Hot Flash: Nursing death

When a breast-fed infant dies from malnutrition, is the mother to blame?

Published June 16, 1998 9:42AM (EDT)

When her baby was hungry, Tatiana Cheeks hushed her, held her close and breast-fed her. Mother's milk and mother's love are two of the most important ingredients in a newborn's life. But in Cheeks' case, these essentials were somehow not enough: She woke one day to find her 6-week-old baby girl, Shanell Coppedge, dead on the couch next to her.

In May, two months after Shanell's death, the Brooklyn Medical Examiner's Office determined that the baby died of malnourishment, weighing only 6 pounds, 5 ounces on the day she died. Law enforcement officials say Cheeks, 21, should have seen the signs that her baby was failing to thrive and arrested her on two counts -- criminally negligent homicide and second-degree manslaughter. Her case is now before a grand jury in Brooklyn, according to criminal court officials there.

This is not the first time that a mother has been arrested in the death of a malnourished, breast-fed child. Nineteen-year-old Tabitha Walrond is awaiting trial on the same charge of criminally negligent homicide, after her 2-month-old died under similar circumstances last October in the Bronx. In both cases, relatives of the women say they sought medical attention for their infants but were turned away by clinics. Walrond didn't have insurance and Cheeks, who was on welfare, couldn't pay the $25 clinic fee, according to the New York Times.

These two cases, while unusual, beg the question, can breast-feeding be dangerous? Is mother's milk not always enough? Salon spoke with Dr. Ruth Lawrence, professor of pediatrics at the University of Rochester School of Medicine and director of the university's Breast-feeding and Human Lactation Studies Center, and Dr. Richard Aubry, professor of obstetrics and gynecology at the State University of New York Health Science Center in Syracuse, about these two cases and the questions they raise about young mothers and their ability to breast-feed properly as well as the access poor women have to health care.

Should Tatiana Cheeks be punished because her child was malnourished -- even though she breast-fed?

Dr. Ruth Lawrence: You'd be tempted to say just the opposite. After all, mother's milk is the best thing and not all babies have the privilege of getting it. A mother who goes to the trouble of breast-feeding her baby deserves a lot of credit, especially in contrast to the mother who takes the easy way out and bottle feeds it.

Dr. Richard Aubry: My own feeling is that there are no bad mothers, only bad societal influences. Ms. Cheeks apparently attempted to get medical care and was turned away -- but she was trying. It's crazy to accuse her of somehow not doing the right thing.

We're taught that breast-feeding is the best thing for our babies and then something like this happens. Are there risks associated with breast-feeding that aren't commonly known?

Aubry: Walking across the street has risks, so it would be impossible to say that there aren't risks with breast-feeding. But there's more to it than that. This woman was poor, she tried what she could based on her understanding and couldn't get the help she needed.

Whatever happened, the fact is a baby is dead. Should the mother be prosecuted?

Aubry: My initial reaction was, how dare they prosecute somebody who tried to bring her child to health-care providers and was then turned away? I don't see how anyone could point a finger at this person -- she should be consoled.

Lawrence: On the basis of feeding her baby at the breast and having her baby not do well -- no, she should not be prosecuted. If there is more to the story, if there was more she could have done, then the picture changes.

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Who is responsible for this baby's death then?

Lawrence: We tell new mothers that a baby should be seen within a week of leaving the hospital. If the hospital had just weighed the baby and examined the mother's breast, they could have gotten a good sense of whether or not she had a supply of milk. So I don't know, is the clinic culpable? How culpable are her relatives who were aware of this?

Did this happen because she was poor and didn't have as much access to the health-care system?

Aubry: The baby died because she was ill. The mother apparently knew this because she brought the baby to the clinic -- but then she was turned away. So shouldn't these people be accused of being involved in this baby's death? Is it an economic problem? Yes, which translates into a health-care availability problem. Here we are trying to knock ourselves out, encouraging the poor to breast-feed because of all the advantages, but where do they go if there's a problem?

If there are risks with breast-feeding, they certainly would be higher in the people who are asked to do this and then not given the support necessary to minimize the risk. For example, if an affluent mother has trouble breast-feeding, she has access to several private pediatricians, 24 hours a day, seven days a week. Whereas, what do you think would happen if an indigent mother calls the clinic at 5 o'clock? Not too likely she'll get an answer back, and if she does, it's probably not going to be a trained person or a breast-feeding counselor.

Is it possible that Tatiana Cheeks had a problem with her milk supply that might have led to the baby's death? Is that common?

Lawrence: It isn't common. We don't know really what the percentage is of women who can't provide enough milk because we don't know how many women out there can provide enough milk. In a pediatric clinic, they might see two mothers a year who have trouble making enough milk.

Often when an individual practitioner sees a mother who is not producing enough milk, it's usually that she didn't have the proper help or guidance. Sometimes it's because the baby wasn't put to the breast properly or the baby didn't stimulate the breast and the breast didn't respond by making enough milk. If she had been seen in the clinic, maybe this could have been fixed. Rarely, you see a mother who just tries everything -- has gone to classes, read the books, has had all the help in the world from experienced lactation consultants and still cannot produce enough milk. In that case, it's something inherent that you can't do anything about.

Would the baby have been better off if she were bottle-fed? That way you can at least see how much is being consumed.

Lawrence: With bottles, yes you can measure how much the baby is drinking, if that's your only goal. But failure to thrive among bottle-fed babies and babies who are not held is much more common than among breast-fed babies. The one thing about breast-feeding is that you have to have that body contact, whereas a mother can ignore her bottle-fed baby by keeping it laying in the corner somewhere and popping a bottle in every once in a while. [Problems occur] when formula isn't prepared properly -- either by overdiluting the formula or not sterilizing it properly.

Would it be hard for an inexperienced mother to tell if her baby was properly nourished?

Lawrence: All hospitals tell mothers the following: You want the baby to wet at least six to eight diapers a day, you want the baby to have three or four stools a day, or at least one per day. The mother should also have some sensation of her breast filling a little and becoming softer after a feeding, she should see milk in the baby's mouth and her breasts should drip when stimulated. There is a litany of things that we tell mothers to look for and if there is any faltering, they should be seen.

Do you think cases like this will change the way breast-feeding is looked at?

Lawrence: I hope not. What we need to change is follow-up after babies leave the hospital. We need to make sure that newborns are being seen. Breast-feeding has tremendous benefits: It decreases infection and the likelihood of illness in general; it decreases the cost of medical care and food in the first year of life; and in the long term, it decreases allergies and increases intelligence. You want to sweep all those benefits out the door because of one case where a baby dies who happened to be breast-fed? I hope not.

By Dawn MacKeen

Dawn MacKeen is a former senior writer for Salon, and author of a forthcoming book about her grandfather’s survival of the Armenian Genocide, "The Hundred-Year Walk: An Armenian Odyssey" (Houghton Mifflin Harcourt, January 2016).

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