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Breast-feeding is a skill -- not a crime


San Diego Union-Tribune

By Jennifer Coburn
March 24, 1999

Tabitha Walrond, a 19-year-old mother from the Bronx, is living one
nightmare after another. After her newborn son, Tyler, was repeatedly
denied medical care, her first child died in her arms of malnutrition at
seven weeks. Now, she's being prosecuted for manslaughter and, if
convicted, could serve 15 years in prison for her son's death.
The welfare recipient's crime was doing what the American Academy of
Pediatrics recommends as the best means of providing optimal nutrition
for
babies. Walrond exclusively breast-fed her son. The problem was that she
suffered from an extremely rare condition called insufficient milk
syndrome.
Her ability to produce milk was inhibited in part by breast-reduction
surgery she had four years prior to the pregnancy. But Walrond's doctors
never mentioned the possibility that her surgery could affect milk
production. Had the new mother been able to cut through red tape blocking
the entrance to a health-care clinic, her son's pediatrician could have
diagnosed a birth defect known as congenital adrenal hypoplasia.
The defect, discovered during the boy's autopsy, causes loss of appetite
and dehydration. The real crime here is that in seven weeks, this child
never had a single medical examination. By law, baby Tyler was entitled
to
automatic Medicaid coverage from birth. Health-care financing experts say
a
city case worker had to approve and secure the baby's enrollment in
Medicaid.
Due to bureaucratic delays and mistaken computer rejections, Tyler had no
Medicaid number and was repeatedly turned away when Walrond tried to
schedule his check-up. When she went for her post-partum examination, her
doctor remarked that five-week-old Tyler looked underweight. He made no
attempt to help the mother secure a pediatric appointment, nor did he
examine the child himself.
Because of fetal distress, Tyler had been delivered Caesarean section,
and
Walrond developed complications which kept her in the hospital for 12
days.
Because she was taking medication, she was only allowed to nurse for five
days. The hospital staff should have known that breast-milk production
follows the law of supply and demand. The more a baby nurses, the more
milk
a mother will produce.
The human breasts make exactly as much milk as they perceive a baby
needs.
The fact that Tyler was formula-fed for seven days, and therefore not
nursing, likely played a major role in Walrond's limited breast-milk
supply. The mother should have been offered a breast pump to help
maintain
adequate milk production.
This case will certainly frighten women who are considering
breast-feeding
their babies. But Walrond's tragedy has little to do with breast-feeding
and everything to do with limited access to health-care services and
education for the poor. Last year, then-California Assemblyman Kevin
Murray
introduced AB 2438, a maternal and child-health services bill which would
require medical insurance plans to cover lactation consulting, prenatal
diagnostic testing, nutritional assessments and health education.
Further, it would have required that health education include information
on childbirth preparation, newborn care, breast-feeding instruction,
infant
safety, cardiopulmonary resuscitation and parenting skills.
Unfortunately,
the bill was gutted beyond recognition. All that survived was a single
provision for alpha feto diagnostic testing. Had Walrond received the
education and services like those outlined in Murray's bill, she would
have
learned warning signs of infant malnutrition.
La Leche League, the world's foremost authority on breast-feeding,
advises
mothers to nurse frequently and on demand. To ensure that babies are
receiving enough milk, mothers should feed newborns 8-12 times a day and
listen to hear the baby swallowing. If the child is getting adequate
nutrition, he will have at least five wet diapers and two bowel movements
after the third day of life.
The baby should gain at least four ounces per week after the fourth day
of
life, and will appear healthy, have good color, firm skin and will be
growing in length and head circumference.
Several months ago, an episode of Chicago Hope joined in the chorus of
anti-breast-feeding hysterics. New parents arrived in the Emergency Room
with a baby who later died from dehydration. The mother, who also
suffered
from insufficient milk syndrome, refused to supplement her breast milk
with
formula. The middle-class mother was chastised by the medical staff, but
spared manslaughter charges.
As it turns out, the episode of the TV hospital drama was sponsored by
Abbott Labs, a pharmaceutical company which generates 50 percent of its
income through formula sales. In fact, insufficient milk syndrome is
exceedingly rare. Even more rare is death resulting from it. On the other
hand, 400 babies around the world die every day from unsafe bottle
feeding.

Though many pediatricians educate themselves about breast-feeding and
offer
their patients excellent advice, they are only required to have two hours
of training in breast-feeding. Many times, this training consists of
watching a video tape produced by formula manufacturers that do little
more
than discuss potential problems with nursing and offer tips on weaning.
Two hours may seem like enough training for something that is assumed to
come naturally for mothers. But compared to the minimum of 80 hours in
lactation training the volunteer mothers at La Leche League are required
to
complete before becoming accredited counselors, it is clear that the
pediatric community is woefully uneducated about the benefits and
practical
application of breast-feeding.
After all, doctors can only offer patients as much information as they
have
themselves. Though some may use the death of Tyler Walrond to make a case
for the need for breast-milk substitutes, we must see this tragedy for
what
it really is -- a health-care system that failed a young woman and her
newborn son.
COBURN is a San Diego based free-lance writer.

Copyright 1999 Union-Tribune Publishing Co.