> the baby had died during
> the breastfeed.  The postmortem showed that there was an underlying problem
> of sepsis, which had not been apparent at the time.

The first sign of illness in the newborn (less than 28 days old) is so
often feeding problems, that it is almost a standard symptom. Other
subtle behaviors are also present however, and I believe the Home Visit
Nurse was picking up on those signs from her expertise - she was right
to send the baby in. However I think it was just the most incredible
ironic tragedy that the baby happened to die at the breast. It sounds to
me like the baby was already past the "point of no return" and it was
purely, unfortunately, coincidental. If it hadn't died at her breast, it
would have died later under a warmer bed or in an incubator or in a
bassinet, and if monitered would have been subjected to a full code -
probably without success, but with alot of trauma.

Anecdotally, from my own practice in L&D and postpartum nursing, I can
recall 3 babies who were "suffocating" at the breast but were noticed
and/or rescued in time. One baby was doing its first BFing - maybe all
of 45 minutes old (I remember I was still cleaning up the delivery
instruments in the room) when I heard the mother say "Oh, what an
interesting color you've turned!" I immediately went to her side see her
baby strongly latched on, sucking for all his worth, nares totally
occluded and the color of a deep blueberry blue. After I "gently
snatched" her baby from her and started doing *vigorous* stimulation
with no response for a few (my own) heart-stopping moments, the baby
gasped and resumed breathing. This baby and the other 2 in my personal
experience, upon observation in the nursery, were found to be beta-strep
septic. There was also one case (not my patient but at my hospital) of a
fresh c-section post-spinal (read: lie flat for 12 hours) mom on a
meperidine patient-controlled analgesia pump who was given one of her 5
pounds twins to nurse at her size F breast during the night; baby was
found dead by the nurse when she came back to pick up the baby 30
minutes later. The subsequent flurry of idiocy that resulted found the
hospital trying to pass new policies to a) prevent nighttime BFing, b)
prevent BFing by C-sections, c) prevent BFing by babies under 6 pounds,
etc. Fortunately some sort of logic prevailed ultimately. That sad story
had a lot of red flags of caution that were ignored however (mother on a
narcotic, fresh c-sect after prolonged labor unable to position herself,
no rooming-in spouse or family to help, large soft breasts with small
baby, etc) and I think a prudent common-sense approach could have
averted that one.

It is never easy when a newborn dies. Small consolation that baby died
in the most comfortable, loving place in the world. Mom did *not* cause
her little one's death; in fact, her breastmilk may have prolonged it by
a few days. Sepsis is a big killer of neonates. My condolances and love
to mom and all concerned.

Katharine West, BSN, MPH
Sherman Oaks, CA