Tabitha Walrond, a 19-year-old mother from the Bronx, is living one nightmare after another. The story that will be heard in court is that after her newborn son, Tyler, was repeatedly denied medical care, he 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 breastfed her son.
It appears, however, that Walrond 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. Did Walrond's doctors ever mention the possibility that her surgery could affect milk production? She says not. And had the new mother been able to cut through red tape blocking the entrance of a health care clinic, her son's pediatrician hopefully could have diagnosed a birth defect, known as congenital adrenal hypoplasia. The defect, discovered during the boy's autopsy, causes loss of appetite, wasting 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. But apparently due to bureaucratic delays and mistaken computer rejections, Tyler had no Medicaid number and was repeatedly turned away when Walrond tried to schedule his checkup.
When Walrond went for her postpartum examination, her doctor remarked that five-week-old Tyler looked underweight. But she says he made no attempt to help her secure a pediatric appointment, nor did he examine the child himself.
Because of fetal distress, Tyler was delivered by Cesarean section and Walrond developed complications which kept her in the hospital for 12 days. Because she was taking medication, she was allowed to nurse for only five days.
Surely the hospital staff knew 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 use of a breast pump could have helped maintain adequate milk production.
This case will certainly frighten women who are considering breastfeeding their babies. But Walrond's tragedy has little to do with breastfeeding, and everything to do with limited access to health care services and education for the poor.
Last year, then-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, breastfeeding 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 could have learned warning signs of infant malnutrition. La Leche League, the world's foremost authority on breastfeeding, advises mothers to nurse frequently and on demand. To ensure baby is 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 and 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-breastfeeding 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 television 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 breastfeeding and offer their patients excellent advice, they are only required to have two hours of training in breastfeeding. Many times this training consists of watching a videotape produced by formula manufacturers that does 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 leaders are required to complete before becoming accredited counselors, it is clear that the pediatric community is woefully under-educated about the benefits and practical applications of breastfeeding. 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 system that failed a young woman and her newborn son.