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Breastfeeding on Trial: The Case for Better Instruction

This May, Tabitha Walrond, a 21-year-old mother in New York City, was convicted of criminally negligent homicide in the death of her 2-month-old son, who died of starvation and dehydration due to inadequate breastfeeding. Her defense was that she had vigorously attempted to breastfeed but was unaware that her earlier breast reduction would lead to insufficient milk production. (Her attorneys intend to appeal.)

Many experts questioned whether it was fair to lay the blame for this tragedy on the mother alone, and saw larger issues behind the case.

Parenting talked to contributing editor Marianne Neifert, M.D., a leading authority on breastfeeding and an expert witness for Walrond's defense at the trial.

Q. How does this case reflect the information that most women get about nursing?

A. The underlying issue is the enthusiastic promotion of breastfeeding without balancing it with realistic facts and information. Many breastfeeding advocates are reluctant to talk about the risk factors and how to watch for warning signs in the baby. Much of the literature tends to give an oversimplified version of things, such as saying, "Don't worry if your baby looks thin, babies come in all shapes and sizes." Breastfeeding is natural, but it's also a learned art.

Q. Could the death of Tabitha Walrond's son have been avoided?

A. Yes. As I testified during the trial, her breast-reduction surgery was noted on her chart, but no one made the connection between that and her intention to breastfeed. It should have been clear that breastfeeding alone wouldn't work in her case. Yet she was simply discharged from the hospital. Given the proper information and follow-up, this wouldn't have happened.

Q. What can be done to avoid another such tragedy?

A. There's an enormous knowledge gap on the part of health- care professionals. Breastfeeding needs to be taught in medical schools and made part of the training for all doctors -- especially obstetricians. They should know what resources are available for mothers and should be responsible for making appropriate referrals. As for the information that new parents receive, both from doctors and from the breastfeeding literature, there should be less "Don't worry if..." and more "Here's when to seek help."

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