Nursed to death

Tabitha Walrond tried to breast-feed her baby. Now she could go to jail for malnourishing her child.

Published May 21, 1999 4:00PM (EDT)

Thursday in New York's Bronx Supreme Court, Tabitha Walrond was convicted of starving her breast-fed baby to death. The charge of criminally negligent homicide carries a maximum sentence of four years in prison. Sentencing will take place on June 30. In the meantime, questions linger
about the public health system that may have
contributed to her son's death.

Two years ago, Tyler Walrond died seven weeks after his birth. Tired and teary-eyed, Walrond, 21, described to the jury what happened the night of her son's death.

"I came out of the shower. My breasts started to leak. I leaned over the baby on the bed and I saw something was wrong. His mouth was open and there was foam around it. I grabbed him up and showed him to my mother. I said, 'Mama, there's something wrong with my baby.'"

Her voice cracking, Walrond recounts running out to the street to hail a cab to the hospital, clutching the $20 bill her mother had given her. Tears streaming, she explains that she hoped a cab would be faster than waiting for an ambulance. "I told the cabbie hurry up, hurry up, pass the red light. But he wouldn't. 'I'm sorry, miss, I can't,' he told me. I'm crying, 'Something is wrong with my baby, hurry up, hurry up.'"

Walrond is certain she saw her baby die as she sat waiting in that cab for the light to turn green. "He passed in the cab. He left me in the cab. His eyes were different, all of a sudden, in the cab."

Tyler, born weighing almost 8 pounds, died of malnutrition weighing only 5 pounds. While no one disputes that Walrond, then 19, breast-fed her baby regularly, the overwhelming physical evidence of the baby's malnourished state was enough to convince jurors that she was responsible for his death.

During a trial that has gripped New York for three weeks, everything from Medicaid policy to abortion to HMOs to teen pregnancy was brought to bear in the case. According to Bronx Assistant District Attorney Robert Holdman, Walrond's motive was simple: She was angry with the baby's father, Keenan Purell, for leaving her for another girlfriend, also pregnant. Distraught, Walrond said she was going to get an abortion.

"This event, ladies and gentlemen, is what led the defendant to a road that led to Tyler's death," Holdman told the jurors in his opening statement. In fact, Holdman insisted, Walrond never wanted this baby in the first place. Walrond admitted to asking a friend about abortion, explaining, "There's a lot of things to consider when you're pregnant and 19." In Holdman's eyes, this consideration was proof enough that she had malicious intent toward her child, and that she starved him to exact revenge against Purell.

But defense attorney Susan Tipograph insisted Holdman's conclusions were absurd: "To imply that if a woman considers an abortion that must mean she later wants to kill her baby? That's a fairly offensive concept." Tipograph presented Walrond as a devoted and caring mother who was being used as a scapegoat for a host of social ills. "This was a breakdown of a lot of different systems, including mother, father, Medicaid, friends, city," Tipograph said. While Walrond failed to recognize that her baby was ill, she was not "a crackhead who left her baby in a bathroom somewhere," Tipograph said.

In the end it must have been the pictures presented by the prosecution that tugged at the hearts and minds of the jurors. The post-mortem images of a starved and emaciated infant were so disturbing that some jurors turned away in horror. The photos show a baby with sunken, gray cheeks, protruding ribs, a concave belly and bony, fleshless legs. They were pictures that made viewers want to grab Tabitha Walrond and shake her and say, "How could you not see this baby was starving?"

It is difficult to combat such visceral images, even with facts. The defense mounted a vigorous case, presenting Walrond as a conscientious mother-to-be who went to all her prenatal checkups, paid $175 out of pocket for childbirth classes and avidly read up on parenting. "I read birthing books, BabyTalk, Parenting magazine, Lamaze magazine and they all said that breast is best," Walrond told the jury. Based on what she read and learned, Walrond decided that breast milk, rather than formula, would be best for her baby. But her decision would prove easier to make than to carry out.

As a 15-year-old with a bra size of 42G, Walrond had had two breast-reduction surgeries. Such surgeries often make breast-feeding impossible or difficult. Adding to the complications, Walrond had an emergency C-section and developed an infection. Two days after Tyler was born, doctors put Walrond on antibiotics. She couldn't breast-feed for 10 days, so Tyler was fed with a bottle. Infants who are initially bottle-fed sometimes develop a syndrome called "nipple confusion" when presented with the mother's breast. In addition, women who have breast-reduction surgery may encounter problems with their milk supply. Though the breast-reduction surgery was noted in her records -- as well as the 10-day nursing suspension -- no one monitored Walrond's milk supply or advised her that there might be problems.

For instance, Walrond was not told about Tyler's dramatic weight drop during the first few days of nursing, before she contracted the infection. Concerned about the baby's 12 percent loss of body weight, a nurse did alert a doctor. But Tyler was switched over to formula soon after and steadily gained weight during the remaining 10 days mother and child were in the hospital.

"When they sent me home from the hospital they told me I should feed him as much as he wanted, on demand, and that my breast milk would accommodate to his appetite," Walrond recalled. "When I left, they seemed more concerned about me, about how I was feeling, than Tyler." Though she only mentioned it once during the trial, Walrond had been exhausted after her son's birth. "On Wednesday I graduated from high school. On Thursday, I picked up my diploma. On Friday, I gave birth. In the weeks before that I was in night school, taking classes so I could graduate on time, and also taking Lamaze at night. I was exhausted."

According to Walrond, when nurses discharged her from
the hospital,
They reminded her to schedule a well-baby visit and
she tried to do just
that. She says that when she showed up at the clinic for her HMO, the Health
Insurance Plan of New York (HIP), she was turned away by a receptionist who told her she would need a
separate insurance card for the baby. HIP officials
deny this, insisting that Tyler would have been seen on a "timely
basis" had his mother sought care. Walrond says she was instructed to fill out
a form, which she did. She was then told her that she needed a Medicaid card for the baby before she could receive HIP insurance. A social worker handling her Medicaid request then told her she needed a copy of the baby's birth certificate and Social Security card before the baby's insurance could be processed. The birth certificate and Social Security card did not arrive until Tyler was 6 weeks old.

When they came in the mail, Walrond said she returned to the social worker with the papers. Copies of the Medicaid card and HMO card would arrive in the mail soon, the social worker promised. Until they did, Walrond and Tyler would have to wait for their first visit to the doctor. "I asked for a temporary card, she said that wasn't her department, " Walrond recalled. The case worker was very nice, though. "She congratulated me on the baby and told me how cute Tyler was," Walrond said.

Six days later Tyler died of malnutrition.

Two months after his death, the Medicaid card arrived in the mail; three months after that, his HIP membership card arrived.

In court, the prosecutor hammered away at Walrond. Bureaucratic snafus aside, why didn't she insist that her baby see a pediatrician? Why didn't she take him to a clinic? The hospital? The emergency room? Walrond's answer: "He wasn't sick."

For Tabitha Walrond, who saw her baby every day, the three pounds he shed were invisible. When others observed that he looked a little "skinny," Walrond's mother reassured her that she was also a thin baby. What might have been dehydration and lethargy was interpreted as contentment, "a happy baby." When Keenan Purell's mother fussed and insisted on feeding the baby formula, Walrond resisted. "I told her that I was breast-feeding and anyway, [when they supplemented in the hospital] he had another kind of formula. I was worried that they were giving him a different kind and I wasn't happy because I know babies' digestive systems are sensitive." Walrond repeats the mantra that she encountered everywhere: "Breast is best, they told me."

In New York, the Walrond trial has taken place completely without context. In the dozens and dozens of articles this trial has generated, no one acknowledges that Tabitha Walrond -- like all new moms today -- was under considerable pressure to breast-feed, that she felt her self-esteem and competency as a mother hinged on her ability to breast-feed successfully. The complete turnaround on breast feeding by the medical establishment in the last 20 years is not noted in the press. The breast-is-best philosophy, peddled by many hospitals as if bottle-feeding were tantamount to child abuse, goes undocumented.

Consider the literature: The U.S. Department of Health and Human Services advises women that breast milk is of "distinct and irreplaceable value to the human infant" and tells them that it "creates an even more profound and psychological experience than carrying the fetus in utero." Aside from the clear nutritional advantages, mothers are also reminded that children who breast-fed exclusively were found to be "more mature, secure and assertive, and they progressed further on the developmental scale than non-breastfed children."

On Page 2 of that bible of 1990s parenting "What to Expect the First Year," an item called the "Facts Favoring Breastfeeding" lists 20 reasons to breast-feed, ranging from "less risk of diaper rash" to "decreased risk of childhood cancer." For its part, the La Leche League describes breast-feeding as "the key to good mothering," explaining that "a nursing mother is physically different than a non-nursing mother. She is in a different hormonal state. Because she is breastfeeding, she has a high level of prolactin -- the 'mothering' hormone."

The American Academy of Pediatrics, the American College of Obstetricians and Gynecologists and the United States surgeon general's office actively promote the superiority of breast-feeding. Their goal is to have 75 percent of American women breast-feeding their infants by the year 2000. Currently, 50 percent of women do.

In 1999, breast-feeding is a barometer of a mother's dedication. Failure to breast-feed is just that, failure. And while deaths from dehydration or malnutrition among breast-fed babies are rare, many -- maybe even most -- women have trouble getting started with breast-feeding.

"Experts" sternly lecture expectant moms with statistics and slogans. But in practical terms, little is done to help new moms with issues like sore nipples, babies who aren't latching on properly and the (sometimes valid) fear that the baby isn't getting enough nourishment. Exhausted, recovering from a grueling labor, many women find it difficult to retain the barrage of instructions and warnings they're discharged with: The baby should nurse eight to 12 times a day, but if she nurses 12 to 14 times it could be a sign she's not getting enough milk; there should be six wet diapers and dirty diapers every 24 hours; the baby will lose 10 percent of its weight but should then gain at least half an ounce a day. And the list goes on.

Though it's standard practice in most European countries for nurses or lactation specialists to pay free follow-up visits to new moms, few American hospitals provide this service. There have been a smattering of efforts to introduce legislation that would mandate insurance coverage for such services, but they haven't gotten very far. A California assembly member introduced a bill last year that would require insurance to cover birthing classes, breast-feeding classes and post-birth visits with a lactation consultant, but the measure didn't pass. Even more problematic is the U.S. government's recommendation that women breast-feed their newborns for one year, while failing to mandate comparable family leave policy that enables them to do it. (Even with breast pumps, most women find it a Herculean task to take a half-hour several times a day to sit in a bathroom at the office, run an extension cord into the stall, pump, then store their breast milk in the fridge next to their boss' leftover Chinese food.) Still, the U.S. Department of Health and Human Services advises, "Breast milk should not be withheld from any infant unless absolutely necessary."

But apparently Tabitha Walrond did not withhold breast milk from her baby. In fact, she breast-fed him regularly. What led to Tyler's death is still uncertain. The problem may have been that Walrond's milk supply was low, that it lacked nutrients or, as one doctor, an expert witness, pointed out, the infant was unable to digest the milk he did drink, a condition caused by an abnormality in the adrenal gland. While an autopsy found Tyler's adrenal gland to be abnormally small, it was not established whether malnutrition caused the abnormality or vice versa. Walrond followed the experts' advice; according to the defense, she thought she was doing the right thing for her baby.

Assistant DA Holdman disagreed. He could not believe Tyler's 3-pound weight loss went unnoticed. When he asked Tabitha what Tyler looked like when he died, she replied that he looked like he always had, like her son. When asked more pointedly if she noticed the flaps of skin hanging from his
bottom, whether she felt his ribs poking out when she held him, she repeated that he did not look sick; he looked like her
son. Holdman's final round of questioning came hard and fast: Did Tabitha agree that Tyler did not have enough food, that he was malnourished, that he did not get proper medical care? All were met with objections that were sustained. Finally Holdman asked,

"You were his mother, right, Ms. Walrond?"

Tabitha nodded her head.

"No other questions."

Despite the evidence that Tabitha tried to be a good mother, the photographs of Tylers wasted body proved overpowering. "No matter what, she was the mother," one of the jurors told the New York Times. "She was failed [by the system], but she should have been strong enough to do more."

Several years ago, when some highly publicized cases of dehydration
from breast-feeding and jaundice went undetected among white, middle-class newborns, there was a hue and cry against "the system." Everyone from doctors to mothers groups to the first lady decried a dangerously flawed protocol. How could HMOs cut costs by sending exhausted and inexperienced new moms home from the hospital 24 hours after giving birth? Legislators were lobbied and, ultimately, forced to change the law so that no woman could be forced out of the hospital for at least 48 hours after giving birth. In this case, the public has acknowledged a flawed system but let Walrond, a poor, young, black woman, take the hit.

Defense attorney Susan Tipograph, who argued the case pro bono, has heard from a few supporters but has received only $2,500 to help defray costs of the trial. A select group of women, headed by New York City Council member Ronnie Eldridge, has voiced outrage at Walrond's prosecution, but the cry has not reverberated. There were no protests or new laws drafted. No chorus of concerned citizens demanded that the HMO, or the hospital, or the city's Medicaid program be investigated, fined or reformed. By next week, the city will have forgotten about the bureaucratic "snafus" that prevented Tyler from getting health care. A baby died. Justice was meted out. End of story.

Until the next child dies.

By Karen Houppert

Karen Houppert is a freelance journalist, assistant professor at Baltimore's Morgan State University and the author of "Chasing Gideon: The Elusive Quest for Poor People's Justice."

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