Criticism and comments on “Emergency preparedness for those who care for infants in developed country contexts”

To: Whom it May Concern

Re: Criticism and comments on Karleen D. Gribble and Berry, Nina J.; “Emergency preparedness for those who care for infants in developed country contexts”. International Breastfeeding Journal 2011, 6:16.

From: The collective voices of FearlessFormulaFeeder.com

We the undersigned are gravely concerned with the assumptions, myths, and potentially harmful information presented in the paper, “”Emergency preparedness for those who care for infants in developed country contexts”, appearing in the International Breastfeeding Journal on November 7, 2011 (henceforth referred to as “the paper”).

In the course of the past week, we have been engaged in an online discussion with the lead author of this review, Karleen Gribble. While her intentions are clearly admirable, and her willingness to debate is appreciated, we feel strongly that her paper has the potential to do far more harm than good.

Who we are

This commentary was compiled through the feedback received on a post at FearlessFormulaFeeder.com, a website dedicated to supporting women who have either struggled to breastfeed or have made a well-informed choice to formula feed for a variety of personal reasons. The international readership of this site encompasses a wide range of feeding experiences (many of the readers are/were exclusively breastfeeding mothers or are “combo feeders” who supplement with formula, but primarily breastfeed) as well as ethnic and socioeconomic backgrounds. The author and members of this site are steadfastly in favor of protecting and supporting breastfeeding; however, we are also concerned with the impact the “breast is always best” mentality has had on Western society in terms of both the emotional and physical health of mothers, fathers, and babies; and on public discourse and policy surrounding feeding choices.

The paper

This review paper, according to Gribble, is written to give emergency management authorities information to “provide those who care for infants with accurate and detailed information on the supplies necessary to care for them in an emergency, distinguishing between the needs of breastfed infants and the needs of formula fed infants. Those who care for formula fed infants should be provided with detailed information on the supplies necessary for an emergency preparedness kit and with information on how to prepare formula feeds in an emergency.”

We don’t doubt that, provided a mother is physically and emotionally able to breastfeed her infant in the wake of a disaster, breastfeeding is a safer and more economical way to ensure that the nutritional needs of an infant are met. However, rather than simply illustrating this point and providing logistics for those who cannot exercise this option, the authors have offered a biased, embarrassingly inaccurate portrait of what formula feeds should entail in times of disaster. We feel that this paper not only adds to a growing body of breastfeeding literature that relies on a limiting, unrealistic, one-size-fits-all view of infant feeding, but could also 1) lead parents to spend needless money on emergency supplies 2) contribute to the already despicable lack of knowledge surrounding formula feeding and 3) mislead breastfeeding mothers into being ill-prepared for disaster situations.

Lack of impartiality

The paper begins with the WHO recommendations for infant feeding. This frames the remaining information as a diatribe on the dangers and inconvenience of formula, rather than what the paper claims to be (a manual of sorts, providing real, useful, and necessary information for all parents). Instead of explaining the reasoning behind the authors’ recommendations vis-à-vis actual disaster data – possible time frame of being left without aid, clean water, shelter, etc – the message we are left with is “breast is best”, not only in terms of disaster preparation, but “in general”. This seems punitive; while many women in our society do combo-feed (both formula and breastfeeding) and may be able to choose one over the other, women will either be breastfeeding or formula feeding at the time a disaster strikes, many others will have no choice but to continue their previously initiated method of feeding. Relactation is indeed possible (1), and was in fact recommended by UNICEF as a strategy superior to formula donation and distribution during the 2010 disaster in Haiti (2). However, there is no available data on mass, post-disaster relactation that provided evidence for the efficacy of this recommendation, and the experience of the women who frequent this website suggests that relactation is difficult in the best, most privileged of circumstances. Even the WHO document cited above (2) states, “(l)ittle research has been conducted specifically into the physiology of relactation in humans” and later advocates ensuring that a relactating woman should have “enough rest and relief from other jobs while she re-establishes a breastmilk supply.” It seems logical that the reality of a disaster situation might make an already arduous process more difficult, and possibly unrealistic, at least in the short term.

In our online discussion (3) on FearlessFormulaFeeder.com, Gribble infers that the heavy-handed focus on the superiority of breastfeeding was in part a logistical tactic to discourage unnecessary use of formula – a practice which can, in theory, sabotage breastfeeding. Again, we do not argue that breastfeeding should be encouraged and protected during disasters; however, we are concerned that the overwhelming bias of UNICEF and like-minded aid organizations is coloring the determination of what is “unnecessary” or inappropriate. We cannot blur the lines between breastfeeding promotion and post-disaster survival.

Gribble admits that UNICEF will not “touch” donations (even of ready-to-feed, single-serve formula containers which would negate the need for washing and sterilizing during the formula prep process – more on this later) from formula companies. “UNICEF’s sponsorship policy places companies that breach the International Code of Marketing of Breastmilk Substitutes as more untouchable than tobacco companies because of the impact of their unethical marketing practices on the wellbeing of children. They purchase what they need at market prices,” she states (3). In our opinion, this speaks to an obvious bias: if the aid organizations in question would refuse help due to moral convictions, what does that say about their worldview? If formula is an instrument of the proverbial devil, then anything formula-related is going to be looked as an avoid-at-all-costs evil. UNICEF does have a large body of research and documentation regarding the unethical promotion of formula in third world countries (4); this is not an argument about their reasoning, but rather the bias inherent in the way they approach infant feeding in every situation, including disasters. We feel that especially in the developed world, where “unethical marketing” of formula is a matter of debate (5) depending on where you stand on the issue of infant feeding choice, it is irresponsible for aid organizations to deny contributions which would help infants and mothers, instead opting to spend precious dollars on buying formula at market price.

Lack of due diligence

The authors spend a good portion of the paper detailing what a formula feeding parent needs for their emergency preparedness kit: A breastfeeding mother needs only “100 nappies and wipes”; in contrast, the formula feeding parent needs “56 serves of ready-to-use liquid infant formula, 84L water, storage container, metal knife, small bowl, 56 feeding bottles and teats/cups, 56 ziplock plastic bags, 220 paper towels, detergent, 120 antiseptic wipes, 100 nappies and 200 nappy wipes. If powdered infant formula is used, an emergency preparedness kit should include: two 900g tins powdered infant formula, 170L drinking water, storage container, large cooking pot with lid, kettle, gas stove, box of matches/ lighter, 14kg liquid petroleum gas, measuring container, metal knife, metal tongs, feeding cup, 300 large sheets paper towel, detergent, 100 nappies and 200 nappy wipes”, which will cost $250 (Australian dollars) for the powdered version, and $550 for the ready-to-use liquid.
We do not disagree that a laboratory-perfect, sterile preparation of formula would be ideal in a situation where sewage is present and resources for hand-washing are scarce; however, we believe that this list of supplies (and the corresponding instructions on how to prepare feeds) is misguided at best; deliberately misleading at worst. Firstly, many of the “dangers” of formula feeding in both disaster situations and resource-poor areas are due to contaminated water sources; using ready-to-feed formula would minimize most of these risks. Gribble also argues that water is needed for cleaning hands (something breastfeeding mothers need not do, apparently, even if they are breaking a latch with a finger; we also question whether a breast could not be similarly germ-ridden as a hand, considering both are covered by the same epidermal layer). Depending on the disaster in question,couldn’t antibacterial wipes (6) be sufficient for cleaning hands prior to preparation of ready-to-feed formula in disposable bottles? Considering many of us were given ready-to-feed nursers in maternity wards with pre-sterilized nipples, and given no instructions except to attach the nipple to the bottle, it seems odd that this would be good enough for an hours-old baby and yet deadly (in a statistically significant regard) for a 5-month-old trapped in his home after an earthquake.

When we presented Gribble with the suggestion of ready-to-feed single-serve nursers (available from all three major formula companies in the United States) and disposable, pre-sterilized nipples, she claimed that these were not available in Australia or Japan, and were in fact illegal to purchase in Australia. A reader of the FFF blog did a few hours of research on this matter, and discovered that in Australia:

“…You can purchase Ready to feed formula in disposable bottles from here: http://www.fishpond.com.au/Lif…. I rang Australian Quarantine and Inspection Services and Steve on the floor in Brisbane said that milk imports from USA are fine at the moment unless the value is over $1000 in which case it maybe looked into but probably passed as long as there is a legit reason for that quantity.” (3)

This is a far cry from “unavailable” or “illegal”; a parent provided with the right resources could easily obtain this much safer and more economical option. Within the United States – one of the countries that this protocol is presumably directed towards – these products are readily available. A baby under 4 months could likely survive on 20 oz/day. To do this with Similac 2-oz nursettes, this would come out to be about $250; with Good Start, which makes 6-oz nursers, it would be under $200. Another option is a pack of 48, 2-oz nursers which come with a ready to use nipple and ring – Similac offers a pack of 48 for $41.94 on Amazon.com (7).

Even if a mother is relegated to using ready-to-feed formula which does not come in serving-size nursers, the same Australian mother did a breakdown of costs for this method and found the following:

A five month old will need approximately 42 250ml RTF cartons. The standard way to calculate how much formula a baby needs is 150mls – 200mls of formula x body weight of baby. According to my Queensland government personal health record chart by the National Center of health Statistics a 5 month old averages about 7kgs. 7kgs x 200mls (to be on the safe side) equals 1400 mls per 24 hours or 6 250ml cartons/day (again to be on the safe side) x 7 days equals – 42 cartons.

COST: $41.75 from Chemist warehouse. (this cost is based on buying them in lots of 6 – I am sure you maybe able to find them cheaper in bulk.)

WATER

To wash hands: I DID THIS and I used approximately 100ml to thoroughly clean my hands. (Give it a go – see how much you need)

To clean preparation surface: again DID THIS and used another 100 mls.

Approximately 200mls of water per feed for cleaning – 1.2L a day or 8.4L a week

COST: 10L (with a little extra just in case) – $6.09 (Coles)

BOTTLES

You can buy disposable sterile bottles (50 for about $50) or my local Crazy Clarks (a discount chain) sells 6 250ml standard plastic bottles for $6.95

COST: $48.65 for 42 bottles

A storage container $11.00 (crazy clarks)

50 Large Zip lock bags – $5 (Coles)

Paper towels – 400 $4.70 (Coles)

Detergent – 1L $1.06 (Coles)

Antiseptic Wipes – 80 pack – $10.68 (Coles)

Packet of strong sharp disposable knives – 50 pack – $3.20

TOTAL COST: $132.13

This is based on one mother’s research, and we are concerned that if her cost assessment was significantly different than Gribble’s (both women are from the same country), something is amiss. Perhaps a little non-biased, real-world perspective might go a long way in honing these recommendations. We wonder if formula feeding recommendation written by admitted breastfeeding activists is really the way to go?

Lack of adequate information

As many of us are, or have been breastfeeding mothers, we are also concerned with what we feel is a lack of information (and a lack of realism) about breastfeeding in the developed world. Many women have a steep learning curve with breastfeeding; it is often a learned skill (8). Some of us have struggled with insufficient supply in the best of situations; we wonder how a brand new mother, possibly dealing with the death of loved ones, a loss of a home, etc, would be able to handle successful breastfeeding in the worst of situations? Furthermore, what would happen if an exclusively breastfeeding mother were at work or out at the time the disaster hits? Or if the mother is severely injured or killed? If a baby is separated from its mother, an alternative food supply will be needed; it seems that it would be far safer to suggest that even breastfeeding families have a supply of formula on hand.

Dehydration and stress can also have a deleterious effect on breastfeeding. While stress has not been shown to impede milk production, as Gribble points out in our discussion, it has been shown to cease lactation in a few documented cases (9) and has been proven to inhibit letdown response (10); by Gribble’s own account, handling this problem requires support from those knowledgeable in lactation. Regardless of the mechanics involved, if the milk is not flowing, a baby is not getting fed. Considering the amount of psychological and physical stress in times of disaster (11)(12), we wonder: how many lactation professionals will need to be deployed to meet the needs of every struggling lactating mother? It may be true that for a mother who has already established breastfeeding, even times of extreme stress and lack of food and water will not affect the nursing dyad; we are concerned with the new mothers who suddenly find themselves trapped in their homes, and who are struggling to breastfeed in the way we all have (13) in much more comfortable situations (and our experiences run the gamut). If these mothers have been told not to have an emergency stash of formula in case of disaster, what will happen? It is a well-known argument that having formula in the home can discourage breastfeeding (14), but we feel that a paper focusing on disaster prep, not breastfeeding promotion, should look beyond a few self-reported studies and concentrate on the worst-case scenarios.

Ultimately, while no one here is arguing the fundamental point of this paper – that breastfeeding is a better disaster preparedness strategy – we feel it is obscenely dismissive of the lived realities of most women in “developed” nations. To suggest that a woman delays weaning in case of emergency is inane. To ignore the possibility that a breastfeeding mother may not be able to breastfeed her baby, either due to injury, emotional state or separation/death, is unrealistic. To ignore the options available to formula feeding parents, and to the aid organizations themselves, out of a disgust for formula companies or formula feeding as a practice, is irresponsible.

We ask that this paper be amended to include better, less biased information that is truly concerned with helping all babies rather than presenting yet another reason why breastfeeding is best. If nothing else, we hope that government agencies dealing with disaster preparedness will think seriously about the points we have illustrated, and refrain from using this biased, poorly-researched paper as a reference for recommendations.

Sincerely,

The Readers and Author of FearlessFormulaFeeder.com

Sources

1) http://www.ennonline.net/pool/files/ife/who-chs-cah-98-14-relactation-document.pdf

2) http://www.ennonline.net/pool/files/ife/joint-statement-iycf-haiti.pdf

3) http://www.fearlessformulafeeder.com/2011/11/formula-feeding-in-disaster-situations.html

4) http://www.unicef.org/nutrition/index_24824.html

5) http://www.fearlessformulafeeder.com/search/label/WHO%20Code

6) http://www.homefrontemergency.com/sadexanwi.html

7) http://www.amazon.com/Similac-Advance-Newborn-2-Fluid-Packaging/dp/B000N351WQ

8) http://www.bestforbabes.org/prepare-the-learning-curve-of-breastfeeding

9) http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1307254/pdf/westjmed00150-0094.pdf

10)http://www.sciencedirect.com/science/article/pii/S0031395505702960

11) http://psycnet.apa.org/journals/amp/39/3/252/

12) http://www.ptsd.va.gov/professional/pages/phases-trauma-reactions.asp

13) http://www.fearlessformulafeeder.com/search/label/FFF%20Friday

14) http://health.usnews.com/health-news/managing-your-healthcare/healthcare/articles/011/09/26/breast-feeding-boost-fewer-hospitals-handing-out-free-formula

FFF Friday: “Have a sense of pride with whatever choice you’ve made.”

Welcome to Fearless Formula Feeder Fridays, a weekly guest post feature that strives to build a supportive community of parents united through our common experiences, open minds, and frustration with the breast-vs-bottle bullying and bullcrap.

Please note, these stories are for the most part unedited, and do not necessarily represent the FFF’s opinions. They are also not political statements – this is an arena for people to share their thoughts, and I hope we can all give them the space to do so.




FFF Dara found breastfeeding a lot more challenging than she expected. I wish she didn’t feel that being under-prepared was her fault; the way we are taught about breastfeeding in our culture is for the most part unrealistic and dismissive of individual experiences. No matter how much you “prepare”, you never know what your personal limits or stressors may be. I also think the fact that Dara had no family around is key to her story… I’ve often thought that the biggest social impediment to breastfeeding is not formula advertising, lack of maternity leave, or a puritanical culture, but rather the fact that so many of us are essentially on our own – no family or close friends who can help us out in a meaningful way postpartum. Our partners have less time off than we do, so who is there to help when your baby is screaming, you’re in pain, and you just can’t get him to latch? Maybe if the government wants us to breastfeed so badly, they could provide paid leave for partners or free in-home baby nurses to help out. That might be more effective than the current strategy (i.e., guilt-tripping moms).

Happy Friday, fearless ones!

– The FFF

***

Like many, I desperately wanted to breastfeed. That’s what I’d planned on doing from the moment I found out I was pregnant. I made a list of everything breast-feeding related to get—everything. But I neglected to really do my research.

I suppose I never really knew how difficult it was to breastfeed. I thought it would be simple—baby’s born, he latches on and bam, simple as that. Boy was I wrong.

My son was born big—8 and a half pounds. He had a difficult time latching. Even the lactation consultant made a brief comment about it. Why wasn’t it as easy as I thought? Why couldn’t I do it? The LC showed me all the positions to try—cradle, football, etc. all the while extolling the greatness of breastfeeding.

I asked her if I could start pumping and she told me flat out “Don’t even consider it for at least six weeks. You shouldn’t need to.” What?! I could see the look on my husband’s face…he wanted to be as much a part of bonding with the baby as I was. By that time my little guy was getting hungry. He still wasn’t getting much—my milk hadn’t come in yet and he was already displaying the signs of having a large appetite.

My husband and my mom tried to help me but we couldn’t get him to latch. And when he did—the pain was almost excruciating. I was told it would be uncomfortable but not that painful. Every moment I was consumed with thinking about the next feeding and if my son would even get anything. My husband already suggested getting formula after seeing how stressed I was but I told him no.

I think the most painful part of those days in the hospital was the last day. My parents were heading back home 3 hours away and I was in tears trying to get my little guy to latch. He was screaming, I was crying, my husband was frustrated and I had to say goodbye to my parents that way. The look of pain on my mom’s face—that’s something I’ll never forget. A time that’s supposed to be happy ended up being partially ruined by the stress of getting my little guy fed.

I think the thing that irritated me the most about the whole situation was the complete lack of understanding by the LC. Looking back at it now, she definitely was not open minded to anything but breastfeeding. The fact she didn’t even want to consider me pumping for six weeks just boggles my mind. She did in the end get me a pump set that went along with the hospital pumps, which she gave to me for free because she felt bad for me for the difficulties I was having. Still, she urged me not to give up, to wait the six weeks and to keep breastfeeding even if my little guy cried for awhile. She said “It’ll get better.”

Hours later, when my husband and I were finally home, my son screamed for milk. I kept trying and trying to get him to latch and he kept pulling away. This went on for at least an hour, if not longer, as his screams became more desperate.

By this point, I just wanted him fed. I felt like I was going to have a breakdown already—and it was only the first night home! After many moments of wrestling with my guilt and having my husband convince me that our son needed fed, I opened one of the little bottles of formula the hospital gave us. My son drank the 2 oz in less than 10 minutes. Two days later, he was already eating 4 ounces of formula every 2 hours.

For days—weeks even–I was so wracked with guilt for giving up so soon. I kept asking myself, “What if I tried a little longer?” and feeling like I was weak. I mean, most moms can at least breastfeed their little ones for a few weeks—why couldn’t I?

I think that sense of guilt stayed with me for those first weeks until it finally sank in—I’m feeding my baby, he’s happy (and BIG!) and healthy. Why in the world was I beating myself up over it?

The way I see it now, I probably would’ve had to give up breastfeeding rather soon anyway. I do not think my milk production would’ve kept up with my son’s rapidly growing appetite. Who knows…maybe it would’ve but there’s no sense in playing the “what if” game anymore. Time has passed and I know I’d make the same decision again. My son is now four and a half months, slightly over 18lbs and has a full 8 oz of formula every 3 to 4 hours.

Anyway, I wholeheartedly support breastfeeding moms and have a new appreciation for the work it takes. I truly wish that there was a sense of understanding on both sides of this feeding debate (although I still don’t get why there should be one!) and maybe, just maybe, my story can help others see that it doesn’t matter whether your child is fed from the boob or the bottle—all that matters is he or she is fed and happy and that you, as the mom, have a sense of pride with whatever choice you’ve made.

***

If you feel like sharing your story, email me at formulafeeders@gmail.com, and join a community of brave women (and the occasional man) who have brought greater understanding to the breast versus bottle debate.

Formula feeding in disaster situations: Is there a dose of reality in your emegency kit?

I hope there is a correlation between formula feeding and developing a good bullshit meter, because guys – you all need one to survive what’s going on in the world of infant feeding.

Someone emailed me today about emergency preparedness. She was in the process of weaning, after an extremely difficult struggle with breastfeeding and an emotionally draining decision to stop the madness. There were storms where she lived, and she got to thinking that in the case of emergency, she’d need formula. So she did what any educated, concerned, modern mother would do: she googled. And instead of finding practical information on what should be in a formula feeding parent’s emergency preparedness kit, she found endless supplies of breast-is-best admonishments.

Her email could not have come at a more opportune time, because later in the day, I came across a series of Tweets about a “new study” outlining the specifics of emergency preparedness for both breastfeeding and formula feeding moms. The tweets linked to articles alluding to this paper from the International Breastfeeding Journal (surprising, isn’t it?), which the media presented as a “study” about how dangerous it is to be a formula fed baby in a disaster, even in a developed country.

Erm, no.

The “study” is actually a paper talking about the stuff mothers should have in stock in case of emergency. Now, it’s perfectly understandable that breastfeeding is far more ideal than formula feeding in emergency situations. Formula feeding in times of disaster, especially when water and supplies are scarce, is terribly difficult. But the way that this paper presents these facts is highly offensive, as it reads like a bad joke: What do formula feeding moms need in disasters? $500 worth of gasoline, formula, bottled water, cleaning supplies, a tool kit, knife, and Davy Crockett. What do breastfeeding moms need? Diapers and wipes.

There’s truth to this, of course. The abstract states that “Emergency management authorities should provide those who care for infants with accurate and detailed information on the supplies necessary to care for them in an emergency, distinguishing between the needs of breastfed infants and the needs of formula fed infants.” Fair enough… I agree that it is vitally important that parents and emergency workers know how to prepare and provide safe formula to babies.

Going back to that bullshit meter, though, mine was registering a 9/10 for this “study”. As early on as the introduction, the authors reveal their bias:

“In an emergency situation, infants who are exclusively breastfed have their health and well being protected by the food, water and immune factors provided by breast milk. Breastfeeding also mitigates physiological responses to stress in both infants and their mothers, helping them to cope with the stress of being caught up in an emergency situation… mothers who are exclusively breastfeeding are able to continue to provide food to their infants regardless of the stress they might be experiencing and their own access to food.”

Based on WHAT? They do not cite any studies for the latter claim; as for the one about breastfeeding mitigating stress, the only citation is an e-pub by one of the same authors as this study, in a journal called “Disasters.” I’ll have to track it down, because I’m curious what evidence they have for this dubious statement. Frankly, knowing the trouble most American women have initiating breastfeeding successfully, I kind of doubt a mom with a 5-week-old would find breastfeeding less stressful than trying to prepare formula safely (even if she had to use a knife and liquid petroleum gas, as this paper suggests).

As for the assertion that a mom can produce adequate milk no matter if her own food supply is insufficient or if she is under extreme stress, I again cry bullshit. What about this study, which shows that stress hinders letdown? Or this one, which talks about the effect of dehydration on lactating mothers? (Let me not the scarcity of studies on maternal stores… lots of them on goats, but not so much on human females. Doesn’t seem to matter if the mom drops dead from malnutrition or dehydration as long as the baby is getting enough, apparently.)

Then, the authors begin to delve into what appears to be their real agenda – discouraging formula donations, even from the formula companies themselves. They claim it’s because breastfeeding moms may receive the samples and sabotage their breastfeeding abilities (okay, I will concede that point, but what about the moms who are having trouble keeping up supply for the reasons above?), and also because it might be distributed to those who don’t know how to properly store and prepare it. Bullshit. If it’s between a baby starving to death or taking the risk that the parents don’t know you’re supposed to slice the top of the formula jar with a knife cooked to 100 degrees celsius, well, I think the answer is pretty obvious. A parent will either know this stuff because the message has been adequately imparted, or they won’t. Not having enough formula is not going to change that. The authors recommend that money be given to the “proper” organizations instead, who can correctly distribute the formula. No offense, but UNICEF has not impressed me with their knowledge or concern for formula feeding or non-breastfeeding Western women.

Speaking of non-breastfeeding Western women, I also wanted to know – especially in light of that Tweet about the Japan earthquake I talked about yesterday – what all of this hullabaloo was based on. The authors of this study cite a case (no citation, so I can assume this was something the authors heard word-of-mouth) from Katrina where a 3-week-old baby starved to death after being stranded on a roof with its mother and no formula. Apparently, the woman’s breasts were full of milk, but “initiating breastfeeding had not occured to her.”

Maybe that happened. If it did, that is horribly tragic. But we’re talking about disasters. Disasters. People do not think straight. That woman was stuck on a roof with a baby. Even if she had been successfully breastfeeding, god knows what would have happened. It seems really inhumane to me to take stories like this and turn them into cautionary tales against formula feeding.

The authors claim that “(t)he purpose of this paper is to detail the supplies needed by the caregivers of breastfed and formula fed infants in an emergency situation where essential services such as electricity and clean water supplies are unavailable and to discuss some of the practicalities of caring for infants in emergencies. The amounts provided for each emergency item are based on the clinical experience of the authors’, the author’s trial of the procedures, and the manufacturer’s instructions.” So again, I’m not convinced that any of this is based on actual empirical evidence, but rather assumptions and vague reasoning from people with an obvious axe to grind against formula feeding. Bullshit.

As for practical advice on what should be in your own emergency preparedness kit, I’ll work on it, peeps. Besides the normal emergency stuff (tons of bottled water, etc) I personally have a week’s worth of bottles of RTF formula, a few packs of disposable bottle liners and the bottles you use with them (you know, from that company that rhymes with Shmaytex), and about 10 nipples. I also have antibacterial wipes, in spades. That’s probably not the safest way to go about things, so I will look into the realities of what this paper recommends. Somehow, I don’t think it would cost $550 Australian dollars (about $569 USD) to ensure a formula fed baby’s safety for a week. But I’ll have to look at it more closely, because I seriously know nothing about disaster prep.

Until then, I’d be more concerned with honing your bullshit meter than worrying about a natural disaster. Statistically, it’s a fair assumption that you’ll be needing the former way more than the latter.

The tale of the asshat pediatric GI

Recently, the Academy of Breastfeeding Medicine held their annual conference. I followed the Twitter stream from the conference, and some of the soundbytes coming out of there were frightening, even more so because they were coming from the mouths of medical professionals. One speaker was quoted in numerous tweets for spouting this lovely tidbit: “I don’t say, ‘breastfeeding is so protective for mothers.’ I say, ‘Formula feeding is so dangerous.’” This came from a woman whose CV mentions an interest in the “responses of women to life stressors such as trauma.” Sounds about right; she can traumatize them with comments like that, and then study them to see the effect.
My main problem with this conference is that I think calling it the Academy of Breastfeeding MEDICINE is misleading. If it’s the Academy of Breastfeeding Medicine, let’s talk medicine. Presentations like “The Dermatology of the Breast” and “ Exclusively Human DIET (EHD) for Infants <1250 grams to Prevent Nectrotizing Enterocolitis (NEC)" sound perfectly suited to this event; "Effect of Delaying the Bath on Exclusive Breastfeeding Rates” and “ A Report from Japan: What We Learned from the 3.11 Disaster”? Not so much. 
Okay, quick irrelevant aside, because I just can’t let it go. According to the abstract, the “findings” of the latter report were:
The myth that the artificial milk was safe collapsed in the developed country such as Japan. Though the information that indicated the safety of breastfeeding at the time of a disaster was easily accepted, the assertion to be said not to receive liquid milk donated from foreign countries was hard to be understood not only by general public but journalists. The problem about nuclear accidents is now going on.
Maybe it’s a language barrier, but isn’t this stating that that the public and journalists were pissed off that UNICEF was discouraging formula donations – ready-to-feed formula donations, to be specific? Did they not see why people would be pissed? (And yes, I know the reasons why UNICEF has it’s protocol for infant feeding in disasters; I’m on the fence about it, actually. But it isn’t a totally black and white issue, either.) Am I reading too much into this abstract and the tweets coming from its presentation if I say these folks sounded mighty gleeful that the disaster “collapsed the myth” that formula was safe?
Anyway. Back to the reason this makes me so uppity…  I worry that by morphing together breastfeeding advocacy and breastfeeding science, we are coloring the judgment of those who should be treating us on a case-by-case, individual basis.
And speaking of case-by-case, here’s a case in point. A little story about the FFF in my  Fear-ful days, when I was a brand new mom; a floundering mess with a child who wouldn’t stop crying and a pump which wouldn’t stop screaming “YOUSUCKYOUSUCKYOUSUCK” every time I turned the blasted thing on.
Fearless Child had been miserable pretty much since the 4th hour of his life. First, he’d been starving; once we realized he’d never latch and resorted to exclusive pumping, he gained weight fast, but he never seemed healthy. He had a weird rash all over, never slept, screamed before, during and after feedings, and had mucous-filled diarrhea about 15 times a day. My doctor suggested cutting out milk, soy and nuts; I did so for two weeks, to no avail (actually, I’m about 90% vegan to start with, so there was little dairy in my diet to begin with. Soy was a lot harder for me to cut out.). The third or fourth time I visited our pediatrician about FC’s stomach issues, she looked at the poor little guy, still screaming his rashy head off; felt his tight, gurgly abdomen; and suggested that we see a pediatric gastroenterologist. As she wrote down the contact info for the referral, she told me she’d also give me a sample of a special, hypoallergenic formula, to try in the interim. “The guy we refer to will probably have you try this for 48 hours to see if there’s a difference, rather than putting FC through a lot of invasive testing. You might as well try it out while you’re waiting for an appointment – no need for him to suffer any more than he already has, and it’s worth a shot.”
Within twenty-four hours, we pretty much already had our diagnosis. The hypoallergenic formula stunk to high heaven, but FC lapped it up like it was chocolate milk. And after he finished the first bottle of the special formula, he slept for a record four hours. That night, although he still fussed a bit, like normal babies do, Fearless Husband and I were able to sit down and eat dinner for the first time in weeks. FC let us put him in his swing – practically unused, up until this point – and he stared up at the attached mobile, eyes clear and wide. We knew better than to declare victory. Instead, we held our breath and hoped, hoped, hoped.

 

We came close to cancelling our appointment with the specialist many times in the following week. FC was an entirely different baby, a smelly-and-expensive-formula-induced changeling. I began realizing why people would actually choose to be parents. It was kind of fun when the kid wasn’t miserable and wailing twenty-four hours a day. His rash cleared up and his diapers no longer scared us. It seemed that we had our answer, and it came in a purple can with a $30 per week price tag.
Still, we figured it couldn’t hurt to get a definitive diagnosis so we would know what the future held. What happened to dairy and soy intolerant kids when they were weaned off formula – were they sentenced to a life of rice milk and birthday cake deprivation?
After a two-hour wait, we were taken into a small room where FC was weighed and measured. It appeared that in the week since we’d seen the pediatrician, he had apparently shrunk an inch. When we asked the nurse about this, she just shrugged her shoulders and said that measurements could be off between offices.
A few moments later, a young woman entered the room and introduced herself as the doctor’s resident. She spent a half-an-hour obtaining a ridiculously detailed history of our son and his feeding issues, stopping several times to excitedly tell us that this was “classic” milk/soy protein intolerance behavior.  FC even added his two cents to the discussion in the form of a dirty diaper, which the resident encouraged us to hold onto for testing. Considering we’d been on the hypoallergenic formula for a week, and his system was free and clear of all offending foods, she wasn’t sure this would be an accurate diagnostic tool, but she wanted to doctor to have the option.
By the end of this warm-up act, we were even more geared up and anxious to hear from the illustrious doctor himself. The resident seemed pretty enthusiastic, too – she told us that it was clear our pediatrician had diagnosed this correctly, but she wanted the doctor to confirm and explain the condition to us in detail. She left the room to go over her notes with him, and promised to return, doctor in tow, in a few minutes.
My memory of what happened next is fuzzy. I know the doctor came into the room, and proceeded to school us on Baby Basics 101. He referred to what FC had as “colic”, suggesting that I “call my mom to come help me out if it’s too much for me”; when we explained we had no family in the area, he blithely quipped that we should “just hire someone.” (We could barely afford FC’s formula at this point, let alone a caregiver for a newborn.)  He refused to even look at the detailed history the resident had taken (she stood behind him, mouth agape, and sending apologetic glances in our direction); he threw out the diaper we’d kept for his inspection without even looking at its contents. I remember pleading our case, trying to get a logical answer as to why FC had rashes and mucousy diapers for so long, and recovered so remarkably once he was switched to hypoallergenic formula. “The peak of colic is about 6 weeks,” he responded, a condescending smile never budging from his lips. “It was probably just good timing.”
“So you’re saying that he went from a screaming, rashy mess to a calm, happy baby in one day by chance? And it had nothing to do with switching him to hypoallergenic formula?” I asked, the anger churning in my belly so powerfully that I probably needed my own visit with a gastroenterologist.
“Yes, that’s what I’m saying,” Everything out of his mouth sounded syrupy sweet, between his velvety accented English, and the icy smile that capped every sentence.
“You don’t even want to look at the history we just spent 30 minutes rehashing?” Fearless Husband piped in. The doctor shrugged his shoulders and opened the folder containing the resident’s careful, thorough notes. He scanned the first page – simply detailing FC’s height and weight stats – and conceded that there could indeed be a problem, although not the one we suspected.
“You’re overfeeding him,” he proclaimed. “He’s overweight. He’s in the seventy-fifth percentile for weight, but his height-to-weight percentile is closer to the ninety-fifth.  Do you know what that means? Only 5% of babies his height are fatter than him.”
“I think your nurse may have mismeasured him, actually,” my husband muttered. We both knew this was a lost cause. It was no use suggesting that FC may have been comfort eating for the entire time he was on pumped milk – a pattern that had ceased as soon as we’d switched to the hypoallergenic. Or that the poor kid had been growth restricted in the womb, and probably had been making up for lost time (or food, in this case) now that he was able.
Then came the kicker. “It’s a real shame you gave up on breastfeeding,” the doctor sighed. “It’s best for the baby, and so much easier on their stomachs.”
Next to me, I could feel my husband’s entire body tensing up. “That’s funny,” my husband retorted, coldly. “He was the most miserable on her breastmilk. And as we’ve tried to tell you about five different times, now that he’s on hypoallergenic formula, he’s doing great. I’m not sure what you don’t understand about that.”
“Well, I can only tell you what I think,” said the doctor, snapping the file closed.
 
Three years later, I can only tell you what I think. I think that guy was an asshat. But beyond that, I think this experience was what provoked me to start this blog, more than any mommy-war drama, more than any study I’ve seen misrepresented in the news. It was seeing how a doctor could immediately dismiss you, immediately judge you, simply because they were married to the party line regarding breastfeeding. 
And unfortunately, if the tweets from the ABM conference are any indication, there is an awful lot of dismissive judgment going on in the medical field. Unless you’re an exclusively breastfeeding, educated, white, middle-to-upper-class mother; then you’ll be given a gold star. 

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