Coroner Debra Bell
Auckland Coroner’s Office
Level 7
Auckland District Court
65 Albert Street
Auckland
(email: csu.auckland@justice.govt.nz)
11 August 2019
Dear Coroner Bell,
I am writing to express concern regarding the recommendations
published following the inquest into the death of baby Sapphire
Williams in January 2017. I am writing on behalf of a group of
doctors, predominantly from New Zealand, many of whom are
mothers or have special expertise in lactation and breastfeeding
medicine.
It is with sadness that we heard about Sapphire’s death, and the
subsequent inquest and recommendations received widespread
media coverage. Our concerns specifically relate to the conclusion
that breastfeeding from a mother who has consumed alcohol could
result in such a dramatically high blood alcohol level in the infant.
Relating to this conclusion, we disagree with the blanket
recommendation that all breastfeeding mothers must avoid alcohol.
This recommendation has the potential to mislead the public and
professionals without specialty knowledge, and removes focus from
other key issues which were identified in the inquest and may have
contributed to Sapphire’s death. I have attempted to address our
concerns in detail below, as well as addressing the
recommendations and how they relate to the current scientific
literature and international recommendations.
Current recommendations:
It has been well-documented that there is no proven safe amount of
alcohol that can be consumed by a woman when she is pregnant, or
trying to become pregnanti. However, pregnancy and lactation are
two different physiological states – and there is no need for this to
be such a strict recommendation during breastfeeding. This is
agreed by multiple groups and agencies including the Australian
Breastfeeding Associationii, the La Leche Leagueiii, the National
Health Service (UK)iv and the American Academy of Paediatrics v, as
well as the Academy of Breastfeeding Medicine vi.
Instead,
moderation and sensible alcohol consumption is recommended, as it
is with all non-pregnant adults.

 Around two-thirds of mothers of babies three months or older will
consume alcohol. If they consume alcohol, mothers who breastfeed
are more likely to consume a low level rather than a high level, and
are very unlikely to binge drink.vii Leading breastfeeding authorities
agree that a breastfeeding mother consuming alcohol in moderation
is unlikely to put her baby at riskviii.
A mother who has consumed one to two standard drinks would be
under the New Zealand blood alcohol limit to drive (50mg alcohol/
100ml). This mother would have a breastmilk alcohol level of 50mg/
100mL (or 0.05% alcohol by volume) – which is the same as a glass
of orange or apple juice, a ripe banana, and less than a glass of
kombucha or some types of bread rolls. There is no documented
evidence that a baby being fed breastmilk with this kind of alcohol
concentration is at risk of harm.
It seems reasonable that if a
woman is safe to drive, she is safe to breastfeed her baby.
A recent cohort study from Australia reported that mothers who are
breastfeeding will usually consume alcohol at a low level if they are
going to consume any, and/or that they will employ strategies to
minimise the alcohol passing to baby (such as waiting to feed).
This study did not report any adverse health effects in babies under
twelve months who were exposed to low levels of alcohol via
breastmilkix.
Pharmacology and biology:
Alcohol enters the bloodstream and crosses readily to the
breastmilk, with the blood alcohol and milk alcohol levels being
roughly equivalent.x
The levels peak at 30-60 minutes after
consumption, and then decline rapidly if no more is consumed (by
around 15-20mg/ 100mL/ hour).xi
The levels in the milk fall in
keeping with the fall in blood alcohol level, and there is no
accumulation of alcohol in the breasts. We know that a person’s
blood alcohol level is influenced by various factors including the
amount of alcohol that they have had to drink, their gender and
their body weight. These factors similarly influence breastmilk
alcohol concentration in lactating women.
Effects on the baby:
Despite the old wives tales, alcohol does not increase breastmilk
production, or relax babies to help them sleep. xii Alcohol inhibits the
milk letdown reflex when at high levels in the mother’s blood (after
around five standard drinks), reducing the amount of breastmilk that
the baby receives. It has been postulated that an even higher
amount of alcohol (twelve standard drinks or above) could
completely inhibit the suckling-induced oxytocin surge, meaning no
milk letdown at all.xiii Based on this, as intoxication increases, the
milk ejected by the breast will be progressively limited, and

 therefore there is some physiological minimisation of the volume of
alcohol able to be transferred to the breastfeeding infant.
Babies who drink breastmilk containing moderate amounts of
alcohol have been noted to have a short (less than 24 hour) change
in their sleep pattern – they are more restless in sleep immediately
following the alcohol ingestion. They then make up for that sleep
change over the course of the following day. xiv The effect does not
linger. These babies also feed more frequently over the day after
being exposed to alcohol – likely because of the reduced amount of
milk available while the mother had a higher blood alcohol
concentration. Babies who are exposed to extremely high amounts
of alcohol may be more sleepy.
Babies exposed to high levels of alcohol via breastmilk, or prolonged
repeated exposure, may have a delay in motor development xv. This
effect is not noted in breastfed babies whose mothers consumed
little alcohol, or alcohol in moderation.
Data in human infants is limited to mainly observational research,
but animal studies are often quoted in this area when the risks of
breastfeeding and alcohol are discussed. In a rat study, the young
who consume milk from a lactating mother who has ingested alcohol
are more likely to be small due to reduced milk output xvi. This
finding has not been replicated in humans.
There are many singular case studies in the literature of adverse
effects in babies exposed to alcohol, which are occasionally cited.
Some of these date back to 1907 xvii and such historical anecdotes
are not privileged to our current level of physiological understanding
of breastfeeding.
Case studies are often subject to bias and
confounding, and in medicine are considered to represent low
quality evidence when compared to controlled studies of larger
patient groups.
In fact, in the literature to date, there are fewer than ten reported
cases of acute alcohol intoxication in infants younger than 12
months. Only one of these babies died. None of these babies
received the alcohol via breastmilk – they received it mixed into
their infant formula (either accidentally or intentionally), or via the
skin (such as using ethanol to clean the umbilical cord stump, or as
a bath).xviii
Maternal alcohol ingestion risks harm to the infant through the
intoxication of the mother. Dangers include poor decision-making or
judgement, accidental injury through dropping the baby, or falling
asleep in bed with the baby while still under the influence of alcohol
(and thus unsafely bedsharing). This could be considered to be

 much more dangerous to the baby than the consumption of a small
amount of alcohol via the breastmilk.
Infant formula as an alternative?
Breastfeeding is the biological norm, and is protective against many
acute and chronic illnesses in both childhood and adulthood
(including diabetesxix, childhood cancersxx, asthma and allergyxxi).
The use of infant formula reduces this protection. Babies who are
mixed-fed are at an increased risk compared to their exclusively
breastfed counterparts, and babies who are entirely formula fed are
at an even higher risk, missing out completely on the protections
afforded by breastmilk. The bacterial population in a baby’s gut (the
microbiome) starts to change dramatically from the very first bottle
of infant formula that is introduced, and there is increasing research
available on the importance of the microbiome for healthxxii.
Women are autonomous, and there is a large degree of loss of
autonomy during pregnancy, when her body becomes subject to
many restrictions. Some will prioritise their bodily autonomy over
breastfeeding,
and
choose
to
introduce
infant
formula.
Recommendations such as those released after Sapphire’s inquest
powerfully
influence
maternal
decision-making
regarding
breastfeeding. There can be no doubt that this recommendation will
make some women stop breastfeeding, or start to mix-feed their
babies when they otherwise would have no indication to. This use of
formula may be planned, it may be a result of having a “back-up”
tin of formula available in case of consuming alcohol, or it may
occur in a complete panic as the breastfeeding woman remembers
or is told that her breastmilk will become harmful to her baby after
the glass of wine she just had. In the context of maternal alcohol
ingestion, the safe preparation of formula represents a risk which
could pose more harm to the infant than that of minimal alcohol
consumption via breastfeeding.
In summary, it is unproven that breastmilk containing a tiny
percentage of alcohol is harmful to babies, but it is proven that
there are risks associated with infant formula, a reduction in
breastfeeding, or weaning entirely. There is simply no need to put
this doubt or thought into women’s minds.
Other effects of this recommendation:
By recommending that all mothers who breastfeed entirely abstain
from alcohol, and emphasizing this specific aspect of the case, the
potential to make otherwise meaningful recommendations and learn
from Sapphire’s death was lost. Instead of placing the blame and
responsibility on an individual or group of individuals, change could
have been made on a population level. What could have been

 learnt from this case, is what moderation looks like for breastfeeding
mothers, or what steps mothers could take to help increase safety.
Possible alternative recommendations:
- If breastfeeding mothers choose to consume alcohol, it should
be in moderation, as with other non-pregnant adults. There is
no evidence of harm to babies if mothers consume one or two
alcoholic drinks.
- If there is expressed breast milk available, then a mother who
has ingested alcohol could choose to feed this to her baby
instead of breastfeeding, and wait for an hour or two before
feeding her baby from the breast instead. If expressed breast
milk is not available ahead of time, it is still likely to be safer
for baby to be fed breastmilk with a tiny percentage of
alcohol, than it is to introduce artificial baby milk (with the
risks of this outlined previously).
- Women who have been ingesting alcohol can express their
breastmilk if they need to for comfort or to maintain milk
supply. Alcohol levels in milk decline in keeping with levels in
blood, and pumping it out won’t reduce the alcohol in the
breasts. The expressed milk can be given directly to baby if
the mother has been drinking in moderation, or it can be
diluted with non-alcoholic milk and given later.
- If a breastfeeding mother is planning on consuming large
amounts of alcohol, then she needs to have the support of
somebody who is sober to care for her baby while she is
inebriated. She should be supported to express breast milk
for the baby ahead of time.
- If a breastfeeding mother consumes a large amount of alcohol
without planning ahead and storing expressed milk, she is still
likely to be safer to breastfeed her baby than to begin the
process of introduction of infant formula (especially if she
waits after peak concentration time to feed). This is due to
the risks previously discussed. Most importantly, she needs
help to care for this baby – and there needs to be some
thought about the mother’s circumstance and supports, if
excessive alcohol use is occurring.
- If a breastfeeding mother consumes alcohol, she should not
share a bed with her baby because she is not likely to be as
aware of her environment. Bedsharing can be a safe way of
sleeping for breastfeeding mothers and babies, but there are
guidelines that should be followed to ensure safety.
- Women should use common sense and discretion when it
comes to consuming alcohol in the context of young babies,
premature babies, small babies or sick babies.
- Women should consider making sure that breastfeeding is well
established before introducing alcohol (for the aforementioned
risks of it reducing milk supply, or affecting infant sleep).

 -

Women can download apps for their phones to help plan or
estimate when their breastmilk will be free of alcohol (like
Feed Safe).
There is support available for all mothers, breastfeeding or
not, who are concerned about their alcohol intake or their use
of alcohol to “get through” their days of parenting. Mothering
small children is incredibly difficult at times, and often
isolating, and alcohol dependence for these women is a very
real problem.

Recommending that all breastfeeding women remain sober for the
entirety of their breastfeeding journey isolates the breastfeeding
mother in today’s society.
The World Health Organisation
recommends that babies are exclusively breastfed until around six
months of age, and continue to be breastfed until at least the age of
two yearsxxiii. It is not fair to scaremonger and recommend every
mother remains alcohol-free for the duration of her time trying to
conceive, her pregnancy, and then two years or longer of
breastfeeding.
Breastfeeding mothers already get an incredibly
hard time in our culture. While it is recommended to breastfeed, it
somehow seems to offend individuals when breastfeeding goes on
too long, or stops too early, or is done in public, or while pregnant,
or when eating certain foods or taking medications. A breastfeeding
mother’s body is subject to a lot of arbitrary rules and perspectives
by the public.
Recommendations around alcohol consumption
contribute to negative societal perception of breastfeeding, instead
of promoting inclusivity. This serves only to isolate mothers further.
Is it possible for an infant to have such a high blood alcohol
level solely from breastfeeding from a mother who had
consumed alcohol?
It was reported that baby Sapphire’s blood alcohol level, in her
heart, was 308mg/ 100mL. This test was run more than once, could
not be explained by the pathologist, and was not correlated by a
high alcohol level in her stomach or liver. This is an incredibly high
blood alcohol level. It would make many adults comatose. For
Sapphire to have a level this high in her blood, she would have had
to consume an incredible amount of alcohol. One would hope that
the blood alcohol level of the second twin was also tested, as well as
the blood alcohol and breastmilk alcohol levels of the mother, in
order to link Sapphire’s blood alcohol level to breastfeeding. I have
completed some calculations based on the information available in
the public domain and have attached my work as an Appendix.
When the information publicly available is used, and combined with
the science of alcohol ingestion and metabolism, as well as infant
feeding knowledge – it can be calculated that the maximum blood
alcohol concentration that baby Sapphire could have reached by

 ingesting her mother’s breastmilk is 34mg alcohol/ 100mL of blood.
This is a tenth of what has been reported.
To reach a blood alcohol level of over 300mg/ 100mL, she would
have needed to consume 6.47g of ethanol. To achieve this, she
would have needed to consume a litre of milk in a single feed from a
mother with a blood/ breast alcohol level of 700mg/ 100mL.
Alternatively, if she had a normal-sized breastfeed, then her
mother’s blood alcohol level would have had to be 6470mg/ 100mL
– for which the mother would have had to consume over 200
standard drinks (and is a blood alcohol level 4-5 times the highest
blood alcohol levels ever recorded).
The numbers don't make sense here. Therefore it does not make
sense for breastmilk alone to have killed this baby, and so it is unfair
for the sole recommendation to come from this case to be that
breastfeeding mothers should consume zero alcohol.
There are so many factors at play here. Deprivation, poverty,
homelessness, health inequity, unsafe bedsharing.
What
circumstances led to this mother binge drinking so soon after
bringing her preterm twins home from the hospital? There must
have been a lack of wraparound support in place for this homeless
family with seven children. To blame this on breastfeeding alone is
bizarre. In fact, it is even more important for babies born into
poverty to be breastfed – not to have their mothers dissuaded from
doing so.
In summary:
We are surprised that the conclusion reached in this case was that
baby Sapphire died from alcohol ingestion through breastfeeding.
This does not appear to be physiologically possible given the
information available to us, and does not fit with the current
evidence around breastfeeding and infant exposure to alcohol. In
fact, it seems that it would be the world’s first reported case of
acute alcohol intoxication and death from breastfeeding.
We are disappointed that the recommendation was that women who
are breastfeeding must not consume alcohol. Breastfeeding is so
incredibly important. There should be a lot of consideration before
sweeping statements are made that could undermine breastfeeding,
alienate breastfeeding mothers, and subvert all the good work that
is put in to informing women about breastfeeding. An opportunity to
enhance the breastfeeding narrative has been missed here, by an
influential government agency, which is likely to disadvantage
mothers and children.

 We are available for correspondence via the primary author of this
letter (Dr Heather Johnston) should you wish to respond.
Kind regards,
Dr Heather Johnston (MBChB, PGDipOMG)
And the following 726 doctors:
Dr Charlotte Adamson (MBChB)
Dr Mariana Adjemian
Dr Angela Aitken (MBChB, PGCertWHlth, DipPaed)
Dr Emily Aitken (MBChB)
Dr Olivia Albert (MBChB, FANZCA)
Dr Marlize Alberts (MBChB, ACEM Certificate)
Dr Anna Alderton (MBChB, FRNZGP, FRACGP, PGDipChildHealth,
PGCertWH, BPhEd)
Dr Grace Aldridge (MBChB, BSc, MRCP)
Dr Danuta Amelung (BHB, MBChb, Dip Paed, PGCertWH,
FRNZCGP)
A/Professor Lisa Amir (MBBS, MMed, PhD, IBCLC, FABM, FILCA –
Australia)
Dr Emily Amos (MBBS, FRACP, DCH, IBCLC – Australia)
Dr Elizabeth Anderson (MBChB, DCH)
Dr Briony Andrew (MBBS, FRACGP, DRANZCOG (Adv), IBCLC –
Australia)
Dr Laura Andrews (MBChB, PGDipOMG, DCH)
Dr Shreya Andric (BmedSci, MBBS (Hons), FACD – Australia)
Dr Hannah Annesley (MBChB, PGCertWH, DCH)
Dr Pilar Aparisi-Gomez (MBChB, FRANZCR)
Dr Catherine Appleby (MBChB, PGDipOMG, FRANZCOG)
Dr Cheryl Archer (MBChB, FRNZCGP)
Dr Lorna Archer (MB, BS, BSc (Physiol))
Dr Caroline Ariaens (MBChB, FANZCA, PGDipOMG)
Dr Antonia Arlidge (MBChB, BmedSc, BA)
Dr Alice Armstrong (MBChB, DCH, FRNZCGP)
Dr Lauren Arnold (MBChB)
Dr Natalie Arnold (MBChB)
Dr Melissa-Jane Austen (MBChB)
Dr Michelle Bailey (MBChB, DipObs, FRANZCOG, CREI)
Dr Ra Baillie (MBChB, BMedSci(Hons))
Dr Paula Barlow (MBChB, FRACP – Australia)
Dr Karen Bartholomew (MBChB, MPH, FNZCPHM Public Health
Medicine)
Dr Caroline Bartolo (MD)
Dr Kris Bascomb (MBBS, FRACGP, FACRRM, DCH, DRANZCOG
(Adv), Grad Cert MH(GP) – Australia)
Dr Carmen Basu (MBChB, Paediatric Fellow)

 Dr Nicky Baxter (MBChB)
Dr Charlotte Beaton-Rose (MBChB)
Dr Jenna Beaumont (MBChB)
Dr Rachel Beard (Developmental Paediatrician, FRACP)
Dr Rachel Bell (MBChB, BHSc, BCom)
Dr Lara Benoiton (MBChB)
Dr Sarah Benson-Cooper (MBChB)
Dr Rachael Bentall (MBChB)
Dr Simone Besseling (MBChB)
Dr Kirsten Bevin (MBChB, FRANZCR)
Dr Nina Bevin (MBChB, MPH, FRNZCGP)
Dr Ekta Bhasin (MBChB, BPharm, BSc (pharmacology),
PgCertClinPharm)
Dr Lauren Bidois (MBChB)
A/Professor Marie Bismark (MBChB, LLB, MBHL, MPH, MD, FAICD,
FAFPHM, Public Health Physician)
Dr Nicola Blomfield (MBChB, FRNZCGP)
Dr Sophia Blomfield (MBChB)
Dr Su-Lin Boey (MBChB, DCH, FRNZCGP)
Dr Fiona Bolden (MBChB, FRNZCGP(dis))
Dr Sarah Bombell (MBBS, FRACGP, DRANZCOG (Adv), IBCLC)
Dr Christi Bowern (MBChB, BScN, MN)
Dr Jessica Bowker (BSc, MBChB)
Dr Alexandra Bowles (MBChB, PGDipOMG)
Dr Sarah Bowman (MBBS, BmedSci, FANZCA – Australia)
Dr Nicola Boyd (BOccThy, MBBS, DCH, DavMed(UK), FRACGP –
Australia)
Dr Arvenia Boyke (MBChB)
Dr Kristin Boyle (MBBS, FACEM - Australia)
Dr Christine Brabyn (MBChB, FRACP, FACEM)
Dr Kelly Bradley (RACGP Registrar, DRANZCOG (Adv) – Australia)
Dr Vasanthi Bradley (MBChB, FRNZCGP)
Dr Derryn Brain (MBChB, FRNZCGP)
Dr Irene Braithwaite (MBChB, MD, PhD)
Dr Megan Briscoe (MBChB)
Dr Tamara Brodie (MBChB)
Dr Lisa Brown (MBChB, PhD)
Dr Erena Browne (MBChB, PGDipOMG)
Dr Anna Brownson (MBChB, PGDipOMG)
Dr Gabrielle Budd (MBChB)
Dr Carmel Built (MBChB)
Dr Stephanie Built (MBChB, PGDipPaed)
Dr Romy Busbridge (BmedSc, MBBS, FANZCA – Australia)
Dr Catherine Burton (MBChB, FRNZCGP, PGDipGP, Senior Medical
Lecturer)
Dr Anna Byrne (BM, BSc (int), MRCP(UK), FRCPath(UK)
Dr Imogen Caldwell (MBChB)
Dr Ruth Cameron (MBChB, FRNZCGP)
Dr Victoria Campion (MBChB, FRACP, FRCPA)

 Dr Jade Candy (MBChB)
Dr Rachel Care (BmedSci, BMBS(Hons), PGDipClinEd, FRACS)
Dr Sarah Carr (MBChB, FACEM, Senior Emergency Physician)
Dr Rona Carroll (FRNZCGP, MBChB, IBCLC)
Dr Emma Carter (BSc, MBChB, PGCertWHlth)
Dr Aisling Carville (MPharm, MBChB)
Dr Sarah Cashen (MBChB)
Dr Terina Caughey (MBChB, FRANZCR)
Dr Charlotte Cave (MBChB, PGCertWHlth, DipPaed, FRNZCGP)
Dr Neroli Chadderton (BHB, MBChB, FANZCA)
Dr Carol Chan (BHB, MBChB, PGDipPaed, FRACP)
Dr Christina Chan (Cardiologist, MBChB, MMedSci, FRACP,
FCSANZ, FASE)
Dr Daniela Chan (MBBS, BmedSc, FRACP – Australia)
Dr Jennifer Chan (MBBS, FRANZCP)
Dr Joanna Chan (MBChB, PGDipOMG)
Dr Jennifer Chandler (MBChB, MRCPCH)
Dr Parteshma Chand (MBChB, PGDipOMG, FRNZCGP)
Dr Rebekah Cherry (MBChB)
Dr Isobella Cheung (MBChB, Dip Paeds, FRNZCGP)
Dr PaoLin Chi (MD, CLC, Paediatric Fellow)
Dr Corina Chilibeck (MBChB, BSc)
Dr Alexia Chisholm (MBChB, DCH, IBCLC)
Dr Sheng-Tsung Chiu (MBChB)
Dr Prathima Chowdary (MBChB, FRANZCOG)
Dr Karen Chung (BHB, MBChB, PGCertWHlth, FRNZCGP)
Dr Carolyn Clark (BSc, MBChB, FRACP, PhD)
Dr Rachel Clarke (BSc(Hons), MBChB, DCH, FRACP (Paeds))
Dr Sarah Clarke (MBChB, FRNZCUC, FRHMNZ)
Dr Amanda Cleland (MBChB)
Dr Helen Clement (MBChB)
Dr Liadhan Coakley (MBBChBAO, Bcomm, BA, DipPaed)
Dr Ruellyn Cockcroft (MBChB, Mmed(Paed))
Dr Joanne Cole (FACEM, PEM, MBChB)
Dr Megan Cole (MBChB, DRANZCOG, FRNZCGP)
Dr Erin Coleman (MBChB)
Dr Elizabeth Conner (MBChB)
Dr Brigid Connor (MBChB, RANZCR, EBIR)
Dr Chloe Corbett (BbiomedSci, MBChB, DCH)
Dr Leilani Corbett (BSc (Hons), MBBS, FRACGP, DRANZCOG (Adv),
DCH – Australia)
Dr Sarah Corbett (MBChB, FRANZCOG)
Dr Christine Coulter (MBChB, DipObs, DipPaed, FRNZCGP)
Dr Emma Coutts (MBChB)
Dr Jillian Cox (MBBS – Australia)
Dr Marnie Cox (MBChB, FRANZCR)
Dr Stephanie Cox (BHB, MBChB, PGDipOMG, FRACP (Obstetric
Medicine))
Dr Rachelle Cox (MBChB, DCH)

 Dr Rebecca Crabbe (MBChB, PGDipOMG)
Dr Terrianne Cripps (MBChB, BMLSc, PGDipSurgAnat)
Dr Fiona Croft (MBChB, BSc(Hons), PGCertClinEd)
Dr Rosalind Crombie (MBChB, FCICM, FACEM, PGDipOMG,
PGDipSEM)
Dr Sonja Crone (BSc, BHB, MBChB, FRACP, General Paediatrician)
Dr Angela Cross (MBChB, FRANZCOG)
Dr Georgia Crosson (MBChB)
Dr Nicola Culliford-Semmens (MBChB, DCH)
Dr Katherine Culliney (MBChB, PGDipOMG)
Dr Lauren Cumberpatch (MBChB, FRNZCGP, DCH, PGCertWHlth)
Dr Anne-Marie Cumins (MBChB, ClinDipPallMed)
Dr Anna Cunliffe (MBBS – Australia)
Dr Alexandra Currie (BHB, MBChB, FRCPA, GradCertTertiaryEd)
Dr Nilofer D’Sousa (MBChB, FRACP, FRCPA (Haem)
Dr Gloria Dainty (BSc, MBChB, DCH)
Dr Francesca Dalzell (MBChB)
Dr Debbie Dance (BSc, MBChB, FANZCA)
Dr Kerry Daniel (FRNZCGP)
Dr Anna Dare (MBChB)
Dr Kimberley Davies (MBChB, FRNZCGP, DipPaeds)
Dr Whitney Davis (MBBS (Hons), PGDipOMG)
Dr Anna Davison (BSc, MBChB, DipPaeds, DipObs, FRNZGP)
Dr Lynn Dawber (MBChB, FRNZCGP)
Dr Lisa Dawes (MBChB, PGDipOMG)
Dr Jennifer Dawson (MBBS, FRANZCGP, FRHMNZ, FAChPM, Dip
Obs)
Dr Penelope Day (MBChB, DCH, DipObs, PGDip SportsMed,
FRCNZGP)
Dr Elizabeth de Lautour (MBChB, FRNZCGP)
Dr Amelia De Nicola (MBBS – Australia)
Dr Ingrid de Ruiter (MBChB, GradDip Arts, MPH, PhD)
Dr Nathalie de Vries (MD, PhD, FRACP)
Dr Nikki de Vries (MBChB)
Dr Emily Deacon (MBChB, PGDipOMG)
Dr Natalie Dent (MBBS, FRNZCGP, PGDipOMH)
Dr Bridget Devaney (MBChB, FACEM, DipDHM)
Dr EJ Deverall (MBChB, FRANZCOG)
Dr Celina Dewe (MBChB, PGDipOMG)
Dr Kiri Diack (MBChB)
Dr Michelle Dickson (MBChB, FRACP, FRCPA)
Dr Bronwyn Dixon (MBChB, FRACP, DCH, CCPU)
Dr Rebecca Dobbs (MBChB, FRNZCGP)
Dr Su Domingo (MBChB, FRNZCGP)
Dr Sarah Donald (MBChB, MPH, FNZCPHM)
Dr Alison Douglas (MBChB, DRCOG, FRNZCGP)
Dr Claire Douglas (BSc, MBChB, FRNZCGP, Dip Paeds, Dip Obs)
Dr Grace Douglas (MBChB)
Dr Michelle Downie (MBChB, FRACP)

 Dr Narena Dudley (BHB, MBChB, DipPaeds, DipOMG, FRANZCOG)
Dr Kathryn Duffy (MBChB)
Dr Charlotte Duley (MBChB, PGDipOMG)
Dr Elizabeth Dunn (BSc, MBChB, FANZCA)
Dr Vanessa Durant (MBChB)
Dr Charlotte East (MBBS)
Dr Julia Eddington (MBBS, BSc)
Dr Lisa Edwards (MBChB, FRNZCUC, FRNZCGP, FRACGP,
DipComEmMed (Merit))
Dr Melissa Edwards (BSc, MBChB, PGDipSurgAnat)
Dr Morgan Edwards (BSC(Hons), MBBS, FANZCA, PGDipSci)
Dr Lauren Elizabeth (BSc, MBChB)
Dr Daniela Erdmann (PhD in medicine, Associate of RNZCGP,
PGDipOMG)
Dr Carly Etheridge (BPharm, MD – Australia)
Dr Helen Evans (BSc, MBChB, MRCP(UK), MRCPCH, FRACP)
Dr Geraldine Fancy (BSc, MBChB, DCH, MRNZCGP)
Dr Jennifer Fife (MBChB, PGDipRPHP, DipPallMed (Clinical))
Dr Paula Clare Fisher (MBChB, FRCA, FANZCA)
Dr Lucy Fitton (MBBS, FRACGP – Australia)
Dr Leanora Fisk (DipPaed, MBChB)
Dr Sarah Fitzgibbon (MBChB, FRANZCOG)
Dr Kate Fitzmaurice (MBChB)
Dr Alice Flavell-Birch (MBChB)
Dr Julia Foley (BSc, MBChB, FANZCA)
Dr Lindy Fookes (MBChB, Dip Obs)
Dr Nicola Ford (MBChB, DCH, FRNZCGP)
Dr Katie Fourie (MBChB, IBCLC)
Dr Callum Fowler (MBChB)
Dr Laura Frampton (BSc, MSc(Dist), MBChB, PgcertWHlth, DCH,
FRNZCGP)
Dr Renee Franklin (MBChB, FANZCA)
Dr Melissa Franks (MBBS – Australia)
Dr Elspeth Frascatore (MBChB, FACEM)
Dr Angela Fraser (BHB, MBChB, DipPaed, FRNZCGP)
Dr Angela Fraser (MBBS, MPHTM, FACEM – Australia)
Dr Cobi Fredric (MBChB)
Dr Jennifer Frith (RNZCGP, DipPaeds, MBChB)
Dr Jenny Fu (MBChB, FACEM)
Dr Midori Fujino (MBChB)
Dr Jessica Fulton (MBChB)
Dr Kirsten Gaerty (MBChB, PGDipOMG, FRANZCOG)
Dr Nicole Gale (MBBS (Hons), FRACGP – Australia)
Dr Laura Garlick (BA, MBChB)
Dr Penelope Geens (MBChB, BSc)
Dr Victoria George (MBBS, MRCPCH)
Dr Emily Geraghty (BA, BSc, MBBS, FRACGP – Australia)
Dr Cara Gibbs (MBChB, BSc)
Dr Jordan Gibbs (MBChB, BmedSc(Hons))

 Dr Fiona Gilmour (MBChB, FRCA)
Dr Elizabeth Glanville (MBChB)
Dr Hayley Glasson (MBBS(Hons), DRANZCOG, DCH, FRACGP –
Australia)
Dr Nicole Gledhill (MBChB)
Dr Sarah Gleeson (MBBS, DRANZCOG(Adv), FRACGP, FARGP –
Australia)
Dr Corinne Glenn (BA, MBBS, FRNZCGP)
Dr Maple Goh (MBChB)
Dr Catherine Goldsmith (MBBS – Australia)
Dr Rachel Goodwin (MBChB, PGDipOMG)
Dr Katherine Gordon (BBiomedSc, MBChB)
Dr Rachel Gordon (MBChB, DCH)
Dr Sonal Gosai (MBChB, DipPaeds, PGCertWH)
Dr Madison Goulden (MBChB, FANZCA)
Dr Bronwyn Graham (MBChB, PGDipPaeds, PGDipOG)
Associate Professor Rebecca Grainger (MBChB, BMedSc, PhD,
FRACP, Chair of Aotearoa New Zealand Adult Medicine Division
Committee RACP)
Dr Rosie Grant (MBChB, DCH)
Dr Asti Grard (MBChB, PGDipOMG)
Dr Anna Gray (MBChB, DipPaeds)
Dr Kate Gregory (MBChB)
Dr Naomi Gribble (MBChB)
Dr Georgia Griffin (MBChB)
Dr Rebecca Griffith (MBChB, FRACP)
Dr Megan Griffiths (MBChB, MRCGP)
Dr Katie Griggs (MBChB, DCH)
Dr Kate Grundy (MBChB, FRACP, FAChPM)
Dr Nurus Halbi (MBChB, FRNZCGP, PGCertTravMed)
Dr Rebecca Hall (MBChB, FRANZCR)
Dr Hasfazilah Hamdan (MBBChBAO)
Dr Suzanne Hamilton (FACEM, MBChB, Cert Clin Toxicology)
Dr Michelle Hamrosi (MBBS, FRACGP, DCH, IBCLC – Australia)
Dr Adelle Hanna (MBChB, PGDipOMG)
Dr Rachel Hanney (MBBS, FACEM)
Dr Clare Harford (MBChB, DCH, FRNZCGP)
Dr Harriet Harper (MBChB, FACEM)
Dr Rhiannon Harris (MBBCH)
Dr Debbie Harrison (MBBS, FRNZCGP)
Dr Amber Hart (MBBS, BSc, DRANZCOG, FRACGP, IBCLC –
Australia)
Dr Michelle Hart (MBBS, FRACGP – Australia)
Dr Sarah Hart (MBChB)
Dr Nicki Hartland (MBChB, Dip Obs, FRNZCGP)
Dr Noriko Harun (BMedSci, BMBS, FRACP)
Dr Melissa Hassan (MBChB, PGDipPaeds)
Dr Aimee Hawker (BSc, MBChB, DCH, FRNZCGP)
Dr Alice Hawkins (MBChB, PGDipOMG)

 Dr Emily Hay (MBBS, FRACGP, FACRRM – Australia)
Dr Jessica Haydon-Clarke (BSc(Hons), MBChB, DCH)
Dr Jenny Hayward (FRANZCOG)
Dr Tori Hayward (BSc, MBChB, DipPaeds)
Dr Chivala Heal (MBChB)
Dr Cheyenne Heka (MBChB)
Dr Adrienne Henderson (MBChB, FRNZCGP)
Dr Sarah Heng (MBChB, DipPaed)
Dr Jessica Henry (MBChB(Hons), FRANZCP Cert Adult Psych)
Dr Sophie Hesling (BSc, MBChB, DCH, PGDipOMG)
Dr Jennifer Heyes (MBChB, PGCertTravMed)
Dr Belinda Hibble (MBBS, FACEM, MPH, DCH, CertWH,
GradCertEmrgHlth – Australia)
Dr Megan Higgins (BA, MBBS, DCH, FRNZCGP)
Dr Rachel Highton (MBChB, DCH, PGDipOMG, FRNZCGP)
Dr Jennifer Hill (MBChB, Dip Obs, FRNZCGP)
Dr Nicola Hill (MBChB, FANZCA)
Dr Tara Hillister (BSc, MBBS – Australia)
Dr Helen Hobson (BA (Hons), MBBS, FRACGP - Australia)
Dr Madelin Hobson (BBMS, MBBS)
Dr Sophie Hodgins (MBChB, DipPaeds, FRNZCGP)
Dr Julie Holden (MBChB, DipObst, FRNZCGP)
Dr Erika Hollow (MBChB, FRNZCGP)
Dr Jane Hopgood (MBBS, FRNZCGP, DFFP, EMC(ACEM))
Dr Kendra Hopper (MBBS, MWomHMed – Australia)
Dr Erin Horsfall (MBChB)
Dr Sarah Hortop (MBBS, FRNZCGP, DipRHC)
Dr Kristen Hoy (BMed, FRNZCGP)
Dr Sofia Huddart (MBChB, FRCA, FANCA)
Dr Anna Hudspith (MBChB, PGDipOMG)
Dr Lana Hughes (MBChB, PGDipOMG)
Dr Leighanne Hughes (MBChB, MRCP, FRACP)
Dr Phoebe Hunt (MBChB, PGDipOMG)
Dr Hannah Hurst (MBChB, MRNZCGP)
Dr Jane Hutchison (MBChB)
Dr Alveera Hynes (MBChB, FRNZCGP, PGDipTravMed)
Dr Cayley Ingham (MBChB, DCH)
Dr Rachel Ingham (MBChB)
Dr Epenesa Iosua (MBChB, BmedSci(Hons))
Dr Auzita Irani (BHSc, MBChB)
Dr Tineke Iversen (MBChB, DCH, FRNZCGP)
Dr Shareen Jacob (MBChB, MRCS)
Dr Marjie Jansen (MBBS)
Dr Yawani Jansz (MBBS, MD, FACEM)
Dr Rebecca Jarvis (MBBS, PhD, BSc(Hons))
Dr Rebekah Jaung (MBChB)
Dr Hannah Jenkins (MBChB, FRACGP)
Dr Niamh Jennings (MBBS)

 Dr Philippa Jerram (FANZCA, MBChB, BmedSci(Hons), Clinical
Lecturer)
Dr Sandra Jessop (MBChB, DipObs, FRNZCGP)
Dr Miriam Jobson (MBChB, DipPaed)
Dr Susan Johns (MBChB, FRNZCGP, DCH)
Dr Rachel Johnson (MBBS, FRACP (Paeds))
Dr Holly Johnstone (MBChB)
Dr Nichola Johnstone (MBChB, BSc(Hons), Immunol, FRNZCGP)
Dr Janice Jolly (MBChB, DipObs, FRNZCGP(dist))
Dr Sunniva Jones (BSc, MBChB)
Dr Julia Jonggowisastro (MBChB)
Dr Rachel Jordan (MBChB)
Dr Andrea Junge (MBBS)
Dr Jayani Kannangara (MBChB, DipPaeds, PGCertWH)
Dr Astha Kantroo (MBChB)
Dr Bryony Kapo (MBChB, PGDipOMG)
Dr Jasveen Kaur (BSc, MBChB, PGDipOMG)
Dr Tanvir Kaur (BSc, MBChB, DipPaeds)
Dr Emily Keane (MBChB)
Dr Helen Keeman (MBChB)
Dr Jessica Keepa (MBChB)
Dr Alyson Kelly (BA, BBMedSci, MBBS – Australia)
Dr Lauren Kelly (MBChB(Dist), FANZCA)
Dr Yvette A Kelly (BSc, MBBS, RANZCP, PGDipHSc)
Dr Jane Kennedy (BSc, MBChB, PGDipOMG, DCH, FACSHM)
Dr Tanya Keogh (MBChB, FRNZCGP)
Dr Kate Kerr (MBChB, FACEM)
Dr Yasmin Khanbhai (BSc, BA, MD)
Dr Grace Kim (MBChB)
Dr Lara Kimble (MBChB, BSc)
Dr Alyssa Kirby (MBChB, ClinDipPallCare, FRACP)
Dr Kiyomi Kitagawa (MBChB, PGDipOMG)
Dr Joanna Knight (MBChB, FRANZCOG)
Dr Alice Krige (MBBS, RACS registrar – Australia)
Dr Fiona Kuang (MBChB, DCH, FRNZCGP)
Dr Megan Kwong (MBBS, FRACP – Australia)
Dr Bo Ying Paula Lam (MBChB)
Dr Rain Lamdin (MBChB, GrapDip ED, PhD)
Dr Justine Lancaster (MBChB, DipObs, DHC, RNZCGP, General
Practitioner)
Dr Yung Yung Lau (MBChB)
Dr Ainsleigh Laumatia (MBChB)
Dr Charlotte Laurent (MBChB)
Dr Tina Lavulo (MBChB, PGDipOMG)
Dr Alice Law (MBChB, FRANZCP)
Dr Aniva Lawrence (FRNZCGP)
Dr Emma Lawrey (FACEM, MBChB, DipPaeds, Dip Clinical
Toxicology CertClinEd)
Dr Hannah Laws (MBChB, PGDipOMG)

 Dr Angela Lawson (BSc, MBChB, PGDipSPMX, PGCertHealthSci)
Dr Hui-Peng Lee (MBChB, FRACP, FRCPA)
Dr Hye Suk (Sophie) Lee (MBChB, FRACP, FRCPA, PhD)
Dr Yvonne LeFort (BSc, MD, FRNZCGP, FCFP (Canada), FABM,
IBCLC, Family Physician and Breastfeeding Medicine Specialist)
Dr Marion Leighton (MBBS, MRCP, FRACP, PGDipClinEd)
Dr Sharon Leitch (MBChB, DCH, PGDipGP, FRNZCGP)
Dr Christina Lennon (BexSci, MBBS, DCH – Australia)
Dr Ruth Lennox (MBChB, DipObst, FRACP)
Dr Robyn Lester (MBChB)
Dr Rodania Levi (BSc, MBChB)
Dr Wai Yan Grace Li (BPharm, MBChB)
Dr Renee Liang (MBChB, FRACP, MNZM)
Dr Catherine Liddle (MBChB, PGDipOMG)
Dr Rachel Lines (MBChB, DipObst)
Dr Fiona Loan (MBChB, BSc, FRNZCGP, FRACGP, PGCertWH)
Dr Christabel Logan (MBChB)
Dr Audrey Long (MBChB, MRCOG, FRANZCOG)
Dr Ken Looi (BMedSci, MBChB, FRNZCGP)
Dr Belinda Loring (BMed, MPH, FAFPHM)
Dr Lucy Loweth (MBBS (Hons) – Australia)
Dr Anna Ludeke (MBChB, PGCertWHlth)
Dr Stephanie Luoni (MBChB, PGDipOMG)
Dr Amiria Lynch (MBChB, DCH, GCCS, FRACS (Paediatric Surgery)
Dr Jessica Lynch-Larkin (MBChB)
Dr Jennifer Lyon (MBChB, PGDipOMG)
Dr Amanda Lyver (BSc, MBChB, DCH, FRACP, Paediatrician)
Dr Jasmine MacKay (BSc, MBChB, DipCEM, FRNZCUC)
Dr Caroline MacVicar (BCom(Hons), MBChB)
Dr Bree McAllum (BSc, MBChB, DCH, FRNZCGP)
Dr Laura McAulay (MBBS, PGCertWH)
Dr Hinewaiora McCleery (MBChB)
Dr Amanda McConnell (MBChB, MEmergHlth, FACEM)
Dr Bethany McCullum (MBChB, DCH, PGDipOMG)
Dr Maree McCracken (MBChB, FRNZCGP)
Dr Kate McDonald (MBBS, BA (Psych), FRACGP – Australia)
Dr Maria McDowell-Hook (MBChB, BSc)
Dr Miranda McEwan (MBChB, PhD)
Dr Rachael McEwing (MBChB, FRANZCR)
Dr Virginia McGowan (MBChB, DCH, FRNZCGP)
Dr Karen McIlhone (MBChB, DipPaed, MPH(Hons))
Dr Kirsty McKellar (MBChB, DRCOG, FRNZCGP)
Dr Sophie McKellar (MBChB)
Dr Carolyn McKenzie (MBChB, BCs, MRNZCGP)
Dr Christina McLachlan (MBChB, FRACP)
Dr Keryn McLeay (BSc, MBChB, PGDipOMG)
Dr Lauren McManus (BMedSc (Hons), MBChB)
Mr Will McMillan (BSC(Hons), MBChB, FRACS)
Dr Heidi McMillan (MBChB, DipPaeds, FRNZCGP)

 Dr Kelly McNamara (BSc(Adv), MBBS(Hons), GradCertIntHlth,
FRANZCOG trainee – Australia)
Dr Kirsten McSweeny (MBChB, FRANZCOG)
Dr Kerry Macaskill-Smith (MBChB, DCEM, DipPaeds, FRNZCGP)
Dr Sophie Mace (MBChB, PGDipOMG, RNZCGP)
Dr Joanne Macgregor (MBChB, Dip Obs, FRNZCGP)
Dr Sarah Machin (MBChB, FRANZCOG)
Dr Susan Macpherson (MBBS, PGDipMedSci)
Dr Bridget Maher (MBChB, MPH)
Dr Awras Majeed (MBChB, FRACP (Paeds))
Dr Sallie Malpas (MBChB, FANZCA)
Dr Nisha Manoheran (MBBS, RACGP, DRANZCOG – Australia)
Dr Joy Marriott (MBChB, MRCOG, FRANZCOG)
Dr Miriam Martin (MBChB, DipObst, DipCem, DCH, MRNZDUC,
MRNZCGP)
Dr Allie Maskill (MBChB, FRNZCGP)
Dr Rachel Mattock (MBChB)
Dr Tammy Maxwell (FACRRM, DRANZCOG (Adv), DCH – Australia)
Dr Jessica May (MBChB)
Dr Laura Mayhew (MBChB)
Dr Antonia Mead (BSc, MBChB, PGCertWHlth)
Dr Ashlea Meehan (MBBS, FANZCA – Australia)
Dr Suneela Mehta (MBChB, MPH, FNZCPHM, Public Health
Physician)
Dr Felicity Meikle (MBChB, MmedSc, FRACS)
Dr Riah Mildenhall (MBChB)
Dr Hayleigh Miller (MBChB, BmedSc(Hons))
Dr Wendy Miller (MBChB, DCH, FRACP)
Dr Nikki Mills (BHB, MBChB, Dip Paeds, FRACS, IBCLC)
Dr Julie Milmine (MBChB)
Dr Penelope Milsom (MBChB, MPH)
Dr Cliodhna Minogue (BSc, MBChB)
Dr Annemarie Mitchell (MBChB, CICM)
Dr Kate Mitchell (BHB, MBChB)
Dr Saman Moeed (MBChB, FRANZCOG)
Dr Sara Moeke (MBChB, Dip Child Health)
Dr Nina Molteno (MBChB, MmedSci, FRNZCGP)
Dr Rachel Monk (BHB, MBChB, DipObs, FRNZCGP)
Dr Penny Montgomery (MBChB, FRNZCGP)
Dr Helen Moore (MBChB, FRACP, FRCPA)
Dr Kirsty Moore (MBChB, DCH, PGCertWHlth)
Dr Linda Moore (MBChB, DCH, FRNZCGP)
Dr Vicki Mount (MBChB, DipPaeds, GP registrar)
Dr Lindsay Moran (MBChB, MRCGP, FRACGP – Australia)
Dr Jane Morgan (MBChB, MRCP, PGDipRepordHealth, FAChSHM,
MD)
Dr Frances Morrison (MBChB, DCH, MRCPCH, Consultant
Paediatrician UK)
Dr Mercy Moxham (MBChB, BSc)

 Dr Claire Munro (BSc, MBChB)
Dr Rebecca Munro (MBChB)
Dr Julia Murdoch (BSc, MBBS, RACP trainee – Australia)
Dr Yvonne Murray (BSc, MD, FRCPC, FANZCA, FFPMANZCA)
Dr Maryam Mussa (MBChB, DipPaed)
Dr Alexandra Muthu (FAFOEM, MRO (Alcohol and Drug), MBChB,
PGDipPaeds, PGDipOccMed, PGDipPH(dist), Chair RACP AFOEM
NZ, Teaching Fellow Victoria University of Wellington, CMInstD)
Dr Bridget Myers (MBChB, DCH)
Dr Miriam Nakatsuji (MBChB, FRNZGP)
Dr Johanna Nally (MBBS, BmedSci, DCH, FRACGP – Australia)
Dr Jennifer Naper (MbBchBAO, EmCert(ACEM), DTMH(LSTM),
DipObs)
Dr Kaylee Nash-Rawnsley (MBBS, FRACGP – Australia)
Dr Aimee Neels (MBChB, PGDip Child Health)
Dr Lisa Newby (MBChB, PGDipOMG)
Dr Samantha Newman (MBChB, BSc(Hons), PGDipOMG)
Dr Alex Newton (BA, BMed)
Dr Marisa Nguyen (BSc, MBBS, MIPH, DCH – Australia)
Dr Mandy Nichols (BMBS, FRANZCOG – Australia)
Dr Rachael Niederer (MBChB, PhD, FRANZCO)
Dr Alexandra Nippard (BSc, MBChB)
Dr Hannah Noel (MBChB, DipPaed, FRACP)
Dr Aimee Normal (MBChB)
Dr Katherine Norton (MBChB, DCH, DTMH, FRACP)
Dr Saleen Nottingham (MBChB)
Dr Kelly Nunn (PGCertHSc, DipPaed, MBChB)
Dr Michelle O’Brien (MBChB, PGDipPaed)
Dr Caitlyn O’Fallon (MBChB, PGCert Child Health)
Dr Robyn O’Grady (BHSc (Hons), MBBS – Australia)
Dr Sarah O’Neill (MBBS – Australia)
Dr Cathryn O’Sullivan (MBChB, RACP)
Dr Jodie O’Sullivan (MBChB, DRCOG, FRNZCGP)
Dr Leaanne O’Sullivan (MBChB, Dip Obs, FRNZCGP)
Dr Karen Oldfield (MBChB, BMLSc(Dist), FRNZCGP)
Dr Natalie Olds (MBChB)
Dr Heidi Omundsen (MBChB, FANZCA, MBHL)
Dr Lauren Osborne (BSc, MBChB)
Dr Emily Oughton (MBChB, FRNZCGP, DCH)
Dr Lesley Overend (MBChB, FRCPA)
Dr Hannah Painter (BSc, MBChB)
Dr Jennifer Palmer (MBBS, FRACP trainee – Australia)
Dr Alice Pan (MBChB, PGDipOMG, FRANZCOG)
Dr Kristina Panzic (MBChB, ClinDipPallMed)
Dr Serena Park (BHB (Hons), MBChB, FRCPA)
Dr Sophie Parnham (MBChB)
Dr Mariam Parwaiz (BHSc, MBChB, MPH(Hons))
Dr Joanne Paver (MBChB, FANZCA)
Dr Olivia Payne (MBChB, DipOMG)

 Dr Rebecca Pearce (BSc(Hons), MBBS)
Dr Morgan Pedersen (BSc, MBChB)
Dr Harriet Pengelly (MBChB)
Dr Andrea Penman (MBChB, PGDipOMG, PGDipBusAdmin)
Dr Heather Penman (MBChB)
Dr Rowan Percival (BSc, MBChB, FRNZCGP)
Dr Susana Pereira (MBChB, Dip Paeds, FRACP)
Dr Fiona Perelini (MBChB, FRACP)
Dr Leanna Perret (MBBS, DCH – Australia)
Dr Carrie Peterson (MBChB, PGDip Child Health)
Dr Sarah Phipps (BSc, BA, MBChB, FANZCA)
Dr Sara Pietersen (BHB, MBChB, DipPaeds, FRNZCGP)
Dr Susan Plunkett (MBChB, FRACP, FCSANZ)
Dr Nicki Pointing (MBChB)
Dr Valerie Pollard (FRNZCGP, FRANZCP)
Dr Suzanne Poole (MBChB, MD, MRCP, FRACP)
Dr Gabriela Popa (FRNZGP)
Dr Alexandra Powell (MBChB)
Dr Sadhya Prasad (MBBS, FRACGP – Australia)
Dr Caitlin Prendergast (MBChB, PGDipOMG)
Dr Hanna Preston (MBChB)
Dr Sarah Prior (MBChB, PGDipOMG, FRNZCGP)
Dr Phillippa Pucar (MBBS(Hons), FRACP, FRCPA – Australia)
Dr Christy Punnoose (MBBS, DipPaed)
Dr Karen Quay (BHB, MBChB, FACEM)
Dr Megan Quedley (BHSc (Physio), PGCertHSc, MBChB, FACEM)
Dr Letesha Radford (MBChB)
Dr Casey Raffills (MBChB, FRNZCUC, FRNZCGP)
Dr Rosanna Rahman (PhD, MBChB)
Dr Natasha Ramathas (BMLSci, PGDipMLSci, MBChB, PGCert
Women’s Health)
Dr Kirsten Ramsay (MBChB, FRACP)
Dr Sarah Rance (MBChB, PGCertWHlth)
Dr Jennifer Randle (MBChB)
Dr Amy Rankin (MBChB, BHSc)
Dr Unre-Anne Rapley (MBChB, DipPaed, PGCertWHlth)
Dr Kate Rapson (MBChB)
Dr Angela Rassi (BSc (Adv), MBBS (Hons I), FRACGP, DCH –
Australia)
Dr Kate Rassie (MBChB)
Dr Pamela Rawlings (MBChB, DCH)
Dr Kate Rea (MBChB(dist))
Dr Susan Reader (MBChB, DipObs)
Dr Sarah Redfern (MBChB, FRNZCGP)
Dr Rosalind Reid (FRNZCGP, MBChB, BHB, DipPaeds)
Dr Sarah Rennie (BMSc(Hons1), MBChB, PhD, FRCSEd(Medal),
FRACS)
Dr Bronwen Rhodes (MBChB, FRACP)
Dr Janet Rhodes (BMSc, MBChB)

 Dr Kathryn Rice (MBChB, FRACP)
Dr Astrid Richards (BBNSc, MBBS(Hons), FRACGP, DCH –
Australia)
Dr Jay Ritzema (MBBS, PhD, FRACP, FCICM)
Dr Katherine Rix-Trott (BSc, MBChB, DTMH)
Dr Nicola Roberts (MBChB, PGDipPaeds)
Dr Rebecca Roberts (MBBS, BSc)
Dr Vicki Roberston (MBChB, DipObst, FRANZCOG)
Dr Natasha Roberton (MBChB, FRNZCGP)
Dr Jessica Robinson (MBChB, FRNZCGP, DipObsGyn, DipPaed)
Dr Nicola Robson (MBChB, DCH)
Dr Nova Robinson (MBChB)
Dr Sarah Robson (MBChB)
Dr Katy Roff (MBBS, FRNZCGP)
Dr Nicola Rolton (MBChB)
Dr Sofie Rose (MBChB, ATCL)
Dr Eva-Christine Ross (MBBS)
Dr Sylvia Ross (MBChB, PGDipOMG, BbioMedSci)
Dr Rebecca Roughan (FRACP Paeds, MBChB, BMedSci, Child and
Youth Mortality Review Committee)
Dr Marnie Rowan (Bpharm, MBBS(Hons), FRACGP, IBCLC –
Australia)
Dr Natalie Rowley (MBChB)
Dr Meghan Ryall (MD, Diplomate ABFM, ACEM certificate)
Dr Caroline Ryan (MBChB, DCH, FRNZCGP)
Dr Lisa Salter (MBBS, RACGP Registrar – Australia)
Dr Rachna Samal (MBChB)
Dr Smita Samuelraj (MBBS, FRACGP – Australia)
Dr Meghan Sandle (MBChB)
Dr Kennedy Sarich (MBChB)
Dr Riley Savage (MBBS, FACRRM, DRANZCOG Adv – Australia)
Dr Nina Sawicki (MGP, FRNZCGP, MBChB)
Dr Anisha Saxena (BMed, JMP, GP Registrar – Australia)
Dr CJ Schauer (MBChB, PGDipOMG)
Dr Allanah Scott (MBChB, FANZCA)
Dr Monique Scott (MBChB, FRACGP, DCH – Australia)
Dr Victoria Scott (MBChB, FRCS, Paediatric Surgeon)
Dr Hannah Scowcroft (MBChB)
Dr Leigh Searle (MBChB, PGDipOMG, FRANZCOG, MRepMed)
Dr Keerth Chellam Seeman (BSc, MBChB)
Dr Elly Sekikawa (MBChB)
Dr Ruth Semprini (MBBS, PhD)
Dr Claire Shadwell (MBChB, DipObs, DipClinEd, FACEM)
Dr Saira Shafi Goroo (MBBS, FRNCGP, Dip Cert Women’s Health)
Dr Eleanor Sharland (MBBS, FRACGP – Australia)
Dr Nessie Sharpe (BSc, LLB (Hons), MBChB)
Dr Phoebe Shearman (MBChB, DipPaeds)
Dr Renee Shepherd (BSc, MBBS, FRANZCR trainee)
Dr Louise Sherman (MBBSc(Hons), DCH, FRCA, FANZCA)

 Dr Joanna Sheriff (MBChB, DCH, FRACP (Paeds))
Dr Beth Shore (MBChB, DCH)
Dr Lauren Shorthouse (MBBS, DRANZCOG, FRACGP – Australia)
Dr Puai Yee Shum (MBChB, PGDipOMG)
Dr Sara Simmons (MBChB, FRNZCGP, DCH)
Dr Caroline Simpson (MBChB)
Dr Ruth Sinclair (MBChB, FRACP)
Dr Natalia Sjardin (MBChB)
Dr Anna Skinner (MBChB, FRNZCGP, DipObsMedGyn)
Dr Nicole Sladden (FRCPA (anatomical pathology))
Dr Katie Sleeman (MBChB)
Dr Charlotte Smith (MBChB, DCH)
Dr Delia Smith (MBChB, BmedSci(Hons), DTM&H)
Dr Felicity Smith (MBChB, DRCOG, DTM&H, FRNZCGP)
Dr Hayley Smith (MBChB, PGDipOMG)
Dr Nicola Smith (BHB, MBChB, FRACP)
Dr Rhiannon Smith (MBBS, FRACGP, DRANZCOG (Adv), DCH,
IBCLC – Australia)
Dr Alison Soerensen (FRACGP – Australia)
Dr May Ching Soh (FRACP, PhD)
Dr Melanie Speer (MBChB, FANZCA)
Dr Rose Spence (MBChB)
Dr Simone Spry (MBBS, MPH, DCH, CertSRH, Cert IV
Breastfeeding Education)
Dr Alison Stacey (MBBS(Hons), BmedSci, DRANZCOG, DCH,
FRACGP, Cert IV Breastfeeding Education, IBCLC, Dip
Breastfeeding Management – Australia)
Dr Erin Stalenburg (FRACGP, MBBS, BbioMedSc, GradDipScComm
– Australia)
Dr Amanda Stanton (MBChB, DCH, PGDipOMG)
Dr Erika Stark (MBChB)
Dr Frederica Steiner (MBChB, PGDip Child Health)
Dr Jeremy Steinberg (MBChB, DipMuscMed CertCPU)
Dr Elizabeth Stevens (BPhysio(Hons), BMBS, DRANZCOG –
Australia)
Dr Janine Stevens (FNZCPHM, MPH, MBChB, BPharm)
Dr Rachael Stevenson (MSc, MBChB)
Dr Rebecca Stevenson (MBChB)
Dr Victoria Stiebel (MBChB)
Dr Alannah Stockwell (MBChB, DipOMG, FRNZCGP)
Dr Samantha Stockwell (MBChB, BSc(Hons) Biochem, DipPaeds)
Dr Helena Stone (MBChB, FANZCA)
Dr Mary Stonehouse (MBBS, MRCPCH, FRACP – Paeds)
Dr Caroline Stuart (BHB, MBChB, PGDipSM)
Dr Olivia Stubbersfield (MBChB)
Dr Dayani Subawickrama (MBBS (Hons), FRACGP, DCH –
Australia)
Dr Jacqueline Sutton (MBBS, FRACGP, DCH – Australia)
Dr Sophie Swart (BmedSc(Hons), MBChB, PGDip Child Health)

 Dr Alice Tait-Jamieson (MBChB, FRNZCGP)
Dr SE Talbot (MBChB, DipObs, FRNZCGP)
Dr Michelle Tan (MBBS, BmedSc, DCH, DipPracDerm, FRACGP –
Australia)
Dr Tokilupe Taumoepeau (MBChB, FRACS)
Dr Angela Tay (MBChB, PGDipOMG)
Dr Jennifer Taylor (MBChB, FANZCA)
Dr Jennifer Taylor (MBChB, FRACP)
Dr Juliet Taylor (MBChB, FRACP)
Dr Kirsten Taylor (MBChB, PGDipOMG, DCH)
Dr Lynelle Taylor (BSc(Hons), BMBS)
Dr Stephanie Taylor (BPHEd(Hons), MBChB, FRNZCGP)
Dr Tawera Taylor (MBChB)
Dr Vivien Teh (MBChB, MRNZCGP)
Dr Sara Temelkovski (BHB, MBChB, DipPaeds)
Dr Gabriella Templer (MBChB)
Dr Geraldine Tennent (MBChB, DipPaeds, PGDipOMG, FRNZCGP)
Dr Sarah Te Whaiti (MBChB, PGDipOMG)
Dr Usha Thiagaraja (MBBS, FRNZCGP)
Dr Courtney Thomas (MBChB, FANZCA, PGDipClinEd)
Dr Emma Thomas (BA, BHB, MBChB, Dip Paeds, FANZCA)
Dr Rebecca Thomas (MBChB, PGDipOMG, FRACS)
Dr Sarah Thompson (MBChB)
Dr Kimberley Thomson (MBChB, Dip Paeds, FRANZCR)
Dr Shelley Thomson (MBChB, FRNZCGP)
Dr Su Thon (MBBS, FANZCA)
Dr Kerry Thornbury (MBChB, DCH, BSc, FRNZCGP)
Dr Katie Thorne (MBBS, FRACP, PallMedDip)
Dr Kalina Tonga (MBChB)
Dr Karlina Tongotea (MBChB)
Dr Sara Trafford (MBChB)
Dr Ellen Tyler (MBChB)
Dr Claudia Vallebella (German State Exam MD, PGDip Child
Health)
Dr Sonia van Gessel (MBChB, MPH, FNZCPHM, FRNZCGP)
Dr Katie van Rijn (MBChB)
Dr Martinique van Ryn (MBChB)
Dr Amanda van Zyl (MBChB)
Dr Rebecca Velluppillai (MBChB, FRNZCGP, PGDipPaed,
PGCertWHlth)
Dr Deborah Vercoulen (MBBS, FRACGP – Australia)
Dr Susan Vickers (MBBS(Hons), FRACGP, IBCLC – Australia)
Dr Saidhanya Viswanathan (MBChB, BSc)
Dr Mathanki Vivekananda (BSc, MBChB)
Dr Claire Vivian (MBChB)
Dr Nicole Vogts (MBChB)
Dr Chloe Waddell (MBChB)
Dr Amber Wakefield (BA, MA, PGDipClinPsych, MBChB,
PGDipSurgAnat)

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Penelope Walbran-Oakley (MBChB)
Annette Walker (MBChB, FRNZCGP, Police Medical Officer)
Jacqui Walker (BSc, MBChB)
Marcia Walker (BHB, MBChB, DipPaed, FRNZCGP)
Moana Walsh (MBChB, FRNZCGP)
Briar Warin (MBChB, BHSc, BA)
Rebecca Watt (BSc, MSc, MBBS, FRACGP, DCH – Australia)
Melanie Webster (BSc, MBChB, DCH, FRNZCGP)
Ellie Wernhem (MPH, RM)
Rebecca Westcott (BSc(Hons), MBChB)
Karen Whale (MBChB(Hons), FRCPA – Australia)
Bonnie White (MSc, MBChB)
Joanna White (MBChB, FRNZCGP, DCH)
Patricia Whitfield (MBChB, FRACP)
Samara Whitham (BSc, BA, MBChB, DCH, MRNZCGP)
Rosie Whiting (MBChB, PGDipOMG)
Katrina Whittfield (MBChB, FRNZCGP)
Fiona Whitworth (BM, BCh, MRCGP, DCH, FRNZCGP)
Kiri Wicksteed (MBChB, DCH)
Tapairu Wilson (MBChB)
Rachael Windsor (MBChB, PGDipOMG)
Naomi Whyler (MBChB, MSc, MRCP)
Irene Whyte (MBChB, PGCertClinEpi, FANZCA)
Laura Wilkinson (BSc, MBChB)
Rachel Wilkinson (MBChB, PGDipOMG, FRNZCGP)
Sophie Wilkinson (BSc, MBChB)
Emma Williams (MBBS, MA, DCH)
Felicity Williams (MBChB, PGDipOMG, EADTMH)
Phoebe Williams (FRACP – Australia)
Ella Williamson (MBChB)
Felicity Williamson (MBChB, MSc, MPH (1st class hons)
Michele Wills (MBChB, FRNZCGP)
Emma Wilson (MBChB)
Greer Wilson (MBBS, FACEM – Australia)
Meg Wilson (MBChB, FRNZGP)
Rebekah Wilson (MBChB, FRNZCGP)
Shea Wilson (MBBS, FRACGP, DCH – Australia)
Prasangi Wimalasena (MBChB, FRNZCUC)
Helen Winrow (MBChB, DipTMH)
Rebecca Wire (BmedSci, BMBS, DipTMH, FRNZCGP)
Amelia Wong (MBChB, DipPaed)
Hayley Wong (MBChB)
Karen Wong (MBChB, FRNZCGP)
Amber-Jane Wood (BSc, MBChB)
Kate Wood (BMedSci, MBChB, FRANZCR)
Verity Wood (MBChB, FRANZCR)
Zoe Wood (BBS (Hons), BSc, MBBS)
Esther Woolston (MBChB, DipOMG)

 Dr Caroline Wright (MBChB, FRNZCGP, DCH, PGDipHSc (Palliative
Care))
Dr Cherie Wyatt-Hutana (MBChB, DipPaeds, FRNZCGP)
Dr Anne-Marie Yardley (MBChB, MOphth, FRANZCO)
Dr Sneha Yelle (MBChB)
Dr Jacqueline Yeoh (MBBS, FRACGP – Australia)
Dr Nadya York (BHB, MBChB, FRACS)
Dr Yu-Ching Yu (MBChB, DTM&H, DRANZCOG, MPH)
Dr Alice Zwart (MBChB, Dip Sex, FRNZCGP)

 Appendix I: Calculations to estimate the blood alcohol
concentration in baby Sapphire
Assumptions made in these calculations – endeavouring to
overestimate rather than underestimate, to ascertain the “worst
case scenario”
- That the information reported by the media was accurate
- That the mother was an estimated body weight of 70kg, and
not a chronic alcoholic
- That baby Sapphire was around 3kg (one week old when
gestational age adjusted for prematurity)
- That the case of alcoholic drinks were high percentage (7%)
and moderate volume (250mL)
- That all 18 drinks were consumed in quick succession to get
the highest blood alcohol concentration possible in the mother
- That she fed baby Sapphire at the peak concentration of
alcohol in her blood and milk
- That baby Sapphire had a large feed of 100mL of breastmilk
(given her age, likely size, and the uncertainty of maternal
milk supply as she predominantly used formula, but was also a
mother of twins)
Background information:
- Twin babies were born at 33 weeks gestation and low birth
weight, and baby Sapphire died 8 weeks later – therefore they
were eight weeks old, or only one week old when gestational
age was corrected for prematurity, and therefore probably
around 3kg looking at growth charts for premature babies.
- The articles mention a "case" of 18 premixed bourbon and
cola. After doing some research about what meets that
description – we are looking at 250ml cans, 7% ABV (one
standard drink per can).
- 7% of 250ml = 17.5ml of alcohol per can x 0.789 (density of
ethanol at room temperature) = 13.8g of alcohol per can
If all 18 cans were consumed by mum = a total 248g of alcohol
consumed.
This would be a maternal blood alcohol level of around 700mg/
100mL (above lethal levels for most people).
Estimating a maternal body weight of 70kg, and a mother who
drank 18 standard drinks, 13.8g alcohol each, and if she consumed
them all at the same time to get the highest concentration of
alcohol in her blood
- If she breastfed at the peak concentration of alcohol (3060min after consumption), assuming complete absorption, a
volume of distribution in of 35L and no maternal metabolism:
(13.8/35) x 18 = 7.097g/L of alcohol into her breastmilk (which
is the same as her blood alcohol content)

 With a baby fed milk directly from the breast, it is impossible to
know exactly how much milk she received. However, we can
estimate.
- General guidelines for feeding new babies is to give them
150mL/ kg/ day. If she was 3kg, that would be 450mL over a
day (and an eight week old, or one week adjusted gestational
age baby should receive a minimum of eight feeds a day =
less than 60mL per feed).
- One of the media articles stated that the babies were mostly
formula fed, but that they received occasional breastmilk this would reduce mum’s milk supply. However, they were
also twins – which could increase mum’s milk supply.
- I have estimated a feed at 100mL as a big feed for a baby of
this size and situation
If baby was 3kg and had 100mL of breastmilk, and a body water of
70%:
(0.1L milk x 7.097g/L alcohol in milk) / (0.7L/kg x 3kg)
= 0.7097 / 2.1
= 0.338g alcohol/ L blood
= A maximum of 33.8mg/ 100mL blood alcohol level in baby
when units are converted.
Framed differently/ worked backwards:
- To obtain a blood alcohol level of 308mg/100mL, the same
baby would have had to consume 6.47g of ethanol.
[308mg/100mL = 3.08g/L (unit conversion)
3.08 x 2.1 = 6.47g of alcohol]
-

If she had the same 100mL feed, the milk alcohol level would
have been 6.47g in 0.1L (or 64.7g /L)
In order for a level of 64.7g/L in milk, mum’s blood alcohol
level would have to be equivalent, and when the units are
converted, 64.7g/L = 6470mg/100mL.

-

A blood alcohol level of 6470mg/ 100mL can also be written as
6.47% - more than four times the highest blood alcohol level
ever recorded, 129 times the legal driving limit, and 7-13
times the upper limit where alcohol-related death is likely.

-

A “standard drink” in New Zealand is equivalent to 10g of
alcohol. In order to obtain a blood alcohol level of 6470mg/
100mL, this mother would have needed to consume 226
standard drinks, or more than 9 cases of the premixed

 bourbon and colas that she was reported to be drinking the
night before her baby died.

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