Friday
Aug032012
Breastfeeding is More Than a Choice. It is a Challenge.
Friday, August 3, 2012
There has been a lot of controversy and discussion over the past week about the Latch on New York initiative that seeks to, among other things, limit the ability of infant formula companies to market directly to mothers in the hospital. The initiative is designed to protect women who want to breastfeed from having infant formula pushed on them by hospital staff or formula companies.
There has been a lot of misunderstanding about the initiative, stating that women will not be able to access formula if they need it or want it for their babies. That is not the case at all. The measures are simply designed to ensure that something that should have been happening already is happening, i.e. that moms who say they want to breastfeed exclusively are given every opportunity to do so without interference or pressure to use formula.
I think this is an important step. I don't think that it is taking away anyone's choice about how to feed their baby.
I believe that all women should be able to choose how to feed their babies and deserve to be supported in that choice. As I've said before, there is too much pressure to breastfeed and not enough support to do so.
Breastfeeding can be hard.
Putting formula samples, formula coupons, and formula company propoganda in front of moms as they try to face that challenge (and 90% of them do), creates unnecessary temptation for mothers who are trying to overcome the challenges of breastfeeding. It does impact breastfeeding rates -- the research supports that.
Moms who give in to the temptation of a formula sample late at night when their baby won't stop crying aren't weak or uncommitted. Moms who reach for a free can of formula when their nipples are bleeding are not weak or uncommitted. Breastfeeding is hard. It is hard in the same way that quitting smoking or drinking or overeating is hard. If the temptation is constantly in front of you and if "just one bottle" is presented as the solution to challenges instead of good quality, accessible breastfeeding support, it is no wonder that moms doubt themselves, their ability to breastfeed, their ability to overcome challenges.
You don't get a free pack of cigarettes "just in case" with your smoking cessation kit. There are no free Jack Daniels samples at AA meetings. There are no Burger King coupons at Weight Watchers. Moms who want to succeed at breastfeeding, should have support at every turn, not a formula sample at every turn.
Moms who can't or don't want to breastfeed, should also be supported in that decision and shouldn't be given a lecture at every turn. They should have access to human breast milk or infant formula (their choice) to feed their baby.
Choice, to me, doesn't mean pressuring moms to breastfeed while shoving formula samples in their bag. Choice means asking the mom, "How can I support you in feeding your baby?"
Other great posts on this issue:
Ask Moxie - The illusion of choice, the free market and your boobs
A Mother in Israel - Why My Maternity Ward Locks Up Infant Formula
TIME - Bloomberg's Breastfeeding Plan: Will Locking Up Formula Help New Moms?
Breastfeeding vs Gift Bags: A Public health issue, not a lifestyle choice, says AAP
Image credit: Rachel Coleman Finch on flickr
There has been a lot of misunderstanding about the initiative, stating that women will not be able to access formula if they need it or want it for their babies. That is not the case at all. The measures are simply designed to ensure that something that should have been happening already is happening, i.e. that moms who say they want to breastfeed exclusively are given every opportunity to do so without interference or pressure to use formula.
I think this is an important step. I don't think that it is taking away anyone's choice about how to feed their baby.
I believe that all women should be able to choose how to feed their babies and deserve to be supported in that choice. As I've said before, there is too much pressure to breastfeed and not enough support to do so.
Breastfeeding can be hard.
Putting formula samples, formula coupons, and formula company propoganda in front of moms as they try to face that challenge (and 90% of them do), creates unnecessary temptation for mothers who are trying to overcome the challenges of breastfeeding. It does impact breastfeeding rates -- the research supports that.
Moms who give in to the temptation of a formula sample late at night when their baby won't stop crying aren't weak or uncommitted. Moms who reach for a free can of formula when their nipples are bleeding are not weak or uncommitted. Breastfeeding is hard. It is hard in the same way that quitting smoking or drinking or overeating is hard. If the temptation is constantly in front of you and if "just one bottle" is presented as the solution to challenges instead of good quality, accessible breastfeeding support, it is no wonder that moms doubt themselves, their ability to breastfeed, their ability to overcome challenges.
You don't get a free pack of cigarettes "just in case" with your smoking cessation kit. There are no free Jack Daniels samples at AA meetings. There are no Burger King coupons at Weight Watchers. Moms who want to succeed at breastfeeding, should have support at every turn, not a formula sample at every turn.
Moms who can't or don't want to breastfeed, should also be supported in that decision and shouldn't be given a lecture at every turn. They should have access to human breast milk or infant formula (their choice) to feed their baby.
Choice, to me, doesn't mean pressuring moms to breastfeed while shoving formula samples in their bag. Choice means asking the mom, "How can I support you in feeding your baby?"
Other great posts on this issue:
Ask Moxie - The illusion of choice, the free market and your boobs
A Mother in Israel - Why My Maternity Ward Locks Up Infant Formula
TIME - Bloomberg's Breastfeeding Plan: Will Locking Up Formula Help New Moms?
Breastfeeding vs Gift Bags: A Public health issue, not a lifestyle choice, says AAP
Image credit: Rachel Coleman Finch on flickr
Reader Comments (80)
I think it's harsh, and quite frankly incorrect, to compare free formula samples in hospital rooms is like booze at an AA meeting. But I do agree with you in that choice has a lot to do with how to support a mother in however she feeds her baby.
I just don't think this initiative is about that.
i live in england and my son was born in a place where schemes like this already run. I am not a fan of hospitals in general, but I could not fault the care I recieved. I did struggling with breastfeeding but recieved all the support I needed to overcome those problems.
I cannot commit on it from the formula feeding side of things, but from the breastfeeding angle and my own personal experience it was first rate
Not sure about the analogy either, but...
This, ''Choice, to me, doesn't mean pressuring moms to breastfeed while shoving formula samples in their bag,'' is bang on.
Pressuring moms to breastfeed while undermining their attempts is exactly what is going on right now.
And it's feeding the mommy war, because breastfeeding mothers feel the power of formula companies + incompetence from the medical staff undermining their breastfeeding relationship... while formula feeding moms, on the receiving end of all that pressure to breastfeed, believe that breastfeeding moms are already getting all they need.
Both feel they are on the wrong side of an unequal battle. And both are being cheated.
The only thing about this measure I don't like is the thing I've heard (which could be false rumors) that mothers will have to listen to a pro-breastfeeding lecture before getting formula. I don't mind making it hard to get formula, but there shouldn't be harassment involved either.
Great post. However, on the same tack as Motherhood Uncensored (Kristen), please tread carefully before casting the issue of formula in hospitals & breastfeeding support in the same light as supporting someone who is overcoming an addiction. Two completely separate issues.
The initiative doesn't bother me at all...but I am one who kind of takes what goes on in hospitals with a grain of salt as far as it determining what I am really going to do (and I do my best to stay the hell out of them). I don't care if people's feelings are "hurt" by a "lecture"...but at the same time the idea that women are too weak to overcome the "unnecessary temptation" of giving formula is bothersome. Someone really needs to have purposed in their head and heart to breastfeed, and be fully educated on the matter, BEFORE that difficult immediate post-partum time in the hospital...none of this "well, I'm going to *try* and breastfeed" stuff. Honestly, from the comments I read online, I'm not sure any measures are going to help...people are going to do what they're going to do. And yes, it is frustrating to read/hear about...
I don't think it is harsh. I'm not comparing formula to booze. I'm talking about the way that corporate interests prey on people when they are vulnerable as they try to overcome personal health-related challenges.
In this context, I don't think they are completely different issues. Resisting temptation when you are trying to overcome addiction or lose weight is quite similar to resisting temptation when you are trying to breastfeed.
The biggest difference, in my opinion, is that you often only have one shot at breastfeeding. Once a woman has made the decision to wean and switch to formula, it is incredibly hard (but not impossible) to go back to breastfeeding). With addiction, however, if someone isn't able to meet their own goals, they can try again the next day, the next week, the next year.
That is a false rumour. This is from an e-mail I received from the mayor's office:
If a mother decides she wants to use formula (or a combination), she will be supported in her decision and her baby will be given formula during the hospital stay. Likewise, if the mother changes her mind or requests formula at any time, her baby will be given formula.
I could not nurse my first child. I couldn't even hold him for large segments of time, from hours to days, as he was very critically ill and had open-heart surgery which left him in a medically induced coma with his chest open for days. I did, however, pump. I pumped, and I pumped, and I pumped. I pumped so much milk that I ran out of room for it at the Ronald McDonald House and the Children's Hospital. When we came home I pumped so much I donated it to babies at the local L4 NICU who had to be fed through NG tubes.
With my first child, I was so supported by all the medical staff in my pumping efforts. Even the Children's Hospital gave me free juice, milk, water, and tea to keep me hydrated. My son only ever had formula in the first few days after his chest was closed and his ventilator removed as a augmentation to the breast milk to spike the calories and help him recover and again in his 11th month of life when my second pregnancy put an end to my pumping. Since I struggled with infertility for my first, I was rather shocked to find myself pregnant again so soon.
My first pregnancy/baby experience was extraordinary and not what most people experience. No one would have judged me if I'd gone with formula, but pumping gave me a certain sense of power when I was almost entirely powerless.
A year later, with my second child, who is blessedly healthy, the lactation consultants at the local hospital (not where my son was born) bullied me and made me feel guilty that my daughter would not/could not latch on. Their motivational tactics were guilt-trips. She was born so healthy but quickly got sick because she was literally starving. I was so exhausted and our son was having an unplanned fourth heart surgery already a month after our daughter was born (we thought he was done for a couple of years, little did we know he was just getting started). So, I got out my pump.
My daughter NEVER had formula, EVER, but I didn't nurse her. I made so much milk pumping that I fed her and one of my nieces when my sister's milk gave out. Yet, I still feel bad because of what the breast feeding "support" people told me about giving up and how I was doing us both a disservice. . . whereas I always felt I was just getting through an unfortunate set of circumstances the best way I could do. When we say we're going to support mother, it really has to come without snide comments and sidelong glances or backhanded "compliments."
I have many nieces and nephews who were formula-fed. I was formula-fed way back in 1974. I don't look down on people who make that choice because I know from my own rocky road that we take the path that works for us at the time. We don't live in an ideal world, we live in reality and sometimes we just deal with it. It's all about wearing another woman's shoes.
W/R/T the formula, I always just donated it to the local Women's Shelter or the Ronald McDonald House pantry with my first child, or I gave it to my sister-in-law who adopted her baby with my second child. I think we should work harder on giving girls who become women the confidence to make their own informed choices our first priority in everything from dating, to drinking, to breast feeding.
I'm more ambivalent about the give-aways because I had that confidence in spite of many other unexpected pressures. I wish as a society we better at celebrating women's brains and trusting them choose what to do with their own bodies without taking our individual preferences and opinions into account. But we live in reality.
I agree with most of what you said, except that formula is NOT a toxic or addictive substance. You can't compare formula with cigarettes or alcohol because that's absurd. All women should be supported in whichever way they decide to feed their kids WITHOUT pressure. This initiative is unlike most positive projects. It's not just a pro-breast feeding initiative, it's an anti-formula attack. All women should have a choice. No pressure, no added stress. The days immediately following the delivery of a baby are stressful enough. Women are at their most vulnerable and don't need to be attached, pressured or stigmatized for making choices that are right for them. Sure, hospitals don't need to push formula, but they don't need to push breast feeding either. I was harassed and made to feel bad by every urse that entered my hospital room because I had chosen to formula feed. That didn't feel good. If a woman wants formula, the hospital should be able to provide it for her...breast feeding isn't the right choice for everyone.
Using "just one bottle" of formula can have the same impact on a woman's quest to breastfeed as having "just one cigarette" can have on someone's quest to quit smoking.
I'm curious which part of NYC's initiative strikes you as "anti-formula". Would you care to elaborate?
Just like a doctor can and should encourage you to lose weight, because it is healthy, I also think it's important to talk to mom's about breastfeeding and encourage - but just like other health measures, some people simply do not want to, nor is it right for them. It should be a hospital's job to EDUCATE. I totally agree with getting rid of samples in the check out kit. I really wish the formula companies would stop sending formula to my house while they are claiming to be "helpful" - when in reality they are selling me their product. I also wish the claims on the formula itself did not say they are similar to breastmilk. They are not.
With that said, I do not think this is an issue anywhere near addiction... Yes, formula can be tempting during late night cry sessions or when your baby is refusing to nurse, but I do not think it is the same as drugs sitting in a cabinet of an addict.
Thanks for the thought provoking post <3
Coming from a family with serious addiction issues, I have to agree with the folks who are taking issue with your analogy. I do know what you're trying to say, and I agree with your point that Moms should be offered good breastfeeding support instead of formula when they're having problems breastfeeding, but relating it to alcohol or food addiction doesn't enhance the argument. A biological, neurological compulsion to harm yourself is not comparable to painful breasts or latch issues leading someone to choose formula.
While reading this it struck me that perhaps the problem is that women aren't used to taking definitive positions, particularly those related to motherhood, and especially after they've just given birth. There's a lot of ambiguity out there about what is best, what to do, etc. There are die-hards on both sides, and I think the majority is turned off by this and prefers to be seen as more agreeable. Therefore it's hard to see women as demanding one or the other, especially first time moms who are bewildered after the extraordinary process of giving birth.
That said, I do agree with your post. I have a 23-month-old I'm still breastfeeding, but in his first 24 hours I was told he was dehydrated and needed formula. I gave in - it was 3 in the morning, and I was in enormous pain and sleep deprived. The moment we went home it stopped (even though they tried to send samples home with us) and it still makes me very angry when I think about what they did. They knew my strong preference for breast feeding and they overrode it. Why? Probably to get us out of the hospital faster. That should never happen to any woman, and I'm lucky for the support that followed me home that made it possible for me to ignore their advice.
You are trying to explain yourself, but the fact is that you did compare formula to cigarettes and booze. And that's deeply offensive IMO.
I BF my son for over a year, but I may very well choose formula next time. I almost lost my mind to sleep deprivation due to my total inability to cosleep successfully and a newborn who wanted to feed every 2 hours round the clock (sometimes every hour), and I'm not going back down that road. And I shouldn't have to explain that to anyone I don't want to. A woman doesn't need a reason to choose formula.
I think it's perfectly fine to get rid of bags, because those are marketing, but making the nurses sign out the formula every time? Keeping it under lock and key? It's food. Formula is food. Not cigarettes. Not booze. Not McDonald's. It's food for infants.
No, I didn't compare them. I used an analogy. The definition of analogy is: “Similarity in some respects between things that are otherwise dissimilar.”
Another example of an analogy would be "food is to the human body as fuel is to a car". That doesn't mean that food is like fuel or that human bodies are like cars. It is the relationship between the food and the body and the fuel and the car that is similar.
In my opinion, embedded in a lot of the hostility appears to be an unrealistic sense of what it is like to try to breastfeed in the majority of US hospitals. My read is they seem to view formula and breastfeeding both as equal choices and as equally available. The latter is, in my opinion, the biggest problem, because it is absolutely not the case. We know from research that many, many women want to breastfeed and initiate breastfeeding in hospital, and then stop; the numbers in the US drop dramatically when we look at rates of initiation to rates of exclusive breastfeeding by three months, or even six weeks. Annie had a post about why women stop breastfeeding a while ago on this site. There are obviously multifaceted reasons why women stop nursing, but clearly lack of institutional support and misinformation and poorly trained LC are a huge part of the problem. I hear horror stories all the time about breastfeeding "advice" women are given in hospitals from L&D nurses or LCs (rarely IBCLCs). Pediatricians also give out amazing amounts of misinformation. The most common areas of misinformation have to do with supply (how to build and maintain a supply) and routine (putting bf babies on "schedules"), but these are just a two categories. The AAP declares that breastfeeding is a global public health problem (not a lifestyle choice) - it is a crisis in some areas of the world; they agree with the CDC and WHO on these issues. The AAP's 2012 statement of human milk is really informative - you can download it as a pdf, and on p. 8 it details some of the CDC's research on breastfeeding unfriendly practices common at hospitals. And yes babies are still being given formula without their parents' consent at some hospitals. The lock and key isn't to keep the parents from the formula, it's to keep the HOSPITAL STAFF from pushing formula on parents. It's about changing institutional culture in a way that increases breastfeeding rates for mothers who want to breastfeeding (and again, according to research, this is the majority of mothers, though certainly not all).
I'm not saying AAP, CDC, or WHO are infallible, but when they all look at the available research and decide, I think we should also consider carefully what they are saying and recommending. I know many people believe that formula and human milk are equal, but that is simply not what the medical research says, and the most vulnerable populations are the ones most negatively impacted by the absence of human milk. NYC's new initiative follows the recommendations of the AAP, CDC, and WHO. Hospital policies, procedures and cultures sabotage breastfeeding in multitude of ways, even as many pay lip-service to the idea that "breast is best" (hence the booby traps, and this intolerable situation that American women are in where we are guilt tripped about breastfeeding but sabotaged from breastfeeding successfully at the exact same time). I'm pretty gobsmacked by the amount of uproar and hostility to the initiative, when it is just following the guidelines of highly respected public health organizations. The idea that stopping predatory practices by formula practices somehow destroys women's rights to choose is strange to me, but I guess in the US we've developed this very entrenched culture where government regulation of a corporation = oppression but entirely unregulated business practices even with detrimental health effects = freedom. People's unwillingness to understand how and why formula advertising practices violate the WHO code and common decency is strange to me too. Everyone seems to want to believe that they are immune to advertising, in spite of the research says on this topic.
The analogy is about people who aren't being supported in their goals, and more than that, who are being undermined and sabotaged . Just as it would be wrong to undermine someone who was trying to overcome an addiction, it's wrong to intentionally throw obstacles in the path of someone who wants to breastfeed but is struggling.
Myself and my fiance Becki are v.pro breastfeeding, and she's worked as a breastfeeding support councillor in the UK for the past couple of years. Infant formula is NOT a replacement for breast milk, but Midwives in the UK are simply not educated about breastfeeding and actively promote formula.
IMO midwives need to keep their ill-informed opinions out of the equation, and the NHS needs to get more specialist breastfeeding specialists into hospitals to educate mums about the benefits and help them feed their newborns.
That said, formula isn't like booze or drugs! That's a far out comment above. Well, apart from the fact it's expensive and unneccesary perhaps. If a new mum gives it a try I don't give them a hard time.
Well, in theory it can, but not always the case. Has it ever been empirically proven that one bottle is likely to sabotage the likelihood of breastfeeding?
Anecdotal evidence, i.e. my experience with my first born was that giving him a number of formula feeds in the first two weeks of his life was actually helpful for my wellbeing and this had profound impact on my ability to exclusively nurse him thereafter.
I am saying this in retrospect. At the time though, the guilt was just so overpowering as I was socialised to think that one bottle means doom!
I am glad there is no "lecture" prior to giving formula, if it is asked for or needed. I have a friend who feels she was lectured to when she asked for a bottle (this from her perspective, I was not there and suspect people can *feel* they are being lectured to when receiving info they don't really want to hear, no matter how it is actually presented...), and I think that experience pushed her AWAY from bf. Lectures don't work. BUT I do think if a woman chooses or needs to use formula, she does need to be told the risks of not bf by someone, somehow. And the risks of supplementation on milk production. There ARE risks. It is not "free choice" when one is making it without the proper information, and so many are (I can speak from my own experience as a new mom; I never, ever thought in terms of the risks of not bf, only the "benefits" of bf -- I did no research and "everyone says" formula is "just as good". Fortunately, I was able to successfully bf, after a very rocky start, with no supplementation.) You wouldn't take medicine or give medicine to your baby without understanding the risks, even if the benefits end up outweighing them. The same should apply to artificial infant feeding.
And just to add, it's a darn good thing I was never offered formula samples in hospital, or pushed to bottlefeed. Because I sure as heck didn't get much support or education around breastfeeding (I've mentioned before how, among other things, I went home tube-feeding, and yet none of the nurses mentioned Dr. Newman's clinic was IN the hospital...), so I doubt I would have been able to resist them.
Well said. It's like having interventions offered to you in the middle of birth. Of course I want an episiotemy after 3 hours of pushing! Your job as my midwife/ doula is to try to talk me out of it. Assuming it's not medically necessary, of course. But you get the idea. No one wants to make a critical decision while in agony -- you want to surround yourself with people/ tools that support your long-term goals, not your short-term desperation.
I really like the analogy with Weight Watchers.
Wow...I think I still wouldn't want the epi after just 3 hours...eek! ; )
It actually kind of is like McDonald's, though...
This is all so silly. Go to any kindergarten in America and tell me which kid got formula and which one was breast fed. You can't. As long as the child is loved and well cared for and the mother is doing what works in her individual situation, who cares? There are many factors that go into raising a healthy human being.
Laura:
You are right and that is EXACTLY the point here. This is about supporting the mother as she does "what works in her individual situation". If a mom says she wants to breastfeed, the formula marketing vultures shouldn't be invited to circle over her head waiting for her to fail. If the mom says she wants to formula feed, she shouldn't be subject to a lecture about why breast is best. Moms should be supported in their choices. That is important, not silly.
I think I have a slightly different perspective on this. I delivered at a "Baby Friendly" hospital, which meant there were no formula bags, no free samples, no readily available formula and TONS of breastfeeding support. And my baby still would not breastfeed. All of my nurses in the postpartum unit were also trained LCs, they brought in another more experienced LC and still nothing. He wouldn't latch. Because there were concerns about dehydration, he was given formula (through finger tubing) as his first meal, while I pumped. I was devastated and felt like a failure.
I had to use formula, which logically I knew was fine, but because I have read and heard so much about the evils of formula and how it's incomplete nutrition and all a money making scheme by evil corporations, I felt like I had failed my son. It may not be outright shaming, but when so much negative attention is given to formula, those of us who have (or choose) to use it, feel shamed. I feel awful every time I have to supplement with formula because I can't keep up with my son's demand while pumping, which I hate, but do anyway. And in that way, locking up formula, making it sound as though those who use formula while breastfeeding aren't trying hard enough, is just a more discrete way of shaming.
If there was a way to get the nurses, doctors, and other staff at the hospital to understand that moms who have chosen to breastfeed should not be given formula unless they ask for it and get them to comply with that, then maybe the formula wouldn't need to be locked up. The problem isn't with formula or with moms who want or need formula. The problem is with the way it is being managed by hospitals.
Moms are pressured to breastfeed, but not supported sufficiently. Then they have formula pushed on them, and are shamed when they use it. I'd like to remove pressure, shame and pushing from that equation and replace it with SUPPORT, SUPPORT, SUPPORT for all moms and their choices. I don't want formula feeding moms to be shamed any more than I want breastfeeding moms to be undermined.
I think this is a Wonderfully written piece. And I agree wholeheartedly. Yes, I'm prepared to be flamed. But as a staunch supporter of breast feeding, I see it daily. Breast feeding moms are given formula bags and little support, and those bottles end up being used. Breast feeding exclusively works for late preterm infants, large for gestational age babies, small for gestational age infants, and everyone in between. As long as it works for mom, it works for babies (medical problems excluded) That being said, if it's not the right choice for moms, it's not the right choice for babies.
I'm still, a day later, a bit surprised at the reactions to the analogy here and on twitter. This isnt' about comparing formula to booze, cigarettes, or fast food. It is about not pushing things on people that they are specifically working really hard to avoid.
It could also be like:
- Offering someone trying to run a marathon a ride to the finish line
- Asking a kid trying to finish really tough math homework to come outside and play
- Asking someone to go on a shopping spree when you know they're trying to pay down their debt
Playing outisde, going shopping, riding in a car are not inherently bad (and neither is formula or a good glass of wine or a nice burger for that matter), but dangling those things in front of people who are trying to achieve something hard is disrespectful of their goals. That is the point I was trying to make.
Or, fresh baked bread in front of someone cutting gluten, or brie in front of someone cutting dairy. Not bad things, just not things they are choosing at this time. And things they might be tempted to accept if offered. To dangle them in front of people like that is not supportive.
Actually, I care. I care that most moms claim they want to breastfeed and don't get the support and education to meet their goals. I care that people are blind to the predatory marketing tactics of formula companies (they have a vested interested in the failure of bf! they spend millions (billions?) on ads and samples and partnerships with hospitals--because it works!) I care that our population is at higher risk of certain conditions and diseases because of generations of artificial infant feeding. I care that in the US in particular, maternity leave is virtually non-existent, making it that much more difficult for moms to exclusively bf, or bf at all. There is a place for formula in infant feeding, but it should not be (as it currently is) the norm, it should be the exception. There IS a difference, there ARE risks to not bf, even if it's not readily visible in any kindergarten in America (or Canada). Sure, you wouldn't be able to tell that I was exclusively ff from birth. But my mom is at higher risk for certain cancers as a result, I care about that. It's a public health issue, and yes, I care about that. I don't think it's silly in the least to care about moms and babies and the overall health of our society.
They did well at my hospital with keeping formula out for those of us who chose to breastfeed. When I was admitted to L&D I was asked my feeding choice, and let them know my plan to breastfeed. It was noted in my chart, and my daughter had an "I eat at moms" sign in her bassinet, along with our names, doctor, and her bath time. I wasn't offered formula at all. My daughter wasn't given any. When I needed to rest and sent her to the nursery the nurses brought her back to me. (i was alone 2 nights post C). When I was chapped from her learning to latch the nurses brought me cream and helped me get a better latch. They also gave me the shells. The LC was proud of me when I told her I hadn't used any formula.
I chose to breastfeed, my hospital supported it.
Of course, everyone living in developed countries knows breast is best. You'd have to be living in a high rise on Mars not to know that. We get it. The literature and research is readily available. MY point is breast milk is not a magical elixir of everlasting health and well-being. It is one small element. Once you travel down the parenting road a few miles, you realize how many other parenting decisions affect the life of your child such as: making them wear a seatbelt, insisting on a bike helmet, teaching them how to properly cross the street, no smoking, no drinking, no texting while driving, no drinking while driving, no unprotected sex, eating vegetables, proper oral hygiene, stranger danger and on and on it goes. If you can breastfeed and it works for you that is fantastic. If it doesn't work out, that is o.k. as well. I was fortunate enough to be able to nurse all three of my children and it was a very different experience with each one. Now that i have the perspective of having teenagers, I wish someone would have given me permission to pop a bottle in their mouths a few times so I could take a much needed nap and my husband could man the ship for a few hours. As a new mother, I felt intense, crushing pressure to provide only breast milk to them. And frankly, that feeling was a major psychological and physical bummer. Now I know what a small slice of the parenting pie breastfeeding really is when you consider the entire span of the child rearing years. I don't want or need the government anywhere near my bedroom, my church or my breasts.
Annie, I love the last paragraph of this post, but I don't know if the first 2/3 of the piece goes along with it. I too spoke to people in the mayor's office, and one source told me in confidence that they were "backpedaling" a bit b/c of the reaction online to the announcement of Latch On NYC. It WAS extreme. It WAS intending to "lecture" women every time they requested a bottle. It says so in the original Q&A posted on the site, prior to their sneaky little "Myths and Facts" addition. So while this initiative may indeed be supporting breastfeeding moms who are adverse to formula supplementation (which is not all breastfeeding moms - many I know were able to create a lasting BFing relationship because they did supplement at the beginning, rather than allow their breastfeeding dyad to disintegrate due to significant weight loss, latching issues, etc), it is absolutely NOT supportive to formula feeding moms. We can't sacrifice one at the expense of the other. All moms - and all babies - deserve support, and once the choice to formula feed is made, that mom should receive the same level of support, education, and assistance as a breastfeeding mom. That's all I'm asking for. I wholeheartedly agree with you that formula should not be thrown in the faces of new moms who intend to breastfeed - but if they request it on their own, those wishes should be respected without any sort of "are you sure? Do you want to hear about the risks one more time?" because otherwise, I think it is entirely comparable to wanting a mom to get an ultrasound prior to an abortion. Others have made this analogy and it has been dismissed, but in both cases, we have public officials trying to "educate" women out of a choice which has been deemed unpalatable.
This is not a question, IMO, about whether breastmilk is better than formula. This is a question of providing adequate support for all mothers. If a city makes an announcement about how they will be treating formula as a controlled substance, and uses rhetoric about the superiority of breastfeeding and the risks of formula feeding to justify this policy, then it immediately becomes about the "right" and "wrong" choices. Thus the issue is loaded with judgment, and I worry about how this will affect new moms who are struggling with a variety of emotional or physical issues. I believe there's a way to keep formula out of the maternity ward until it is requested, at which point it should be allowed in, no questions asked.
Pushing formula is wrong, but so is pushing breastfeeding on a woman who doesn't want to, or who thinks she wants to, but then decides she doesn't. I just don't understand why there can't be a happy medium here. How about having women sign a release stating that they requested formula and have been informed that the hospital recommends breastfeeding?
Sorry - in the above comment, it should read " a WOMAN to get an ultrasound..." not "a mom". Geesh. Serves me right for posting at midnight after BlogHer! ;)
So here's my problem with this initiative: if breastfeeding is as challenging as, say, kicking a nicotine addiction (and I share other readers' discomfort with this choice of analogy), then limiting new mothers' access to formula is perhaps a useful - but also perhaps THE LEAST useful - step towards offering them the support they need to breastfeed successfully. Want to ban free formula samples in the hospital? Fine. But how about we follow that up by mandating the re-training of postpartum nurses, ensuring that hospitals and pediatricians' offices have well-trained lactation consultants on hand, and working toward better family leave policies that give new moms the resources they need (including TIME) to nurse? I couldn't be more on board with the general intentions behind this initiative, just as I also believe that no good can come of the sale of gargantuan full-calorie sodas (to reference Bloomberg's other recent, and infamous, public health initiative). And to the extent that this policy is meant to change the behavior of hospitals rather than patients/mothers, I'm on board. But it also feels way too easy - a potential contribution to the situation you're describing in which mothers are pressured to breastfeed without, on the other hand, being offered real resources to deal with just how hard it can be. Again I'm really not a fan of the analogy, but we know that smoking cessation requires MUCH more than just limiting former smokers' access to cigarettes (and lecturing them on why they should quit, since if they're already trying to quit they know why they should!) - most smokers need a lot of support! So, where's the "support" component of this policy that accompanies the formula "ban"? And if there is none, then who's really served by this initiative?
I think the problem with the analogy is that those "just in case" formula samples are less about the mother than the baby. If your baby needs to eat, she needs to eat. That's wildly different than someone with an addiction whose bottle of "just in case" vodka can kill them.
Feeding your baby formula isn't poisoning them...it's simply feeding them. So I'm glad to hear that your real point is that all mothers should be supported the best we can, and their choices honored. And most of that starts long before the hospital visit.
I agree with this. I read the original release from the Mayor's Office and it was exceedingly clear that mothers requesting formula would need a doctor's permission (medical condition, etc), plus a speech from the nurse. Then it read "if she still insists on formula..." which I think is the very language that made an otherwise well-intended effort something more controversial.
You're surprised? You crack me up!
If everyone in North America knew that breast was normal (forget "best") and did their research, the bf rates would not be so low.
I can't think of very many circumstances where a formula sample would be a necessity for the baby. I agree that if the baby needs to eat, she needs to eat. But mothers breasts do not go from making enough milk to making no milk at all suddenly at 3am when there are no stores open. I've had a hungry baby at 3am and I put her (or in the case of my son, the pump), back on my breast repeatedly until she was satisfied. That not only met her needs, but also helped to secure and increase my milk supply. Pulling out a formula sample in frustration at that point would have been about my needs and would have contributed to further supply problems.
There are instances when supplementation is medically indicated for a mom who is planning to breastfeed. In those instances, a supplementation plan should be developed in conjunction with a lactation consultant who is mindful both of the need to feed the baby and the need to preserve and increase the mom's milk supply.
The formula company that hands out the "just in case" sample for the mom to reach for at 3am is not at all invested in helping maintain and increase that mom's milk supply.
I agree with you.
When I filled in the forms for labour and delivery at my hospital, I was asked a variety of different questions. I think one of the questions on there should have been "How do you plan to feed the baby?" with breastfeeding, formula feeding, combination feeding and not sure as options. If the mom says breastfeeding, she should never be given formula by anyone other than an International Board Certified Lactation consultant, unless of course she specifically indicates a change in preference about how to feed her baby. If she says formula feeding, she should be given formula. If she says combination feeding, she should be given information about how to combination feed successfully, which would likely also mean no formula in the hospital since it is critical to build her supply during those first few days/weeks. If the mom says she is not sure, she should then be asked what additional information she needs to help make her choice and that should be evidence-based, non-judgmental information.
I agree that it definitely needs to be combined with support and retraining and changes in policies and procedures. I wrote a post a few years ago about whether http://www.phdinparenting.com/2009/07/19/can-breastfeeding-promotion-learn-something-from-drunk-driving-ads/" rel="nofollow">breastfeeding promotion can learn something from drunk-driving ads that looked at the type of anti-drunk-driving ad that is effective (ones that provide options and alternatives to driving drunk, not ones that try to scare people away from doing it) and suggested that breastfeeding ads designed to scare moms are not the right direction to go.
Regarding your comments about "lock and key"...I'd like to see the actual systems the hospitals are using to do so. I have read that the formula usage will be tracked by institution...I'd have to wonder what sort of trickle down pressure there will be to cut formula usage. I'd also have to wonder if this would cause some unintended tracking of staff individual by individual to see who signs out the most cases.
I'm a nurse, but not in this sort of setting. I hope people realize that any sort of "jumping through hoops" needed by staff to access supplies and equipment takes away the hospital's staff time to have real interaction with ALL of her patients, whether breastfeeding or not.
I actually think it's willful ignorance and/or denial mixed in with a healthy dose of simply not caring. Formula is "good enough" and the masses are rather lackluster when it comes to doing anything that requires commitment, is not convenient, etc. Look at the percentage of people who are overweight. Yes, everyone should know better...and yet...
Great post, Annie. The misunderstanding of this initiative by the media is very frustrating. So many think that anything short of giving out free formula is passing judgement and shame any mother who asks for formula.
One "small element" that could save 900 lives and $13 billion in healthcare costs if 90% of babies were breastfed for their first six months. http://www.usatoday.com/news/health/2010-04-05-study-breast-feeding_N.htm
Doesn't sound silly to me.