In the prenatal class, they talked about everything leading up to the birth, but they never discussed sleeping with your baby afterward."
The grieving mother also wishes that health-care professionals had been more forthright. Initially, she was told the baby died of SIDS, to spare her feelings of guilt.
Ms. Halladay learned only months later, when she was reading the coroner's report, that she had asphyxiated her baby. Rex was not breathing when he was removed from under his mother and it took doctors almost an hour to revive him. The baby was transferred to another hospital on life support and went home to die about 10 days after his birth.
The coroner who investigated Rex's death recommended that teachers of prenatal classes use the case for educational purposes and warn parents-to-be about the potential dangers of co-sleeping.
In her search for answers about her baby's death, Ms. Halladay also learned that there are no national or provincial rules regarding new mothers sleeping with their babies. Policies, when they exist, are at the hospital level and, more often than not, at the discretion of nurses.
Ms. Halladay said that when her second child is born in the coming days, the baby will never sleep in the bed with her. "After what happened, it's just not something I would be able to do."
She does not pass judgment on parents who advocate and practise co-sleeping but hopes they do so with full knowledge of the risks, as well as the benefits. "We've been robbed of so much joy that I don't want this to happen to anyone. If we save just one baby by telling our story, in some ways, that will keep Rex's memory alive."
André Picard