On a Thursday in November 2007, Sherkendra Burch breastfed and burped her 6-week-old daughter, S'marri, and laid her down for the night on a queen-size bed. At midnight, Burch crawled in beside the girl and fell asleep gently holding her, the same way she did every night. But when the 20-year-old first-time mother awoke the next morning, she couldn't find her baby.
It was a little before 7 when Burch flicked on the lights and saw S'marri's tiny feet dangling from the edge of the mattress.
"My baby!" she screamed. "My baby!"
Dressed in a pink floral onesie, S'marri showed no signs of life. Burch began CPR while her mom called 911. Paramedics raced the newborn to a Bradenton hospital, where a doctor broke the news that S'marri had suffocated in the night.
"My brain shut down," Burch remembers. "He said that she wasn't coming back, and it's like I didn't hear anything else."
After investigating, detectives closed the case as an unfortunate accident that happened while cosleeping. But the death left Burch with unshakable guilt and a question that haunts every parent in a similar situation: Why me?
"The doctor put me on suicide watch for two weeks," Burch says. "I wanted to go with her... Like, I have no reason to be here anymore. I can't raise a child, so just go ahead and bury me with her."
Every year, sleep-related deaths kill more children than drownings in Florida. Some are smothered while sleeping with their parents; others suffocate after being laid on their stomachs or placed too close to pillows and blankets. In 2016, 176 babies died in unsafe sleeping environments, more than twice the number of children who drowned.
In each of Florida's largest counties, that means as many as a dozen babies are buried every year.
"If you add it together, that's an entire kindergarten class in two years," says Dr. Bill Pellan, director of investigations for the Pinellas County medical examiner's office in St. Petersburg.
Last year in Miami-Dade, at least 12 babies died due to sleep-related causes, including nine who were put to sleep with a parent. And as an influx of young Puerto Rican families cram into small apartments here to escape the ravages of Hurricane Maria, some observers fear that figure will grow in the coming months.
"With the cost of living, there are a lot more people with limited resources who don't have the luxury of having a bed and a crib and a space to put it," says Manny Fermin, CEO of the Healthy Start Coalition of Miami-Dade, which works to reduce the infant mortality rate. "Eventually, I'm concerned where the numbers are going to go."
To understand exactly how deadly the phenomenon can be, consider the final week of May 2017. As Memorial Day weekend began Friday, a 7-month-old girl near Orlando suffocated on a mattress next to her 19-year-old mother. The following morning, a Broward mom woke up beside her 6-month-old son and found him unresponsive. That Sunday, a 10-week-old Orlando-area girl died while sleeping with her mom, who might have been intoxicated.
That Monday, a 3-month-old from the Fort Myers area and a 4-month-old near Tampa stopped breathing after being put to sleep in unsafe adult beds. Tuesday morning, a 9-month-old from Daytona choked to death on a plastic heart in a crib filled with suffocation hazards. By the time the month ended Wednesday, two more children were dead: a 3-week-old preemie from St. Petersburg who suffocated next to his parents, and a 10-week-old from outside Orlando who'd been swaddled and left on his side.
Nationally, research suggests an alarming number of babies are regularly placed in danger by their parents. A 2016 study published by the American Academy of Pediatrics shows that about 28 percent of newborns go to sleep with another person, while more than 90 percent sleep with loose bedding or another suffocation hazard within reach.
So why do parents continue to sleep with their young children? Some accidentally doze off while breastfeeding or snuggling with their babies on couches or rockers late at night. Others are simply unaware of the risks of sharing a bed with an infant.
"Their parents or grandparents told them: 'I slept with all of my babies, and they all survived,'" says Pellan, the Pinellas death investigator.
But studies show some educated parents also choose to sleep with their children. Many couples believe sharing a bed encourages bonding with a new baby, while some breastfeeding mothers say it makes feeding a newborn throughout the night less disruptive. Cosleeping proponents such as James McKenna, director of the Mother-Baby Behavioral Sleep Laboratory at the University of Notre Dame, argue that when steps are taken to mitigate the risks, bed-sharing can be mutually beneficial.
"Mother-infant cosleeping with breastfeeding is humankind's oldest and most successful sleeping arrangement," McKenna writes on his website.
And cosleeping is still commonly practiced in attachment parenting, a '90s-era philosophy that remains popular in middle- and upper-class families. Dr. William Sears, the California pediatrician who coined the term, teaches that bed-sharing is "even more relevant in today's busy lifestyles."
"As more and more mothers, out of necessity, are separated from their baby during the day, sleeping with their baby at night allows them to reconnect and make up for missed touch time during the day," he writes on his website.
Throughout history, though, the practice has remained controversial. As early as the 12th Century, Britain and Germany had laws against parents sleeping with their babies, viewing it as potentially dangerous to children. In the 1600s, fatalities were so common that Italians put their infants to sleep in covered wagon-looking devices called arcuccios that made accidentally smothering them impossible. Mothers who didn't use the device could be thrown in the stocks and excommunicated if they rolled over on their children while sleeping.
Medical examiners believe asphyxiation is the real reason so many babies die in their sleep.
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Until the late 1800s, it was commonly accepted that babies who died in bed with adults had suffocated. But as cribs came into use and infants continued to die, the theory was called into question. By 1969, the phenomenon known as "crib death" received a more formal name: sudden infant death syndrome (SIDS). The diagnosis was applied to any baby who died unexpectedly after all other causes had been ruled out.
In recent years, though, the pendulum has swung back: Medical examiners across the nation have come to believe the 12th-century theory was right all along — asphyxiation is the real reason so many babies die in their sleep.
"It's 50 years later, and we still haven't discovered a cause, if [SIDS] really is a disease," says Dr. Michael Bell, the chief medical examiner in Palm Beach County. "You've gotta ask yourself: Is this really a disease or simply a death that's the result of a suffocation, which shows the exact same findings as SIDS?"
After pediatricians began recommending in the '90s that infants be put to sleep alone, on their backs, and in cribs, the number of SIDS deaths across the nation drastically declined. Medical examiners such as Bell say that's because babies' airways are no longer being restricted.
"Suffocation in infants leaves absolutely no marks, no findings — the same thing as SIDS," Bell says. "If you look at all the infants that die suddenly, we discovered that most of them were sharing a bed or sofa or chair with a human being much bigger than them."
In Florida, SIDS deaths have dropped 96 percent over the past two decades, according to state Department of Health records. In 1996, 145 babies were diagnosed with SIDS; in 2016, there were only six such cases.
But the reduction is more or less an artificial victory. While SIDS deaths have declined, the number of accidental suffocations has shot up. Only 14 babies were thought to have suffocated in bed in 1996; in 2016, the count was up to 87.
"The same number of babies are dying," Pellan says. "Just instead of being called SIDS, they're being called something else."
Ten weeks after the death of her blue-eyed baby, Erin Piche-Pitts was hauled off to jail and charged with the aggravated manslaughter of her 18-day-old son, Javier. In front of a gaggle of reporters, Polk County Sheriff Grady Judd explained it wasn't the first time the 25-year-old mom had fallen asleep while breastfeeding and suffocated a newborn — in 2009, her 13-day-old daughter had died the same way.
"She was irresponsible, and as a result, she's got two dead babies," Judd said at a December 2016 news conference announcing the arrest. "It's time for her to go to prison. It's time for her to pay the price."
Even though there were no drugs in her system or any evidence she'd purposely harmed her son, Piche-Pitts became one of the unlucky few to be criminally charged in a sleep-related death. Because of the case-by-case nature of investigations — and the difficulty identifying a precise cause of death — parents in similar circumstances can end up facing drastically different consequences.
Compare Piche-Pitts' case to that of Tiffany Morrison, whose 2-month-old daughter, Alicianna Black, died in Hollywood in February 2014. Like Piche-Pitts, Morrison had already lost a child to cosleeping, in 2003. And also like Piche-Pitts, Morrison had fallen asleep in bed after feeding her newborn. When she awoke three hours later, Alicianna wasn't breathing.
Though the two cases are similar, the circumstances surrounding Alicianna's death were arguably worse: Morrison screened positive for cocaine immediately afterward, and Hollywood Police found a baggie of marijuana in the bed within arm's reach of the baby. The state even classified the case as "medical neglect" due to the 29-year-old mom's failure to immediately call 911.
Despite those concerns, no charges were ever filed against Morrison. The Broward medical examiner was unable to determine the cause of Alicianna's death, and police said there was nothing to suggest Morrison purposely hurt her daughter.
"I was unable to determine if there was any criminal intention or criminal negligence to harm the deceased infant," Hollywood Det. Elliot Langley wrote in a final report. "That concludes my investigation into this case."
For each case where an arrest was made, there's an identical case where parents were not prosecuted.
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The disparity in consequences between the two cases highlights the ambiguity involved in investigating sleep-related deaths. Because there's no law against cosleeping or bed-sharing in Florida, police and prosecutors have enormous discretion in filing charges against parents.
A New Times review of hundreds of death investigations in Florida confirms there's virtually no uniformity in how investigators decide which parents go to jail. An analysis of nearly 800 sleep-related deaths investigated by the Department of Children and Families from 2009 to the present, as well as a search of Florida newspaper archives, turned up fewer than ten cases in which mothers or fathers were criminally charged. For each case where an arrest was made, New Times was able to identify a virtually identical case where parents were not prosecuted.
The majority of cases that ended in arrest involved a parent using drugs. In February 2006, 18-year-old Kayla Rice was charged with felony child neglect after her 6-month-old daughter suffocated on a queen-size bed in Polk County. Rice, who admitted to sharing a blunt with friends while her daughter slept, was ultimately sentenced to five years of probation.
Marijuana use was also involved in the November 2009 death of a 7-month-old Broward girl accidentally smothered by her father, who had stayed up all night playing videogames and smoking pot before lying down with her. Thirty-year-old Emanuel Lawrence was charged with aggravated manslaughter and later served a year and a half in prison.
Not every case involving parental drug use ends in an arrest, though. After a 6-month-old girl suffocated while sleeping next to her dad in December 2015, Hollywood Police declined to press charges despite the fact that the father admitted to smoking pot that day.
In a January 2009 case, a Naples-area mother told investigators she drank two glasses of wine before getting into bed with her 2-month-old son, who was dead when she awoke the next morning. The mom tested positive for marijuana and amphetamines, but deputies were unable to determine whether she'd been using drugs the day of her baby's death. No charges were filed.
Among those arrested, Piche-Pitts is an anomaly. Despite having a history of substance abuse, her drug screens came up negative after Javier's death. And the evidence showed she hadn't purposely slept with him but simply dozed off. Despite the accidental nature of what happened, she now faces up to 30 years in prison.
Following her arrest, Piche-Pitts worked out a deal with prosecutors to plead guilty in exchange for six months in jail and 15 years of probation. But on her court date in June 2017, Circuit Judge Mark Carpanini shut the negotiation down, saying she deserved a harsher punishment.
"I don't do this lightly, and I rarely do it, but I can't bring myself to approve this plea agreement," he told the attorneys on both sides. "So I'm going to ask you to go back to the drawing board on this."
Lumped in the same category as violent offenders, Piche-Pitts has been held in jail without bond since December 2016. Over the summer, her lawyer waived her right to a speedy trial, meaning it could be years before the case is heard by a jury.
Sherkendra Burch was home from college working a summer job at McDonald's when she found out she was pregnant. The year was 2007, and she was preparing for her sophomore year at Bethune-Cookman University in Daytona Beach, where she was studying psychology.
At first she ignored the warning signs, but when several pregnancy tests came back positive, she could no longer deny the baby growing inside her. By the time she made her first doctor's appointment, she was seven months along.
The oldest of seven children, Burch had always felt responsible for her little brothers and sisters, helping her single mother raise them in a modest four-bedroom home in Bradenton. And she was great with kids: As a teenager, she made extra money babysitting and knew from a young age that some day she wanted children of her own.
"Like every girl, I wanted to get married first," she says now, a wistful smile on her face. "Big mansion, lots of money, three trucks in the yard."
It didn't work out that way, though. By the time Burch underwent an emergency C-section October 12, 2007, the baby's father was no longer in the picture. She was 19 years old, afraid, and unprepared, having only a few weeks of prenatal care and not a single birthing class under her belt. But as the doctor delivered her daughter, she was swept with a sense of pride, gratitude, and responsibility toward the perfect, seven-pound baby who emerged.
"It felt good to hear her cry," Burch says. "I can't even explain it, the feeling. It's like, Oh my gosh, I just gave birth to this human being. Like, this person is going to look up to me for everything... It's just the best feeling in the world."
Burch named her daughter S'marri, a variation on the name of a family friend's son, S'marion, and a reference to the biblical tale of the Good Samaritan. After leaving the hospital, she went home with her mom and prepared to move into her first apartment. She quit school, bought a new car, and set up an interview with Walmart, which promised full-time hours and better pay than her job at McDonald's.
"It was definitely exciting knowing that I was going to have my apartment, have my car, have my daughter, and take on life full force," she says.
From day one, it was clear S'marri was her mother's child — she cried hysterically when anyone else picked her up but would instantly relax in Burch's arms. Her big brown eyes seemed to follow Burch throughout the room, and if Burch went outside to grab something from the car, the baby's gaze wouldn't leave the door until her mom returned. Burch's younger siblings enjoyed playing with S'marri too.
"They loved her to pieces," Burch says. "It was definitely a lot of fun."
But during the transition between living at home and moving into her apartment, Burch wasn't in a rush to buy a crib for her baby.
"She had already been sleeping in the bed with me for six weeks," Burch says. "It didn't really seem like a big deal."
Only a week after Thanksgiving, S'marri took her last breath. Less than two months after her daughter's birth, Burch had to plan the funeral.
"For at least a week, I just could not stop crying," she says. "It was nonstop."
The guilt weighed on her for years. When she gave birth to a second child, Isaiah, in 2010, she sank deep into postpartum depression, terrified something would happen to him.
"It did bring back the memories and just wondering, Can I do this? Is it going to happen again? Am I suited to be a mom?" she says. "I just had to reassure myself that it wasn't going to happen again, and I made a promise to myself and to him that I wasn't going to let it happen."
Burch learned from S'marri's death — before her son was even born, she bought him a crib. Ten years after losing her first child, she has made it her mission to talk to new moms about her experience and her regrets about sharing a bed with her daughter. There are still nights when she wakes up in a cold sweat looking for S'marri, but as time has passed, the guilt has loosened its grip.
"The pain is still there," she says, "but I don't hurt the same."
In a conference room at his office near Miami International Airport, Manny Fermin pulls a portable crib from a cardboard box and begins assembling it on top of the table. Dressed in a black suit and checked dress shirt, the CEO of the Healthy Start Coalition of Miami-Dade quickly switches into dad mode as he pushes the sides of the bassinet into place.
"I'm a father of four, so we always have Pack 'n Plays," he says. "But they're not as easy to put together as you would think!"
Last year, Healthy Start — a state-funded organization that works with pregnant women — distributed 300 portable cribs to Miami parents. Because more families are living paycheck-to-paycheck or in cramped quarters, the goal is to remove barriers to safe sleep.
"The South Florida area has become one of the most expensive places to live, and we're seeing a lot more people doubling up in their living arrangements for economic reasons," Fermin says. In those circumstances, "people also tend to do the bed-sharing with toddlers and little ones, and that's a concern."
For years, child advocates such as Fermin have faced the daunting task of figuring out how to stop or slow sleep-related deaths. Although most of the fatalities are preventable, educating the public has been challenging.
Though handing out free cribs is a popular approach, the tactic has limits. Access to cribs is irrelevant for sleep-deprived parents who accidentally nod off with a baby, and even less useful to moms or dads who ignore or are unaware of the American Academy of Pediatrics' advice against bed-sharing.
One Florida study showed that many parents who had cribs at home weren't using them. After analyzing 39 infant sleep-related deaths in the St. Petersburg area from 2011 to 2015, the Pinellas County medical examiner's office found that 95 percent of caretakers had access to a crib or bassinet, but more than half slept with their babies anyway.
Healthy Start consultant Amy Olen says it's crucial to ask why they made that choice. Studies have shown some parents in low-income neighborhoods sleep with their babies to protect them from rodents, insects, or even drive-by shootings. For others, sleeping with children is a cultural norm.
Access to cribs is irrelevant for sleep-deprived parents who accidentally nod off with a baby.
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"There are many, many different reasons why a parent might choose to bring their baby into bed with them," Olen says. "If we're not addressing those reasons in our education or outreach, then I don't think we're going to make as much progress in reducing these deaths."
In the Healthy Start model, a caseworker ideally gets to know families over a period of time, allowing for gentle conversations that don't make new parents feel judged or ashamed. But in recent years, caseworkers have been saddled with other demands that leave less time to foster those relationships.
"We haven't stopped the education, but we've had other crises," Fermin says. "Last year was the Zika virus. We saw over 2,200 pregnant women get tested that required our case management. This year, now we're dealing with the hurricane evacuees from Puerto Rico and the Virgin Islands."
In 2013, the Florida Legislature shifted some of the educational burden to birth centers, which are now required by law to talk to moms about safe sleeping practices before and after they give birth. Alan Hays, a former Republican state senator who's now the supervisor of elections in Lake County, says he sponsored the bill after meeting with his district medical examiner. The new legislation ultimately passed unanimously.
"I cannot fathom the heartache and the anguish that a parent would go through," Hays says. "The reason that this bill is still so vivid in my memory is that this was one small way that I, as a legislator, could possibly help the families who suffered these tragedies."
Despite the bill's good intentions, the number of sleep-related deaths has actually risen slightly in the years since the new law passed, from 164 to 176 annually. Since leaving the Florida Senate, Hays says he hasn't had the opportunity to track the data.
"I have no idea how successful it's been," he says, "but I would hope that all the birthing centers and hospitals are complying."
After years of investigating deaths in Palm Beach County, Bell is skeptical anything more can be done. "In my office, we maybe get six cases a year. I don't think you're ever going to have zero," he says bluntly. "How many resources are you going to put into getting six down to four or three?"
Instead of pushing for more education, some states have tried to criminalize cosleeping. But those attempts have largely failed. After Republican Wisconsin state Rep. Samantha Kerkman proposed making it illegal to sleep with a baby while intoxicated in 2013, the bill was opposed by everyone, from the Milwaukee medical examiner to the Children's Hospital of Wisconsin, where administrators wrote they were "concerned that criminalizing intoxicated cosleeping will not serve as a deterrent to the behavior... but rather encourage delay in reporting and less honest disclosure."
In Florida, no lawmaker has touched the issue recently. And Bell says he would oppose any efforts to put a new law on the books. "The whole idea that there should be charges brought against a caretaker just seems to be overly punitive," he says. "They've already been punished enough. They lost their child. Can you think of anything worse?"
According to a 2016 study published in Current Pediatric Reviews, having bereaved parents talk to new moms and dads is one proven prevention strategy. In 2010, the Baltimore health department filmed talks by three parents whose babies had died while bed-sharing. It showed them in hospitals, social services offices, jails, and jury duty waiting rooms. Four years later, the rate of sleep-related deaths had dropped 46 percent.
Former Bradenton-area Healthy Start director Luz Corcuera says that's why she enlisted the help of Burch.
"When you are going to talk about losing a child to an unsafe sleep environment, we wanted to find someone that had gone through the experience and learned something about it," Corcuera says. "We didn't want to just have a lecture or some brochures."
Burch says it took her about two years following her daughter's death to feel confident enough to tell her story. Over the years, she's given speeches at Healthy Start luncheons and met with new moms one-on-one. She's also connected with other parents who have lost a child while bed-sharing.
"It's kind of therapeutic for them knowing that someone else went through this," she says. "It's soothing for them to hear it from someone who has overcome, who realizes that life does go on and that it's not wrong to be happy again."
This past October 12, a day that would have been S'marri's tenth birthday, Burch went to her daughter's gravesite with her mother and 6-year-old son, Isaiah. They released ten pink balloons, watching them until they disappeared into the blue sky.
Six weeks later was the anniversary of S'marri's death. Burch has forgiven herself, but she can never forget.
"Was it preventable? Yes. But given the moment and the opportunities that I had at the time, I did the best I could," she says. "If I could turn back the hands of time, I would have watched her sleep every night. I would have never gone to sleep until I got her a bed."
