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)
Great post, Annie, as said above. You keep on keeping on, girl!
THIS. This is exactly the right analogy (although I definitely understood and appreciated the analogies offered in the blog post.) But it's this: short-term desperation clouds our judgement and we need *support* to stick to our decisions in that moment, not undermining. And if a woman wants to breastfeed and *does* cave in to giving some formula at 3am when she's exhausted and in pain, she needs support to continue with her breastfeeding relationship, not guilt over what happened.
Laura, I know someone who feels this way about carseats. She does other things to keep her children safe and healthy, so she's angry that the government is all in her business telling her that her 4 youngest kids should be in various levels of safety seats and none of them should ride in front. If other people can afford those seats and are willing to experience the hassle of installing them and are willing to buy a car with enough seatbelts for all their family members, and that works for them, that is fantastic. But she and her husband believe their 1970s sedan is safer than a newer car, and they believe in the importance of doing everything together as a family, so they put the baby in the same carseat they bought when his 10-year-old sister was born, and the 5- and 8-year-old share a seatbelt, and the 2-year-old sits in front between her parents, and that's what works for them, and they wish everybody would stop hassling them because protecting your children from car accidents is just a small part of parenting, right?
Do you agree?
Ok, Annie. Now I think you should run for office. That is exactly what should happen, and a totally clear, common-sense explanation of how it should go down. Thank you.
Another great post, Annie. Thank you!
wherever you are in the world, I think this statement is so true.
there is too much pressure to breastfeed and not enough support to do so.
People think that breastfeeders get lots of support when in fact they don't. We need much more support for women and to make it more "normal" in daily life before we see women being able to manage breastfeeding without running the risk of turning to formula at the first hurdle.
Banning formula samples and information in hospitals (which already exists in the UK) is a massive step in helping women overcome issues. What we need to back that up is free, readily available supporters to help them through.
Yes. This.
"There is too much pressure to breastfeed and not enough support to do so."
Thank you for this post.
(And I enjoyed spending time with you at BlogHer!)
"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."
Yes, in fact, they ARE interested in DECREASING Mom's supply. Making that "just in case" scenario even more likely.
Formula samples are DESIGNED to interfere with the natural supply-demand breastmilk-baby system. Formula samples are DESIGNED to undermine mom's trust in herself.
Free formula SAMPLES are NOT intended to be the emergency baby-feeding plan for a baby who *really needs formula* for some medical reason. Free formla samples aren't about those mother/baby pairs - those issues are already dealt with directly by pediatricians and lactation consultants and formula is provided as a medical intervention - the New York initiative has NOTHING to do with that. There aren't any at-risk babies who are going to be put at further risk because free formla samples aren't available at mom's bedside or doorstep or thank you bag.
As someone who has given birth in a NYC hospital once, and hopes to do so again (although NOT the same one) in the next year, I am very interested in seeing how this initiative actually plays out. My experience in trying to breastfeed at a NYC hospital (LICH) was thus: I informed the staff I wanted to exclusively breastfeed, but I felt that they were constantly trying to subtly pressure me to give my son formula. I went to the breast feeding class provided, but while I was still in the hospital my nipples were already getting VERY uncomfortable and whenever I asked one of the nurses if everything looked ok, they barely glanced on how he was latched on, and said it was fine.
It only took a few days for sore nursing to become excruciating. Luckily, our pediatrician recommended a wonderful LC who came to help me out ASAP. She was very hands-on, helped me figure out pumping, and was available for questions by phone after her visit. BUT she also cost a fair bit of money. I knew about the benefits of breastfeeding. I had a supportive husband. I developed a network of mom-friends who were supportive. I did not work until my son was seven months, and when I did start working, I was able to purchase a pump and speak up about my need to have a private place to pump.
I suspect most people who read and comment on this blog (which I do enjoy reading!) are aware of the benefits of breastfeeding, but I think we would be surprised by the number of women who don't. More importantly, so many women were either not breastfed themselves, or have not been around mother who have breastfed. The concern I have with the Latch On initiative is that promoting breastfeeding it is not just about getting rid of goody bags of form, it is about making significant cultural changes, both in hospitals and out. According to the press release, 90% of mothers begin breastfeeding, but after 2 months only 31% are still exclusively breastfeeding. Access to lactation consultants AFTER leaving the hospital and community initiatives to normalize breastfeeding, and REAL maternity leave are also essential, if not more essential.
I wanted to also add that because I was breastfeeding, the nursing staff were not going to give me any free samples of formula in my "goodie bag" (a diaper bag which I actually used for 7 months), but I asked for them anyway. During our first night home, I panicked and fed my son a few ounces of formula. I must be of a non-addictive personality, since I was able to resist the pull of formula for the next 9 or 10 months, despite those little bottles sitting in the cupboard.
Great post and some really informative debates going on!
I couldn't agree with you more, Annie. And your analogies are spot-on. They're making people angry because they hit a nerve, and make us think, and most of us don't like that. Most women don't realize that you can make your own formula cheaply and easily, use raw goat milk as a supplement, and also get donated milk (human2human is a FB initiative that's awesome. I pumped for two friends and had a third friend with a freezer full of milk that she gave away. I never had a lot of extra but a lot of women do, and they all want to help!) American and Canadian women WANT to nurse as much as women anywhere else. But our for-profit medical system in the United States makes it very difficult. I wrote about this today as well. Women need to feel angry about the huge lack of support and the million ways their ability to nurse is undermined. Angry, not guilty: http://jennifermargulis.net/blog/2012/08/women-who-dont-breastfeed-shouldnt-feel-guilty-they-should-feel-angry/
Katie - I am sorry you had that experience. But a newborn baby can survive for more than a week with no food or water. I believe that your providers thought what they were doing was best but I am skeptical about the concerns about dehydration. That in itself must have stressed you out and made it even harder for you to nurse. Even though breastfeeding did not work, you did not have to use formula. Another mom could have given you milk, if we lived in the kind of environment that would support that. You could have used donor milk or made your own. I don't say this to shame you but just to remind Annie's readers that formula is NOT the only option if breastfeeding doesn't work.
Laura, I wish you were right but you're not.
Go to any kindergarten in America and you can tell which children were formula fed. How? They are more likely to have asthma (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC314207/), more likely to be obese (http://www.usbreastfeeding.org/NewsInfo/NewsRoom/201002PreventingObesityBeginsatBirth/tabid/169/Default.aspx; see also this peer-reviewed scientific study: http://pediatrics.aappublications.org/content/115/5/1367.abstract?ijkey=c857b5c35c7d9f3505cd54853b432dacc021226b&keytype2=tf_ipsecsha), less likely to score high on intelligence tests (breastfeeding is correlated with higher intelligence in infants, preschoolers, and even children at age 10), and more likely to have higher cholesterol later in life (Owen, CG, Whincup, PH, Odoki, K, Gilg, JA, Cook, DG. Infant feeding and blood cholesterol: A study in adolescents and a systematic review. Pediatrics. 2002;110:597-608.). I remembering learning in college (I think it was a memoir of a WWII survivor but I can't remember which one) that the adults who survived the devastating illnesses in the Concentration Camps were those who had been exclusively breastfed. We're not talking about the difference between eating white bread or whole wheat. We're talking about something so fundamental (humans are mammals, named for our mammary glands) that it affects your health for the rest of your life.
YES. Just ... yes. Let's stop pressuring, and start empowering and supporting moms to meet their goals. Really, we all deserve better than we're getting..
I did give my 2nd baby formula for a couple of days. It was 3am, and I had been nursing her for literally hours (she was 2-3 days old so my milk was still coming in). Here's what you all might find amazing - I had literally not a drop of formula in the house, because I did not give birth in a hospital but even if I had, the hospital I would have gone to is Baby Friendly and so does not give formula samples. So, I got in my car and drove 3 minutes to a local store that was open, and bought some formula. They took my money and everything. Then I drove home and gave her a small bottle so that I could sleep for the first time in 2-3 days. She didn't starve and waste away in the 10 minutes I was gone to the store to buy formula. Amazing!! And if I lived further away from a store or not near one open 24/7, and was concerned about my lack of formula, I would have bought some prior to giving birth. I can't imagine a single scenario in which a formula *sample* given on discharge from a hospital has ever saved a baby's life. Get real, folks.
The ending to my tale - once my milk came in I stopped the formula cold turkey, my daughter gained 1 lb/wk her first 6 months on my milk alone, and she still occasionally nurses at age 4(!). Using formula didn't sabotage my breastfeeding relationship with my daughter, but it was MY choice to go get it, to use it, and to stop using it - and I did all this with considerable education and experience under my belt of having exclusively breastfed my first child. How many people leaving the hospital with a "goodie bag" of formula are in that position? Not many.
What a perfectly written post, thank you. I breastfed all three of my children, each longer than the next and you are so right when you say that "it is hard".
I used some formula at the hospital with my son because I was handed it and felt that it was "what to do", especially in those ready-to-eat sizes. It had a very real impact on our breastfeeding experience and my son was more than a month old before we were able to move to the breast completely. In that time I was pumping, bottle feeding (breast milk) and nursing. It was awful, but eventually we got it. I would have very much appreciated support and education at that time and I would love to see that available to all mothers, no matter their choice.
I appreciated this post. While I was reading it, the thought occurred to me ... If this isn't an issue, why did I receive cans of formula from TWO DIFFERENT companies while I was pregnant (in the mail after I bought some maternity clothes), but not, say, a nursing shield (which actually WAS what made it possible for me to breastfeed my baby)? Oh wait, maybe because Medela doesn't make 20-40 dollars a week off me?
I was grateful that a thoughtful nurse brought me a nursing shield in the hospital -- it was preemie sized, so too small for me, but it worked and was a huge help -- but not so thrilled that after baby didn't latch at the first try, the Lactation Consultant immediately broke out a bottle of formula and said "Try this." (My hospital was in the process of "becoming" baby/breastfeeding friendly!)
As to coupons/promotions/free samples: One of the reasons breastfeeding is so important to me is that we can't really afford formula. I don't think that the cost of a can or two up front (which is all you get free) or a $2 coupon here and there, are going to make the difference between a bottle-feeding mom being able to afford feeding her baby and not. Long-term programs and initiatives like WIC would OF COURSE be able to continue to provide help with this where really needed; but the formula company didn't mail me three cans to made formula-feeding affordable to me -- they did it to make sure I bought my expensive formula twice a week from THEIR company!
I think that the NY Latch On program was too harsh and therefore created needless controversy over a controversial topic. Locking up formula is not the answer....education is the answer and better communication. Education on the part of the OB and lactation staff as to non-judgmental and supportive care to all moms whether breast feeding or formula feeding.
It has long been a belief that babies need "enough" nourishment to keep bilirubin down and newborns making stools which aids in the bilirubin excretion. Shortened hospital stays accentuate all of the issues...no mom is really settled into breastfeeding after 24-36 hours postpartum.
Politicians getting involved to this level, to me just galvanizes people into their positions which does nothing for anyone.
Why we cannot achieve a balance is so sad...each mom should feel comfortable and supported with her choice.
Can you provide a few references to support your claim about a newborn baby being able to survive more than a week with no food or water, without having ill effects?
I'm all for breastfeeding, but you cannot go to any kindergarten and instantly tell who was breastfed...to imply otherwise is misleading.
We know that newborns can survive without food or water from the fact that many have during earthquakes and other natural disasters. A very sad way to gather statistics. One can only imagine the psychological effects are devastating. I did not mean to imply that the baby would have no ill effects. I was first given this information by Dr. Gro Nylander, M.D., a Norwegian obstetrician who teaches at the University of Oslo. She founded and directs the University of Oslo's Breastfeeding Resource Center (the Norwegians take breastfeeding so seriously they have an academic department devoted to it.). Here is one reference: http://www.huffingtonpost.com/ben-sherwood/haitis-tiny-miracles-how_b_433388.html. Here is a story of an 11-day-old who survived for 7 days in an earthquake: http://www.dailymail.co.uk/news/article-1245033/Haiti-earthquake-Miracle-week-old-baby-Eisabeth-Joassaint-pulled-rubble-alive.html
I'M very familiar with Rosin's "Case against breasfeeding". If she'd presented it as opinion regarding her own breastfeeding experience, I would have been fine with it. Instead she attempted to make a scientific argument using bad science and a societal argument that excludes the experience of much of society.
I love this post. With my first baby, my sister was by my side the whole time helping me through the hurdles of breastfeeding. And thank goodness, because the hospital had offered no support. With my 2nd, I had him at a hospital where 95% of the patients were on public assistance. I wasn't expecting much from them (bad stereotype), but I didn't have my sister with me. I was prepared to go it alone. Instead, the hospital had incredibly supportive nurses. Especially when baby was in the NICU for two weeks. I also had a visit from their lactation consultant several times a day. In spite of the stress of having a preemie in the NICU, it was the best experience ever.
I'm also a nurse. I see this as a very positive initiative. Formula will be treated essentially as a medication. We currently have to sign out and access all patients medications through a very specific process - this is for safety and accountability. It is the same with oxygen, I need a doctors order to administer it. Everything in a hospital is accounted for. I do not think having to sign out some formula will interfere with patient care. It will be a matter of putting your initials down on the client chart - not a big deal. There will be no "tracking" of staff to see who "signs out the most cases" that is just absurd. Nurses are autonomous professionals (to an extent, we do still have to follow doctors orders) there is no secret spying - it is a professional workplace with transparent practices. This initiative just means that hospital staff will need to have a *reason* for accessing formula, whether that me mom's personal choice or a medical problem. It is a synthetic product with very well documented risks - I see it as very comparable to medication. Why shouldn't it fall under the same scrutiny?
Jennifer: Just because some babies have survived for more than a week without food or water doesn't mean that there are no risks involved or that there's no reason to supplement a baby who is becoming too dehydrated and exhausted to latch on. I find it frightening that that's your evidence for being 'skeptical' about the possibility that the trained health care providers who were there, on the scene, caring for this infant, were actually correct in their assessment that he was becoming dehydrated enough to need supplementation.
And, yes, it would be great if screened donor milk was more widely available for newborns. But if it wasn't available when Katie's baby needed it then it wasn't available, and talking about what a great option it could theoretically have been was not going to get that baby fed.
Here's my little n=1 story:
I had trouble getting my first child to latch comfortably on one breast while with the other everything went fine. The first six weeks were often quite painful and I did shed a few tears. As I recall (and the mists of time--19 1/2 years--are fogging things up), during the 5 days I spent at the Royal Victoria Hospital in Montreal (C-section, in those days you stayed for a while), no one ever gave me formula or suggested to me that it would be a good idea.
I persevered despite the pain. I paid out of my own pocket to have a lactaction consultant come to my home. The "football" position saved me. That, and the support of a woman I knew whose baby was maybe a year older than mine. We weren't great friends, in fact she bored me stiff, but she kept calling me and cheering me on.
It took about six weeks to straighten things out, but then it was smooth sailing until my son was about eight months old. I developed hyperthyroid disease (Graves) and had to go on medication. I was really, really sick and had no choice. I cried the first time I gave my son formula.
Son number two latched fairly well on both sides. I breastfed for about ten months, but he got bored and weaned himself. Different strokes for different baby folks.
I definitely feel that mothers need more support with breastfeeding. One of the best pieces of advice I got (I don't remember from where) was to give it six weeks. That was one of the things that saved me.
When my first son was about three months old, my lactation consultant asked me and my baby to give a "demonstration" to a group of expectant mothers. I had a blast. Maybe a year later, I was at a garage sale and a woman came up to me and said she knew me, but she couldn't remember where we'd met. We finally figured out that she'd been one of the pregnant women at the class where baby and I had had done our thing. She told me that having met us inspired her to breastfeed. Hearing that was one of the happiest moments of my life.
Interesting read, but I have a bunch of scattered thoughts about it and I'm gonna try to get them out..
If I'd said "no, offering formula is nothing like the alcohol to an alcoholic thing...it's more like offering a butter knife to someone who was trying to finish their entire stack of pancakes using only a fork", you would in all likelihood say that I was reducing the importance of breastfeeding to parallel eating pancakes and how that was disrespectful, and all those things. So with that said, you really can't back out of the parallel you've very purposefully drawn with the drugs and alcohol here. By setting up the parallel to such a negative and destructive thing, you're creating associations that manipulate the reader. Now, you could argue that your readers are smart enough to not get sucked into one interpretation among many, and you could be right. However, if the point of the article is about all of the pressure put on mothers because they are given samples of formula, there's this constant suggestion of weak will to begin with (of course coupled with the legit concern that there is a lack of support). So if by giving mothers emergency formula packs, they are subliminally being pressured to succumb, then by drawing parallels like drug addiction you are definitely on the same boat, just on the opposite end, no?
My wife and I just had our first (beautiful baby boy) and I support her and her decisions all day...however, I can't help but take issue with the notion of "personal challenges" that either come before, or even compromise the well-being of the entire family. Obviously breast feeding is better for a baby in terms of nutrition and bonding time and all of these measurable, quantifiable ways. Also, obviously formula has measurable risks. However, a mother who insists on NEVER giving the child formula under any circumstances runs less quantifiable risks of added exhaustion, frustration, and other control issues down the road with the child, etc. I would like to keep my child from eating processed, sodium heavy, nutrient-free foods, because they are bad, right? But, is it at all possible (maybe it's not and I'm just way off...I truly acknowledge that possibility) that my child would have more to gain from us as a family occasionally just ordering a pizza and not worrying about grocery shopping and cooking and all that, than they would have to lose by eating a slice of pizza once a month? Does it necessarily make me a worse parent because I didn't face the marathon challenge head on of never putting crap food in my child's system if I decide we'd all be better off just hanging out at home and chillin together while we wait for the pizza to arrive?
I don't know. I should restate that I dig the article, and maybe it's just the contrarian in me. Anyway, thanks for this.
Benzo:
I think you're making some unfair assumptions. In response to your pancake analogy, I wouldn't respond that it is reducing the importance of breastfeeding or that it is disrespectful. I would, however, question the logic of the analogy. A butter knife is undeniably helpful to someone trying to finish a stack of pancakes. Formula, on the other hand, is not helpful to the vast majority of people who are trying to breastfeed.
The pizza analogy is more interesting to me. I would agree that it is important to take a mother's mental and physical health into consideration when deciding how to feed a child, whether that is an infant or an older child. If there was a coupon for a free pizza with free delivery sitting on my counter top on the night when I was completely exhausted, I might go for that, just as a mom of a newborn who is exhausted might reach for the formula sample. The question, however, is whether ordering that free pizza makes me less likely to grocery shop, cook, and feed my family a healthy meal in the days, weeks, and months that follow. Maybe it does, maybe it doesn't. I do know that the statistics show that moms who received formula samples are less likely to exclusively breastfeed than those who didn't receive samples (and therefore would have had to go out and buy the formula themselves if they wanted that break). Would the same hold true for one free pizza? I'm not sure. Maybe, maybe not.
Nice. I definitely am making some unfair assumptions, and I'm sorry for that. Just a little jaded from all the fiery debates I've been having ;)
To the pancake thing, a knife is absolutely only helpful to eating the pancakes...not to eating the pancakes when I've set out to do it only using a fork. In the same way, formula absolutely is helpful to feeding the baby, but not helpful to the person who has set out to do it only breastfeeding. Where my parallel falls apart is whether or not the knife lines up in terms of its degree of utility in comparison to formula for completing the task of eating pancakes. But I sorta deliberately did that just to contrast the alcohol analogy.
And if the stats (which I believe) show that mothers who receive the formula packets are less likely to EXCLUSIVELY breast feed, that's largely different from the "are they less likely to grocery shop, cook healthy meals, EVER" argument. I'm mostly just contending the logic here, as I have very few facts (ever, in my life). Maybe if the stat was that women who receive formula packets almost never breastfeed, then we'd have a different approach, no?
Again, I thank you for the peace and insight.