It’s a parent’s worst nightmare: finding her baby girl motionless in her crib with blood trickling from her nose.
This was the fate of two-month-old Sapphire on January 2, 2017, in Ahipara, New Zealand. The coroner suspects the cause of death was alcohol poisoning via breastmilk ingestion. The toxicology report showed alcohol levels of 308 milligrams per 100 milliliters of blood in the baby’s heart. For comparison, the legal alcohol blood limit in the USA and UK is 80 milligrams per 100 milliliters.
The doctors were astounded by the high reading. They requested another test, but the result was the same. They did research on the family to understand how baby Sapphire could have ingested that much alcohol.
Sapphire’s Time of Death
Sapphire Rose Moengaroa Williams was delivered with her twin sister, Honey, through caesarean on November 4, 2016, at the North Shore Hospital in Takapuna, New Zealand. They were both preemies, born at 33 weeks, with low birth weight and accompanying medical issues.
Their mother, Janice Tua, had five children under the age of 6 before the twins were born.
The family was experiencing difficulties before the time of Sapphire’s death. Tua, and the father, Joe Williams, were staying with relatives in Ahipara. They were homeless at the time and were waiting for Housing New Zealand to assign them a new place.
Tua fed Sapphire about every three to four hours, switching between formula and breast milk. The baby was supposed to take iron and vitamin C supplements, but they were left in Kaeo two weeks prior before they moved in with family. Tua had not returned to retrieve them.
On New Year’s Day, there seemed to be nothing out of the ordinary. Their mother placed the twins in their usual cot to sleep, before climbing into a bed she was sharing with her husband and two of their children.
That night, Sapphire woke up at 1 a.m. and began to cry. While the bottle of formula cooled, Tua gave the baby some breast milk. Then Honey woke up and Tua put Sapphire back to bed to console her sister. Once Honey was pacified, Tua returned to the cot and noticed Sapphire had gone limp and blood was dripping from her nose.
Tua ran to wake up her husband who administered CPR on Sapphire. His sister called the ambulance. It was 3 a.m. then, and Sapphire did not wake up. 
Finding the Baby’s Cause of Death
Pathologist Dr. Simon Stables led the post-mortem examination and found a high amount of alcohol in Sapphire’s heart and some in her liver. Interestingly enough, there was none to be found in her stomach.
Coroner Debra Bell called the police to get statements from the parents to uncover how Sapphire’s blood alcohol levels could be so extreme.
Tua admitted that on New Year’s Day, she had visited a cousin and drank 18 cans of bourbon and coke. She herself blamed the death on the breastfeeding with those drinks in her system.
Coroner Debra Bell believed the same. “Unfortunately, her mother chose to drink a large quantity of alcohol and subsequently at a later stage chose to breastfeed her,” Bell said.
“Ms. Tua accepts the alcohol in Sapphire’s blood must have come from her consumption of alcohol. Sapphire’s mother’s actions highlight what has been well documented; alcohol can pass to a child via breast milk.”
However, the doctors couldn’t believe the death was from a single breastfeed. They suspected a few other reasons, namely acute alcohol intoxication, prematurity, hazardous sleeping location, suffocation, and possible septicemia (blood poisoning).
The police confirmed no other suspicions about the death and shut the case. 
The Drinking and Breastfeeding Debate
Auckland pediatrician Dr. Alison Leversha declared the case “very unusual.”
“I haven’t, in my professional experience, ever seen a case of alcohol poisoning through breast milk,” she said.
She does warn nursing mothers against drinking. “The main advice, if you are pregnant or breastfeeding, is not to consume alcohol because alcohol passes very freely into the baby and that has lifelong effects on brain development.”
Hei Hei Health clinical director and Christchurch GP Dr. Robert Sneddon-Smith said the baby’s acute intoxication could not have happened solely through breastfeeding. “In order for a baby to have got enough alcohol to achieve those levels from breastfeeding the mother would have had to have twice the deadly level of alcohol.”
Children’s Commissioner Judge Andrew Becroft called the case “perplexing” because of the blurry cause of death. “The case does, however, point to the need for much more research and clarity as to the effect of breastfeeding mothers consuming alcohol and any potential dangers to the baby.
“It is an important issue. It is impossible for me to go further than this given the state of the science as recorded in this finding.” 
University of Otago toxicologist Dr. Belinda Cridge believes that mothers don’t need to refrain from drinking altogether. She does confirm that alcohol does enter breastmilk, and cautions mothers to drink responsibly.
“If you are going to do it, drink right after you’ve breastfed so there’s the longest possible time before you’re feeding your baby again,” she advises.
However, it is acknowledged across the board that it’s best to avoid drinking while nursing, particularly in the first month.
If you do, here are a few things to consider:
- The baby’s age — the younger the child, the less mature their liver is and the more they are affected by alcohol
- Your weight — a lighter person digests alcohol more slowly than a heavier person
- Amount of alcohol — the more drink consumed, the longer it stays in the body
- Food eaten — alcohol drunk with food has less absorption
- Alcohol does not stimulate milk production.
- Pumping and dumping does not remove the alcohol in the bloodstream. Only time does that.
- A mother’s excessive drinking can lead to the baby struggling to gain weight, sleeping too much, difficulty sucking—which leads to malnutrition—and even delayed development. Heavy drinkers should either consider cessation or use formula to keep their babies healthy.
If you are attending a party or event with alcohol, plan ahead. Pump beforehand so you can feed the baby on schedule, or wait for the alcohol to leave the body before breastfeeding. A general rule is that if you are sober enough to drive, you can breastfeed. 
Disclaimer: This information is not intended to be a substitute for professional medical advice, diagnosis or treatment and is for information only. Always seek the advice of your physician or another qualified health provider with any questions about your medical condition and/or current medication. Do not disregard professional medical advice or delay seeking advice or treatment because of something you have read here.
- Kristen Edge. Coroner: Breastfeeding mothers should not consume alcohol, after baby dies with high alcohol level in blood https://www.nzherald.co.nz/nz/news/article.cfm Aug 9, 2019
- Emily Writes. Coroner says breastfeeding mums should never drink alcohol. 400 doctors disagree https://thespinoff.co.nz/society/13-08-2019/coroner-says-breastfeeding-mums-should-never-drink-alcohol-400-doctors-disagree/ Aug 13, 2019
- Michael Morrah. Coroner’s advice to breastfeeding mothers concerns doctors https://www.msn.com/en-nz/news/national/coroners-advice-to-breastfeeding-mothers-concerns-doctors/ar-AAFJHCs#page=2 Aug 13, 2019
- La Leche League. Drinking Alcohol and Breastfeeding https://www.llli.org/breastfeeding-info/alcohol/
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