Salon | Letters to the editor

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_______________ NURSING DEATH BY DAWN MacKEEN (06/16/98)

I am writing in response to the tragic story about the death of Tatiana Cheeks' baby. I do not believe that breast-feeding is dangerous. Surely you realize that formula-fed babies can fail to thrive and die of malnutrition.
As a board-certified lactation consultant, I regularly teach parents -- before they leave the hospital -- how to tell if their babies are getting enough to eat. By about the fifth day of life, the fully breast-fed baby should be wetting six to eight diapers, having three or more bowel movements daily, and the stools should be changed to yellow and seedy. There are other signs to look for as well, and of course weight gain should be monitored regularly. According to the American Academy of Pediatrics, "When discharged 48 hrs. after delivery, all breast-feeding mothers and their newborns should be seen by a pediatrician or other knowledgeable health care practitioner when the newborn is 2 to 4 days of age."
In Cheeks' case, whether the mother, family members or the health-care system was culpable I cannot say. But, believe it or not, I still get calls from worried moms whose babies are not feeding, stooling or gaining well after the two-week checkup. They tell me that their doctor (or clinic) is not concerned and has advised them to continue to do whatever they are currently doing -- and to return in one month. This is dangerous advice. Some doctors, nurses and clinic staff do not know how to assess effective breast-feeding and do not recognize breast-feeding problems that could be corrected early. I hope this kind of tragic event will be the impetus to increase education to health care providers and to parents about all aspects of breast-feeding.
-- Laurie Wheeler, RN, MN, IBCLC
Violet, La.
My daughter was delivered by caesarean, slightly premature and at a birth weight at the low end of "normal." She did not nurse easily although she tried very hard. I was absolutely a pro-breast-feeding mom. During the one and a half days I remained in the hospital, I asked for assistance with her feeding a number of times and received only one visit at 2 a.m. from a nurse who was overworked, not assigned to me but who took pity on our situation. I chose to believe the doctors' and nurses' harried reassurances that I knew how to do it, was doing it right and that all would work out.
Back at home she woke every 1.5 hours, 24 hours a day, to feed. She would nurse, or appeared to nurse for half an hour, would fall asleep again, and then we'd repeat the process. I had plenty of milk, if engorgement and heavily leaking breasts are any sign at all. Three times I called the advice line that continued to tell me she was going to be OK, that she showed none of the signs we all recognize as dangerous. She steadily lost weight. At 10 days we returned to the doctor, who weighed her. We again stated our concerns, then nearly desperate, that there seemed to be a problem with the feeding. The doctor assured us that all babies will lose up to 10 percent of their birth weight. I pointed out that the doctor's scale showed that she had lost 20 percent. The doctor agreed but said she believed we'd be fine. My baby then weighed less than five pounds.
My mother and sister, who stayed near, worried about us but also listened to doctors and kept quiet. At every turn I was assured that all was well, and at every turn I was treated more and more like a neurotic female.
At 11 days old she slept for six hours for the first time. I got frightened and woke her up with great difficulty, called our pediatrician and insisted against her reluctance that she call the emergency room. At the emergency room they took one look at my child and we were whisked in, where she was put screaming onto an IV, remaining on it for eight days, recovering from severe dehydration and electrolyte imbalance. I began to pump my breast milk and, once she could take food again, I repeatedly asked for the assistance of a lactation specialist, which I eventually received. At the time of my daughter's release, and after watching us struggle for three days, the specialist decided (again!) that I was doing it right and that the baby would surely "catch on." Nonetheless I insisted on taking a bottle of formula home in case things remained difficult at home.
My baby still kept to the pattern of waking and nursing that had landed her in the hospital. I tried for several more days and then switched to pumped milk, which she drank immediately. I pumped milk every four hours for four months, feeding it to her in a bottle, and switched to formula when my breasts began to develop continual blockages and minor infections from the action of the pump.
I can barely contain my outrage at the attempt to punish the mother whose baby died at 3 months. I had the help of family, specialists and one of the best pediatric hospitals in the nation, and still nearly lost my baby. Without adequate help, and without a diagnosis of her troubles, I lost the opportunity of both her and my lifetime to provide her with the mother-child bond that nursing produces. I have also completely lost faith in her safety when under the care of specialists. My loss in trust is the only loss arising from this experience that I welcome. Our country is in a health-care crisis whose victims will continue to be the weak, the poor and the trusting. Thank God my baby did not have to die for me to learn the extent of this crisis.
The people interviewed in this story showed tremendous ignorance both of breast-feeding problems and of the overburdened medical establishment that continues to place the concerns of poor women in a file marked, "Neurotic: Ignore." Oh yes, I forgot. We were on Medi-Cal at the time.
-- Jackie Gamble
Berkeley, Calif.
I am still wondering why you used the catch line "Nursing death" for the article on two breast-fed infants dying of failure to thrive. While I believe these deaths must be discussed and should have been prevented, to imply that breast-feeding was to blame is irresponsible and, in my opinion, borders on libel. What killed those babies was the lack of follow-up care and support, not breast-feeding. Breast-feeding is not deadly. Ignorance and lack of support are deadly.
I had problems breast-feeding and, as a La Leche League member for a year and a breast-feeding advocate for much longer, met many other women who had difficulties ranging from minor to very serious. The vast majority of breast-feeding problems can be overcome with proper support from knowledgeable and compassionate people. When problems cannot be overcome, that same support can help the mother detect this and make the transition to formula.
The benefits of breast-feeding range from increased infant immunity to improved social skills, especially in boys. Breast-fed babies even show higher IQs than bottle-fed babies. When weighed against the convenience and ease of measuring formula, there is no comparison. The risks involved in formula feeding are far more serious and numerous than any risk involved in breast-feeding. Especially for poor women, they include failure to thrive resulting from inadequate formula supplies, bottle propping, improper storage and contaminated water.
The worst that can happen if you try to breast-feed is that you cannot do it and have to switch to formula. With proper follow-up care and support, which was what these women lacked, you will know this long before the baby begins to suffer. The real risks, which the article does not cover, involve contamination of milk by outside substances, physiological abnormalities in the mother and maternal malnutrition. Should any of these factors have been involved in these two deaths, proper follow-up care would have revealed them and these babies would be alive today.
The deaths of these babies should be discussed because they vividly illustrate how little medical and practical support is available for poor and marginalized mothers. By no means should they be used to question the safety and benefits of breast-feeding. If a woman makes an informed choice to bottle feed, that is her choice. But let's not start touting it as a superior choice for the health of the baby when all of the clinical evidence weighs against it.
-- Ann Baillie
SALON | June 24, 1998

R E C E N T L Y+| UNEASY RIDER BY SARAH VOWELL

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	- - - - - - - - - - - - - - - - - - - page 2 of 2
_______________ NURSING DEATH BY DAWN MacKEEN (06/16/98)
	I am writing in response to the tragic story about the death of Tatiana Cheeks' baby. I do not believe that breast-feeding is dangerous. Surely you realize that formula-fed babies can fail to thrive and die of malnutrition. As a board-certified lactation consultant, I regularly teach parents -- before they leave the hospital -- how to tell if their babies are getting enough to eat. By about the fifth day of life, the fully breast-fed baby should be wetting six to eight diapers, having three or more bowel movements daily, and the stools should be changed to yellow and seedy. There are other signs to look for as well, and of course weight gain should be monitored regularly. According to the American Academy of Pediatrics, "When discharged 48 hrs. after delivery, all breast-feeding mothers and their newborns should be seen by a pediatrician or other knowledgeable health care practitioner when the newborn is 2 to 4 days of age." In Cheeks' case, whether the mother, family members or the health-care system was culpable I cannot say. But, believe it or not, I still get calls from worried moms whose babies are not feeding, stooling or gaining well after the two-week checkup. They tell me that their doctor (or clinic) is not concerned and has advised them to continue to do whatever they are currently doing -- and to return in one month. This is dangerous advice. Some doctors, nurses and clinic staff do not know how to assess effective breast-feeding and do not recognize breast-feeding problems that could be corrected early. I hope this kind of tragic event will be the impetus to increase education to health care providers and to parents about all aspects of breast-feeding. -- Laurie Wheeler, RN, MN, IBCLC Violet, La. My daughter was delivered by caesarean, slightly premature and at a birth weight at the low end of "normal." She did not nurse easily although she tried very hard. I was absolutely a pro-breast-feeding mom. During the one and a half days I remained in the hospital, I asked for assistance with her feeding a number of times and received only one visit at 2 a.m. from a nurse who was overworked, not assigned to me but who took pity on our situation. I chose to believe the doctors' and nurses' harried reassurances that I knew how to do it, was doing it right and that all would work out. Back at home she woke every 1.5 hours, 24 hours a day, to feed. She would nurse, or appeared to nurse for half an hour, would fall asleep again, and then we'd repeat the process. I had plenty of milk, if engorgement and heavily leaking breasts are any sign at all. Three times I called the advice line that continued to tell me she was going to be OK, that she showed none of the signs we all recognize as dangerous. She steadily lost weight. At 10 days we returned to the doctor, who weighed her. We again stated our concerns, then nearly desperate, that there seemed to be a problem with the feeding. The doctor assured us that all babies will lose up to 10 percent of their birth weight. I pointed out that the doctor's scale showed that she had lost 20 percent. The doctor agreed but said she believed we'd be fine. My baby then weighed less than five pounds. My mother and sister, who stayed near, worried about us but also listened to doctors and kept quiet. At every turn I was assured that all was well, and at every turn I was treated more and more like a neurotic female. At 11 days old she slept for six hours for the first time. I got frightened and woke her up with great difficulty, called our pediatrician and insisted against her reluctance that she call the emergency room. At the emergency room they took one look at my child and we were whisked in, where she was put screaming onto an IV, remaining on it for eight days, recovering from severe dehydration and electrolyte imbalance. I began to pump my breast milk and, once she could take food again, I repeatedly asked for the assistance of a lactation specialist, which I eventually received. At the time of my daughter's release, and after watching us struggle for three days, the specialist decided (again!) that I was doing it right and that the baby would surely "catch on." Nonetheless I insisted on taking a bottle of formula home in case things remained difficult at home. My baby still kept to the pattern of waking and nursing that had landed her in the hospital. I tried for several more days and then switched to pumped milk, which she drank immediately. I pumped milk every four hours for four months, feeding it to her in a bottle, and switched to formula when my breasts began to develop continual blockages and minor infections from the action of the pump. I can barely contain my outrage at the attempt to punish the mother whose baby died at 3 months. I had the help of family, specialists and one of the best pediatric hospitals in the nation, and still nearly lost my baby. Without adequate help, and without a diagnosis of her troubles, I lost the opportunity of both her and my lifetime to provide her with the mother-child bond that nursing produces. I have also completely lost faith in her safety when under the care of specialists. My loss in trust is the only loss arising from this experience that I welcome. Our country is in a health-care crisis whose victims will continue to be the weak, the poor and the trusting. Thank God my baby did not have to die for me to learn the extent of this crisis. The people interviewed in this story showed tremendous ignorance both of breast-feeding problems and of the overburdened medical establishment that continues to place the concerns of poor women in a file marked, "Neurotic: Ignore." Oh yes, I forgot. We were on Medi-Cal at the time. -- Jackie Gamble Berkeley, Calif. I am still wondering why you used the catch line "Nursing death" for the article on two breast-fed infants dying of failure to thrive. While I believe these deaths must be discussed and should have been prevented, to imply that breast-feeding was to blame is irresponsible and, in my opinion, borders on libel. What killed those babies was the lack of follow-up care and support, not breast-feeding. Breast-feeding is not deadly. Ignorance and lack of support are deadly. I had problems breast-feeding and, as a La Leche League member for a year and a breast-feeding advocate for much longer, met many other women who had difficulties ranging from minor to very serious. The vast majority of breast-feeding problems can be overcome with proper support from knowledgeable and compassionate people. When problems cannot be overcome, that same support can help the mother detect this and make the transition to formula. The benefits of breast-feeding range from increased infant immunity to improved social skills, especially in boys. Breast-fed babies even show higher IQs than bottle-fed babies. When weighed against the convenience and ease of measuring formula, there is no comparison. The risks involved in formula feeding are far more serious and numerous than any risk involved in breast-feeding. Especially for poor women, they include failure to thrive resulting from inadequate formula supplies, bottle propping, improper storage and contaminated water. The worst that can happen if you try to breast-feed is that you cannot do it and have to switch to formula. With proper follow-up care and support, which was what these women lacked, you will know this long before the baby begins to suffer. The real risks, which the article does not cover, involve contamination of milk by outside substances, physiological abnormalities in the mother and maternal malnutrition. Should any of these factors have been involved in these two deaths, proper follow-up care would have revealed them and these babies would be alive today. The deaths of these babies should be discussed because they vividly illustrate how little medical and practical support is available for poor and marginalized mothers. By no means should they be used to question the safety and benefits of breast-feeding. If a woman makes an informed choice to bottle feed, that is her choice. But let's not start touting it as a superior choice for the health of the baby when all of the clinical evidence weighs against it. -- Ann Baillie SALON \| June 24, 1998