I’m a little surprised that I haven’t see this story circulating around the blogosphere, but it has remained conspicuously absent from my Twitter feed and blog reader: Californian mother Maggie Jean Wortmon is being charged with second degree murder after her 6-week-old son died, supposedly from ingesting her methamphetamine-laced breastmilk.
Reading the comment threads on articles about this case has been enlightening. ” …If you don’t know that anything you consume while breastfeeding is passed on to your child via breast milk, you are too stupid to have a child. especially as it would be impossible for you to go through the process of childbirth and release from the hospital without being told at least five times that anything you consume is passed on to your child via breast milk,” one person said. “Its common knowledge that while nursing, what goes in, goes out in your milk, and to the baby,” said another.
But is it common knowledge?
According to the popular and respected site BreastfeedingBasics.com:
As a nursing mother, you should be aware that there are three things we know for sure about drugs and breastmilk:
1. Nearly all drugs pass into human milk.
2. Almost all medication appears in very small amounts, usually less than 1% of the maternal dose.
3.Very few drugs are contraindicated for nursing mothers.
The site does explain that drugs are metabolized in different ways, and that the younger/smaller an infant is, the more he or she might be affected by the drugs. But the message that rings the loudest is this:
“We…live in a society, which, in general, doesn’t place a high value on breastfeeding… Doctors tend to err on the side of caution and recommend that a mother wean rather that do research and reassure the mother that the medication is safe for her baby (as the majority of drugs are), or explore alternative, safer medications…..Most of the time, their primary source of drug information is the famous PDR…The PDR is not the best source of breastfeeding information, because it is an unfortunate fact that pharmaceutical manufacturers often discourage breastfeeding solely for fear of litigation, rather than for well-founded pharmacologic reasons…In deciding which drug to take, you should always look at the situation from a risk/benefit perspective: The benefits of breastfeeding are well known and undisputed, so doctors should recommend a mother wean only when there is scientific documentation that a drug will be harmful to her infant. In the rare cases where that is proven, a doctor who believes in the value of breastfeeding should take the time to explore alternative therapies, or if nursing must be interrupted, encourage the mother to continue pumping her milk to maintain her supply and return to breastfeeding as soon as possible. If your doctor prescribes a drug which he says in incompatible with breastfeeding, it is reasonable to ask for documentation and/or alternative medications. If your doctor isn’t flexible about this, and doesn’t understand how important continuing to breastfeed is to you, it makes sense to seek another opinion.”
Now, obviously, BreastfeedingBasics is assuming their target audience is a woman debating whether she should take a prescription muscle relaxant after back surgery, not your run-of-the-mill, 6-week-postpartum meth addict. But there is a pervading belief in the breastfeeding community that the benefits of breastmilk far outweigh the “unproven” negatives of nursing while using medications, tobacco, or alcohol. If I were the meth-mom’s lawyer, I’d look to the breastfeeding literature as my best defense.
Addicts are not counseled to bottle feed, but to breastfeed, even if their habit is far from kicked. “Breast milk contains small quantities of methadone, but the advantages of breastfeeding outweigh any possible negatives of passing very small amounts of methadone to the baby through breast milk,” states one site directed towards pregnant heroine addicts. An article written by an Australian IBCLC cites evidence of a plethora of substances – alcohol, nicotine, meth, marijuana, and more – coming through breastmilk in significant amounts, but then urges care providers to push breastfeeding at all costs:
“Babies born to mothers who abuse drugs start life with a handicap. Their compromised intra-uterine life has affected their nutritional status, their growth and in some cases their intellectual ability. After birth they go through withdrawal symptoms that affect their health and adaptation to extra-uterine life…Artificial baby milk provides second grade nutrition, no protection against infections, has the potential to cause chronic disease and further inhibits the intellectual potential of the infant. Breastmilk is medicine for these babies and breastfeeding is about more than merely providing nutrition. Breastfeeding develops a bond between mother and baby, which may empower and motivate positive change on the part of drug-abusing parents, while decreasing the risk of future child maltreatment. This should be considered along with concerns about the likelihood or degree of drug exposure the baby has if breastfed….Giving birth and then breastfeeding can be an empowering and life changing experience for a woman and may be the catalyst that causes her to stop her substance abuse. Before counselling a woman to feed artificial baby milk, consider giving her the opportunity to meet this challenge.”
Yeah, that worked out real well for Wortmon.
To be fair, as many of these sites point out, depending on a meth addict to properly mix and serve formula is not the most reassuring state of affairs, either. But if we’re talking about a woman too high to feed her infant responsibly, we should probably be getting Child Protective Services involved. It’s almost an entirely separate discussion than the issue of breastfeeding and medications. Personally, I am more concerned with this potentially harmful meme that it is “common knowledge” that substances pass through breastmilk, with such conflicting messages out there.
Obviously, if a woman believes that formula is poison, and that it will harm her child, the “possible” risks of drug-infused breastmilk pale in comparison. If care providers are explaining the risk-benefit analysis in this way, who could blame a mom for choosing breastfeeding, even if she is taking a contraindicated substance?
It’s time we told women the truth. If nicotine passes through breastmilk, we have a right to know. If more than few glasses of wine is going to do more than make a baby a little sleepy, we have a right to know. If we’re addicted to cocaine and someone is telling us to try breastfeeding, because it will help us break the addiction, we have a right to know what might happen if we accidentally “slip up”.
We have a right to know that formula is not poison, that children will grow well and thrive and be fine no matter if we feed them Enfamil or Similac or Earth’s Best or the Sam’s Club brand. We have a right to know exactly what the studies say about the differences between breastfed kids and formula fed kids, and what the real world meaning of these studies actually is, so that we can make an informed decision on which risks we’re willing to take. (I’d choose the possibility of a few more ear infections a year over potentially overdosing my newborn due to a medication which hasn’t been proven safe, but that’s just me.)
As for Maggie Jean Wortmon…well, as one astute comment on the ABC version of this story suggested, “Breastfeeding is so pushed on Mothers and if she was off her face, she probably just thought she was doing the right thing.”