“Top Ten List: What Every Health Professional Should Know

1. Cosleeping is “normative” human behavior, it is not “surprising, unexpected, nor irresponsible behavior..it Is not child abuse nor neglect; Sweeping public health recommendations must resonate emotionally&socially with the constituencies for whom they are intended (anti-co-sleeping messages do not): Where infants sleep is often unplanned, and very fluid; most babies sleep in more than one context..from solitary to social. Health brochures capturing social and solitary environments are critical. Co-sleeping is biologically inter-dependent with breast feeding; 5. There is a difference between the act of co-sleeping or co-sleeping in the form of bedsharing and the conditions within which it occurs (which can be safe or unsafe); 6. Co-sleeping is not a SIDS risk factor in the same way that prone sleep is. Why? no consensus scientifically, data are inconsistent across sub-groups and cultures; Co-sleeping is natural, biologically appropriate Cosleeping is heterogeneous 7. For both moral and ethical reasons PARENTS (not medical authorities) must remain the final arbiters of their infant’s nighttime needs and sleeping arrangements; 8. Where babies sleep is not ultimately a medical issue at all, but is instead, “relational” and sometimes economic; 9. No one-size must-fit all strategy will work: there is more than one way to save babies lives; 10. Co-sleeping is not illegal, child abuse or neglect, or immoral behavior; “Top Ten List: What Every Health Professional Should Know

2. (Are you a good person or a good scientist ? If so…. Accept arguments that bedsharing is always dangerous..one simple, single message is necessary..”never do it..” Omit safety information about bedsharing; Dismiss any evidence accept epidemiological which supports dangers of bedsharing; Dismiss persons, professionally, fire them, question their moral standing, if they reject simple, negative message; attack anyone or any idea that contradicts the simple negative message..call them “irresponsible”. In contrast: …Do not accept unqualified statements about co-sleeping or bedsharing..distinguish between them..always!! Acknowledge rights of parents to make their own decisions, and to follow their special knowledge..and their inclinations with access to safety information and guidance; Accept mixed message as necessary more closely reflects human behavior, and a more accurate, holistic, scientific perspective; Value connections between breastfeeding and bedsharing in our culture..promote safer forms of co-sleeping, understand that co-sleeping is, for the most part, irrepressible because is is what parents and infants are supposed to do, it makes them happy. Don’t tell parents what they must do and judge them. Respect them. Inform them of conditions that we know makes bedsharing or other forms of co-sleeping, unsafe. BE AWARE The “co-sleeping-bedsharing debate” has slipped into a battle worse than the debate about teaching evolution, akin to the abortion debate, practically reaching “Salem Witch Hunt Proportions”.. Not to be against bedsharing under all circumstances is a religious violation for many SIDS researchers and “First Candle”.. “Unsafe sleep” is synonymous with the presence off the mother on the same sleep surface. It is dogma i.e. ideology ..in search of data ..There is no other possible correct position either scientifically or morally other than a complete condemnation of mothers sleeping with their babies..and the resurrection of medical authorities as those that “know” and parents who….don’t.

3. Bedsharing safety..how safe is safe? Who decides? Informed parents ? Medical authorities? Government ? Police officials? Prosecutors? What populations (high risk) determine safety? Evidence (whose) ? What kind of evidence is privileged or prioritized? Only Epidemiology? Laboratory? Home Studies? Ethological? Evolutionary? Cross-cultural? Who decides which lines of evidence can be dismissed? Who decides how to determine risks and which risks are worth taking and what risks are worth investing in to eliminate? Interpretations of findings: what is healthier and for whom (mother? Infant?) as regards: awakenings? Nighttime feedings vs.consolidated sleep? Light maternal-infant sleep vs. deep sleep? Infant’s protesting separation? Infants accepting separation? Higher or lower infant body temperatures? Are the independence and problem solving skills i.e advantages in other domains achieved by routine at birth co-sleepers as valuable, or more valuable than the willingness of children to sleep alone, which is achieved much earlier by routine solitary sleepers? Because some families cannot bedshare safely does it mean that no families can..or that all parents should be denied their own inclinations and /or familial reactions, solutions or decisions? Where the controversies lie? (General Questions) (Questions Specific to Sleep Research)

4. If to the researcher accepts that co-sleeping/breastfeeding is normative, appropriate and expectable (biologically-socially) then.. Babies accepting separation and isolation without protesting may do so at their own peril; Or--Infants who accept separation without protesting are developmentally immature and not adapted vigorously; Infants who “sleep through the night’ at young ages may be “at risk”; Infants resting body temperature while sleeping alone is sub-normal; Infant night wakings are advantageous especially when associated with breastfeeding.. Judging babies who protest separation by crying as spoiled or in need of therapy is like blaming the victim for the crime; If co-sleeping/breastfeeding is not regarded as normative, appropriate and expectable (biologically) then.. Night wakings are a problem to be eliminated, as are feedings..as soon as possible; Protesting sleep isolation is a “problem to be solved” a disorder..a developmental deficiency; Infants sleeping through the night represents adaptation, not a potential risk I.e. spending sleep time in deep sleep rather than light sleep; Co-sleeping infants experience hyperthermia; Any and every problem associated with co-sleeping becomes an indictment against the practice, and proof the practice should be eliminated rather than a “problem to be solved “ Challenging Non-conscious Cultural Ideologies: How One Interprets Infant Sleep Related Behaviors Depends on One’s Initial Assumptions and Social Values

5. Interacting factors-- (most and least relevant ?) From: Sally Baddock (New Zealand) Peter Blair and Helen Ball (Great Britain), Caroline McQuillan (Australia) James McKenna and Lane Volpe (USA) Cultural least relevant Where babies actually sleep is determined by… Scientific Public Health Family including economic status Infant andParental Biology Including Feeding Method most relevant

6. In the west solitary infant sleep became entangled with, and one and the same with, “good” safe , appropriate sleep and “good” moral standing..an erroneous slippage between that what is perceived to beA medical “good” with an infant’s moral stature… if...sleeping alone through the night is medically “good” for babies then don’t “good” babies do so, and “good parents” enforce it?

7. Cascading Inter-connections Regarding Parent-infant Sleep Conflicts • (Infants rarely have sleep problems, parents do..!) • Western parents suffer from a variety of damaging diseases not the least of which is.. the disease of false and unrealistic expectations..a cultural and not a biological model of infant’s sleep patterns; • the disease of confusing parental desires and wishes and “best interest” with that of their infants • the “die”model of sleep--the only “good” sleep is an uninterrupted one; • that infant sleep behavior correlates with good moral character, and general future social skills and competencies…in domains other than sleep; • the presumption of an adversarial relationship existing between infants and parents as regards sleep..Consider the book title: “Winning Bedtime Sleep Battles”..and “Babywise” ;

8. What is the best public health strategy regarding bedsharing..? • Chianese J, Ploof D, Trovato C, Chang JCInner-city caregivers' perspectives on bed sharing with their infantsAcad Pediatr. 2009 Jan-Feb;9(1):26-32Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA. • OBJECTIVE: To understand parents' motivations for bed sharing with their infants aged 1-6 months, their beliefs about safety concerns, and their attitudes about bed-sharing advice. METHODS: Researchers conducted 4 focus groups with primary caregivers of infants ages 1-6 months who regularly shared beds with their infants. We recruited participants from an inner-city primary care center in Pittsburgh, serving primarily African American families who received medical assistance. Discussions were audiotaped and transcribed. Two investigators coded the transcripts and identified themes in an iterative process to achieve agreement between coders.

9. What Strategy? • RESULTS: A total of 28 caregivers aged 17-50 participated. The majority were African American (86%), female (93%), single (50%), and high school graduates (71%). Eleven percent of participants breast-fed their infants. We identified 5 themes, common to all groups, to explain parents' motivations for bed sharing: 1) better caregiver and infant sleep, 2) convenience, 3) tradition, 4) child safety, and 5) parent and child emotional needs. Parents expressed divergent views about the safety of bed sharing: 1) ambivalence regarding balancing risks of overlaying and suffocation with benefits of bed sharing, or 2) assertion that bed sharing poses no risks for their child. Common to all groups was the finding that clinicians' advice against bed sharing did not influence parents' decision, but advice to increase safety when bed sharing would be appreciated. • Chianese J, Ploof D, Trovato C, Chang JCInner-city caregivers' perspectives on bed sharing with their infants. Acad Pediatr. 2009 Jan-Feb;9(1):26-32

10. Conclusion • Parents' motivation to bed share outweighed the concerns and the warnings of others. An understanding of parents' perspectives on bed sharing should inform counseling to promote safe sleeping practices.

11. “Breast Feeding and the Risk of Post-neonatal Death In the United States” • Studied 1204 infants who died between 28 days and 1 year from causes other than congenital anomaly/tumor.and (7740 children who lived at 1 year) (controls); • Calculated odds specific odd ratios for ever/never breast feeding amongst all children …race-birth weight specific analysis--and duration-response effects; • Longer breast feeding associated with lower risk: odds ratio range from: • .59 95% CI 0.38-0.94 for injuries to 0.84% (95%CI:.67-1.05) for sudden infant death syndrome (SIDS); (Amin Chen and Walter J.Rogan) • “Breast feeding has the potential to save or delay ~720 post=neonatal deaths in the United States each year • Pediatrics (2004) 113: E435-439…url:http://www/pediatrics.org/cgi/content/full/113/e435

12. Dr. Peter Blair (Swiss Study) • Fleming and Blair developed the SWISS (South West England Infant Sleep Study) to look more closely at the sleeping environment and what factors are responsible for lethal outcomes pertaining to forms of co-sleeping, especially in the form of bedsharing. They collected data from all SIDS infants aged 0-2 years in the South West over a four-year period from 2003-2006. There were 90 cases of SIDS, and 86 were analysed and allocated randomized controls, weighted for age and day or night sleep. • Bliar susggests: “If we demonise co-sleeping we have tired mothers who need to feed their babies sometimes several times during the night. We cannot use simplistic labels saying bed sharing is safe or unsafe, advised Dr Blair. We should be in the business of explaining to parents the specific circumstances where co- sleeping should be avoided.

13. Limitations of Western Pediatric Sleep and SIDS Research adult-centric; Authoritative..dismisses knowledge system of mother-parents; non-evolutionary; ethnocentric; (a)theoretical (no theory around which to interpret clinical events or research results) Who infants are, what infants need, what criteria should be used to decide, relates only to present cultural snapshot and ideologies..no continuity with their biology; biological? species-wide? local? Western reductionist science methods have not served infants well.. Eliminated concept of “the mother-infant dyad” as the unit of analysis

14. Pediatric Sleep Researchers…traditionally privilege mother-infant separation…and prioritize (above all else) sleep consolidation (not nutrition, breastfeeding and breastfeeding delivery )Consolidated sleep is where the action is..the goal…the earlier the better… (accordingly, breastfeeding seems to be something pediatric sleep researchers think mothers just need to get through, but to end as quickly as is possible)

15. To sleep or not to sleep with baby? Is the wrong question.A “debate” that refuses to go away?No. It is not a debate, it is a discourse, which involves different answers. The answers are not either /or but rather how, when, by whom, for what reasons, and under what circumstances….

16. for the record… there is no ‘one place’ or space within which infants sleep; ordinarily there are several… Sleeping arrangements are much more fluid than is generally acknowledged

17. Bedsharing safety..how safe is safe? Do informed parents benefit by education as to what makes a safer or less safe bedsharing environment..or should it be a top down declaration? What right do medical authorities or child protective services have in making or drawing conclusions about the safety of ALL bedsharing from circumstances that have little to do with most families? Evidence (whose) ? What kind of evidence is privileged or prioritized? Only Epidemiology? Laboratory? Home Studies? Ethological? Evolutionary? Cross-cultural? Who decides which lines of evidence are unimportant? Medical authorities dismiss all non-epidemiological data, violating the rules of evidence -based medicine, according to Sackett et al.2000. Who should decide whose scientific understandings and/or findings and facts should be dismissed? Who decides which risks are worth taking and what risks are worth investing in to eliminate? Interpretations of findings: what is healthier and for whom as regards: awakenings? Nighttime feedings vs.consolidated sleep? Light maternal-infant sleep vs. deep sleep? Infant’s protesting separation? Infants accepting separation? Higher or lower infant body temperatures? Long term vs. short term findings or is independence and problem solving skills i.e advantages in other domains achieved by routine at birth co-sleepers as valuable or more valuable than willingness to sleep alone, achieved much earlier by routine solitary sleepers? Because some cannot bedshare safely does it mean that nobody can..or should be permitted to try? Where the controversies lie? (General Questions) (Questions Specific to Sleep Research)

18. If to the researcher co-sleeping/breastfeeding is normative, appropriate and expectable (biologically) then.. Babies accepting separation and isolation without protesting do so at their own peril; Or--Infants who accept separation without protesting are developmentally immature and not adapted vigorously; Infants who “sleep through the night’ at young ages are “at risk”; Infants resting body temperature while sleeping alone is sub-normal; Infant night wakings are advantageous especially when associated with breastfeeding.. If co-sleeping/breastfeeding is not normative, appropriate and expectable biologically then.. Night wakings are a problem to be eliminated, as are feedings..as soon as possible; Protesting sleep isolation is a “problem to be solved” a disorder..a developmental deficiency; Infants sleeping through the night represents adaptation, not a potential risk I.e. spending sleep time in deep sleep rather than light sleep; Co-sleeping infants experience hyperthermia; Any and every problem associated with co-sleeping becomes an indictment against the practice, and proof the practice should be eliminated rather than a problem to be solved How One Interprets Infant Sleep Related Behaviors Depends on Initial Assumptions

19. Supine sleep position and presence of committed adult caregiver’ Exclusive breastfeeding to nonsmoking mother; Parental knowledge of safe crib and co-sleeping environments; Stiff mattresses, use of sleep suits, absence of soft-clothy materials surrounding infant face; Absence of gaps, holes, spaces surrounding sleep structure into which infants can fall to be wedged; Absence of drugs, alcohol desensitizing medicines; Absence of all but mother and/or father in co-sleeping environment..no children co-sleeping with infant; If routinely bedsharing, pull frame off of bed, center in middle of room on floor; If bottle feeding, or a smoker, avoid bedsharing, place crib or bassinet next to bed, separate surface; Adhere to routine practice; Avoid co-sleeping on couches, armchairs, recliners, or waterbeds; Avoid indifferent attitude; if bedsharing, agree that each adult has responsibility for monitoring presence of baby; If bedsharing, do so enthhusiastically with both partners agreeing; What Makes Infant Sleep Safer

20. Mother-infant co-sleeping with nighttime breastfeeding….. The normative species-wide context of infant sleep behavior and physiology; and, yet, rarely if ever is co-sleeping explored using a level scientific playing field. Problems associated with co-sleeping typically constitute the argument against the practice ..rather than being viewed as problems worth solving or that can be solved in the same way that problems associated with solitary infant sleep can be solved …

21. THE UNDERMINING OF MATERNAL CONFIDENCE AND KNOWLEDGEBenjamin Spock wrote to mothers in: Baby Care “You know more than you think you do…. don’t be afraid to trust your common sense. Bringing up baby won’t be a complicated job if you take it easy, trust your own instincts,and follow the directions your doctor gives you! cited by tina thenevin,1993, mothering and fathering

22. Decision -making hierarchy is distributed--physician at top, lactation consultant, nurses, parents at bottom; “the power of authoritative knowledge is not that it is correct but that it counts” “Standard Care” enforced by legal and institutional actions; Examples: prosecution of Salt Lake City couple whose infant died after co-sleeping (child abuse homicide); or lactation consultants fired if they give safety information on bedsharing. Invalidates other knowledge systems; Parental knowledge counts for nothing Parents must override instincts- as medical personnel always know best; To understand current debate/discourse over sleep must understand Bridget Jordan’s delineation of the place of “authoritative medical knowledge” in our western culture. Modified from: Birth In Four Cultures by Bridget Jordan

23. Authoritative medical knowledge… “…to legitimize one way of knowing as “authoritative” devalues, often totally dismisses, all other ways of knowing. Those who reject authoritative knowledge systems tend to be seen as backward, ignorant, or naïve troublemakers…”

24. Socio-cultural and Historical Factors and Forces Leading to Erroneous Scientific Understandings (Undermining Parental Confidences and Empowerment) • rise of child care experts using moral judgments as a basis of recommending what infants “need’..what is worth “investing in” as a practice.. • belief in superiority of technology, rather than on maternal bodies to stimulate, hold and nurture; • emphasis on “average expectable population outcomes” rather than on individual variability or potential.. per any given behavioral parenting strategy; • emphasis on ethnocentric social values and ideologies (not biology) to guide research and conclusions..”fallacy of medical normalcy” (GWilliams) • improper medicalization of relational (caregiving) issues ..assumed to be best understood by pediatricians (who generally have no training in human social development or human evolution… • “Pathologizing” of normal behavior (crying when left alone) ..making infants into patients (blaming the victim for the crime) in need of correction when they fail to follow cultural scripts..”Never let a baby fall asleep at the breast” AAP Guidelines For Infant Sleep • social constructions of infancy, not /biological- evolutionary based (influences of Freud, Klein, Watson..psychology in general); • “Science” of infant feeding (bottle-formula feeding) and sleep pediatrics became one and the same with… mutually reinforcing moral ideas about who infant should be, or become, rather than who they are…and how husbands and wives should relate vis a vis distance, authority and separation from children…also, ideologies about the bedroom as a “sexual place..”

26. The Complex History of Infant Sleeping Arrangements In Western Industrial Societies Is Reduced To Simple Understandings Congruent With Present Cultural Beliefs: • inevitable suffocation/overlying/SIDS • inevitable psychic damage to infant • inevitable rupture to conjugal (husband/wife) relationship • inevitable prolonged dependency of infant/ child • inevitable lack of autonomy in infant/child • NOTE: not one controlled scientific study documents the benefits of solitary infant sleep, or the alleged deleterious social/psychological/physiological consequences of safe cosleeping with breast feeding

27. How A Folk Myth (normal, healthy babies sleep alone) Achieved Scientific Validation #1: Initial test condition—infant sleeps alone, is bottle fed, and has little or no parental contact #5: To produce “healthy” infant sleep, replicatethe test condition “Scientific” validation of solitary infant sleep as “normal” and “healthy” #2: Derive measurements of infant sleep under these conditions #4: Publish clinical model on what constitutes desirable, healthy infant sleep. #3: Repeat measurements across ages, creating an “infant sleep model”

29. Changing perceptions….of what’s good for baby…“The constant handling of an infant is not good for him. The less he is lifted, held and passed from one pair of hands to another, the better, as while he is young his bones are soft and constant handling does not tend to improve their development nor the shapeliness of his little body. the newborn infant should spend the greater portion of his life on the bed” FROM: THE BABY MARIANNA WHEELER 1901 HARPER BROS: NEW YPRK LONDON

30. CHANGING PERCEPTIONS OF WHAT INFANTS NEED... THE MOTHERHOOD BOOK (1935) “Babies should be trained from their earliest days to sleep regularly and should never be woken in the night for feeding….” “Baby should be given his own bedroom from the very beginning. he should never be brought into the living room at night”

31. Richard Ferber, M.D. Director, Center for Pediatric Sleep Disorders, Children’s Hospital, Boston slide courtesy of Meret Keller and Wendy Goldberg

32. Dr. Richard Ferber “changes his mind”..?? But the larger and more important question is…What is it about our culture that makes us care, or makes it important what someone who has no familiarity with our baby or our family thinks about this very personal issue? • “If you find that you actually prefer to to sleep with your baby you should consider your own feelings very carefully”. • “Whatever you want to do , whatever you feel comfortable doing, is the right thing to do, as longs as it works….. most problems can be solved regardless of the philosophical approach chosen” (Ferber: 2006: 41) 1976 2006

33. Changing concepts related to where babies can or should sleep..the beat goes on… (1976, 1999)“…Sleeping in your bed can make an infant confused and anxious rather than relaxed and reassured. Even a toddler may find this repeated experience overly stimulating”(2006) “Children do not grow up insecure just because they sleep alone or with other siblings, away from their parents; and they are not prevented from learning to separate, or from developing their own sense of individuality simply because they sleep with their parents” (Ferber 2006:41).

34. Controlled crying (or controlled comforting..or sleep training) • a technique to manage infants and young children who do not settle alone or who wake at night, or who settle only if held or if permitted to sleep in proximity or contact with their parents…. • involves leaving the infant to cry for increasingly longer periods of time before providing comfort… • the goal is to condition infants or young children to “sooth” themselves back to sleep and to stop them from crying or calling out during the night

35. Australian Association of Infant Mental Health Position Paper… • “It is normal and healthy for infants and young children not to sleep through the night and to need attention from parents. This should not be labeled a disorder except where it is clearly outside the usual patterns”; • “Parents should be reassured that attending to their infants needs/crying will not cause a lasting “habit”..Waking in older infants and young children may be due to separation anxiety, and in these cases sleeping with or next to a parent is a valid option. This often enables all to get a good nights sleep”

36. Australian Association of Infant Mental Health “The AAIMHI is concerned… “controlled crying” is not consistent with what infants need for their optimal emotional and psychological health, and may have unintended negative consequences” From “Controlled Crying: AAIMHI Position” Paper November 2002

37. Traditional Western Pediatric and Clinical Approaches and assumptions to Infant Sleep: • perpetuate the very environmental conditions that give rise to the parent-infant sleep problems they are asked to solve…

38. Controlled crying and or sleep training techniques and philosophies … reflect social ideologies not scientific findings about who infants are and what infants need based on empirically-based, scientific- biological studies; techniques reflect who we think we want infants to be (convenient) or become or should become (autonomous/independent) as early in life as is possible;

39. First Question What cultural assumptions about infants and their sleep and developmental needs, lead to caregiving practices which induce infants to cry in the first place, which in turn make “controlled crying” techniques seemingly necessary?

40. Second Question (there is a choice) : • What exactly needs to be changed? • should babies be changed… can they be changed (biologically? -or- • should the ideas and assumptions which underlie and justify recent western infant care recommendations be changed ? • who gets to decide?

41. It’s one thing to ask if some infants can be conditioned or trained to sleep alone, unattended.. “through the night” (unsupervised, unfed and unintended) It’s altogether a different and more serious matter to ask if they should be, or if it is not nice, dangerous or injurious in either the long or short run…

42. “ Misunderstandings by parents often motivate the use of “controlled crying” techniques…. Parents are led to believeinfants will be cognitively or socially handicapped of they co-sleep or parents do not ignore their cries --no scientific studies support such predictions..

44. All studies confirm that bedsharing improves and enhances breast feeding (McKenna et al 1997, Ball 2003, Baddock 2006, Young 1999)

45. Mean Interval Between Feeds (in min) Per Group Per Night =indicates normal infant sleep experience

46. Breast Feeding Matters In All Areas Of Infant Mortality Especially Effecting African Americans • “Breastfed infants are 80% less likely to die before age 1 year than those who never breast fed, even controlling for low birthweight”; • For every 100 deaths in the formula-fed group, there were 20 deaths in the breast fed group • Using breast feeding as the normative behavior (20 deaths in the first year) the formula group with 100 deaths, had five times as many deaths or a 500% increase in mortality.. • Forste et al 2001:108 291-296Pediatrics

47. Forste et al. 2001 “Analysis of infant mortality indicated that breast feeding accounts for race difference in infant mortality in the United States at least as well as low birth weight does” Pediatrics 2001;108:291-296

48. “Breast Feeding and the Risk of Post-neonatal Death In the United States” • Studied 1204 infants who died between 28 days and 1 year from causes other than congenital anomaly/tumor.and (7740 children who lived at 1 year) (controls); • Calculated odds specific odd ratios for ever/never breast feeding amongst all children …race-birth weight specific analysis--and duration-response effects; • Longer breast feeding associated with lower risk: odds ratio range from: • .59 95% CI 0.38-0.94 for injuries to 0.84% (95%CI:.67-1.05) for sudden infant death syndrome (SIDS); (Amin Chen and Walter J.Rogan) • “Breast feeding has the potential to save or delay ~720 post=neonatal deaths in the United States each year • Pediatrics (2004) 113: E435-439…url:http://www/pediatrics.org/cgi/content/full/113/e435

50. Present hospital policies warn mothers about what their bodies do TO their infants, rather than what their bodies do FOR their babies • “Babies Sleep Safest Alone.” • New York State Public Health Campaign • “For you to rest easy, your baby must rest alone.” • Philadelphia Public Health Campaign. • “We know the value of holding your child, cuddling your child, loving your child. But if you take the baby to bed with you and fall asleep, you are committing a potentially lethal act” • Deanne Tilton Durfee, Director of the Los Angeles County Inter-Agency Council on Child Abuse and Neglect. Los Angeles Times 4/24/08. • Mothers body presented as lethal weapon over which neither the the mother nor the infant has control, • nor does mother have the right to to be with her infant, to make her own informed decision