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Tuesday
Oct132009

Nestle Answers: Using health care professionals as intermediaries

This is one of a series of posts that features Nestle’s answers to my questions that came out of the Nestle Family event. To access the other questions and answers, go to follow-up questions for Nestle and click on the questions you are interested in. Answers will be posted as they are received and analyzed.

Question


You maintain that “Nestle does not provide mothers in the developing world with free samples of your infant formula products – in fact Nestle has no contact at all with mothers with regards to these“. Are samples provided to doctors? Is information about the “benefits” of your formula provided to doctors or other health professionals?

Nestle's Answer


Nestlé does not provide mothers in the developing world with free samples of products. Samples of formula may be provided to individual health workers for the exclusive purpose of professional evaluation and in very specific instances (e.g. introduction of a new formula product). In such cases, the health worker may only be given one or two cans of the product and one time only. When in contact with health workers, Nestlé staff emphasises the superiority of breast-feeding and gives objective information on scientific and factual matters pertaining to formula and its correct use.

My Response


I've been working on a response to some of the other questions, but wanted to tackle this one because it is hitting extremely close to home this week. Let's start in the developing world...

Developing countries


When looking at Nestle's practices in developing countries, Mike Brady from Baby Milk Action points to the investigative reporting of The Guardian that uncovered the ongoing practice of promoting formula to mothers via their health professionals. The article, Milking it, outlines numerous questionable practices that are designed to get health professionals to warm up to formula companies like Nestle and also to give them the tools to easily recommend their formula if the mother is having any breastfeeding difficulties. I highly recommend that you read the whole article, but here are a few telling excerpts:
"The reps are very aggressive - there are three or four companies, and they come in every two weeks or so," he says. "Their main aim is to recommend their product. Sometimes they bring gifts - Nestlé brought me a big cake at new year. Some companies give things like pens and notebooks, with their brand name on them. They try very hard - even though they know I am not interested, that I always recommend breastfeeding, still they come."

....

[Despite rules against contacting mothers directly] Nestlé and other manufacturers are getting their message through to mothers none the less. Here's how: on Zaman's desk, lots of small pads lie scattered: each contains sheets with information about formula milk, plus pictures of the relevant tin. The idea, he says, is that when a mother comes to him to ask for help with feeding, he will tear a page out of the pad and give it to her. The mother - who may be illiterate - will then take the piece of paper (which seems to all intents and purposes a flyer for the product concerned) to her local shop or pharmacy, and ask for that particular product either by pointing the picture out to the pharmacist or shopkeeper, or by simply searching the shelves for a tin identical to the one in the picture on their piece of paper.

....

[Nestle claims that it provides information on the benefits of breastfeeding, but the reporter] saw no evidence whatsoever of any Nestlé-sponsored pro-breastfeeding literature, despite spending two days touring hospitals, maternity wards and paediatric clinics: doesn't it seem odd that Nestlé is highly efficient at getting its tear-off slips into mothers' hands in Bangladesh (there were prescription pads in abundance in many of the places we visited), and yet fails, as far as I could tell, in getting them what they could really use, which is information on how to breastfeed? And anyway, campaigners question how realistic it is to think that a company such as Nestlé - which has huge amounts of money tied up in formula milk sales - is going to be committed to spreading the "breast is best" gospel.

The article is full of examples of mothers who were struggling with breastfeeding being told by their health professional to use formula, rather than being given breastfeeding help. Tearing a sheet off of a pad of paper is an easier short-term solution than addressing the challenges that sometimes come with breastfeeding. But that approach is truly short-sighted.

While that article provided a spotlight on one developing country, the promotion of formula to and via health care professionals and health care facilities is commonplace. Many other examples of Nestle's practices in this area can be found in the Nestle chapter of the most recent Breaking the Rules report. In addition, Aamar Raza, a former Nestle employee in Pakistan, wrote a scathing whistleblower report on how Nestle executives routinely ignore the directions in their own Charter by doing things like giving gifts and samples to doctors. There are many examples of other companies violating this aspect of the International Code of Marketing of Breast-Milk Substitutes too in the other sections of the Breaking the Rules reports.

Developed countries


In developed countries the situation isn't much better. While the circumstances here are not as dire (we have clean water and many, but not all, parents have the means to purchase formula), the fact remains that:

We are not meeting our goals for breastfeeding in the developed world. Not our personal goals, not our societal goals, and we are paying for it.

There are many societal barriers to breastfeeding and two of the key ones are formula advertising and health professionals lack of knowledge about breastfeeding. When formula companies market directly to health professionals it only serves to exacerbate both of those problems. Nestle and other formula companies know full well that moms might be convinced by glossy magazine advertising, but they are even more likely to be convinced by a doctor spewing lies like "formula these days is so great that it is really close to breast milk" or "your baby gets all the benefits of breastfeeding in the first 15 days". With statements like these coming out of doctors mouths it is evident that they are buying into what the formula companies are telling them rather than reading up on the scientific benefits of breastfeeding and figuring out how to help a mother with her breastfeeding challenges rather than sabotaging her efforts.

According to breastfeeding expert Dr. Jack Newman, you can tell that a health professional is not supportive of breastfeeding if (see article for explanation of each of these):

  1. S/he gives you formula samples or formula company literature when you are pregnant, or after you have had the baby.

  2. S/he tells you that breastfeeding and bottle feeding are essentially the same.

  3. S/he tells you that formula x is best.

  4. S/he tells you that it is not necessary to feed the baby immediately after the birth since you are (will be) tired and the baby is often not interested anyhow.

  5. S/he tells you that there is no such thing as nipple confusion and you should start giving bottles early to your baby to make sure that the baby accepts a bottle nipple.

  6. S/he tells you that you must stop breastfeeding because you or your baby is sick, or because you will be taking medicine or you will have a medical test done.

  7. S/he is surprised to learn that your six month old is still breastfeeding.

  8. S/he tells you that breastmilk has no nutritional value after the baby is 6 months or older.

  9. S/he tells you that you must never allow your baby to fall asleep at the breast.

  10. S/he tells you that you should not stay in hospital to nurse your sick child because it is important you rest at home.

  11. S/he does not try to get you help if you are having trouble with breastfeeding.


Now to explain why this is all hitting very close to home right now. You may have heard about an Alberta pediatric nutrition conference that was canceled due to protests because it was initially supposed to be heavily sponsored by Nestle. These are the types of events were formula companies have the opportunity to wine and dine doctors while doing their indoctrination (indoctrinating doctors, oh my!). That was just one of many events and other tactics that formula companies use to market to health professionals.

So I was disappointed, but not necessarily surprised, when I saw an article called Have a baby feeding backup plan that heavily quoted pregnant Ottawa-based pediatrician Dr. Susan Russell it read like a point by point real-life example of the things Dr. Jack Newman warns about:
"So it's not your second night home from the hospital, and it's 3 o'clock in the morning, and the baby is screaming, and you can't get him to latch on. And now what do you do?" cautions Ottawa-based pediatrician Dr. Susan Russell, who is expecting her first child this month. "It's good to be prepared before you run into that."

....

"So there are lots of things that can come up," Russell points out.  And if those issues arise, then it's time to supplement with formula.

....

"I think it's important for people to recognize that formula is a healthy and a really nutritious alternative to breast milk," Russell emphasizes. "We would always say breast milk is best, but the formulas we have today on the market really are as close to breast milk as you can possibly get. So I have no problem with supplementing with formula if need be." Make sure you have formula in your house before you come home from the hospital with your new baby, Russell recommends.

Otherwise, you could find yourself running to the grocery store in a panic the second night you're home with a new baby who's starving and screaming -- which is not the best case scenario for choosing a formula.

"In Canada we're lucky, because all formulas are regulated by the federal government and the Canadian Food Inspection Agency," Russell points out.

....

The latest development in baby formula is the addition of probiotics, used to improve the immune systems of babies. Nestle Good Start Natural Cultures, for example, is enhanced with a probiotic.

....

"And so, I'm going to, if I need to, definitely start with the (Nestle) Good Start (formula) and see what happens."

A ringing endorsement from your pediatrician of Nestle formula and a back-up plan that doesn't involve a lactation consultant. Something is very very wrong here.

Health care professionals may be smart, but they are also human, overworked, and expected to know a lot about everything. Unfortunately, there are many reasons why health care professionals are more likely to promote formula than breastfeeding if a mom runs into trouble.

On top of that, throw in a sponsored conference, a gift, a nice meal with the formula company and you've got yourself a formula pushing doctor.

Do formula companies and medical professionals really support breastfeeding?


Supporting breastfeeding involves more than just saying "breast is best". It involves helping mothers who are facing difficulties and not just telling them formula is fine or close to breast milk.

It seems like in most places the message that breastfeeding is best has sunk in. But as discussed above, a lot of medical professionals do not seem to have the knowledge or the interest in helping mothers with breastfeeding difficulties. Is this because they do not understand enough about the risks of formula vis-a-vis breastfeeding? Is it because the formula companies have done such a good job selling them on how close to breastfeeding their formula is? I think it is probably both.

I understand that there is sometimes a point where going to formula is best for a particular mom and baby or where supplementing is the right choice. I do not, however, think that the doctors and nurses that most mothers see these days, in the developing and the developed world, have the knowledge to be able to help a mother to overcome breastfeeding challenges. They do, however, thanks to gifts, sponsored conferences, visits, samples and "information" from formula companies have everything they need to help a mom give up.

So where are the breastfeeding support tear-off sheets? Ones with the phone numbers for lactation consultants, La Leche League, breastfeeding drop-in clinics, and so on? We need those in doctor's offices instead of formula information and formula samples. Where are the sponsored conferences, lunches, and gifts from breastfeeding supporters? Oh wait, there are none because there are not enough profits involved in having women continue breastfeeding.

There isn't an easy way to fix this problem, but keeping the formula pushers away from our health professionals would be a good start.
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Reader Comments (30)

Wow! Only 16% in Canada nurse exclusively for 6 mos? I'm shocked! I'm shocked because my entire group of friends nursed - I can't think of a single friend that didn't! Mind you, when I think back it may be because most of us delivered with mid-wives. I wonder if mid-wives became more popular if breastfeeding rates would increase?

October 13, 2009 | Unregistered CommenterJanice @ Mom On The Run

Oh wow. I just read that article. It's very upsetting. I'm really sad right now. I can't believe that is being passed off as journalism. I'm so sad for the mums and babies whose breastfeeding relationships will be sabotaged by that article.

Also, Nestle is evil.

October 13, 2009 | Unregistered CommenterLindsay @ Kickypants

Wow, those quotes from Dr. Russell are horrifying. She makes it sound as if your baby is going to starve to death unless you have formula on hand. And as if formula is really just super spiffy.

The continued lack of real support for breastfeeding is so disappointing. I don't believe that I am in any position to judge how another family chooses to feed their baby. However, I definitely believe that more mothers would breastfeed if they had better support and information, instead of hearing that formulas are really close to breast milk and you'd better buy some just in case.

October 13, 2009 | Unregistered CommenterAmber

I wholeheartedly support more support for breastfeeding..even as formula feeding mom. I have at least always started my kids out on the boob and while I suck at it...I do believe breast is best and the more encouragement the better.

I don't feel uneducated and I don't feel like a total failure...I am just doing what works for me.

I have to share this though...My sister in law is probably the prime example/target of companies like Nestle...from formula onward.

She did try to bf..but had a rough start with a kid in the nicu and not much support..so I don't judge her at all....but she is strong in her belief that the Nestle Formula is the next best thing.

She thinks I am weird that I don't use Nestle.
Now..there is nothing wrong with the formula....I have explained I just can't support a company like them.

She doesn't get it.

She also said, when we were talking about solids ..that since her boy is her one and only..that only the best will do, so she will be feeding him the 'best' jarred food out there.

I was cooking thanksgiving dinner at the time and had to stop..come out to the living room and look at her....'er..I said....'home cooked baby food would be the BEST then, not the packed stuff, would it not?'

She stated she didn't cook and so that was that.

This is the type of mom who the big companies do the best with. She believes and trusts the marketing wholeheartedly...and no amount of literature will change her mind.

And yes..I use the jarred stuff too....but also cook what I can AND know that the less pre packaged ANYTHING is better...

Much of the population does not.

October 13, 2009 | Unregistered CommenterCrunchy

I didn't realize that conference got cancelled. And I checked the link and it didn't say that it did - just that you should write a letter voicing your concerns due to the Nestle employee being a speaker. Is there another link that's missing? Just wondering. I'd be so stoked if that conference really did get cancelled. I wrote about it a few months back on my blog when it was announced.

October 13, 2009 | Unregistered CommenterMelodie

@Melodie: Yes, it got cancelled. I sent an e-mail complaining about it. When it got cancelled, I received an e-mail letting me know. From the e-mail:

The 1st Annual Canadian Perinatal & Pediatric Nutrition Conference scheduled for September 25-26, 2009 in Edmonton Alberta has been cancelled.

With the move to united programming within Alberta Health Services, a number of programs, including AHS-sponsored conferences, have been cancelled this year while we complete an assessment of staff educational needs. Unfortunately, the Perinatal & Pediatric Nutrition Conference is on this list.

So they didn't cite the complaints as the reason for the cancellation, but my guess is that it had something to do with it. I think it is too bad that they had to cancel it, but I think it is better to not have an event than to have one where corporations are going to be able to push their products and their ideas on medical professionals

October 13, 2009 | Unregistered Commenterphdinparenting

@Janice:

I think that the post-partum support provided by midwives is a huge factor in successful breastfeeding and I think you are probably right that breastfeeding rates are likely higher among clients of midwives than among clients of OB/GYNs.

In terms of the 16% rate though, I think early introduction of solids probably still accounts for a large portion of the women that do not make it to six months of exclusive breastfeeding. I'm not saying that introducing solids early is okay, but just wanted to point out that it doesn't necessarily mean that 84% are using formula.

October 13, 2009 | Unregistered Commenterphdinparenting

@Crunchy:

...and soon she'll be giving them Stouffer's every night for dinner. Because it has no preservatives.

October 13, 2009 | Unregistered Commenterphdinparenting

This article hit close to home. I delivered in a top research hospital in the US. I had complications at the delivery and had to BEG the nurse to bring my son to the floor where I was (we were separated) so that I could BF him. I was MOCKED by one of the doctors in front of his residents for breastfeeding. I threw him out of my room. The hospital pediatrician also came and told me that since my son had lost 6% of his body weight, I needed to supplement with formula. I refused, and told her that it's perfectly normal for a baby to lose up to 10% of his body weight following delivery. Well, she couldn't say anything to me then, since that is fact. There was more that happened in regards to me being given a hard time about BFing too. I was so glad to get out of that hospital!!! I was livid and incredulous.

Women, educate yourselves before delivery! We can not rely on our healthcare providers to give us accurate information, as this whole article points out.

October 14, 2009 | Unregistered CommenterMZ

Many thanks for this analysis.

At the risk of being tedious, here is some follow-up on what happened about the fliers in Bangladesh. Nestlé attempted to justify them as permitted educational materials. I analysed this response in detail here with links:
http://boycottnestle.blogspot.com/2007/05/nestl-responds-to-investigation-in.html

Here are the key things that the International Code of Marketing of Breastmilk Substitutes says. Remember, Bangladesh is not one of the countries where Nestlé falsely claims the Code does not apply - it claims to follow it as a minimum standard:

In a published response, the Nestlé (UK) Head of Corporate Social Responsibility stated:

"Save the Children alleges that Nestlé gives health professionals pictures of Lactogen to pass on to mothers in order to get around the code’s prohibition of direct contacts between mothers and companies. The article describes these leaflets as “to all intents and purposes flyers for the product concerned”. But giving information to health workers is permitted by the code."

Yet the Code is extremely clear. Article 7.2 of the Code states:

7.2 Information provided by manufacturers and distributors to health professionals regarding products within the scope of this Code should be restricted to scientific and factual matters, and such information should not imply or create a belief that bottle feeding is equivalent or superior to breastfeeding.

So scientific and factual information may be provided to health workers, but the Code is clear that this should not be passed to mothers. Article 6.2 states:

6.2 No facility of a health care system should be used for the purpose of promoting infant formula or other products within the scope of this Code. This Code does not, however, preclude the dissemination of information to health professionals as provided in Article 7.2.

If that is not clear enough, this is Article 6.3:

6.3 Facilities of health care systems should not be used for the display of products within the scope of this Code, for placards or posters concerning such products, or for the distribution of material provided by a manufacturer or distributor other than that specified in Article 4.

Nestlé has admitted its fliers are for mothers. A clear breach of both these articles.

Article 4 concerns educational materials prepared with the written permission of the appropriate government authority or within its guidelines. But even if we view Nestlé’s product fliers as education material Article 4 is abundantly clear:

"...Such equipment or materials may bear the donating companys name or logo, but should not refer to a proprietary product that is within the scope of this Code, and should be distributed only through the health care system."

In other words, fliers for handing on to mothers cannot have information about Lactogen infant formula.

This is a clear breach however you look at it.

Nestlé can read these articles. It claims to follow them. It is demonstrably not telling the truth.

What needs to be done? Write to them. Boycott them. Support legislation with sanctions that will not be paid off with a few seconds turnover. Prison would be good.

October 14, 2009 | Unregistered CommenterMike Brady

Hi there!

I'm a mother from Romania, a developing country, signatore of the Code. We do have a (quite small) group of mothers aware of the Nestle boycott and what it means, but I found my self in a very ugly posture when quite close friends of mine said that our brestfeeding campaines are too agresive and we are not suppose to boicot nestle just because they sell formula, who, of course, can save lifes (?!@?$^@) (some of us have the nestle free zone on our blogs, this means agressive!!!)

I don't have the time or energy to make a clear and documented post/articole about the boycott and you sinthetized it very very well, AND I think the quicker the better, so I was wondering if you agree for me to translate some of your boicot posts into romanian. Of course, giving you all the credit for this. I will also write to Mike Brady for this, but his articols are, though complete and fully documented, a little too long for somebody who hears the first time of the boicot.

Ah, here, in Ro, in every single city maternity (i don't know about the rurals ones) you receive nestle (and milupa and ... and..) flyers. Also, every maternity gives formula to the babies and they all hide it when sanitary control comes in the hospital. Doctors have those special clothes (i can't remeber how you call them, the ones they use in the hospital) with nestle or milupa written all over....

October 14, 2009 | Unregistered Commenterdiana

Wow, fascinating and horrifying all at once.

Tangentially, when my second was born I somehow wound up on an Enfamil mailing list (I suspect a well meaning relative might have signed me up). I wish I'd saved the stuff they kept sending me, rather than throwing it out in disgust. It was really well done material if by 'well done' you mean 'very subtle messages about first adding formula to your baby's diet and eventually switching altogether'.

These companies aren't stupid. They know how to manipulate, whether it's here in Canada with literature that arrives in your mailbox around the six week mark subtly suggesting that a baby will just sleep so much better with a tummy full of formula, or in the third world.

October 14, 2009 | Unregistered CommenterEmma

@diana: I'll send you an e-mail. :)

October 14, 2009 | Unregistered Commenterphdinparenting

This hits close to home for me as well. I don't recall seeing any formula info in my ped's office, nor was I ever directly offered samples (though when I had a really tough time in the beginning with my first, one of the doctors did assure me that he'd be just fine if I switched to formula -- oddly enough, knowing I had options actually helped me relax and figure out the breastfeeding!) They have however been surprised at each check up to find out I was "still" nursing (2.5 years with DS1, 2 years and going strong with DS2), and at least mentioned that I "could" stop (so much for supporting the CPS reco!) They have also suggested CIO, and that my big babies didn't "need" to nurse in the night. But, the worst was when a friend sent me a link to a "breastfeeding help" video on a formula manufacturer's site (I think it WAS Nestle, but I am not 100% sure) -- and recognizing my sons' pediatrician as the "expert"! The video focussed on all the ways bf could be difficult -- e.g. sore nipples, challenge of twins, and how you should be prepared for problems...True, it can be difficult, I know that very well. But seriously, a mom visiting a formula site is not really looking for bf help, is she, she's probably already made up her mind. Hearing horror stories about nursing is NOT going to convince her to stick with it.

We're in the process of switching doctors.

October 14, 2009 | Unregistered CommenterAndrea

And oh yeah, that is a horrible, horrible, horrible article from the Leader Post! Advertorial at its worst! I'm shocked, actually. Unfortunately it is not set up for comments. Heaven forbid women be directed to ACTUAL breastfeeding help.

October 14, 2009 | Unregistered CommenterAndrea

I hate hearing about mothers being pushed to use formula - I've seen it, but was lucky enough not to experience it when my son was born (in Canada). I nursed my son within an hour of his birth and the hospital would not discharge me until I attended a BFing class and the nurses were confident I knew what I was doing and that my son had a good latch.

My son lost interest in BFing and weened himself at 10 months. Reluctant to start him on whole milk early (I am intolerant), we gave him formula for 2 months. Although her office had pamphlets and posters from Enfamil, his pediatrician said "Don't believe the hype. No formula is superior to another. Get whatever is cheapest and start him on milk once he turns one

October 14, 2009 | Unregistered CommenterSarah @sarahcasm

Yah! Similac's "Strong Moms" campaign is pretty bad too. Our hospital gave out free Similac samples to all moms leaving the hospital, and I'm guessing that's how I got on Similac's mailing list (is the hospital allowed to do that?). Anyway, when my son was 3 months old, Similac sent me a note congratulating me on "making it" 3 months breastfeeding and then attaching lots of coupons for their product, basically saying "you worked hard, now let us take over."

October 14, 2009 | Unregistered CommenterMZ

Re #7 - surprised may be ok as long as the context is right. My son and I got a real hard start. We had several visits with an LC. His pediatrician was surprised he was still breast fed at 6 months. Surprised and pleased and encouraging. She admitted she hadn't thought we'd make it there, and said she was impressed and to keep it up as we introduced solids. That still felt supportive to me, and reminded me how far we'd come.

October 14, 2009 | Unregistered CommenterLaura

I grew up boycotting Nestle and still never buy anything from them. It's horrifying to realize that the boycott in the 70s didn't actually change much!

I would love to see Pediatricians more trained on breastfeeding - you see them the most and if you are struggling w/ any issue (I did - baby wouldn't swallow, not producing enough milk, etc.) it would be nice if your pediatrician could help!

I had a lactation consultant w/ my 2nd which was good b/c we had tons of nursing issues. She came every other day for 2 weeks to get us nursing successfully. I could write a whole blog post on "camel-back" nursing - and how my baby and I worked as a team to be successful. But, it wasn't easy. Thank, God, I had help and was encouraged.

Melissa

October 14, 2009 | Unregistered CommenterMelissa Taylor

I wish there was the same outrage in Lesotho as there had been in Edmonton.... Just a few months ago, Nestle sponsored an infant nutrition session for a local health practitioners forum that meets on a monthly basis. Nestle. Sponsoring a "nutrition" session. In a country where breastfeeding is recommended to all but a few mothers, both for HIV prevention and to combat infant mortality. In a country where over 40% of the population under 5 years of age is facing stunting as a result of malnutrition. Sickening, isn't it? "Giving objective information," my fanny....

October 14, 2009 | Unregistered CommenterElizabeth

Ah, Nestle. I'm from Jamaica and my mum remembers the "baby nurses" that came to weigh me at her home!! I want to reiterate how much money is involved in formula and the marketing thereof. I have four kids, including twins, and exclusively bf all of them for over 2 years. I was inspired to start One Hot Mama in 1998 with hot nursingwear I designed myself. Back then, there was an Association of Nursingwear Manufacturers that I contacted to see if we could work together to promote breastfeeding, but they were on the way out. I called my local "very best" hospital, Cedars Sinai, where I delivered, to see what it would take to include One Hot Mama info in the diaper bags they give away (as I remember, the bags are filled with formula coupons, but the actual formula cans were mailed to my home. I trashed them.) The marketing person laughed and me and said no way would I have enough money. I think if was over a quarter million dollars to be included in the packets for a year, not counting what I'd have to spend on the giveaway materials.

There is no profit in breastfeeding -- except healthier babies, more fulfilled moms etc etc. We happen to sell nursing clothes, but I tell anyone who'll listen that you don't actually need a single extra possession to nurse your baby. It breaks my heart that people spend nearly a thousand bucks on a stroller, but won't shell out for a lactation consultant out of pocket.

I get despondent that "our" side doesn't have the big bucks to promote breastfeeding. But guess what, no-one spends money on promoting real legs over prosthetics, either. We just know that real is better. The only weapon we have is to nurse our kiddie early and often, and in public (and yes, I think it's better to be a wee bit discreet because we are fighting a battle here; no point in giving ammunition to the morons who equate nursing with a face full of boob!) -- let your friends and family see your happy healthy baby and it wil be seen as normal (so funny that we have to work on a natural thing being seen as natural). Best part of this dreadful economy? More people will run the numbers and nurse just because it's free. I hope. :)

October 14, 2009 | Unregistered CommenterRoxanne Beckford Hoge

@Laura: I agree, it does depend on the context. I think the point is that if the doctor is surprised to hear about someone breastfeeding "that long", then that probably means that doctor doesn't have a very good track record in terms of encouraging breastfeeding and providing support for breastfeeding.

October 14, 2009 | Unregistered Commenterphdinparenting

I've been lucky enough to have generally supportive health care professionals. My son got one bottle of formula after he was born while I recovered from the C-section, but fortunately that didn't impact breastfeeding and the hospitals always had lactation consultants available for free.

On the other hand, every time we've gotten the bag with all the formula marketing garbage. I've never used any of it.

October 14, 2009 | Unregistered CommenterStephanie

That article quoting Russell is beyond horrible. This part:

"“So there are lots of things that can come up,” Russell points out. And if those issues arise, then it’s time to supplement with formula."

No mention of actually advising women how to seek help with breastfeeding. I have to wonder how much Dr. Russell makes in kickbacks from Nestle, how many lunches with them she's been on. She sounds like she's on their payroll. Truly disgusting that a pediatrician can be "bought" in that way.

October 14, 2009 | Unregistered CommenterClaire

Interesting post and a good read.
I find myself constantly butting heads all the time when I work in postpartum as a RN. There are SO many mixed messages about breastfeeding. I find working some cultures tend to lean towards formula feeding because, 'there is no milk!'. There is much education to be done and I think it is great to start with people who will be interacting with parents. Understanding the normal behavior of newborns, the actual nutritional needs and that breastfeeding CAN be hard but CAN get easier. I feel like a record player at work when I have to continually repeat, 'the babies stomach is the size of a chick pea. There is the perfect amount of colostrum to feed the baby. The baby does not need 60 cc of formula as a second feeding. No, the baby does not need water."

Keep up the supportive breastfeeding posts.

October 14, 2009 | Unregistered CommenterMama in the City

I just wanted to reply to this part, "Health care professionals may be smart, but they are also human, overworked, and expected to know a lot about everything. Unfortunately, there are many reasons why health care professionals are more likely to promote formula than breastfeeding if a mom runs into trouble."

So, I am a hospital nurse who promotes breastfeeding. Sometimes we have crying exhausted parents who just want a moments rest and so...they ask for formula and we educate and inform and allow them to make a decision. They will end up deciding on formula, 'just this one time..or maybe a second time'.

Sometimes we have jaundiced babies who are dropping ounces more than 10% of their body weight and so.. we give them formula top ups on top of their breastfeeding. We feel uncomfortable that babies drop weight but we know that when the milk comes in they will regain their weight.

There is no great conclusion and some nurses will work hard to try and educate and support and be present to help with breastfeeding BUT sometimes there are not enough BF advocates and instead of educating and supporting some HCP just want to see calories go into the baby and so they give formula no problem.

We don't have a LC in our hospital and so sometimes we get babes that are difficult to latch and, since we might be short on time or have too many, babies will breastfeed and get a formula top up. Not my favorite practice but I see it on every single shift that I work. Of course the baby has an incredibly full stomach and sleeps for 2-3 hours and the parents are so very pleased that the formula 'did the trick! hooray'.

Such a confusing situation for everyone. More education! For everyone! For new parents and for HCP too.

October 14, 2009 | Unregistered CommenterMama in the City

I think it's nice your doctor was honest that there is no "superior" formula, but, why the Enfamil posters at all? Without saying anything, her other patients likely get the message that she recommends Enfamil. And did she offer you any help in continuing to breastfeed once your son lost interest -- because generally, babies of this age go on strikes or get distracted, they don't really self-wean, and with the proper support, bf can continue. Sadly, so many doctors are quick to suggest weaning because they don't have the proper expertise.

I too was kept another night in hospital when my first wouldn't latch -- but I guess they needed the bed the next night, because I was discharged still feeding my baby ebm through a tube. After much stress and conflicting info from the nurses each shift change, I even asked "isn't there an expert in this hospital?" (I had heard there was, but sadly hadn't done my own research thoroughly enough) and it was not until I was on my way out the door a nurse gave me a card for an LC that worked with Dr. Newman. Not one nurse actually mentioned that Dr. Newman, at that time, HAD A CLINIC IN THE HOSPITAL! Instead I paid for a home visit from that LC (well worth it) or I never would have stuck with it.

IMHO, any medical professional that works with infants should also be an LC or at least have extensive training in lactation.

October 15, 2009 | Unregistered CommenterAndrea

[...] We need to ensure more Certified Lactation Consultant training for health workers, rather than more visits from formula company representatives to their offices. “It must also be underlined that the vast majority of women in developing countries [...]

[...] PhD in Parenting has been running a great series called Nestle Answers… if you are curious about this then take a look! Here is her post on the Nestle Boycott and this is my favorite post in the series: “Nestle Answers: Using Health Care Professionals as Intermediaries.” [...]

[...] 8. You maintain that “Nestle does not provide mothers in the developing world with free samples of your infant formula products – in fact Nestle has no contact at all with mothers with regards to these“. Are samples provided to doctors? Is information about the “benefits” of your formula provided to doctors or other health professionals? ANSWER HERE [...]

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