Baby's death after mother fell asleep while breastfeeding recorded as open verdict
SINGAPORE — The death of a 15-day-old baby who was discovered unresponsive after his mother breastfed him while lying on a bed has been recorded as an open verdict at a Coroner’s Inquiry.
The baby boy’s mother had fallen asleep while she was breastfeeding him on 1 September last year.
When she woke up one and a half hours later, she found vomit and bloodstains on the baby’s swaddling cloth. He was conveyed to the Sengkang General Hospital where he was pronounced dead.
In findings delivered on Wednesday (2 October), State Coroner Kamala Ponnampalam stated that while the medical cause of the baby’s death was not ascertained, it was “likely to have been the result of unintentional suffocation” when his mother fell asleep while breastfeeding him.
The SC recorded an open verdict, which means that the cause of death is unspecified.
From a senior nurse manager’s testimony, it was “evident” that the baby’s death could have been avoided if the safe breastfeeding techniques taught by KK Women’s and Children’s Hospital (KKWCH) had been observed by the mother, the SC noted.
“Unintentional suffocation is a known hazard of the side lying method of breastfeeding and should only be practised if a third person is present to keep observation.”
First two weeks
The baby was born at KKWCH on 17 August last year. He was found to be generally well and a routine screening on the first day of his life revealed no abnormalities. His mother stated that when she was at the hospital, she declined the offer by several nurses to teach her how to breastfeed as she could still remember the methods from her firstborn, a girl whom she had breastfed until 11 months old.
The firstborn was 17 months old at the time of her brother’s birth.
His mother started breastfeeding her second child soon after his birth. Nurses observed that the process went smoothly and left the mother to it.
According to the mother, she would carry the baby with a “football hold” - tucking him under her arm like a football - to feed him. She would also use the side lying method, where she would lie beside the baby to feed him.
While at the hospital, the mother was often tired and would fall asleep with him in her arms while breastfeeding. Nurses would then carry the baby away. At home, however, the mother was often alone while breastfeeding as her husband would be tending to their daughter.
The baby and his mother were discharged from KKWCH on 20 August last year. They returned to the home of the baby’s maternal grandparents.
Baby became unresponsive
The mother continued to breastfeed the baby at home up to seven times during the day. He would also feed at night until about 4am.
On 1 September last year, at about 1.30am, when the baby cried, his mother woke up and breastfed him using the side lying method. It was the first time that she used this method for a night feed.
The mother placed the baby on the bed on her left side and fed him with her left breast, while her left arm was stretched out above her head, underneath the pillow.
She fell asleep during the process. At about 3am, her husband woke up to use the toilet and the noise woke the mother. When she moved her left hand to lift the baby, she felt something wet.
Sensing something was wrong, the woman asked her husband to turn on the lights and found vomit and bloodstains on the baby’s swaddling cloth. His face was pale, and there was vomit on his cheeks and a bloodstain at his right nostril.
The mother immediately called for an ambulance and the unresponsive baby was conveyed to Sengkang General Hospital (SKGH).
Upon arrival at SKGH, the baby was assessed to be in critical condition. Apart from having dilated pupils, the baby had no pulse and was not breathing. He was pronounced dead at 4.56am.
Side lying method
Considering how the baby was found, it was possible that he suffocated while his mother fell asleep as she was breastfeeding him, according to the forensic pathologist Belinda Lee Wai Leng. “However, this cannot be proven based on autopsy findings as suffocation may not be associated with any physical findings,” said SC Ponnampalam.
“Dr Lee further clarified that suffocation can occur when an infant’s nose and mouth becomes obstructed, such as by pillows, bedding material or other individuals when they co-sleep on the same bed together.”
KKWCH’s Senior Nurse Manager Teo Puay Ling testified that mothers are planning to give birth at the hospital typically go through regular breastfeeding classes before delivery. After delivery, nurses would personally teach the mothers breastfeeding techniques. The mothers are encouraged to room in with their babies and nursing rounds are conducted every two hours to check on them.
At discharge, a breastfeeding booklet is given to all mothers. KKWCH staff will contact them within 72 hours after discharge.
Teo stated that KKWCH does not encourage the side lying method to avoid unintentional suffocation should the mother fall asleep, adding that mothers may feel sleepy when the relaxing hormone, oxytocin, is released during breastfeeding.
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