Last week, I read about the case of Stephanie Greene, a South Carolina woman who was sentenced to 20 years in prison for allegedly killing her six-week-old daughter through morphine that was passed to her daughter through her breast milk. From a report on the case:
Alexis was born healthy, and her mother chose to breast feed. Forty-six days later, Greene called 911 to report her baby was unconscious in her bed. … A toxicology report from the baby’s autopsy found a level of morphine in the child’s body that the pathologist testified could have been lethal for an adult, prosecutor Barry Barnette said.
Stephanie Greene was reportedly taking morphine as a result of debilitating, chronic pain for a car crash that she was in ten years ago. It is worth noting that she is not a particularly sympathetic defendant. She concealed her pregnancy from her doctors in order to keep getting painkillers, and she has a history of getting drugs illegally. She lost her nursing license for this.
Unsympathetic defendant or not, as a breastfeeding mother, I find this case unsettling. To start with, morphine is an L3 class drug (“moderately safe”) that is approved by the AAP for breastfeeding. If her breast milk killed her infant, it was an issue of dose rather than drug safety. She wasn’t taking something clearly contraindicated (for example, snorting cocaine). I would guess that she was sleep-deprived and in pain, and the sleep deprivation that comes with having a baby doesn’t lend itself to great decision-making skills. Maybe she figured/hoped it would be okay to increase her dose. If it was in fact a prohibitively high dose of morphine in her breast milk that killed her baby, she was tragically wrong. Either way, she’ll live with guilt and grief for the rest of her life.
I’ve been pregnant or breastfeeding (or both) since May 2010. Over the past four years, I’ve had to take a few medications. I’ve taken medication for postpartum anxiety, ibuprofen* and Tylenol for pain, and Nyquil* for really bad, miserable colds. I’ve also occasionally taken Unisom to help me sleep. Each time I’ve been prescribed something or decided to take something over the counter, I’ve asked my doctor if it’s safe and (in the case of the Nyquil) called the InfantRisk hotline. I did this because the last thing that I would want to do is hurt my baby.
But what if, accidentally, I had? What if I’d misread the acceptable dose of Tylenol and my baby died from an acetaminophen overdose? Does it make sense to put me in jail for 20 years for that? Frankly, I don’t see what purpose it would serve. As a deterrent to other women who might do the same thing? To prevent me from doing the same thing again? Jail time isn’t really the answer for either – I think reporting the story widely in the media to raise awareness and taking away custody any other children would accomplish the same results.
Another issue that I have with this case is the fact that even though no woman has ever before been convicted of killing her child through a substance transmitted through her breast milk, there was no forensic evidence that established how the breast milk killed the baby. From the forensic expert that testified for the defense:
The problems for Mrs Greene started when the police forensics laboratory found almost 50 times greater levels of morphine than would be expected in her baby – possibly enough to kill an adult. The finding warranted further investigation. Unfortunately for Mrs Greene, the additional investigative efforts were shoddy and incomplete.
If the morphine had come from the mother’s milk, one would have expected to find high concentrations of morphine in the stomach, but the dead infant’s stomach contents were not tested. If Mrs Green had been taking more morphine than prescribed, morphine metabolites would have accumulated in her blood, but her blood wasn’t tested for morphine, let alone morphine metabolites, or even her breast milk.
Her hair wasn’t tested either. Morphine is stable in hair for months, and hair analysis would have revealed whether Mrs Greene was taking more medication than had been prescribed. That test was also deemed unnecessary. In short, no real forensic investigation was conducted, just an autopsy with no diagnostic findings.
They didn’t even test her breast milk? I find it baffling that in the first case that implicates a woman for killing her baby through her breast milk, the milk itself wasn’t even tested. It seems as if the process of elimination – how else could the morphine have gotten in there? – was good enough for the the jury. The willingness of the jury to assign the blame of an infant’s death to breast milk without forensic evidence makes breastfeeding mothers far more vulnerable to prosecution than formula feeding mothers if, for example, their baby dies of SIDS.
I’m surprised that breastfeeding activists aren’t talking more about this case. If I was a new mother and knew that I needed to take a medication, this case would give me a compelling reason to formula feed. First, I might think that “safe” drugs really aren’t always safe, and that it would be better to not breastfeed at all. (Incidentally, this case also might make doctors less willing to prescribe drugs that are considered safe out of the fear of a lawsuit.) Second, I would know that if I made an honest mistake with my medication and the unthinkable happened, I could go to jail for 20 years. Formula, by comparison, looks pretty risk-free.
* Just to clarify – Ibuprofen and Nyquil should not be taken during pregnancy; I took them while breastfeeding. I took Nyquil only once my baby was older (10 months old), and I pumped and dumped the morning after I took it.